About the Interactive Risk Charts
The numbers in the charts come from Federal government vital statistics, the best available data for cancer and non-cancer deaths, supplemented with data from federal surveys, national cohort studies and the published literature. The specific sources are the Surveillance, Epidemiology and End Results Program (SEER, National Cancer Institute) and the National Center for Health Statistics (Centers for Disease Control).
Details about the methods used to create the charts are available in Journal of the National Cancer Institute:
Woloshin S, Schwartz LM, Welch HG. The risk of death by age, sex, and smoking status in the United States: putting health risks in context. J Natl Cancer Inst. 2008 Jun 18;100(12):845-53.
[CITATION FOR ARTICLE UNDER REVIEW]
This website was created in collaboration with Lisa M. Schwartz, MD, MS and Steven Woloshin, MD, MS from the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH and Victoria Landsman, PhD from the Institute for Work & Health and University of Toronto.
About the Numbers
Most of us aren't used to seeing numbers about the chance of dying. Here is some background information to help you understand and use the information in the charts.
What are my chances of dying? This is the question the charts try to answer. But it is a not a simple question! The answer depends on a number of things. Your age, for example. Most people realize that the chance of dying goes up as you get older. Sex and race matter too – some diseases are more common or deadlier for males or females, or among Blacks or Whites. The time frame also matters. Your chance of dying in the next year is much lower than your chance of dying in the next 50 years. And of course, smoking makes a big difference. Smoking substantially increases your chance of dying from many things including heart attack, stroke, lung cancer, chronic lung disease and all-causes combined.
The purpose of the charts is to let you see your chances based on these critical factors -- age, sex, race and smoking status -- for a variety of time frames. Of course other things also affect your chance of dying. The charts do not account for other important factors - like a strong family history of a certain disease or various behaviors (like heavy drinking) or exposures (working with asbestos).
Get some perspective. A 60-year-old Black male who has never smoked has about 0.5% (5 out of 1000) chance of dying from colon cancer in the next 10 years. Is that a big or small chance? To decide, it helps to get perspective by comparing this chance with other chances. Comparing the chance of dying from different diseases helps you to appreciate which are the biggest threats you face (the ones you might want to do something about), and which threats are less worrisome. Compared to his chance of colon cancer, this 60 year old man's chance of dying from coronary heart disease in the next 10 years is much bigger, 2.8% (28 out of 1000); his chance of dying from prostate cancer is about the same (0.6%), while his chance of dying from rabies is much lower - less than 0.1%, (less than 1 out of 1000).
Another important way to get perspective is to consider the chance of dying from anything (called "all causes" in the charts). It allows you to see how each individual cause of death contributes to the total. Because there are so many causes of death, you can't simply add up the numbers in each column of the charts. So we have a row across the top of the big picture charts with the chance of dying from all causes at each age. In our example, the chance that a 60-year old Black male who never smoked will die from anything over the next 10 years is 13.6%.
Don't smoke. The charts really show how smoking increases the chance of death. In our example, this 60-year-old Black male never smoker's chance of death from any cause over the next 10 years would increase from 13.6% to 36.5% if he were a smoker. The 10-year risk of death for a never-smoker isn't that high until after age 70. In terms of the chance of dying, then, being a current smoker added more than 10 years to this man's age. So remember, avoiding cigarettes is the most powerful way to lower your chance of dying overall or suffering or dying from a variety of diseases, such as lung cancer, emphysema, heart or vascular disease.
The big picture charts are all about the chance of dying over the next 10 years. While the 10-year time frame is arbitrary, it makes sense. It's not too long (it's easy to imagine) and it's not too short (so the chances aren't forced to look too small). And it allows time to do things like change your lifestyle (most importantly not smoking) or consider proven screening tests - to lower your chances.
Changing the time frame matters a lot. The longer the time, the larger the chance. To see how chances change over time, you can create custom charts which provide the chances over the next 5, 10, or 20 years.
The Your Chances option lets you see the top 5 or 10 causes of death (or all the causes included in the charts) for a person based on the sex, race and exact age you select. To show how much smoking matters, we show the causes for a never, former or current smoker. To show you how things change over time, we also show the causes for the same person when they will be 10 years or 20 years older.
And the special cancer tables give you a different kind of perspective: they let you compare the risk of diagnosis and death for a variety of cancers. For most diseases, getting the disease is much more likely than dying from it. Although many people believe cancer is a death sentence, this is far from the case. By comparing the risk of being diagnosed with a cancer to your risk of death from the cancer you can get a sense of how deadly the cancer really is.
If you want to read more about how to make sense of messages about chance, you can download the book "Know your chances: Understanding health statistic - How to see through the hype in the medical news, ads and public service announcements" (University of California Press) for free from the National Library of Medicine.
