Premature Death

Premature Death in Texas

Texas

Premature death is a measure of years of potential life lost due to death occurring before the age of 75. Deaths at younger ages contribute more to the premature death rate than deaths occurring closer to age 75. For example, a person dying at age 70 would lose five years of potential life, whereas a child dying at age five would lose 70 years of potential life. 

According to the National Center for Health Statistics WISQARS Years of Potential Life Lost (YPLL) Report, unintentional injury, cancer, heart disease, COVID-19, suicide, homicide and liver disease were, in order, the leading causes of years of potential life lost before age 75 in 2020. Suicide and drug deaths have been increasing steadily since 2000, contributing to the rise in premature death. 

Risk factors for premature death include obesity, smoking and exposure to environmental hazards such as reduced air quality. Risk factors for heart disease, such as high blood pressure, high cholesterol, Type 2 diabetes and physical inactivity, are also risk factors for premature death. Occupational hazards and certain behaviors, like not wearing seatbelts or motorcycle helmets and misusing drugs, can increase the risk of unintentional injuries and premature death. Social factors such as low education, poverty, racial segregation and inadequate social support also contribute to premature death. While not the direct cause of death, social factors can play a role in how and why a person dies.

Populations at higher risk for premature death include:

• American Indian/Alaska Native people, who have premature death rates persistently 50% greater than those of non-Hispanic whites. Infant mortality rates are almost 2 times higher among American Indian/Alaska Native children than white children and are a major contributor to the premature death rate. American Indian/Alaska Native populations also have a disproportionately high rate of unintentional injury deaths due to a number of factors, including rural environments, lack of traffic safety and higher rates of alcohol-related accidents. 
• Black people, whose premature mortality rates were consistently double those of the white population from 1960 through 2009. Racial disparities in cardiovascular disease and homicide have long been the leading drivers of higher rates of premature mortality, as well as staggering and persistent gaps in birth outcomes. Black populations have the highest infant mortality rate in the United States — more than twice those of non-Hispanic white and Asian populations.
• People who live in rural counties compared with those in urban counties. Non-Hispanic Black adults in rural counties have the highest mortality rate; however, non-Hispanic white adults in rural areas are the only population with a steadily increasing mortality rate. This spike is largely due to increased poisonings, including drug overdoses and suicides.

The conditions that contribute to premature death differ from community to community and local solutions need to be found that account for specific health needs. The Centers for Disease Control and Prevention (CDC) estimates that 20-40% of premature deaths are preventable. Lifestyle changes can help prevent premature deaths by reducing risk factors. These may include changes in diet, exercise, alcohol consumption and tobacco use, as well as medical treatment for chronic conditions such as depression, diabetes or hypertension. 

The CDC has documented several strategies for reducing health disparities, including:

• The Traditional Foods Project, aimed at reducing rates of Type 2 diabetes in American Indian/Alaska Native populations.
• The Boston Children’s Hospital’s Community Asthma Initiative, an intervention for Black and Hispanic children at risk of asthma complications.
• Programs funded by the CDC’s Colorectal Cancer Control Program (CRCCP) that implemented multicomponent interventions to increase colorectal cancer screening among racial and ethnic minority populations.

Intervention strategies that encourage individuals to seek preventive medical care and achieve healthy lifestyles can be effective in reducing premature death by:

• Screening for certain health risks, such as alcohol misuse, diabetes, depression, obesity, high blood pressure and breast, cervical and colorectal cancers.
• Raising vaccination rates. Vaccines are a safe and cost-effective way of protecting infants, adolescents and adults from potentially life-threatening preventable diseases. A complete list of vaccine-specific recommendations is available from the Advisory Committee on Immunization Practices and the CDC publishes vaccine schedules by age.

Increasing access to mental health and primary care for currently underserved minority populations is critical for decreasing premature death rates. More research is needed to determine effective methods of increasing access to behavioral health and primary care for racial and ethnic minority populations.

One of the overarching goals of Healthy People 2030 is to “attain healthy, thriving lives and well-being free of preventable disease, disability, injury and premature death.” While Healthy People 2030 does not have a specific goal for reducing premature death, it does set goals for many contributors to premature death, including reducing cancer, unintentional injuries, smoking, obesity, heart disease and maternal, infant, child and adolescent deaths.

Alegría, Margarita, Kiara Alvarez, Rachel Zack Ishikawa, Karissa DiMarzio, and Samantha McPeck. 2016. “Removing Obstacles to Eliminating Racial and Ethnic Disparities in Behavioral Health Care.” Health Affairs 35 (6): 991–99. https://doi.org/10.1377/hlthaff.2016.0029.

