Preventable Deaths From Key Diseases Decline in United States

Tara Haelle

November 18, 2016

The number of potentially preventable deaths caused by three leading causes of death — heart disease, cancer, and stroke — declined between 2010 and 2014, whereas those caused by unintentional injuries increased, researchers report in an article published in the November 18 issue of Morbidity and Mortality Weekly Report.

An increase in falls and overdose from both prescription and illegal drugs contributed most to the increase in unintentional injuries. Meanwhile, potentially preventable deaths from asthma, bronchitis, emphysema, and other chronic lower respiratory diseases remained steady.

However, the rates of death for each of these causes varies geographically, depending on social determinants of health, access and use of health services, and public health efforts. Deaths from all five leading causes are highest in the Southeast United States.

"Public health officials can use the decreases observed as benchmarks for improving population health, while using observed increases to direct targeted efforts to reduce the number of potentially preventable deaths," write Macarena C. García, DrPH, from the Center for Surveillance, Epidemiology and Laboratory Services at the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues in the report.

"Specifically, given the reported increase in potentially preventable deaths from unintentional injuries, these findings might inform the selection and implementation of evidence-based interventions to prevent deaths from injuries such as falls and drug overdoses, based on epidemiologic burden."

Dr Garcia and colleagues analyzed mortality data from the National Vital Statistic System, using the same model as that used in a 2010 analysis to allow for comparison.

Overall deaths from heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injuries increased over 2010 to 2014, commensurate with population increases, but the rate of increase for heart disease, cancer, and stroke was slower than the growth in population.

The mortality increase was 6% for heart disease, 4% for cancer, 4% for stroke, and 8% for chronic lung and respiratory diseases. "These increases were smaller than would be expected to result from population growth, particularly growth in population size among older age groups during this period," the authors write.

Thus, the researchers calculate that potentially preventable deaths from cancer declined 25% (from 84,443 to 63,209), those from stroke declined 11% (from 16,973 to 15,175), and those from heart disease declined 4% (from 91,757 to 87,950). Those from chronic lower respiratory disease also declined 1% (from 28,831 to 29,232) but without statistical significance. Deaths from unintentional injuries, meanwhile, increased 23% (from 36,836 to 45,331).

Together, deaths from all these causes comprised 63% of all deaths in 2014, a drop of 2.3% from 2010.

The authors attributed the decline in cancer deaths to prevention, early detection, and treatment. They attributed the drop in deaths from heart disease and stroke to improved quality of care and a drop in risk factors, including an increase in blood pressure control for those with hypertension.

Several risk factors remain prevalent, however, such as obesity, which contributes to chronic lower respiratory disease, heart disease, cancer, and cerebrovascular disease. In addition, although a decline in smoking and other tobacco use has led to a drop in deaths from tobacco-related causes, 16.8% of US adults still smoked in 2014.

"Implementation of evidence-based tobacco control interventions, including increased tobacco product prices, implementation and enforcement of comprehensive smoke-free laws, media campaigns, and access to proven resources (e.g., quit lines) to help persons quit tobacco use varies among states," the authors report.

"Examples of state actions to reduce drug overdose include developing or enhancing prescription drug monitoring programs, adopting clinical prescribing guidelines, and increasing access to medication-assisted treatment for opioid use disorder and naloxone to reverse opioid-related poisoning," the authors add.

The report's limitations include using a benchmark from 2010 data that relied on the states with the lowest death rates for each condition, the fact that preventable deaths may not necessarily be independent if a person "transfers" from one to another cause category, and the fact that these causes are complex and diverse, so not everyone within a particular overall category may actually have had a preventable death.

The research was funded by the Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2016;65:1245-1255. Full text

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