MONROE -- The good news is that North Carolina has lower rates of heart disease – the number one cause of death in America – than the rest of the nation.

The bad news is the state ranks higher in the nine other top leading causes of death, according to 2006 data from the Centers for Disease Control.

From the number 2 to number 10 cause of death, those are: cancer, stroke, chronic lower respiratory disease, accident, diabetes, Alzheimer’s disease, influenza and pneumonia, kidney disease and septicemia.

Union County has lower rates for most of those causes as compared to the rest of the state, although the difference is minimal.

“Three behaviors underlie two-thirds of North Carolina’s premature deaths and disability...:physical inactivity, poor nutrition and tobacco use,” said Jeremy Moseley

Acting Director, Tri-State Stroke Network.

The state’s highest ranking is for the nation’s third leading cause of death, stroke. North Carolina ranks sixth.

The ranking is part of a regional trend. Stroke deaths from seven states – North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi and Alabama – is higher than in the rest of the nation. The states comprise “the stroke belt.”

Although the reason for the cluster of states burdened by strokes remains unclear, some health officials attribute it to the region’s dietary habits as well as the disparity in access to quality health care for various socioeconomic groups and races.

For instance, American Indian and black North Carolinians have higher stroke death rates than do white North Carolinians and blacks are also more likely to die of stroke at relatively young ages than are their white counterparts.

For some causes of death, such as accidents, health officials said that the state’s geography is to blame.

“We’re not Kansas. We don’t have flat roads,” said Scott Proescholdbell, state injury epidemiologist with the Division of Public Health. “But engineering can be done to improve that.”

Unintentional poisoning - especially of prescription medication - falls under the umbrella of accidents, Proescholdbell said, and is of growing concern for health officials.

Between 1999 and 2008, poisonings rose 200 percent, from 300 incidents to over 1,000.

“We’re working on physician awareness,” he said, adding that providers can now look into the controlled substance reporting system and see what other providers have prescribed the same patient. The goal is to prevent harmful drug interactions or prescription drug abuse, he said.

Ruth Petersen, section chief for chronic disease and injury in the division of Public Health, said most of the top leading causes of death are chronic diseases and that people can lower their risk of getting those diseases by eradicating certain factors from their lives.

Those top risk factors include tobacco use, diet and physical inactivity, and risky sexual behavior.

But she added that some aspects such as socioeconomic status and race have an imbedded risk attached to them.

“It’s money. It’s all about money. People’s health status is determined by socioeconomic status,” Petersen said. “People who are poor probably don’t eat well, are more stressed out and probably smoke.”

Petersen said the Southeast is generally poorer than other regions – a possible reason why North Carolina and other Southern states lead in some of the top causes of death.

But it’s not just up to individuals to make pro-wellness changes in their environment. Chris Bryant, director of the state diabetes prevention and control branch, said some risk factors can be reduced if the state made certain policy changes.

“Take sugar out of vending machines and feed them healthy food at least while they’re in school,” he said, adding that obesity is the number one cause of diabetes, as well as a cause of other chronic diseases.

Diabetes prevalence in North Carolina increased by 102 percent between 1995 and 2006.

Illiteracy and poor education also have an indirect effect on health, he said.

Those who are illiterate might not finish school, narrowing the job options they have. Without an adequate income, they might not get health insurance or receive inadequate health care.

North Carolina has one of the lowest high school graduation rates in the nation. Bryant said state officials should continue to address those low rates.

Despite the state’s less than ideal rankings, health officials said most of the trends are slowly reversing thanks to public education and legislation.

Rates for the leading causes of death have all decreased in North Carolina with the exception of kidney disease, which increased by a rate of 0.4 between 2005 and 2006.

But Petersen stressed the importance of focusing more on prevention steps that can be made versus disease rates.

“There are preventable risk factors that contribute to the leading causes of death,” she said. “We have to make all the environments in the state better so it promotes well being.”

For information on other state rankings, visit www.cdc.gov/nchs/pressroom/stats_states.htm.

How N.C. Stacks Up (box)

Cause of Death U.S. Death Rate* N.C. Death Rate* Rank

Heart Disease 200.2 195.3 24

Cancer 180.7 192.8 14

Stroke 43.6 52.4 6

Chronic lower respiratory disease 40.5 45.0 19

Accidents 39.8 47.0 17 (tie)

Diabetes 23.3 24.9 20(tie) Alzheimer’s Disease 22.6 26.4 16

Influenza and pneumonia 17.8 19.6 15 (tie)

Kidney Disease 14.5 18.9 13(tie) Septicemia 11.0 13.6 15

*Number of deaths per 100,000 population, age-adjusted