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.

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
Preventable medical errors in hospitals (USA)210,000 to 448,000 [13] 23.1%Estimates vary, significant numbers of preventable deaths also result from errors outside of hospitals.
Adverse events in hospitals in low- and middle-income countries2.6 million deaths [14] "one of the 10 leading causes of death and disability in the world"
Smoking tobacco 435,000 [11] 18.1%
Obesity 111,900 [15] 4.6%There was considerable debate about the differences in the numbers of obesity-related diseases. [16] The value here reflects the death rate for obesity that has been found to be the most accurate of the debated values. [17] Note, however, that being overweight but not obese was associated with fewer deaths (not more deaths) relative to being normal weight. [15]
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. [18] About 80 percent [19] 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 [20] 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: [21]

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 muscle due to plaque buildup in the hearts arteries

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

<span class="mw-page-title-main">Obesity</span> Medical condition in which excess body fat harms health

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.

The health effects of long-term alcohol consumption on health vary depending on the amount of ethanol consumed. Even light drinking poses health risks, but small amounts of alcohol may also have health benefits. Chronic heavy drinking causes severe health consequences which outweigh any potential benefits.

Lifestyle diseases can be defined as diseases linked with one's lifestyle. These diseases are non-communicable diseases. They are 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> Prevent and minimize 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 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 so-called "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">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">Birth weight</span> Weight of a human baby at birth

Birth weight is the body weight of a baby at their birth. The average birth weight in babies of European and African descent is 3.5 kilograms (7.7 lb), with the normative range between 2.5 and 4.0 kilograms. On average, babies of Asian descent weigh about 3.25 kilograms (7.2 lb). The prevalence of low birth weight has changed over time. Trends show a slight decrease from 7.9% (1970) to 6.8% (1980), then a slight increase to 8.3% (2006), to the current levels of 8.2% (2016). The prevalence of low birth weights has trended slightly upward from 2012 to the present.

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

Excessive alcohol intake is associated with an elevated risk of alcoholic liver disease (ALD), heart failure, some cancers, and accidental injury, and is a leading cause of preventable death in industrialized countries. Some studies have suggested that one drink per day may have cardiovascular benefits. However, these studies are controversial, and the common view is that no level of alcohol consumption improves health. There is far more evidence for the harmful effects of alcohol than for any beneficial effects. It is also recognized that the alcohol industry may promote the unsubstantiated benefits of moderate drinking.

<span class="mw-page-title-main">Non-communicable disease</span> Medical condition

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

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Cancer prevention is the practice of taking active measures to decrease the incidence of cancer and mortality. The practice of prevention is dependent upon 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.

The association between obesity, as defined by a body mass index of 30 or higher, and risk of a variety of types of cancer has received a considerable amount of attention in recent years. Obesity has been associated with an increased risk of esophageal cancer, pancreatic cancer, colorectal cancer, breast cancer, endometrial cancer, kidney cancer, thyroid cancer, liver cancer and gallbladder cancer. Obesity may also lead to increased cancer-related mortality. Obesity has also been described as the fat tissue disease version of cancer, where common features between the two diseases were suggested for the first time.

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.
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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. ↑ James, John T. (2013). "A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care". Journal of Patient Safety. 9 (3): 122–28. doi: 10.1097/PTS.0b013e3182948a69 . PMID   23860193. S2CID   15280516.
  14. ↑ "Patient Safety". WHO. 13 September 2019. Retrieved 16 June 2022.
  15. 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)
  16. ↑ 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.
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  18. ↑ Centers for Disease Control and Prevention. "Colorectal Cancer Statistics". Archived from the original on May 27, 2019. Retrieved January 12, 2015.
  19. ↑ Carol A. Burke; Laura K. Bianchi. "Colorectal Neoplasia". Cleveland Clinic. Archived from the original on October 4, 2018. Retrieved January 12, 2015.
  20. ↑ "Deaths: Preliminary Data for 2011" (PDF). CDC. Archived (PDF) from the original on 2014-02-02. Retrieved 2014-02-21.
  21. ↑ "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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