Macarena C. García, DrPH1; Brigham Bastian2; Lauren M. Rossen, PhD2; Robert Anderson, PhD2; Arialdi Miniño, MPH2; Paula W. Yoon, ScD1; Mark Faul, PhD3; Greta Massetti, PhD4; Cheryll C. Thomas, MSPH4; Yuling Hong, MD4; Michael F. Iademarco, MD1 (View author affiliations)
Deaths from heart disease, cancer, chronic lower respiratory disease, cerebrovascular diseases (stroke), and unintentional injuries account for the five leading causes of death in the United States. Death rates for these diseases vary widely across states, related to variation in the distribution of social determinants of health, access and use of health services, and public health efforts.
What is added by this report?
There has been a significant decrease in the number of potentially preventable deaths among three of the five leading causes of death (diseases of the heart, cancer, and stroke) during 2010–2014. However, the number of potentially preventable deaths from unintentional injuries increased significantly during the same period. This is mostly attributed to an increase in drug poisoning (overdose from prescription and illicit drugs) and falls. No significant change was observed in potentially preventable deaths from chronic lower respiratory disease (e.g., asthma, bronchitis, and emphysema).
What are the implications for public health practice?
Public health officials can use the decreases observed as benchmarks for improving population health, while using observed increases to direct targeted efforts to reduce the number of potentially preventable deaths. A joint effort of public health and health care organizations can support analysis and action to reduce the number of potentially preventable deaths from the five leading causes of death. Specifically, given the reported increase in potentially preventable deaths from unintentional injuries, these findings might inform the selection and implementation of evidence-based interventions to prevent deaths from injuries such as falls and drug overdoses, based on epidemiologic burden.
Death rates by specific causes vary across the 50 states and the District of Columbia.* Information on differences in rates for the leading causes of death among states might help state health officials determine prevention goals, priorities, and strategies. CDC analyzed National Vital Statistics System data to provide national and state-specific estimates of potentially preventable deaths among the five leading causes of death in 2014 and compared these estimates with estimates previously published for 2010. Compared with 2010, the estimated number of potentially preventable deaths changed (supplemental material at https://stacks.cdc.gov/view/cdc/42472); cancer deaths decreased 25% (from 84,443 to 63,209), stroke deaths decreased 11% (from 16,973 to 15,175), heart disease deaths decreased 4% (from 91,757 to 87,950), chronic lower respiratory disease (CLRD) (e.g., asthma, bronchitis, and emphysema) deaths increased 1% (from 28,831 to 29,232), and deaths from unintentional injuries increased 23% (from 36,836 to 45,331). A better understanding of progress made in reducing potentially preventable deaths in the United States might inform state and regional efforts targeting the prevention of premature deaths from the five leading causes in the United States.
To determine significant changes in the number of potentially preventable deaths for the five leading causes of death in the United States, CDC analyzed National Vital Statistics System mortality data from 2014 (1) using the same analytic model presented in the original report that used 2010 data as benchmarks (2). The number of potentially preventable deaths per year per state in persons aged <80 years was determined by comparing the number of expected deaths (based on the cause-specific average death rate of the three states with the lowest 2008–2010 average rate by age groups) with the number of observed deaths in 2010 and 2014. Further detail on age-adjusted rates by state and cause can be found in yearly publications on final death data (1).
Population estimates for 2010 and 2014 were produced by the U.S. Census Bureau. The calculations of potentially preventable deaths were restricted to U.S. residents and deaths in persons aged <80 years. Premature death was defined as a death that occurred in a person aged <80 years, based on the average life expectancy for the total U.S. population, which was nearly 79 years in 2010 (2). Analysis was restricted to deaths with an underlying cause of death among the five leading causes, based on International Classification of Diseases, 10th Revision (ICD-10) codes.† The five leading causes of death represented 63% of all deaths in 2014, a decrease of 2.3% compared with 2010. In 2014 the next five most frequent causes accounted for approximately 12% of deaths (3).
The number of potentially preventable deaths for each of the five leading causes of death by state in 2014 was calculated in four steps. The first step was to calculate and rank state disease-specific death rates by age group. Using 2008–2010 data, the three states with the lowest observed death rates for each age group and specific cause of death category were selected and their death rates averaged across the three states to calculate a lowest average age-specific death rate for each cause of death. For example, during 2008–10, among persons aged 40–49 years, the three states with the lowest rate of death from unintentional injuries were Maryland, New Jersey, and New York, and the benchmark average was 25.2 (supplemental material at https://stacks.cdc.gov/view/cdc/42342).
The average of the lowest three states was chosen to minimize the effect of any extreme outlier and to represent the low end of the distribution of death rates among the states. The second step was to calculate expected deaths for each age group and state by multiplying the age-specific state populations for 2010 by the 2010 benchmark death rates (i.e., the lowest three-state average age-specific death rates for each cause). Total expected deaths for each cause and state were calculated by summing expected deaths over all age groups aged <80 years, effectively taking into account differences in mortality across age groups. These state-specific and cause-specific expected death counts represent the number of deaths expected if all states were to achieve the 2010 death rate benchmarks (2). Third, the 2010 potentially preventable deaths were calculated by subtracting expected deaths from 2010 observed deaths. Finally, the same 2010 benchmark death rates for each cause were used to calculate 2014 potentially preventable deaths by repeating the third and fourth steps with 2014 population and mortality data. Specifically, the number of expected deaths in 2014 was calculated by multiplying the 2010 benchmark death rates by the 2014 age-specific populations; these expected counts were then subtracted from 2014 observed deaths. The numbers of potentially preventable deaths for each cause were assumed to follow a Poisson distribution, and standard errors were calculated, taking into account stochastic variation, consistent with methods described previously (2), in both the expected and observed number of deaths,§ for each cause and year. Statistically significant changes from 2010–2014 were assessed using a two-sided z-test (p<0.01). Results are presented for the United States as a whole, by state, and by the 10 U.S. Department of Health and Human Services regions.¶
The five leading causes of death for persons aged <80 years in 2014 (diseases of the heart, malignancies [cancer], cerebrovascular diseases [stroke], chronic lower respiratory diseases [CLRD], and unintentional injuries [accidents]) represent 63% of deaths from all causes. The estimated number of potentially preventable deaths and the proportion preventable among the five leading causes of death in persons aged <80 years were 87,950 for diseases of the heart (30% preventable); 63,209 for cancer (15% preventable); 45,331 for unintentional injuries (43% preventable); 29,232 for CLRD (36% preventable); and 15,175 for stroke (28% preventable) (Figure).
