June is Men’s Health Month. To honor the occasion, we’ll take a look at the most common threats to the health and wellbeing of men. The list of top causes of death in American men was released by the Centers for Disease Control and Prevention (CDC). The rankings boast few surprises; heart disease and cancer top the list and have for decades. But the list also speaks broadly to men’s inherent will to push the envelope, eat and drink too much and live up to the stereotype of putting off screenings and medical care.
1. HEART DISEASE
Heart disease remains the number one killer of Americans and for men, the numbers are particularly grim. According to the American Heart Association (AHA), one in every nine men will experience sudden cardiac death, compared to one in 30 women. AHA data also reveals more than one in three men have some form of cardiovascular disease.
“Overall in the country, we’ve made progress in terms of cardiovascular disease and the death rate,” says Raj Chakka, M.D., a heart surgeon with CHI St. Vincent Heart Clinic Arkansas in Little Rock. “[But] in the big picture of things, Arkansas is lagging behind.”
Dr. Chakka says it’s no coincidence that Arkansas ranks as high as it does in terms of deaths to heart disease. Such conditions typically go hand-in-hand with poor diet, obesity and other medical conditions such as diabetes, which all affect Arkansans at a rate higher than the national average.
“I think some of it is cultural in terms of our dietary habits, and they’re hard to change,” he says. “But other ones are practical problems in society where both parents have to work and time has become a big factor also, because preparing a healthy meal at home does take time.”
HEART DISEASE AT A GLANCE
• In 2009, the overall death rate from cardiovascular disease was 236.1 per 100,000 men in the U.S. Death rates were 281.4 for white males, 387.0 for black males.
• Men at age 45 have a 10.9 percent lifetime risk of sudden cardiac death; more than three times that of women.
• At any age, men with two or more major risk factors (smoking, high cholesterol, diabetes or elevated blood pressure) increase their lifetime risk for sudden cardiac death by at least 12 percent.
According to colorectal surgeon Jonathan Laryea, M.D., associate professor of surgery at UAMS, the most common forms of cancer in men are prostate, lung, colorectal and bladder cancer, respectively. On a mortality basis, lung cancer leads the field followed by prostate and colorectal varieties.
“Pancreatic cancer does not get a lot of attention, but it is a very deadly cancer with a very low survival rate,” Dr. Laryea says. “Even though it does not make the top 10 list, in terms of incidence, it is the fourth leading cause of cancer mortality in men.”
Advancements in prostate cancer treatment, including several new drugs on the horizon, underscore the longtime assertion that when caught early, this condition can be completely cured. However, not all men are candidates for treatment.
“Prostate cancer typically is slow-growing,” says Tim Langford, M.D., managing partner of Arkansas Urology in Little Rock. “If we diagnose someone who does not have at least a 10-year life expectancy, a lot of times we won’t treat, just because of that. Younger men tend to have more aggressive cancers and benefit more from treatment than older men.”
Screening for all types of cancer is key to early detection, broader treatment options and chances of survival. However, many men fail to adhere to this simple recommendation.
“Finding cancer at an early stage generally leads to good outcomes,” says Dr. Laryea. “For example, the treatment for stage 1 and most stage 2 colon cancers is surgery only. It is the more advanced cancers that typically require aggressive treatments. This is why screening is very important because it either prevents cancer or helps to identify early stages of cancer so that the treatment and outcomes are more favorable.”
Dr. Langford adds, “Men, in general, are not as good as women about being proactive about their health, especially screening for prostate cancer. But for localized disease, for prostate cancer we catch early, I would say depending on the situation, somewhere between 70 and 95 percent or more of patients can be cured if it’s caught early enough.”
CANCER AT A GLANCE
• Prostate cancer screenings for most men should start at age 50; African-American men or men with a family history of prostate cancer may undergo prostate screenings as early as age 40.
• Colorectal cancer screenings should begin at age 50; African-American men should start colorectal screenings at age 45.
• Screening for lung cancer is recommended for current or former smokers ages 55 to 74 years old with at least a 30-pack per year smoking history.
3. UNINTENTIONAL INJURIES
Unintentional injuries – from auto crashes to accidental shootings and snakebites – are the top killer of males ages 4 to 44.
