Annual Causes of Death in the United States

(alcohol - liver failure and warnings for acetaminophen and NSAIDS) "... we [the U.S. Food and Drug Administration, HHS] have recent data suggesting that acetaminophen may be the most common cause of acute liver failure in the United States (Ref. 13). Therefore,we believe that the word "severe" is appropriate in the liver warning. In addition, we agree with the submission that the word "severe" is also appropriate in the stomach bleeding warning on OTC NSAID [nonsteroidal anti-inflammatory drug] products."

Editor's Note: The required labeling for acetaminophen and NSAID products in this Federal Register entry was:

"For products containing acetaminophen:
"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask a doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage."

"For products containing NSAIDs:
"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take (name of active ingredient) or other pain relievers/fever reducers. (Name of active ingredient) may cause stomach bleeding."

Causes of Death - Data

(2010 - causes of death - death penalty) "Up to 1000 people are executed for drug offences each year, in direct violation of international law.⁽²⁾"

(2000-2010 - death and serious patient outcomes from FDA approved drugs) "These data describe the outcome of the patient as defined in U.S. reporting regulations (21 CFR 310.305, 314.80, 314.98, 600.80) and Forms FDA 3500 and 3500A (the MedWatch forms). Serious means that one or more of the following outcomes were documented in the report: death, hospitalization, life-threatening, disability, congenital anomaly and/or other serious outcome. Documenting one or more of these outcomes in a report does not necessarily mean that the suspect product(s) named in the report was the cause of these outcomes."

Editor's Note: These data show "deaths" totaling 452,780 and "serious outcomes" equaling 2,816,297 occurred during the eleven years from 2000 to 2010 as tabulated from the FDA's Adverse Event Reporting System for prescription drugs.

Comparing the five years (2001-2005) with the five years (2006-2010) finds that the number of deaths grew by +66.7% for the second time frame as compared to first. For the same comparative spans, serious patient leaped by almost three quarters (+77.5%).

^{1 AERS = Adverse Events Reporting System. This system managed by the U.S. Food and Drug Administration (FDA) contains over four million reports of adverse events and reflects data from 1969 to the present. Data from AERS are presented as summary statistics. These summary statistics cover data received over the last ten years. These data are presented at the individual report level; some of the numbers may reflect duplicate reporting due to factors such as follow-up reports received on a case or different persons reporting on the same patient case.}

(2009 - causes of death - emergency room visits) "In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pharmaceuticals, compared with 1.0 million ED visits related to use of illicit drugs such as heroin and cocaine (3)."

(2009 - causes of death - drug violence in Mexico) "The cross-border flow of money and guns into Mexico from the United States has enabled well-armed and well-funded cartels to engage in violent activities. They employ advanced military tactics and utilize sophisticated weaponry such as sniper rifles, grenades, rocket-propelled grenades and even mortars in attacks on security personnel. DTOs have openly challenged the GOM through conflict and intimidation and have fought amongst themselves to control drug distribution routes. The results led to unprecedented violence and a general sense of insecurity in certain areas of the country, particularly near the U.S. border. Between January and September 2009, there were 5,874 drug-related murders in Mexico, an almost 5 percent increase over 2008 (5,600)."

(2009 - causes of death - harms of prescription drugs) "Each year offers new examples of injuries and deaths caused by untoward dangers in prescription drugs. Prominent illustrations from recent years include Vioxx, a popular arthritis painkiller that more than doubled the risk of heart attacks and strokes,⁶ a risk that lingered long after users stopped taking the drug;⁷ “Phen-fen,” a diet drug that caused heart damage;⁸ and Propulsid, a drug that reduced gastric acid but also threatened patients’ hearts.⁹ Once information on these side-effects became known to the public, the manufacturers of each of these drugs stopped selling them and, eventually, paid millions or billions of dollars to settle claims for resulting injuries.¹⁰ Merck, for example, having withdrawn the profitable Vioxx drug¹¹ from the market in 2004, settled nearly 50,000 Vioxx cases in late 2007 for $4.85 billion.¹² In 2009, Eli Lilly agreed to plead guilty and pay $1.415 billion in criminal and civil penalties for promoting its antipsychotic drug, Zyprexa, as suitable for uses not approved by the Food and Drug Administration (“FDA”).¹³ These cases may be among the more prominent, but they represent just the tip of the iceberg of damage caused by prescription drugs."

