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November 10, 1993, Vol 270, No. 18 >
ARTICLE | November 10, 1993

Actual Causes of Death in the United States FREE

J. Michael McGinnis, MD, MPP; William H. Foege, MD, MPH
[+] Author Affiliations

Reprint requests to the Deputy Assistant Secretary for Health, Disease Prevention and Health Promotion, US Department of Health and Human Services, 330 C St SW, Room 2132, Washington, DC 20201 (Dr McGinnis).


JAMA. 1993;270(18):2207-2212. doi:10.1001/jama.1993.03510180077038
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References

Objective.  —To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.

Data Sources.  —Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained.

Study Selection.  —Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.

Data Extraction.  —Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.

Data Synthesis.  —The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.

Conclusions.  —Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.(JAMA. 1993;270:2207-2212)

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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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9 +
Higginson J, Muir CS.  Environmental carcinogenesis: misconceptions and limitations to cancer control. J Natl Cancer Inst . 1979;;63:1291-1298.
10 +
Gori GB, Richter BJ.  Macroeconomics of disease prevention in the United States: prevention of major causes of mortality would alter life table assumptions and economic projections. Science . 1978;; 200:1124-1130.
11 +
White CC, Tolsma DD, Haynes SG, McGee D.  Cardiovascular disease. Am J Prev Med . 1987;;3 ( (suppl) ):43-54.
12 +
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989;.
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Goldman L, Cook EF.  The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med . 1984;;101:825-836.
14 +
Paffenbarger RS, Hyde RT, Hsieh C, Wing AL.  Physical activity, other life-style patterns, cardiovascular disease and longevity. Acta Med Scand . 1986;;711( (suppl) ):85-91.
15 +
Smith ESO.  The economic impact of preventable ischemic heart disease. Can Med Assoc J . 1977;; 117:507-512.
16 +
Manson JE, Tosteson H, Satterfield S, et al.  The primary prevention of myocardial infarction. N Engl J Med . 1992;;326:1406-1416.
17 +
Centers for Disease Control and Prevention.  Cigarette-attributable mortality and years of potential life lost—United States, 1990. MMWR Morb Mortal Wkly Rep . 1993;;42:645-649.
18 +
Kleinman JC, Pierre MB, Madans JH, Land GH, Schramm WF.  The effects of maternal smoking on fetal and infant mortality. Am J Epidemiol . 1988;;127:274-282.
19 +
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20 +
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Shultz JM, Novotny TE, Rice DP.  Quantifying the disease impact of cigarette smoking with SAMMEC II software. Public Health Rep . 1991;;106: 326-333.
23 +
National Center for Health Statistics. Health, US, 1992 . Hyattsville, Md: US Dept of Health and Human Services; 1993;. US Dept of Health and Human Services publication PHS 93-1232.
24 +
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25 +
Paffenbarger RS, Hyde RT, Wing AL.  Physical activity and physical fitness as determinants of health and longevity.  In: Bouchard C, Shephard RJ, Stephens T, Sutton JR, McPherson BD, eds. Exercise, Fitness, and Health . Champaign, Ill: Human Kinetics Books; 1990;.
26 +
Powell HE, Caspersen CJ, Hoplan JP, Ford ES.  Physical activity and chronic diseases. Am J Clin Nutr . 1989;;49:999-1006.
27 +
Powell HE, Thompson PD, Caspersen CJ, Hendrick JS.  Physical activity and the incidence of coronary heart disease. Ann Rev Public Health . 1987;; 8:253-287.
28 +
Lee I, Paffenbarger RS, Hsieh C.  Physical activity and risk of developing colorectal cancer among college alumni. J Natl Cancer Inst . 1991;;83:1324-1329.
29 +
Hahn RA, Teutsch SM, Rothenberg RB, Marks JS.  Excess deaths from nine chronic diseases in the United States, 1986. JAMA . 1990;;264:2654-2659.
30 +
Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M.  INTERSALT study findings: public health and medical care implications. Hypertension . 1989;;14:570-577.
31 +
Law MR, Frost CD, Wald NJ.  By how much does dietary salt reduction lower blood pressure? III: analysis of data from trials of salt reduction. BMJ . 1991;;302:811-824.
32 +
Herman WH, Teutsch SM, Geissm LS.  Diabetes mellitus. Am J Prev Med . 1987;;3( (suppl) ):72-82.
33 +
Henderson BE, Ross RH, Pike MC.  Toward the primary prevention of cancer. Science . 1991;; 254:1131-1138.
34 +
Doll R.  The lessons of life: keynote address to the nutrition and cancer conference. Cancer Res . 1992;;52( (suppl) ):2024S-2029S.
35 +
Newberne PM.  Diet and nutrition. Bull N Y Acad Med . 1978;;54:385-396.
36 +
Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH.  A prospective study of exercise and incidence of diabetes among US male physicians. JAMA . 1992;;268:63-67.
37 +
US Dept of Health and Human Services. Seventh Special Report to the US Congress on Alcohol and Health . Washington, DC: National Institute on Alcohol Abuse and Alcoholism; 1990;. US Dept of Health and Human Services publication ADM 90-1656.
38 +
Schoenborn CA.  Exposure to alcoholism in the family—United States, 1988. Advance Data From Vital and Health Statistics No. 205 . Hyattsville, Md: National Center for Health Statistics; 1991;. US Dept of Health and Human Services publication PHS 91-1250.
39 +
West LJ, Maxwell DS, Noble EP, Solomon DH.  Alcoholism. Ann Intern Med . 1984;;100:405-416.
40 +
Johannes RS, Kahane SN, Mendeloff AI, Kurata J, Roth HP.  Digestive diseases. Am J Prev Med . 1987;;3( (suppl) ):83-88.
41 +
McCoy GF, Johnstone RA, Nelson IW, Duthie RB.  A review of fatal road accidents in Oxfordshire over a 2-year period. Injury . 1989;;20:65-68.
42 +
Smith GS, Falk H.  Unintentional injuries. Am J Prev Med . 1987;;3( (suppl) ):143-163.
43 +
Centers for Disease Control.  Alcohol-related mortality and years of potential life lost—United States, 1987. MMWR Morb Mortal Wkly Rep . 1990;; 39:173-178.
44 +
Bennett JV, Holmberg SD, Rogers MF, Solomon SL.  Infectious and parasitic diseases. Am J Prev Med . 1987;;3( (suppl) ):102-114.
45 +
National Center for Health Statistics. Vital Statistics of the United States—1990, Volume II: Mortality . Hyattsville, Md: US Dept of Health and Human Services. In press.
46 +
Williams WW, Hickson MA, Kane MA, Kendal AP, Spika JS, Hinman AR.  Immunization policies and vaccine coverage among adults. Ann Intern Med . 1988;;108:616-625.
47 +
Centers for Disease Control.  ACIP: recommendations for protection against viral hepatitis. MMWR Morb Mortal Wkly Rep . 1985;;34:313-335.
48 +
Di Bisceglie AM.  Chronic viral hepatitis and hepatocellular carcinoma in the United States.  In: Tabor E, Di Bisceglie AM, Purcell RH, eds. Etiology, Pathology, and Treatment of Hepatocellular Carcinoma in North America . Houston, Tex: Portfolio Publishing Co; 1990;.
49 +
Jereb JA, Kelly GD, Dooley SW, Canthen GM, Snider DE.  Tuberculosis morbidity in the United States: final data, 1990. MMWR Morb Mortal Wkly Rep . 1991;;40:23-27.
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
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BMJ 2010;341:c5893-c1494.
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