A comprehensive assessment of the risk factors for preventable deaths in
the United States has found that smoking and high blood pressure are
responsible for the greatest number of preventable deaths - each
accounting for around 1 in 5 deaths in US adults. The study, published in
the
open-access journal PLoS Medicine this week, finds that other dietary,
lifestyle and metabolic risk factors also cause a substantial number of
deaths
in the United States.
Majid Ezzati, of the Harvard School of Public Health, and colleagues
estimated the number of preventable deaths caused by twelve selected risk
factors. These are factors related to lifestyle, including smoking and
physical inactivity, dietary factors, such as high salt intake and low
intake
of fruit and vegetables, and metabolic factors that often result from diet
and lifestyle but may also have clinical interventions such as high blood
pressure and blood glucose. They are known as "modifiable risk factors"
because although it is well established that these risk factors shorten a
person's life expectancy through the increased risk of heart disease,
stroke, cancers, and other chronic diseases, they can also be changed or
controlled by individuals themselves or through public health as well as
medical interventions.
Previous studies had indicated that some lifestyle risk factors are
responsible for a huge number of premature deaths in the United States.
But
Ezzati and colleagues used a more comprehensive method that estimated the
number of deaths across different risk factors, including dietary and
metabolic factors that had been left out of previous analyses. They
devised a "comparative risk assessment" - an estimate of the number of
deaths that would be prevented if the distribution of the lifestyle,
dietary and metabolic risk factors were at a hypothetical optimum (e.g. if
nobody
smoked). Gathering data on the risk factors from nationally representative
surveys that had already been conducted, they obtained information on
deaths from the US National Center for Health Statistics. Of the 2.5
million US deaths in 2005, the researchers estimated that almost 470,000
were
associated with tobacco smoking and nearly 400,000 with high blood
pressure. Being overweight or obese accounted for nearly 1 in 10 deaths of
US
adults, whilst high salt intake was responsible for 1 in 25 deaths of US
adults - the most of any of the dietary factors analyzed.
The analysis suggests that by targeting a few risk factors there is great
potential to reduce the number of preventable deaths in the United States.
Importantly, the authors stress that there are interventions at an
individual and a population level that are already shown to be effective
at
combating the two deadliest risk factors in the United States - smoking
and high blood pressure. Yet despite knowledge of these interventions, the
reduction of blood pressure and tobacco smoking has stagnated and even
reversed in some areas.
Comparable information on lifestyle, diet and metabolic risk factors is
crucial for forming health policy and priorities, and Ezzati and
colleagues
conclude by suggesting that "research, implementation, monitoring and
evaluation related to interventions" is crucial to reduce the number of
preventable deaths in the United States and elsewhere.
Funding: This research was supported by a cooperative agreement from the
Centers for Disease Control and Prevention (CDC) through the Association
of
Schools of Public Health (ASPH) (Grant No. U36/CCU300430-23). The contents
of this article are solely the responsibility of the authors and do not
necessarily represent the official views of CDC or ASPH. The funders had
no role in study design, data collection and analysis, decision to
publish,
or preparation of the manuscript.
Citation:
"The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors."
Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009)
PLoS Med 6(4): e1000058.
doi:10.1371/journal.pmed.1000058
Source
Plos Medicine