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Potentially Preventable Deaths Among the Five Leading Causes of Death — United States, 2010 and 2014

Weekly / November 18, 2016 / 65(45);1245–1255


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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)

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Summary

What is already known about this topic?

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).

Discussion

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.††††

Acknowledgments

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.

Corresponding author: Macarena C. García, mcgarcia@cdc.gov, 404-539-4410.

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.


* http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.

† 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.

** http://www.cdc.gov/nchs/data/databriefs/db220.pdf.

††http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.

§§http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm.

¶¶http://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/obesity-evidence-review.pdf.

*** http://www.cdc.gov/steadi/pdf/stay_independent_brochure-a.pdf.

†††http://www.cdc.gov/nchs/products/vsrr/mortality-dashboard.htm.

§§§http://www.cdc.gov/mmwr/preview/ind2013_su.html.

¶¶¶https://www.healthypeople.gov/.

**** https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/.

††††https://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care.

References

  1. Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016;65(4):1–122. PubMed
  2. 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
  3. Heron M. Deaths: leading causes for 2014. Natl Vital Stat Rep 2016;65(5):1–96. PubMed
  4. 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. CrossRef PubMed
  5. 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.
  6. 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. CrossRef PubMed
  7. 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. CrossRef PubMed
  8. 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. CrossRef PubMed
  9. 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. CrossRef PubMed
  10. 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
Return to your place in the textFIGURE. Number of potentially preventable deaths among the five leading causes of death, for persons aged <80 years — United States, 2010 and 2014

Return to your place in the textTABLE 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.

Return to your place in the textTABLE 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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