Where you live may determine how you die, study suggests

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By JoNel Aleccia

Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests.

Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country.

In 2013, nearly two-thirds of Oregonians who died did so at home, compared with fewer than 40 percent of people elsewhere in the US, according to the report published Wednesday in the New England Journal of Medicine. Previous research had shown that more than 85 percent of Americans say they’d prefer to die at home.

“Obviously, if you’ve spent decades trying to improve your end-of-life care, it’s pretty rewarding to see that something changes,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, who co-led the study.

The review analyzed Medicare fee-for-service claims data from 2000, 2005, and 2013, and it compared end-of-life care in Oregon and Washington — a nearby state with similar demographics and attitudes toward end-of-life care — with the rest of the US, excluding those two states.

It found that in 2013, ICU use in the last 30 days of life was about 18 percent in Oregon, compared with 23 percent in Washington and 28.5 percent in the rest of the US. Nearly three-quarters of patients in Oregon hospitalized in the last month of life were discharged to home, compared with slightly fewer than two-thirds in Washington state and a little more than half — 54.2 percent — in the rest of the US.

More than 40 percent of patients in Oregon were enrolled in home hospice in 2013, compared with about 30 percent in Washington and fewer than 20 percent in the rest of the US, the analysis found.

Oregon, which enacted the nation’s first death-with-dignity law and led the way on implementing portable medical orders for treatment at the end of life, may be reaping the results of those and other efforts, said Tolle’s coauthor, Dr. Joan Teno, a professor of medicine, gerontology, and geriatrics at the University of Washington in Seattle.

“When you look at the patterns, it’s very different than the rest of the United States,” she said. “It’s even different than a borderline state.”

Pat Duty, 64, who ran a Portland floor-covering business with her husband, Jimmy, for years, said Oregon’s palliative care culture helped guide treatment decisions after his 2013 diagnosis of lung cancer and dementia. Jimmy Duty wanted limited medical interventions; he had a do-not-resuscitate order, plus a request to avoid the ICU.

“He was very clear that quality of life was his first choice,” Pat Duty recalled. “We knew we needed to discuss these things while he could make decisions for himself. We wanted to give him the dignity and grace he deserved for his final couple of years.” He died in October 2015 at age 74.

Creating such a culture is much harder than it looks, Tolle and Teno argued. Oregon has successfully integrated awareness of end-of-life care at all levels, from state government and emergency care to individual decisions made by patients and their doctors.

“If patients’ goals are not linked to actionable care plans that are supported by local health care systems and state regulations, many patients who wish to remain at home will die intubated for all the reasons the current system fails them,” they wrote.

Across the US, there’s been a push to promote ways to indicate end-of-life treatment preferences, including advance directives, which provide guidance for future care, and Physician Orders for Life-Sustaining Treatment, or POLST, portable medical orders authorizing current care. Twenty-two states now have POLST programs and others are working on or considering them, said Tolle, who co-led the creation of POLST in the early 1990s.

But the researchers warned that, while POLST efforts are important, simply filling out the forms is not enough.

“We were highlighting that there’s no simple answer,” Tolle said. “You can’t just do one thing and think that you will change the culture of end-of-life care. It is a whole lot of work.”

Dr. Scott Halpern, a medical ethics and health policy expert at the Perelman School of Medicine at the University of Pennsylvania, has been a chief critic of POLST efforts, contending that there’s little evidence that the medical orders improve quality of life near death.

The new analysis by Tolle and Teno doesn’t fill the gap, he said. But he agreed with the authors’ contention that a focus on single interventions ignores the complexity of end-of-life decisions.

“Good end-of-life care involves physicians eliciting patients’ values, hopes and fears and making treatment decisions that align,” Halpern said.

The new analysis, which was funded by a grant from the Robert Wood Johnson Foundation, underscores that families and patients outside of Oregon must be vigilant to ensure they receive the care they want, Tolle said.

“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,” she said.

Complete Article HERE!

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New research identifies a ‘sea of despair’ among white, working-class Americans

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Princeton economists Angus Deaton and Anne Case continue to report on sickness and early death among white, middle-aged, working-class Americans.

Sickness and early death in the white working class could be rooted in poor job prospects for less-educated young people as they first enter the labor market, a situation that compounds over time through family dysfunction, social isolation, addiction, obesity and other pathologies, according to a study published Thursday by two prominent economists.

