Public Enemies

No. 1 Top Killer: Cardiovascular Disease

As a killer, cardiovascular disease (CVD) is in a class by itself: Worldwide, it’s responsible for 30 percent of all deaths—about 17 million a year. In developed countries, it’s the principal cause for half of all deaths.

There’s an irony about this apex killer: Mortality from CVD is down by 50 percent over the past several decades. “Heart disease is definitely an amazing success story,” says Josef Coresh, MD, PhD ’92, MHS ’92, an Epidemiology professor and director of the George W. Comstock Center for Public Health Research and Prevention. Changes in diet and exercise as well as the use of statin drugs have sent rates of fatal heart attacks plummeting.

Stats

Women are more likely to die of heart disease than men. That’s partly because women live longer than men, increasing their chances of dying from this persistent killer.

Trends

CVD mortality rates have declined dramatically in white men and women; less so in black women and least of all in black men, according to Coresh and others. Why? Half a century ago, it was a disease of affluence, says Coresh, when affluence was associated with excessive smoking and eating, and little exercise.

Final Take

“In terms of survival, we in the U.S. have been doing better for the past 40 years when it comes to heart disease. Not so for those who are now behaving like we once did—eating high-fat diets, moving less, smoking more. Heart disease is a growing problem in Eastern Europe, China and the Middle East.”

Most Underestimated: Diabetes

When it comes to top killers, diabetes is the most underestimated. The chronic disease underlies a significant percentage of fatal heart attacks and strokes, says Elizabeth Selvin, PhD ’04, MPH, associate professor, Epidemiology.

Stats

Worldwide, 347 million people have diabetes, and diabetes deaths globally will increase by two-thirds between 2008 and 2030, according to WHO. Overweight and obesity are now linked to more deaths worldwide than is underweight, WHO reports. Some developing nations are dealing with dual epidemics; malnutrition/famine and obesity/diabetes, Selvin says, adding: “Diabetes and obesity start among the well-to-do, then settle in the middle- and low-income classes.”

Trends

Selvin is amazed—and alarmed—by data from the National Health and Nutrition Examination Survey that compares the body mass index of Americans today with that of just three decades ago: “It’s remarkable to see such a complete and dramatic shift of distribution of body fat, indicating a tremendous increase over just these past 25 years of people who are overweight or obese.” Especially sobering: In the 1970s, about 5 percent of American kids were overweight or obese; now, almost 20 percent are.

Final Take

“It’s scary to think that the obesity/diabetes epidemic potentially could, in the near future, impact life expectancy by wiping out some major gains we’ve made in cardiovascular disease.”

Deadly Duo: Pneumonia/Prematurity

Staggering numbers of young children die preventable deaths. Of the 7.6 million worldwide who died in 2010 before reaching their fifth birthday, 1.4 million succumbed to pneumonia. Prematurity, the next leading cause of death in children, takes the heaviest toll on neonates and babies up to about 6 months, says Robert Black, MD, PhD, chair and the Edgar Berman Professor of International Health.

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Pneumonia deaths of children are declining faster (3 percent) than deaths from preterm birth complications (2 percent). Although Black’s most recently published data suggest a decline in the total number of deaths between 2000 and 2010, it’s not sufficient, cautions the researcher, to reach Millennium Development Goal 4, seeking by 2015 to cut child mortality by two-thirds.

Trends

Local community health workers bearing antibiotics now are treating and diagnosing much of the world’s pneumonia and diarrhea cases. India has upward of 600,000 community health workers, and Ethiopia, 20,000, according to Black.  

Final Take

“We don’t yet have good interventions to reduce the rates of premature birth. But we can address some complications resulting from prematurity [with kangaroo-care which promotes immediate breast feeding and skin-to-skin contact with the mother] as well as mortality from pneumonia [with newly implemented vaccines, for instance, and cook-stoves engineered to reduce indoor air pollution].”

Best Dressed: Tobacco

Joanna Cohen, PhD, MHSc, collects cigarette packages. With beveled edges and holograms, some exude sophistication. Others, named “Long Life” or branded with panda bears, convey health and innocence. “They don’t look like death,” observes Cohen, who holds the Bloomberg Professorship in Disease Prevention. Tobacco will claim 1 billion lives in the 21st century if current trends continue, says Cohen, director of the Institute for Global Tobacco Control. Smoking, she says, is a major underlying risk factor for death from heart attacks, strokes and cancers, to name-drop a few of the primary killers appearing on people’s death certificates.

Stats

Worldwide, almost 6 trillion cigarettes are produced—and consumed—annually. Every six seconds, someone dies because of tobacco products.

Trends

More than 40 countries now require graphic pictures on packages that convey tobacco’s dangers. The U.S. is a different story. Tobacco companies have sued over new package picture-warnings, which Cohen considers wholly inadequate to warn U.S. consumers.

Final Take

“Public health is hard enough; convincing people to change behaviors that may result in AIDS, for instance, or malaria, is difficult, despite [the fact] that no one’s cheering for the virus or financing the mosquito. With tobacco, we have multinational companies, the top six of which had combined profits upward of $35 billion in 2010, pushing to sell the products that kill one out of every two of long-term users.“

Most Determined: Suicide/Oldest Old

Worldwide, the highest suicide rates occur among those over the age of 75—one of the fastest growing age groups.

Having examined suicide trends among the old (65 to 79 years) and the oldest old (80-plus years), Annette Erlangsen PhD, adjunct assistant professor, Mental Health, says that certain life events, such as illness or losing a partner, are associated with increased suicide risk. In fact, the oldest-old men who had been hospitalized had the highest suicide rate among the elderly. Her research suggests that hospital staff could help identify those at risk.

Stats

Using national data from Denmark, Erlangsen discovered that about half of the oldest old who commit suicide are not receiving antidepressant medication though it might be indicated.

Trends

The number of suicides among the oldest old is likely to increase as more people live longer. New prevention efforts need to address the fact that suicide among the oldest old is rarely impulsive. In fact, more than half of older adults who die by suicide have mentioned their plans to others.

Final Take

“It’s very peculiar that people who are approaching the natural ends of their lifespans are very carefully and determinedly planning to take their own lives. We need to address the issues that make life no longer worth living."