The Leading Causes of Death in Hawaii

What's Killing Us? You’ve got to go somehow. Here are the things you should really worry about.

We all know we need to eat fruits and vegetables, get enough sleep and exercise and make appointments for yearly checkups—all of which are easier said than done. And despite our best efforts, we’re all going to… well, let’s face it, die. Last year in Hawaii, 9,627 people died, according to the state Department of Health’s preliminary 2010 vital statistics. (On the upside, 18,933 babies were born.) So what are the leading causes of death in Hawaii? You might be surprised by some of them. We used data from the most recent Hawaii State Data Book—but we’ve also included contact information for the nonprofits that help us combat these leading causes of death, whether through support groups, education or fundraising for research.

No. 1 Schemic Heart Disease

Heart disease,  specifically ischemic heart disease, is the No. 1 killer. (Ischemic refers to a reduced blood supply to the heart because of coronary artery disease.) In 2008, it claimed 1,275 lives in the Islands, and it’s the leading cause of death for both men and women, not only here but across the country. Ischemic heart disease can cause congestive heart failure, such as a heart attack or arrhythmias.

Fighting Back against Heart Disease and Stroke

The American Heart Association of Hawaii deals with both of these leading causes of death. Honolulu office: 538-7021,

Next event: Black Tie & Blue Jeans at Marriott Waikiki Beach Resort and Spa. July 16, 6 p.m., 457-4971. Other events include the posh Honolulu Heart Ball in February, the Golf Classic at Mid-Pacific Country Club in April and fun runs throughout the year on multiple islands.


Hawaii’s adult smoking rate in 2010, down from 15.4 percent in 2009.

Hawaii’s Health Disparities

Native Hawaiians are at a higher risk than the rest of the population for the majority of the leading causes of death in Hawaii. Researchers and health organizations believe it’s due both to genetics and socioeconomic factors, such as lack of education, lower income and decreased access to healthcare and insurance. Imi Hale, the Native Hawaiian Cancer Network, works to reduce the rate of cancer and the mortality rate from cancer among Native Hawaiians and other minority populations. The program provides educational materials on different types of cancer, such as breast, prostate, colon and skin cancer, and more. The pamphlets come in both hard copy and PDF formats. “These materials are made in Hawaii, with Hawaii faces, with Hawaii words,” says research director Kathryn Braun.

No. 2 Stroke

The No. 2 killer in Hawaii is cerebrovascular disease, commonly known as a stroke. According to the most recent Hawaii State Data Book, 629 people died from strokes in 2008. Unlike the majority of the top medical killers on our list, more women than men die from strokes in the state. “It’s because women live longer, when they get a stroke they are older [and less likely to survive them]. Men get strokes when they are younger,” says Dr. Kore Liow, the medical director of neuroscience at Castle Medical Center and the director of the Hawaii Pacific Neuroscience Center. Liow started the neuroscience center in Kailua because “there’s a huge elderly population on the Windward Side, including a lot of stroke and Alzheimer’s disease patients,” he says. Hawaii has the second-largest elderly population in the United States, per capita, after Florida. Liow works with stroke survivors as well as those with varying progressions of Alzheimer’s disease. To better help stroke patients, he is also in the process of starting the Hawaii Memory Clinic at the center. “It’s an interdisciplinary approach that brings together different specialties,” he says.

What Is a Stroke?

A stroke, sometimes called a “brain attack,” occurs when a clot blocks the blood supply to the brain (an ischemic stroke), or when a blood vessel in the brain bursts (a hemorrhagic stroke).

Every 40 Seconds

Someone in the U.S. has a stroke.

By the Numbers

Around 800,000 people in the U.S. have strokes each year. Around 185,000 people in the U.S. who survive strokes eventually have another. Today, more than 6 million people have survived strokes. Every three to four minutes, someone in the U.S. dies from a stroke.

Signs of a Stroke and What to Do

If someone is exhibiting possible symptoms of a stroke, such as a severe headache, sudden confusion, numbness on one side of the body or trouble walking, use the F.A.S.T. method: Face: Ask the person to smile. Does one side of the face droop? Arms: Ask the person to raise both arms. Does one arm drift downward? Speech: Ask the person to repeat a simple phrase. Does the speech sound slurred? Time: If you observe these signs, call 911.


