Mortality and Longevity
Virginians are living longer, thanks to declining death rates from chronic diseases and from reduced infant mortality rates. As preventative care, access to health care, and medical treatments all improve, the traditional leading causes of death continue to fall. At the same time, injuries and longevity-related conditions such as Alzheimer's disease are growing in relative importance.
Generally speaking, the United States has mediocre mortality outcomes when compared to other developed nations. Virginia, however, generally does fairly well when compared to US averages for these same measures. Virginians have lower death rates for cardiovascular disease, chronic lung disease, accidents, diabetes and suicide, but lag the nation for cancer and infant mortality. Virginia hopes to reduce these rates further by targeting behavioral risk factors and improving the health care delivery system.
Why is This Important?
Approximately 64,000 Virginians died from all causes in 2014. Four chronic diseases (cardiovascular disease, cancer, lung disease, and diabetes) accounted for 60 percent of these deaths. The economic costs of chronic diseases and early death include reduced quality of life, lost work years, and medical costs.
Accidents killed an additional 3,147 people in 2014. And although they are numerically less significant as drivers of the overall death rate, infant mortality and suicide are economically and socially important. The infant mortality rate affects the most vulnerable among us at the earliest age and is considered an important indicator of how well a nation or region's healthcare system does its job. Suicides are also more common among younger adults and exact an enormous toll in terms of lost human potential and the grief and disruption of families.
How is Virginia Doing?
Along with Life Expectancy, Virginia's leading causes of death are presented below, in order of rank. Use the quick menu below to jump to a particular topic.
Cardiovascular disease -- blocked or weakened blood vessels, arrhythmia, and other conditions that lead to heart attacks and strokes -- is Virginia's leading cause of death. The state's death rate from diseases of the circulatory system has fallen every year since 2004 (and earlier). After adjusting for differences in age, in 2014 there were 207.1 deaths per 100,000 people in Virginia and 218.6 in the nation, giving Virginia the 24th lowest rate in the country. Minnesota again had the lowest age-adjusted rate at 163.7 per 100,000. Virginia's rate has consistently been lower than Tennessee (267.9), Maryland (219.6), and North Carolina (216.9).
Cardiovascular death rates also continue to fall across much of the Commonwealth. In 2014, the Northern (151.9), Valley (209.8), and Central (214.4) regions of Virginia had the lowest age-adjusted death rate for major cardiovascular disease, followed closely by the Hampton Roads region with 217.5 deaths. The Southside and Southwest regions again had the highest rates in 2014, with 277.8 and 274.7 deaths per 100,000 people.
Cancer is the second leading cause of death in Virginia. According to the Centers for Disease Control (CDC), Virginia ranks 22nd among the states for its age-adjusted annual cancer death rate. In 2014, Virginia's rate was 161.5 deaths per 100,000 people, slightly higher than the national average of 161.2. The 2014 cancer death rates in Tennessee, North Carolina, and Maryland were 184.2, 169.3, and 161.7, respectively. Utah again had the lowest rate in the nation at 127.4 deaths per 100,000 people.
CDC data reveal that cancer rates continue to fall in many regions of the state. The Northern region again had the lowest age-adjusted cancer mortality rate at 129.8 per 100,000 in 2014; the Southwest region had the highest rate in 2014 at 188.4 per 100,000 people.
Deaths from unintentional injuries (accidents) ranked 3rd among causes of death among Virginians in 2014, up from 4th in 2013. However, accidents are a leading cause of death for younger adults, ranking first for 18-24 year olds -- and therefore account for more years of potential life lost than many chronic diseases. The most common causes of injury are accidental falls, firearm discharges, drownings, traffic accidents, and poisonings.
Age-adjusted death rates have remained relatively steady over the last 15 years. Although they have been rising since 2010, Virginia ranked 7th lowest among states for accidental deaths, with 36.8 deaths per 100,000 people in 2014, compared to 40.5 for the US. Among peer states, Tennessee (55.6) and North Carolina (44.4) fared much worse than Virginia, while Maryland was lowest in the nation at 26.6 deaths per 100,000 in 2014.
The Southwest, Southside, and Eastern regions had the highest age-adjusted accident rates at 61.7, 57.6, and 51.7 per 100,000 people in 2014. The Northern region had the lowest rate at 28.5 deaths per 100,000 in 2014. However, this rate is higher than the low achieved in 2010 of 21.9 per 100,000.
