Death rates are population health outcome measures that reflect the combined influences of multiple biological and social health determinants, public health efforts, and medical care. Examining which diseases and injuries result in the greatest number of deaths in populations, particularly for deaths that occur earlier than expected, allows health officials to establish disease prevention goals, priorities, and strategies. In the United States, the largest number of deaths during 2008–2010 occurred from diseases of the heart, cancer, chronic lower respiratory diseases, cerebrovascular diseases (stroke), and unintentional injuries. The results of this study demonstrate that if all states achieved the lowest observed mortality levels for the five leading causes, when considered separately, as many as 91,757 premature heart disease deaths, 84,443 cancer deaths, 28,831 chronic lower respiratory disease deaths, 16,973 stroke deaths, and 36,836 unintentional injury deaths might be prevented each year. These calculations translate to approximately one in three premature heart disease deaths, one in five premature cancer deaths, two out of five chronic lower respiratory disease deaths, one out of every three stroke deaths, and two out of every five unintentional injury deaths that could be prevented.
Reducing the number of earlier than expected deaths from the leading causes of death requires risk factor reduction, screening, early intervention, and successful treatment of the disease or injury. For the five leading causes of death, the major modifiable risk factors include 1) diseases of the heart: tobacco use, high blood pressure, high blood cholesterol, type 2 diabetes, poor diet, being overweight, and lack of physical activity; 2) cancer: tobacco use, poor diet, lack of physical activity, being overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances; 3) chronic lower respiratory diseases: tobacco smoke, second hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and occupational agents; 4) cerebrovascular diseases (stroke): high blood pressure, high blood cholesterol, heart disease, diabetes, being overweight, tobacco use, alcohol use, and lack of physical activity; and 5) unintentional injuries: lack of vehicle restraint use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments.
The majority of these risk factors do not occur randomly in populations; they are closely aligned with the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. However, the calculation of potentially preventable deaths in this study did not account for differences in the attributes of states that might influence risk factors and ultimately death rates, such as proportion of the population below the poverty level. If health disparities were eliminated, as is called for by Healthy People 2020, all states should be closer to achieving the lowest possible death rates for the five leading causes of death.
The findings in this report are subject to at least four limitations. First, uncertainty and error in the diagnosis and reporting of cause of death might result in errors in death rate estimations for some causes of death. Second, state affiliation is based on the person's residency at the time of death. With the exception of unintentional injuries, the factors that led to the resulting cause of death for some persons might have accumulated over a lifetime spent in different geographic locations. Third, the potentially preventable deaths are based on existing levels of state performance for the three states with the lowest death rates for each condition and might underestimate the benefit if these three states made full use of optimal health promotion and disease prevention strategies. Finally, to the extent that natural (i.e., random) variability in state death rates from year to year is responsible for the selection of the three states with the lowest death rates, there will be a tendency to regress to the mean. The method used tends to slightly overestimate the number of potentially preventable deaths. Nevertheless, the random component of the variation in state death rates is minimal and any bias is also minimal.
As a further note of caution, potentially preventable deaths cannot be added across causes of death by state or for the nation as a whole because of competing risks. For example, for a state that has been able to reduce its heart disease mortality, some premature deaths will be prevented altogether, but others will be pushed to different causes of death. A person who avoids death from heart disease might then be exposed to a higher risk for dying from injury or cancer. The result is that there is less variation by state in the death rate for all causes combined than for any particular cause of death.
States can use the disease-specific aspirational goals for potentially preventable deaths presented in this report in several ways. They can identify other states with similar populations but better outcomes and examine what those are doing differently to address the leading causes of death. Although each state has a unique set of factors that determine health outcomes, states might find neighboring states or states within their region as good sources of information on effective policies, programs, and services. The goals can also be used to educate state policymakers and leaders about what is achievable if they were able to match the best state outcomes.
Morbidity and Mortality Weekly Report. 2014;63(17):369-374. © 2014 Centers for Disease Control and Prevention (CDC)