4.3 Health in America

Heart Disease

Heart disease has been the leading cause of death globally for more than 20 years and is the most common cause of death in the United States for both men and women overall, as well as for most racial and ethnic groups (CDC, 2023d; World Heart Federation, 2023). The key risk factors for developing this condition include high blood pressure and high blood cholesterol. Several modifiable risk factors, such as smoking, obesity, and physical inactivity, contribute to the development of heart disease, and public health efforts are in place to create awareness (CDC, 2023d). For example, the American Heart Association (AHA) sponsors the Go Red for Women Health Movement to create awareness about heart disease in women.

Cancer

Although deaths from cancer have decreased over the past 30 years, it remains the second leading cause of death in the United States. Lung cancer is the most prevalent cause of cancer death, followed by colorectal, pancreatic, breast, and prostate cancer. Public health campaigns to increase awareness of cancer risk factors, such as smoking, as well as advances in screening and treatment, have contributed to the decrease in cancer deaths (American Cancer Society, 2022; CDC, 2022b). The CDC supports initiatives such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reduce cancer deaths (CDC, 2022b).

Accidents

Accidents or unintentional injuries were the third leading cause of death in the United States in 2022 (Ahmad et al., 2023). The CDC (2022a) identifies unintentional injuries such as unintentional poisoning (including opioid and other drug overdoses), drowning, motor vehicle accidents, and falls as the leading cause of death for Americans aged 1 to 44 years old. Interventions to prevent death from these types of injuries are included in the Healthy People 2030 objectives. For example, as drug overdoses are the leading cause of unintentional deaths, Healthy People 2030 supports interventions such as the distribution of naloxone and providing medication for addiction treatment, and HHS has a prevention strategy for preventing overdoses (ODPHP, n.d.-c;).

COVID-19

As indicated previously, after the start of the pandemic, COVID-19 quickly became a leading cause of death, with the weekly death toll peaking in the week of January 9, 2021, at more than 25,000 deaths per week (CDC, 2023a). However, COVID-19-related deaths have since dropped, and according to the CDC’s provisional mortality data for 2022, it was the fourth leading cause of death that year (Ahmad et al., 2023). It is unclear at this time if COVID-19 will remain a leading cause of death.

The COVID-19 pandemic has strained global health systems and the health care workforce. Even before the pandemic, there was a long-standing health care worker shortage, and the WHO currently predicts a global shortfall of 18 million health care workers by the year 2030, although more recent data indicate these numbers may be improving (WHO, 2022d). The WHO groups its member states into six regions for purposes of data analysis and reporting (GreenFacts, 2023). The health care workforce shortage is of high concern in the African region, which consists of 46 countries, because it bears almost one-quarter (24 percent) of the world’s disease burden but has only 3 percent of the world’s health care workers (WHO, 2022d).

Stroke

Stroke is the fifth leading cause of death in the United States. Deaths from stroke have increased from 2018 and are more likely to occur among low-income populations, certain racial and ethnic groups, and populations in certain parts of the country. The risk of stroke can be decreased by controlling high blood pressure and treating high cholesterol levels. Teaching people to recognize symptoms is key to helping more people get the treatment they need in a stroke emergency (ODPHP, n.d.-g).

Chronic Lower Respiratory Disease

Emphysema, chronic bronchitis, and nonreversible asthma belong to a group of illnesses known as chronic obstructive pulmonary disease, or COPD. The symptoms of COPD make it hard to breathe and can cause death. COPD is a major cause of disability and one of the leading causes of death in the United States. Unfortunately, many people who have COPD may not know it. Healthy People 2030 has a goal to reduce emergency department visits for COPD by reducing smoking and exposure to air pollution, teaching people with COPD how to manage it, and promoting early detection (ODPHP, n.d.-f).

Alzheimer’s Disease

Alzheimer’s disease is a type of dementia characterized by cognitive decline. Growing research suggests ways to help prevent or delay dementia instead of merely treating it and reducing its impact. Although no cure is presently available to eliminate Alzheimer’s disease, early recognition and early intervention may slow its deteriorating progress (ODPHP, n.d.-d).

Diabetes

Adults who are diagnosed with diabetes are at an increased risk of early death. Complications such as heart disease and kidney disease are among the leading causes of death in people with diabetes. Improving diabetes treatments may reduce the risk for these complications and lower the death rate for people with diabetes (ODPHP, n.d.-b).

Chronic Liver Disease, Cirrhosis, and Nonalcoholic Fatty Liver Disease

In the United States, chronic liver disease and cirrhosis are among the leading causes of death. Notably, death rates have been consistently higher for Black Americans. Most cirrhosis deaths are due to alcohol use. Other risk factors include type 2 diabetes, injecting drugs using shared needles, and exposure to others’ blood and body fluids (American Liver Foundation, 2022). Effective policies to reduce cirrhosis deaths include taxing and regulating alcohol sales and restricting alcohol advertising. According to the WHO (2023g), alcohol taxation and price regulation are among the most effective strategies to decrease alcohol-related harm.

Nonalcoholic fatty liver disease (NAFLD) develops when excess fat builds up in the liver for reasons unrelated to alcohol use. This is one of the most common causes of liver disease and is associated with obesity and type 2 diabetes. NAFLD increases a person’s risk of cardiovascular disease, type 2 diabetes, and metabolic syndrome (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], n.d.).

