The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.

Dr. David Sleet, MA, Ph.D
Dr. David Sleet, MA, Ph.D
Health Promotion Assoc, San Diego State U, Emory University;Centers for Disease Control and Prevention
Consultant, Injury Prevention; Bizzell Group; CDC
Injury Prevention
Atlanta and San Diego, Georgia and California | United States
Christopher J L Murray Charles Atkinson Kavi Bhalla Gretchen Birbeck Roy Burstein David Chou Robert Dellavalle Goodarz Danaei Majid Ezzati A Fahimi D Flaxman Foreman Sherine Gabriel Emmanuela Gakidou Nicholas Kassebaum Shahab Khatibzadeh Stephen Lim Steven E Lipshultz Stephanie London Lopez Michael F MacIntyre A H Mokdad A Moran Andrew E Moran Dariush Mozaffarian Tasha Murphy Moshen Naghavi C Pope Thomas Roberts Joshua Salomon David C Schwebel Saeid Shahraz David A Sleet Murray Jerry Abraham Mohammed K Ali Charles Atkinson David H Bartels Kavi Bhalla Gretchen Birbeck Roy Burstein Honglei Chen Michael H Criqui Dahodwala Jarlais Eric L Ding E Ray Dorsey Beth E Ebel Majid Ezzati Fahami S Flaxman A D Flaxman Diego Gonzalez-Medina Bridget Grant Holly Hagan Howard Hoffman Nicholas Kassebaum Shahab Khatibzadeh Janet L Leasher John Lin Steven E Lipshultz Rafael Lozano Yuan Lu Leslie Mallinger Mary M McDermott Renata Micha Ted R Miller A A Mokdad A H Mokdad Dariush Mozaffarian Mohsen Naghavi K M Venkat Narayan Saad B Omer Pamela M Pelizzari David Phillips Dharani Ranganathan Frederick P Rivara Thomas Roberts Uchechukwu Sampson Ella Sanman Amir Sapkota David C Schwebel Saeid Sharaz Rupak Shivakoti Gitanjali M Singh David Singh Mohammad Tavakkoli Jeffrey A Towbin James D Wilkinson Azadeh Zabetian Murray Jerry Abraham Mohammad K Ali Miriam Alvardo Charles Atkinson Larry M Baddour Emelia J Benjamin Kavi Bhalla Gretchen Birbeck Ian Bolliger Roy Burstein Emily Carnahan David Chou Sumeet S Chugh Aaron Cohen K Ellicott Colson Leslie T Cooper William Couser Michael H Criqui Kaustubh C Dabhadkar Robert P Dellavalle Jarlais Daniel Dicker E Ray Dorsey Herbert Duber Beth E Ebel Rebecca E Engell Majid Ezzati David T Felson Mariel M Finucane Seth Flaxman A D Flaxman Thomas Fleming Foreman Mohammad H Forouzanfar Greg Freedman Michael K Freeman Emmanuela Gakidou Richard F Gillum Diego Gonzalez-Medina Richard Gosselin Hialy R Gutierrez Holly Hagan Rasmus Havmoeller Howard Hoffman Kathryn H Jacobsen Spencer L James Rashmi Jasrasaria Sudha Jayarman Nicole Johns Nicholas Kassebaum Shahab Khatibzadeh Qing Lan Janet L Leasher Stephen Lim Steven E Lipshultz Stephanie London Lopez Rafael Lozano Yuan Lu Leslie Mallinger Michele Meltzer George A Mensah Catherine Michaud Ted R Miller Charles Mock Terrie E Moffitt A A Mokdad A H Mokdad A Moran Mohsen Naghavi K M Venkat Narayan Robert G Nelson Casey Olives Saad B Omer Katrina Ortblad Bart Ostro Pamela M Pelizzari David Phillips Murugesan Raju Homie Razavi Beate Ritz Thomas Roberts Ralph L Sacco Joshua Salomon Uchechukwu Sampson David C Schwebel Saeid Shahraz Kenji Shibuya Donald Silberberg Jasvinder A Singh Kyle Steenland Jennifer A Taylor George D Thurston Monica S Vavilala Theo Vos Gregory R Wagner Martin A Weinstock Marc G Weisskopf Sarah Wulf Murray

JAMA 2013 Aug;310(6):591-608

Institute for Health Metrics and Evaluation, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.

Importance: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy.

Objectives: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.

Design: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.

Results: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.

Conclusions And Relevance: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

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