Preventable causes of death

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Figure 1: In 2011, deaths from potentially avoidable causes accounted for approximately 24% of all deaths registered in England and Wales. The leading cause of avoidable deaths was ischaemic heart disease in males and lung cancer in females. Avoidable mortality in England and Wales, 2001-2011.png
Figure 1: In 2011, deaths from potentially avoidable causes accounted for approximately 24% of all deaths registered in England and Wales. The leading cause of avoidable deaths was ischaemic heart disease in males and lung cancer in females.

Preventable causes of death are causes of death related to risk factors which could have been avoided. [1] The World Health Organization has traditionally classified death according to the primary type of disease or injury. However, causes of death may also be classified in terms of preventable risk factors—such as smoking, unhealthy diet, sexual behavior, and reckless driving—which contribute to a number of different diseases. Such risk factors are usually not recorded directly on death certificates, although they are acknowledged in medical reports.

Contents

Worldwide

It is estimated that of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes. [2] In industrialized nations the proportion is much higher, reaching 90 percent. [2] Thus, albeit indirectly, biological aging (senescence) is by far the leading cause of death. Whether senescence as a biological process itself can be slowed, halted, or even reversed is a subject of current scientific speculation and research. [3]

2001 figures

Risk factors associated with the leading causes of preventable death worldwide as of the year 2001, according to researchers working with the Disease Control Priorities Network (DCPN): [4] [5]

CauseNumber of deaths resulting (millions per year)
Hypertension 7.8
Smoking tobacco 5.4
Alcohol use disorder 3.8
Sexually transmitted infections 3.0
Poor diet 2.8
Overweight and obesity 2.5
Physical inactivity 2.0
Malnutrition 1.9
Indoor air pollution from solid fuels 1.8
Unsafe water and poor sanitation 1.6

By contrast, the World Health Organization (WHO)'s 2008 statistics list only causes of death, and not the underlying risk factors.

In 2001, on average 29,000 children died of preventable causes each day (that is, about 20 deaths per minute). The authors provide the context:

About 56 million people died in 2001. Of these, 10.6 million were children, 99% of whom lived in low-and-middle-income countries. More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhea, malaria, and HIV/AIDS. [5]

Western societies

In 2017, The Lancet published a large study by Swiss epidemiologist Silvia Stringhini and her collaborators, analysing the impact of the most important causes of preventable death in Western societies. [6] They estimated the number of years of life lost for each risk factor at the individual level and its contribution to preventable death at the societal level (PAF = Population Attributable Fraction).

The multicohort study and meta-analysis used individual-level data from 48 independent prospective cohort studies with information on socioeconomic status, high alcohol consumption, physical inactivity, current smoking, hypertension, diabetes and obesity, and mortality, for a total population of 1,751,479 from seven high-income WHO member countries.

A limitation of many studies of health risk factors is confounding bias: many risk factors are interrelated and cluster together in high-risk populations. For example: Low physical activity and obesity go hand in hand. People who are physically inactive tend to gain weight, and people who are severely obese have difficulty exercising. The unique advantage of the huge amount of individual data in the Stringhini study is that it allows (estimation of) the relative contribution of each separate risk factor.

As shown in summary Table 2, at an individual level, smoking is the single greatest risk of avoidable death, followed by diabetes and high alcohol consumption. At the population level, diabetes and high alcohol consumption have a low prevalence. Physical inactivity, smoking and low socioeconomic status (SES) are then the top three preventable causes of early death. Smoking, physical inactivity and low SES account for almost two thirds of all avoidable deaths.

Table 2: Risk factors for avoidable death: Pooled hazard ratios, life years lost and population attributable fraction (PAF) for six WHO-defined health risks and socioeconomic status (SES) (Meta-analysis data of prospective cohort studies, from Stringhini et al., Lancet 2017). [6]
Risk factorHazard ratioLive-years lost
between ages
40 and 85 Years		PrevalencePercentage of
deaths who
died prematurely
(PAF)
Physical inactivity1,592,3043,7%24,5%
Current smoking (reference is never smoking)2,084,6023,3%24,0%
Low Socio-Economic Status (reference high SES)1,382,0635,4%17,2%
Diabetes1,793,999,0%6,5%
High alcohol (reference moderate alcohol intake)1,620,486,8%3,7%
Hypertension1,291,5434,0%8,8%
Obesity (reference is normal BMI)1,110,6820,9%Small

A puzzling finding is the small contribution of obesity as a cause of avoidable premature death. There are two reasons why obesity is not an important independent risk factor, as is often assumed.

