Preventable causes of death

{{short description|Causes of death that could have been avoided}} {{Update|date=August 2022|reason=Most data is from 2000/2001}}

thumb|Figure 1: In 2011, deaths from potentially avoidable causes accounted for approximately 24% of all deaths registered in England and Wales. The leading cause of avoidable deaths was ischaemic heart disease in males and lung cancer in females. '''Preventable causes of death''' are causes of death related to risk factors which could have been avoided.<ref>{{Cite journal|last1=Danaei|first1=Goodarz|last2=Ding|first2=Eric L.|last3=Mozaffarian|first3=Dariush|last4=Taylor|first4=Ben|last5=Rehm|first5=Jürgen|last6=Murray|first6=Christopher J. L.|last7=Ezzati|first7=Majid|date=2009-04-28|title=The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors|journal=PLOS Medicine|volume=6|issue=4|article-number=e1000058|doi=10.1371/journal.pmed.1000058|issn=1549-1277|pmc=2667673|pmid=19399161 |doi-access=free }}</ref> The World Health Organization has traditionally classified death according to the primary type of disease or injury. However, causes of death may also be classified in terms of preventable risk factors—such as smoking, unhealthy diet, unprotected sexual behavior (STIs), and reckless driving—which contribute to a number of different diseases. Such risk factors are usually not recorded directly on death certificates, although they are acknowledged in medical reports.

==Worldwide== It is estimated that of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes.<ref name="doi10.2202/1941-6008.1011"/> In industrialized nations the proportion is much higher, reaching 90 percent.<ref name="doi10.2202/1941-6008.1011">{{cite journal | last = Aubrey D.N.J | first = de Grey | author-link = Aubrey de Grey | title = Life Span Extension Research and Public Debate: Societal Considerations | journal = Studies in Ethics, Law, and Technology | volume = 1 | issue = 1, Article 5 | year = 2007 | url = http://www.sens.org/files/pdf/ENHANCE-PP.pdf | doi = 10.2202/1941-6008.1011 | access-date = August 7, 2011 | citeseerx = 10.1.1.395.745 | s2cid = 201101995 | archive-url = https://web.archive.org/web/20190212132207/http://www.sens.org/files/pdf/ENHANCE-PP.pdf | archive-date = February 12, 2019 }}</ref> Thus, albeit indirectly, biological aging (senescence) is by far the leading cause of death. Whether senescence as a biological process itself can be slowed, halted, or even reversed is a subject of current scientific speculation and research.<ref>{{cite web |url=http://sens.org/ |title=SENS Foundation |access-date=2012-10-10 |archive-date=2019-05-27 |archive-url=https://web.archive.org/web/20190527073423/https://www.sens.org/ |url-status=live }}</ref>

===2001 figures=== Risk factors associated with the leading causes of preventable death worldwide as of the year 2001, according to researchers working with the Disease Control Priorities Network (DCPN):<ref>{{cite web|url=http://globalhealth.washington.edu/project/4236|title=DCP3|website=washington.edu|archive-url=https://web.archive.org/web/20130128022124/http://globalhealth.washington.edu/project/4236|archive-date=2013-01-28}}</ref><ref name=Lopez>{{cite journal |vauthors=Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ |title=Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data |journal=Lancet |volume=367 |issue=9524 |pages=1747–57 |date=May 2006 |pmid=16731270 |doi=10.1016/S0140-6736(06)68770-9 |s2cid=22609505 }}</ref>

{| class="wikitable" ! Cause ! Number of deaths resulting (millions per year) |- |Hypertension | 7.8 |- |Smoking tobacco | 5.4 |- |Alcohol use disorder | 3.8 |- |Sexually transmitted infections | 3.0 |- |Poor diet | 2.8 |- |Overweight and obesity | 2.5 |- |Physical inactivity | 2.0 |- |Malnutrition | 1.9 |- |Indoor air pollution from solid fuels | 1.8 |- |Unsafe water and poor sanitation | 1.6 |}

By contrast, the World Health Organization (WHO)'s [https://web.archive.org/web/20121012021254/https://www.who.int/mediacentre/factsheets/fs310/en/index.html 2008 statistics] list only causes of death, and not the underlying risk factors.