Alhusen, Jeanne L., Kelly M. Bower, Elizabeth Epstein, and Phyllis Sharps. 2016. “Racial Discrimination and Adverse Birth Outcomes: An Integrative Review.” Journal of Midwifery & Women’s Health 61 (6): 707–20. https://doi.org/10.1111/jmwh.12490.

Calvin, Rosie, Karen Winters, Sharon B. Wyatt, David R. Williams, Frances C. Henderson, and Evelyn R. Walker. 2003. “Racism and Cardiovascular Disease in African Americans.” The American Journal of the Medical Sciences 325 (6): 315–31. https://doi.org/10.1097/00000441-200306000-00003.

Centers for Disease Control and Prevention. 2016. “Strategies for Reducing Health Disparities — Selected CDC-Sponsored Interventions, United States, 2016.” MMWR. Morbidity and Mortality Weekly Report, Supplement, 65 (1). https://stacks.cdc.gov/view/cdc/37922.

Di, Qian, Lingzhen Dai, Yun Wang, Antonella Zanobetti, Christine Choirat, Joel D. Schwartz, and Francesca Dominici. 2017. “Association of Short-Term Exposure to Air Pollution With Mortality in Older Adults.” JAMA 318 (24): 2446. https://doi.org/10.1001/jama.2017.17923.

Galea, Sandro, Melissa Tracy, Katherine J. Hoggatt, Charles DiMaggio, and Adam Karpati. 2011. “Estimated Deaths Attributable to Social Factors in the United States.” American Journal of Public Health 101 (8): 1456–65. https://doi.org/10.2105/AJPH.2010.300086.

Joseph, Djenaba A., Diana Redwood, Amy DeGroff, and Emily L. Butler. 2016. “Use of Evidence-Based Interventions to Address Disparities in Colorectal Cancer Screening.” MMWR Supplements 65 (1): 21–28. https://doi.org/10.15585/mmwr.su6501a5.

Krieger, Nancy, Jarvis T. Chen, Brent A. Coull, Jason Beckfield, Mathew V. Kiang, and Pamela D. Waterman. 2014. “Jim Crow and Premature Mortality Among the US Black and White Population, 1960–2009: An Age–Period–Cohort Analysis.” Epidemiology 25 (4): 494–504. https://doi.org/10.1097/EDE.0000000000000104.

Quiñones, Ana R., Maya O’Neil, Somnath Saha, Michele Freeman, Stephen R. Henry, and Devan Kansagara. 2011. Interventions to Improve Minority Health Care and Reduce Racial and Ethnic Disparities. VA Evidence-Based Synthesis Program Reports. Washington, D.C.: Department of Veterans Affairs. http://www.ncbi.nlm.nih.gov/books/NBK82564/.

Satterfield, Dawn, Lemyra DeBruyn, Marjorie Santos, Larry Alonso, and Melinda Frank. 2016. “Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities — Traditional Foods Project, 2008–2014.” MMWR Supplements 65 (1): 4–10. https://doi.org/10.15585/mmwr.su6501a3.

Shiels, Meredith S., Zaria Tatalovich, Yingxi Chen, Emily A. Haozous, Patricia Hartge, Anna M. Nápoles, Eliseo J. Pérez-Stable, et al. 2020. “Trends in Mortality From Drug Poisonings, Suicide, and Alcohol-Induced Deaths in the United States From 2000 to 2017.” JAMA Network Open 3 (9): e2016217–e2016217. https://doi.org/10.1001/jamanetworkopen.2020.16217.

Stein, Elizabeth M., Keith P. Gennuso, Donna C. Ugboaja, and Patrick L. Remington. 2017. “The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999–2015.” American Journal of Public Health 107 (10): 1541–47. https://doi.org/10.2105/AJPH.2017.303941.

Woods, Elizabeth R., Urmi Bhaumik, Susan J. Sommer, Elaine Chan, Lindsay Tsopelas, Eric W. Fleegler, Margarita Lorenzi, et al. 2016. “Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma.” MMWR Supplements 65 (1): 11–20. https://doi.org/10.15585/mmwr.su6501a4.

Yoon, Paula W., Brigham Bastian, Robert N. Anderson, Janet L. Collins, Harold W. Jaffe, and Centers for Disease Control and Prevention (CDC). “Potentially Preventable Deaths from the Five Leading Causes of Death--United States, 2008-2010.” MMWR. Morbidity and Mortality Weekly Report 63, no. 17 (May 2, 2014): 369–74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584887/ .