Virginia deaths from chronic lower respiratory (lung) disease have been trending downward and dropped from the 3rd leading cause of death in 2013 to 4th in 2014. The age-adjusted death rate was 35.3 in 2014, marking another decline from 37.3 in 2013, and ranking the Commonwealth 9th best among the states. The national rate was 40.5 per 100,000. The 2014 death rate in Maryland (29.4) was lower than Virginia, but rates were higher in Tennessee (52.5) and North Carolina (45.0). Utah was best in the nation at 17.1 deaths per 100,000 people in 2014.
Although somewhat volatile from year to year, chronic lung disease rates have generally decreased in some regions of the state, but are little changed over the last 10 years in others. The Northern region again had the lowest age-adjusted lung disease rate at 23.9 per 100,000 in 2014, down from 30.6 in 2005. But the Southwest region had by far the highest rate in 2014 at 64.9 per 100,000 people -- and only slightly lower than the 65.8 deaths per 100,000 it saw in 2005.
Diabetes was the sixth leading cause of death in Virginia in 2014, accounting for 1,683 deaths. (This is slightly fewer than Alzheimer's which, at 1,775 deaths, ranked 5th, but almost exclusively affects the elderly.) Thanks in part to better preventive care and public awareness, age-adjusted death rates from diabetes have been decreasing for much of the past decade. In Virginia, the rate dropped from 22.9 per 100,000 people in 2005 to 18.5 in 2014, ranking it 10th lowest among all states. This rate was lower than the national rate in 2014 of 21.0 deaths. Virginia outperformed all peer states as well: Maryland (19.8), Tennessee (23.2), and North Carolina (23.7).
Death rates from diabetes have also dropped in many regions of the state, but remain stubbornly high in others. The Northern region had the lowest age-adjusted diabetes death rate at 13.7 per 100,000 people in 2014; the Southwest (27.6), Southside (26.1), and Hampton Roads (24.2) regions had the highest.
Suicide ranks 11th among the causes of death in Virginia. However, it deserves special scrutiny because it is the second leading cause among 18-24-year olds and exacts a disproportionate toll in terms of loss of life, medical costs, grief and suffering, and disruption of families. Given that research suggests inaccurate reporting on suicides due to the social stigma attached, official figures may understate the true total costs, both emotionally and financially, of suicides and attempted suicides.
Suicide rates have generally been rising to some degree in both Virginia and the nation overall. In 2014, Virginia had the 15th lowest (age-adjusted) suicide rate in the country: 12.9 deaths per 100,000 people. Virginia's rate was slightly lower than the national average rate of 13.1 deaths. Peer states Tennessee (14.1) and North Carolina (13.0) had higher suicide rates than Virginia, while Maryland (10.0) had a markedly lower rate. New York was the leading state, with 8.2 age-adjusted deaths per 100,000 people due to suicide.
In 2014, the Southwest region had the highest age-adjusted suicide rate at 18.9 deaths per 100,000, followed by the Valley region at 16.7 deaths. The Northern region had the lowest rate at 10.0 deaths per 100,000.
Unlike many conditions, numerous factors influence suicide rates, making it very difficult to prevent and treat. These factors include mental health, family history, alcohol and substance abuse, access to lethal methods, cultural and religious beliefs, physical illness, and feelings of loss (illness, relational, social, work, or financial). In addition to troubled youth and the elderly. military veterans -- especially those who have served in Vietnam, Iraq or Afghanistan -- have emerged recently as a group who are at higher risk of suicide, largely due to an increased risk of developing post-traumatic stress disorder (PTSD); left untreated, PTSD can lead some to take their own lives.
In addition, suicide rates tend to rise during recessions and to decrease during periods of economic prosperity. The recent spike in suicides among regions of the state and nation experiencing higher economic hardship may be an aggravating factor for individuals who have other risk factors.
The infant mortality rate measures the death rate during the first year of life and can be attributed to various causes. It is singled out because it serves as an overall measure of health, is used as an indicator for the larger healthcare system, and also has disproportionately large effects on average life expectancy rates.
