The State of Our Health - Causes Of Death — Then And Now

What are we dying of? To begin a look at this topic, let's compare the major causes of death a century apart — in 1900 and in 2000. In a century, methods of classification have changed a little, but the general categories still hold. The leading cause of death, a hundred years ago as now, is the failure of the heart. The heart is a perennial organ — in life as in death. But, thereafter, things are not the same.

Data for the year 1900 combine all of the "major cardiovascular diseases." These include diseases of the heart, stroke (cerebrovascular diseases), hypertension (accompanied or not by renal disease), atherosclerosis, and other forms of heart disease. This combined category also was the leading cause of death in 2000, but data at time of publication were not yet available in full detail to create a matching category. Therefore we show diseases of the heart and stroke in combination. All data are in deaths per 100,000 of population.

In 1900, sulphonamide (sulfa) drugs had not yet been invented and bacterial diseases carried people off in large numbers. Influenza and pneumonia ranked second as a cause of death. The great influenza epidemic of 1918 was still in the future, and pneumonia was known as the "old man's friend" — because the old man (or the old lady) swooned off to death rapidly as the infection, which inflames the pulmonary lining, got into the blood stream and carried people off rapidly and relatively painlessly. It was considered a natural cause of death. Influenza is a severe, contagious, viral respiratory disease that occasionally leads to death, especially for people who already have lung disease or are weak. These diseases were still very much with us in 2000 and still ranked in the top 10 — but in seventh position.

Tuberculosis — once known ominously as consumption, the bloody cough — is an infectious disease that settles in the lungs but can spread from there and attack other organs. According to the National Institutes of Health (NIH), 8 million people are still infected annually around the world, and of these 3 million die. TB, as it is also known, came to be controlled by antibiotics but is now staging a return linked, by NIH, to the HIV/AIDS epidemic (those affected are more vulnerable), crowding (which helps to spread it); poverty (it weakens the constitution); and drug use (which decimates the body). There are also other factors, like immigration. In 2000, TB made news by its reemergence, but it did not rank in the top 10 causes of death.

In 2000, cancer was the second leading cause of death. Among the malignancies, lung cancer is the leading killer. Looking at medical causes only, narrowly construed, heart attack, stroke, and lung cancer take the most lives. It was already present in 1900. In that year, of the top 10 causes of death malignant neoplasms ranked sixth. Lung cancer is associated with smoking. In the 19th century, women largely refrained. The other leading cancers — of digestive organs, genitals, women's breasts, urinary organs, and leukemia — are less clearly linked to behavior.

Chronic lower respiratory diseases include, notably, asthma, bronchitis, and emphysema. Most deaths are associated with a diversity of other lower respiratory ailments, but of those named, emphysema is the leader and is much more likely to have been caused by smoking than by coal dust or other industrial pollution.

Thus in 100 years, we have largely overcome infectious and most viral killers but have replaced them, at least in part, by diseases that may be due to our behavior. The heart's failure, however, then as now, is the leading cause of death.

Source: For 1900 data: U.S. Bureau of the Census. Historical Statistics of the United States. Table B149-166, p. 58. For 2000 data: Centers for Disease Control and Prevention. Online. Available: at http://www.cdc.gov/nchs/hphome.htm.