The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors
- PMID: 19399161
- PMCID: PMC2667673
- DOI: 10.1371/journal.pmed.1000058
The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors
Erratum in
- PLoS Med. 2011 Jan;8(1). doi: 10.1371/annotation/0ef47acd-9dcc-4296-a897-872d182cde57
Abstract
Background: Knowledge of the number of deaths caused by risk factors is needed for health policy and priority setting. Our aim was to estimate the mortality effects of the following 12 modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) using consistent and comparable methods: high blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure; overweight-obesity; high dietary trans fatty acids and salt; low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits and vegetables; physical inactivity; alcohol use; and tobacco smoking.
Methods and findings: We used data on risk factor exposures in the US population from nationally representative health surveys and disease-specific mortality statistics from the National Center for Health Statistics. We obtained the etiological effects of risk factors on disease-specific mortality, by age, from systematic reviews and meta-analyses of epidemiological studies that had adjusted (i) for major potential confounders, and (ii) where possible for regression dilution bias. We estimated the number of disease-specific deaths attributable to all non-optimal levels of each risk factor exposure, by age and sex. In 2005, tobacco smoking and high blood pressure were responsible for an estimated 467,000 (95% confidence interval [CI] 436,000-500,000) and 395,000 (372,000-414,000) deaths, accounting for about one in five or six deaths in US adults. Overweight-obesity (216,000; 188,000-237,000) and physical inactivity (191,000; 164,000-222,000) were each responsible for nearly 1 in 10 deaths. High dietary salt (102,000; 97,000-107,000), low dietary omega-3 fatty acids (84,000; 72,000-96,000), and high dietary trans fatty acids (82,000; 63,000-97,000) were the dietary risks with the largest mortality effects. Although 26,000 (23,000-40,000) deaths from ischemic heart disease, ischemic stroke, and diabetes were averted by current alcohol use, they were outweighed by 90,000 (88,000-94,000) deaths from other cardiovascular diseases, cancers, liver cirrhosis, pancreatitis, alcohol use disorders, road traffic and other injuries, and violence.
Conclusions: Smoking and high blood pressure, which both have effective interventions, are responsible for the largest number of deaths in the US. Other dietary, lifestyle, and metabolic risk factors for chronic diseases also cause a substantial number of deaths in the US.
Conflict of interest statement
The Academic Editor declares that he had no competing interests when the first version of this paper was submitted. After a revised version was submitted, he started working on the global burden of disease from climate change project at the WHO in Geneva. Majid Ezzati is also working on the Global Burden of Disease project.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/2667673/bin/pmed.1000058.g001.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/2667673/bin/pmed.1000058.g002.gif)
Similar articles
-
Adult mortality of diseases and injuries attributable to selected metabolic, lifestyle, environmental, and infectious risk factors in Taiwan: a comparative risk assessment.Popul Health Metr. 2017 May 3;15(1):17. doi: 10.1186/s12963-017-0134-4. Popul Health Metr. 2017. PMID: 28468625 Free PMC article.
-
Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment.PLoS Med. 2012 Jan;9(1):e1001160. doi: 10.1371/journal.pmed.1001160. Epub 2012 Jan 24. PLoS Med. 2012. PMID: 22291576 Free PMC article.
-
Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States.JAMA. 2017 Mar 7;317(9):912-924. doi: 10.1001/jama.2017.0947. JAMA. 2017. PMID: 28267855 Free PMC article.
-
Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.Lancet Diabetes Endocrinol. 2014 Aug;2(8):634-47. doi: 10.1016/S2213-8587(14)70102-0. Epub 2014 May 16. Lancet Diabetes Endocrinol. 2014. PMID: 24842598 Free PMC article. Review.
-
Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010.In: Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME, editors. Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Mar 14. Chapter 3. In: Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME, editors. Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Mar 14. Chapter 3. PMID: 27227239 Free Books & Documents. Review.
Cited by
-
Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations.JAMA. 2024 Jul 29:e2412537. doi: 10.1001/jama.2024.12537. Online ahead of print. JAMA. 2024. PMID: 39073797
-
Advancing Lifestyle Medicine in New York City's Public Health Care System.Mayo Clin Proc Innov Qual Outcomes. 2024 May 21;8(3):279-292. doi: 10.1016/j.mayocpiqo.2024.01.005. eCollection 2024 Jun. Mayo Clin Proc Innov Qual Outcomes. 2024. PMID: 38828080 Free PMC article. Review.
-
Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model.Front Public Health. 2024 May 15;12:1358423. doi: 10.3389/fpubh.2024.1358423. eCollection 2024. Front Public Health. 2024. PMID: 38813428 Free PMC article.
-
Association between Gross Motor Competence and Physical Fitness in Chilean Children Aged 4 to 6 Years.Children (Basel). 2024 May 8;11(5):561. doi: 10.3390/children11050561. Children (Basel). 2024. PMID: 38790556 Free PMC article.
-
Exploring the Effect of Acute and Regular Physical Exercise on Circulating Brain-Derived Neurotrophic Factor Levels in Individuals with Obesity: A Comprehensive Systematic Review and Meta-Analysis.Biology (Basel). 2024 May 6;13(5):323. doi: 10.3390/biology13050323. Biology (Basel). 2024. PMID: 38785805 Free PMC article. Review.
References
-
- McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207–2212. - PubMed
-
- Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–1757. - PubMed
-
- Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–1245. - PubMed
-
- Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986;124:17–27. - PubMed
-
- Stahre M, Naimi T, Brewer R, Holt J. Measuring average alcohol consumption: the impact of including binge drinks in quantity-frequency calculations. Addiction. 2006;101:1711–1718. - PubMed
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical