Actual Causes of Death
in the United States, 2000
Ali H. Mokdad, PhD
James S. Marks, MD, MPH
Donna F. Stroup, PhD, MSc
Julie L. Gerberding, MD, MPH
Context Modifiable behavioral risk factors are leading causes of mortality in the United
States. Quantifying these will provide insight into the effects of recent trends and the
implications of missed prevention opportunities.
Objectives To identify and quantify the leading causes of mortality in the United
Design Comprehensive MEDLINE search of English-language articles that identified
epidemiological, clinical, and laboratory studies linking risk behaviors and mortality.
The search was initially restricted to articles published during or after 1990, but we
later included relevant articles published in 1980 to December 31, 2002. Prevalence
and relative risk were identified during the literature search. We used 2000 mortality
data reported to the Centers for Disease Control and Prevention to identify the causes
and number of deaths. The estimates of cause of death were computed by multiplying
estimates of the cause-attributable fraction of preventable deaths with the total
Main Outcome Measures Actual causes of death.
Results The leading causes of death in 2000 were tobacco (435000 deaths; 18.1%
of total US deaths), poor diet and physical inactivity (400000 deaths; 16.6%), and
alcohol consumption (85000 deaths; 3.5%). Other actual causes of death were microbial
agents (75000), toxic agents (55000), motor vehicle crashes (43000), incidents
involving firearms (29000), sexual behaviors (20000), and illicit use of drugs
Conclusions These analyses show that smoking remains the leading cause of mortality.
However, poor diet and physical inactivity may soon overtake tobacco as the
leading cause of death. These findings, along with escalating health care costs and
aging population, argue persuasively that the need to establish a more preventive orientation
in the US health care and public health systems has become more urgent.
JAMA. 2004;291:1238-1245 www.jama.com