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1-02: Health Maintenance & Disease Prevention

Michael Pignone; René Salazar

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, 2018.
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Table 1–1. Leading causes of death in the United States, 2018.
Category Estimate
All causes 2,839,205
 1. Diseases of the heart 655,381
 2. Malignant neoplasms 599,274
 3. Unintentional injuries 167,127
 4. Chronic lower respiratory diseases 159,486
 5. Cerebrovascular diseases 147,810
 6. Alzheimer disease 122,019
 7. Diabetes mellitus 84,946
 8. Influenza and pneumonia 59,120
 9. Nephritis, nephrotic syndrome, and nephrosis 51,386
10. Intentional self-harm (suicide) 48,344

Data from National Center for Health Statistics 2020.

Table 1–2.Leading preventable causes of death in the United States, 2017.
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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

BMI, body mass index; LDL, low-density lipoprotein.

Data from the US Burden of Disease Collaborators, 2019.

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.

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US Burden of Disease Collaborators. The state of US health, 1990–2016: burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319:1444.
[PubMed: 29634829]  
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Woolf  SH  et al. Life expectancy and mortality rates in the United ...

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