Potentially preventable deaths from cancer declined 25% from 2010 to 2014 (the increase in the expected number of deaths was greater than the increase in the observed number). This decline appears to be driven by a 12% decrease in the age-adjusted death rate from lung cancer from 2010 and 2014. Decreases in age-adjusted death rates from cancer were observed across all U.S. states, except the District of Columbia (supplemental material at https://stacks.cdc.gov/view/cdc/42343). The expected number of deaths was based on benchmark death rates from 2010; however, cancer-related death rates declined during 2010–2014. In both 2010 and 2014 the Southeast (Region 4) had the highest number of potentially preventable deaths for each of the five leading causes of death (Table 1). In 2014, the Northwest (Region 10) had the lowest number of potentially preventable deaths for each of the five leading causes of death except deaths from CLRD and unintentional injuries, where the lowest number occurred in New York and New Jersey (Region 3) (Table 2).
Consistent with increases in population since 2010, particularly among older age groups, the number of observed deaths increased for each of the five leading causes of deaths in 2014, and age-adjusted death rates declined during 2010–2014 for each category except unintentional injuries. Specifically, from 2010 to 2014, age-adjusted death rates per 100,000 population for heart disease declined 6.8% from 179.1 to 167.0; for cancer, from 172.8 to 161.2 (6.7% decrease); for stroke, from 39.1 to 36.5 (6.6% decrease); and for CLRD, from 42.2 to 40.5 (4.0% decrease). For unintentional injuries, age-adjusted death rates increased 6.6%, from 38.0 to 40.5 (supplemental material at https://stacks.cdc.gov/view/cdc/42341) (1). Among subcategories of unintentional injury deaths for all ages, age-adjusted death rates for poisonings increased 25%, and falls increased by 12% (supplemental material at https://stacks.cdc.gov/view/cdc/42344). Prescription drug and illicit drug overdose was a major contributor to the increase in poisonings during 2010–2014 (4).
The results of this analysis show that the number of observed deaths increased for each of the leading five causes of death, consistent with increases in population size in 2014, compared with 2010. Age-adjusted death rates declined overall for all causes of death combined in 2014 compared with 2010. Potentially preventable deaths declined during 2010–2014 for three of the five leading causes of death: diseases of the heart, cancer, and stroke. No change was observed for potentially preventable deaths from CLRD. Potentially preventable deaths from unintentional injuries increased from 2010 compared with 2014. States in the Southeast continued to have the highest number of potentially preventable deaths from all five causes in 2014.
Although substantial progress was made in combatting infectious diseases during the early part of the 20th century, additional focus has shifted toward prevention of noncommunicable diseases, including chronic diseases, and unintentional injuries (5,6). The decrease in cancer deaths can be attributed, in part, to progress in prevention, early detection, and treatment (7). Improvement of quality of care and reduction in risk factors, including increased number of persons with hypertension under control, have contributed to the decline in death rates for heart disease and stroke.** Tobacco use is a risk factor for some of the deaths included in this report, such as heart disease, cancer, CLRD, and cerebrovascular diseases.†† Mortality from tobacco-related causes has decreased in conjunction with national decreases in tobacco use across the United States, but an estimated 40 million adults (16.8%) smoked in 2014 (8). Implementation of evidence-based tobacco control interventions, including increased tobacco product prices, implementation and enforcement of comprehensive smoke-free laws, media campaigns, and access to proven resources (e.g., quit lines) to help persons quit tobacco use§§ varies among states. In addition to tobacco use, other health behaviors contribute to premature deaths and create opportunities for prevention. For example, obesity increases the risk for CLRD, diseases of the heart, and cerebrovascular disease, in addition to some cancers.¶¶
Although the number of potentially preventable deaths declined during 2010–2014 for heart disease, cancer, and stroke, observed deaths increased overall for these causes. Based on the methodology used for this analysis, when the pace of the increase in observed deaths is slower than the growth in population, potentially preventable deaths will decrease. Observed deaths increased 6% for heart disease, 4% for cancer, 4% for stroke, and 8% for CLRD. These increases were smaller than would be expected to result from population growth, particularly growth in population size among older age groups during this period.