Anne Case and Angus Deaton garnered national headlines in 2015 when they reported that the death rate of midlife non-Hispanic white Americans had risen steadily since 1999 in contrast with the death rates of blacks, Hispanics and Europeans. Their new study extends the data by two years and shows that whatever is driving the mortality spike is not easing up.

VIDEO: Here’s what you need to know about the life expectancy drop

The two Princeton professors say the trend affects whites of both sexes and is happening nearly everywhere in the country. Education level is significant: People with a college degree report better health and happiness than those with only some college, who in turn are doing much better than those who never went.

Offering what they call a tentative but “plausible” explanation, they write that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a “cumulative disadvantage” over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease and suicide.

“Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline,” they conclude.

The study comes as Congress debates how to dismantle parts of the Affordable Care Act. Case and Deaton report that poor health is becoming more common for each new generation of middle-aged, less-educated white Americans. And they are going downhill faster.

In a teleconference with reporters this week, Case said the new research found a “sea of despair” across America. A striking feature is the rise in physical pain. The pattern does not follow short-term economic cycles but reflects a long-term disintegration of job prospects.

“You used to be able to get a really good job with a high school diploma. A job with on-the-job training, a job with benefits. You could expect to move up,” she said.

The nation’s obesity epidemic may be another sign of stress and physical pain, she continued: “People may want to soothe the beast. They may do that with alcohol, they may do that with drugs, they may do that with food.”

Similarly, Deaton cited suicide as an action that could be triggered not by a single event but by a cumulative series of disappointments: “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.”

The economists say that there is no obvious solution but that a starting point would be limiting the overuse of opioids, which killed more than 30,000 Americans in 2015.

The two will present their study on Friday at the Brookings Institution.

“Their paper documents some facts. What is the story behind those facts is a matter of speculation,” said Adriana Lleras-Muney, a University of California at Los Angeles economics professor, who will also speak at Brookings.

She noted that less-educated white Americans tend to be strikingly pessimistic when interviewed about their prospects.

“It’s just a background of continuous decline. You’re worse off than your parents,” Lleras-Muney said. “Whereas for Hispanics, or immigrants like myself” — she is from Colombia — “or blacks, yes, circumstances are bad, but they’ve been getting better.”

David Cutler, an economics professor at Harvard who also will be discussing the paper at Brookings, said the declining health of white, working-class Americans suggests that Republican plans to replace the Affordable Care Act are akin to bleeding a sick patient. As he put it, “Treat the fever by causing an even bigger fever.”

Whites continue to have longer life expectancy than African Americans and lower death rates, but that gap has narrowed since the late 1990s. The picture may have shifted again around the Great Recession, however: Graphs accompanying the new paper suggest that death rates for blacks with only a high school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites.

White men continue to die at higher rates than white women in every age group. But because women started with lower death rates, the recent mortality increase reflects a greater change in their likelihood of dying early. The numbers reported by Case and Deaton suggest that white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely.

Case and Deaton play down geography as a factor in the epidemic. Yet they note that white mortality rates fell in the biggest cities, were constant in big-city suburbs and rose in all other areas. The Washington Post’s analysis published last year highlighted the same geographical signature, with a break in death rates between the two most urban classifications (big cities and big-city suburbs) and the four less urban classifications, which The Post described as an urban-rural divide.

Last week, the Centers for Disease Control and Prevention published a report on U.S. suicides by level of urbanization between 1999 and 2015, a period in which 600,000 Americans took their own lives. The report showed rising rates in each of the six urbanization classifications but found “a geographic disparity” in which rates increased as urbanization decreased. That urban-rural divide appears to have widened, particularly in recent years, the CDC reported.

Complete Article HERE!

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Hard Luck

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From a bet gone wrong to the man suffocated by BOOBS…these are 8 of the most bizarre cases of people who died during sex

By George Harrison

THESE are the shocking true stories of the unfortunate people who died whilst having sex.

The tragic stories highlight a dangerous side to everyone’s favourite pastime, so remember to take care next time you get your rocks off.

This mountain of X-rated magazines crushed a man to death at his flat in Japan

Crushed by porn stash

One man recently met a sticky end after being crushed by a mountain of pornographic magazines.

