National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

ESTIMATING THE CONTRIBUTIONS OF LIFESTYLE-RELATED FACTORS TO PREVENTABLE DEATH

A Workshop Summary

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, NW. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This study was supported by Contract No. 200-2000-00629, Task Order No. 163 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.

Copyright 2005 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museum in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Adviser to the Nation to Improve Health

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

PLANNING COMMITTEE ON ESTIMATING THE CONTRIBUTIONS OF LIFESTYLE-RELATED FACTORS TO PREVENTABLE DEATH

JONATHAN M. SAMET, M.D., M.S., Professor and Chair,

Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

J. MICHAEL MCGINNIS, M.D., M.P.P., Senior Vice President and Director,

Health Group, Robert Wood Johnson Foundation, Washington, DC

MICHAEL A. STOTO, PH.D., Senior Statistical Scientist, and Associate Director for Public Health,

Center for Domestic and International Health Security, RAND, Arlington, VA

STAFF

ROSE MARIE MARTINEZ, Sc.D., Director,

Board on Population Health and Public Health Practice

LINDA G. MARTIN, Ph.D.,

Institute of Medicine Scholar-in-Residence

HOPE HARE, M.F.A., Administrative Assistant

Consultants

MIRIAM DAVIS, LLC, Medical Writer & Consultant

SANDRA HACKMAN, Copy Editor

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:


ALFRED O. BERG, M.D., M.P.H., University of Washington School of Medicine

STEPHEN MARCUS, PH.D., National Cancer Institute, National Institutes of Health

DAVID MATCHAR, M.D., Duke University

CHRISTOPHER MAYLAHN, Chronic Disease Director, New York State Health Department


The review of this report was overseen by MELVIN WORTH, M.D., Scholar-in-Residence at the Institute of Medicine, who was appointed by the Institute of Medicine. He was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

CONTENTS

   

 INTRODUCTION

 

2

   

 Measuring the Health Impact of Lifestyles: Scientific Challenges

 

2

   

 Attributing Risks in Preventable Deaths: What Metrics Best Inform Health Policy?

 

4

   

 SETTING THE STAGE FOR DISCUSSION

 

6

   

 Causality

 

6

   

 Attributable Risk in Epidemiology: Interpreting and Calculating Population Attributable Fractions

 

7

   

 METHODOLOGICAL ISSUES WHEN ESTIMATING LIFESTYLE FACTORS

 

11

   

 Partial Adjustment

 

11

   

 Calculating the Number of Deaths Attributable to a Risk Factor Using National Survey Data

 

12

   

 Caveats in Using Estimates of Deaths Attributable to Lifestyle Factors

 

13

   

 Estimating Population Attributable Risks: A Simulation Model Based on the NHANES I Followup Study and NHANES III

 

15

   

 Discussion of Methodological Issues When Estimating Lifestyle Factors

 

16

   

 ATTRIBUTABLE RISK IN PRACTICE: EXAMPLES FROM THE FIELD

 

17

   

 Overview of Actual Causes of Death, 1993

 

17

   

 Rationale for Actual Causes of Death, 2000

 

18

   

 The Numbers Are the Easy Part: Interpreting and Using Population Attributable Fractions

 

20

   

 Estimating the Health Impacts Attributable to Alcohol

 

21

   

 Estimating Deaths Attributable to Alcohol Consumption

 

22

   

 Estimating Adverse Health Impacts Attributable to Tobacco Use

 

24

   

 Tobacco Use and Preventable Mortality

 

26

   

 Obesity, Weight Loss, and Mortality

 

27

   

 Physical Activity

 

30

   

 Assessing the Effects of Multiple Public Health Interventions

 

31

   

 Discussion of Attributable Risk in Practice: Examples from the Field

 

32

   

 ALTERNATIVE METRICS OF BURDEN

 

33

   

 Quality-Adjusted Life Years (QALYs)

 

33

   

 Comparative Risk Assessment (DALYS)

 

35

   

 HALYs: Measuring Lifestyle-Related Factors that contribute to Premature Death and Disabililty

 

38

   

 Estimating National and State Medical Costs from Select Risk Factors

 

39

   

 Using Population Attributable Risk Estimates to Allocate Resources

 

41

   

 Discussion of Alternative Metrics of Burden

 

42

   

 PUBLIC POLICY ISSUES

 

43

   

 General Public Policy Issues

 

43

   

 State Policy Perspective

 

44

   

 Discussion of Public Policy and State Policy

 

45

   

 Ethical Issues

 

45

   

 Communication Challenges

 

47

   

 References and Additional Sources for Further Information

 

48

   

 Rapporteur’s Report

 

48

   

 DISCUSSION OF LESSONS LEARNED AND NEXT STEPS

 

50

   

 Reframing the Debate

 

50

   

 Improving Methodology

 

51

   

 Developing an Action Plan

 

51

   

 Guiding Public Policy and Creating Messages for the Public

 

52

   

 REFERENCES

 

52

   

APPENDIX A   WORKSHOP AGENDA

 

55

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×

Tables and Figures

TABLE 1

 

Findings on Actual Causes of Death, 1990

 

17

TABLE 2

 

Life-Years per $1 Million (1997 dollars)

 

42

TABLE 3

 

Examples of “Attributable” Deaths

 

49

FIGURE 1

 

The 10 Leading Causes of Death in the United States, 2002

 

5

FIGURE 2

 

Admissions for Acute Myocardial Infarction During 6-Month Periods June–November Before, During, and After the Smoke-Free Ordinance

 

6

FIGURE 3

 

Simulation: Prehypertension. Hospitalizations, Nursing Home Admissions, and Deaths Attributable to Prehypertension and Residual Hypertension

 

16

FIGURE 4

 

Relative Risk of All-Cause Mortality by Alcohol Consumption, Age, and Cardiovascular Risk, CPS-II Men and Women Combined

 

24

FIGURE 5

 

Body Mass Index and Probability of Death

 

27

FIGURE 6

 

The Effect of Age on BMI Associated with Lowest Mortality Rate

 

28

FIGURE 7

 

The Association between BMI and Mortality, BFMI and Mortality, and FFMI and Mortality, Adjusted for smoking (BFMI and FFMI Mutually Adjusted).

 

29

FIGURE 8

 

QALY Calculation

 

34

FIGURE 9

 

Attributable Disease Burden of 20 Risk Factors

 

36

FIGURE 10

 

Deaths in AMR-A Region. The region includes Canada, US, and Cuba; US population; represents 85% of the region.

 

37

FIGURE 11

 

Disease Burden in AMR-A Region. The region includes Canada, US, and Cuba; US population; represents 85% of the region

 

38

Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2005. Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11323.
×
Page R8
Next: Workshop Summary »
Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary Get This Book
×
Buy Paperback | $29.00 Buy Ebook | $23.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

This report is the summary of a workshop held by The Institute of Medicine (IOM) of the National Academy of Science December 13-14, 2004 to estimate the contributions of lifestyle-related factors to preventable death. The summary of this workshop includes presentations from experts in statistical design, epidemiology, quality-of-life measures, communication, and public policy and discussions among the participants. Panels of experts addressed the following topics: methodological issues when estimating the public health burden of lifestyle factors; estimating "attributable risk" in practice; alternative ways of measuring the health burden; and public policy issues.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!