No. 3 Lung Cancer

Lung cancer leads to more deaths every year in Hawaii than breast, prostate and colorectal cancers combined. According to the Hawaii Cancer Facts and Figures, lung cancer is the second-most-common type of cancer diagnosed among men, and the third-most common among women in Hawaii. In 2008, 546 people died from lung cancer. Every year, hundreds of new patients are diagnosed—most are over the age of 55—and the cancer is often diagnosed at a later stage. Compared to high-profile cancers like breast cancer, lung cancer isn’t as known to the public. “We need to increase awareness,” says Debbie Odo, director of tobacco control at the American Lung Association in Hawaii (ALAH), who adds that the  biggest cause of lung cancer is smoking. Want to quit? ALAH provides education materials, and also provides support and training for free community smoking-prevention programs such as Teens Against Tobacco Use and Music with a Message. “We train students to advocate against smoking and they create their own methods to do that,” says Odo, who also lobbies for funding for smoking cessation and prevention at the state Legislature. Lung cancer and diseases caused by smoking aren’t just costly in terms of lives; they cost the state $1.1 billion each year, says Odo.

In Hawaii, Filipino men smoke the most, followed by Native Hawaiian women and men. Japanese women smoke the least.

Just Say No

Cigarette smoking among Hawaii’s young people has declined significantly. In 2000, 63 percent of high school students reported they had tried smoking. In 2007, that number dropped to 38 percent. Fewer Hawaii middle schoolers have tried cigarettes, too, from 38 percent in 2000 to 14 percent in 2007.

Fighting Back Against Lung Cancer

The American Cancer Society of Hawaii Pacific hosts multiple fundraisers throughout the year, statewide, including Relays for Life and DetermiNation, a program for sponsoring triathletes to raise money. Of course, the ACS helps people deal with cancer, wherever it strikes, including Hawaii’s No. 8 top killer, colon cancer. Honolulu office: 2370 Nuuanu Avenue, 595-7544,

Lung cancer is the no. 1 cause of all cancer deaths in the world.

Did You Know?

1,000 Hawaii residents die annually from diseases related to tobacco use.

400,000 Number of lung cancer survivors living in the U.S. today.

A Survivor’s Story

In December 1977, Oahu resident Jim Tilton was diagnosed with lung cancer. His doctors removed part of his lung, but he considers himself  fortunate because he didn’t have to go through chemotherapy or radiation. “Since then my lungs have been clear,” he says. Unfortunately, he’s gearing up for another fight, as he’s been diagnosed with brain tumors. When it comes to lung cancer, the earlier the diagnosis, the better. “Don’t let it get you,” says Tilton, who recommends leaning on family, friends and spirituality for support. “Look at what’s important to you.”


No. 4 Chronic Respiratory Diseases

Smoking isn’t the only culprit in lung diseases. Both indoor and outdoor air quality are also critical. More than 130,000 adults in Hawaii suffer from the state’s fourth-most-common cause of death, chronic respiratory diseases, which include asthma and chronic obstructive pulmonary diseases (COPD), such as emphysema. In 2008, they claimed 290 lives. Odo says it’s important to have proper air ventilation when using cleaning products and to stay indoors when possible if you’re affected by vog. While air pollution is inevitable, lucky you live Hawaii. According to the American Lung Association’s State of the Air 2009 report, Honolulu was the third-cleanest U.S. city for long-term particle pollution. Particle pollution is a mix of tiny solid and liquid particles in the air that we breathe, from sources such as car exhaust, construction projects, power plants, sulfur dioxide (vog) and more.


Year the American Lung Association expanded to Hawaii. ALAH’s original mission? Combating tuberculosis.

Fighting Back

The American Lung Association in Hawaii focuses on this top killer, as well as asthma, vog, influenza (No. 6 on this list) and lung cancer (No. 3 on this list.) Honolulu office: 680 Iwilei Road, Suite 575, 537-5966,

More than 3.1 million people have been diagnosed with emphysema in the U.S.