In 2001, on average 29,000 children died of preventable causes each day (that is, about 20 deaths per minute). The authors provide the context: {{Cquote|About 56 million people died in 2001. Of these, 10.6 million were children, 99% of whom lived in low-and-middle-income countries. More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhea, malaria, and HIV/AIDS.<ref name=Lopez/>}}

== Western societies == In 2017, ''The Lancet'' published a large study by Swiss epidemiologist Silvia Stringhini and her collaborators, analysing the impact of the most important causes of preventable death in Western societies.<ref name=":0">{{Cite journal |last1=Stringhini |first1=Silvia |last2=Carmeli |first2=C |last3=Jokela |first3=M |last4=Avendaño |first4=M |last5=Muennig |first5=P |last6=Guida |first6=F |last7=...LIFEPATH consortium |date=2017 |title=Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. |journal=The Lancet |volume=389 |issue=10075 |pages=1229–1237|doi=10.1016/S0140-6736(16)32380-7 |pmid=28159391 |pmc=5368415 |bibcode=2017Lanc..389.1229S }}</ref> They estimated the number of years of life lost for each risk factor at the individual level and its contribution to preventable death at the societal level (PAF = Population Attributable Fraction).

The multicohort study and meta-analysis used individual-level data from 48 independent prospective{{clarify|date=June 2025}} cohort studies with information on socioeconomic status, high alcohol consumption, physical inactivity, current smoking, hypertension, diabetes and obesity, and mortality, for a total population of 1,751,479 from seven high-income WHO member countries.

A limitation of many studies of health risk factors is confounding bias: many risk factors are interrelated and cluster together in high-risk populations. For example, low physical activity and obesity go hand in hand. People who are physically inactive tend to gain weight, and people who are severely obese have difficulty exercising. The unique advantage of the huge amount of individual data in the Stringhini study is that it allows (estimation of) the relative contribution of each separate risk factor.

The following table shows that, at an individual level, smoking is the single greatest risk of avoidable death, followed by diabetes and high alcohol consumption. At the population level, diabetes and high alcohol consumption have a low prevalence. Physical inactivity, smoking and low socioeconomic status (SES) are then the top three preventable causes of early death. Smoking, physical inactivity and low SES account for almost two thirds of all avoidable deaths. {{table alignment}} {| class="wikitable sortable col1left col2left" style="text-align:right;" |+Risk factors for avoidable death: Pooled hazard ratios, life years lost and population attributable fraction (PAF) for six WHO-defined health risks and socioeconomic status (SES) (Meta-analysis data of prospective cohort studies, from Stringhini et al., Lancet 2017).<ref name=":0" /> ! Risk factor !Reference ! Hazard ratio ! Life years lost between ages 40 and 85 ! Prevalence ! Percentage of deaths which were premature (PAF) |- |Physical inactivity|| |1.59 |2.30 |43.7% |24.5% |- |Current smoking||Never smoking |2.08 |4.60 |23.3% |24.0% |- |Low Socio-Economic Status||High SES |1.38 |2.06 |35.4% |17.2% |- |Diabetes|| |1.79 |3.99 |9.0% |6.5% |- |High alcohol||Moderate alcohol intake |1.62 |0.48 |6.8% |3.7% |- |Hypertension|| |1.29 |1.54 |34.0% |8.8% |- |Obesity||Normal BMI |1.11 |0.68 |20.9% |Small |} A puzzling finding is the small contribution of obesity as a cause of avoidable premature death. There are two reasons why obesity is not an important independent risk factor, as is often assumed.

# Being overweight is a risk for early death without correcting for confounding risk factors. Overweight is usually measured by the body mass index (BMI = kg/m2), which is much easier to measure than physical activity. Most studies only measured BMI, not physical activity, and did not correct for confounding. # A major pitfall in many studies of weight and health is that "normal" and "healthy" are often confused. The WHO definition of "normal" adult BMI (between 18.5 and 24.9 kg/m2) is based on a normal weight and height distribution of US citizens in the 1960s, not on the associated risk of death in 2023.<ref>{{Cite journal |last1=Keys |first1=A |last2=Fidanza |first2=F |last3=Karvonen |first3=MJ |last4=Kimuru |first4=N |last5=Taylor |first5=HL |date=1972 |title=Indices of relative weight and obesity |url=https://academic.oup.com/ije/article/43/3/655/2949547?login=true |journal=Journal of Chronic Diseases |volume=25 |issue=6 |pages=329–343 |doi=10.1016/0021-9681(72)90027-6 |pmid=4650929 |via=(Reprinted in Int J Epidemiol 2014: 43(3): 655-665)|url-access=subscription }}</ref><ref>{{Cite web |last=WHO – World Health Organization |date=6 May 2010 |title=A healthy lifestyle - WHO recommendations |url=https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations |access-date=18 June 2023 |website=WHO-World Health Organization}}</ref> A meta-analysis of the association between BMI and mortality in 230 cohort studies with 3.74 million deaths among 30.3 million participants found that the risk of death in adults is not increased between 23 and 30 kg/m2 (see Figure 2).<ref>{{Cite journal |last1=Aune |first1=Dagfinn |last2=Sen |first2=A |last3=Prasad M |first3=M |last4=Norat T |first4=T |last5=Janszky |first5=I |last6=Tonstad |first6=S |last7=Romundstad |first7=P |last8=Vatten |first8=LJ |date=4 May 2016 |title=BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants |journal=British Medical Journal |volume=353 |article-number=i2156|doi=10.1136/bmj.i2156 |pmid=27146380 |pmc=4856854 }}</ref> An adult BMI of 18.5 kg/m2, considered 'normal' by WHO criteria, is associated with a 30% increase in all-cause mortality. However, this is a measure of correlation, not causation, so it does not disprove previously held notions of the relationship between health and weight. thumb|Figure 2: The association between body mass index (BMI) and relative risk of all-cause mortality (data from Aune et al., BMJ 2016; curve fitting by L. Stalpers, Amsterdam UMC, 2023).

