The six leading killers of Americans--coronary heart disease, stroke, lung cancer, colon cancer, diabetes and chronic obstructive pulmonary disease--were responsible for 43 percent of all deaths in 1998. These six are also the major "lifestyle" diseases--that is, diseases that trace mainly to imprudent living, such as poor diet, obesity, lack of exercise, and cigarette smoking. Indeed, shifts in lifestyle account for much of the change in mortality rates over recent decades. Coronary heart disease (CHD), stroke and colon cancer rates declined among both sexes. Rates of lung cancer and chronic obstructive pulmonary disease (COPD), both of which result overwhelmingly from cigarette smoking, declined among men but have been rising among women, a pattern that reflects the later adoption and subsequent abandonment of cigarettes by women as compared to use by men in the years after World War II. Lung cancer and COPD rates among women, however, are expected to turn down eventually because of women's declining use of cigarettes since the 1970s. Diabetes registered a big increase in mortality rates, apparently resulting from the growing trend to obesity.

The prospect for future declines in the leading chronic diseases depends in part on trends in risk factors. Prevalence of cigarette smoking, which sends more than 400,000 Americans a year to a premature death, appears to be stabilizing at about 25 percent of the population. More disappointing is the rise in obesity. The substantial declines in prevalence of high serum cholesterol and high blood pressure of recent decades may be difficult to maintain, as those most concerned about their health have already mended their destructive ways, whereas those practicing a less prudent lifestyle will be less inclined to change. That suggests that mortality rates of the major chronic diseases will not decline as fast in the coming years as in the past, but it is likely that the number of deaths from lifestyle diseases will climb dramatically after 2010, when the baby boomers enter old age.

   
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