Premature Death in District of Columbia

District of Columbia

Premature death is a measure of years of potential life lost due to death occurring before the age of 75. Deaths at younger ages contribute more to the premature death rate than deaths occurring closer to age 75. For example, a person dying at age 70 would lose five years of potential life, whereas a child dying at age five would lose 70 years of potential life. 

According to the National Center for Health Statistics WISQARS Years of Potential Life Lost (YPLL) Report, unintentional injury (including drug overdose deaths, which have risen significantly in the last two decades), cancer, heart disease, COVID-19, suicide, homicide and liver disease were, in order, the leading causes of years of potential life lost before age 75 in 2020. 

Risk factors for premature death include obesity, smoking and exposure to environmental hazards such as poor air quality. Risk factors for heart disease, such as high blood pressure, high cholesterol, Type 2 diabetes and physical inactivity, are also risk factors for premature death. Occupational hazards and risky behaviors like not wearing seatbelts and motorcycle helmets and misusing drugs can increase the risk of unintentional injuries and premature death. Social factors such as low education, poverty, racial segregation and inadequate social support also contribute to premature death.

Populations at higher risk for premature death include:

• American Indian/Alaska Native (AI/AN) people, who have premature death rates 40% greater than those of non-Hispanic white people. Infant mortality rates are nearly 2 times higher among AI/AN children compared with white children and are a major contributor to the premature death rate. AI/AN populations also have a disproportionately high rate of unintentional injury deaths due to a number of factors, including rural environments, lack of traffic safety and higher rates of alcohol-related accidents. The cumulative effects of historical trauma, genocide, forced migration and discrimination are also responsible for higher mortality rates among the AI/AN population. 
• Black people, whose premature mortality rates were consistently double those of the white population from 1960 through 2009, and remain higher than most other racial/ethnic groups today. Racial disparities in cardiovascular disease and homicide have long been the leading drivers of higher rates of premature mortality, as well as staggering and persistent gaps in birth outcomes. Black populations have the highest infant mortality rate in the United States — more than twice those of non-Hispanic white and Asian populations.
• People who live in rural counties compared with those in urban counties. Non-Hispanic Black adults in rural counties have the highest mortality rate; however, non-Hispanic white adults in rural areas are the only population in the United States with a steadily increasing mortality rate. This spike is primarily due to increased poisonings, including drug overdoses and suicides.

The conditions that contribute to premature death differ from community to community and local solutions need to be found that account for specific health needs. Health officials can encourage lifestyle changes to help prevent premature deaths by reducing risk factors. These may include changes in diet, exercise, alcohol consumption and tobacco use, as well as medical treatment for chronic conditions such as depression, diabetes or hypertension. 

The Centers for Disease Control and Prevention (CDC) has sponsored many health equity interventions, including:

• The Traditional Foods Project, aimed at reducing rates of Type 2 diabetes in American Indian/Alaska Native populations.
• The Boston Children’s Hospital’s Community Asthma Initiative, an intervention for Black and Hispanic children at risk of asthma complications.
• Initiatives funded by the CDC’s Colorectal Cancer Control Program (CRCCP), which implement multicomponent interventions to increase colorectal cancer screening among racial and ethnic minority populations.

Intervention strategies that encourage individuals to seek preventive medical care and achieve healthy lifestyles can be effective in reducing premature death by:

• Screening for certain health risks, such as alcohol misuse, diabetes, depression, high blood pressure and breast, cervical and colorectal cancers.
• Raising vaccination rates. Vaccines are a safe and cost-effective way of protecting infants, adolescents and adults from potentially life-threatening preventable diseases. A complete list of vaccine-specific recommendations is available from the Advisory Committee on Immunization Practices and the CDC publishes vaccine schedules by age.

Increasing access to care for currently underserved minority populations is critical for decreasing premature death rates. More research is needed to determine effective methods of increasing access to behavioral health and primary care for racial and ethnic minority populations.

One of the overarching goals of Healthy People 2030 is to “attain healthy, thriving lives and well-being free of preventable disease, disability, injury and premature death.” While Healthy People 2030 does not have a specific goal for reducing premature death, it does set goals for many contributors to premature death, including: 

• Reducing the cancer death rate.
• Reducing fatal injuries. 
• Reducing deaths related to tobacco use.
• Improving cardiovascular health and reducing deaths from heart disease and stroke.
• Reducing maternal deaths.
• Reducing the rate of infant deaths. 
• Reducing the rate of child and adolescent deaths.

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