PHYSICIAN OFFICE LAB
Leading Causes of Death The trends impacting changes in the leading causes of death, and how they relate to newer diagnostic and treatment modalities. Despite the fact that new diagnostic testing and treatment modalities have continued to ad-
By Jim Poggi
vance in recent years, the ranking of the 10 leading causes of death in the United States has remained pretty consistent. However, their trends have not due to changes in health habits and treatment improvements addressing specific conditions. The top 10 in order remain: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases (COPD, emphysema), stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease and suicide. In this column, I will discuss the trends impacting changes in the leading causes of death, how they relate to newer diagnostic and treatment modalities, and speculate a bit on how I see the future.
with Troponin I, and high sensitivity Troponin I promises better outcomes still for acute injury and, more recently, for identification of obstructive coronary artery disease and confirmation of congestive heart failure. On the chronic heart disease front, BNP and lipid testing in combination with evaluation of other risk factors including prediabetes using hemoglobin A1c provide earlier alerts of the need to make lifestyle changes, including a reduction in weight, improved diet and increase in exercise to reduce risk factors for heart attack and also stroke.
Where are the wins? What changed the outlook for morbidity and mortality? From a big picture perspective, what has changed since 1980 to influence the decline in death rates for many of the leading causes of death? Diagnostic imaging, including MRI and CT scans, have made a big difference for heart disease (diagnosis of ischemia and arterial blockage in particular). Newer scanning techniques have also impacted cancer, with low dose CT scans available for Medicare beneficiaries 4
December 2021
•
www.repertoiremag.com
annually who have a history of smoking. Commercial health insurance coverage is also available. Colonoscopies have also had a dramatic effect on the diagnosis of colorectal cancer, with earlier diagnosis leading to far better outcomes. As a result, lung cancer deaths have seen a steady decline in recent years. On the lab side of things, changes have been fundamental. For heart disease, acute cardiac injury is rapidly and accurately diagnosed
The results for heart disease and cancer especially have been impressive, and continue to get better, with even newer technologies on the horizon. Since 1980, overall death rates have declined by 50%, which is a clear tribute to advances in medical care. Heart disease has shown the most dramatic decline in death rates over time, with a reduction of over 53%. From a treatment perspective, management of ischemic heart disease has benefited from better blood