==United States== {{Update section|date=February 2025}} The three risk factors most commonly leading to preventable death in the population of the United States are smoking, high blood pressure, and being overweight.<ref name=Harvard>{{cite journal |last1=Danaei |last2=Ding |last3=Mozaffarian |last4=Taylor |last5=Rehm |last6=Murray |last7=Ezzati |title=The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors |journal=PLOS Medicine |date=2009 |volume=6 |issue=4 |article-number=e1000058 |doi=10.1371/journal.pmed.1000058|pmid=19399161 |pmc=2667673 |doi-access=free }}</ref> Pollution from fossil fuel burning kills roughly 200,000 per year.[https://academic.oup.com/cardiovascres/article/116/11/1910/5770885]

<gallery widths="300" heights="180" perrow="3"> File:Preventable causes of death.svg|alt=Leading preventable causes of death in the United States in the year 2000. Note: This data is outdated and has been significantly revised, especially for obesity-related deaths.|Figure 3: Leading preventable causes of death in the United States in the year 2000.<ref name=JAMA2000/> ''Note: This data is outdated and has been significantly revised, especially for obesity-related deaths.''<ref name=Harvard /> </gallery>

===Accidental death=== <gallery widths="300px" heights="180px" perrow="3"> File:Causes of accidental death by age group.png|alt=Leading causes of accidental death in the United States by age group as of 2002[update].|Figure 4: Leading causes of accidental death in the United States by age group {{as of|2002|lc=y}}.<ref name=cdc2002>[https://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_15.pdf ''National Vital Statistics Report'', Vol. 50, No. 15, September 16, 2002] {{Webarchive|url=https://web.archive.org/web/20190505160036/https://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_15.pdf |date=May 5, 2019 }} as compiled at {{cite web |url=http://www.the-eggman.com/writings/death_stats.html |title=Death Statistics Tables |access-date=2009-06-21 |archive-url=https://web.archive.org/web/20090221120126/http://www.the-eggman.com/writings/death_stats.html |archive-date=2009-02-21 }}</ref> File:Causes of accidental death by age group (percent).png|alt=Leading causes of accidental death in the United States as of 2002[update], as a percentage of deaths in each group.|Figure 5: Leading causes of accidental death in the United States {{as of|2002|lc=y}}, as a percentage of deaths in each group.<ref name=cdc2002/> </gallery> {{anchor|annual_deaths_in_US}}