The Japanese man, named as 50-year-old Joji, was found six months after his six-tonne stash of porn magazines fell on him.

Cleaners tasked with tidying his neglected flat found that the entire apartment was rammed with the explicit magazines.

It is unknown whether the man, a former car-manufacturer, had died from a heart attack and then fell into a stack of pornography, or whether he was crushed to death by his X-rated collection.

Plunge of passion

In 2007 a couple from Columbia, South Carolina, fell to their deaths after plunging naked from the roof of an office building.

The bodies of Brent Tyler and Chelsea Tumbleston, both 21, were found by a taxi driver in the middle of an otherwise-empty street at 5am.

The couple’s clothes were later found on the roof of a nearby building, where they were believed to have been having a risky outdoor romp before falling from the roof.

One man died after taking enough Viagra to get him through a 12-hour romp

Half-day romp ends in tragedy

A Russian man died in 2009 after completing a 12-hour orgy with female pals, who had bet him over £3,500 that he couldn’t keep going for half a day.

Minutes after completing the bet, mechanic Sergey Tuganov died of a heart attack, which had been caused by the huge quantity of Viagra he had guzzled to prepare him for the task.

A woman was mauled to death by a lion after having sex in the nearby bush

Eaten by a lion after romping in the bush

In 2013, a Zimbabwean news website reported that a couple were attacked by a lion after having sex in the bush.

The big cat killed Sharai Mawera after interrupting the couple, although her unidentified lover managed to run away before he could be killed.

After notifying the police, the male lover, who escaped wearing only a condom, found the woman’s mauled body at the scene of the attack.

Smothered to death by lover’s breasts

Donna Lange, 51, smothered her lover to death inside a mobile home.

The intoxicated woman, from Washington, claimed she didn’t know how the man died, although a witness claimed to have seen her crush his face with her chest.

A Chinese student died of a heart attack after making a donation to a sperm bank

Sperm bank heart attack

A trainee doctor, Zheng Gang, died of a heart attack in 2011 – after over-exerting himself whilst producing a sample at a sperm bank.

The 23-year-old was pronounced dead at the scene of China’s Wuhan University, where he had spent two hours inside a booth, having already visited four times that week.

Policeman cops it during a threesome

A cop died in 2009 when his heart gave out during a threesome – and his wife sued his doctor for not warning him against having sex.

William Martinez, a 31-year-old Atlanta police officer, died whilst having sex with another woman and a male friend.

But his wife won $3 million (£2.4 million) after suing his doctor for not warning him that he had a weak heart, and should avoid strenuous activities.

Death by neo-Nazi roleplay

A sick neo-Nazi roleplaying session ended in tragedy, after 38-year-old Simon Burley died when a sex game with lover Elizabeth Hallam went wrong.

The hanging-enthusiast had a noose fitted around his neck whilst his lover played the part of a Nazi executioner, who hanged him as part of a sex game they were playing.

Unfortunately, the knife she planned to cut him down with was blunt, and the man was left to suffocate to death at his house in Grimsby.

Complete Article HERE!

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Dying of a Broken Heart

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Is grief powerful enough to kill? The world is mourning the death of actress Debbie Reynolds who herself was in mourning following the death of her daughter Carrie Fisher just one day earlier. Could that grief have played a part in the stroke that killed her? “I was not surprised to hear of her death,” says Katherine Supiano, PhD, LCSW, FT, Director of the Caring Connections Grief Program at the University of Utah. “This is an uncommon phenomenon, but it does happen. Even the American Heart Association has recognized ‘broken heart syndrome’ as a cause of death following the death of someone close.”

The American Heart Association is not the only organization that has looked into “broken heart syndrome.” A study published in the Journal of the American Medical Association in 2014 found older adults who lost a partner saw their risk of dying from a heart attack or a stroke double in the 30 days following. One reason may be that stress raises the level of cortisol in body. Increased levels of cortisol have been linked to cardiovascular death. Other hormones may play a role as well. “Emotional stressors can also lead to a significant release in adrenaline,” says John Ryan, MD, a cardiologist with University of Utah Health Care. “This can have an impact on the cardiovascular system.”

