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Wednesday 21st August 2019

The USA's six killer illnesses

28th November 2007

The New York Times publishes an in-depth look at the primary causes of poor health and mortality in the USA.


The illnesses which most affect people in America today, listed by prevalence, are: heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), diabetes and Alzheimer's disease. Johnathan Skinner, health economist at Dartmouth College, has said they account for a quarter of the USA's outlay on health care every year.

These illnesses do not exist in isolation in the human body. Some can cause other conditions in the top six to develop - for example, diabetes can lead to heart disease and cancer. Although mortality levels are decreasing, all too often patients are not given the appropriate care.

Heart disease

Every year, 1 million people in America suffer heart attacks and half a million die. Although there is a plethora of knowledge available about how to prevent attacks, many opportunities are missed because of a complacent attitude and the process involved in paying for heart care.

50% of people who should be given treatment to prevent attacks are not treated and 50% of those who are provided with treatment are not treated properly. Although damage to the heart can be dramatically reduced if a patient receives hospital treatment within an hour of their attack, only 10% reach the hospital within that time.

Only a small proportion of America's acute care hospitals can provide angioplasty, a treatment which is able to open blocked arteries. However, other hospitals often do not want to send patients to these hospitals because heart attack patients bring in so much money.


In 2007, there will be over 1.4 million new cases of cancer in America, and over half a million deaths. Cancer can be a complex disease to treat and vulnerable patients may find themselves having to "seek second opinions on biopsies and therapy, fight with insurers and sort out complex treatment options". Although mortality rates from cancer have been decreasing over 15 years in the US, often patients do not receive the best standards of treatment available.

The quality of care shows significant variation between doctors and hospitals. It is left to the patient to find the highest standards of care available for their particular cancer.

Dr Nina A Bickell, an associate professor of health policy and medicine at the Mount Sinai medical school in Manhattan says: “Here it is, a country with such a great health system...but even though we know things that work, not everybody who could benefit gets them".


Around 700,000 people in the US were thought to have had a stroke in 2006. It causes the deaths of 150,000 per year and costs $62.7 billion according to the American Stroke Association.

However, "from diagnosis to treatment to rehabilitation to preventing it altogether, a stroke is a litany of missed opportunities". Emergency doctors delay their diagnosis of stroke and do not give tPA - the only treatment which can really help a stroke patient. Research shows only 3-4% of patients are given it. Hospitals do not have the facilities or neurologists available to diagnose the condition.

“I label this a national tragedy or a national embarrassment,? said Dr. Mark J. Alberts, a neurology professor at the Feinberg School of Medicine at Northwestern University.

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) has dramatically increased as a cause of death in women in the US, primarily because of the "smoking boom in the 1950s, '60s and '70's". Death rates in women almost tripled from 1980-2000.

Every year the disease causes the deaths of 120,000 people. It comes fourth on the list of the top causes of death in the US and is predicted to be the third by 2020. 50% of patients who have the disease are aged under 65 and around 12 million people have been diagnosed, at a cost of $42 billion per year.

Around 85% of cases are caused by smoking.“Women started smoking in what I call the Virginia Slims era, when they started sponsoring sporting events,? said Dr Barry J Make, a lung specialist at National Jewish Medical and Research Center in Denver. “It’s now just catching up to them.?


Almost 73,000 people in America die every year from diabetes. Despite the fact that it is the fifth biggest killer in the US, information from the Federal Centers for Disease Control and Prevention shows that only 7% of people are receiving the right range of treatment. Many patients are treated by junior doctors who have limited knowledge and experience about the illness.

Many diabetes patients are unaware that it can lead to heart disease. Dr David Nathan, director of the Diabetes Center at Massachusetts General Hospital, explained: “when you think about it, it’s not the diabetes that kills you, it’s the diabetes causing cardiovascular disease that kills you."

Alzheimer's disease

Over five million Americans have Alzheimer’s disease. This number is set to more than triple by 2050. Figures from the Alzheimer's Association indicate that it affects one in eight people aged 65 and over, and almost half (42%) of people aged over 85.

Information also shows that 200,000 to 500,000 people younger than 65 have been diagnosed with a form of "early onset" dementia.

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