What are leading causes and types of deaths?

While death has always been a universal component in the human experience, its prevalence and circumstances have changed over the years. Today, we associate death with the elderly, but looking back even one hundred years ago, death was more common among children and in various age ranges. At that time, it was not uncommon for American families to lose a child during childbirth or infancy. Today less than 10% of all deaths worldwide occur to children under the age of 5, but as recently as 1990, that number was nearly 25%.

The graph above shows data from 2016, which reveals that nearly half of the 55 million global deaths occurred to those aged 70 years or older. There is still a great amount of disparity in death statistics based on location and access to medical care. In the United States, for example, deaths in that same age group of 70 years old or older accounted for 65% of total deaths. In this section, we’ll look more closely at the leading causes of death in the United States and throughout the globe.

Most Common Causes of Death

The United States

In 1900, the most common causes of death were infectious diseases, which brought death quickly. Due to advances in healthcare and medicine over the years, this has changed, alongside an increase in average life expectancy. In modern times, chronic diseases, or those in which a slow and steady decline causes health deterioration, are more common.  How might this impact the way we think of death, the way we grieve, and the amount of control a person has over his or her own dying process, in comparison to the infectious diseases that were prevalent in 1900?

As of December 2020, these are the most recent mortality statistics from the Center for Disease Control ( CDC, 2020). In 2018, the 10 leading causes of death (heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide) remained the same as in 2017. Causes of death are ranked according to the number of deaths. The 10 leading causes accounted for 73.8% of all deaths in the United States in 2018.  Below are the specific numbers for each cause of death in 2018.

• Heart disease: 655,381
• Cancer: 599,274
• Accidents (unintentional injuries): 167,127
• Chronic lower respiratory diseases: 159,486
• Stroke (cerebrovascular diseases): 147,810
• Alzheimer’s disease: 122,019
• Diabetes: 84,946
• Influenza and pneumonia: 59,120
• Nephritis, nephrotic syndrome, and nephrosis: 51,386
• Intentional self-harm (suicide): 48,344

From 2017 to 2018, age-adjusted death rates decreased for 6 of 10 leading causes of death and increased for 2. The rate decreased 0.8% for heart disease (from 165.0 in 2017 to 163.6 in 2018), 2.2% for cancer (152.5 to 149.1), 2.8% for unintentional injuries (49.4 to 48.0), 2.9% for chronic lower respiratory diseases (40.9 to 39.7), 1.3% for stroke (37.6 to 37.1), and 1.6% for Alzheimer disease (31.0 to 30.5). The rate increased by 4.2% for influenza and pneumonia (14.3 to 14.9) and 1.4% for suicide (14.0 to 14.2). Rates for diabetes and kidney disease did not change significantly.

Deadliest Diseases Worldwide

In 2019, the top 10 causes of death accounted for 55% of the 55.4 million deaths worldwide (WHO, 2020). The top global causes of death, in order of the total number of lives lost, are associated with three broad topics: cardiovascular (ischaemic heart disease, stroke), respiratory (chronic obstructive pulmonary disease, lower respiratory infections), and neonatal conditions – which include birth asphyxia and birth trauma, neonatal sepsis and infections, and preterm birth complications.

Why do we need to know the reasons people die?

It is important to know why people die to improve how people live (WHO, 2020). Measuring how many people die each year helps to assess the effectiveness of our health systems and direct resources to where they are needed most. For example, mortality data can help focus activities and resource allocation among sectors such as transportation, food and agriculture, and the environment as well as health.

COVID-19 has highlighted the importance for countries to invest in civil registration and vital statistics systems to allow daily counting of deaths, and direct prevention and treatment efforts. It has also revealed inherent fragmentation in data collection systems in most low-income countries, where policy-makers still do not know with confidence how many people die and of what causes.

A Comparison of Death by Age in the United States

The major causes of death vary significantly among age groups. Congenital diseases and accidents are major causes of death among children, then accidents and suicides are the leading causes of death between ages 10 and 24. This changes again in middle and late adulthood, as heart disease and cancer combined cause over 50% of deaths for those aged between 45 and 65.

