Life-extension requires not only an awareness of mechanisms of aging, but an awareness of the most common conventional causes of death -- and appropriate countermeasures.
Because the United States is representative of most developed (industrialized) countries, and since so much data is available for the United States, I will begin by detailing information available from that country. Truly international statistics on causes of death — especially rates of death — is not easy to come by. However, the World Health Organization does have some data (which may not be too accurate) from all its member countries from the mid-1990s as well as some more accurate data for 38 countries which are well developed enough to have reasonably good statistics available. A list of those 38 countries can be found in the Appendix.
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The most common conventional causes of death in industrialized countries are cardiovascular disease, cancer, Alzheimer's Disease and accident (in that order). Alzheimer's victims usually die of pneumonia, a lung condition or a cerebrovascular condition — so Alzheimer's victims are often declared to die of other causes.
% ALL DEATHS
|(1) Diseases of the heart||heart attack (mainly)||28.5%|
|(2) Malignant neoplasms||cancer||22.8%|
|(3) Cerebrovascular disease||stroke||6.7%|
|(4) Chronic lower respiratory disease||emphysema, chronic bronchitis||5.1%|
|(5) Unintentional injuries||accidents||4.4%|
|(6) Diabetes mellitus||diabetes||3.0%|
|(7) Influenza and pneumonia||flu & pneumonia||2.7%|
|(8) Alzheimer's Disease||Alzheimer's senility||2.4%|
|(9) Nephritis and Nephrosis||kidney disease||1.7%|
|(10) Septicemia||systemic infection||1.4%|
|(11) Intentional self-harm||suicide||1.3%|
|(12) Chronic Liver/Cirrhosis||liver disease||1.1%|
|(13) Essential Hypertension||high blood pressure||0.8%|
|(15) All other causes||other||17.4%|
(NOTE: Not included in the above rankings is deaths due to iatrogenic causes — ie, mistakes caused by the actions of health professionals — which by some estimates is the third leading cause of death in the United States [JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION; Starfield,B; 284(4):483-485 (2000)]. )
(NOTE: Death rates due to cardiovascular disease have been dropping more rapidly than death rates due to cancer. Since 2005 cancer has become the leading cause of death for people under the age of 85, although the total number of deaths from cardiovascular disease for all ages is still slightly greater than for cancer. )
(NOTE: Of cardiac disease deaths occurring in 1999, about 63% of those deaths were sudden deaths. Nearly three-quarters of the sudden cardiac deaths occurred outside of a hospital. Among those who died of sudden cardiac death, women were nearly 25% more likely than men to die outside of a hospital — indicative that women more often delay seeking help for cardiac symptoms than do men [CDC MORBIDITY AND MORTALITY WEEKLY REPORT; 51(6):123-126 (2005)].)
(NOTE: Causes of death statistics typically do not include data for aborted embryos & fetuses. The number of aborted embryos/fetus' per year typically are in excess of the number of heart disease deaths — currently in excess of one million abortions per year in the United States. For more information see CDC abortion statistics and Alan Guttmacher Institute statistics. Aborted entitites would not have birth certificates or death certificates. )
PERCENT OF TOP 5
|(5) Heart Disease||3.9%||961|
Seventy percent of all cancer deaths are the result of seven cancers:
PERCENT OF TOTAL
[For infectious diseases in the United States, see: Disaster Center — Center for Disease Control (CDC).]
Trends in the causes of death are indicated by the percent change in listed causes of death in the 1979 to 1998 period. Again, the figures for Alzheimer's Disease may be misleading, because consciousness of Alzheimer's Disease has increased so much in that period that physicians may be increasingly likely to list it as a cause of death.
CHANGE FROM 1979
|Alzheimer's Disease||< 1 %||+1,200 %|
|Septicemia||< 1 %||+91 %|
|Chronic Obstructive Lung||5 %||+46 %|
|Diabetes mellitus||3 %||+39 %|
|Hypertension||< 1 %||+26 %|
|Pneumonia/influenza||4 %||+18 %|
|Nephritis||< 1 %||+2 %|
|Cancer||23 %||-6 %|
|Suicide||< 1 %||-11 %|
|All Causes||100 %||-18 %|
|Homicide||< 1 %||-28 %|
|Accidents||4 %||-30 %|
|Heart Disease||31 %||-37 %|
|Stroke||7 %||-40 %|
|Liver Disease||< 1 %||-40 %|
|Atherosclerosis||< 1 %||-67 %|
In the last 150 years there has been a shift in the major cause of
death from infectious & preventable/treatable conditions to the
degenerative diseases of old age. Thus the most dramatic increase in
life expectancy has occurred for the youngest ages.
