News media and policy makers frequently discuss deaths from firearms, drug overdoses, and motor vehicle accidents. Numerical details about these 3 causes of death are usually presented in news stories and in government reports as absolute numbers (eg, 67,000 drug overdose deaths last year) or as annual rates (eg, 12 motor vehicle accident deaths/100,000 population). But people often have difficulty appreciating the magnitude of both large numbers (such as tens of thousands of deaths) and small numbers (such as a death rate of 0.00012). Cumulative lifetime risk may be a useful metric for understanding the impact of these causes of death. Moreover, previous research indicates that patients prefer to receive cumulative risk estimates, perceive such estimates as indicating higher risk, and are more willing to receive treatment when presented with the lifetime risk of a disease.
A study based on 1992-1994 data estimated lifetime risk of death from motor vehicle accidents, but such deaths have decreased since then. In addition, the lifetime risk of deaths from firearms and drug overdoses have not previously been quantified. As a result, this study sought to determine the lifetime risk of death from these 3 causes for the United States as a whole; for race, ethnicity, and gender subgroups; and for individual states.
Methods
Data on population size and all-cause, firearm, drug overdose, and motor vehicle accident deaths were obtained from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) system for the year 2018. As defined in CDC WONDER, firearm deaths correspond to the International Statistical Classification of Diseases (ICD-10) codes U01.4, W32-W34, X72-X74, X93-X95, Y22-Y24, and Y35.0, whereas motor vehicle accident deaths (including deaths of pedestrians and cyclists involving motor vehicles) correspond to codes V02-V04, V09.0, V09.2, V12-V14, V19.0-V19.2, V19.4-V19.6, V20-V79, V80.3-80.5, V81.0-81.1, V82.0-V82.1, V83-V86, V87.0-V87.8, V88.0-V88.8, V89.0, and V89.2. As defined by the National Institute on Drug Abuse, drug overdose deaths correspond to codes X40-X44, X60-X64, X85, and Y10-Y14. Population size and deaths were categorized into 5-year age groups except for the 2 youngest age groups, which were categorized as <1 year and 1-4 years. These data were obtained for the United States as a whole; for race, ethnicity, and gender subgroups; and for individual states. The first 4 columns in the Appendix available online display the data obtained for the United States for all-cause and firearm deaths. All analyses are based on the underlying cause of death (ie, the disease or injury that led directly to death based on entries by a physician on a death certificate).
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-Ashwini R. Sehgal, MD
