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March 2, 1994

Actual Causes of Death in the United States

Author Affiliations

Wisconsin Department of Health and Social Services Madison
University of Virginia Charlottesville

JAMA. 1994;271(9):659. doi:10.1001/jama.1994.03510330037018

To the Editor.  —The recent article by Drs McGinnis and Foege1 identifies and quantifies major nongenetic factors that contribute to death in the United States. They found that 50% of all deaths in 1990 were attributable to tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit drug use. McGinnis and Foege then note the significance of these findings for health policy priorities. We wholeheartedly applaud their effort and wish to propose and encourage the development of an etiologically based classification of diseases as a supplement to our current mélange known as the International Classification of Diseases. We have been involved in similar research aimed at estimating the contribution of social and behavioral factors to mortality and believe there is great benefit to a cause of death classification system that reflects true etiology.At present, we classify disease using a potpourri of discordant

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