In the hundred years from 1850 to 1950
there was a dramatic reduction in
infant mortality compared to the increased
life expectancy for other ages. But from
1950 to 2004 life expectancy for a 40-year
old white person increased by seven years
(blacks slightly less) — whereas life
expectancy for newborns increased less
than ten years during the same period.
(See Life Expectancy by Age, 1850-2004.)
As a result, people are increasingly surviving to an elderly 70-90 years of age and then dying of heart disease, cancer or degenerative disease.
AGE OF DEATH
ANNUAL RATE PER 100,000
Peculiarly, from age 95 to 105 the annual death rate does not change
for each given year.
A graphical breakdown of the causes of death by percent,
by age and by sex are effectively presented in the following graph.
(A more detailed representation data corresponding to the above graph can be found in matrix format. See also, 10 Leading Causes of Death by Age Group, United States — 2006.)
In general, youth is more vulnerable to violent death, middle age is more vulnerable to disease conditions affecting high risk individuals (cancer, high blood pressure, diabetes, etc.) and old age is more vulnerable to diseases related to general debility (infection, dementia, chronic disease and accidental falls) [JOURNALS OF GERONTOLOGY 58A(6):B495-B507 (2003)]. Vulnerability to death by influenza & pneumonia increases rapidly with age in the United States. A person aged 50−64 is nearly ten times more likely to die from an influenza-associated death as a person in the 5−49 age group. And a person over 65 is over ten times more likely to die from and influenza-associated death as a person in the 50−64 age group. A person over 85 is about 16 times more likely to die an influenza-associated death as a person in the 65−69 age group [JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION; Thompson,WW; 289(2):179-186 (2003)]. Those over age 85 are ten times more likely to have a first stroke than those between ages 55 and 64. The difference in life expectancy between men and women in the United States dropped from 7.8 years in 1979 to 5.3 years in 2005, with women expected to live to age 80.1 in 2005.
The following table of causes of death among the elderly (over 65 years of age) is based on death certificates. (Autopsies are conducted at a decreasing rate as age of death increases.) Death certificate data becomes increasingly unreliable as age of death increases because cause of death is often due to combinations of causes, some of which are omitted. Osteoporosis often leads to fractures that lead to death, but osteoporosis rarely is listed as a cause of death.
|Nervous system disease||2%||3%|
Demented persons are often institutionalized & bedridden in their final days. As such, they are vulnerable to infection (pneumonia). Dementia is often vascular. Immune function is very important for the elderly because infection causes an increasing percentage of deaths for those over 80 years of age [JOURNALS OF GERONTOLOGY 52A(1):B67-B77 (1997) and AMERICAN JOURNAL OF MEDICINE; 114:365-369 (2003)]. Death from infection is more common in hospitals. Cancer as a cause of death peaks at nearly 45% at age 60, declines to less than 15% between 85−89 and drops to about 5% for centenarians [JOURNALS OF GERONTOLOGY 58A(6):B495-B507 (2003)].
Behavior greatly influences the likelihood of dying of every one of these causes. Prevention begins with awareness, so the following statistics may be of benefit in adjusting caution to dangers. A 1993 study by the Carter Center estimated that two-thirds of deaths are due to six risk factors subject to influence by the will: tobacco, alcohol, injury risks, high blood pressure, obesity/cholesterol and poor primary care (prenatal/reproductive). (Only 26% of smokers live to age 80 — in contrast with 57% of nonsmokers [ADDICTION 97:15-28 (2002)] )
It is estimated that at least 55% of the sex differential in total mortality can be attributed to behavioral differences in the use of tobacco, alcohol, guns and cars. Males probably also face a higher rate of occupational deaths due to accidents, homicides and toxicities. Nonetheless, homicide is the leading occupational cause of death for women.
Tobacco use and diet/exercise are the behavioral influences that most strongly contribute to (or delay) death — because cardiovascular disease & cancer are the leading causes of death. Alcohol is responsible for about one-third of the fatal car crashes, one-third of all suicides, and half of all homicides in the United States [NATURE; 468:475 (2010)].