Physical changes in the body are not solely responsible for the increased risk though. People make behavioral changes while under stress or suffering from grief. These may impact their health. “They may not be taking care of themselves,” says Ryan. “They may not be taking medications for underlying conditions, or they may be eating poorly, or start smoking again. All of these can raise their risks of cardiovascular problems.”

The nature of the relationship lost may also be a factor. A close caregiving bond may be harder to lose, especially if that caregiving relationship has been long standing – like that of a mother with a child. “We all know that Carrie Fisher had several difficulties in her life,” says Supiano. “Reynolds may have been in the role of emotional caregiver. When that role was no longer available the stress may have become overwhelming contributing to her death.”

Supiano says that in situations like these it might not just be grief and stress, but also a feeling that now caregiving is no longer needed that the work of the caregiver is done. “We do hear people say that,” she says. “And in some cases, very quietly, their lives end.”

While grief may make a person feel they want to die – the vast majority do not. The levels of stress hormones will dissipate over time, and behavioral patterns will return to normal. Life will go on. “People are hard wired to be able to grieve,” says Supiano. “The majority of people are actually highly resilient and given enough time, and social support most people navigate this pretty well.”

Complete Article HERE!

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How do people die from cancer? You asked Google – here’s the answer

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Every day millions of internet users ask Google life’s most difficult questions, big and small. Our writers answer some of the commonest queries

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 ‘Contrary to popular fears, patients attest that awareness of dying does not lead to greater sadness, anxiety or depression.’
‘Contrary to popular fears, patients attest that awareness of dying does not lead to greater sadness, anxiety or depression.’

Our consultation is nearly finished when my patient leans forward, and says, “So, doctor, in all this time, no one has explained this. Exactly how will I die?” He is in his 80s, with a head of snowy hair and a face lined with experience. He has declined a second round of chemotherapy and elected to have palliative care. Still, an academic at heart, he is curious about the human body and likes good explanations.

“What have you heard?” I ask. “Oh, the usual scary stories,” he responds lightly; but the anxiety on his face is unmistakable and I feel suddenly protective of him.

“Would you like to discuss this today?” I ask gently, wondering if he might want his wife there.

“As you can see I’m dying to know,” he says, pleased at his own joke.

If you are a cancer patient, or care for someone with the illness, this is something you might have thought about. “How do people die from cancer?” is one of the most common questions asked of Google. Yet, it’s surprisingly rare for patients to ask it of their oncologist. As someone who has lost many patients and taken part in numerous conversations about death and dying, I will do my best to explain this, but first a little context might help.

Some people are clearly afraid of what might be revealed if they ask the question. Others want to know but are dissuaded by their loved ones. “When you mention dying, you stop fighting,” one woman admonished her husband. The case of a young patient is seared in my mind. Days before her death, she pleaded with me to tell the truth because she was slowly becoming confused and her religious family had kept her in the dark. “I’m afraid you’re dying,” I began, as I held her hand. But just then, her husband marched in and having heard the exchange, was furious that I’d extinguish her hope at a critical time. As she apologised with her eyes, he shouted at me and sent me out of the room, then forcibly took her home.

It’s no wonder that there is reluctance on the part of patients and doctors to discuss prognosis but there is evidence that truthful, sensitive communication and where needed, a discussion about mortality, enables patients to take charge of their healthcare decisions, plan their affairs and steer away from unnecessarily aggressive therapies. Contrary to popular fears, patients attest that awareness of dying does not lead to greater sadness, anxiety or depression. It also does not hasten death. There is evidence that in the aftermath of death, bereaved family members report less anxiety and depression if they were included in conversations about dying. By and large, honesty does seem the best policy.

Studies worryingly show that a majority of patients are unaware of a terminal prognosis, either because they have not been told or because they have misunderstood the information. Somewhat disappointingly, oncologists who communicate honestly about a poor prognosis may be less well liked by their patient. But when we gloss over prognosis, it’s understandably even more difficult to tread close to the issue of just how one might die.

Thanks to advances in medicine, many cancer patients don’t die and the figures keep improving. Two thirds of patients diagnosed with cancer in the rich world today will survive five years and those who reach the five-year mark will improve their odds for the next five, and so on. But cancer is really many different diseases that behave in very different ways. Some cancers, such as colon cancer, when detected early, are curable. Early breast cancer is highly curable but can recur decades later. Metastatic prostate cancer, kidney cancer and melanoma, which until recently had dismal treatment options, are now being tackled with increasingly promising therapies that are yielding unprecedented survival times.

