What Is Actually Likely to Kill You?

Maybe you should widen your self-protection efforts.

Posted Mar 16, 2020

What is actually going to kill you?  I started digging into this question because, like almost everyone else this week, I am concerned about the possibility that COVID-19 might be the end of me. 

 Wikimedia commons.
Source: Wikimedia commons.

You probably know that heart disease is the Number 1 killer and that cancer isn’t far behind as the Number 2 henchman for the grim reaper. In 2018, heart disease killed 655,381 Americans, cancer 599,274. But as I’ll discuss below, those might not be what you yourself should be prioritizing in your personal prevention campaign.

I have been hearing estimates that between 150,000 and 2 million Americans might die from the COVID-19 virus.  The usual number of deaths from influenza and pneumonia is about 60,000 per year, so that suggests at least triple the number of deaths in that category.  If the “realistic” estimates are to be believed, COVID-19 will kill about 400,000 Americans, high but still fewer than heart disease and cancer this year (though who knows what is realistic is in this case, and that guess may be too pessimistic or optimistic). Whether those numbers are high or low, though, most of those who die will be the same people likely to die of heart disease and cancer – those over 65 years of age. 

But what’s threatening you personally, and what can you plausibly prevent?

In the course of digging around all these cheery death statistics, I found out a few other interesting facts.  Check out Figure 1, which is a graph of the top 10 causes of death for Americans, broken down by age group (from the Centers for Disease Control). 

From Wikipedia.  Based on public records from U.S. Centers for Disease Control.
Figure 1: Leading causes of death by age
Source: From Wikipedia. Based on public records from U.S. Centers for Disease Control.

When I look at this table, a few things strike me as interesting. I always ask my students to estimate the causes of death in the United States, to illustrate what is called the “availability heuristic.” That term simply refers to the fact that people use cognitive accessibility as a way to make a quick estimate of probability. It works well when our experience is relevant and direct.  If I asked a random person on the street whether there are more Asian or Mexican restaurants in their neighborhood, I am likely to get a different answer if the street I’m on is in Vancouver versus Phoenix. And the answer is likely to be right. But that otherwise handy rule of thumb can lead to overestimations if our cognitive searches are biased. Psychology professors like to point out how students typically overestimate the number of homicides, whereas they underestimate the number of suicides. The standard explanation is that the news media always cover homicides in great detail, but rarely talk about suicides (unless they involve someone famous). 

When I look at the CDC graph, however, I am struck by the fact that homicide (red boxes) is indeed among the top 5 causes of death for people under age 45. Suicide (green boxes) is still responsible for relatively more deaths, but homicide is certainly a real, and even prominent, cause for concern in young people (more so than heart disease and cancer). If you are a teenage male, in fact, homicide rises up to the top of the list.  

Wikimedia commons
Man holding handgun
Source: Wikimedia commons

Is there anything you can do to avoid being murdered? Turns out that the major trigger of young male homicides is what’s called a “trivial altercation.” On closer examination, Margo Wilson and Martin Daly found out that these homicides are not about trivia at all, but about something much more significant—social dominance. Young men kill other men who put them down in public. For young guys, being polite and respectful toward other young men is a critical prevention measure, probably even more important than a healthy diet and regular hand-washing practices. 

From an evolutionary perspective, whether one of our ancestors survived from age 15 to 30 was more relevant than whether they survived from age 65 to 80. 

The other interesting thing about that graph is that, until age 45, the biggest cause of death comes from “unintentional injury” (the blue boxes).

Figure 2 delves a little more deeply into the unintentional injury category (the figure includes all injury deaths, including intentional suicides and homicides, but the boxes highlighted in color are all the subcategories of unintentional injury).

Across the lifespan, the biggest causes of unintentional injuries are poisoning (green boxes), motor vehicle accidents (light blue boxes), and unintentional falls (red boxes). 