Particulate air pollution is held responsible for 3% of cardiopulmonary disease cases and 5% of cancer of trachea, bronchus & lungs [JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH,Part A; Cohen,AJ; 68(13-14):1301-1307 (2005)]. Every microgram per cubic meter of particulate air pollution is estimated to increase death rate between 0.6% and 1.6%. At 18 micrograms per cubic meter, Los Angeles has the highest particulate pollution of any major city in the United States. Athens & Mexico City have nearly twice the particulate air pollution as Los Angeles, Mumbai (Bombay) has up to three times as much and Beijing has more than four times as much [NATURE; Marris,E; 444:248 (2006)].
For more details concerning cardiovascular disease, risk factors and prevention — see my essays Sudden Cardiovascular Death and Prevention of Cardiovascular Disease. For details about the nature of cancer (and methods of prevention) — see my essay Cancer.
An 11-year study of German vegetarians showed significantly reduced
mortality, with the greatest reduction among moderate vegetarians —
presumably because those who adopted the practice for purely ethical
reasons were less likely to concern themselves with nutritional planning
[INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 22(2):228-236 (1993)].
More recent epidemiological evidence indicates that adherence to a vegetarian diet for more
than two decades can increase lifespan 3.6 years [AMERICAN JOURNAL
OF CLINICAL NUTRITION 78(Suppl):526S-532S (2003)].
Accidents are the third leading cause of death for males in the United States, but only the seventh leading cause of death for women. The following tables summarize statistics concerning types of accidental death.
|(1) Motor vehicle (MVA)||37.5%|
|(5) Fires, Burns,Smoke||2.6%|
|(6) Medical/Surgical Complication||2.2%|
|(7) Forces of nature||1.8%|
|(8) Firearms discharge||0.7%|
The five leading causes of fatal accidental death have remained the same between 1970 and 1998, and these top 5 account for 80% of all accidental deaths. Approximately forty percent of deaths from acts of nature are due to floods. Approximately forty percent of fire victims die in their sleep.
For 2003 in the United States males over 65 had a 1% chance of dying from a fatal fall every year, and females over 65 had a 0.7% yearly chance [CDC Morbidity and Morbidity Weekly Report; 55(45), November 17, 2006].
Over 70% of American children in the 5 to 14 age group ride bicycles, and these children account for about a quarter of all bicycle fatalities. Fewer than a quarter of child bicyclists wear helmets, despite the estimate that helmets could prevent about three quarters of child bicycle fatalities.
Motor vehicle fatalities are the leading cause of death for people between ages 1-29, and the rate is particularly high between the ages of 15-24. A 16-year-old has 3 times the crash risk of an 18-year-old and 7 times the crash risk of a 25-year-old. Preparing for driving emergencies can reduce fatalities.
In the United Kingdom accident rates are 31% higher in winter months than in summer months. The Virginia Department of Emergency Management estimates that 70% of winter weather deaths are caused by icy road conditions. Bridges can chill faster than roadways, such that bridge ice catches drivers by surprise. Transport Research Area Europe reports that 10% of daily winter traffic occurs between midnight and 7 a.m., but that 23% of winter accidents occur during those hours.
Chains on all four wheels provide nearly twice the traction and braking effectiveness as chains on only two wheels. In North American, and laws vary considerably between States and Provinces concerning the conditions of the legality of the use of snow chains. For example, information concerning snow chain laws in various jurisdictions found on the Wisconsin Motor Carriers Association website contradicts information found on the Tire Chains Required (TCR) website. Local authorities should be contacted for definitive information. For wintertime, four winter tires are recommended even on front-wheel or rear-wheel drive vehicles. Preparation for driving on ice and snow can reduce fatalities.
As reported by the Insurance Institute for Highway Safety, in 2005 the States with the highest number of motor vehicle crash deaths per 100,000 people were Wyoming (33.4), Mississippi (31.9), Montana (26.8) and South Carolina (25.7), whereas the States with the lowest were Massachusetts (6.9), New York (7.4), Connecticut (7.8) and Rhode Island (8.1). The fatalities were most likely to occur in single-vehicle crashes for Montana (72%) and the District of Columbia (71%), whereas fatalities were more likely to occur in multiple-vehicle crashes in Delaware (65%) and Michigan (60%). The percentage of pedestrians killed in motor vehicle accidents was highest in the District of Columbia (33%), Hawaii (25%), New York (22%) and New Jersey (21%), whereas it was lowest in Nebraska, Idaho and New Hampshire at 3%. According to CarandDriver.com there are 2.28 fatalities per 100 million vehicle-miles driven in Mississippi as opposed to only 0.87 in Massachusetts. In Wyoming 24% of the traffic is heavy trucks, whereas Hawaii is at the other extreme with only 3% of traffic being heavy trucks. (Crashes involving left-hand turns are much more likely to result in injury — it is often safer to make three right turns than one left turn.)
