Progress in Chronic Disease Prevention Chronic Disease Reports: Deaths from Nine Chronic Diseases -- United States, 1986

In 1986 in the United States, 1,103,156 persons died with an underlying diagnosis of one of nine chronic diseases (stroke, coronary heart disease, diabetes, chronic obstructive pulmonary disease, lung cancer, female breast cancer, cervical cancer, colorectal cancer, or cirrhosis (1-9)). These deaths accounted for 52% of all deaths and for an overall age-adjusted mortality rate of 457.6 per 100,000 U.S. population (Table 1). In general, higher age-adjusted rates for chronic disease mortality occurred in states east of the Mississippi River (Figure 1, Table 1). The lowest age-adjusted mortality rate occurred in Hawaii (326.8 per 100,000 population), and the highest in Michigan (517.6 per 100,000 population). Reported by: Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office; Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: At least three alternative measures can be used as a baseline for estimating the excess burden of chronic diseases:

1. The state with the lowest age-adjusted rate.

2. A hypothetical state rate constructed by using the lowest age-adjusted state rate for each disease (1-9); in 1986, the sum of these nine rates (i.e., the combined achieved state minimum mortality rate) was 298.4 per 100,000 population.

3. The proportion of deaths theoretically remaining following elimination of known risk factors, estimated as the population-attributable risk (10). Because exposure to multiple risks is common, however, deaths attributed to different exposures cannot be added. Smoking considered alone is associated with 33% of deaths from the nine chronic diseases. The hypothetical minimum mortality rate achievable by the elimination of smoking is approximately 307.5 per 100,000 population.

Each of the three baselines provides a reference point for estimating the excess burden of chronic disease in the United States; by any of these measures, this burden is substantial. Although none of the baselines represents a rate that can be fully achieved by elimination of known risk factors, they all indicate that the potential for prevention is considerable.

One index of the public health response to the chronic disease burden is the public health expenditure to prevent and control chronic diseases reported by states (11). Reported expenditures include screening programs, but not public education, health promotion, or medical care (11). Overall, 45 states and the District of Columbia reported less than 2% of state public health expenditures allocated to these efforts. The mean annual per capita expenditure for prevention of chronic disease in the United States is an estimated 66 cent; state expenditures range from less than 1 cent to $7.64 per capita per year.

Known preventable risk factors include cigarette smoking, hypertension, overweight, high cholesterol, sedentary lifestyle, heavy consumption of alcohol, and nonuse of available screening techniques, such as mammography and Papanicolaou smears (1-9). In addition, failure to obtain effective medical treatment, as well as other social and environmental factors, also contribute to chronic disease mortality. For example, 31% of black/white differences in mortality may be attributable to known risk factors and an additional 38% to differences in socioeconomic characteristics such as access to health care (12).

Reduction of exposure to known risks and increased use of proven screening methods remain important measures for the control of chronic disease, particularly in underserved populations. Surveillance of risk factors, incidence, prevalence, and mortality has been used to design and monitor a cervical cancer prevention program in Kentucky (13), county and state chronic disease programs in Ohio (14), and smoking-related chronic disease prevention programs in many states (15).

References

1. CDC. Chronic disease reports: deaths from stroke--United

States, 1986. MMWR 1989;38:191-3.

2. CDC. Chronic disease reports: coronary heart disease mortality--United States, 1986. MMWR 1989;38:285-8.

3. CDC. Chronic disease reports: deaths from lung cancer--United States, 1986. MMWR 1989; 38:501-5.

4. CDC. Chronic disease reports: deaths from diabetes--United States, 1986. MMWR 1989;38:543-6.

5. CDC. Chronic disease reports: chronic obstructive pulmonary disease mortality--United States, 1986. MMWR 1989;38:549-62.

6. CDC. Chronic disease reports: deaths from breast cancer--United States, 1986. MMWR 1989;38:565-9.

7. CDC. Chronic disease reports: deaths from cervical cancer--United States, 1984-1986. MMWR 1989;38:650-4,659.

8. CDC. Chronic disease reports: deaths from colorectal cancer--United States, 1986. MMWR 1989;38:725-8.

9. CDC. Chronic disease reports: deaths from cirrhosis--United States, 1986. MMWR 1989;38:792,797-9. 10. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont, California: Lifetime Learning, 1982. 11. Public Health Foundation. Public health agencies 1989: an inventory of programs and block grant expenditures. Washington, DC: Public Health Foundation, 1989. 12. Otten MW, Teutsch SM, Williamson DF, Marks JS. The effect of known risk factors on the excess mortality of black adults in the United States. JAMA (in press). 13. CDC. Screening for cervical and breast cancer--Southeastern Kentucky. MMWR 1987;36:845-9. 14. Ohio Department of Health. Chronic disease mortality data. Columbus, Ohio: Ohio Department of Health, Division of Chronic Diseases and Division of Epidemiology, 1988. 15. CDC. State-based chronic disease control: the Rocky Mountain Tobacco-Free Challenge. MMWR 1989;38:749-52.

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