From Wikipedia.  Public domain, U.S. Centers for Disease Control
Figure 2: Causes of unintentional deaths (highlighted)
Source: From Wikipedia. Public domain, U.S. Centers for Disease Control

I wondered why so many people are being poisoned (green boxes), and discovered that this refers not to accidentally ingesting rat poison, but to overdoses from prescription or illegal drugs. If you’re under 50, your biggest preventative measures in this category would be:

  1. Avoid getting high, especially getting really wasted
  2. Avoid getting into an automobile whenever possible. 
Jeanne Boleyn at English Wikimedia
Sicilian girl in front of Fiat
Source: Jeanne Boleyn at English Wikimedia

Those two problems actually compound one another, 28 percent of annual auto fatalities are caused by alcohol-impaired drivers, and other drugs are involved in another 16 percent of motor vehicle crashes, according to the CDC. You’ve probably heard the advice about having a designated driver, but it is really worth reminding yourself before you go out for a night on the town that not designating a sober driver is likely to dramatically increase your chances of ending up in one of those blue boxes in Figure 1—right at the top of the list of factors likely to put you in a pine box before your time.

There’s a third thing to note about those figures, which is obscured in Figure 1 because of the dramatic increases in most causes of death as people get older.  People do not stop dying of unintentional injuries as they get older. In fact, the actual numbers of people dying from motor vehicle accidents stay about the same, as shown in Figure 2. And the actual numbers of people dying from drug overdoses actually gets higher up till age 65. Also interesting is that unintentional falls seem not to be the domain of young people out rock-climbing, as I first suspected. On the contrary, deaths from falling aren’t a problem until age 25, and then they steadily increase as people get older. 

Besides all their elderly woes, aging people should not stop worrying about getting into cars and taking too many drugs, and they should stay close to the ground.  

What? Me worry?

I should be clear that I am not one of the voices saying: “Don’t worry about the coronavirus.” On the contrary, it makes eminent sense to be concerned about this impending threat, which is almost certain to take out at least a noticeable chunk of my generation. Wash your hands frequently, avoid big social gatherings, and sneeze into your elbow rather than someone else's face, by all means. 

But as long as we’re working up a list of emergency precautions, it’s worth taking this opportunity to add a few long-term precautions that have a good chance of prolonging your life, even after the coronavirus has passed.  

To summarize, these are: 

  1. Don’t drive more than is absolutely necessary.  
  2. Remember that getting high is the highest cause of death for people between 25 and 65, but it's also more avoidable than catching a virus. My preferred means of getting high is beer, and after the second can of IPA, the odds that I’ll stop counting go dramatically down.  My intoxication prevention technique is to never chill more than one or two beers at a time and to keep the rest of the six-pack someplace warm and annoying to get at (needing to chill beer for an hour interrupts the immediate gratification cycle, and I also get lazier after drinking a beer; it acts as another major obstacle if I have to do anything more than simply open the refrigerator door). If you are using other substances, there are probably ways of making them difficult to access before you take the initial dose. Or better yet, go for a jog or a fast walk and get high on naturally produced endorphins (doing that regularly will of course also help reduce the eventual risk of heart disease). 
  3. Especially if you’re a young male, avoid dominance confrontations with other young males, particularly young males who are poor (Daly and Wilson found that violent intra-male competition is greatly magnified by poverty).
  4. Note also that suicide is the second-highest cause of death for many years and continues to remain at high numbers for older people (it looks like less only because those diseases of aging get increasingly prominent).  Turns out there’s an easy way to prevent the biggest suicide risk – keep guns out of your house.  Guns are used in fully half of fatal suicide attempts.

If you've had enough all the doom and gloom thoughts about your own mortality, you might want to check out "Some upsides if the coronavirus goes viral."  There, I discuss the pandemic in terms of some classic research on positive psychology, investigating executives who responded to severe stress as opportunities for growth rather than merely catastrophes.


Photo credits:

Sicilian girl with Fiat: Picture credit: This work has been released into the public domain by its author, Jeanne boleyn at English Wikipedia. This applies worldwide.

Man holding handgun: image was originally posted to Flickr by Tac6 Media at https://flickr.com/photos/143258095@N08/26938035304. It was reviewed on 9 October 2019 by FlickreviewR 2 and was confirmed to be licensed under the terms of the cc-by-2.0.

Corona virus: This file, which was originally posted to https://www.scientificanimations.com/wiki-images/, was reviewed on 27 February 2020 by reviewer 4nn1l2, who confirmed that it was available there under the stated license on that date.

Wilson, M., & Daly, M. (1985). Competitiveness, risk taking, and violence: The young male syndrome. Ethology and sociobiology, 6(1), 59-73.

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