Re-run of 1990s Study Confirms Burden of Preventable Mortality

Re-run of 1990s Study Confirms Burden of Preventable Mortality

by David W. Sharp

WHAT'S HOT IN MEDICINE
Rank	Paper	Citations This Period (Mar-Apr 05)	Rank Last Period (Jan-Feb 05)
1	T.J. Lynch, et al., "Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib," New Engl. J. Med., 350(21): 2129-39, 20 May 2004. [Harvard Med. Sch., Boston, MA; Harvard Sch. Public Health, Boston, MA] *821XM	93	2
2	J.G. Paez, et al., *"EGFR* mutations in lung cancer: Correlation with clinical response to gefitinib therapy,"** Science, 304(5676): 1497-1500, 4 June 2004. [7 U.S. and Japanese institutions] *825YR	82	6
3	T.G. Ksiazek, et al., "A novel coronavirus associated with severe acute respiratory syndrome," New Engl. J. Med., 348(20): 1953-66, 15 May 2003. [7 institutions worldwide] *677TJ [see also]	54	1
4	C. Drosten, et al., "Identification of a novel coronavirus in patients with severe acute respiratory syndrome," New Engl. J. Med., 348(20): 1967-76, 15 May 2003. [5 European institutions] *677TJ [see also]	53	3
5	J.W. Moses, "Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery," New Engl. J. Med., 349(14): 1315-23, 2 October 2003. [10 U.S. institutions] *727EM	52	†
6	G.L. Anderson, et al., (Women’s Health Initiative Steering Comm.), "Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women’s Health Initiative randomized controlled trial," JAMA-J. Amer. Med. Assoc., 291(14): 1701-12, 14 April 2004. [Program office: NHLBI, Bethesda, MD] *811RJ	46	†
7	M. Fukuoka, et al., "Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small-cell lung cancer," J. Clin. Oncol., 21(12): 2237-46, 15 June 2003. [16 institutions worldwide] *690TG	44	†
8	P.A. Rota, et al., "Characterization of a novel coronavirus associated with severe acute respiratory syndrome," Science, 300[5624]: 1394-9, 30 May 2003. [CDC, Atlanta, GA: U. Calif., San Francisco; Erasmus U., Rotterdam, Netherlands; Bernhard Nocht Inst. Tropical Med., Berlin, Germany] *683ZW	43	1
9	M.A. Marra, et al., "The genome sequence of the SARS-associated coronavirus," Science, 300(5624): 1399-1404, 30 May 2003. [British Columbia Cancer Agcy., Vancouver; Natl. Microbio. Lab., Winnipeg, Canada; U. British Columbia, Vancouver; U. Victoria, Canada] *683ZW	43	7
10	M.G. Kris, et al., "Efficacy of gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase, in symptomatic patients with non-small cell lung cancer. A randomized trial, " JAMA-J. Am. Med. Assoc., 290(16): 2149-58, 22/29 October 2003. [Correspond. author: Memorial Sloan-Kettering Cancer Ctr., New York, NY] *734CB	43	†
SOURCE: ISI’s Hot Papers Database. the Legend.

he International Classification of Diseases (ICD), now in its 10^th revision, has been around in various forms for 150 years and has proved a useful tool for epidemiologists and statisticians—for example, in making between-country comparisons of mortality due to specific illnesses. However, the ICD codings do not always reveal the underlying cause. In 1993 Dr. J. Michael McGinnis and Dr. William H. Foege explored beneath the ICD by measuring the "major external (nongenetic) factors that contribute to death in the United States" and they called them the "actual" causes of death. Their paper (JAMA, 270[18]: 2207-12, 1993) proved influential. Indeed, in 1999 the report prompted the Robert Wood Johnson Foundation to change its focus from health-care services to the behavioral and social causes of poor health—in other words, to prevention.

Lung cancer (appearing, via the new drug gefitinib, four times in the latest Top Ten) is a significant cause of mortality in the developed world. Severe acute respiratory syndrome (SARS), also with four appearances, is not. Citation league tables in medicine cannot be expected to mirror global disease burdens but hovering at #14 is a paper covering illnesses of all sorts that is likely to prove every bit as influential in public-health terms as its predecessor. Dr. Ali H. Mokdad and colleagues from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, have repeated the McGinnis and Foege study 10 years on. Their paper (JAMA, 291[10]: 1238-45, 2004; latest citation count 38, total cites 103) used publications on risk behaviors and mortality appearing up to the end of 2002 and applied those findings to U.S. mortality data for the year 2000. McGinnis and Foege used 1977-93 evidence and 1990 mortality data. The results of the two studies are similar, perhaps depressingly so.

Mokdad et al. note that the increase in total mortality of about 250,000 over the decade can be attributed to population increases and increasing age. In both studies "actual" causes of death explain roughly half of all deaths. Tobacco-related mortality was up by 35,000 but Mokdad’s group was able to include infant deaths from maternal smoking and also deaths from passive smoking, and the proportion of actual cause that is attributable to tobacco did fall slightly. The CDC group is disappointed at the slow progress here and notes that budget shortfalls mean that "tobacco taxes and settlement dollars" are having to be diverted to correct deficits rather than funding tobacco control projects. More significant, though again not surprising, is the figure of 400,000 for deaths actually caused by poor diet and physical inactivity. The McGinnis and Foege figure here was 300,000. For 400,000, Mokdad et al. argue, we may have to read over 500,000 once the prevalence of overweight has its full impact.

There are successes to report. Fatal motor-vehicle accidents declined over the 10 years, and we can be confident that this was not due to fewer cars on the road or miles driven. Also, non-U.S. readers will be interested in the fall in fatal firearm-related incidents, most notably homicides.

The main point is that about half of all deaths in the United States are associated with "largely preventable behaviors and exposures," and this picture is little changed from what McGinnis and Foege found 10 years ago. And this is just mortality; there will be a huge morbidity burden as well.

Mr. David W. Sharp, M.A. (Cambridge), is a
contributing editor to The Lancet, London, U.K.


	View the top 10 scientists and/or top 3 Hot Papers in Clinical Medicine; for the period of January 1, 1995-April 30, 2005.

Science Watch^®, September/October 2005, Vol. 16, No. 5
Citing URL: http://www.sciencewatch.com/sept-oct2005/sw_sept-oct2005_page5.htm