Cindy sent me a story from Crain’s Chicago Business on Monday that linked to the Chicago Department of Public Health’s website. On it they provide Community Health Profiles for Chicago neighborhoods. The profiles include a wealth of data, including hospital useage statistics and risk factor levels for unhealthy behaviors. I’m happy to report that our neighborhood, Lincoln Square, has a low risk for its residents never having a cholesterol level checked, not exercising, current smoking and obesity. We do, however, have an average risk of binge drinking and non-daily fruit consumption.
I’ve also been reviewing cause of death statistics this week, because I’m thinking about what kills us in contrast to what we take prescription medications for (little corrolation found thusfar.) Our neighborhood’s cause of death statistics are pretty consistent with the national ones. According to the CDC’s National Center for Health Statistics, the leading causes of death in 2002 (the most recent ones issued to date) are, in order:
1. heart disease
4. chronic lower respiratory disease (asthma, emphysema)
8. alzheimer’s senility
9. kidney disease
10.sepsis (systemic infection)
12. liver disease
13. hypertension (high blood pressure)
15. all others
Based on both book knowledge and clinical experience as a nurse, I’m always a little suspicious of cause of death statistics. What the CDC uses to list cause of death are death certificates, yet, what is written on the cause of death line of a death certificate is an inexact, unregulated practice.
An attending physician assigns a cause of death, unless it is a coroner’s case, where the cause of death is unclear and must be established by autopsy. Almost all deaths are caused, in the strictest sense, by cardio-pulmonary arrest. That is, one’s heart stops beating for one reason or another. The underlying cause of the cardio-pulmonary arrest is what is usually listed as the cause of death, but not always. Other conditions that exist sometimes are listed, sometimes are not. So when I see that Alzheimer’s senility, for example, is the eighth leading cause of death, I find that suspicious because Alzheimer’s senility is an underlying condition that does not directly lead to death. Most people who have Alzheimer’s eventually become immoble, which means they will likely die of pneumonia. The same is true of Parkinson’s and many other chronic debilitating diseases. I wonder how many of the pneumonia deaths were really Alzheimer’s patients. And I look at the Alzheimer’s listing and wonder what those people actually died of. As I say, Alzheimer’s is only one example, this causality problem is also the case with AIDS. People don’t die of AIDS in a strict sense, they generally die of an opportunistic infection, yet HIV disease is listed as the cause of 317 deaths in Chicago in 2002. So many of those pneumonia or sepsis deaths could be HIV disease deaths. The deceased person can only appear once, and where they appear can have consequences for public policy, disease prevention resource allocation.
I’m not sure what an alternative to the current system would look like. Cause of death can often be quite a string of incidents – the question is where the final blame is placed, really. Will we ever see cardio-pulmonary arrest caused by stroke caused by hypertension caused by kidney failure caused by diabetes caused by chronic McDonald’s and Coca-Cola consumption? In our current system the cause of death listed on the death certificate could be any of the first five, but never goes as far as that sixth level.
I suspect that one could go so far back in the cause of death chain to get all the way down to non-daily fruit consumption, one of Chicago’s currently monitored risk factors. Then maybe, as I proposed in my produce cartoon, we’d start opening fruit stands in our neighborhoods rather than fast food drive-ins and liquor stores.