The things that kill Knoxvillians before their time
by Joe Tarr
I'm cruising down the highway.
Traffic is heavy, and cars are weaving in and out around me. My wipers creak softly as they clear my windshield of the sprinkling rain.
It's dusk and I've been driving for hours and everything is getting bleary. It's all just relentless boredom: I've been on this road so many times, and I just want to get where I'm going. I flip through the radio dial, but there aren't any decent stations to be found, just tired oldies, classic rock and talk show stations.
It happens so fast, I don't have time to react. I don't see the Ford Explorer veering into my lane until it crunches against my little hatchback and is pushing me underneath the tractor-trailer in the next lane. I can hear steel crumpling and now there is nothing really I can do but perhaps I scream or maybe I just let go to the inevitable. And I wonder if it'll hurt and I wonder who and what I'll think of when I finally see death has arrived.
Well, that's one way I imagine death finding me, anyway. Another strong possibility is that cancer will get me—it runs heavy in my family—and I'll spend my last days puking from the chemotherapy that fails to save me.
As it turns out, those two scenarios are quite likely ways to die in Knox County.
Cancer, heart disease, and accidents are the most probable ways people here will die if they go before age 75, according to "Premature Death in Knox County, TN: 2000; Years of Potential Life Lost," a new study by the Knox County Health Department.
The study is the most complete look ever done here on how people die. Its results are so fresh that few people at the health department have seen them. So the process of figuring out what it means and what problems should be addressed hasn't begun.
"We're probably one of the only counties in Tennessee to have this information," says Micky Roberts, director of community health planning at the health department.
The national Centers for Disease Control defines a premature death as one that happens before a person is 75. (Any death after 75, no matter what the cause, is not defined as "unnatural.") Statisticians then look at the number of potential years lost in a community to determine what the biggest threats are to the community. For instance, if a person dies at 55, that's 20 years lost.
In 2000, Knox County lost 8,290 years from 1,652 premature deaths. Almost a quarter of all the years lost were due to cancer, with lung cancer the most lethal. The county lost an estimated 1,947 years of potential life to cancer (from 500 deaths) in 2000.
This maybe shouldn't be so surprising, given that the Knoxville metropolitan area is second only to Toledo, Ohio, in the number of smokers, Roberts says.
Heart disease claimed the second highest number of premature deaths and unintentional injuries ranked third, taking 1,493 and 1,174 years, respectively (or 18 and 14 percent of all potential years lost in 2000).
The next biggest causes after that are murder and suicide, which each claimed 4 percent of the years lost.
Among African Americans, the most years were lost to cancer, heart disease, and murder. However, their accident rate was fairly low, claiming only 4.7 percent of the years lost.
This data may be somewhat misleading, says Eugene Fitzhugh, the statistician who compiled it. Because African Americans make up such a small percent of the population—about 8.5 percent—a single death from murder can cause a spike in the statistics.
As far as gender differences are concerned, men die earlier from just about everything. Only diabetes and cerebrovascular diseases claimed more women than men under the age of 75.
Roberts says he hopes the findings are taken to heart by all of the county, not just people in the health department. "You can only go so far with that approach," he says. "We know knowledge alone doesn't change behavior. Any kid can tell you what's written on a pack of cigarettes, but that doesn't keep them from smoking."
The best way to deal with it is by getting lots of people and organizations involved, Roberts says. So, the health department has a program to build community coalitions to address public health issues, from smoking to domestic violence to HIV. (HIV killed 12 people in 2000, erasing 107 years of potential life. It was the second lowest of the death causes, above influenza and pneumonia.)
In the past nine years, the health department has helped start 30 coalition programs, 28 of which are still running. One of those programs led to a state law requiring domestic violence awareness training for all police, fire, and ambulance workers, Roberts says.
Knoxvillians have made progress on some health problems, but lost ground on others. The way people keep statistics changes so much that comparisons can be difficult. However, statistics kept by the state show some changes in what threatens us.
In 1940, the leading causes of death (for all ages) in the state were heart disease, cerebral hemorrhage, cancer, tuberculosis and pneumonia, in descending order, according to the state health department.
Heart disease killed 5,545 people, or about 190 people for every 100,000. In 2000, 16,128 people died from heart disease, or 283 for every 100,000. Similarly, cancer death rates mushroomed between 1940 and 2000—from 75 to 216 deaths for every 100,000 people.
Although accidental deaths now rank third in the state, the rate itself has actually decreased. In 1940, 62 people for every 100,000 were killed in accidents. In 2000, the rate was 47.9 for every 100,000.
Finally, people are dying less frequently. In 1940, 1,023 people in every 100,000 died. Two years ago, the figure was 968.
A separate survey, also done by the health department, shows that many Knox Countians don't feel too good these days. The survey found that the average resident reported feeling unhealthy seven days in the past month. On average, they had 2-1/2 days where they felt so bad they had to limit their activities. And 12 out of every 100 adults have frequent mental distress—14 or more days in the month when they felt depressed or worse. But, on the good side, 83 percent of the population felt they had good-to-excellent health.
The results break down notably along income levels. Of those who make more than $50,000 a year, 93 percent reported being healthy. Of those who make less than $15,000, only 60 percent said they feel healthy. Education and race were also indicators. Ninety-one percent of those with college degrees reported being healthy, while only 56 percent of those without a high school diploma did. And, about 84 percent of whites and 77 percent of blacks said they were healthy.
Stephanie Hall, public health officer for the county health department, has spent a lot of the past year preparing for bio-terrorism attacks. And yet, people in Knox County are far more likely to die from cigarettes, cheeseburgers, and automobiles than from smallpox or anthrax.
"People are really terrified of bioterrorism, smallpox, whatever," Hall says. "And yet, what statistically is going to kill them, we live with those risks everyday."
January 2, 2003 * Vol. 13, No. 1
© 2003 Metro Pulse
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