First, being overweight is a risk for early death without correcting for confounding risk factors. Overweight is usually measured by the body mass index (BMI = kg/m2), which is much easier to measure than physical activity. Most studies only measured BMI, not physical activity, and did not correct for confounding.

Second, a major pitfall in many studies of weight and health is that 'normal' and 'healthy' are often confused. The WHO definition of 'normal' adult BMI (between 18.5 and 24.9 kg/m2) is based on a normal weight and height distribution of US citizens in the 1960s, not on the associated risk of death in 2023. [7] [8] A meta-analysis of the association between BMI and mortality in 230 cohort studies with 3.74 million deaths among 30.3 million participants found that the risk of death in adults is not increased between 23 and 30 kg/m2 (see Figure 2). [9] An adult BMI of 18.5 kg/m2, considered 'normal' by WHO criteria, is associated with a 30% increase in all-cause mortality. However, this is a measure of correlation, not causation, so it does not disprove previously held notions of the relationship between health and weight.

Figure 2: The association between body mass index (BMI) and relative risk of all-cause mortality (data from Aune et al., BMJ 2016; curve fitting by L. Stalpers, Amsterdam UMC, 2023). BMI and RR of Mortality.png
Figure 2: The association between body mass index (BMI) and relative risk of all-cause mortality (data from Aune et al., BMJ 2016; curve fitting by L. Stalpers, Amsterdam UMC, 2023).

United States

The three risk factors most commonly leading to preventable death in the population of the United States are smoking, high blood pressure, and being overweight. [10] Pollution from fossil fuel burning kills roughly 200,000 per year.

Accidental death

Annual number of deaths and causes

Table 3: Avoidable causes and numbers of death per year.

Cause of deathNumberPercent of totalNotes
Adverse events in hospitals in low- and middle-income countries2.6 million deaths [13] "one of the 10 leading causes of death and disability in the world"
Smoking tobacco 435,000 [11] 18.1%
Obesity 111,900 [14] 4.6%There was considerable debate about the differences in the numbers of obesity-related diseases. [15] The value here reflects the death rate for obesity that has been found to be the most accurate of the debated values. [16] Note, however, that being overweight but not obese was associated with fewer deaths (not more deaths) relative to being normal weight. [14]
Alcohol 85,000 [11] 3.5%
Infectious diseases 75,000 [11] 3.1%
Toxic agents including toxins, particulates and radon 55,000 [11] 2.3%
Traffic collisions 43,000 [11] 1.8%
Preventable colorectal cancers 41,4001.7%Colorectal cancer (bowel cancer, colon cancer) caused 51,783 deaths in the US in 2011. [17] About 80 percent [18] of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Accordingly, the tabulated figure assumes that 80 percent of the fatal cancers could have been prevented.
Firearms deaths 31,940 [19] 1.3% Suicide: 19,766; homicide: 11,101; accidents: 852; unknown: 822.
Sexually transmitted infections 20,000 [11] 0.8%
Substance use disorder 17,000 [11] [ needs update ]0.7%

Among children worldwide

Various injuries are the leading cause of death in children 9–17 years of age. In 2008, the top five worldwide unintentional injuries in children are as follows: [20]

Table 4: Avoidable numbers of death among children

CauseNumber of deaths resulting
Traffic collision

260,000 per year

Drowning

175,000 per year

Viruses

96,000 per year

Falls

47,000 per year

Toxins

45,000 per year

See also

Related Research Articles

<span class="mw-page-title-main">Body mass index</span> Relative weight based on mass and height

Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms (kg) and height in metres (m).

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. CAD can cause stable angina, unstable angina, myocardial ischemia, and myocardial infarction.

<span class="mw-page-title-main">Obesity</span> Medical condition of excess body fat

Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Other symptoms include increased hunger, having a sensation of pins and needles, and sores (wounds) that heal slowly. Symptoms often develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

The long-term effects of alcohol have been extensively researched. The health effects of long-term alcohol consumption vary depending on the amount consumed. Even light drinking poses health risks, but atypically small amounts of alcohol may have health benefits. Alcoholism causes severe health consequences which outweigh any potential benefits.

