Abstract
Objective
To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.Data sources
Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained.Study selection
Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.Data extraction
Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.Data synthesis
The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.Conclusions
Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.Citations & impact
Impact metrics
Article citations
Screening for social determinants of health among populations at risk for MASLD: a scoping review.
Front Public Health, 12:1332870, 10 Apr 2024
Cited by: 0 articles | PMID: 38660357 | PMCID: PMC11041393
Review Free full text in Europe PMC
Chronic disease prevention and screening outcomes for patients with and without financial difficulty: a secondary analysis of the BETTER WISE cluster randomised controlled trial.
BMJ Open, 14(4):e078938, 15 Apr 2024
Cited by: 0 articles | PMID: 38626970 | PMCID: PMC11029378
Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health.
J Athl Train, 59(4):403-409, 01 Apr 2024
Cited by: 3 articles | PMID: 36827608
Influence of Alcohol on Intracerebral Hemorrhage: From Oxidative Stress to Glial Cell Activation.
Life (Basel), 14(3):311, 27 Feb 2024
Cited by: 0 articles | PMID: 38541637 | PMCID: PMC10971394
Review Free full text in Europe PMC
Foundations of Lifestyle Medicine and its Evolution.
Mayo Clin Proc Innov Qual Outcomes, 8(1):97-111, 20 Jan 2024
Cited by: 1 article | PMID: 38304165 | PMCID: PMC10831813
Go to all (1,235) article citations
Other citations
Similar Articles
To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Actual causes of death in the United States, 2000.
JAMA, 291(10):1238-1245, 01 Mar 2004
Cited by: 2758 articles | PMID: 15010446
Review
CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors--United States, 2005-2013.
MMWR Suppl, 63(4):3-27, 01 Oct 2014
Cited by: 204 articles | PMID: 25356673
The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada.
CMAJ, 162(12):1669-1675, 01 Jun 2000
Cited by: 49 articles | PMID: 10870494 | PMCID: PMC1232500
Actual causes of death in Alaska.
Int J Circumpolar Health, 79(1):1780068, 01 Dec 2020
Cited by: 0 articles | PMID: 32567981 | PMCID: PMC7480475
The impact of unemployment on health: a review of the evidence.
CMAJ, 153(5):529-540, 01 Sep 1995
Cited by: 167 articles | PMID: 7641151 | PMCID: PMC1487417
Review Free full text in Europe PMC