Paging Dr. Frischer - Mortality rates

We Americans are managing to live longer. How? During the last century, United States mortality rates (the number of deaths in a population) greatly improved. In 1900, the annual mortality rate was one in 42. That means that during the year 1900, one out of every 42 people in the United States died! By 1998, the rate had dropped to a third of that, to only one in 125. Even more amazing, during the 20th Century the infant mortality rate (the number of deaths of those under one year old) fell by more than 90%, and maternal mortality rates (the number of women who die in childbirth) dropped by 99%. What innovations and policies contributed most to those gains? Except for a ten-year period between 1955 and 1965, when the mortality rate essentially did not change, the number of deaths has dropped at a relatively constant rate of one to two percent per year throughout that 100-year period. Earlier in the century, these gains were mostly among the young, but during the last half of the century, most of the life expectancy improvements were among those over 45. Infections were the leading cause of death during the first half of the century, and the biggest advances had to do with our ability to fight off infectious diseases. Pneumonia and influenza accounted for 1/3 of all deaths, and tuberculosis contributed as well. Actual medical interventions were minimal back then, but improved nutrition allowed many to avoid getting sick and to withstand the disease once contracted; and better public health measures reduced the spread of disease. These changes had the greatest impact on the very young. As we moved into the middle of the century, between 1940 and 1960, death rates from infectious diseases continued to decline, in large part due to the discovery of penicillin and sulfa drugs in 1935. As a result, by 1960, 70% of infants could be expected to live to be 65. By this point, medical interventions started playing a primary role. The focus was shifting to diseases of aging, like cancer, heart disease and diabetes. Of course, smoking has had a huge impact on mortality through the years. Once a socially accepted behavior, smoking is the leading preventable cause of death and disability in the United States. The CDC reports that annual average cigarette consumption increased from 54 cigarettes in 1900 to 4,345 cigarettes in 1963. That amounted to well over a half a pack a day for every man, woman, and child! By 1998, that number decreased to 2,261 cigarettes. Since then, average cigarette consumption has continued to plummet. When the number of smokers decline, after 10 to 20 years there is a direct impact on the number of deaths from heart disease and smoking-sensitive cancers. During the last century, factors that contributed to the significant improvements in life expectancy included environmental interventions, improvements in nutrition, advances in clinical medicine, improvements in how we monitor diseases, increases in education levels, and improvements in standards of living (rising incomes and social programs offer support and improved access to expensive medical technology). As we move forward into the 21st Century, we'll see that continued advancements in science and technology will continue to lower mortality rates. Medicare for the elderly and Medicaid (Medi-Cal, here in California) for the poor will continue to improve access to medical care. As we continue to better understand how environmental factors affect health, and as we make further improvements in public infrastructure (such as clean water, sewage, sanitation, housing, and improved food), mortality rates will also improve. And finally, as science discovers more about the causes of diseases, and public education on health risks and behavior improves, we will all live longer. Regardless of our age, each of us can do our part in improving our individual lifespan by making wise personal choices every day. I wish you a healthy 2014. Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: Jan. 9, 2014 - Volume 12 - Issue 39