Up to 39% of Premature Deaths Preventable, CDC Says

Larry Hand

May 01, 2014

Up to 39% of annual premature deaths from the 5 leading causes of death could be prevented, the Centers for Disease Control and Prevention (CDC) reported today.

CDC researchers provide, for the first time, a state-by-state analysis of premature deaths of US residents for each of the 5 leading causes of death. The analysis, published in the May 2 issue of the Morbidity and Mortality Weekly Report, covers deaths from 2008 to 2010.

The top 5 causes of death in 2010 were heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries.

The researchers calculated that from 2008 to 2010, the overall average number of annual deaths from the 5 leading causes in people younger than 80 years came to 895,317, or 66% of deaths from all causes during that period.

They calculated that the average number of potentially preventable deaths for each of the leading causes amounted to:

  • 91,757 for heart disease, 34% of all heart disease deaths;

  • 84,443 for cancer, 21% of all cancer deaths;

  • 28,831 for chronic lower respiratory diseases, 39% of all of these deaths;

  • 16,973 for stroke, 33% of all stroke deaths; and

  • 36,836 for unintentional injuries, 39% of all of these deaths.

"As a doctor, it's heartbreaking when we lose a single patient from a preventable condition, but as director of the nation's prevention agency, it's painful almost beyond words to know that we're losing well over 100,000 people every year in this country from diseases and injuries that easily could have been prevented," CDC Director Tom Frieden, MD, MPH, said at a news conference today.

Lifestyle Factors Key in Prevention

Modifiable risk factors may be responsible for many of the leading causes of death, CDC officials say. They include tobacco use as a risk factor for all causes except unintentional injuries. Poor diet and lack of physical activity are among the risk factors for heart disease and cancer. High blood pressure and high cholesterol are among the risk factors for heart disease and stroke, and they include alcohol use among risk factors for cancer, stroke, and unintentional injuries.

Some risk factors can be mediated through changes in behavior, CDC officials say, but other risk factors need to be addressed by correcting disparities resulting from social, economic, and other conditions associated with some neighborhoods.

"The good news is that things that people can change...make a huge difference," Dr. Frieden said. He cited physical activity as just one factor. "Even if you don't lose any weight, being physically active is the closest thing we have to a wonder drug. It reduces blood pressure, reduces cholesterol, reduces your risk of arthritis. It improves mood. It improves independence. There are things that can be done that really do make a difference."

"We think that this report can help states set goals for preventing premature death from the conditions that account for the majority of deaths in the United States," Harold W. Jaffe, MD, the study's senior author and CDC associate director for science, said in the news release. "Achieving these goals could prolong the lives of tens of thousands of Americans."

Modeling Based on Low Risk States

CDC researchers analyzed data from the National Vital Statistics System for the 2008-2010 period. The US Census Bureau and the National Center for Health Statistics provided population estimates for the states and the District of Columbia.

To calculate the number of potentially preventable deaths from the 5 leading causes of death, they first calculated and ranked disease-specific death rates by age group. They selected the 3 states with the lowest death rates for each age group–specific cause of death to calculate a lowest death rate average. They then calculated expected deaths for each age group and state, multiplying state populations by that 3-state average. For the last step, they calculated potentially preventable deaths by subtracting expected deaths from observed deaths.

The authors note that the estimates cannot be combined to give an overall preventable death rate, as prevention in some areas would likely push deaths into another preventable category.

As a region, the Southeast had the highest number of potentially preventable deaths from all 5 causes, whereas other US regions varied by cause of death.

"The Southeast has sometimes been referred to as the stroke belt, and these data confirm that," Dr. Frieden said at the news conference. "It's a confluence of more smoking, more obesity, less physical activity, less access to primary healthcare, resulting in challenges with treatment of high blood pressure and cancer screening follow-up."

The number of potentially preventable deaths varied greatly by state. For instance, Utah had the fewest potentially preventable deaths from heart disease (35) and cancer (0); Connecticut, Hawaii, and the District of Columbia had no potentially preventable deaths from lower respiratory diseases; Connecticut and New Hampshire had the fewest preventable deaths from stroke (5 each); and Maryland had no preventable deaths from unintentional injuries.

On the high side, Texas had the most potentially preventable deaths from heart disease (7256), lower respiratory diseases (1922), and stroke (1783); Florida and Texas had the most preventable deaths from cancer (5054 and 4998, respectively) and unintentional injuries (3252 and 3061).

"These deaths are not random. They are clustered by geography, by state, and that's a reflection of the huge impact that healthcare policies can have," Dr. Frieden said. "It is important that we move the needle on programmatic changes and policy changes that increase people's likelihood of living free of disease, injury, illness, that could be prevented by action that we can take together."

He is, however, optimistic about the future because of programs such as Million Hearts, a public–private initiative that aims to prevent a million heart attacks and strokes in 5 years. Because of the program, he said, 40 million Americans have access to healthier food and are more physically active.

Also, he added, "As more people get access to healthcare [under the Affordable Care Act], they have the potential of getting preventive screenings for cancers and treatment for high blood pressure, high cholesterol, and smoking cessation. With preventive care, we can drive down heart disease and stroke, in particular, as well as [improve] cancer screening."

Morb Mortal Wkly Rep. 2014;63:369-373. Full text

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