Driving under the influence of alcohol is the most important cause of death in automobile accidents — followed by driver fatigue. The percentage of traffic fatalities attributed to alcohol dropped from 57.2% in 1982 to 45% in 1992. The figure is probably much higher, because amounts of alcohol below the legal level of intoxication (all amounts of alcohol) reduce cognitive & physical function. More than a third of pedestrians killed by a motor vehicle fatalities in 1992 were intoxicated.
A Gallop poll indicated that nearly a third of respondents remember falling asleep while driving an automobile. People often have "microsleeps" without being aware of them. Automobile accidents due to such incidents are typically unexplained or attributed to other causes. Alcohol and sleepiness interact in a way that is far more dangerous than might be expected. Experiments with twelve healthy men in the 20−26 age range showed that either restriction of sleep to 5 hours or a blood alcohol level roughly equal to the United Kingdom limit for automobile driving nearly tripled the number of lane drifting incidents in the 30−60 minute driving period on a driving simulator. Combining both those levels of alcohol with sleep deprivation again nearly tripled the number of lane drifting incidents above that seen for either the alcohol or sleepiness alone. But the reported sleepiness of those who had the alcohol/sleep-deprivation combination was no greater than what was reported by those who had only been sleep deprived [OCCUPATIONAL AND ENVIRONMENTAL MEDICINE; Horne,JA; 60(9):689-692 (2003)].
(For more on the subject of sleep and sleepiness, see my essay The Nature of Sleep and its Impact on Health.)
For non-motor vehicle accidents in the United States between 1975-1995 33%, ethanol intoxication accounted for 32% of fatal falls, 42% of fatal fires/burns, 34% of fatal drownings and 29% of fatal poisonings. 32% of homicide victims and 23% of suicide victims were intoxicated [ANNALS OF EMERGENCY MEDICINE 33(6):659-701 (1999)]. (The most common cause of poisoning is carbon monoxide.)
Drivers of Sport-Utility Vehicles (SUVs) are especially vulnerable to fatal rollovers. Rollover accidents account for only 3% of all U.S. motor-vehicle accidents, but they cause nearly a third of all vehicle-occupant fatalities. An SUV occupant is 3 times as likely to die as a result of a rollover than an occupant of a passenger car.
The chances of dying in an automobile accident in 1953 was four times greater than in 2003, based on fatalities per mile driven in the United States. Better roads & medical care along with tougher drunk-driving laws have been attribued to some of this difference. But there was considerable improvement in vehicle safety features over the 50-year period. Significant safety improvements included power brakes, front disc brakes, four-wheel antilock brake systems, radial-ply tires, penetration-resistant windshields, padded dashboards, collapsible stearing columns, auto-body structures that crumple around passenger compartments, lap-and-shoulder safety belts, dual air bags and sun visors. The Insurance Institute for Highway Safety evaluates vehicles for crash-test strength against frontal, side, and rear-end crashes. Digital cameras, tire-pressure monitors, emergency-brake assist, night-vision assist and computer-controlled navigation devices should further improve driving safety, among other newer technologies.
Road fatalities in the US fell from 52,627 in 1970 to 42,116 yearly while in the same period road fatalities in Germany fell from 21,000 to 6,949 per year. A large part of the difference is attributed to Electronic Stability Control (ECS) which is found in half of German cars, but only 6% of those in the USA.
On a per-mile basis the risk of dying on a 1,000 mile airline flight are about equivalent to the risks of dying while driving 1,000 miles, because most flying deaths occur on take-off and landing. (Longer flights are safer.) Commuter planes crash more than twice as often as planes of large airlines — and the crash rate is Alaska is considerably higher due to so many inexperienced bush-pilots. Less pilot experience is also the reason given for the greater danger from commuter flights.
The death rate per driven mile is more than 35 times higher for motorcycles than it is for cars. The per-mile death rate is also higher for bicyclists. Two-thirds of bicycle fatalities occur due to traffic violations and 90% involve collisions with motor vehicles.