(2009 - causes of death - annual causes of death by cause)

^{1 Based on the International Classification of Diseases, Tenth Revision, Second Edition, 2004
2 Drug induced include both legal and illicit drugs.
3 As calculated in the American Journal of Public Health.}

(1999-2008 - causes of death - opiate pain reliever overdose deaths) "During 1999–2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR increased in parallel (Figure 2). The overdose death rate in 2008 was nearly four times the rate in 1999. Sales of OPR in 2010 were four times those in 1999."

(2008 - causes of death - prescription drug overdose) "In 2008, a total of 36,450 deaths were attributed to drug overdose, a rate of 11.9 per 100,000 population (Table 1), among which a drug was specified in 27,153 (74.5%) deaths. One or more prescription drugs were involved in 20,044 (73.8%) of the 27,153 deaths, and OPR were involved in 14,800 (73.8%) of the 20,044 prescription drug overdose deaths."

(2008 - causes of death - drug violence in Mexico) "More than 5,600 people died in drug trafficking violence in Mexico in 2008, more than double the prior year. This escalation in the level of violence was matched by a growing ferocity. Beginning in early 2008, there was an increase in assassinations of high-level law enforcement officials, gruesome murders including beheadings, violent kidnappings, use of a growing and varied arsenal of high-powered weapons, and one incidence of indiscriminate killing of civilians.⁶ The battle for control of the multi-billion dollar drug trade has been—and continues to be—brutal. While the U.S. and Mexican media began to shift their attention away from the sensational crimes allegedly committed by the Mexican DTOs in late spring, the high numbers of killings have continued, exceeding an estimated 2,000 thus far in 2009."

(1999-2007 - causes of death - opioid deaths) "From 1999 to 2007, the number of U.S. poisoning deaths involving any opioid analgesic (e.g., oxycodone, methadone, or hydrocodone) more than tripled, from 4,041 to 14,459, or 36% of the 40,059 total poisoning deaths in 2007. In 1999, opioid analgesics were involved in 20% of the 19,741 poisoning deaths. During 1999–2007, the number of poisoning deaths involving specified drugs other than opioid analgesics increased from 9,262 to 12,790, and the number involving nonspecified drugs increased from 3,608 to 8,947."

(2006 - cause of death - alcohol) "In 2006, a total of 22,073 persons died of alcohol-induced causes in the United States (Tables 23 and 24). This category includes not only deaths from dependent and nondependent use of alcohol, but also accidental poisoning by alcohol. It excludes unintentional injuries, homicides, and other causes indirectly related to alcohol use as well as deaths due to fetal alcohol syndrome."

(2007 - cause of death - alcohol) "In 2007, a total of 23,199 persons died of alcohol-induced causes in the United States, 1,126 more deaths than in 2006."

(2006 - causes of death - suicide) The US Centers for Disease Control reports that in 2006, there were a total of 33,300 deaths from suicide in the US.

(2006 - causes of death - drug induced) "In 2006, a total of 38,396 persons died of drug-induced causes in the United States (Tables 21 and 22). This category includes not only deaths from dependent and nondependent use of legal or illegal drugs, but also poisoning from medically prescribed and other drugs. It excludes unintentional injuries, homicides, and other causes indirectly related to drug use, as well as newborn deaths due to the mother’s drug use."

(2007 - causes of deaths - drug induced causes) "In 2007, a total of 38,371 persons died of drug-induced causes in the United States."

(2006 - causes of death - homicide) "The US Centers for Disease Control reports that in 2006, there were a total of 18,573 deaths from homicide in the US.

(2003 - causes of death - HIV and race) The Centers for Disease Control reported that in 2003, HIV disease was the 22nd leading cause of death in the US for whites, the 9th leading cause of death for blacks, and the 13th leading cause of death for Hispanics.

(2000 - causes of death - illicit drug use) "Illicit drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. An estimated 3 million individuals in the United States have serious drug problems. Several studies have reported an undercount of the number of deaths attributed to drugs by vital statistics; however, improved medical treatments have reduced mortality from many diseases associated with illicit drug use. In keeping with the report by McGinnis and Foege, we included deaths caused indirectly by illicit drug use in this category. We used attributable fractions to compute the number of deaths due to illicit drug use. Overall, we estimate that illicit drug use resulted in approximately 17000 deaths in 2000, a reduction of 3000 deaths from the 1990 report."

