Defining Health and Wellness - Mortality

Years of Potential Life Lost

"Years of potential life lost" (YPLL) is a term used by medical and public health professionals to describe the number of years deceased persons might have lived if they had not died prematurely (before their life expectancy). In 2002 most YPLL resulted from malignant neoplasms (cancer), heart disease, and unintentional injuries (accidents). (See Table 1.10.)

The increase in life expectancy in the twentieth century has meant a decrease in the YPLL rate. In 1980 a total of 10,448.4 years per one hundred thousand population were lost to people younger than age seventy-five; by 2002 that number had declined to 7,499.6 total years lost. (See Table 1.10.) Although heart disease remains the number-one killer in the United States, it has been responsible for a smaller proportion of YPLL since 1980 (2,238.7 in 1980 and 1,212.7 in 2002). Similarly, years lost to cerebrovascular diseases (e.g., strokes), liver diseases, pneumonia, and motor vehicle accidents also have declined since 1980. And after increasing dramatically between 1980 and the mid-1990s, years lost to HIV TABLE 1.6 Infant, neonatal, and postnatal mortality rates by race and Hispanic origin of mother, selected years 1983–2002 Adapted from "Table 19. Infant, Neonatal, and Postnatal Mortality Rates, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)infection decreased almost fourfold between 1995 and 2002. However, YPLL rates for diabetes increased over this same period and chronic lower respiratory diseases remained roughly the same.

With the exception of suicide, the YPLL due to all causes for African-Americans was significantly higher than for white males and females. In 2002, for all causes, African-Americans lost 12,401 years of potential life per one hundred thousand population, compared with 6,936.6 years for white Americans. African-Americans lost considerably more years of life to heart disease, cerebrovascular diseases, cancers, HIV, and homicide than did whites. (See Table 1.10.)

RACIAL AND GENDER DIFFERENCES

Significant racial and ethnic variations exist in the ten leading causes of death. (See Table 1.9.) In 2002 chronic liver disease and cirrhosis were not listed as leading causes of death for all Americans; they were, however, listed as leading causes of death among all men, American Indian or Alaskan Natives, and Hispanics. In contrast, homicide was a leading cause of death for African-American and Hispanic men; it ranked ninth for American Indian or Alaska Native men and was the tenth-leading cause of death of Asian or Pacific Islander men. In 2002 homicide did not rank as a leading cause of death for women of any race/ethnicity.

AGE DIFFERENCES

In 2002, as would be expected, death rates were highest for people age eighty-five and older (14,828.3 per one hundred thousand population). From age twenty-five on, death rates doubled with each additional decade. (See Table 1.11.)

The ten leading causes and numbers of deaths vary by age. In 2002 accidents (unintentional injuries) were the leading cause of death for children one to four years of age, followed by congenital malformations and homicide. Although children five to fourteen years old were also most likely to die from accidents, cancer was the second most prevalent cause of death, followed by congenital malformations, homicide, and suicide. (See Table 1.12.)

Accidents (unintentional injuries) were the leading cause of death in 2002 for young people ages fifteen to twenty-four. Homicide was the second-leading cause of death, followed by suicide. Cancer was the fourth-leading cause of death among this age group. (See Table 1.12.)

TABLE 1.7 Infant mortality rates and international rankings by selected countries, selected years 1960–2002 "Table 25. Infant Mortality Rates and International Rankings: Selected Countries, Selected Years 1960–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed December 8, 2005)

Among adults ages twenty-five through forty-four in 2002, accidents were the most frequent cause of death, and cancer was second. Heart disease and suicide were the third- and fourth-leading causes, respectively, followed by homicide and HIV disease. (See Table 1.12.)

Among adults forty-five through sixty-four years old, cancer and heart disease were ranked the first- and second-leading causes of death, respectively. Among those age sixty-five and older, these two categories were reversed. (See Table 1.12.)

"Actual" Cause of Death

Actual causes of death are defined by the CDC as lifestyle and behavioral factors such as smoking and physical inactivity that lead to leading killers, including heart disease, cancer, and stroke. According to a CDC fact sheet released in March 2004 (http://www.cdc.gov/od/oc/media/pressrel/fs040309.htm), in 2000 the most common actual causes of death in the United States were tobacco (responsible for four hundred and thirty-five thousand deaths), poor diet and physical inactivity (four hundred thousand deaths), alcohol consumption FIGURE 1.3 Life expectancy by race and sex, 1970–2003 Donna L. Hoyert, et al., "Figure 2. Life Expectancy by Race and Sex: United States, 1970–2003," in Deaths: Final Data for 2003, Health E-Stats, Centers for Disease Control and Prevention, National Center for Health Statistics, January 19, 2006, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/finaldeaths03/finaldeaths03.htm (accessed January 24, 2006)(eighty-five thousand deaths), microbial agents (for example, influenza and pneumonia; seventy-five thousand deaths), toxic agents (for example, pollutants and asbestos; fifty-five thousand deaths), motor vehicle accidents (forty-three thousand deaths), firearms (twenty-nine thousand deaths), sexual behavior (twenty thousand deaths), and illicit use of drugs (seventeen thousand deaths). Taken together, these accounted for about half of all 2.4 million U.S. deaths in 2000.

Many epidemiologists and other public health researchers contend that sedentary Americans are eating themselves to death, and they fear that the adverse health outcomes, in terms of morbidity and mortality, resulting from unhealthy eating and inactivity will soon outpace tobacco as the top actual and preventable cause of death. The CDC reports the gap between the two in 2000 was substantially narrower than in 1990, when poor diet and inactivity caused three hundred thousand deaths (14%), compared with four hundred thousand for tobacco (19%).