Tuesday, May 20, 2014

Perspectives on preventable causes of death

A few years ago, I blogged about varying definitions of "actual" causes of death, which include disease-specific causes (the top five in the U.S. being heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries); behavioral causes (tobacco, poor diet/physical inactivity, alcohol, infectious agents, environmental toxins); or socioeconomic determinants (low education, racial segregation, low social support, poverty, income inequality). Prevention-minded clinicians and policymakers understand that reducing premature deaths from diseases requires addressing unhealthy behaviors and social problems that influence them.

Researchers at the Centers for Disease Control and Prevention recently examined state-level differences between the top five disease-specific causes of death between 2008 and 2010, then took this data one step further and proposed that disparities in death rates between the best-performing states (i.e., states with the lowest disease-specific death rates) and all the others were "potentially preventable" deaths. The researchers acknowledge that actually preventing these deaths would by necessity involve reducing or eliminating health disparities:

The majority of these risk factors do not occur randomly in populations; they are closely aligned with the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. However, the calculation of potentially preventable deaths in this study did not account for differences in the attributes of states that might influence risk factors and ultimately death rates, such as proportion of the population below the poverty level. If health disparities were eliminated, as is called for by Healthy People 2020, all states should be closer to achieving the lowest possible death rates for the five leading causes of death.

A couple more caveats about this study. First, since we can't defeat death (as Atul Gawande famously wrote, "the enemy has superior forces"), reducing death rates from one cause leads to increasing death rates from another. Also, there's no reason to believe that the best-performing states represent the very best we can do. (See any one of a number of depressing international comparisons.)

For those of you who prefer visuals to data crunching, here is a neat infographic put together by the company Zweena Health. The only part that I disagree with is their assertion that "routine medical visits can save lives." Not that it isn't true (I wouldn't still be practicing medicine if I didn't think I save lives now and then), but routine social work visits and public policies that spur economic growth, reduce unemployment, and increase access to decent, affordable housing make a much bigger difference in health outcomes than do medical preventive services.