In contrast, both observed and potentially preventable deaths from unintentional injuries increased during 2010–2014. Examples of state actions to reduce drug overdose include developing or enhancing prescription drug monitoring programs, adopting clinical prescribing guidelines, and increasing access to medication-assisted treatment for opioid use disorder and naloxone to reverse opioid-related poisoning (9). As the U.S. population aged, falls among older adults increased. Tools such as STEADI, designed to assist clinicians in assessing fall risk, educating patients, and selecting interventions, are available from CDC.***
The findings in this report are subject to at least five limitations. First, the same method used in a previous report was applied to set a benchmark for potentially preventable deaths (2). These benchmarks are based on data from the states with the lowest death rates for each condition during 2008–2010 alone. The benchmarks might need to be reevaluated over time, especially given shifts in cause-specific death rates observed using provisional mortality data from 2015–2016.††† For example, death rates from unintentional injury were increasing before 2008–2010, resulting in benchmarks that might not be comparable to historical lows or international points of reference. Second, alternative ways of defining and measuring potentially preventable or premature avoidable mortality have been used in other studies and no gold standard exists (10). Third, a lowest average rate was calculated based on individual states. The sum of the individual potentially preventable deaths by state is qualitatively different from estimating the number of potentially preventable deaths for the United States as a whole. Fourth, changes in the number of potentially preventable deaths by cause are not necessarily independent. For example, whereas some cancer deaths might be prevented entirely, some might be shifted into another cause grouping, such as heart disease. Finally, defining potentially preventable deaths across the five leading causes does not take into consideration the fact that these are complex and diverse causes of death. Not all deaths are equivalently preventable across the leading causes or within each leading cause. For example, certain types of cancer might be considered more or less preventable than other types, and some specific mechanisms of injury deaths (e.g., drug poisoning) might be considered completely preventable and other mechanisms less preventable. In addition, the majority of risk factors do not occur randomly in populations; they are closely related to the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which persons live and work.§§§ However, from a health equity perspective, every state can be compared with the same benchmark rates regardless of demographic differences. If health disparities were eliminated, as is called for by Healthy People 2020,¶¶¶ all states could be closer to achieving the lowest possible death rates for the five leading causes of death.
Further analysis of state and regional differences in death rates for the five leading causes of death could assist state and federal health officials in establishing prevention goals, priorities, and strategies. Clinical preventive services, including physician tobacco cessation counseling, as recommended by the U.S. Preventive Services Task Force**** for heart disease, stroke, cancer, and CLRD also provide opportunities for addressing preventable deaths.††††
Chad Heilig, PhD, Paul Z. Siegel, MD, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Peter Briss, MD, National Center for Chronic Disease Prevention and Health Promotion, CDC.
1Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 2National Center for Health Statistics, CDC; 3National Center for Injury Prevention and Control, CDC; 4National Center for Chronic Disease Prevention and Health Promotion, CDC.
† Diseases of the heart codes I00-I09, I11, I13, I20-I51; cancer C00-C97; CLRD J40-J47; cerebrovascular diseases (stroke) I60-I69; and unintentional injuries V01-X59, Y85-Y86.
§ Standard error = the square root of [expected number + observed number of deaths].
¶ Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Region 2: New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands. Region 3: Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Region 7: Iowa, Kansas, Missouri, and Nebraska. Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau. Region 10: Alaska, Idaho, Oregon, and Washington.
Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016;65(4):1–122. PubMed
Yoon PW, Bastian B, Anderson RN, Collins JL, Jaffe HW. Potentially preventable deaths from the five leading causes of death—United States, 2008–2010. MMWR Morb Mortal Wkly Rep 2014;63:369–74. PubMed
Heron M. Deaths: leading causes for 2014. Natl Vital Stat Rep 2016;65(5):1–96. PubMed
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep 2016;64:1378–82. CrossRefPubMed
Epidemiology Program Office, Office of the Director, CDC. Achievements in public health, 1900–1999: changes in the public health system. MMWR Morb Mortal Wkly Rep 1999;48:1141–7.
Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384:45–52. CrossRefPubMed
Ryerson AB, Eheman CR, Altekruse SF, et al. Annual report to the nation on the status of cancer, 1975–2012, featuring the increasing incidence of liver cancer. Cancer 2016;122:1312–37. CrossRefPubMed
Jamal A, Homa DM, O’Connor E, et al. Current cigarette smoking among adults—United States, 2005–2014. MMWR Morb Mortal Wkly Rep 2015;64:1233–40. CrossRefPubMed
Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM. What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug Alcohol Depend 2014;145:34–47. CrossRefPubMed
Schieb LJ, Greer SA, Ritchey MD, George MG, Casper ML. Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease—United States, 2001–2010. MMWR Morb Mortal Wkly Rep 2013;62:721–7. PubMed
TABLE 1. Number of expected, observed, and potentially preventable deaths among the five leading causes of death and significant changes in potentially preventable deaths, for persons aged <80 years, by U.S. Department of Health and Human Services (HHS) region — United States, 2010 and 2014
HHS region
2010
2014
Z-test significance
Expected
Observed
Potentially preventable
Expected
Observed
Potentially preventable
Diseases of the heart
1
8,904
10,286
1,382
9,798
10,468
670
*
2
16,765
24,477
7,712
18,170
24,272
6,102
*
3
18,327
28,563
10,236
20,099
29,185
9,086
*
4
38,367
65,198
26,831
43,235
69,897
26,662
5
30,726
47,280
16,554
33,618
50,437
16,819
6
20,656
35,898
15,242
23,245
39,907
16,662
*
7
8,281
12,769
4,488
8,958
13,425
4,467
8
5,782
6,464
682
6,616
7,325
709
9
26,030
33,352
7,322
29,622
35,133
5,511
*
10
7,422
8,401
979
8,539
9,216
677
Malignant neoplasms (cancers)
1
15,587
19,061
3,474
17,216
18,995
1,779
*
2
29,259
34,735
5,476
31,827
34,826
2,999
*
3
32,039
42,003
9,964
35,241
43,236
7,995
*
4
66,962
90,439
23,477
75,522
95,461
19,939
*
5
53,686
71,553
17,867
58,975
73,529
14,554
*
6
36,074
46,950
10,876
40,693
49,216
8,523
*
7
14,443
19,028
4,585
15,692
19,653
3,961
8
10,123
10,708
585
11,625
11,387
-238†
*
9
45,439
50,611
5,172
51,835
53,179
1,344
*
10
13,041
15,861
2,820
15,018
16,700
1,682
*
Cerebrovascular diseases (stroke)
1
1,722
1,863
141
1,914
1,781
-133
*
2
3,261
3,742
481
3,556
3,716
160
*
3
3,568
5,239
1,671
3,947
5,511
1,564
4
7,538
12,960
5,422
8,567
13,934
5,367
5
5,988
8,832
2,844
6,603
9,143
2,540
6
4,040
7,174
3,134
4,575
7,749
3,174
7
1,628
2,405
777
1,773
2,490
717
8
1,128
1,374
246
1,302
1,440
138
9
5,078
6,904
1,826
5,822
6,952
1,130
*
10
1,439
1,867
428
1,679
1,991
312
Chronic lower respiratory diseases (CLRD)
1
2,234
2,774
540
2,505
3,068
563
2
4,218
4,794
576
4,634
4,697
63
*
3
4,630
6,951
2,321
5,166
7,234
2,068
4
9,820
18,612
8,792
11,254
21,025
9,771
*
5
7,740
13,494
5,754
8,623
14,669
6,046
6
5,174
9,539
4,365
5,911
10,547
4,636
7
2,111
4,318
2,207
2,317
4,644
2,327
8
1,442
2,447
1,005
1,686
2,681
995
9
6,514
8,447
1,933
7,550
8,977
1,427
*
10
1,857
3,082
1,225
2,195
3,357
1,162
Unintentional injuries (accidents)
1
2,771
3,703
932
2,866
4,817
1,951
*
2
5,357
5,692
335
5,531
6,824
1,293
*
3
5,703
8,769
3,066
5,916
10,261
4,345
*
4
11,650
23,804
12,154
12,338
24,789
12,451
5
9,724
15,104
5,380
9,984
17,898
7,914
*
6
7,040
13,487
6,447
7,530
14,598
7,068
*
7
2,566
4,720
2,154
2,639
4,901
2,262
8
1,985
3,479
1,494
2,136
4,046
1,910
*
9
8,845
12,264
3,419
9,420
13,768
4,348
*
10
2,414
3,840
1,426
2,569
4,358
1,789
*
*Significant change from 2010 to 2014, p<0.01. † Negative potentially preventable deaths occurred when an HHS region included one or more of the states with the lowest three death rates (the lowest three death rates were averaged to create the benchmark death rates) for at least a few age groups. Negative potentially preventable deaths are preserved in this table to test changes from 2010 to 2014.
