COMMENTARY

What Is Killing Us and What Can We Do About It?

Tom G. Bartol, NP

Disclosures

February 15, 2017

Mortality in the United States, by the Numbers

The National Center for Health Statistics (NCHS) periodically publishes data briefs, which provide statistics on current public health topics in what they call a "straightforward format." One such brief includes mortality data in the United States for the year 2015, adjusted for gender, race, ethnicity, and cause of death.[1]

A total of 2,712,630 deaths were registered in the United States in 2015. The 10 leading causes of death (heart disease, cancer, chronic lower respiratory diseases, unintended injuries, stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide) accounted for 74.2% of all deaths. The report shows a slight 0.1-year reduction in life expectancy from 78.9 to 78.8 years. The age-adjusted death rate increased from 724.6 deaths/100,000 people in 2014 to 733.1/100,000 in 2015.

Viewpoint

Statistics on death and the risk of dying from various causes are ubiquitous. These reports are often powerful and emotionally charged. We hear such claims as "prostate cancer is the second leading cause of cancer death in men," "more than 50,000 people will die of colon cancer this year," or "1 in 8 women will be diagnosed with breast cancer in their lifetime." These statements can induce worry, concern, and confusion.

This NCHS data brief tells us that the total age-adjusted mortality rate for 2015 in the United States was 731.1/100,000 people, representing an increase of 1.2% over 2014. About 23% of the deaths were caused by heart disease and 22%by all cancers. These two categories are by far the biggest killers. Ranking a distant third was chronic lower respiratory diseases, which were responsible for 5.5% of deaths.

These data can be compared with those of the Surveillance, Epidemiology, and End Results (SEER) program, a branch of the National Cancer Institute. The most recent SEER data are from 2013.[2] The 2013 death rate from colon cancer, according to SEER, was 14.5/100,000; from breast cancer it was 20.7/100,000, and from prostate cancer it was 19.2/100,000.[3,4,5]

These numbers make it clear that only a small proportion of deaths each year are from these three well-publicized cancers. The 50,000 annual colon cancer deaths account for only about 2% of all deaths. One in eight women who live to age 80 will get breast cancer, but only about 3% of annual deaths are the result of this disease. Although it's the second leading cause of cancer death in men, prostate cancer is the cause of only 2.5% of all annual deaths.

To improve health and reduce death rates, efforts must focus on preventing the leading causes of death. Screening and early detection of cancer or heart disease will not make as big an impact as preventing these diseases. The Centers for Disease Control and Prevention claim that avoiding tobacco, increasing physical activity, and healthier eating could prevent about 900,000 deaths of the 2.7 million, or about one third of all deaths annually.[6] Understanding causes of mortality can help to prioritize preventive services.

When we can share with patients the dramatic impact of lifestyle change on prevention of disease, they can make informed choices about healthier lifestyles. It is easy to focus on quality measures, screening, and pharmacotherapy, but the real impact on health will come when patients understand the dramatic role that lifestyle plays on actual health outcomes. Along with actions such as screening mammography, colonoscopy, and statins for prevention of heart disease, we must educate patients and model in our own lives the positive impact of exercise, healthy eating, and smoking cessation on morbidity and mortality.

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