Notice that unintentional injuries are the leading cause of death for the widest variety of ages, and recall from the previous section above that accidents were also found to have become increasingly common as causes of death within the United States population between 2000 and 2016. These were the top causes of death for various age groups in the United States in the year 2016:

• < 1 year – Congenital anomalies
• 1 – 4 years – Unintentional Injury
• 5 – 9 years – Unintentional Injury
• 10 – 14 years – Unintentional Injury
• 15 – 24 years – Unintentional Injury
• 25 – 34 years – Unintentional Injury
• 35 – 44 years – Unintentional Injury
• 45 – 54 years – Malignant Neoplasms (cancer)
• 55 – 64 years – Malignant Neoplasms (cancer)
• 65 + – Heart Disease

The causes of death on this list resemble the causes presented in the previous sections, but the breakdown of these causes by age group highlights the true prevalence of each. Unintentional injury (accidents), for example, was found to be the third most common cause of death within the United States population, but it becomes apparent from this list that it is the most common for the widest range of age groups or developmental stages. Heart disease was found to be the most common cause of death overall, but this list shows that it is more restricted to one age group (65+) than other causes. Similarly, cancer was found to be the second most common cause of death within the United States population, but this list reveals that it is most prevalent for individuals in middle to late adulthood.

Death and The Media

Interestingly, the things that actually result in death are not often the things we hear about on the news. Because of the availability heuristic—a cognitive shortcut in which people rely heavily on information that is most readily available in their mind, people may erroneously be more afraid of sensational deaths than death by more normal causes, such as heart disease.

The Process of Dying

Aspects of Death

One way to understand death and dying is to look more closely at physiological death, social death, and psychological death. These deaths do not occur simultaneously, nor do they always occur in a set order. Rather, a person’s physiological, social, and psychological deaths can occur at different times (Butow, 2017).

Physiological death occurs when the vital organs no longer function. The digestive and respiratory systems begin to shut down during the gradual process of dying. A dying person no longer wants to eat as digestion slows, the digestive track loses moisture, and chewing, swallowing, and elimination become painful processes. Circulation slows and mottling, or the pooling of blood, may be noticeable on the underside of the body, appearing much like bruising. Breathing becomes more sporadic and shallow and may make a rattling sound as air travels through mucus-filled passageways. Agonal breathing refers to gasping, labored breaths caused by an abnormal pattern of brainstem reflex. The person often sleeps more and more and may talk less, although they may continue to hear. The kinds of symptoms noted prior to death in patients under hospice care (care focused on helping patients die as comfortably as possible) are noted below.

When a person is brain dead or no longer has brain activity, they are clinically dead. Physiological death may take 72 or fewer hours. This is different from a vegetative state, which occurs when the cerebral cortex no longer registers electrical activity but the brain stems continue to be active. Individuals who are kept alive through life support may be classified this way.

Social death begins much earlier than physiological death. Social death occurs when others begin to withdraw from someone who is terminally ill or has been diagnosed with a terminal illness. Those diagnosed with conditions such as AIDS or cancer may find that friends, family members, and even health care professionals begin to say less and visit less frequently. Meaningful discussions may be replaced with comments about the weather or other topics of light conversation. Doctors may spend less time with patients after their prognosis becomes poor. Why do others begin to withdraw? Friends and family members may feel that they do not know what to say or that they can offer no solutions to relieve suffering. They withdraw to protect themselves against feeling inadequate or from having to face the reality of death. Health professionals, trained to heal, may also feel inadequate and uncomfortable facing decline and death. A patient who is dying may be referred to as “circling the drain,” meaning that they are approaching death. People in nursing homes may live as socially dead for years with no one visiting or calling. Social support is important for quality of life and those who experience social death are deprived of the benefits that come from loving interaction with others.

Psychological death occurs when the dying person begins to accept death and to withdraw from others and regress into the self. This can take place long before physiological death (or even social death if others are still supporting and visiting the dying person) and can even bring physiological death closer. People have some control over the timing of their death and can hold on until after important occasions or die quickly after having lost someone important to them. In some cases, individuals can give up their will to live. This is often at least partially attributable to a lost sense of identity.  The individual feels consumed by the reality of making final decisions, planning for loved ones—especially children, and coping with the process of his or her own physical death.

Interventions based on the idea of self-empowerment enable patients and families to identify and ultimately achieve their own goals of care, thus producing a sense of empowerment. Self-empowerment for terminally ill individuals has been associated with a perceived ability to manage and control things such as medical actions, changing life roles, and the psychological impacts of the illness (Butow, 2017).

Treatment plans that are able to incorporate a sense of control and autonomy into the dying individual’s daily life have been found to be particularly effective in regards to general attitude as well as depression level. For example, it has been found that when dying individuals are encouraged to recall situations from their lives in which they were active decision-makers, explored various options, and took action, they tend to have better mental health than those who focus on themselves as victims. Similarly, there are several theories of coping that suggest active coping (seeking information, working to solve problems) produces more positive outcomes than passive coping (characterized by avoidance and distraction). Although each situation is unique and depends at least partially on the individual’s developmental stage, the general consensus is that it is important for caregivers to foster a supportive environment and partnership with the dying individual, which promotes a sense of independence, control, and self-respect.