But the sobering truth is that advanced cancer is incurable and although modern treatments can control symptoms and prolong survival, they cannot prolong life indefinitely. This is why I think it’s important for anyone who wants to know, how cancer patients actually die.

Cancer cells release a plethora of chemicals that inhibit appetite and affect the digestion and absorption of food’
Cancer cells release a plethora of chemicals that inhibit appetite and affect the digestion and absorption of food’

“Failure to thrive” is a broad term for a number of developments in end-stage cancer that basically lead to someone slowing down in a stepwise deterioration until death. Cancer is caused by an uninhibited growth of previously normal cells that expertly evade the body’s usual defences to spread, or metastasise, to other parts. When cancer affects a vital organ, its function is impaired and the impairment can result in death. The liver and kidneys eliminate toxins and maintain normal physiology – they’re normally organs of great reserve so when they fail, death is imminent.

Cancer cells release a plethora of chemicals that inhibit appetite and affect the digestion and absorption of food, leading to progressive weight loss and hence, profound weakness. Dehydration is not uncommon, due to distaste for fluids or an inability to swallow. The lack of nutrition, hydration and activity causes rapid loss of muscle mass and weakness. Metastases to the lung are common and can cause distressing shortness of breath – it’s important to understand that the lungs (or other organs) don’t stop working altogether, but performing under great stress exhausts them. It’s like constantly pushing uphill against a heavy weight.

Cancer patients can also die from uncontrolled infection that overwhelms the body’s usual resources. Having cancer impairs immunity and recent chemotherapy compounds the problem by suppressing the bone marrow. The bone marrow can be considered the factory where blood cells are produced – its function may be impaired by chemotherapy or infiltration by cancer cells.Death can occur due to a severe infection. Pre-existing liver impairment or kidney failure due to dehydration can make antibiotic choice difficult, too.

You may notice that patients with cancer involving their brain look particularly unwell. Most cancers in the brain come from elsewhere, such as the breast, lung and kidney. Brain metastases exert their influence in a few ways – by causing seizures, paralysis, bleeding or behavioural disturbance. Patients affected by brain metastases can become fatigued and uninterested and rapidly grow frail. Swelling in the brain can lead to progressive loss of consciousness and death.

In some cancers, such as that of the prostate, breast and lung, bone metastases or biochemical changes can give rise to dangerously high levels of calcium, which causes reduced consciousness and renal failure, leading to death.

Uncontrolled bleeding, cardiac arrest or respiratory failure due to a large blood clot happen – but contrary to popular belief, sudden and catastrophic death in cancer is rare. And of course, even patients with advanced cancer can succumb to a heart attack or stroke, common non-cancer causes of mortality in the general community.

You may have heard of the so-called “double effect” of giving strong medications such as morphine for cancer pain, fearing that the escalation of the drug levels hastens death. But experts say that opioids are vital to relieving suffering and that they typically don’t shorten an already limited life.

It’s important to appreciate that death can happen in a few ways, so I wanted to touch on the important topic of what healthcare professionals can do to ease the process of dying.

In places where good palliative care is embedded, its value cannot be overestimated. Palliative care teams provide expert assistance with the management of physical symptoms and psychological distress. They can address thorny questions, counsel anxious family members, and help patients record a legacy, in written or digital form. They normalise grief and help bring perspective at a challenging time.

People who are new to palliative care are commonly apprehensive that they will miss out on effective cancer management but there is very good evidence that palliative care improves psychological wellbeing, quality of life, and in some cases, life expectancy. Palliative care is a relative newcomer to medicine, so you may find yourself living in an area where a formal service doesn’t exist, but there may be local doctors and allied health workers trained in aspects of providing it, so do be sure to ask around.

Finally, a word about how to ask your oncologist about prognosis and in turn, how you will die. What you should know is that in many places, training in this delicate area of communication is woefully inadequate and your doctor may feel uncomfortable discussing the subject. But this should not prevent any doctor from trying – or at least referring you to someone who can help.

Accurate prognostication is difficult, but you should expect an estimation in terms of weeks, months, or years. When it comes to asking the most difficult questions, don’t expect the oncologist to read between the lines. It’s your life and your death: you are entitled to an honest opinion, ongoing conversation and compassionate care which, by the way, can come from any number of people including nurses, social workers, family doctors, chaplains and, of course, those who are close to you.

