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Does the Thought of Death Impact How You Live?

Columnist: Peter Brett, M.D.
June, 2018 Issue
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Peter Brett, M.D.
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This is supposed to be a column on living, but sometimes you gain a new appreciation for something when you contrast it with its opposite—in this case, dying. The truth is you never really know what you have until it’s gone. And death is certainly all around us, making life seem pretty scary. How many news stories detail deaths, often untimely and tragic, and sometimes gruesome? Reading about deaths in the news can give you a skewed idea of why we die, and that can affect the way we live.

I was talking with a friend last week, and our conversation brought this into sharp focus. He travels from Napa to Mississippi twice a year to visit his elderly mother, but he drives instead of catching a flight. Why? He’s genuinely afraid of dying in a plane crash. He knows the odds of the plane going down are low, but news stories of terrible crashes keep reinforcing that this seems to be a dangerous activity. Driving just seems safer. It’ll take him three days to drive there and three days to drive back, so this skewed perception of risk does impact his life.

Then the other day a Los Angeles Superior Court judge ruled that coffee companies will have to post warnings that coffee can cause cancer. Roasted coffee has small amounts of acrylamide, which in huge amounts in mice may increase their risk of cancer. Should a theoretically small risk of getting a life-threatening disease mean you should panic and stop going to Starbucks?

To put these life circumstances into perspective, you have to put death into perspective. First, it’s sometimes easy to forget that every single one of us—everyone we like and love—is absolutely going to die. Though it’s hard to predict exactly why and when you’re going to die, we have a pretty good idea of what’s likely, and a pretty good idea of what can lower the risk of an untimely death for a person who starts out healthy.

Probably most of us don’t have the slightest idea of what the odds are that we’ll die in the next five years. A fascinating study published in the medical journal Lancet in 2015 looked at 162 putative predictors of risk of death in about 6,000 people between ages 40 to 70. They looked at results from blood tests, cognitive function, early life factors, family history, health and medical history, lifestyle and environmental factors, physical measures, psychosocial factors, and socio-demographics. Pretty much everything you can think of. Taking into account which factors predicted death in the following five years, they were able to boil everything down to a quick survey you can take with just a few questions that predicts your risk of death in five years with high accuracy.

I encourage you to take this test, available for free online at: ubble.co.uk. The test differs for men and women. It’s clear from the questions that the most important factors predicting if you’ll make it the next five years are whether you’re free of diabetes or cancer, if you’re financially okay, if you consider yourself healthy, do you avoid risky behavior like smoking, and whether you walk briskly.

But what about beyond the next five years? Most of us have heard that the average life expectancy is 76 years for men and 81 years for women. Does that mean that if you’re a 75-year-old healthy man now, you’re only likely to live one more year? Of course not, and that’s because these are life expectancies predicted from birth. If you’re healthy and you’ve made it to 75, you should do a lot better than living just another year. To figure that, you need a longevity calculator, and fortunately, the Society of Actuaries has put this together for us, taking into account your current age, your health status, and whether you smoke or not. You can try this at www.longevityillustrator.org. (I’m 58, and it tells me I have less than a 10 percent chance of living until 100, but about even odds of making it to 86.)

This gives us a sense of how long we might live, but what are we actually going to die from? For many of us, it’s heart disease—one in four of us, according to the CDC—or cancer—one in five of us, according to the American Cancer Society. The rest is mostly stroke, lung disease, diabetes, and, yes, accidents. There’s only one chance in 200,000 you’ll die in a plane crash, so probably no need to worry much about that. Other traumas are more likely to kill you, though such as having a car accident, falling down, and suicide—each one chance in 100. And there’s one chance in 300 you’ll be killed by a gun.
Now how much of this is preventable? Again, we’re all going to die of something, but in a detailed analysis by the CDC they calculated that deaths from heart disease are 30 percent preventable; from cancer 15 percent preventable; from injuries 40 percent preventable; from lung disease 40 percent preventable; and from stroke 30 percent preventable.

My conclusion is that it’s probably good not to sweat the small stuff. It’s the big stuff that usually gets you. What can you do to reduce your risk of dying from the big stuff? A large study published in the American Journal of Public Health identified just four low-risk behaviors that will—on average—increase your lifespan about 11 years if you practice all four behaviors. The study advises the following four tips:
Don’t smoke (for all the reasons you already know)
Eat a healthy diet (essentially high in fruits and vegetables)
Get adequate exercise (a moderate workout five times a week)
Drink alcohol moderately (0 to 2 drinks/per day maximum)

As for me, I’m not going to worry about acrylamide in coffee, and I’m flying next time I go to the East Coast.

Peter Brett, M.D., is a board-certified medical oncologist at Sutter Medical Group of the Redwoods in Santa Rosa, and affiliated with the Sutter Santa Rosa Regional Hospital. He’s been practicing oncology for more than 25 years. For more information, go to sutterpacific.org, or call (707) 521-7750.



 

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