An Ounce of Prevention: Deaths Averted from Implementing Evidence-based Primary Prevention Interventions in the United States in 2010

The United States (U.S.) lags in the nationwide adoption of primary prevention interventions. However, the potential population health benefit of various primary prevention interventions remains unclear. Based on a systematic review the literature, we estimated the number of deaths that could have been averted in the U.S. in 2010 if all rigorously-studied, efficacious primary prevention interventions for which population attributable risk could be estimated were implemented nationwide. We calculated the number of preventable deaths from interventions by applying the population attributable risk formula to the Centers for Disease Control and Prevention Underlying Cause of Death database for all causes of death with greater than 1,000 deaths in 2010. We estimated that 186,498 (7.4%) deaths in the United States could have been averted if all rigorously-studied, efficacious primary prevention protocols were implemented nationwide. Two in 3 deaths averted would have been from cardiovascular disease or malignancy. The proportion of preventable deaths varied by cause of death, prevention protocol, and demographic profile. Protocols ranged in efficacy from RR=0.15 (human papillomavirus vaccine, type 16) to RR and OR=0.88 (school-based smoking prevention program and home fall prevention environment/assistive technology interventions). Implementing a smoking prevention protocol was responsible for the highest number of potential deaths averted in 2010 (51,485; 2.1% of all-cause mortality), despite being among the least efficacious protocols identified. Despite the considerable gaps in the current primary prevention science literature, our findings suggest that increased investment in efficacious primary prevention across all sectors could result in substantial improvements in mortality.