Over 2,000 years ago, the Greek philosopher Epicurus observed that the art of living well and the art of dying well were one. More recently, Oliver Sacks reminded us of this tenet as he was dying from metastatic melanoma. If die we must, it’s worth reminding ourselves of the part we can play in ensuring a death that is peaceful.

Complete Article HERE!

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The top 10 leading causes of death in the U.S.

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By MARY BROPHY MARCUS

hospital

Heart disease and cancer still top the list as the leading causes of death in the United States, but the gap is closing between the two. A new report out from the Centers for Disease Control and Prevention looks at the shifting trends in Americans’ health and mortality, and the conditions most likely to take lives.

In 2014, a total of 2,626,418 deaths were reported in the United States, and the age-adjusted death rate decreased 1 percent to a record low.

Bob Anderson, chief of the CDC’s Mortality Statistics Branch, told CBS News the 15 leading causes of death in 2014 remained the same as in 2013.

“We all have to die of something at some point. When you’re looking at these categories you have to account for the fact that there are competing risks, but you can’t avoid death,” said Anderson.

Why the list, then?

“We want to create a society where we live as long as we can, as healthy as we can,” he said. Crunching the data provides researchers with information that will help develop prevention programs, he explained.

Anderson, who oversaw the production of the National Center for Health Statistics report, shared some insights into the top ten:

1. Heart disease

While heart disease has topped the list for years now, the actual number of deaths and the death rate for heart disease has come down by quite a bit over recent decades, said Anderson.

“The decline goes back about 50 years. For trends in heart disease, you see a substantial increase from the beginning of 20th century to 1950 or so, and then it starts to come down. It mirrors the rise and decline in smoking in the United States

“What we’ve seen in last 20 or 30 years is rapid decline in heart disease. The decline has been fairly rapid and rapid enough so it’s sort of overshadowed the aging of the population,” said Anderson.

However, a new study published this week in JAMA Cardiology, by Kaiser Permanente researchers, shows that the decline in deaths from heart disease and stroke has slowed, nearly leveling out since 2011.

2. Cancer

Cancer has seen a gradual rise in deaths over time although death rates have declined gradually since 1990. While smoking cessation’s perks were pretty quickly reflected in a drop in heart disease-related deaths, the increasing number of cancer deaths reflect the longer term damage smoking can do, as well as a growing aging population.

“Cancer tends to occur a little bit later, it’s a more chronic issue. It kills you later than heart disease does on average,” said Anderson. “You see this increase in cancer mortality — a lot of it is lung cancer.”

He noted that the gap between heart disease and cancer deaths has narrowed substantially over time.

3. Chronic lower respiratory diseases

Chronic obstructive pulmonary disease (COPD), largely due to smoking, makes up the majority of deaths in this category. It also includes deaths from chronic bronchitis, emphysema and asthma. Again, smoking earlier in life or throughout life plays a large part in respiratory disease deaths, including secondhand smoke-related illnesses.

4. Accidents

Motor vehicle accidents, unintentional drug overdoses, and accidental falls and other injuries make up this category.

“The largest proportions of these are motor vehicle accidents and drug overdoses,” said Anderson, noting that this category does not include intentional overdoses that lead to suicide. The number of accidental drug-related deaths has been on the rise amid a growing epidemic of heroin and opioid painkiller addiction.

Deaths from motor vehicle accidents declined when seat belts and car seats for kids were mandated. “They have made a huge difference,” he added.

5. Stroke

Cerebrovascular disease, or stroke, is not considered heart disease — it involves blood vessels.

“Stroke is centered on the brain, heart disease is centered on heart. Both infarction, a blockage in blood vessels leading to the brain, and hemorrhage due to things like brain aneurisms, are included,” said Anderson.

This is another category that has dropped substantially, he added.

“For a long time cerebrovascular disease was the third leading cause of death and now it’s at five. Smoking and healthy behaviors and our ability to treat these diseases have had an impact. We’ve gotten very good at treating cardiovascular disease generally and that’s had an impact on both heart disease and stroke deaths. It’s a combination of both prevention and treatment,” Anderson said.