According to the Organisation for Economic Co-operation and Development (OECD), in 2013 -- the most recent year available for global data -- the United States again ranked near the bottom among the world's developed nations for infant mortality, although its mortality rate improved slightly from 6.1 infant deaths per 1,000 births in 2010 to 6.0 deaths in 2013.
Things were looking a bit better in 2014, the most recent year available for national-level data. Virginia's infant mortality rate has been dropping for years, and in 2014 dropped again, to 5.8 deaths per 1,000 births, ranking the state 28th nationally. This rate was equal to the national average of 5.8 infant deaths, and better than all peer states: Maryland (6.5), Tennessee (6.9) and North Carolina (7.1). California had the lowest infant mortality rate in the nation in 2014 at 4.3 infant deaths per 1,000 births.
Since 2007, the Virginia Department of Health (VDH) has been working with local health districts and community health leaders to combat infant mortality in especially vulnerable areas of the state. Although there are sometimes marked swings in regional performance, that approach overall is yielding results, as VDH's figures for 2014 show the average infant mortality rate had dropped to 5.7. The Northern region had the lowest rate of infant deaths at 4.2, while the Southside region had the highest rate at 9.8 deaths per 1,000 live births.
Virginia ranked 12th out of the 50 states in terms of adequacy of prenatal care in 2011, with 85 percent of pregnant women receiving care in the first trimester.
Life expectancy is a measure of the overall health of the population. It represents the average number of years of life that could be expected if current death rates were to remain constant. As with infant mortality, average life expectancy in the US lags behind most other developed nations; according to the OECD, US life expectancy rates across 2011-2015 ranked 26th and below nations as diverse as Costa Rica, Slovenia, and Korea.
In 2000, Virginia slightly lagged the US in overall life expectancy, but has exceeded it ever since. Life expectancy in the United States increased from 77.6 years in 2004 to 78.8 years in 2013; over the same time period, Virginia life expectancy increased from 77.8 to 79.6 years.
Using estimates from the Institute for Health Metrics and Evaluation, in 2010 Virginia ranked 25th nationally, with a life expectancy of 78.5 years, the same as the national average that year. Life expectancy was higher than peer states Tennessee (76.1) and North Carolina (77.4), and equal with Maryland (78.5 years). Hawaii continues to lead the nation in life expectancy; in 2010, their average life expectancy was 80.6 years.
Average life expectancy has also increased in each of Virginia's regions during the last twenty-five years. From 1985 to 2010, averages for life expectancy advanced the most in the Northern and Central regions; residents there gained 5.7 years and 5.1 years, respectively. Overall state averages saw an increase of 4.8 years. In 2010, the highest life expectancies were found in the Northern region (81.6 years), followed by the Valley region (78.3 years). The lowest life expectancy occurred in the Southwest (75.2 years) and Southside (75.3 years).
What Influences Mortality and Longevity?
Health outcomes are influenced by a wide variety of variables, including behavior, family history/genetics, socioeconomic levels, the environment, access to health care, and support for public health services. Reducing lifestyle risk factors is paramount. A nutritious and well-balanced diet; regular exercise; and abstinence from smoking, high alcohol consumption, and substance abuse are all important. Regular checkups for early detection of metabolic problems like high blood pressure, high cholesterol, diabetes, and being overweight or obese also play a significant part in maintaining good health. Exposure to environmental pollutants (e.g., cigarette smoke, lead, asbestos, industrial chemicals, biologic agents and viruses, occupational safety hazards) have also been linked to poor health outcomes.
Access to health care for prevention and treatment is another key determinant of health quality. Communities with high rates of poverty and unemployment, substandard housing, and low levels of education are at higher risk for almost all poor health outcomes.
Life expectancy at birth is influenced by infant, child, and adult mortality rates. Gender affects longevity, as females tend to live longer than males, and longevity rates are higher in richer regions than in poorer ones. Access to health care, advances in medicine, healthier lifestyles, and better health before age 65 have contributed to the significant decline in death rates among older Americans.
Federal and state-level funding for public health services has been declining for nearly a decade. Although the amount Virginia spends in combined federal and state allocations on public health remains above the national median, it has dropped from $110.95 per capita in 2008 to $64.73 in 2015. This affects the state's ability to adequately address complex challenges such as opioid addiction and public education on the importance of preventive, rather than reactive, health care.
What is the State's Role?
