Top Ten Causes of Death in the United States

Ranking causes of death is a popular way to gauge mortality. This measure gauges the relative burden of cause-specific mortality. Experts have been gathering national data on this topic ever since 1952, with little change in methodology.

According to the National Vital Statistics Reportspublished by the HHS in June 2019, the top 10 causes of death in 2017 accounted for 74% of total US deaths. Proportions of total death per disease were gathered from 2017 death certificates issued in all 50 states, as well as in Washington, DC.

Let’s take a closer look at each of these top 10 causes of death.

10. Suicide

Incidence in 2017: 41,173

Percent of total deaths: 1.7

The well-intentioned physician may be inclined to think that patient suicide is out of their control. But physicians should always ask about suicidal ideation among patients with depression or those with a history of suicide attempts.

According to the American Academy of Family Physicians (AAFP), clinicians can minimize the risk of suicide with a thorough assessment of at-risk patients for psychiatric illnesses, having an awareness of the clinical and social situations that could precipitate suicide, and initiating treatment in patients with psychiatric disorders or helping them get access to treatment through referrals. AAFP experts also stress that asking high-risk patients about their suicidal intent has been shown to lead to better outcomes without increasing the risk of suicide.

9. Nephritis, nephrotic syndrome, and nephrosis

Incidence in 2017: 50,633

Percent of total deaths: 1.8

Chronic kidney diseases include a constellation of processes linked by abnormal kidney function and slow decline in glomerular filtration rates. End-stage renal disease refers to the stage of chronic kidney disease marked by the accumulation of toxins, fluids, and electrolytes that results in death without dialysis or kidney transplantation.

8. Influenza and pneumonia

Incidence in 2017: 55,627

Percent of total deaths: 2.0

Like a trained assassin, influenza can cause death in many ways. It can kill quickly via respiratory failure secondary to inflammation. It can also predispose the elderly and immunocompromised to develop pneumonia, which can lead to death.

7. Diabetes mellitus

Incidence in 2017: 83,564

Percent of total deaths: 3.0

Most people with diabetes have type 2—which is a huge health burden in the United States, both on individuals and the health-care system. It is the leading cause of end-stage renal disease, lower extremity amputations, and adult blindness. It also predicts cardiovascular diseases. The medical treatment of type 2 diabetes ranges from metformin to insulin, depending on the degree of insulin resistance.

6. Alzheimer disease

Incidence in 2017: 121,404

Percent of total deaths: 4.3

Late-onset Alzheimer disease is the most common form of this disease, wherein symptoms become apparent in adults in their mid-60s. Although no specific gene has been found to directly cause this illness, one type of apolipoprotein E, APOE ε4, has been shown to increase the risk. As with things genetic, some people with this gene don’t develop the disease, while others develop the disease without harboring the gene. Alzheimer disease is a diagnosis of exclusion, with definitive diagnosis available only upon autopsy. Unfortunately, Alzheimer disease cannot be stopped, but engaging in certain lifestyle changes in conjunction with early treatment with cholinesterase inhibitors may help preserve daily functioning and forestall cognitive decline.

5. Cerebrovascular diseases

Incidence in 2017: 146,383

Percent of total deaths: 5.2

There are two types of stroke that kill—ischemic and hemorrhagic. (Transient ischemic attack, the third type of stroke, doesn’t usually kill, but serves as a harbinger of death.) About 87% of strokes are ischemic. Of hemorrhagic strokes, intercerebral strokes are more common than subarachnoid strokes. Hypertension, diabetes mellitus, tobacco use, atrial fibrillation, and atherosclerosis can all predict stroke.

Tissue plasminogen activator (tPA) is the only FDA-approved treatment for stroke. It is given intravenously, and dissolves the clot and increases blood flow to oxygen-starved areas. Most importantly, tPA should to be given within 3 hours of symptom onset (up to 4.5 hours in some patients).

4. Chronic lower respiratory disease

Incidence in 2017: 160,201

Percent of total deaths: 5.7

The most common types of chronic respiratory disease affecting the lower airways include chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases, and pulmonary hypertension. Based on etiology, different types of treatment can assist with the dilation of major air passages and improvement of shortness of breath. The goals of treatment are symptom control and enhanced quality of life. Triggers for chronic lung disease include smoking, air pollution, and occupational exposure to chemicals and dust, as well as frequent upper respiratory infections during childhood. Although chronic respiratory disease is a big problem in the United States, it’s an even bigger problem worldwide, with > 90% of deaths attributable to COPD, most often occurring in low- and middle-income countries.

3. Accidents

Incidence in 2017: 169,936

Percent of total deaths: 6

As a physician you may be stumped as to what you can do to prevent your patients from having accidents, defined as unintentional injuries. Keep in mind, however, that during the history and physical exam, you can ask about seat belt use, domestic violence, and gun safety in the home.

2. Malignant neoplasms

Incidence in 2017: 599,108

Percent of total deaths: 21.3

Cancer: where do we even begin? More than 100 types of cancer exist. Treatments can include chemotherapy, radiotherapy, stem-cell transplant, or immunotherapy/biologic therapy. To date, the NCI has sponsored nine clinical trials examining whether antioxidant supplements can prevent cancer. In the aggregate, these trials did not support the use of antioxidants to prevent cancer. On a related note, the US Preventive Services Task Force (USPSTF) found that the use of vitamin and mineral supplements don’t prevent cancer either.

1. Heart disease

Incidence in 2017: 647,457

Percent of total deaths: 23.0

The most common cause of heart disease is coronary artery disease. Another major cause of heart illness is valvular disease. Air pollution can trigger heart attacks, strokes, and arrhythmias in patients who are at risk for these conditions. Tests used to evaluate heart disease include lipid levels, high-sensitivity C-reactive protein (hs-CRP), EKGs, stress tests, and echocardiography. Treatments include statins, blood thinners, chelation, and surgery (eg, coronary artery bypass graft [CABG]). Preventive measures include lowering blood pressure levels, smoking cessation or abstinence, and physical activity. Individuals who have or are at risk for heart disease and other heart conditions are recommended to check weather forecasts and avoid high-pollution areas when possible.

This list of health-related causes of death does not necessarily reflect the greatest public health concerns with respect to mortality. For instance, if tabulated separately, lung cancer would be ranked the sixth leading cause of death. However, in the current rankings, lung cancer is lumped into the category of malignant neoplasms. Finally, these rankings differ by age, sex, race, and Hispanic origin.

Source: https://www.mdlinx.com/internal-medicine/article/3848