• Three quarters of deaths from heart disease and stroke aren’t preventable

    Austin sent me a news story, “One in four deaths from heart disease and stroke in the US is preventable“:

    More than 200 000 of the 800 000 deaths from heart disease and stroke in the United States each year are preventable, the US Centers for Disease Control and Prevention (CDC) has said in a report.

    The CDC’s director, Tom Frieden, said in a telephone press briefing, “These findings are really striking because we’re talking about hundreds of thousands of deaths that don’t have to happen when they happen.”

    The report looked at deaths from heart disease and stroke in Americans under age 75 that could have been prevented by lifestyle changes, medical care, or public health measures.

    Here’s the study itself:

    Background: Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

    Methods: National Vital Statistics System mortality data for the period 2001–2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

    “Preventable” deaths aren’t as easy to define as you might hope. But previous work has defined any death under the age of 75 due to heart disease, stroke, or high blood pressure to be preventable. By that definition, about one quarter of all such deaths, of 200,000 of them, are preventable. The highest rates of preventable deaths were among males, non-Hispanic blacks, and Southerners.

    News stories such as this one focus on the preventable deaths, and on public health and lifestyle measures that can make them less common. But I think it’s also important to focus on the fact that three quarters of such deaths aren’t preventable. We’re all going to die of something, eventually. For many, it’s heart disease or stroke. But every time I hear someone describe a death from one of these things, it’s followed by questions as to what that person did wrong (ie eating, drinking, or smoking). Most deaths from these causes aren’t someone’s fault, and they’re not avoidable.

    I have long maintained that preventive care is important, but not the silver bullet for fixing everything that’s wrong with our health care system. That’s still the case. We should work on preventing the deaths we can by changing what we do every day, but there are still other improvements to make, too.


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    • Maybe the headline should have read… “one in four deaths from heart disease and stroke in the US could be delayed”

      Prevention has benefits but sooner or later we all will die. The goal of public policy should be to educate people about ways to extend longevity economically and balance the conflicting goals of resources spent extending life versus resources used for other things. By that I mean, as a society do we prefer to spend $250,000 extending life by 6 months using costly cancer drugs? Or would most people trade 6 months of life (while ill at age 90) for a better standard of living while raising a family or for retirement? Everyone will have a different answer to this question, which would likely change over time. However it seems many public health advocates often don’t feel comfortable making this trade-off.

    • Studies like this one will, I hope, help re-focus attention to the source of the crisis in health care: chronic illness. The explosion in the number of cases of chronic illness is, of course, a direct result of advancements in medicine: illnesses that were at one time death sentences are now treatable, chronic illnesses, including cancer, heart disease, diabetes, old age (I include old age as a chronic illness because there’s no cure for it). And its breaking both the health care system and the individuals (and families) with the chronic illnesses. For those who believe ACA’s limit on out of pocket expenses fixed the latter problem, guess again: the limit does not apply to non-covered services, so unless the insured has a plan with exceptionally broad and generous benefits, the insured will continue to suffer financial ruin. For the poor, that’s not the greatest concern because, being poor, they have little or nothing to lose, but for the middle class, it means depletion of savings and other assets, further eroding the middle class. What’s the solution? I don’t know. One possible solution making the rounds is that ACA won’t preclude someone with, for example, a bronze plan from upgrading to a platinum plan if the insured is diagnosed with a chronic illness. I can’t believe that’s the case, for it will surely decimate the insurers. Anyway, I hope the study referred to by Dr. Carroll will help re-focus attention away from prevention to managing chronic illness in a way that doesn’t break the system and the patients.

    • Managing chronic disease in a way that doesn’t break the system requires some body to put the brakes on cost. It won’t be the providers — they get paid for providing more service and sued for providing not enough.

      It won’t be the patients, they, for the most part, don’t have the knowledge and get much of their information from their doctor.

      That leaves the insurance companies or the Gov’t.

      Getting medical costs under control is doable, but it requires facing facts, looking at how other countries did it, and not pretending that the market for open heart surgery is just like the market for some commodity, like cars.

    • Aaron,

      how would you redefine/operationally define “preventable deaths” or would you use a new term altogether?