Dr. Clif CleavelandWide variations exist across our nation in mortality rates for those conditions most likely to kill us. Where we live can influence the likelihood of our dying from heart disease, cancer or other disorders.
An extensive analysis in the Dec. 13, 2016 issue of the Journal of the American Medical Association (JAMA 2016; 316:2385-2401) utilized death records from 1980 to 2014 to determine causes of mortality on a county-by-county basis. During that interval, 80.4 million deaths occurred in the U.S. In addition to cataloging and evaluating deaths, the study estimated Years of Life Lost (YLL) to each disease. The YLL for an individual is calculated by subtracting his age at the time of his death from his life expectancy. In the JAMA analysis, colored maps highlight the striking disparities in causes of death across the country.
Cardiovascular diseases were the leading cause of death and the second-leading cause of YLLs from 1980 to 2014. The deaths attributable to these disorders declined by 50 percent during this time period. The highest mortality rates in 2014 were seen in counties within a band stretching from Oklahoma to Mississippi and in eastern Kentucky. Counties in central Colorado and parts of Idaho, Montana and Wyoming had the lowest rates.
Cancers were the second-leading cause of death in the study and the leading cause of YLLs. The death rate due to malignancies decreased during the timeframe of the study, although more than 18 percent of counties actually showed an increased incidence. In 2014, the highest death rates were found in counties in eastern Kentucky and adjacent western West Virginia as well as counties bordering the lower Mississippi River and western Alaska.
Neurological disorders, which include stroke, were the third-leading cause of death and the fourth-leading cause of YLLs. The pattern of occurrence is similar to that of cardiovascular disease, although differences among counties were less striking. From 1980 to 2014, the death rate of neurological diseases increased by almost 19 percent.
A broad category that includes diabetes, other endocrine or glandular diseases and kidney disorders was the fourth-leading cause of death and the third-leading cause of YLLs. Counties in the Southeast showed the highest death rates along with counties in the Dakotas that contain Native American reservations. Counties in Colorado and parts of Alaska and Maryland showed the lowest rates.
Violence, whether directed against oneself or others, was the eight-leading cause of death and the fifth-leading cause of YLLs.
The national death rate fell by 22 percent during the interval of the study. The highest death rates were seen in Alaska, New Mexico, Arizona, Nevada and on Native American reservations in the Dakotas. The upper Midwestern states and New England had the lowest mortality rates.
Chronic lung diseases ranked fifth in mortality and sixth in YLLs in 2014, with striking increases seen in adjacent counties of Kentucky and West Virginia, southeastern Colorado and the central coast of Alaska.
A disturbing upward trend in mortality was seen in mental and substance abuse disorders, where the death rate increased by 188 percent for the study’s time period. In 2014, these disorders accounted ranked 12th in mortality rate and eighth in YLLs.
A review of the maps that plot specific disease groups reveals a hotspot for multiple diseases in the coal country of eastern Kentucky and southwestern West Virginia. Deaths related to cardiovascular disease, cancer, diabetes, chronic respiratory disease, mental and substance abuse disorders and common infectious diseases figure prominently in mortality in this region.
Southeastern states, excluding most of Florida, show higher rates of deaths for cardiovascular, malignant and diabetic, renal and neurologic disorders.
This important review raises questions and challenges for all of us. What are the specific causes for the high prevalence of so many diseases in Kentucky and West Virginia? Are lifestyle issues, such as frequency of smoking, the cause? Are specific toxins or other environmental issues related to mining responsible? Are failures in the health care system in the region to blame?
Consider the high incidence of cancers in counties abutting the lower Mississippi River. Are water-borne carcinogens to blame? Are the causes correctable?
Are environmental monitoring and public health services in states with high incidences of specific diseases adequately funded and deployed to determine causes and corrections?
The sharp rise in deaths due to mental disorders and substance abuse poses the greatest challenge to health professionals, legislators, educators and law enforcement officials. This is clearly the category of disease that is gaining momentum, killing increasing numbers and disabling countless others.
We ignore the findings of this study at our peril.
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.