Research Article: The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors

Date Published: April 28, 2009

Publisher: Public Library of Science

Author(s): Goodarz Danaei, Eric L. Ding, Dariush Mozaffarian, Ben Taylor, Jürgen Rehm, Christopher J. L. Murray, Majid Ezzati, Simon Hales

Abstract: Majid Ezzati and colleagues examine US data on risk factor exposures and disease-specific mortality and find that smoking and hypertension, which both have effective interventions, are responsible for the largest number of deaths.

Partial Text: Valid and comparable information on mortality caused by diseases, injuries, and their modifiable risk factors is important for health policy and priority setting [1],[2]. The standard death certificate is valuable for assigning deaths to specific diseases or injuries, but does not provide information on the modifiable risk factors that cause these diseases. Previous research has indicated that modifiable risk factors are responsible for a large number of premature deaths in the United States [1],[3]. However, prior analyses did not use consistent and comparable methods for the mortality effects of different risk factors. More importantly, previous analyses did not include any dietary risk factors. The only metabolic risk factor—i.e., those measured by physiological indicators such as blood pressure, blood glucose, serum cholesterol, and body mass index (BMI)—in these analyses was overweight–obesity.

We conducted a population-level CRA (comparative risk assessment) for 12 major modifiable dietary, lifestyle, and metabolic risks. The CRA analysis estimates the number of deaths that would be prevented in the period of analysis if current distributions of risk factor exposure were changed to a hypothetical alternative distribution. The inputs to the analysis are (1) the current population distribution of risk factor exposure, (2) the etiological effect of risk factor exposures on disease-specific mortality, (3) an alternative exposure distribution, and (4) the total number of disease-specific deaths in the population.

In the year 2005, 2,448,017 US residents died; 49% of these deaths were among men. Ninety-six percent of all deaths in the US were in people ≥30 y of age. After adjustment for comparability of cause-of-death assignment [22],[23], the four most common causes of death were IHD (434,000 deaths), lung cancer (163,000 deaths), stroke (150,000 deaths), and chronic obstructive pulmonary diseases (124,000 deaths).

Our analysis of the mortality effects of major dietary, lifestyle, and metabolic risk factors in the US using comparable methods showed that tobacco smoking and high blood pressure were the leading risk factors for mortality, responsible for nearly one in five and one in six deaths in US adults, respectively. The large effects of tobacco smoking were caused by long-term cumulative exposure in current smokers as well as the remaining effects in former smokers, especially in men. The large numbers of deaths attributable to high blood pressure were related to high exposure levels, particularly in women [39]. Overweight–obesity, physical inactivity, and high blood glucose each caused about one in ten deaths, and both affected women disproportionately more than men. In those younger than 70 y of age, tobacco smoking was by far the leading modifiable cause of death, and overweight–obesity caused more deaths than did high blood pressure. Other lifestyle, metabolic, and dietary risk factors for chronic diseases also caused significant adult mortality, although their individual effects were 3%–24% of those of smoking. A comparison of our results with those of other risk factors is shown in Table S2. This comparison was done only for those risk factors included in previous analyses, because these analyses had included substantially fewer metabolic and dietary risks than ours.



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