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 2001 most YPLL resulted from malignant neoplasms (cancer), heart disease, and unintentional injuries (accidents).

TABLE 1.6
Percent low birthweight by weight gain of mother during pregnancy, gestation period, and race or Hispanic origin of mother, 2002
[Low birthweight is defined as weight of less than 2,500 grams (5 lb 8 oz)]

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 100,000 population were lost to people younger than age seventy-five; by 2001 that number had declined to 7,531.2 total years lost. 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 1,221.1 in 2001). 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 infection decreased almost fourfold between 1995 and 2001. However, YPLL rates for diabetes and chronic lower respiratory diseases increased over this same period. (See Table 1.13.)

With the exception of suicide, the YPLL due to all causes for African-Americans, male and female, was significantly higher than for white males and females. In 2001, for all causes, African-Americans lost 12,579.7 years of potential life per 100,000 population, compared with 6,941.6 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 1.13.)

Leading Causes of Death

According to the CDC publication Health, United States 2003, heart disease was the leading cause of death among Americans in 2001. Cancer (malignant neoplasm) was the second most frequent cause of death among Americans.

TABLE 1.7
Low birthweight live births, according to mother's race, Hispanic origin, and smoking status, selected years 1970–2001
[Data are based on birth certificates]

RACIAL DIFFERENCES.

Significant racial and ethnic variations exist in the ten leading causes of death. (See Table 1.12.) In 2001 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, Hispanics, and white males. In contrast, homicide was a leading cause of death for African-American and Hispanic men; it ranked low as a cause of death for both Asian and Pacific Islander men and American Indian/Alaska Native men. Homicide did not rank as a top cause of death for men or women of any race/ethnicity.

AGE DIFFERENCES.

In 2001, as would be expected, death rates were highest for people age eighty-five and FIGURE 1.4
Spina bifida rates, 1991–2002 older (15,112.8 per 100,000 population). From age twenty-five on, death rates doubled with each additional decade. (See Table 1.14.)

The ten leading causes and numbers of deaths in 2001 are shown in Table 1.15. Accidents (unintentional injuries) were the leading cause of death for children one to four years of age, followed by congenital malformations and cancer. 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 anomalies, homicide, and suicide.

Accidents (unintentional injuries) were the leading cause of death 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.

Among adults ages twenty-five through forty-four in 2001, 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.

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.

"Actual" Causes 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. In 2000, the most common actual causes of death in the United States were tobacco (responsible for 435,000 deaths), poor diet and physical inactivity (400,000 deaths), alcohol consumption (85,000 deaths), microbial agents (e.g., influenza and pneumonia, 75,000 deaths), toxic agents (e.g., pollutants and asbestos, 55,000 deaths), motor vehicle accidents (43,000 deaths), firearms (29,000 deaths), sexual behavior (20,000 deaths), and illicit use of drugs (17,000 deaths).