(2001 - homicide rates by country) "Since the definition of homicide is similar in most countries, absolute comparisons of rates are possible. For the period 1999 to 2001, the average rate (the number of homicides per 100,000 population) was 1.6 in the EU with the highest rates in Finland (2.9), Northern Ireland (2.7) and Scotland (2.2). For the other countries, the highest rates were found in Russia (22.1), Estonia (10.6), Lithuania (10.6) and the USA (5.6)."

(2000 - causes of death - leading causes) "The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400,000 deaths; 16.6%), and alcohol consumption (85,000 deaths; 3.5%). Other actual causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000)."

Correction: According to a correction published by the Journal on January 19, 2005, "On page 1240, in Table 2, '400,000 (16.6)' deaths for 'poor diet and physical inactivity' in 2000 should be '365,000 (15.2).' A dagger symbol should be added to 'alcohol consumption' in the body of the table and a dagger footnote should be added with 'in 1990 data, deaths from alcohol-related crashes are included in alcohol consumption deaths, but not in motor vehicle deaths. In 2000 data, 16,653 deaths from alcohol-related crashes are included in both alcohol consumption and motor vehicle death categories."

(1999 - causes of death - marijuana safety) "Indeed, epidemiological data indicate that in the general population marijuana use is not associated with increased mortality."

(1998 - causes of death - hospitalization) "Our study revealed that experiencing an ADR [Adverse Drug Reaction] while hospitalized substantially increased the risk of death (1971 excess deaths, OR 1.208, 95% CI 1.184-1.234). This finding reflects about a 20% increase in mortality associated with an ADR in hospitalized patients. Extrapolating this finding to all patients suggests that 2976 Medicare patients/year and 8336 total patients/year die in U.S. hospitals as a direct result of ADRs; this translates to approximately 1.5 patients/hospital/year."

(1998 - causes of death - marijuana safety)
"3. The most obvious concern when dealing with drug safety is the possibility of lethal effects. Can the drug cause death?

"4. Nearly all medicines have toxic, potentially lethal effects. But marijuana is not such a substance. There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality.

"5. This is a remarkable statement. First, the record on marijuana encompasses 5,000 years of human experience. Second, marijuana is now used daily by enormous numbers of people throughout the world. Estimates suggest that from twenty million to fifty million Americans routinely, albeit illegally, smoke marijuana without the benefit of direct medical supervision. Yet, despite this long history of use and the extraordinarily high numbers of social smokers, there are simply no credible medical reports to suggest that consuming marijuana has caused a single death.

"6. By contrast aspirin, a commonly used, over-the-counter medicine, causes hundreds of deaths each year.

"7. Drugs used in medicine are routinely given what is called an LD-50. The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity. A number of researchers have attempted to determine marijuana's LD-50 rating in test animals, without success. Simply stated, researchers have been unable to give animals enough marijuana to induce death.

"8. At present it is estimated that marijuana's LD-50 is around 1:20,000 or 1:40,000. In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette. NIDA-supplied marijuana cigarettes weigh approximately .9 grams. A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response.

"9. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity."

(1998 - causes of death - adverse drug reactions) "Adverse drug reactions are a significant public health problem in our health care system. For the 12,261,737 Medicare patients admitted to U.S. hospitals, ADRs were projected to cause the following increases: 2976 deaths, 118,200 patient-days, $516,034,829 in total charges, $37,611,868 in drug charges, and $9,456,698 in laboratory charges. If all Medicare patients were considered, these figures would be 3 times greater."

(1996 - causes of death - NSAIDS) "Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States." (NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid.)

(1993-1999 - causes of death - emergency department visits, hospitalizations and deaths from acetaminophen-related liver injury) "... acetaminophen-related liver injury led to approximately

• 56,000 emergency department visits (1993–1999),
• 26,000 hospitalizations (1990–1999), and
• 458 deaths (1996–1998).

"Of these cases, unintentional acetaminophen overdose was associated with
• 13,000 emergency department visits (1993–1999),
• 2189 hospitalizations (1990–1999), and
• 100 deaths (1996–1998) (71 FR 77314 at 77318)."