What’s Killing Americans?

BY Matthias Rumpf and Gaetan Lafortune  August 28, 2013 at 11:14 AM EST

Editor’s Note: This article is part of a series in which the PBS NewsHour and the Organisation for Economic Co-operation and Development, or OECD, explore how health care and health policy in OECD’s 34 member countries compare with the United States. Below, Gaetan Lafortune, a senior OECD health economist, examines the top causes of death for Americans. Infographic by Matthias Rumpf and photo by Cristina Pedrazzini via Getty Images.


Nearly 2.5 million people died in the United States in 2010.

As in other OECD countries, the two main causes were cancer and cardiovascular diseases, including ischemic heart disease and stroke. Together, they accounted for more than 55 percent of all deaths in the U.S. that year.

Deaths from respiratory diseases — including pneumonia, asthma and chronic obstructive pulmonary disease — and from accidents and external causes, including homicides, also accounted for a large number of deaths, representing 10 percent and 8 percent of all deaths.

Taking into account the size and structure of the population, the mortality rates in the U.S. were close to the OECD average. But they were also more than 20 percent higher than in Japan, Australia and Switzerland.

There have been large reductions in mortality rates among women and men in the U.S. over the past few decades, but these reductions have been more modest than in many other OECD countries. Hence, the gap with leading countries has been widening.

For example, the life expectancy for U.S. men in 2010 was 4.2 years shorter than in Switzerland, up from less than three years in 1970; for U.S. women, it was 4.8 years shorter than in Japan — a country where there was no gap in 1970.

Higher GDP per capita and health spending per capita are generally associated with lower mortality rates and higher life expectancy, although this relationship diminishes in countries with the highest GDP and health spending per capita. Given its level of GDP and health spending, the United States has relatively high mortality rates and low life expectancy, although many other factors affect mortality beyond the overall economic development of a country and its health spending.

Mortality rates in the U.S. are much greater among socioeconomically disadvantaged groups and certain racial groups. For example, black women are more likely to give birth to low birth-weight infants. They also have an infant mortality rate more than double that for white women (11.6 vs. 5.2 in 2010).

For a broader perspective on the top conditions that kill Americans — and how those death rates compare with other OECD countries, check out the data visualization below. To expand, select “full screen.”

Click “next story” for a guided walk-through of the infographic, or hover your mouse over individual circles to see the death rates for particular conditions.

In their 2013 report “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” the U.S. National Research Council and Institute of Medicine suggested a number of possible explanations to the slower progress in the United States in reducing mortality rates and increasing life expectancy compared with other OECD countries, including:

  • The highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care and a large share of the population uninsured
  • Health-related behaviors, including higher calorie consumption per capita and obesity rates, higher consumption of prescription and illegal drugs, higher deaths from road traffic accidents and higher homicide rates
  • And adverse socioeconomic conditions affecting a large segment of the U.S. population, with higher rates of poverty and income inequality than in most other OECD countries.

Combined, those factors result in a unique climate for the following conditions.

Cardiovascular diseases

Cardiovascular diseases are the main cause of mortality in the United States, as in most other OECD countries, accounting for nearly one-third (32 percent) of all deaths in the U.S. in 2010. This covers a range of diseases related to the circulatory system, including ischemic heart disease (including AMI or heart attack) and cerebrovascular diseases such as stroke.

Ischemic heart disease (IHD) alone was responsible for 15 percent of all deaths in the U.S. in 2010 (a greater share than the 12 percent average across OECD countries). Mortality rates from IHD are higher in the U.S. than in most other OECD countries.

Cerebrovascular disease (including mainly stroke) was the underlying cause for 5 percent of all deaths in the United States in 2010 (a lower share than the 8 percent average across OECD countries). By contrast with IHD, mortality rates from cerebrovascular disease are lower in the United States than in most other OECD countries.

Cancer

Cancer accounted for nearly one-fourth of all deaths in the United States in 2010 (24 percent). However, the mortality rate from cancer is lower in the U.S. than in most other OECD countries, and it has come down at a more rapid pace over the past 20 years than the average across OECD countries.

Cancer mortality rates are persistently higher for men than for women in the U.S., as in other OECD countries. This gender gap can be explained partly by the greater prevalence of risk factors among men, notably smoking rates.

Lung cancer imposes the highest mortality burden, accounting for 27 percent of all cancer-related deaths in the U.S. in 2010 (28 percent among men and 25 percent among women).

Accidents and External Causes

Transport accidents

In 2010, transport accidents in the U.S. accounted for 38,000 deaths, with more than two-thirds of these fatalities occurring among men. The United States had the third highest death rates from road accidents among OECD countries, after Mexico and Korea.

The largest number of road transport accidents in the U.S., as in other OECD countries, occurs among the younger age groups, with the risk of dying due to a road accident peaking at ages 15-24.

Homicides

More than 16,000 people were killed in the U.S. in 2010, with more than three-quarters of these deaths among men. Death rates from homicides are much higher in the U.S. than in all other OECD countries with the exception of Mexico. In fact, the U.S. rate is a full two-and-a-half times greater than the OECD average, and nearly four times greater if Mexico is excluded.


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