The US: A 5.4%er in Infectious Disease Mortality

As nations civilize and become rife with sanitation, vaccines, health care providers that causes of death of the population will change. In this transition, infectious diseases became less substantial components of overall mortality as heart disease, cancer, strokes, and other conditions -- typically associated with longer life spans -- begin to became the major causes of death. Such has been the case in the US for quite some time. Indeed, the decline of infectious diseases after the advent of penicillin is what first gave rise to the need for a distinct group of physicians to develop specialized knowledge of what had become relatively rare illnesses.

A new paper. published in JAMA, attempts to quantify what proportion of deaths in the US can be attributed to an infectious cause. The verdict is that between 1980 and 2014 infectious diseases comprised 5.4% of the causes of mortality of the US. While the 5.4% number may seem relatively small there are a couple of important aspects of this statistic that merit consideration:

  • The revolutionary impact of antiretroviral treatment on survival rates of those infected with HIV
  • The rise of deaths from infections such as Clostridium difficile and West Nile Virus
  • The relative plateauing of deaths from pneumonia and influenza
  • The decline death rate from vaccine preventable illnesses

I wonder, however, if 5.4% is the true number as it was ascertained from death certificates which I have found to be pseudo-random in what is listed as a cause of death. Additionally, sepsis -- a final common pathway to death for many infections -- is clearly a major contributor to deaths, accounting for half of all hospital deaths. It is debatable whether sepsis, as a non-specific non-pathogen centric diagnosis, should be included however, strictly speaking, it is infectious disease-related.

Another important aspect of this research is understanding how low we can get with infectious disease mortality. There are several avenues for this and it is unclear from where the highest yield will emerge.  One strategy that come to my mind includes attacking the pneumonia/influenza death rate -- which comprises 40% of infectious disease deaths-- through a better influenza vaccine coupled to higher uptake of influenza and pneumococcal vaccines.

I think it is long since time the US aim for, join, and found the 1% club for infectious disease mortality.