Public Health and Causes of Death

[liveonearth]

"...the function of protecting and developing health
must rank even above that of restoring it when it is impaired"
--Hippocrates

--public health efforts are intended to extend life expectancy
--convergence of 3 sciences: epidemiology, social justice, politics
--the numbers and odds matter for direction prevention efforts
--consider years of potential life lost (before age 75)
--accidents (esp car wrecks) + suicide + homicide trump disease these days
--consider cost effectiveness
--individual freedom versus greater good: when do you make vaccination mandatory?
--whites live longer than blacks live longer than natives
--higher education correlates with higher life expectancy
--new challenges today: plastics, toxins
--in the US approximately 2 million die/year and about 1/2 of those deaths are preventable (temporarily)
--leading disabilities in US: 1) neuropsychological (depression) 2) cardio 3) accidents
--iatrogenic causes of death are hidden, nurse drug errors are tracked, physician errors are hidden

PERPECTIVE
--approximately half of deaths in US are from preventable causes
--prevention efforts would best focus on 1) smoking cessation 2) diet 3) exercise
--the decrease in US death rate from infectious disease since 1900 has been mostly pre 1940, ie before antibiotics, so what caused it?
--WWII exclusion criteria: must have 6+ opposable teeth: more men were not permitted to join the military for this reason than for any other
--1990 top 8 modifiable death factors: diet/exercise, alcohol/drugs, guns/cars, environment, sex
--LEAD in kids, test in their teeth, when lead levels are higher school problems are worse, lower lead levels in everyone since it was removed from gasoline
--leading causes of death in 2000: heart dz, malignant neoplasm (lung leads in both sexes), cerebrovascular dz (strokes), chronic lower respiratory dx (smoking), unintentional injuries, diabetes mellitus (increasing quickly), influenza and pneumonia, alheimer's, nephiritis, septicemia, other
--total death count in 2000 was 2,403,351
--"actual" causes of death in the US: prevalence remained the same in 1990 and 2000: 1) tobacco, 2) poor diet and physical inactivity, 3) alcohol consumption, 4) microbial agents, 5) toxic agents 6) motor vehicles 7) firearms (lots of suicide, then homicide, then accidents), 8) sexual behavior, 9) illicit drug use
--deaths due to the causes listed just above in 1990 were 1,060,000 and in 2000 were 1,159,0000, right around half the total deaths

SMOKING
--smokers have lower body weight but higher mortality
--435,000 deaths attributable to smoking in 2000
--35,000 of those are from second hand smoke
--1,000 infant deaths due to maternal smoking
--painfully slow progress in reducing tobacco-caused mortality rates in spite of all efforts
--telephone quit lines seem to be helping

POOR DIET AND PHYSICAL INACTIVITY
--study assessed impact of poor diet and physical inactivity by computing deaths due to overweight
--overweight has increased in all segments of the US population in the 90's
--study found that over 80% over "excess" (preventable) deaths were associated with class II or III obesity
--a very conservative estimate: 385,000 of the unneccessary deaths were caused by being overweight (lots more people died who were overweight but causation was not assigned) (several studies estimated the number over 500,000)

DRINKING
--18,539 deaths were reported as alcohol induced in 2000
--people don't report binge drinking when reporting their regular intake
--people underreport their regular intake
--a lot of the auto-related deaths involve alcohol

MICROBES
--65,313 deaths from influenza and pneumonia in 2000
--31,224 from septicemia
--776 from tuberculosis
--mortality from all infectious and parasitic dz has declined since 1990
-- ~ 18,650 deaths a year in the U.S. caused by antibiotic-resistant bacteria (2007 est)

TOXIC AGENTS
--caused 55,000 deaths in 2000
--exposure to asbestos, benzene and lead has declined
--air pollutants have declined: carbon monoxide, lead, ozone, nitrogen dioxide, sulfur dioxide, particulates
--particulate matter is the only one of those associated with significant increase in mortality (about 60% of toxicity related deaths)
--toxic agents are causing more cancer, respiratory and cardiovascular dz
--top toxic agents that kill: indoor air pollution, environmental tobacco smoke, radon, lead in drinking water, food contamination