MOTOR VEHICLE ACCIDENT (MVA)
|(1) Between vehicles||43%|
|(2) With fixed object||27%|
|(5) Collision pedacycle||2%|
|(6) Collision train||1%|
|50% of MVA deaths were at night|
|50% of MVA deaths involve intoxicants in driver|
|62% of MVA deaths were rural|
|65% OF MVA pedestrian deaths were urban|
|25% of urban MVA deaths were pedestrian|
|(1) Driving at unsafe speed||16.5%|
|(2) Failure to yield right-of-way||7.8%|
|(3) Crossed the centre line||7.5%|
|(4) Passed stop sign||2.6%|
|(5) Improper overtaking||2.5%|
|(6) Disregarded a signal||2.2%|
|(7) Followed too closely||0.6%|
|(8) Other violations||15.3%|
Data available from the United Kingdom provides more detail on motor vehicle deaths. Of those who died within 30 days of a MVA about half died instantly, two-thirds died within 25 minutes and 75% died within 12 hours of the accident [INJURY 2(2):99-102 (1970)]. Causes of death in MVAs was reported as follows:
CAUSE OF DEATH
|(2) Cerebral injury||30.5%|
|(3) Combined injury||15.2%|
|(4) Spinal injury||5.5%|
|(5) Crush asphyxia||4.9%|
|(6) Chest injury||2.1%|
The odds of being killed during a scheduled airline flight are about one per million — nearly four times greater than the odds of being killed in an automobile ride. But most car trips are for far fewer miles. Per passenger mile an automobile ride is 10 times more likely to result in fatality than an airplane journey. (Airplane fatalities occur most frequently during takeoff & landing — especially takeoff.) Buses are safer — per passenger mile an automobile is 25 times more likely to lead to death than a bus. Conversely, motorcycles are 35 times per passenger mile more likely to cause death than automobiles. Boat travel is hard to compare per passenger mile, but the risk of death during a boat trip is far more dangerous than one in a car. Most boating deaths are due to drowning — with 80% of those dying not wearing life jackets.
Odds summarized in the journal NATURE give the following lifetime odds of dying of the following causes: 1:90 for motor vehicle accident, 1:9,000 for drowning, 1:30,000 for airplane crash (not just scheduled airlines), 1:130,000 for earthquake, 1:600,000 for fireworks accident, 1:720,000 for asteroid impact, 1:300,000,000 for food poisoning by botulism and 1:8,000,000 for shark attack [NATURE; Harris,A; Volume 453; page 1178; 26 June 2008]. Needless to say, type and frequency of airplane flights taken, living and swimming in Florida rather than Kansas, proximity to fireworks and restaurant selection can play a significant role in modifying these odds.
44% of non-motor vehicle accidents occurred in the home:
|(4) Obstructed airway||8.7%|
|(8) All other||13.8%|
Falls as a percent of fatal home accidents has been increasing. More than 86% of the victims are 65 years old or older. An estimated 30% of persons 65 years or older in the United States have been affected by a serious fall. For that age group annual fatality rates from falls increased about 45% for men and about 60% for women between 1993 and 2003, attributed largely to the increase in life expectancy from 75.5 to 77.6 years in the same period. Regular exercise and greater awareness of drug interactions & side effects could prevent many of these falls [CDC MORBIDITY AND MORTALITY WEEKLY REPORT; 55(45):1221-1224 (2006)].
Although the elderly constitute 12% of the American population, they account for 75% of deaths from falls. Falls cause 70% of accidental deaths of persons over age 75 [AMERICAN FAMILY PHYSICIAN; Fuller,BF; 61(7):2159-2168 (2000)].
CAUSE OF FATALITY
|(3) Machinery, falling objects||15%|
|(4) Environmental contamination||10%|
The largest number of workers injured is in the restaurant industry, but the highest incidence of injury occurs in nursing & heavy manufacturing. (Hospitals are dangerous for patients as well as for nurses. The number of people who die annually from infections acquired in a hospital is equal to that of those who die of all forms of accident — cars, planes, boats, falls, etc.) For males, motor vehicle crashes & homicide are the leading causes of work-related deaths. For females, homicide is leading cause of occupational death — accounting for more than a third of all female work-related fatalities. The annual fatality rate among civilian workers in the United States dropped from 8.9 per 100,000 to 5.6 between 1980 and 1989. The occupations with the greatest annual chance of being a murder victim are taxi-driver (nearly 1 in 30,000), followed by convenience store worker (1 in 45,000) and gas station attendant (1 in 60,000).