6. Alzheimer’s disease

Alzheimer’s disease has climbed up the list.

“A lot of the increase we’ve seen has to do with better diagnosis. Folks who work on this have come up with better diagnostic criteria. Some of these [deaths] may have in previous years been reported as dementia, which goes to a separate category,” said Anderson.

But not all of the increase has to do with better diagnosis and reporting, he noted.Alzheimer’s risk tends to increase with age, so as there have been substantial declines in heart disease and stroke, more people are living to older ages and developing Alzheimer’s.

7. Diabetes

Diabetes has bobbled up and down on the top ten list over the years.

“It hasn’t changed a whole lot over last 10 years or so. There are different risk factors. Some are inherited, like in type 1 diabetes. Much of type 2 is associated with obesity. Diabetes is also connected with other diseases, such as cardiovascular disease,” said Anderson.

He said diabetes-related deaths are likely under reported — physicians may not make it the primary cause of death on a death certificate, but “if you look at any mention of diabetes on death certificates, cases where it’s a contributing factor, the numbers are much much larger.”

There are about 76,000 deaths caused by diabetes each year, but it is listed as a contributing factor in death on close to 245,000 death certificates annually, Anderson said.

8. Influenza and pneumonia

“You have to be careful here,” Anderson said. “These are not all flu-related deaths. We combine influenza and pneumonia because we use this combination category for flu mortality surveillance. Perhaps as much as 20 percent of deaths in this category are actually associated with the flu. A lot of these deaths are elderly folks who, say, have a stroke and are in the hospital and may develop pneumonia from being in a static position.”

He said that the deaths that specifically mention flu tally only about 3,000 to 5,000 deaths a year. The deaths in this category associated with flu tend to fluctuate by flu season, but the numbers due solely to pneumonia stay pretty stable over time.

“The fluctuations in this category help us determine the effects of flu season on mortality. So that’s why these two are combined,” he explained.

9. Kidney disease

This category includes chronic kidney issues, including kidney failure or end-stage renal disease.

“A large proportion of this category is renal failure. Some are probably related to diabetes in some way, or heart disease and heart failure, and high blood pressure. It’s always been on the second half of the list, at least in recent memory,” Anderson said.

10. Suicide

Suicide is the nation’s 10th leading cause of death, and the number of cases has been on the rise. “The rate of suicide has gone up nearly steadily since 1999,” Sally Curtin, a statistician with the National Center for Health Statistics at the CDC, said when the latest figures were released this spring.

“It has typically been there between number 10 and 15, but occasionally it has popped up into the top ten and it’s something we’re keeping our eye on,” said Anderson.

Other causes

Blood poisoning, chronic liver disease and Parkinson’s disease didn’t make the top 10 list, but aren’t far behind.

“Parkinson’s is a fairly important category. It’s one of those that’s gone up — the numbers have increased over time,” Anderson said. It wasn’t on the list in the year 2000, for example.

A study out earlier this year also suggested medical errors can be blamed for a significant number of deaths each year, although they were not included on this list. Anderson said many physicians likely do not report medical errors on death certificates.

Another significant cause of death, HIV/AIDS, has been declining since its peak in 1995, but the disease still takes a high toll among men in certain age groups. For men ages 25-34, HIV/AIDS was the 8th leading cause of death in 2014.

Life expectancy

The report also found that life expectancy at birth is 78.8 years, unchanged since 2012. Life expectancy rose for black males, Hispanic males and females, and non-Hispanic black males. Life expectancy shrunk for non-Hispanic white femalesfrom 2013 to 2014, possibly due to a rise in opioid use and suicide.

Preliminary data for 2015 suggest the death rate is going up. The Centers for Disease Control and Prevention posted the numbers earlier this month. They are based on a preliminary look at 2015 death certificates. The overall death rate rose to nearly 730 deaths per 100,000 people last year, from about 723 the year before.

“I think, ideally, what we would like to see is people living well into their nineties and even early 100s in relatively good health, and dying as things just kind of wear out. That’s what I’d like to see,” Anderson said. “That’s one of the reasons for creating these lists.”

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Can You Die of Laughter?

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While laughter provides plenty of health benefits, laughing uncontrollably for a longer duration carries health risk for individuals with heart ailments.

healing experience

Laugh your way to good health. This is one piece of advice that often works in improving overall well-being. A good hearty laugh can work wonders in relieving stress. There is no better feeling than being with someone who makes you laugh. However, it appears that laughing too hard continuously may not be as good as it seems.

