The Burden of Disease: What Kills Us

Reading time: 2 – 4 minutes

Disease has changed over the last one hundred years. A Perspective 200th Anniversary Article in the New England Journal of Medicine compares the way Americans die today versus a century ago [1].

The chart above ranks the top ten causes of death in the years 1900 and 2010. Overall, the number of deaths per 100,000 people has decreased by almost half. However, two diseases have surged to become the top two causes of death in the United States: heart disease and cancer. Each disease also claims more lives today than they did in 1900. Heart disease increased from 137.4 to 192.9 people out of every 100,000; cancer increased from 64.0 to 185.9.

While cancer and heart disease claim more lives today than they did in 1900, remember that they generally affect people late in life. As life expectancy has increased over the same period — from 49.2 in 1900 to 78.5 in 2009 [2-3] — the numbers reflect advances in medicine and improved healthcare in the country.

Thanks to vaccines, antibiotics, and improvements in the standard of living, other ailments have disappeared completely from the list. The first successful diphtheria vaccine was developed in 1913, and tuberculosis later in 1921.

The authors also reflect on the changing burden of disease and the roles of medicine and health policy. From the Perspective Article [1]:

Is there a best health policy? Our goal should be an integrated policy under which health care and public health programs together fully address the disease burden. But the details depend on how we conceptualize and measure disease. And disease is never static. Just as organisms evolve to keep up with changing environmental conditions (the “Red Queen Effect”), medicine struggles to keep up with the changing burden of disease. Since therapeutic innovation takes time, the burden shifts even as solutions appear. By the time antibiotics and vaccines began combating infectious diseases, mortality had shifted toward heart disease, cancer, and stroke. Great progress has been made to meet these challenges, but the burden of disease will surely shift again. We already face an increasing burden of neuropsychiatric disease for which satisfying treatments do not yet exist.

References

1. Jones et al. The burden of disease and the changing task of medicine. N Engl J Med. 2012 Jun 21;366(25):2333-8.
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2. Life Expectancy in the United States. CRS Report for Congress. 2006 Aug 16.
3. Life Expectancy. Centers for Disease Control and Prevention. Accessed 1012 Jul 8.