Waiting to Inhale

Shirley Uyehara has been living with emphysema for seven years. “I smoked for 40-plus years,” says the 66-year-old, “and I enjoyed every bit of it.” While she doesn’t regret her former habit, today Uyehara breathes with the assistance of an oxygen tank, is admitted to Pali Momi Medical Center frequently and has a hard time getting up and down stairs. Her doctors said she might get some reprieve by finding a new home for her two cockatoos and two Chihuahuas, “but they’re my life,” she says, “so I suffer through it.” Uyehara does find comfort at the Better Breathers Club of Hawaii. The meetings, spearheaded by Brenda Moniz, of the American Lung Association in Hawaii, allow members to talk story about their medical conditions and offer support and advice.

Emphysema is a condition in which the walls between the alveoli, or air sacs within the lung, lose the ability to stretch and recoil.


No. 5 Diabetes

“Diabetes has always been an issue in Hawaii. It’s been steadily increasing over the years,” says Valerie Ah Cook, the program coordinator of the Hawaii Diabetes Prevention and Control Program. The disease killed 283 people in the Islands in 2008, but almost a 100,000 people have diabetes in Hawaii, or 8.3 percent of the state’s population. An additional 26,000 are estimated to be undiagnosed, and, therefore, untreated. The Hawaii Diabetes Prevention and Control Program is run by the state Department of Health program, and receives federal funding from the Centers for Disease Control and Prevention (CDC). All states have a similar program. Ah Cook says, “Our strengths are surveillance and disease management.” The program provides support and consultation services for the staffs of community health centers. “The [centers] work for the uninsured and the underinsured populations, who are at greater risk,” she says. The biggest risk factors for diabetes? Obesity, high blood pressure and high cholesterol. In addition to proper diet and exercise, Ah Cook also recommends at-risk people have their blood-sugar levels checked twice a year.

Fighting Diabetes

This month, the National Kidney Foundation is hosting the third annual “Kidney Disease in the Pacific: Meeting the Challenge” conference in Honolulu, bringing the region’s healthcare professionals, from doctors to dieticians, together for the latest information on dialysis and care of kidney disease patients. Unusual fundraiser: Kidney cars. Donate your old car by calling 596-7575,

Medical Firsts

  • 1839: Hawaii’s first mass immunization effort, administering a smallpox vaccine to 8,000 to 10,000 Native Hawaiians.
  • 1847: Hawaii’s first three pharmacies open.
  • 1853: A smallpox epidemic kills half the population of Oahu.
  • 1870: Dr. Gerrit P. Judd opens Hawaii’s first medical school. It accepts 10 students, with a Native Hawaiians-only admissions policy.
  • 1916: First ambulance in Honolulu deployed by the Honolulu Police Department.
  • 1944: Penicillin first made available for civilian use in Hawaii.


No. 6 Influenza

Think the flu is no big deal? Think again; influenza causes the sixth highest number of deaths in the state. The virus claimed the lives of 266 people, the majority of them elderly, in 2008. Dr. Sarah Park, the state epidemiologist, works with the Department of Health’s Hawaii Influenza Surveillance Program to identify influenza and pneumonia trends in the state. “We don’t know of all the flu cases,” she says, “because not all doctors test [for influenza] and not everyone goes to the doctor.” The CDC funds the surveillance program—every state has one. Between 12 and 18 Hawaii physicians statewide send weekly reports indicating how many of their patients had acute respiratory symptoms and submit specimen tests. Schools, hospitals and commercial laboratories also send reports to the DOH. “It helps us get a better handle on what comes to Hawaii. Diseases don’t start here,” says Park, adding that the biggest flu preventatives are still the time-tested ones: Wash your hands and cover your face when you cough or sneeze.

Free Flu Shots

HMSA holds free flu shot clinics, and local pharmacies also offer free or low- cost flu shots.

Safety in Numbers

The state DOH provides free, voluntary flu shots to children through its Stop Flu at School program. The program covers both public and private schools statewide. Students in kindergarten through the eighth grade can receive flu shots on their campuses starting every October. Last year, more than 70,000 students were vaccinated. This benefits adults, too, through “herd immunity,” and the Influenza Surveillance Program has shown that flu vaccinations are having a positive impact.