Lightning as a cause of death seems to excite a disproportionate amount of interest, associated with the mistaken idea that it is a random, uncontrollable natural event. Lightning is comparable to floods as a storm-related cause of death in the US. In a given year the chance of being struck by lightning is about one in 700,000 and the chance of being killed by lightning is less than one in 6 million in the United States. But the chance is far less where thunderstorms are infrequent, such as in San Francisco and far greater where thunderstorms are frequent, such as in central Florida. The chances are far greater for avid golfers who refuse to leave the golf course when a thunderstorm is approaching. A safe location should be sought immediately whenever the sound of thunder follows lightning by less than 30 seconds. Avoid high places, open areas, bodies of water, metal fences and isolated trees or poles. In a house, avoid contact with plumbing or electrical fixtures. A vehicle can be a safe shelter if the windows are rolled-up and there is no contact with metal surfaces.
In Canada (presumably representative of other developed countries), males are more than twice as likely as females to commit suicide. The probability of committing suicide does not change significantly with age, even though the probability of dying from suicide declines significantly. Suicide death declines as a relative cause of death beyond the age of 40 only because deaths from other causes rise exponentially. Although the homicide rate is greater than the suicide rate in the 15-24 age group, for an aggregate of all age groups there are nearly twice as many deaths by suicide as deaths by homicide.
Suicide rates have been reported to be highest on Mondays and lowest on Saturdays. Despite reports in popular magazines to the contrary, suicides are not more frequent on Christmas day or any other major holidays [ARCHIVES OF GENERAL PSYCHIATRY 30(1):89-91 (1974) and AMERICAN JOURNAL OF PSYCHIATRY 142(6):782 (1985)].
A review of epidemiological literature found that all-cause mortality among those whose spouses had died increased 50%. The suicide rate in the first year following death was 2.5 times greater than normal. The risk for males was greater than the risk for females. [PSYCHOSOMATIC MEDICINE 39(5):344-357 (1977)]. A more recent study based on a very large sample in Finland found an excess mortality of 30% for men in the first 6 months after spouse death and 20% thereafter. For women the excess mortality was 20% in the first 6 months and under 10% thereafter. [JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 50:264-268(1996)].
Several studies have shown a decline in death rate before birthdays and a rise immediately thereafter. Death rates have been shown to decline in the United States before Presidential elections. Both Thomas Jefferson & John Adams died on the 4th of July, exactly 50 years after the proclamation of the Declaration of Independence, which they co-authored.
Scientific studies have consistently shown a decrease in death rate in the days preceding and including Christmas and other major holidays, with a compensating increase shortly thereafter. Further confirmation comes from the same result being found for Jewish people at Passover [THE LANCET 2(8613):728-732 (1988)] and Chinese people at Harvest Moon [JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 263(14):1947-1951 (1990)].
In both the Northern and Southern hemisphere, mortality in developed countries is lowest in late summer/early fall [CANADIAN MEDICAL ASSOCIATION JOURNAL; Falagas,ME; 181(8):484-486 (2009)]. Respiratory disease, coronary heart disease, and strokes all cause more deaths in winter. Blood pressure & obesity is higher in winter, and angina can be precipitated by both cold and unaccustomed exertion (such as shoveling snow). Less Vitamin D due to reduced sun exposure in winter can increase risk to many diseases, including influenza [QUARTERLY JOURNAL OF MEDICINE; Pell,JP; 92(12):689-696(1999)]. Seasonality of death has been declining since the 1930s, probably mainly due to improved air-conditioning in buildings and vehicles.
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The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system can be highly predictive that Intensive Care Unit (ICU) patients will die in the hospital. A medical patient with an APACHE II score greater than 35 has a 90% chance of dying in hospital. APACHE II is much less predictive for surgical patients (99% of surgical patients do not die during the hospital visit associated with the surgery) [AMERICAN JOURNAL OF CRITICAL CARE; Chang,L; 15(1):47-53 (2006)]. The APACHE II score is based on 11 physiological variables which include heart rate, serum sodium, haematocrit, white blood cell count, arterial pH and temperature [ANAESTHESIA; Goldhill,DR; 51(8):719-723 (1996) and CURRENT PROBLEMS IN SURGERY; Hunt,JP; 34(7):527-599 (1997)].