“Men tend to have patterns of injuries that are more consistent with not always using the best common sense, especially young men,” says George Hutchison, M.D., director of the emergency department at CHI St. Vincent Infirmary in Little Rock. “For instance, snake bites – if you look at the pattern of snake bites in people you can almost always tell if it’s a man or a woman by where they’re bitten. Almost always, a man’s bitten on the hand or upper extremity. Women are usually bitten on the ankle or feet. There’s a reason for that.”
Dr. Hutchison says many unintentional injuries are seasonal – gunshot or arrow wounds during hunting season or water skiing injuries in the summer, for example. He also says men tend to ignore their limits, particularly when getting back into an activity from their youth. As much as anything, having an audience is generally all many men need to try something they shouldn’t.
“The last thing a lot of men who show up in the ER say is, ‘Hey, watch this!’” says Dr. Hutchison. “If a man has that inkling to say, then it’s probably something that he should not be attempting to do.”
UNINTENTIONAL INJURIES AT A GLANCE
• Obey all safety warnings and speed limits when operating motorized vehicles and boats. Wear safety equipment when biking, riding motorcycles or operating power tools.
• Alcohol greatly increases the chances of accidents of all kinds; never drink and drive or operate machinery.
• Know your limits and return to strenuous activities slowly. If you’re a beginner, take lessons or work your way up in activities such as rock climbing.
4. CHRONIC LOWER RESPIRATORY DISEASE
Among this family of diseases are lung cancers, chronic obstructive pulmonary disease (COPD) and nontuberculous mycobacteria (NTM) lung infection which is caused by inhaling naturally occurring organisms in the environment.
Lung cancer, among the most widespread and lethal of cancers, is brought on by smoking, or in some cases, breathing in hazardous particulate matter on worksites. COPD, a chronic lung disease, is currently diagnosed in about 11 million Americans.
“Lung cancer can present for the first time in an advanced stage,” says Harneet Pahwa, M.D., of CHI St. Vincent Pulmonary Clinic in Hot Springs. “Screening for lung cancer is readily available if patients meet the criteria; patients can receive an annual CT screening of the lungs.”
An overwhelming risk factor for lung disease is smoking; in fact, the CDC reports almost nine out of 10 lung cancers are caused by cigarettes. What’s more, smokers today have a greater risk of lung cancer than those in 1964, despite smoking far fewer cigarettes, due in part to the chemicals in modern cigarettes.
“Red flags for lung cancer could be persistent cough, coughing up blood and unresolving or reoccurring pneumonia,” Dr. Pahwa says. “Treatment of lung cancer has advanced in recent years. It depends on type and stage of lung cancer.”
CHRONIC LOWER RESPIRATORY DISEASE AT A GLANCE
• About 85 to 90 percent of COPD is caused by smoking. COPD (which includes emphysema and chronic bronchitis) often does not present symptoms until advanced stages of the disease.
• Underlying chronic lung disease can be a risk factor for acquiring NTM disease, which usually requires multiple antibiotics for months.
• Lung functions begin to improve as quickly as two weeks after quitting smoking; after 10 years, the risk of dying from lung cancer matches that of a non-smoker.
Stroke may round out the top five causes of death nationally, but it is of primary concern in Arkansas, part of the so-called “Stroke Belt” of the southeastern U.S.
“As a state, Arkansas ranks fifth in stroke mortality,” says Tim Freyaldenhoven, M.D., a neurologist at Conway Regional Neurosciences Center. “The rates of stroke have fallen along with the fall in cigarette smoking. Improved blood pressure control is also thought to have reduced stroke rates. Unfortunately, there has been a marked increase in the rates of [strokes related to] diabetes and ‘pre-diabetes’ or metabolic syndrome.”
A stroke is a vascular event that results in the death of a portion of the brain. A majority of these events are the result of a lack of blood flow from a clot, called an ischemia. Occasionally, there will be an ebb and flow of this clot formation, leading to a staggered onset of symptoms.
“Pain is not a common symptom of stroke, especially ischemic strokes,” says Dr. Freyaldenhoven. “However, it is often a symptom of a hemorrhage into or around the brain. It may also indicate the presence of an underlying condition predisposing someone to an ischemic stroke. A new, different, severe headache, especially with a sudden ‘thunderclap’ onset, is more likely to indicate a significant underlying problem and should always be evaluated.”
