Preventive medicine can be categorized as primary, secondary, or tertiary. Primary prevention aims to remove or reduce disease risk factors (eg, immunization, giving up or not starting smoking). Secondary prevention techniques promote early detection of disease or precursor states (eg, routine cervical Papanicolaou screening to detect carcinoma or dysplasia of the cervix). Tertiary prevention measures are aimed at limiting the impact of established disease (eg, partial mastectomy and radiation therapy to remove and control localized breast cancer).
Tables 1–1 and 1–2 give leading causes of death in the United States and estimates of deaths from preventable causes. Recent data suggest increased mortality rates, driven by increases in suicide and substance misuse and its sequelae. Unintentional injuries, including deaths from opioid-related overdoses, have become the third leading cause of death in the United States. Non-Hispanic whites with a high school education or less have suffered disproportionately.
Table 1–1.Leading causes of death in the United States, 2017. ||Download (.pdf) Table 1–1. Leading causes of death in the United States, 2017.
|Category ||Estimate |
|All causes ||2,179,857 |
| 1. Diseases of the heart ||647,457 |
| 2. Malignant neoplasms ||599,108 |
| 3. Unintentional injuries ||169,936 |
| 4. Chronic lower respiratory diseases ||160,201 |
| 5. Cerebrovascular diseases ||146,383 |
| 6. Alzheimer disease ||121,404 |
| 7. Diabetes mellitus ||83,564 |
| 8. Influenza and pneumonia ||55,672 |
| 9. Nephritis, nephrotic syndrome, and nephrosis ||50,633 |
|10. Intentional self-harm (suicide) ||47,173 |Table 1–2.Leading preventable causes of death in the United States, 2017. ||Download (.pdf) Table 1–2. Leading preventable causes of death in the United States, 2017.
|Category ||Estimate |
|Dietary risks ||503,390 |
|High systolic blood pressure ||454,346 |
|Tobacco ||437,706 |
|High fasting plasma glucose ||420,192 |
|High BMI ||408,831 |
|High LDL cholesterol ||221,557 |
|Impaired kidney function ||173,378 |
|Air pollution ||107,506 |
|Alcohol use ||104,536 |
|Drug use ||104,440 |
|Low physical activity ||70,844 |
|Occupational risks ||63,580 |
Many effective preventive services are underutilized, and few adults receive all of the most strongly recommended services. Several methods, including the use of provider or patient reminder systems (including interactive patient health records), reorganization of care environments, and possibly provision of financial incentives to clinicians (though this remains controversial), can increase utilization of preventive services, but such methods have not been widely adopted.
et al. Few Americans receive all high-priority, appropriate clinical preventive services. Health Aff. (Millwood). 2018 Jun;37(6):925–8.
et al. Confronting the rise and fall of US life expectancy [Editorial]. JAMA. 2019 Nov 26;322(20):1963–5.
et al. Quality and experience of outpatient care in the United States for adults with or without primary care. JAMA Intern Med. 2019 Mar ...