Discussion: Causes of Death in the US

[Laidback Al]

FluTrackers was initially established to track the emergence of H5N1 Avian Influenza infections in humans. Later, FluTrackers encompassed more novel infectious diseases and eventually expanded its scope to include all public health issues. Recently, the emphasis at FluTrackers has been on Ebola, MERS, etc. with the Zika virus outbreak in the Western Hemisphere dominating the latest posting activities.

The first and, so far, only Zika-associated death in the US and its territories was a man in San Juan, Puerto Rico who died in February 2016 from complications associated with the Zika virus. (link) Two deaths from Ebola were reported in the US in 2014. No MERS death have been reported from the US, although two imported were reported in the US in 2014.

Deaths from uncommon and rare diseases only occur infrequently in the US. Notifiable diseases and conditions are reported to the CDC through a large public health network in the US. In a 2015 report, the CDC tabulated the annual deaths between 2005 and 2011 from data accumulated by National Notifiable Diseases Surveillance System (NNDSS). The table below from the 2015 report identifies the number of deaths per year between 2005 and 2011 for about 50 notifiable diseases and conditions. As noted in the table, HIV deaths are the most common death. The table also reveals that between 11,300 and 16,500 deaths have occurred each year between 2005 and 2011 from these notifiable diseases. HIV related deaths represent about 70% of all of these deaths. The number of deaths each year has been declining every year since 2005 primarily because of the reduction in HIV deaths annually.




In contrast, the number one cause of death in the US has been heart disease. In 2015, Medical News Today (2) reports that the top 10 causes of death in the US were

1. Heart disease
2. Cancer
3. Chronic lower respiratory disease
4. Accidents
5. Stroke
6. Alzheimer?s disease
7. Diabetes
8. Influenza and pneumonia
9. Kidney disease
10. Suicide

Deaths from uncommon and rare notifiable diseases and conditions do not make the top 10 list.

An article published last week in the BMJ (3) by authors from the Johns Hopkins University School of Medicine suggests that the third most frequent cause of death in the United States is medical errors. According to these authors,

We calculated a mean rate of death from medical error of 251,454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013. We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths. . . .Comparing our estimate to CDC rankings suggests that medical error is the third most common cause of death in the US.

According to a graphic in their article, the top 7 causes of death in the United States are listed below.
1. Heart disease
2. Cancer
3. Medical error
4. COPD
5. Suicide
6. Firearms
7. Motor vehicles

[For a rejoinder to this article see (4)]

According to these authors medical errors are projected to be responsible for more than 250,000 deaths per year. Contrast that number of deaths with the 11,000 to 16,000 deaths each year from notifiable diseases and conditions.

The take-home message from this discussion is that if you live in the US you should be more worried about dying from routine medical care than from an Ebola or Zika virus infection.

(1) Summary of Notifiable Infectious Diseases and Conditions ? United States, 2013
(2) The top 10 leading causes of death in the US
(3) Medical error ? the third leading cause of death in the US
(4) Don?t believe what you read on new report of medical error deaths

[Gert van der Hoek]

Thanks All, this is a trend we see worldwide, according to WHO:

Of the 56 million global deaths in 2012, 38 million, or 68%, were due to noncommunicable diseases

The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease - COPD - and asthma) and diabetes.

80% of premature heart disease, stroke and diabetes can be prevented.

IMHO those who suffer most from chronic diseases, are most at risk in case of an infectious disease, like developing pneumonia when infected by flu or MERS.

[Gert van der Hoek]

This study is an illustration of what I meant to say:

Receptor for advanced glycation end products is detrimental during influenza A virus pneumonia

Abstract

Pneumonia caused by influenza A virus (IAV) can have devastating effects, resulting in respiratory failure and death. The idea that a new influenza pandemic might occur in the near future has triggered renewed interests in IAV infection. The receptor for advanced glycation end products (RAGE) is expressed on different cell types and plays a key role in diverse inflammatory processes. We here investigated the role of RAGE in the host response to IAV pneumonia using wild-type (wt) and RAGE deficient (−/−) mice.