TABLE 2. Number of expected, observed, and potentially preventable deaths among the five leading causes of death and significant changes in potentially preventable deaths, for persons aged <80 years, by state — United States, 2010 and 2014
State
2010
2014
Z-test significance
Expected
Observed
Potentially preventable (95% CI)
Expected
Observed
Potentially preventable (95% CI)
Diseases of the heart
Alabama
2,993
6,604
3,611 (3,419–3,803)
3,266
6,933
3,667 (3,469–3,865)
Alaska
331
463
132 (77–187)
377
497
120 (62–178)
Arizona
3,885
4,735
850 (668–1,032)
4,512
5,061
549 (357–741)
Arkansas
1,845
3,808
1,963 (1,816–2,110)
1,998
4,258
2,260 (2,105–2,415)
*
California
19,742
24,707
4,965 (4,552–5,378)
22,358
25,338
2,980 (2,552–3,408)
*
Colorado
2,707
2,815
108 (-38–254)
3,153
3,246
93 (-64–250)
Connecticut
2,176
2,569
393 (258–528)
2,362
2,552
190 (53–327)
Delaware
575
857
282 (208–356)
658
929
271 (193–349)
District of Columbia
310
729
419 (356–482)
337
733
396 (332–460)
Florida
13,352
17,586
4,234 (3,889–4,579)
15,121
19,121
4,000 (3,637–4,363)
Georgia
5,120
9,103
3,983 (3,749–4,217)
5,890
9,911
4,021 (3,775–4,267)
Hawaii
836
1,007
171 (87–255)
920
1,217
297 (206–388)
Idaho
883
1,080
197 (110–284)
1,025
1,240
215 (122–308)
Illinois
7,249
11,424
4,175 (3,907–4,443)
7,898
11,839
3,941 (3,666–4,216)
Indiana
3,783
6,421
2,638 (2,440–2,836)
4,145
6,779
2,634 (2,429–2,839)
Iowa
1,892
2,716
824 (691–957)
2,032
2,622
590 (456–724)
Kansas
1,636
2,248
612 (490–734)
1,766
2,402
636 (509–763)
Kentucky
2,662
5,332
2,670 (2,495–2,845)
2,912
5,798
2,886 (2,703–3,069)
Louisiana
2,609
5,784
3,175 (2,995–3,355)
2,861
6,149
3,288 (3,102–3,474)
Maine
928
1,083
155 (67–243)
1,026
1,167
141 (49–233)
Maryland
3,303
5,321
2,018 (1,836–2,200)
3,701
5,476
1,775 (1,587–1,963)
Massachusetts
3,926
4,416
490 (311–669)
4,333
4,382
49 (-134–232)
*
Michigan
6,056
10,327
4,271 (4,020–4,522)
6,646
11,461
4,815 (4,551–5,079)
*
Minnesota
3,050
2,720
-330† (-479 to -181)
3,414
2,951
-463 (-619 to -307)
Mississippi
1,750
4,183
2,433 (2,282–2,584)
1,903
4,428
2,525 (2,369–2,681)
Missouri
3,691
6,553
2,862 (2,664–3,060)
4,011
7,113
3,102 (2,895–3,309)
Montana
650
826
176 (101–251)
733
910
177 (98–256)
Nebraska
1,063
1,252
189 (95–283)
1,149
1,288
139 (42–236)
Nevada
1,566
2,903
1,337 (1,206–1,468)
1,832
3,517
1,685 (1,542–1,828)
*
New Hampshire
828
916
88 (6–170)
931
976
45 (-41–131)
New Jersey
5,243
7,106
1,863 (1,645–2,081)
5,703
7,145
1,442 (1,220–1,664)
*
New Mexico
1,253
1,510
257 (154–360)
1,382
1,642
260 (152–368)
New York
11,522
17,371
5,849 (5,516–6,182)
12,467
17,127
4,660 (4,323–4,997)
*
North Carolina
5,679
9,021
3,342 (3,104–3,580)
6,456
9,223
2,767 (2,522–3,012)
*
North Dakota
406
512
106 (47–165)
437
542
105 (44–166)
Ohio
7,164
11,875
4,711 (4,441–4,981)
7,736
12,697
4,961 (4,681–5,241)
Oklahoma
2,267
4,857
2,590 (2,425–2,755)
2,456
5,300
2,844 (2,671–3,017)
Oregon
2,364
2,421
58 (-79–193)
2,714
2,622
-92 (-235–51)
Pennsylvania
8,221
12,668
4,447 (4,164–4,730)
8,824
12,689
3,865 (3,578–4,152)
*
Rhode Island
636
820
184 (109–259)
689
855
166 (89–243)
South Carolina
2,896
5,413
2,517 (2,338–2,696)
3,335
5,742
2,407 (2,220–2,594)
South Dakota
491
590
99 (35–163)
541
741
200 (130–270)
Tennessee
3,916
7,956
4,040 (3,826–4,254)
4,353
8,741
4,388 (4,164–4,612)
Texas
12,683
19,939
7,256 (6,902–7,610)
14,549
22,558
8,009 (7,631–8,387)
*
Utah
1,194
1,229
35 (-61–131)
1,383
1,349
-34 (-136–68)
Vermont
411
482
71 (12–130)
457
536
79 (17–141)
Virginia
4,609
6,588
1,979 (1,772–2,186)
5,185
6,978
1,793 (1,577–2,009)
Washington
3,844
4,437
593 (415–771)
4,424
4,857
433 (244–622)
West Virginia
1,308
2,400
1,092 (973–1,211)
1,395
2,380
985 (865–1,105)
Wisconsin
3,424
4,513
1,089 (914–1,264)
3,779
4,710
931 (750–1,112)
Wyoming
333
492
159 (103–215)
369
537
168 (109–227)
United States
181,261
272,688
91,757 (90,436–93,078)
201,902
289,265
87,950 (86,576–89,324)
*
Malignant neoplasms (cancers)
Alabama
5,227
7,595
2,368 (2,146–2,590)
5,714
7,796
2,082 (1,854–2,310)
Alaska
588
703
115 (45–185)
670
782
112 (37–187)
Arizona
6,775
7,460
685 (451–919)
7,857
8,085
228 (-19–475)
*
Arkansas
3,219
4,720
1,501 (1,326–1,676)
3,487
4,897
1,410 (1,231–1,589)
California
34,454
38,226
3,772 (3,244–4,300)
39,157
39,678
521 (-29–1071)
*
Colorado
4,752
4,944
192 (-1–385)
5,553
5,188
-365 (-568 to -162)
*
Connecticut
3,805
4,367
562 (385–739)
4,144
4,219
75 (-104–254)
*