<span class="mw-page-title-main">Lifestyle disease</span> Diseases linked with the way people live their life

Lifestyle diseases can be defined as the diseases linked to the manner in which a person lives their life. These diseases are non-communicable, and can be caused by lack of physical activity, unhealthy eating, alcohol, substance use disorders and smoking tobacco, which can lead to heart disease, stroke, obesity, type II diabetes and lung cancer. The diseases that appear to increase in frequency as countries become more industrialized and people live longer include Alzheimer's disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, colitis, irritable bowel syndrome, type 2 diabetes, heart disease, hypertension, metabolic syndrome, chronic kidney failure, osteoporosis, PCOD, stroke, depression, obesity and vascular dementia.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Preventive healthcare</span> Prevention of the occurrence of diseases

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

Recurrent miscarriage or recurrent pregnancy loss (RPL) is the spontaneous loss of 2-3 pregnancies that is estimated to affect up to 5% of women. The exact number of pregnancy losses and gestational weeks used to define RPL differs among medical societies. In the majority of cases, the exact cause of pregnancy loss is unexplained despite genetic testing and a thorough evaluation. When a cause for RPL is identified, almost half are attributed to a chromosomal abnormality. RPL has been associated with several risk factors including parental and genetic factors, congenital and acquired anatomical conditions, lifestyle factors, endocrine disorders, thrombophila, immunological factors, and infections. The American Society of Reproductive Medicine recommends a thorough evaluation after 2 consecutive pregnancy losses; however, this can differ from recommendations by other medical societies. RPL evaluation can be evaluated by numerous tests and imaging studies depending on the risk factors. These range from cytogenetic studies, blood tests for clotting disorders, hormone levels, diabetes screening, thyroid function tests, sperm analysis, antibody testing, and imaging studies. Treatment is typically tailored to the relevant risk factors and test findings. RPL can have a significant impact on the psychological well-being of couples and has been associated with higher levels of depression, anxiety, and stress. Therefore, it is recommended that appropriate screening and management be considered by medical providers.  

<span class="mw-page-title-main">Diseases of affluence</span> Health conditions thought to be a result of increasing wealth in society

Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Sedentary lifestyle</span> Type of lifestyle involving little or no physical activity

Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and/or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socializing, watching TV, playing video games, reading or using a mobile phone or computer for much of the day. A sedentary lifestyle contributes to poor health quality, diseases as well as many preventable causes of death.

<span class="mw-page-title-main">Alcohol and cardiovascular disease</span> Effects of alcohol consumption on cardiovascular health

In a 2018 study on 599,912 drinkers, a roughly linear association was found with alcohol consumption and a higher risk of stroke, coronary artery disease excluding myocardial infarction, heart failure, fatal hypertensive disease, and fatal aortic aneurysm, even for moderate drinkers. Alcohol abuse may also cause occupational cardiovascular disease. The American Heart Association states that people who are currently non-drinkers should not start drinking alcohol.

<span class="mw-page-title-main">Non-communicable disease</span> Medical conditions that cannot transmit from one individual to another

A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others. NCDs may be chronic or acute. Most are non-infectious, although there are some non-communicable infectious diseases, such as parasitic diseases in which the parasite's life cycle does not include direct host-to-host transmission.

The obesity paradox is the finding in some studies of a lower mortality rate for overweight or obese people within certain subpopulations. The paradox has been observed in people with cardiovascular disease and cancer. Explanations for the paradox range from excess weight being protective to the statistical association being caused by methodological flaws such as confounding, detection bias, reverse causality, or selection bias.

<span class="mw-page-title-main">Overweight</span> Above a weight considered healthy

Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.

Health in Malta has seen improvements in recent years, with one of the highest life expectancies in Europe. Malta has a good overall quality of health and has seen rapid growth and improvement in key health indicators. Malta has seen significant development in the practice of mental health which has been supported by new infrastructure and increased government health spending. The introduction of health-focused government initiatives, particularly around nutrition, alcohol, smoking, and health will likely contribute to the further improvement of overall health nationwide.

