Measuring the Risks and Causes of Premature Death Summary of Workshops (2015) / Chapter Skim
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3 Data from Major Studies of Premature Mortality
3 Data from Major Studies of Premature Mortality
Pages 27-46
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From page 27... ...
UPDATING MCGINNIS' ACTUAL CAUSES OF DEATH At the 2013 workshop, Michael McGinnis presented analyses of the determinants of premature mortality, comparing the contribution of known preventable factors from 1990, 2000, and 2010. He applied the same methodology to derive estimates in each of those years using available mortality data and, as previously, used a rounding rule to avoid false precision.
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Total of premature mortality 1,095,000 1,105,000 (1,115,000) All causes of mortality 2,150,000 2,400,000 2,470,000 NOTES: Provisional estimates are shown in parentheses.
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FINDINGS FROM INTERNATIONAL COMPARISONS Several presentations at the 2013 workshop and the follow-up meeting in 2014 addressed comparisons between the United States and other countries on causes of premature mortality and associated risk factors. Explaining Divergent Levels of Longevity in High-Income Countries Samuel Preston presented the major findings from the National Research Council (NRC)
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This study examined seven risk factors for shorter lifespans across 10 countries, including the United States. Of the seven factors -- health care system, inequality, social integration and social interaction, smoking, obesity, physical activity, and hormone replacement therapy -- smoking and obesity emerged as the most important factors explaining the differences in longevity.
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Since that time, the sex difference in mortality has contracted substantially because smoking prevalence peaked for women born during World War II. The heavy smoking history in the United States manifests itself in lung cancer mortality.
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For nearly all comparison countries, more than half of the difference in life expectancy compared to the United States is due to mortality under age 50 for men, because U.S. men have higher mortality rates at younger ages.
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Ho explained that although the United States had lower fatality rates per kilometer driven than other countries until 2004, Americans have more fatalities because they have much more exposure to this risk, driving many more total miles per year than people in other countries. Nontransport injuries explain 16 percent of the difference in YLL for men, the majority of which are accidental drug overdoses due primarily to prescription drugs like opioid painkillers, which have overtaken heroin and cocaine in causing overdose deaths.
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34 MEASURING THE RISKS AND CAUSES OF PREMATURE DEATH Males Females FIGURE 3-2 Cause-specific contribution to the U.S. disadvantage in years of life lost below age 50, 2006–2008.
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More research is needed to understand these phenomena, he stated. Risk Factors for Premature Mortality The top risk factors for premature mortality are diet, high blood pressure, obesity, and tobacco use, he reported.
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Behavioral risks top metabolic and environmental risk factors in terms of explaining premature mortality in the United States, Murray explained, noting that about 35 percent of U.S. premature mortality is related to behavioral risks.
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By contrast, far more is known about the determinants of cardiovascular disease and cancer, he explained. VARIATION WITHIN THE UNITED STATES Geographic and Socioeconomic/Race/Ethnicity Disparities in the Causes of Premature Death Haidong Wang presented findings from two studies of the geographic disparities in life expectancy in the United States based on work he published in July 2013 and ongoing work on the socioeconomic status (SES)
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Some of the lowest life expectancies are found where proportions of Native American populations are highest. Wang suggested four possible explanations for the disparities in life expectancy he observed: domestic and international migration; SES factors like education and poverty; lack of access to or poor quality of health care; and behavioral, environmental, or metabolic risk factors.
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At the 2014 meeting, Wang presented new analyses aimed at determining patterns of risk factors that would explain disparities in longevity and mortality rates at the county level. He and his colleagues examined out iers, l those counties whose life expectancies decreased despite improving per capita income and vice versa.
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40 Males Females FIGURE 3-3 Annualized rate of change in U.S. smoking prevalence, by county, 1996–2012.
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Males Females FIGURE 3-4 Obesity prevalence in U.S. counties, 2011.
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Ali Mokdad also described recent research that found that being from an area with higher risk factors earlier in life was an important risk factor in explaining mortality rates. Cullen and Haaga affirmed these findings in their own work.
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In models considering gender differences and predictive factors in the United States, high school graduation, income, poverty, and obesity are significant, but smoking adds little predictive power to the model. According to Cullen, "upstream determinants are probably pretty strong predictors of such things as smoking, dietary factors, activity, and the like." Similar patterns can be observed between countries and within other countries.
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Nevertheless, he argued that it is important to understand the direct effects of behavior. SUMMARY McGinnis and Murray both provided recent analyses of the behavioral determinants of premature mortality, indicating that the risk factors amenable to change account for between 35 and 50 percent of early deaths in the United States.
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M 3. Risky behavior is an important determinant of premature death, particularly for men over time (Cullen, Crimmins)
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