In a study of patients designated "terminally ill" (less than six weeks to live) by physicians, nearly 83% died within one week and over 92% died within two weeks. About 10% showed apparent recovery, but half of those died within the six weeks. In about 43% of the cases the basis of diagnosis was "little or no fluid intake", for about 32% it was "generalized weakness", for about 25% it was "little or no nutritional intake" and for about 21% it was "respiratory problems" [ARCHIVES OF INTERNAL MEDICINE; Brandt,HE; 165(3):314-320 (2005)].
The most common symptoms seen in dying patients are breathing difficulties (especially), cachexia, weakness, fever, pain, restlessness, confusion, vomiting and urinary incontinence or retention [JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION; Paolini,CA; 101(10):609-615 (2001) and SINGAPORE MEDICAL JOURNAL; Seah,STA; 46(5):210-214 (2005) and Symptoms of Active Dying and How To Recognize Someone is Actively Dying].
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Map and Table of World Death Rates
Rankings of 13 developed countries (Japan, Sweden, Canada, France, Australia, Spain, Finland, Nethelands, United Kingdom, Denmark, Belgium, United States and Germany — the order ranked in terms of general health care) have placed the United States at the bottom for infant mortality and near the bottom for life expectancy up to age 40. Elderly people in the United States, however, rank very high in life expectancy [JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION; Starfield,B; 284(4):483-485 (2000)].
The 2002 WORLD REPORT ON VIOLENCE AND HEALTH published by the World Health Organization (WHO, Geneva) lists the following top ten causes of death for all its member states. Because data-gathering is poor in many countries of the world the precision implied by the decimal places is misleading. It should also be noted that the total deaths due to the top conditions mentioned only amount to 54%. This can be contrasted to the top ten causes listed for the United States, which constitute well over 90% of all causes.
PERCENT OF TOTAL
|(1) Ischemic Heart Disease||12.4%|
|(2) Cerebrovascular Disease||9.2%|
|(3) Lower Respiratory Infections||6.9%|
|(5) Chronic Obstructive Pulmonary Disease||4.5%|
|(6) Perinatal conditions||4.4%|
|(7) Diarrhoeal Diseases||3.8%|
|(9) Road Traffic Injuries||2.3%|
|(10) Trachea, Bronchus, Lung Cancers||2.2%|
According to an April 2011 World Health Organization report [NATURE; 472:395 (2011)] nearly 3/5 of African deaths are due to communicable diseases, about 3/10 are due to non-communicable diseases (mainly heart disease, diabetes, and cancer), and about 1/10 are due to injuries. Europe also has about 1/10 of deaths due to injuries, but also only 1/10 of deaths due to communicable diseases, leaving about 4/5 of deaths due to non-communicable diseases, many of which are due to tobacco, poor diet, physical inactivity, or harmful use of alcohol. Other regions of the world are between these two extremes in terms of relative proportions of communicable and non-commuicable diseases as causes of death.
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The following statistics are for the 38 countries listed in the Appendix. Most of these countries are fairly well-developed, however there is still a wide variation in development as well as a wide variation in the reliability of the statistics given for each individual country (depending on quality of reporting). Statistics are for the mid-1990s.
|(1) Heart Disease|
|(2) Malignant Neoplasms|
|(3) Cerebrovascular Disease|
|(4) Accidents & Adverse Effects|
|(7) Mental Disorders|
|(8) Senility Without Psychosis|
|(9) Diabetes Mellitus|
|(10) Embolism & Thrombosis|
|(1) Motor Vehicles|
|(3) Drowning (Nontransport)|
|(4) Fires & Flames|
|(5) Poisoning, Solids & Liquids|
|(6) Medical Misadventures|
|(8) Natural & Environmental|
|(9) Water Transport|
|(10) Machinery, Cutting & Piercing|
Falls include both falling to another level — as in falling from stairs, ladders & windows — or same level falls such as slipping, tripping & stumbling. Deaths from falls were highest in Hungary, the Czech Republic, Norway, Slovenia & Finland — and lowest in Albania, Mauritius, Bahamas, Argentina & Chile. (Countries listed in order of death rate.)
Fire death rates were highest in the Russian Federation, Mauritius, Romania, Hungary & Chile — and lowest in the Netherlands, Venezuela, Israel and Spain. Drowning (swimming or in a bathtub) rates were highest in the Russian Federation, Romania, Bahamas, Trinidad/Tobago & Mauritius — and lowest in the United Kingdom, Netherlands, Portugal & Germany. The drowning rate in the Russian Federation was nearly twice that of Romania, the country with the second highest rate.
