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EPIDEMIOLOGY

CAUSES OF DEATH

In 2019, 2,854,838 individuals died in the United States (Table 12-1). Approximately 74% of these deaths occurred in those aged ≥65 years. The epidemiology of death has changed significantly since 1900 and even since 1980. In 1900, heart disease caused ~8% of all deaths, and cancer accounted for <4% of all deaths. In 1980, heart disease accounted for 38.2% of all deaths, cancer 20.9%, and cerebrovascular disease 8.6% of all deaths. By 2019, there had been a dramatic drop in deaths from cardiovascular and cerebrovascular diseases. In 2019, 23.1% of all deaths were from cardiovascular disease and just 5.3% from cerebrovascular disease. Deaths attributable to cancer, however, had increased slightly to 21.0%. The proportions of deaths due to chronic lower respiratory disease, diabetes, Alzheimer’s, and suicide have increased. Interestingly, in 2019, HIV/AIDS accounted for <0.18% of all U.S. deaths. While unlikely to continue being a leading cause of death in the future, COVID-19 was also the cause for >600,000 deaths in 2020–2021, and the official figure is almost certainly an undercount of the actual death toll.

TABLE 12-1Ten Leading Causes of Death in the United States and Britain

This change in the epidemiology of death is also reflected in the costs of illness. In the United States, ~84% of all health care spending goes to patients with chronic illnesses, and 12% of total personal health care spending—slightly less than $400 billion in 2015—goes to the 0.83% of the population in the last year of their lives.

In upper-middle- and upper-income countries, an estimated 70% of all deaths are preceded by a disease or condition, making it reasonable to plan for dying in ...

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