The British Medical Journal in its recent report highlights the ill-effects of excessive laughing in people suffering from various medical conditions. The research was carried out by University of Birmingham’s R. E. Ferner and Oxford University’s J. K. Aronson.

  • A normal laugh where there is no excessive sound is indeed good for the cardiovascular system. However, excessive laughter causes the blood pressure to increase substantially, putting too much pressure on the heart. A defective heart due to medical conditions like coronary artery disease and congestive heart failure (CHF) may not be able to handle such excessive pressure.
  • Intense laughter also increases the heart rate considerably, which patients with heart conditions are unlikely to tolerate for long. To put it simply, a faulty heart might not be able to sustain the increased heart rate associated with hard laughter.
  • Excessive laughter can also be fatal to people affected with cerebral aneurysm. Laughing out vigorously can considerably increase intracranial pressure (ICP refers to pressure inside the skull). This can cause the aneurysm to burst, which may lead to stroke. Even people with other neurological disorders are advised to avoid uncontrollable laughter to keep complications at bay.

Laughter-induced Asthma

  • People suffering from asthma should also stay away from laughing too hard. In one study, patients noticed that their symptoms laughing too hard(chest pain and coughing) worsened due to excessive laughing. However, it was observed that laughter-induced asthma wasn’t a case of medical emergency.
  • Also, the patients reported that when they can manage their asthma well, symptoms do not flare up when laughing for a longer duration. This means that exacerbation of symptoms due to laughter indicates that asthma is not being managed properly. Nevertheless, intense laughter may trigger asthma attacks. Hence, patients ought to take a cautionary approach when it comes to laughing loudly.
  • Laughing too hard also puts excessive strain on the chest muscles. Hence, people affected with respiratory conditions such as collapsed lung are often advised to avoid laughing loudly.

Laughter-induced Syncope

  • It is observed that intense laughter increases the breathing rate and when this continues for a longer duration, say for 10 to 15 minutes, it can be risky even to healthy individuals.
  • People have experienced shortness of breath during fits of laughter. There also have been reports of people losing their consciousness temporarily (for around 3 to 5 minutes); some have blacked out for a few seconds due to unrestrained laughter. Experts warn that excessive laughter tends to cause hyperventilation, which carries health risk but is unlikely to result in death.

A fit of hysterical laughter can also cause hernia to bulge out. Jaw trauma such as a dislocated jaw can also be one of the side effects of laughing too much. Excessive laughter is also responsible for triggering cataplexy, a condition that is marked by sudden temporary loss of muscle function.
Dr. Martin Samuels, professor of neurology at Harvard Medical, opines that extreme strong feelings related to sorrow or happiness stimulate an area of the brain corresponding to fight or flight response. During a fight or flight response, chemicals like adrenaline are released into the body. Too much of adrenaline can be detrimental to health, particularly the heart. So handling emotions (good or bad) in a better way is necessary to manage overall health.

Death from Laughter

  • There also have been confirmed reports of people laughing their way to death. In one instance, in 1989, Ole Bentzen, a Danish audiologist while watching a heist-comedy film A Fish Called Wanda went into uncontrollable fits of laughter. He began laughing so intensely that his heart started beating very fast and the heart rate was found to be fluctuating between 250 to 500 heartbeats per minute. This eventually caused cardiac arrest.
  • In another instance, in 1975, Alex Mitchell from England had uncontrollable fits of laughter while watching a television episode of Goodies, a popular British comedy series telecasted during the 1970s. He laughed hard non-stop for 25 minutes, which left him breathless due to severe heart failure. Later, it was found that Alex was a patient of long QT syndrome, a rare congenital heart disorder. This heart ailment may also have contributed to his death.

On the whole, experts say that contributory factors such as an underlying medical condition are likely to have played a role in causing deaths due to laughter. However, the fact remains that laughing too hard for long, although not fatal, can cause breathlessness.

Keep in mind that continuous fits of laughter can be risky but that doesn’t mean you should avoid laughing altogether. A good hearty laugh on a daily basis is in fact considered an elixir of life but make sure that the laughter-inducing moments do not leave you out of breath.

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