Deaths from poisoning were substantially higher in the Russian Federation (41.4 per 100,000) than in Finland (11.8), Romania (7.3) & Poland (6.3). Poisonings in Israel, Mauritius, Germany and the Netherlands were 0.3 per 100,000 or less. Of 27 countries for which more details were available 52% of deaths were due to drugs, 28% due to other solids/liquids and 20% due to gases/vapors. Drugs accounted for 82% of the deaths in the United States, but only 5% in the Czech Republic. Gases/vapors caused 72% of the deaths in the Czech Republic (the highest country rate for that category).
Of 18 countries for which occupational deaths were listed, mining & quarrying was by far the most dangerous industry, followed by construction and fishing.
DEATHS PER 100,000
|(1) Russian Federation||130.8|
|(4) Czech Republic||56.7|
DEATHS PER 100,000
|(2) United Kingdom||20.5|
|(6) Trinidad & Tobago||26.3|
DEATHS PER 100,000
|(4) Russian Federation||22.3|
DEATHS PER 100,000
|(3) United Kingdom||6.2|
|(7) Trinidad & Tobago||10.3|
The reported death rates per 100,000 due to motor vehicle accidents can be especially misleading, even if the reporting is assumed to be uniform because the percentage of people driving varies widely between the countries listed. Fifteen countries reported deaths per 100 million vehicle-miles driven in 1996. For most of these countries the numbers indicate death within 30 days after the accident, but for the United States it is one year (making it a safer place to drive than the statistic might indicate) whereas in Japan it is 24 hours (making it less safe than indicated).
DEATHS PER 100 MILLION VEHICLE-MILES
|(2) United Kingdom||1.4|
|(4) United States||1.7|
|(11) Hong Kong||4.0|
|(15) South Korea||35.8|
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According to a 1996 report on 44 countries [BRITISH MEDICAL BULLETIN; Peto,R; 51(1):12-21 (1996)] smoking was responsible for 23% of male deaths and 9% of female deaths in developed countries in 1990. For former socialist economies, smoking was responsible for 26% of male deaths and 4% of female deaths. On average, smokers lived 8 fewer years than nonsmokers, and smokers who died deaths attributed to tobacco lived 16 fewer years.
Focusing on middle-aged deaths (35-70 years of age), the highest 1990 death rates due to smoking for males in developed countries were in Belgium (41%), the Netherlands (38%) and Italy (37%) — and the lowest were in Japan (16%), Sweden (16%), Norway (21%), and Portugal (21%). For females the highest 1990 middle-aged death rates were in the USA (28%) and Denmark (27%) — and the lowest were in Portugal & Spain (none reported). The greatest divergence of male and female smoking-related deaths were in Spain (33% male, 0% female), Portugal (21% male, 0% female), France (32% male, 2% female), and Italy (37% male, 5% female). The smallest divergence was in the United States (36% male, 28% female) and Denmark (32% male, 27% female).
For middle-aged deaths in former socialist economies, the highest 1990 death rates for males were in Kazakhstan (43%). Russia (42%), and Poland (42%) — and the lowest were in Tajikistan (14%) and Uzbekistan (20%). For females the highest death rates were in Hungary (14%), Kazakhstan (12%) and Poland (10%) — and the lowest rates were in Tajikstan, Turkmenistan and Azerbaijan which reported no female deaths due to smoking. The greatest sexual divergence was in countries with the fewest female deaths and the lowest divergence was in the countries with the most female deaths.
For all 44 countries there was a general increase in smoking-related death rates for middle-aged males between 1955 to 1965, but a decrease thereafter. Portugal is exceptional in having a continuous increase in smoking-related deaths among middle-aged males, but the smoking-related death rates is among the lowest for all countries. For females there has been a general increase in smoking-related deaths in all countries since 1955.
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Data for 38 countries comes from a compilation of data by National Safety Council from the World Health Organization (WHO) and published in The 2002 INTERNATIONAL ACCIDENT FACTS (Second Edition). (The Third Edition is now available.) The 38 countries are:
|(13) Czech Republic|
|(26) New Zealand|
|(31) Russian Federation|
|(35) Trinidad & Tobago|
|(36) United Kingdom|
|(37) United States|
(Note: For some of the statistics only 37 countries are listed. The omitted country in many of these cases is the Russian Federation.)
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List of countries by death rate
Nationmaster.com Map & Graph of Lifespans