Researchers have found that 70% of adults who died from natural causes had not seen a healthcare provider in the 30 days before their death.

Scientists at the University of Texas Health Science Center at Houston and the Harris County Institute of Forensic Sciences (IFS) in Texas have uncovered some of the key factors related to premature deaths among adults. They have now published their results in the journal PLOS One.

A 2016 report that the Centers for Disease Control and Prevention (CDC) compiled found that more than 2 million people in the United States die every year. The leading causes of death in the United States are heart disease and cancer, with around 635,000 deaths and 600,000 deaths per year, respectively.

Before getting into the details of the study, it is important to understand what constitutes a natural cause of death: A natural cause of death rules out the involvement of external causes such as an accident, a murder, or a drug overdose.

Identifying modifiable factors

The team wanted to identify modifiable characteristics that could help health-care providers prevent deaths from natural causes. To do this, the scientists focused on the 1,282 adults who died in Harris County, TX, in 2013. They analyzed autopsy reports and legal death investigation records.

One study, from 2015, found a significant increase in all-cause mortality of non-Hispanic Americans in the 21st century. This increase seems to be due to rising death rates from drug and alcohol poisonings, suicide, and chronic liver disease.

"I had noticed younger people dying when I worked at the IFS, so I set out to identify the causes in Harris County," says lead study author Stacy Drake, PhD, an assistant professor at the University of Texas Health Science Center.

The team identified common modifiable characteristics within two categories that are growing in prevalence: deaths from natural causes and drugs. "We need to dive into what is going on with these folks and find out where we can break the chain of events leading to their deaths," says Drake.

Links to poverty and health care access

The researchers discovered that 912 deaths were due to natural causes and 370 were due to drug overdoses. Study co-author Dr. Dwayne A. Wolf, PhD—Harris County IFS deputy chief medical examiner—collaborated with Drake's team.

"As medical examiners, we perform autopsies and present findings in court. As physicians, we appreciate the opportunity to translate our findings into improvements in health care, in injury prevention, or even in preventing deaths."

—Dr. Dwayne A. Wolf, PhD

Deaths to natural causes included alcohol use, tobacco use, substance use, and documented past medical history. The top causes of death were linked to the circulatory system, digestive system, and endocrine and metabolic conditions. The data also revealed that more than half of these people did not have a health-care provider.

"They had symptoms and knew they were getting worse," explains Drake. "Yet, they didn't seek the attention of a health-care provider. We need to conduct further research to answer the question of 'why?'"

In particular, the team focused on three areas where the number of premature deaths was higher: North Central (Trinity Gardens), South (Sunnyside), and East (Baytown). Here, education, income, and employment are comparatively low, and there is a lack of access to health-care services.

"Overall, they're dying of diseases that we treat every day," Drake concludes. Of the 370 drug-related deaths, most of them were accidental and a very small number were down to suicide. The researchers found cocaine, opioids, antidepressants, and alcohol in toxicology tests. They also showed that white people, compared with black people, were more than twice as likely to die from drug-related deaths.

The authors hope that "these findings may influence the initiation of interventions for medically underserved and impoverished communities."