“There are lies, damned lies and statistics.”-Mark Twain
What are the leading causes of death in the United States?;
Simple question. You’d think there would be one correct answer, but there’s not. It turns out, the answer depends entirely on how you define what is considered a ‘cause of death’.
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), initiated by the World Health Organization (WHO) and the World Bank, measures epidemiological trends worldwide. The study looks at 240 causes of death. Venous thromboembolism (VTE) is not one of them.
Venous thromboembolism (VTE) = blood clots which occur in a deep vein of the body; VTE = deep vein thrombosis (DVT) + pulmonary embolism (PE)
The WHO methodology for defining ‘cause of death’ gets picked up by other organizations, such as the Centers for Disease Control and Prevention (CDC). The CDC’s mortality statistics are compiled in accordance with WHO regulations which specify that member nations classify and code causes of death in accordance with their methodology for consistency. For its National Vital Statistics report, the CDC reports on 113 select causes of death. VTE is not one of them. Therefore, you will also not find VTE listed among the CDC’s top causes of death either.
If VTE were considered a cause of death for reporting measures, where would it rank? The CDC estimates upwards of 900,000 new VTE cases each year, with 300,000 deaths. This would place VTE among the top 3 causes of death…more than AIDS, breast cancer and car accidents combined. VTE deaths in America even exceed (by 26 times more!) those due to firearm homicides, which the CDC places at 11,208.
The Agency for Healthcare Research and Quality calls VTE “the most common preventable cause of hospital death“. Efforts have been made for the WHO and CDC to add VTE as a cause of death. So far, this has not been done.
The problem with not including VTE as a cause of death is that it is difficult to advocate for what isn’t reported. What is reported as the ‘top causes of death’ influences public perceptions and more importantly, it impacts where policymakers choose to focus limited public health funding. A ‘top 10’ chart is easy to understand and it would not occur to policymakers nor the public that it is incomplete.
There is $0 line-item allocation for VTE in the US federal budget today. By comparison to illustrate the loss, AIDS which doesn’t even break into the top 10 on the CDC chart, received a $31.7 billion allocation for FY 2016, with $927.8 million of that going directly to the CDC. Diabetes, the seventh condition on the CDC cause of death list, receives a $1.818 allocation via The National Institute of Diabetes and Digestive and Kidney Diseases.
This is a disservice to patients. Funds are not being invested on conditions where they are truly most needed. Most VTE are preventable. Nearly a third of VTE result in death. There are effective prevention, diagnostic and treatment strategies. Yet, it is hard to argue that VTE is a serious problem which needs funding and dedicated efforts when it doesn’t even show up on on the lists of causes of death and disability.
A 2008 Surgeon General Call to Action report found VTE was “a major public health problem, exacting a significant human and economic toll on the Nation”. The report found gaps existed in the systematic application of clinical knowledge and that the condition itself suffered from low public awareness….both ideal preconditions for a coordinated public health intervention to have impact if only there was funding attached to a Congressional mandate to create one.
To not consider VTE as a cause of death is to employ selective statistics. Currently, there is no national monitoring system nor data collection for VTE, making it difficult to understand the true burden of VTE. It is high time for governmental and non-governmental organizations which are charged with protecting public health to include VTE in their presentation of morbidity and mortality data. To not do so, is to not fully address all causes of preventable patient harm.