STROKE AT A GLANCE
• In addition to age and family history, important risk factors for stroke include smoking, hypertension and type 2 diabetes. Type 1 diabetes is also an important risk factor but far less common.
• Awareness of symptoms is key; symptoms include any difficulty with thinking, speaking, vision or eye movement; strength or limb movement; and loss of balance, coordination or sensation.
• Time until treatment is a critical factor for salvaging brain activity; an ischemic stroke kills 1.9 million brain cells in 60 seconds. There is also a mere four-hour window outside of which current treatments become ineffective.
Arkansas is considered to be epidemic for the number of people who have diabetes, says Rhonda Tosh, a dietitian and certified diabetes educator with the Conway Regional Diabetes Management and Wellness Program.
“Approximately 14.8 percent of the adult population has diabetes, including 11.3 percent of the male adults in Arkansas,” she says. “Diabetes is the seventh leading cause of death in Arkansas, according to the Arkansas Department of Health.”
Despite these statistics, the more shocking fact is that 40 percent of people with the disease don’t know they have it.
“Diabetes is the result of our bodies not being able to utilize blood sugar appropriately,” says Adam Cox, M.D., an internal medicine specialist with Conway Regional Medical Clinic. “There are two main types of diabetes, type 1 and type 2, with both types thought to have genetic and environmental components that lead to their development.”
“Diabetes can wreak havoc on the entire body, resulting in anything from vision loss to sexual dysfunction and poor mental health to kidney failure, heart attacks and strokes.
DIABETES AT A GLANCE
• Type 1 diabetes is often diagnosed in childhood or in young adults while type 2 is by far the most prevalent, accounting for 90 to 95 percent of cases.
• Risk factors include obesity, family history, sedentary lifestyle, high blood pressure, age, high cholesterol and ethnic background.
• Routine screenings can be conducted by primary care physicians during checkups; these screens are highly recommended for individuals ages 40 to 70 years who are overweight or obese or have other risk factors.
Caucasian men ages 50 and older represent the single highest demographic for suicide in the United States. Arkansas is no different.
“Arkansas stats have followed national trends so far as demographics, but we have been higher in our loss and attempt rates,” says Susie Reynolds Reece, a violence-prevention specialist at CHI St. Vincent and CEO of Suicide Prevention Allies. “So, in comparison, I would have to say our number of deaths are higher.”
Suicide is a murky area of public health. Statistics are often skewed as families report deaths as accidents or overdoses to avoid the stigma of suicide. What drives people to take their own lives is often hard to pin down, too.
“Generalizations are a dangerous game. But for men, we see more status or economically driven triggers compounded on the underlying issues that can cause suicidality,” Reece says. “Teens and youth tend to deal more heavily with bullying and cyberbullying on top of their already stressful lives.”
Prevention often starts with the courage to speak up, Reece says.
“I think we feel that our guts have lost some merit in this day and age, when they still hold true in terms of the human condition. If you’re worried about your loved one, speak out. If they are not their ‘normal’ selves, speak out. It would be better to have asked and found out it wasn’t a problem than to not ask and lose that person.”
SUICIDE AT A GLANCE
• Red flags vary, but people contemplating killing themselves often talk frequently about death or dying, express feelings of hopelessness or being trapped or give possessions away. However, there are no hard and fast things to watch for.
• Teens will often copy their peers or admired celebrities who kill themselves, resulting in a “cluster” effect.
• Resources include the National Suicide Prevention Lifeline (1-800-273-TALK). This operates 24/7, is free and confidential. People can also text ARK to the Crisis Text Line at 741-741.
8. ALZHEIMER’S DISEASE
Experts have a hard time pinning down the exact scope of Alzheimer’s disease, the most common form of dementia. Recent statistics from the Alzheimer’s Association place the number of Arkansans diagnosed with the disease at around 60,000.
Elise Siegler, executive director of Alzheimer’s Arkansas, suggests the number is much higher, but it’s obscured by shame and lack of consistent diagnosis.
“The stigma of Alzheimer’s is still there,” she says. “There is still the feeling of shame. It’s just kind of in the back of your brain: ‘I could have prevented this. I could have prevented this if I’d seen this or done this.’ But it’s not preventable. We don’t know that it’s genetic, inherited, environmental, caused by alcohol, caused by stroke.”
