A Better Way to Measure Mortality Trends?

Cleveland Clinic researchers suggest “life-years lost” as better measure of mortality trends than cause of death

A new study from Cleveland Clinic suggests long-term mortality trends may be better understood by focusing on life-years lost — remaining life expectancy for a decedent — instead of solely looking at cause of death.

The research published today in the American Journal of Public Health, calculated years of life lost to the top 15 causes of death in the United States between 1995 and 2015 (examining more than 2 million death certificates each year), compared it to the number of deaths and examined reasons for differences.

“Focusing on life-years provides perspective on the societal burden of disease and highlights the disparities in disease burden,” said Glen Taksler, Ph.D., Cleveland Clinic researcher and lead author of the study. “Reordering mortality by life-years lost paints a more complete picture of changing mortality and its distribution across various populations.”

As an example, researchers concluded that, although heart disease is the leading cause-of-death overall, other conditions, such as cancer, caused more life-years lost. In 2015, heart disease caused 6 percent more deaths than cancer — 635,310 compared to 596,730 — but cancer caused 23 percent more life-years lost (9,260,413 for cancer compared to 7,529,750 for heart disease), because cancer is more common in young and middle-aged adults.

This analysis also highlights the differential success in treating heart disease and cancer. Improvements in primary and secondary prevention for atherosclerotic coronary artery disease, coupled with better acute treatments such as primary angioplasty and stenting, have led to a 42 percent reduction in years of life lost to acute myocardial infarction since 1995.

In contrast to the gains in heart disease, years of life lost to cancer increased 16 percent from 1995 to 2015.  This was mostly because of growth in the number of middle-aged Americans.    Life-years lost only declined for six types of cancer, highlighting the need to target cures for the least survivable cancers to achieve population-level gains.

Conditions that disproportionately affect young people appeared more prominently when measured by life-years lost. For example, highlighting the growing epidemic of drug overdoses, the entire gains of the past 20 years in preventing and treating HIV were offset by the increase in life-years lost to accidental deaths.

Racial disparities were also studied. Progress in heart disease was mostly limited to whites; life-years lost increased 20.8 percent for black males and 3.5 percent for black females, attributable to increased population size and life expectancy for young and middle-aged minorities.

The researchers noted that life-years lost was not a new concept but had rarely been used to assess long-term mortality trends for all leading causes of death.

“Looking at mortality trends through life-years lost tells us that future progress in prevention and treatment of chronic heart conditions, cancers and addictions appear critically important,” said Dr. Taksler. “We believe this thinking can best inform policymakers to prioritize research funding and measure progress toward mortality reduction on the basis of disease burden.

 

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 51,000 employees are more than 3,500 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 10 regional hospitals, more than 150 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2016, there were 7.1 million outpatient visits, 161,674 hospital admissions and 207,610 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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