The Surprising Ways Americans Die in all 50 States

TIME

Click or tap the arrows to see which cause of death is disproportionately high in your state compared to national mortality rates.

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Accidental gunfire claimed 348 lives from 2001-2010 in Alabama, and gunshots of undetermined intent killed 147 in Arizona. And while both resulted in far fewer than 1 death per 100,000 people, the rates are unusually high compared to rates nationwide, according to a new study released by the Centers for Disease Control and Prevention (CDC). By comparing the mortality rate of 136 causes of death at state and national levels, the CDC found the most common atypical ways people died in every state.

In Michigan, for example, coronary artery disease killed 35 out of 100,000 people, while nationwide only 20 of 100,000 people perish from the condition. Because of the way these calculations are done, most of the diseases in the CDC report are obscure, from…

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Who should be screened for PAD?

• Symptoms of claudication
• Non-healing wounds in lower extremities
• Age >/= 65
• Age >/= 50 with history of smoking or diabetes
• Abnormal lower extremity pulses on exam
• Known atherosclerotic coronary, carotid or renal artery disease

ACC/AHA PAD Guidelines 2011

Special thanks to Dr. Ariel Vinas for the information!

Wilson’s Disease

General Information:

• Typically, we ingest more copper in the diet than necessary – most is excreted through the biliary system (some through the urine)
• Normally, ingested copper is stored in plasma as ceruloplasmin.
• Patients with Wilson’s disease, have a decreased rate of copper incorporation into ceruloplasmin and a decreased rate of biliary excretion

Clinical Manifestations:

• Typically considered a disease that presents in young people, but can present at any age
• The most common presentations are with liver disease or neuropsychiatric disturbances
• Wilson’s disease can manifest with an impressive spectrum of neurological, behavioral or psychiatric disorders, which may be its first clinical manifestation, appearing simultaneously with hepatic signs, or some years later.
• System-specific
  • Liver: cirrhosis; increased bilirubin out of proportion to alkaline phosphatase, which may be abnormally low; AST>>ALT
  • Heme: hemolytic anemia, caused by release of copper into the circulation
  • Neurologic: movement disorder (tremor, poor coordination) or rigid dystonia, including bulbar sx
  • Psych: highly variable—from OCD to psychosis to depression
  • Ocular: Kayser-Fleischer rings caused by copper deposition (not required for dx, nor are they specific for Wilson’s—may be found in other types of chronic liver disease)
  • Renal: Fanconi’s syndrome (proximal tubular dysfunction resulting in Type 2 RTA, glucosuria with normal serum glucose, hypouricemia and hypophosphatemia)
  • Also: arthritis, cardiomyopathy, rhabdo, pancreatitis

Diagnostic Tests: 

• Serum ceruloplasmin: classically, this is low. May be normal in up to 5% of patients; can also be low in other forms of chronic liver disease
• 24 hour urinary copper: elevated; good confirmatory test
• Slit-lamp exam for Kayser-Fleischer ring
• Liver biopsy

Management:

• Copper chelation: penicillamine, trientene, or zinc
• Fulminant hepatic failure generally requires transplant
• Family screening is key for siblings of those affected, as early treatment can greatly improve prognosis