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Abstract
Modifiable behavioral risk factors are leading causes of mortality in the United States.
Quantifying these will provide insight into the effects of recent trends and the implications
of missed prevention opportunities.
To identify and quantify the leading causes of mortality in the United States.
Comprehensive MEDLINE search of English-language articles that identified epidemiological,
clinical, and laboratory studies linking risk behaviors and mortality. The search
was initially restricted to articles published during or after 1990, but we later
included relevant articles published in 1980 to December 31, 2002. Prevalence and
relative risk were identified during the literature search. We used 2000 mortality
data reported to the Centers for Disease Control and Prevention to identify the causes
and number of deaths. The estimates of cause of death were computed by multiplying
estimates of the cause-attributable fraction of preventable deaths with the total
mortality data.
Actual causes of death.
The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US
deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and
alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial
agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents
involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17
000).
These analyses show that smoking remains the leading cause of mortality. However,
poor diet and physical inactivity may soon overtake tobacco as the leading cause of
death. These findings, along with escalating health care costs and aging population,
argue persuasively that the need to establish a more preventive orientation in the
US health care and public health systems has become more urgent.