<span class="mw-page-title-main">Cancer prevention</span> Taking measures to decrease cancer incidence

Cancer prevention is the practice of taking active measures to decrease the incidence of cancer and mortality. The practice of prevention depends on both individual efforts to improve lifestyle and seek preventive screening, and socioeconomic or public policy related to cancer prevention. Globalized cancer prevention is regarded as a critical objective due to its applicability to large populations, reducing long term effects of cancer by promoting proactive health practices and behaviors, and its perceived cost-effectiveness and viability for all socioeconomic classes.

References

  1. ↑ Danaei, Goodarz; Ding, Eric L.; Mozaffarian, Dariush; Taylor, Ben; Rehm, Jürgen; Murray, Christopher J. L.; Ezzati, Majid (2009-04-28). "The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors". PLOS Medicine. 6 (4): e1000058. doi: 10.1371/journal.pmed.1000058 . ISSN   1549-1277. PMC   2667673 . PMID   19399161.
  2. 1 2 Aubrey D.N.J, de Grey (2007). "Life Span Extension Research and Public Debate: Societal Considerations" (PDF). Studies in Ethics, Law, and Technology. 1 (1, Article 5). CiteSeerX   10.1.1.395.745 . doi:10.2202/1941-6008.1011. S2CID   201101995. Archived from the original (PDF) on February 12, 2019. Retrieved August 7, 2011.
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  4. ↑ "DCP3". washington.edu. Archived from the original on 2013-01-28.
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  6. 1 2 Stringhini, Silvia; Carmeli, C; Jokela, M; Avendaño, M; Muennig, P; Guida, F; ...LIFEPATH consortium (2017). "Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women". The Lancet. 389 (10075): 1229–1237. doi:10.1016/S0140-6736(16)32380-7. PMC   5368415 . PMID   28159391.
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  9. ↑ Aune, Dagfinn; Sen, A; Prasad M, M; Norat T, T; Janszky, I; Tonstad, S; Romundstad, P; Vatten, LJ (4 May 2016). "BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants". British Medical Journal. 353: i2156. doi:10.1136/bmj.i2156. PMC   4856854 . PMID   27146380.
  10. 1 2 Danaei; Ding; Mozaffarian; Taylor; Rehm; Murray; Ezzati (2009). "The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors". PLOS Medicine. 6 (4): e1000058. doi: 10.1371/journal.pmed.1000058 . PMC   2667673 . PMID   19399161.
  11. 1 2 3 4 5 6 7 8 Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). "Actual causes of death in the United States, 2000" (PDF). JAMA. 291 (10): 1238–45. doi:10.1001/jama.291.10.1238. PMID   15010446. Archived (PDF) from the original on 2019-06-20. Retrieved 2008-08-28.
  12. 1 2 National Vital Statistics Report, Vol. 50, No. 15, September 16, 2002 Archived May 5, 2019, at the Wayback Machine as compiled at "Death Statistics Tables". Archived from the original on 2009-02-21. Retrieved 2009-06-21.
  13. ↑ "Patient Safety". WHO. 13 September 2019. Retrieved 16 June 2022.
  14. 1 2 Flegal, K.M., B.I. Graubard, D.F. Williamson, and M.H. Gail. (2005). "Obesity". Journal of the American Medical Association. 293 (15): 1861–67. doi:10.1001/jama.293.15.1861. PMID   15840860.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ↑ Flegal, Katherine M. (2021). "The obesity wars and the education of a researcher: A personal account". Progress in Cardiovascular Diseases. 67: 75–79. doi: 10.1016/j.pcad.2021.06.009 . PMID   34139265. S2CID   235470848.
  16. ↑ "Controversies in Obesity Mortality: A Tale of Two Studies" (PDF). RTI International. Archived (PDF) from the original on 2016-03-03. Retrieved 2014-02-21.
  17. ↑ Centers for Disease Control and Prevention. "Colorectal Cancer Statistics". Archived from the original on May 27, 2019. Retrieved January 12, 2015.
  18. ↑ Carol A. Burke; Laura K. Bianchi. "Colorectal Neoplasia". Cleveland Clinic. Archived from the original on October 4, 2018. Retrieved January 12, 2015.
  19. ↑ "Deaths: Preliminary Data for 2011" (PDF). CDC. Archived (PDF) from the original on 2014-02-02. Retrieved 2014-02-21.
  20. ↑ "BBC News | Special Reports | UN raises child accidents alarm". BBC News. December 10, 2008. Archived from the original on July 5, 2018. Retrieved May 8, 2010.
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