Alzheimer’s is a progressive brain disorder in which segments of the brain start to die off. Early symptoms of forgetting or failure to recognize family and familiar places eventually give way to the brain “forgetting” how to walk, eat or perform organ functions.
“Medications can manage behaviors; as far as seizures or rigidity or a gait or incontinence, medications can handle those symptoms, but they can’t slow [Alzheimer’s] down and they can’t stop it,” Siegler says. “It will kill you.”
ALZHEIMER’S DISEASE AT A GLANCE
• About 5.7 million Americans live with Alzheimer’s; this population is expected to grow to 14 million by 2050.
• Deaths from Alzheimer’s grew 123 percent between 2000 and 2015. Arkansas has the fourth highest death rate from Alzheimer’s in the country.
• Scientists don’t understand what causes Alzheimer’s; there is no prevention, restorative treatment or cure.
More than 200 people died of the flu in Arkansas in 2018. In 2017, an average of 17 people died of pneumonia per 100,000. Given these statistics, it’s easy to see why these conditions made it on to the top 10 list and why such illnesses are so serious.
“Influenza and pneumonia are caused by infectious viruses and bacteria which are common in our country and worldwide,” says Robert Hopkins, Jr., M.D., a professor of internal medicine and pediatrics and director of the division of general internal medicine at UAMS. “They are major causes of mortality and morbidity for men. Most of the deaths and disability from influenza and pneumonia in adults are due to worsening of chronic medical conditions associated with the infection.”
It may seem surprising that, with ready access to vaccines, such diseases would continue to be a major health hazard. Dr. Hopkins says the explanation is reasonably simple.
“Vaccinations against influenza and against pneumococcal disease are effective but they are not utilized by a majority of our population,” he says. “About 46 percent of adults in Arkansas received the flu vaccine in 2016-2017 and rates are likely similar for 2017-2018. Pneumococcal vaccination rates are around 20 percent for high-risk adults under age 65 and 60 percent for those 65 and older.”
INFLUENZA/PNEUMONIA AT A GLANCE
• Men over 65 who have chronic medical conditions are at higher risk of disability and death from influenza and pneumonia than those who are younger and healthier.
• Appropriate preventive care can reduce the likelihood of influenza and pneumonia. These measures include; not smoking, maintaining a healthy weight, getting regular exercise and seeking health care when ill.
• Getting a flu shot every year is highly recommended; some populations can get them for free at clinics or major drugstores. Many companies provide free flu shots at work as an employee benefit.
10. CHRONIC LIVER DISEASE
Hepatitis C and alcohol-related liver disease head the list of liver conditions that are most prevalent in Arkansas, according to Ali Safdar Khan, M.D., director of endoscopy, gastroenterology and hepatology at Baptist Health Medical Center-Little Rock. Both diseases represent major health issues for the state.
“The mortality rates from cirrhosis or scarring of the liver and chronic liver disease in Arkansas rank worse than some of the surrounding states,” he says. “Here in our state, the age-adjusted mortality is somewhere between 11.8 to 12.4 per 100,000 total population, whereas in neighboring Louisiana and Missouri the same statistic is around 9.8 to 11.8.”
Globally, a third liver condition has gained in prevalence, known as fatty liver disease or steatohepatitis.
“Fatty liver disease, also called non-alcoholic fatty liver disease (NAFLD), is now considered the most common liver disorder in western industrialized countries where it has taken on epidemic proportions,” he says. “Some studies have reported a prevalence of NAFLD of as high as 10 to 46 percent.”
As the name suggests, fatty liver disease is tied to other prevalent health issues and risk factors, namely the rise in obesity.
“Most people diagnosed with NAFLD are in their 40s and 50s, although with increases in childhood obesity the age of onset is considered lower than that,” says Dr. Khan. “The main reason behind the increase in fatty liver disease is thought to be environmental. In the United States, the rise of fatty liver disease has been paralleled by an increase in systemic hypertension, obesity and diabetes.”
LIVER DISEASE AT A GLANCE
• Screenings that check enzymes in the liver can be performed by a primary care physician via blood test, liver ultrasound and, rarely, a liver biopsy.
• Genetics and heredity play an important role in some liver diseases and these factors are often compounded by environmental factors such as excessive alcohol consumption, smoking and obesity.
• People born between 1945 and 1965 should get tested for hepatitis C; this population is five times more likely to develop the disease than other adults.