State governments help to improve the overall health of the population in several different ways:
- Detection and Monitoring. State and local public health agencies are at the forefront of detecting infectious disease outbreaks, bioterrorism and emerging health threats as varied as opioid addiction, asthma, and the Zika virus. State labs perform tests to identify infectious diseases and contaminants. They also collect health statistics and monitor epidemiological data for demographic and regional patterns.
- Planning and Evaluation. Although Virginia currently does not align its statewide goals and plans with the national health agenda, Healthy People 2020, it does work with agencies, localities and non-profit organizations on strategic planning efforts, funding opportunities, etc. The Virginia Department of Health also works with local health departments and other organizations to evaluate the effects of prevention efforts across the state.
- Education. State and local health agencies work to educate the public about the importance of disease prevention through healthy lifestyles and regular check-ups. These efforts can help influence behaviors, lifestyles, and conditions that affect health outcomes, such as smoking, substance abuse, poor nutrition, exercise, lack of prenatal care, medical problems, and chronic illness. Government also assists health care practitioners by giving them timely updates in guidelines for treating patients at risk. By funding medical research in its public research universities, states can expand health knowledge and treatment options.
- Regulation. To reduce health risks, the state enacts certain regulations that help limit public exposure to environmental contaminants and infectious disease. Examples of such regulation are laws that restrict exposure to second-hand public smoking, household lead contaminants, and unsanitary dining conditions. States also typically establish, monitor, and enforce licensing and certification standards for the health professional work force, facilities, and services to ensure quality and uniformity.
- Health Care Access. The state assists the poor or uninsured with obtaining health insurance through Medicaid and emergency care for uninsured patients who use emergency room services. The Affordable Care and Patient Protection Act has expanded opportunities for gaining health insurance coverage through public health exchanges, insurance subsidies for lower-earning households, and expanding the types of services covered by health insurance plans (such as mental health services).
- Tax Policy. State governments provide indirect subsidies for health care spending and insurance through the special tax treatment accorded employer-provided health insurance and health insurance savings accounts. Health insurance payments and health care expenses can also be itemized if these expenses reach a certain annual threshold.
State rankings are ordered so that #1 is understood to be the best.
Data and Definitions
Cardiovascular, Cancer, Lower Respiratory, Accidents, Diabetes, and Suicides
Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER On-line Database. wonder.cdc.gov/cmf-icd10.html
All state and regional level data are age-adjusted to the 2000 US population
Cardiovascular deaths (categories I00-I78) includes deaths of the circulatory system: Acute rheumatic fever, chronic rheumatic heart diseases, hypertensive diseases, ischemic heart diseases, pulmonary heart disease and diseases of pulmonary circulation, other forms of heart disease, cerebrovascular diseases, and diseases of arteries, arterioles and capillaries. Cancer deaths (categories C00-C97) includes malignant neoplasms. Chronic lower respiratory deaths (categories J40-J47). Accidental deaths include (V01-V99, W00-X59, Y85-Y86) transport and other external causes. Diabetes mellitus deaths include categories E10-E14. Suicide includes intentional harm (U03, X60-X84, Y87). Note: Eastern Region suicide rates for 2000-2001, 2003-2004, 2006-2007, and 2009 were interpolated because of undisclosed data.
Global Data: Organisation for Economic Cooperation and Development, OECD Data, Infant Mortality Rates
State Data: National Center for Health Statistics, Centers for Disease Control and Prevention, www.cdc.gov/nchs/products/nvsr.htm
Prenatal Health Care Data: United Health Foundation, America’s Health Rankings.
Regional Data: Virginia Department of Health, Center for Health Statistics
Organisation for Economic Cooperation and Development, OECD Data, Life Expectancy at Birth
National Vital Statistics Report, Deaths: Final Data
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics
Source: Life Table, Virginia Department of Health
State and Regional, (1985, 1990, 1995, 2000, 2005, 2010)
Source: Institute for Health Metrics and Evaluation (IHME)
Regional life expectancies were computed by weighting IHME county male and female life expectancy estimates by corresponding county male and female populations estimates from National Cancer Institute, Surveillance Epidemiology and End Results (SEER) Population Data
Public Health Spending
America's Health Rankings, 2015 Annual Report, Virginia public health spending
See the Data Sources and Updates Calendar for a detailed list of the data resources used for indicator measures on Virginia Performs.