MOTOR VEHICLES
--43,354 deaths including pedestrians in 2000
--numbers down from 1990 (47,000)
--approx 26,500 had no alcohol involvement

GUNS
--28,663 deaths in 2000
--16,586 suicides
--10,801 homicides
--unintentional 776
--230 undetermined intent
--270 "legal intervention" (cops)
--from bearded guy lecture: 80 deaths/day by gun, mostly suicides and white men and African men

SEXUAL BEHAVIOR
--20 million new infections with STD's per year in US
--mortality rate is declining due to improved HIV care
--2,000 deaths due to STD's in 2000 (10,000 in 1990 during AIDS crisis)

ILLICIT USE OF DRUGS
--associated with suicide, homicide, motor-vehicle injury, HIV, pneumonia, violent, mental illness and hepatitis
--17,000 deaths in 2000, down by 3,000 from 1990

OTHER FACTORS
--poverty
--low educations
--lack of access to medical care and preventive services
--biological characteristics and genetic risk factors
--race

Comments

[rinku.livejournal.com]

A few notes on your notes:

- I wouldn't put suicides under guns, because there's a higher suicide rate in Japan, it's just that they don't use guns to do it, so it might be unrelated to gun access. (Also a large portion of our suicides are done without guns.)

- I'd include aging as a major cause of death, even as a cause of death prior to age 75; although you don't die of old age before age 75, you can die of diseases caused by age long before you're in danger of dying of old age.

- "the decrease in US death rate from infectious disease since 1900 has been mostly pre 1940, ie before antibiotics, so what caused it?" -- Improvements in sanitation, I suspect. And just a general increase in wealth: there was that whole 'roaring 20s' thing, where the economy improved drastically. In 1900 we were a very poor nation, not at all a superpower, either militarily or economically, but in 1940 we were the largest economy in the world.

- Vaccination isn't even mandatory right now, it's only mandatory if you want to attend school. So I wouldn't consider it a loss of individual freedom, because a person can choose to go to private school or be home schooled and never be vaccinated.

[rinku.livejournal.com]

Another major change I just thought of between 1900 and 1940: electricity. Most houses in 1900 had no power at all, most houses in 1940 had electrical outlets. This could contribute via refrigeration, as refrigerated food causes less infectious diseases.

[liveonearth.livejournal.com]

Thanks for your thoughts.

Refrigeration definitely reduced the prevalence of GI cancers, esp stomach, because we are eating less salted/preserved meat.

Regarding vaccination, currently we still have "herd immunity" because most people from my generation (X) got the standard vaccines. People being born these days are getting considerably fewer vaccines, sometimes to their advantage, and some of which will incur more troublesome infectious outbreaks in the future as the herd immunity declines.

Oh, and the suicides that the study is reporting are all by gun. They did not report on the other ways to kill yourself, which are many. I would be interested to see those numbers too.

[rinku.livejournal.com]

I was curious and found this:

http://en.wikipedia.org/wiki/Suicide#Suicide_methods

"In countries where firearms are readily available, many suicides involve the use of firearms. Over 52% of suicides that occurred in the United States in 2005 were by firearm. Asphyxiation methods (including hanging) and toxification (poisoning and overdose) are fairly common as well. Both comprised about 40% of suicides in the U.S. during the same time period. Other methods of suicide include blunt force trauma (jumping from a building or bridge, stepping in front of a train, or car collision, for example). Exsanguination or bloodletting (slitting one's wrist or throat), intentional drowning, self-immolation, electrocution, and intentional starvation are other suicide methods."

[liveonearth.livejournal.com]

So.....92% of suicides in 05 by gun, asphyxiation and overdose... Interesting.