Number of fatalities in 1848 and early 1849 from measles, whooping cough, dysentery and influenza epidemics in Hawaii. This represented one-tenth of the population, the equivalent of losing 130,000 Islanders in a single year in 2011.


No. 7 Alzheimer's Disease

n 2008, 266 people died from Alzheimer’s, a progressive, ultimately fatal, disorder in which certain types of nerve cells in select areas of the brain degenerate and die for unknown reasons. As with stroke, women have a higher mortality rate. But “the truth of the matter is that Hawaii does not know how many cases of Alzheimer’s and related dementias we presently have,” said Tom Harding, a local neuropsychologist and the author of the book, You Can Prevent Alzheimer’s! “Nor do we have an accurate process in place to determine the number of future cases and what we can do to reduce those numbers.” Harding says that people have a 50-percent chance of getting dementia in their 80s—age is the greatest risk factor. He’s working to bring stakeholders together to start a Dementia Task Force for the state to survive what he calls “the baby boomer silver tsunami.” (Hawaii has the second highest aging population in the nation.) He’s already met with HMSA executives to gather Alzheimer’s disease data from their member database and with Gov. Neil Abercrombie to pitch ideas on disease prevention. Harding also partnered with Dr. Kore Liow of the Hawaii Pacific Neuroscience Center to treat those with dementia-related diseases. Early intervention and screening are key, he says.

Lend Support

The Alzheimer's Association Aloha Chapter has offices on each of the major islands, in which the staff provides support and education. The chapter also holds fundraiser walks, too.


The estimated number of people living with Alzheimer’s disease in Hawaii.

Tracking Alzheimer’s

There is no single clinical test that can be used to diagnose Alzheimer’s disease. A complete evaluation includes health history, a physical exam, neurological and mental health assessments, blood and urine analysis, an electrocardiogram, and an imaging exam, such as CT or MRI.

Today, 5.4 million people in the U.S. are living with Alzheimer’s disease; two thirds of those with the disease are women.

No. 8 Colon Cancer

No. 8 is colorectal cancer. In 2008, 196 Hawaii residents died from it. Colon cancer is the second-most-common type of cancer among women and the third-most common among men. But, approximately 90 percent of all colon cancer deaths are preventable, according to researchers. The problem is lack of cancer screenings; if detected early, colon cancer is very treatable. That’s why local health stakeholders, such as the DOH, Queen’s Medical Center, UH and Imi Hale, the Native Hawaiian Cancer Network program, are developing a colorectal cancer screening campaign to raise awareness about early detection. “Minority populations have the lowest screening rates, so our goal is to increase that,” says Koa Robinson, the Imi Hale community health educator. Robinson says that increasing education about colon cancer and how to test for it is important. “I think there’s still an ‘icky’ factor,” he says, referring to the way the screenings are performed, either through colonoscopies or blood stool tests. While the tests are uncomfortable, being diagnosed with colon cancer is worse.


Age after which 9 out of 10 colorectal cancer cases are diagnosed.

Final Wishes

  • 2,343: The number of people buried in Hawaii in 1980.
  • 2,241: The number of people cremated in Hawaii in 1980.
  • 2,455: The number of people buried in Hawaii in 2008.
  • 6,506: The number of people cremated in Hawaii in 2008.
  • 63: The number of bodies donated to medical science in 2008.

NOT Deadly

While car accidents can be sudden and horrific, far fewer people die from them than from heart disease or lung cancer. According to the Hawaii State Data Book, car accidents were at the bottom of the list, accounting for just 104 deaths in 2008. Even the suicide rate in the state was higher—131. There were 28 homicides in the state that year, among the lowest in the nation.

Sources: American Heart Assoc., CDC, National Institutes of Health, National Stroke Assoc., American Stroke Assoc., Smoking and Tobacco use in Hawaii: Facts and Figures, American Cancer Society, American Lung Assoc. in Hawaii, Hawaii Diabetes Plan, The Hawaiian Journal of History, Alzheimer’s Assoc., First and Almost Firsts in Hawaii, Hawaii State Data Book, Hawaii State Dept. of Health