Nephritis, Nephrotic Syndrome, and Nephrosis

Nephritis and nephrotic syndrome/nephrosis are forms of kidney disease and a leading cause of death in the United States. Nephritis is an inflammatory condition, frequently resulting from infection, that can lead to renal failure if untreated. Nephrosis or nephrotic syndrome is a group of symptoms that reflect poor renal function caused by renal diseases or other causes, such as diabetes or hepatitis. The symptoms include proteinuria, hypoalbuminemia, peripheral edema, and hyperlipidemia (NIDDK, n.d.). Chronic kidney disease affects more than one in seven adults, and many do not realize they have it (NIDDK, 2023). Additionally, these conditions disproportionately affect low-income and racial and ethnic minority groups (ODPHP, n.d.-a; Norris, 2021).

Mortality Trends in Infectious Disease

Infectious disease remains a public health threat in the United States despite its decline as a leading cause of mortality. COVID-19, as previously discussed, is still a leading cause of death in the United States. Americans of all ages are at risk for mortality from other infectious diseases, such as bacterial sepsis in newborns or influenza and pneumonia for people from 1 year of age through late adulthood. Vaccines, such as those for COVID-19 and influenza, significantly reduce the risk of these infectious diseases and their complications (CDC, 2021b).

Mortality Trends in Chronic Disease

Chronic disease is a condition that is present for more than 1 year and requires ongoing medical intervention and/or limits activities of daily living. According to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP, 2022c), 6 out of 10 Americans have one chronic disease, and 4 in 10 have two or more. The major chronic diseases in the United States include heart disease and stroke, diabetes, and cancer. These diseases are the leading causes of death and disability in the United States and share the same risk factors, which include:

• tobacco use,
• exposure to secondhand smoke,
• poor nutrition,
• physical inactivity, and
• excessive alcohol use.

Chronic diseases account for most health care costs in the United States, and interventions to prevent them have significant economic and health benefits for Americans (NCCDPHP, 2022a). Because it is estimated that by 2050, most Americans aged 50 years and above across all races will have one or more chronic conditions, it is imperative that health promotion efforts address this concerning trend (Ansah & Chiu, 2022).

Mortality Trends in Suicide and Drug Overdose

Suicide is a major public health concern in the United States. As defined by the National Institutes of Health, suicide is death caused by self-directed injurious behavior with intent to die as a result of the behavior. Suicide rates increased by 37 percent between the years 2000 and 2018 and then decreased by 5 percent between 2018 and 2020. Unfortunately, rates nearly returned to their peak in 2021 (National Institute of Mental Health, 2023). Suicide is a leading cause of death for Americans aged 10 to 34. High suicide rates correlate to certain demographic factors, such as Native American ethnicity, and certain occupations, such as military service. Research suggests that increased suicide rates correlate to increases in mood and affective disorders and are associated with alcohol and drug use (Martinez-Ales at al., 2020).

Drug overdoses can be intentional or unintentional. The United States is currently experiencing an opioid overdose epidemic. There were more than six times the number of fatal drug overdoses in 2021 compared to 1999. The epidemic involves three waves or types of deaths. The initial wave started with prescription opioids in the 1990s, followed by increases in heroin-related deaths in 2010, and the third wave began in 2013 with synthetic opioids such as illegally manufactured fentanyl (CDC, 2023g). For more information on drug overdoses, refer to Caring for Populations and Communities in Crisis.

Trends in Maternal-Newborn Mortality

In the United States, maternal mortality is measured in three different ways. Pregnancy-associated deaths are those that occur during pregnancy or within a year after the end of pregnancy, regardless of the cause of death. Pregnancy-related deaths occur either during pregnancy or within one year after the end of pregnancy from a pregnancy-related complication; days 43 to 365 postpartum are considered “late” maternal deaths. Finally, maternal mortality refers to deaths that occur while pregnant or within 42 days after the end of pregnancy from any cause related to or aggravated by the pregnancy or its management, not including accidental or incidental causes. Nurses should understand these distinctions because many pregnancy-related deaths in the United States occur during the postpartum period (Tikkanen et al., 2020).

The maternal mortality rate in the United States exceeds that of other high-income countries and is increasing (Douthard et al., 2021). This trend is concerning, as the mortality rate of peer countries is decreasing, and more than 8 out of 10 maternal deaths are preventable. The maternal mortality rate is exceptionally high for Black Americans (Trost et al., 2022). Adverse maternal outcomes are often related to a combination of factors, such as an increased prevalence of chronic conditions, barriers to health care, or pregnant clients’ distrust of the health care system. Pregnant clients also experience variations in the quality of care they receive throughout the pregnancy, which is related to geographical location and socioeconomic status (Collier & Molina, 2019).

Infant mortality refers to an infant’s death before their first birthday, and the rate in the United States also exceeds that of peer countries (Petrullo, 2023). Infants born to Black people in the United States are at higher risk for mortality than those born to White people (Office of Minority Health, 2022). A primary cause of infant mortality is maternal pregnancy complications. Social and economic inequities drive maternal and infant mortality disparities in the United States. Initiatives at the federal, state, and community levels are striving to address the maternal and infant health crisis in America. Preventing pregnancy complications and maternal death is also a Healthy People 2030 goal (Hill et al., 2022).

Health Care Disparities

Various factors are responsible for the health disparities, or preventable differences in attaining health, among population groups in the United States. Disparities exist along many dimensions, including race or ethnicity, sexual orientation, age, socioeconomic status, and geographic location. Health care disparities can originate from health inequities, which are avoidable differences in the health of groups and communities (National Academies of Sciences, Engineering, and Medicine, 2017; Ndugga & Artiga, 2023). Barriers such as a lack of insurance or transportation and cultural differences between clients and providers affect health care quality. All Americans deserve an opportunity to attain their highest health level, which will only occur if disparities are addressed and health equity is achieved (CDC, 2022e). Health Disparities covers this topic in greater detail.