About the Cause of Death Categories
In most cases, we used standard National Center for Health Statistics' 113 most common causes of death categories as defined in the Deaths: Leading Causes reports available from the CDC's National Vital Statistics Reports. We modified standard categories, however, in several instances to enhance clinical meaning. For example, the NCHS 113 list includes the category "ischemic heart disease" which consists of deaths from acute myocardial infarction, other acute and chronic ischemic heart disease, and atherosclerotic cardiovascular disease. We modified the list to create a category called "coronary heart disease," which includes all the foregoing "ischemic heart disease" deaths plus deaths from associated complications (eg, congestive heart failure and arrhythmia). In addition, some causes of death have been removed from our list (e.g., "Certain other intestinal infections"). Refer to the Cause of Death Definitions for the ICD-10 codes used to define the causes of death included in this website.
About the Problems With Death Certificate Data
The accuracy of the charts ultimately depends on accurate attribution of death on death certificates and the methods used by the National Center for Health Statistics to assign the underlying cause of death. Assigning an underlying cause of death for individuals with multiple medical problems is particularly challenging since there is often uncertainty in the chain of events leading to death. It is likely that both under- and over-counting of deaths occurs. Diabetes and hypertension deaths, for example, are probably under-counted: they are often reported as contributing factors rather than as the underlying cause of death.
Probability of being diagnosed and dying from cancer
This website provides probabilities of dying from a variety of cancer and non-cancer causes based on your age, sex, race (White/Black/all races) and category of smoking exposure (current/former/never smoker), and the probabilities of being diagnosed with many different cancers by age, sex and race (but not by smoking status). These probabilities have been calculated by the US National Cancer Institute (NCI) software DevCan, with additional calculations necessary to derive mortality rates by smoking status which are used as input into DevCan. For more information about the methods used in the probability of dying calculations, please see Methods Used in DevCan.
Data for the Big Picture Charts, Custom Charts and Your Chances tabs are from the National Center for Health Statistics (NCHS, using years 2016-2018) (mortality); the National Health Interview Survey (NHIS, smoking prevalence), and the NHIS linked mortality file (NHIS-LMF); and multiple cohort studies (Carter, NEJM, 2015; CPS II Nutrition cohort, NIH-AARP cohort, and Nationwide American Cancer Society Prospective Cohorts), (relative risks).
Data for the Special Cancer Tables tab are from the 21 registries of the Surveillance, Epidemiology, and End Results (SEER) program (incidence), and the National Center for Health Statistics (NCHS) (mortality) - both for years 2016-2018.
Cause of Death Definitions
|Cause of Death||Smoking-related
|ICD-10 Coding 3|
|Abdominal Aortic Aneurysm||Yes||I71.3, I71.4|
|Acute Myeloid Leukemia||Yes||C92.0|
|Aortic Aneurysm Outside Abdomen||Yes||I71.0-I71.2, I71.5-I71.9|
|Breast Cancer (Female)||Yes||C50|
|Chronic Liver Disease and Cirrhosis||Yes||K70, K73-K74|
|Colon and Rectum Cancer||Yes||C18-C21, C26.0|
|Coronary Heart Disease||Yes||I20-I25, I42.0, I42.8, I42.9, I44-I46, I50|
|Heart Lining Disease||Yes||I30-I32|
|Heart Rhythm Disease (Atrial fibrillation/flutter)||Yes||I47-I49|
|Heart Valve Disease||Yes||I00-I02, I05-I09, I33-I39|
|High Blood Pressure||Yes||I10-I15|
|Kidney and Renal Pelvis Cancer||Yes||C64-C65|
|Lung and Bronchus Cancer||Yes||C34|
|Lung Circulation Disease||Yes||I26-I28|
|Oral Cavity and Pharynx Cancer||Yes||C0-C14|
|Peripheral Vascular Disease (PVD)||Yes||I739|
|Urinary Bladder Cancer||Yes||C67|
|Acute Lymphocytic Leukemia||No||C91.0|
|Acute Monocytic Leukemia||No||C93.0|
|Brain and Other Nervous Systems Cancer||No||C70-C72|
|Chicken Pox & Shingles||No||B01-B02|
|Chronic Lymphocytic Leukemia||No||C91.1|
|Chronic Myeloid Leukemia||No||C92.1|
|Complications of Health Care||No||Y40-Y84, Y88|
|Criminal Justice System||No||Y35, Y89.0|
|Enlargement of the Prostate||No||N40|
|Kidney Failure||No||N00-N07, N17-N19, N25-N27|
|Kidney Infections||No||N10-N12, N13.6, N15.1|
|Lung Disease Due to Aspiration||No||J69|
|Lung Disease from Environmental Exposure||No||J60-J66, J68|
|Malnutrition and Vitamin Deficiencies||No||E40-E64|
|Meningitis||No||A39, G00, G03|
|Multiple Myeloma||No||C90.0, C90.2|
|Non-Hodgkin Lymphoma||No||C82-C85, C96.3|
|Other Anemia||No||D50-D54, D60-D64|
|Scarlet Fever and Erysipelas||No||A38, A46|
|Shigellosis and Amebiasis||No||A03, A06|
|Sickle Cell Anemia||No||D57|
|Suicide||No||U03, X60-X84, Y87.0|
|Thalassemia and Other Hereditary Anemias||No||D55-D56, D58-D59|
|Tick Related Brain Infections||No||A83-A84, A85.2|