Delaware
1,006
1,352
346 (251–441)
1,151
1,426
275 (176–374)
District of Columbia
543
742
199 (129–269)
592
837
245 (171–319)
Florida
23,195
28,249
5,054 (4,609–5,499)
26,279
29,519
3,240 (2,777–3,703)
*
Georgia
8,967
11,820
2,853 (2,570–3,136)
10,323
12,738
2,415 (2,117–2,713)
Hawaii
1,467
1,555
88 (-20–196)
1,616
1,693
77 (-36–190)
Idaho
1,546
1,753
207 (94–320)
1,796
1,995
199 (78–320)
Illinois
12,654
16,558
3,904 (3,569–4,239)
13,840
16,862
3,022 (2,679–3,365)
*
Indiana
6,612
9,385
2,773 (2,525–3,021)
7,268
9,821
2,553 (2,297–2,809)
Iowa
3,295
4,127
832 (663–1,001)
3,559
4,258
699 (526–872)
Kansas
2,854
3,624
770 (612–928)
3,098
3,758
660 (498–822)
Kentucky
4,655
7,499
2,844 (2,628–3,060)
5,104
7,815
2,711 (2,488–2,934)
Louisiana
4,562
6,909
2,347 (2,137–2,557)
5,021
7,137
2,116 (1,900–2,332)
Maine
1,627
2,259
632 (510–754)
1,805
2,186
381 (257–505)
*
Maryland
5,788
7,218
1,430 (1,206–1,654)
6,499
7,616
1,117 (884–1,350)
Massachusetts
6,865
8,319
1,454 (1,212–1,696)
7,609
8,341
732 (484–980)
*
Michigan
10,600
14,394
3,794 (3,484–4,104)
11,671
14,884
3,213 (2,894–3,532)
Minnesota
5,328
6,273
945 (734–1,156)
5,992
6,267
275 (58–492)
*
Mississippi
3,055
4,731
1,676 (1,503–1,849)
3,330
5,019
1,689 (1,510–1,868)
Missouri
6,442
9,023
2,581 (2,337–2,825)
7,020
9,345
2,325 (2,074–2,576)
Montana
1,143
1,304
161 (64–258)
1,291
1,445
154 (51–257)
Nebraska
1,852
2,254
402 (276–528)
2,014
2,292
278 (149–407)
Nevada
2,743
3,370
627 (474–780)
3,205
3,723
518 (355–681)
New Hampshire
1,455
1,772
317 (206–428)
1,642
1,846
204 (88–320)
New Jersey
9,147
10,948
1,801 (1,523–2,079)
9,986
10,965
979 (695–1,263)
*
New Mexico
2,194
2,393
199 (66–332)
2,423
2,451
28 (-109–165)
New York
20,112
23,787
3,675 (3,264–4,086)
21,842
23,861
2,019 (1,600–2,438)
*
North Carolina
9,931
13,297
3,366 (3,067–3,665)
11,304
14,393
3,089 (2,775–3,403)
North Dakota
708
780
72 (-4–148)
767
852
85 (6–164)
Ohio
12,514
17,413
4,899 (4,560–5,238)
13,570
18,043
4,473 (4,125–4,821)
Oklahoma
3,957
5,787
1,830 (1,637–2,023)
4,293
5,896
1,603 (1,405–1,801)
Oregon
4,153
5,212
1,059 (869–1,249)
4,771
5,496
725 (526–924)
Pennsylvania
14,340
19,114
4,774 (4416–5,132)
15,463
19,064
3,601 (3,237–3,965)
*
Rhode Island
1,112
1,423
311 (212–410)
1,210
1,442
232 (131–333)
South Carolina
5,079
7,063
1,984 (1,768–2,200)
5,846
7,487
1,641 (1,415–1,867)
South Dakota
856
1,054
198 (112–284)
950
1,115
165 (76–254)
Tennessee
6,853
10,185
3,332 (3,076–3,588)
7,622
10,694
3,072 (2,807–3,337)
Texas
22,143
27,141
4,998 (4,563–5,433)
25,469
28,835
3,366 (2,909–3,823)
*
Utah
2,080
1,931
-149 (-273 to -25)
2,413
2,105
-308 (-440 to -176)
Vermont
723
921
198 (119–277)
807
961
154 (72–236)
Virginia
8,073
1,0162
2,089 (1,824–2,354)
9090
10,651
1,561 (1,286–1,836)
*
Washington
6,754
8,193
1,439 (1,199–1,679)
7,781
8,427
646 (396–896)
*
West Virginia
2,289
3,415
1,126 (978–1,274)
2,446
3,642
1,196 (1,043–1,349)
Wisconsin
5,978
7,530
1,552 (1,324–1,780)
6,635
7,652
1,017 (783–1251)
*
Wyoming
585
695
110 (40–180)
651
682
31 (-41–103)
United States
316,652
400,949
84,443 (82,783–86,103)
353,645
416,182
63,209 (61,489–64,929)
*
Cerebrovascular diseases (stroke)
Alabama
588
1,277
689 (604–774)
646
1,335
689 (602–776)
Alaska
62
91
29 (5–53)
72
87
15 (-10–40)
Arizona
771
848
77 (-2–156)
905
912
7 (-77–91)
Arkansas
365
718
353 (289–417)
398
738
340 (274–406)
California
3,839
5,366
1,527 (1,339–1,715)
4,374
5,324
950 (757–1,143)
*
Colorado
520
604
84 (18–150)
614
633
19 (-50–88)
Connecticut
420
425
5 (-52–62)
460
405
-55 (-113–3)
Delaware
113
170
57 (24–90)
130
172
42 (8–76)
District of Columbia
61
107
46 (21–71)
66
88
22 (-2–46)
Florida
2,655
3,481
826 (672–980)
3,030
3,812
782 (620–944)
Georgia
989
1,965
976 (869–1,083)
1,150
2,060
910 (799–1,021)
Hawaii
163
244
81 (41–121)
182
234
52 (12–92)
Idaho
174
234
60 (20–100)
204
268
64 (21–107)
Illinois
1,412
2,047
635 (520–750)
1,547
2,175
628 (508–748)
Indiana
739
1,240
501 (414–588)
816
1,289
473 (383–563)
Iowa
373
462
89 (32–146)
403
465
62 (4–120)
Kansas
321
485
164 (108–220)
349
489
140 (83–197)
Kentucky
520
934
414 (339–489)
573
948
375 (299–451)
Louisiana
510
1,003
493 (417–569)
564
1,176
612 (530–694)
Maine
180
229
49 (9–89)
202
222
20 (-20–60)
Maryland
636
935
299 (221–377)
720
1,025
305 (223–387)
Massachusetts
761
807
46 (-32–124)
846
784
-62 (-141–17)
Michigan
1,178
1,743
565 (459–671)
1,306
1,792
486 (377–595)
Minnesota
592
662
70 (1–139)
669
705
36 (-37–109)
Mississippi
344
827
