Q. Hello, Dr. C. My name is Brad and I live in Atlanta. My father lived in Savannah and recently passed away suddenly at home. I reviewed my dads death certificate and found it very confusing. It stated in the space cause of death that he died of cardio respiratory arrest. On the next line, it stated that this was due to a heart attack. On the next line for other illnesses, it stated hypertension and diabetes mellitus. Can you explain all this?

A. Brad, first I am sorry to hear of the death of your father. Whenever such an event happens it can be very distressing but when it happens suddenly it is doubly more upsetting and numerous questions frequently remain incompletely answered. Working from the death certificate, several problems arise. The cause of death from an emergency room diagnosis sheet may have been cardio respiratory arrest because your father when formally assessed by a physician was found to have neither pulse nor respiration. With additional information provided from the emergency room or a formal post-mortem examination (i.e. autopsy), it was established that your father suffered a myocardial infarction, that is a heart attack and expired. Nearly half of all heart attacks occur suddenly, at home, and patients are transported to hospitals in the hope that survival can be secured. Common causes of heart disease include hypertension and diabetes mellitus. In all likelihood, your fathers family physician provided the information about these risk factors your father carried that led to his heart attack and death. The Centers for Disease Control and Prevention list the ten leading Causes of Death for all age groups (less than 1 year to 65 years and older) in the United States as follows: Heart Disease is the leading cause of death accounting for 696,000 deaths annually. Next is cancer, accounting for 557,000 deaths. Strokes, chronic lung disease, injury, diabetes mellitus, pneumonia, Alzheimers disease, kidney failure, and infections are listed three to ten in that order of frequency as causes of death in this country. You did not mention your fathers age; it is an important factor in compiling this list. In the 25-34 year age range, the list is very different with accidents, suicides, homicides listed above cancer, heart disease, HIV, and diabetes mellitus. Possibly relevant to your father, if he were in the 55-64 age group, the leading cause of death is cancer, followed by heart disease, chronic lung disease, diabetes, stroke, injury, liver disease, and suicides in order of frequency. Why are such lists important? They provide a direction for physicians and research scientists as we seek to reduce death from all causes. For example, in a report published in JAMA last year, the above listed causes of death were related to life-style risk factors such that the leading causes of death were due to tobacco (435,000) poor diet and physical inactivity (400,000), and alcohol consumption. Other death causing behavioral risk factors included HIV, motor vehicle accidents, firearms, and drug abuse. Regarding poor diet and physical inactivity, it appears that obesity may soon overtake tobacco as the leading cause of death by virtue of leading to early heart attacks, diabetes, strokes, and cancer. From this report, if your father had been a smoker and obese, it may be the sad truth that his cause of death may have been these factors and yet be absent from the current death report. With all of this information, it is clear that much more attention must be given to preventive care and that the public must be willing to adopt life-style changes that will promote good health and reduce avoidable causes of death. I hope this answers some of your questions regarding the very important question of Cause Of Death. P>