Whereas strong RAGE was constitutively expressed in the lungs of uninfected wt mice, in particular on endothelium, IAV pneumonia was associated with enhanced expression on endothelium and de novo expression on bronchial epithelium. Additionally, the high-affinity RAGE ligand high mobility group box 1 was upregulated during IAV pneumonia. RAGE−/− mice were relatively protected from IAV induced mortality and showed an improved viral clearance and enhanced cellular T cell response and activation of neutrophils.

These data suggest that RAGE is detrimental during IAV pneumonia.

This is a bit technical perhaps, I am no expert, but the way I understand this is: our normal, western food and lifestyle promotes the increase of advanced glycation end products (AGE's), the more AGE's you have, the more prone you are to chronic illnesses such as diabetes and hartdisease (2 sides of 1 coin IMHO).

The article is focussing on the cell receptors for AGE's, called RAGES's. The more AGE's are produced, the more receptors (RAGE's) your cells are producing, and the more damage will be done to your body. Your body can handle AGE's, but our normal modern food and the way it is prepared produces way to much.

So if you have a lot of AGE's you also will have a lot of RAGE's, and that is not good if you catch a flu. In fact RAGE's are not at the root of the problem, it is food and lifestyle which produce more (or less) AGE's in your body.

Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet

[sharon sanders]

A few days ago we started a new forum on the front page:

Chronic Illnesses

We have begun to gather information in this forum. Later today I will be moving more threads from other parts of the forum to this new forum.


The medical error death figure is shocking.

I have a hospital routine in my family which I have posted about before. When someone is admitted to the hospital (THIS IS NOT MEDICAL ADVICE):

1) Go with a buddy.

2) The buddy writes down everything that is going on. For example, "10:45 am - Nurse Smith came in and hooked a new saline IV bag onto the stand".I think when health care workers see a person who is keeping track of the situation, they are more likely to re-check their information regarding the patient before they administer any drug and/or treatment.

3) The buddy takes a bottle of rubbing alcohol and wipes down everything that the patient is touching. For example: bathroom door knobs, toilet handle, phone, tv remote, bed handrails, etc,

4) The buddy reminds everyone to wash their hands and/or put on a fresh set of gloves upon entering the room including health care workers and all guests.


We try to find the doctor and hospital that health care workers use. Who do they want to operate on them, and where? In my opinion nurses always know who is the best doctor.

[Gert van der Hoek]

Interesting comment regarding deaths from medical errors :

The greatest paradox of medicine is that the more lives it saves the more responsible it becomes for not saving lives. The sicker and frailer the patient, the more invasive lines and tubes they have, the more likely they are to benefit from the intensity of treatment, and the more at-risk they are to medical error. You?re at greatest risk from medical error when you have most to lose from no medical care. At death?s door medicine is both your friend and foe. Antibiotics can save you from death from sepsis or kill you from toxic megacolon from pseudomembranous colitis. The antibiotic is both Florence Nightingale and Chengiz Khan. It is our failure that we have not articulated this paradox to the public at large.

[Gert van der Hoek]

Another example of research linking food and lifestyle/environment to infectious disease, malaria in this case.

2016 Mar 24

Do advanced glycation end-products play a role in malaria susceptibility?

There are growing data supporting the differences in susceptibility to malaria described between sympatric populations with different lifestyles. Evidence has also been growing for some time that nutritional status and the host?s metabolism are part of the complex mechanisms underlying these differences.

The role of dietary advanced glycation end-products (AGEs) in the modulation of immune responses (innate and adaptive responses) and chronic oxidative stress has been established. But less is known about AGE implication in naturally acquired immunity and susceptibility to malaria. Since inflammatory immune responses and oxidative events have been demonstrated as the hallmark of malaria infection, it seems crucial to investigate the role of AGE in susceptibility or resistance to malaria.

This review provides new insight into the relationship between nutrition, metabolic disorders, and infections, and how this may influence the mechanisms of susceptibility or resistance to malaria in endemic areas.

LINK TO FULL ARTICLE