483 (416–550)
377
858
481 (412–550)
Missouri
724
1,164
440 (355–525)
793
1,263
470 (381–559)
Montana
127
162
35 (2–68)
146
182
36 (1–71)
Nebraska
209
294
85 (41–129)
227
273
46 (2–90)
Nevada
305
446
141 (87–195)
361
482
121 (64–178)
New Hampshire
158
163
5 (-30–40)
181
174
-7 (-44–30)
New Jersey
1,015
1,319
304 (209–399)
1,111
1,322
211 (114–308)
New Mexico
246
310
64 (18–110)
275
321
46 (-2–94)
New York
2,246
2,423
177 (43–311)
2,445
2,394
-51 (-187–85)
North Carolina
1,108
1,894
786 (679–893)
1,271
2,110
839 (725–953)
North Dakota
80
127
47 (19–75)
87
120
33 (5–61)
Ohio
1,400
2,271
871 (752–990)
1,523
2,328
805 (683–927)
Oklahoma
448
889
441 (369–513)
488
894
406 (333–479)
Oregon
461
635
174 (109–239)
536
699
163 (94–232)
Pennsylvania
1,611
2,194
583 (462–704)
1,740
2,388
648 (522–774)
Rhode Island
123
148
25 (-7–57)
135
114
-21 (-52–10)
South Carolina
567
1,119
552 (472–632)
661
1,185
524 (440–608)
South Dakota
97
126
29 (0–58)
107
108
1 (-28–30)
Tennessee
765
1,463
698 (605–791)
859
1,626
767 (669–865)
Texas
2,471
4,254
1,783 (1,622–1,944)
2,850
4,620
1,770 (1,601–1,939)
Utah
238
282
44 (-1–89)
276
325
49 (1–97)
Vermont
79
91
12 (-14–38)
90
82
-8 (-34–18)
Virginia
891
1,369
478 (385–571)
1,014
1,354
340 (245–435)
Washington
743
907
164 (84–244)
867
937
70 (-13–153)
West Virginia
257
464
207 (154–260)
276
484
208 (154–262)
Wisconsin
667
869
202 (125–279)
742
854
112 (34–190)
Wyoming
65
73
8 (-15–31)
73
72
-1 (-25–23)
United States
35,390
52,360
16,973 (16,392–17,554)
39,737
54,707
15,175 (14,573–15,777)
*
Chronic lower respiratory diseases (CLRD)
Alabama
765
1,778
1,013 (914–1,112)
848
1,897
1,049 (946–1,152)
Alaska
77
112
35 (8–62)
92
116
24 (-4–52)
Arizona
1,004
1,558
554 (455–653)
1,189
1,870
681 (573–789)
Arkansas
476
1,101
625 (547–703)
523
1,339
816 (731–901)
*
California
4,904
6,047
1,143 (938–1,348)
5,650
6,073
423 (211–635)
*
Colorado
665
1,141
476 (393–559)
795
1,301
506 (416–596)
Connecticut
544
509
-35 (-99–29)
601
586
-15 (-83–53)
Delaware
147
224
77 (39–115)
172
231
59 (20–98)
District of Columbia
78
73
-5 (-29–19)
85
73
-12 (-37–13)
Florida
3,501
5,327
1,826 (1,642–2,010)
4,018
5,855
1,837 (1,642–2,032)
Georgia
1,263
2,413
1,150 (1,031–1,269)
1,486
2,729
1,243 (1,116–1,370)
Hawaii
212
141
-71 (-108 to -34)
239
151
-88 (-127 to -49)
Idaho
224
409
185 (136–234)
267
485
218 (164–272)
Illinois
1,815
2,740
925 (793–1,057)
2,010
2,891
881 (744–1,018)
Indiana
954
2,154
1,200 (1,091–1,309)
1,063
2,389
1,326 (1,211–1,441)
Iowa
485
859
374 (302–446)
528
968
440 (364–516)
Kansas
414
826
412 (343–481)
455
938
483 (410–556)
Kentucky
675
1,792
1,117 (1,020–1,214)
750
2,078
1,328 (1,224–1,432)
*
Louisiana
658
1,106
448 (366–530)
733
1,360
627 (537–717)
*
Maine
237
443
206 (155–257)
268
494
226 (172–280)
Maryland
818
1,035
217 (133–301)
936
998
62 (-24–148)
Massachusetts
984
1,115
131 (41–221)
1,105
1,205
100 (6–194)
Michigan
1,527
2,721
1,194 (1,066–1,322)
1,712
2,939
1,227 (1,093–1,361)
Minnesota
762
960
198 (117–279)
871
1,153
282 (194–370)
Mississippi
446
1,016
570 (495–645)
492
1,129
637 (558–716)
Missouri
941
2,090
1,149 (1,041–1,257)
1,039
2,175
1,136 (1025–1,247)
Montana
166
341
175 (131–219)
192
380
188 (141–235)
Nebraska
270
543
273 (217–329)
296
563
267 (210–324)
Nevada
395
701
306 (241–371)
472
883
411 (339–483)
New Hampshire
206
315
109 (64–154)
237
352
115 (67–163)
New Jersey
1,312
1,436
124 (21–227)
1,447
1,391
-56 (-160–48)
New Mexico
320
535
215 (158–272)
361
605
244 (183–305)
New York
2,906
3,358
452 (297–607)
3,186
3,306
120 (-38–278)
*
North Carolina
1,436
2,698
1,262 (1,136–1,388)
1,663
3,077
1,414 (1,279–1,549)
North Dakota
104
170
66 (34–98)
113
162
49 (17–81)
Ohio
1,818
3,729
1,911 (1,765–2,057)
1,996
3,922
1,926 (1,775–2,077)
Oklahoma
581
1,736
1,155 (1,061–1,249)
638
1,787
1,149 (1,052–1,246)
Oregon
599
1,110
511 (430–592)
706
1,153
447 (363–531)
Pennsylvania
2,101
3,051
950 (809–1,091)
2,287
3,223
936 (791–1,081)
Rhode Island
160
225
65 (27–103)
176
242
66 (26–106)
South Carolina
740
1,391
651 (561–741)
870
1,693
823 (724–922)
South Dakota
126
226
100 (63–137)
140
202
62 (26–98)
Tennessee
995
2,197
1,202 (1,091–1,313)
1,125
2,567
1,442 (1,323–1,561)
*
Texas
3,139
5,061
1,922 (1,745–2,099)
3,656
5,456
1,800 (1,613–1,987)
Utah
298
383
85 (34–136)
350
451
101 (46–156)
Vermont
103
167
64 (32–96)
118
189
71 (37–105)
Virginia
1,148
1,647
499 (395–603)
1,320
1,714
394 (286–502)
Washington
956
1,451
495 (399–591)
1,130
1,603
473 (371–575)
