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Death Comes In Many Different Ways. And Some Are A Bit Surprising

A vigil is held against violence in Cali, Colombia. The country has seen some 1,090 homicides this year.
Luis Robayo
AFP/Getty Images
A vigil is held against violence in Cali, Colombia. The country has seen some 1,090 homicides this year.

We're living longer.

And cardiovascular disease and infectious diseases aren't taking quite as much of a toll as they did a couple of decades ago.

But that doesn't mean we're immortal.

Road accidents, suicide, chronic kidney disease, alcohol-related diseases ... these are a few of the topics to discuss after looking at a new country-by-country analysis of causes of death by the Institute for Health Metrics and Evaluation at the University of Washington.

There are 188 countries included. We spoke to IHME's director, Dr. Christopher Murray, about some of the more unusual findings.

Stroke, heart disease and lung cancer are the three big killers. What else are you seeing?

In Central America you start to see really interesting things. Violence is the No. 1 cause of premature death in El Salvador, Colombia and Venezuela. Chronic kidney disease is No. 2 in Mexico. And you wouldn't even find a national policy on chronic kidney disease. It's a big issue in not just Mexico but other countries in Central America, and it's starting to be a big issue in East Asia.

Why is chronic kidney disease a problem in these parts of the world?

The Central American issue is very controversial. Partly it's diabetes and obesity. But it's believed to be pesticide-related by one group. Another group believes it might be an unrecognized viral illness that's the cause. There's active research on what might account for this, but very little recognition [by governments] of how huge it is.

What else strikes you in the data?

Road traffic injuries is the No. 1 cause of premature death in four countries in the Middle East, the No. 3 cause of premature death in China.

Is that because of dangerous drivers or careless pedestrians?

Probably both. Probably poorly enforced traffic regulations, drunk driving, lots of vehicles without safety restraints like air bags and seat belts. And the mixing of pedestrians and cars. There are ways you can intervene that would not be that expensive.

Like what?

Railings at danger points, for example, so people can't walk across the street at random.

Anything strike you as just plain odd?

One that's very strange is that there are a very large number of deaths in Bolivia recorded as "foreign body aspiration," where kids, in particular, get a foreign body stuck in their airway and die.

What kind of foreign body?

I don't know. When we were inquiring about this in Bolivia, they gave us local names for things — I don't know what they were.

Alzheimer's is on the top 10 causes of death for 2013 but was not in 1990. How come?

Because the population in the world is much older, many more people die from Alzheimer's. But it's not yet a big issue in sub-Saharan Africa. There are very few people living into their 70s and 80s.

Suicide is a leading cause of death in South Korea and also in China. Why is that?

I don't know why in Korea, but if you're the government of South Korea and you look at these numbers, you have to try to understand the trend. We know more about suicide in China. There's a huge variation across provinces, almost as much as fivefold variations in suicide. There are theories that say once you have high suicide rates it's kind of self-perpetuating. People know people who've committed suicide; they also know about the means of suicide. There's this notion that it's almost a contagion. But these are theories. The good news in China is that suicide rates are down a lot in the last 20 years. We attribute a lot of that to economic progress and to more emancipation of younger people from their families.

The report also notes that women are living longer than men, and the gap in death rates for men and women in the 20-44 age bracket is widening.

One of the big drivers is men in the countries of the former Soviet Union. There's a big increase in the death rate [in that bracket] in Eastern Europe and alcohol is likely a part of it.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Marc Silver
Marc Silver, who edits NPR's global health blog, has been a reporter and editor for the Baltimore Jewish Times, U.S. News & World Report and National Geographic. He is the author of Breast Cancer Husband: How to Help Your Wife (and Yourself) During Diagnosis, Treatment and Beyond and co-author, with his daughter, Maya Silver, of My Parent Has Cancer and It Really Sucks: Real-Life Advice From Real-Life Teens. The NPR story he co-wrote with Rebecca Davis and Viola Kosome -- 'No Sex For Fish' — won a Sigma Delta Chi award for online reporting from the Society of Professional Journalists.
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