===Annual number of deaths and causes=== {{table alignment}} {| class="wikitable col2right col3right sortable" |+Avoidable causes and numbers of death per year ! width=280|Cause of death !! Number of deaths !! Percent of total !! class=unsortable|Notes |- | Smoking tobacco || 435,000<ref name="JAMA2000">{{cite journal |vauthors=Mokdad AH, Marks JS, Stroup DF, Gerberding JL |title=Actual causes of death in the United States, 2000 |journal=JAMA |volume=291 |issue=10 |pages=1238–45 |date=March 2004 |pmid=15010446 |doi=10.1001/jama.291.10.1238 |bibcode=2004JAMA..291.1238M |url=http://www.csdp.org/research/1238.pdf |access-date=2008-08-28 |archive-date=2019-06-20 |archive-url=https://web.archive.org/web/20190620213829/http://www.csdp.org/research/1238.pdf |url-status=live }}</ref>|| 18.1% || |- | Obesity | 111,900<ref name="Flegal2005">{{cite journal |author=Flegal, K.M., B.I. Graubard, D.F. Williamson, and M.H. Gail. |title=Obesity |journal=Journal of the American Medical Association |volume=293 |issue=15 |pages=1861–67 |year=2005 |pmid=15840860 |doi=10.1001/jama.293.15.1861|doi-access= }}</ref>|| 4.6% || There was considerable debate about the differences in the numbers of obesity-related diseases.<ref>{{cite journal |last1=Flegal |first1=Katherine M. |title=The obesity wars and the education of a researcher: A personal account. |journal=Progress in Cardiovascular Diseases |date=2021 |volume=67|pages=75–79 |doi=10.1016/j.pcad.2021.06.009 |pmid=34139265 |s2cid=235470848 |doi-access=free }}</ref> The value here reflects the death rate for obesity that has been found to be the most accurate of the debated values.<ref>{{cite web |url=http://www.rti.org/pubs/IssueBrief_1.pdf |title=Controversies in Obesity Mortality: A Tale of Two Studies |publisher=RTI International |access-date=2014-02-21 |archive-date=2016-03-03 |archive-url=https://web.archive.org/web/20160303230927/http://www.rti.org/pubs/IssueBrief_1.pdf |url-status=live }}</ref> Note, however, that being overweight but not obese was associated with fewer deaths (not more deaths) relative to being normal weight.<ref name="Flegal2005" /> |- | Alcohol || 85,000<ref name="JAMA2000" />|| 3.5% || |- | Infectious diseases || 75,000<ref name="JAMA2000" />|| 3.1% || |- | Toxic agents including toxins, particulates and radon || 55,000<ref name="JAMA2000" />|| 2.3% || |- |- | Traffic collisions || 43,000<ref name="JAMA2000" />|| 1.8% || |- | Preventable colorectal cancers || 41,400 || 1.7% || Colorectal cancer (bowel cancer, colon cancer) caused 51,783 deaths in the US in 2011.<ref>{{cite web | author=Centers for Disease Control and Prevention | title=Colorectal Cancer Statistics | url=https://www.cdc.gov/cancer/colorectal/statistics/ | access-date=January 12, 2015 | archive-date=May 27, 2019 | archive-url=https://web.archive.org/web/20190527025433/https://www.cdc.gov/cancer/colorectal/statistics/ | url-status=live }}</ref> About 80 percent<ref>{{cite web | author1=Carol A. Burke | author2=Laura K. Bianchi | title=Colorectal Neoplasia | publisher=Cleveland Clinic | url=http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/colorectal-neoplasia/ | access-date=January 12, 2015 | archive-date=October 4, 2018 | archive-url=https://web.archive.org/web/20181004192452/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/colorectal-neoplasia/ | url-status=live }}</ref> of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Accordingly, the tabulated figure assumes that 80 percent of the fatal cancers could have been prevented. |- | Firearms deaths || 31,940<ref name="CDC2011">{{cite web |url=https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf |title=Deaths: Preliminary Data for 2011 |publisher=CDC |access-date=2014-02-21 |archive-date=2014-02-02 |archive-url=https://web.archive.org/web/20140202154454/http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf |url-status=live }}</ref>|| 1.3% || Suicide: 19,766; homicide: 11,101; accidents: 852; unknown: 822. |- |Sexually transmitted infections || 20,000<ref name="JAMA2000" />|| 0.8% || |- |Substance use disorder || 17,000<ref name="JAMA2000" />{{update inline|date=August 2022}}|| 0.7% || |}

==Among children worldwide== Various injuries are the leading cause of death in children 9–17 years of age. In 2008, the top five worldwide unintentional injuries in children were as follows:<ref name=bbc>{{cite news |url=http://news.bbc.co.uk/2/hi/in_depth/7776127.stm |title=BBC News | Special Reports | UN raises child accidents alarm |work=BBC News |access-date=May 8, 2010 |date=December 10, 2008 |archive-date=July 5, 2018 |archive-url=https://web.archive.org/web/20180705093413/http://news.bbc.co.uk/2/hi/in_depth/7776127.stm |url-status=live }}</ref>{{Needs update|date=June 2025}} {{table alignment}} {| class="wikitable col2right" |+Avoidable numbers of death among children ! Cause ! Deaths per year |- | Traffic collision |260,000 |- | Drowning |175,000 |- | Viruses |96,000 |- | Falls |47,000 |- | Toxins |45,000 |}

==See also== * {{annotated link|Accidental death}} * Health effects of alcohol ** Short-term effects of alcohol consumption ** Long-term effects of alcohol consumption * {{annotated link|Lifestyle medicine}} * List of causes of death by rate * Particulates * {{section link|Health effects of tobacco#Mortality}} * {{annotated link|Preventive healthcare}} * {{annotated link|Public health}}

==References== {{reflist|30em}}

* Preventable causes of death Category:Demography Category:Prevention

Preventable causes of death

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