West Virginia
338
921
583 (513–653)
367
995
628 (556–700)
Wisconsin
862
1,190
328 (239–417)
970
1,375
405 (310–500)
Wyoming
83
186
103 (71–135)
95
185
90 (57–123)
United States
45,738
74,458
28,831 (28,151–29,511)
51,840
80,899
29,232 (28,518–29,946)
Unintentional injuries (accidents)
Alabama
910
2,036
1,126 (1,020–1,232)
939
2,104
1,165 (1,057–1,273)
Alaska
131
331
200 (158–242)
137
348
211 (168–254)
Arizona
1,191
2,341
1,150 (1,034–1,266)
1,284
2,562
1,278 (1,156–1,400)
Arkansas
551
1,221
670 (587–753)
568
1,172
604 (522–686)
California
6,886
8,627
1,741 (1,497–1,985)
7,315
9,818
2,503 (2,246–2,760)
*
Colorado
940
1,525
585 (488–682)
1,018
1,833
815 (710–920)
*
Connecticut
679
905
226 (148–304)
696
1,142
446 (362–530)
*
Delaware
172
296
124 (82–166)
183
350
167 (122–212)
District of Columbia
117
169
52 (19–85)
128
177
49 (15–83)
Florida
3,675
6,927
3,252 (3,050–3,454)
3,951
6,997
3,046 (2,841–3,251)
Georgia
1,791
3,133
1,342 (1,204–1,480)
1,905
3,342
1,437 (1,295–1,579)
Hawaii
259
344
85 (37–133)
272
356
84 (35–133)
Idaho
285
516
231 (176–286)
304
575
271 (213–329)
Illinois
2,395
3,093
698 (553–843)
2,449
3,642
1,193 (1,040–1,346)
*
Indiana
1,209
2,064
855 (743–967)
1,250
2,425
1,175 (1,056–1,294)
*
Iowa
571
892
321 (246–396)
587
948
361 (284–438)
Kansas
525
1,010
485 (408–562)
539
1,004
465 (388–542)
Kentucky
826
2,240
1,414 (1,305–1,523)
852
2,225
1,373 (1,264–1,482)
Louisiana
850
1,771
921 (821–1,021)
882
2,074
1,192 (1,085–1,299)
*
Maine
262
390
128 (78–178)
267
487
220 (166–274)
Maryland
1,093
1,065
-28 (-119–63)
1,147
1,217
70 (-25–165)
Massachusetts
1,252
1,507
255 (152–358)
1,310
2,085
775 (661–889)
*
Michigan
1,869
2,923
1,054 (918–1,190)
1,916
3,455
1,539 (1,395–1,683)
*
Minnesota
993
1,342
349 (254–444)
1,034
1,440
406 (309–503)
Mississippi
553
1,395
842 (756–928)
567
1,438
871 (783–959)
Missouri
1,133
2,328
1,195 (1,080–1,310)
1,164
2,414
1,250 (1,133–1,367)
Montana
190
416
226 (178–274)
199
418
219 (170–268)
Nebraska
337
490
153 (97–209)
349
535
186 (128–244)
Nevada
510
952
442 (367–517)
549
1,032
483 (405–561)
New Hampshire
255
381
126 (77–175)
263
507
244 (190–298)
*
New Jersey
1,665
1,888
223 (106–340)
1,718
2,309
591 (467–715)
*
New Mexico
386
1,013
627 (554–700)
397
1,249
852 (772–932)
*
New York
3,692
3,804
112 (-58–282)
3,813
4,515
702 (523–881)
*
North Carolina
1,802
3,268
1,466 (1,326–1,606)
1,915
3,592
1,677 (1,532–1,822)
North Dakota
127
193
66 (31–101)
138
233
95 (57–133)
Ohio
2,184
4,016
1,832 (1,678–1,986)
2,230
4,928
2,698 (2,532–2,864)
*
Oklahoma
703
1,870
1,167 (1,068–1,266)
732
1,944
1,212 (1,111–1,313)
Oregon
730
1,068
338 (255–421)
773
1,254
481 (393–569)
Pennsylvania
2,435
4,319
1,884 (1,723–2,045)
2,486
4,993
2,507 (2,337–2,677)
*
Rhode Island
200
339
139 (93–185)
205
408
203 (154–252)
South Carolina
883
1,910
1,027 (923–1,131)
942
2,032
1,090 (983–1,197)
South Dakota
151
284
133 (92–174)
159
320
161 (118–204)
Tennessee
1,209
2,895
1,686 (1,560–1,812)
1,268
3,059
1,791 (1,662–1,920)
Texas
4,551
7,612
3,061 (2,845–3,277)
4,951
8,159
3,208 (2,984–3,432)
Utah
470
765
295 (226–364)
510
927
417 (343–491)
Vermont
122
181
59 (25–93)
125
188
63 (28–98)
Virginia
1,521
1,889
368 (254–482)
1,604
2,390
786 (662–910)
*
Washington
1,269
1,925
656 (545–767)
1,355
2,181
826 (709–943)
West Virginia
364
1,031
667 (594–740)
368
1,134
766 (690–842)
Wisconsin
1,074
1,666
592 (489–695)
1,105
2,008
903 (794–1,012)
*
Wyoming
106
296
190 (151–229)
111
315
204 (164–244)
United States
58,055
94,862
36,836 (36,070–37,602)
60,929
106,260
45,331 (44,530–46,132)
*
Abbreviation: CI = confidence interval. *Significant change from 2010 to 2014, p<0.01. † Negative potentially preventable deaths occurred when a U.S. Department of Health and Human Services region included one or more of the states with the lowest three death rates (the lowest three death rates were averaged to create the benchmark death rates) for at least a few age groups. Negative potentially preventable deaths were preserved in this table to test changes from 2010 to 2014, but were truncated to zero and not included in the totals for the United States in the table and text.
Suggested citation for this article: García MC, Bastian B, Rossen LM, et al. Potentially Preventable Deaths Among the Five Leading Causes of Death — United States, 2010 and 2014. MMWR Morb Mortal Wkly Rep 2016;65:1245–1255. DOI: http://dx.doi.org/10.15585/mmwr.mm6545a1.
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