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


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.

DOI: 10.1001/jama.2013.13805

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@article{Murray2013TheSO, title={The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.}, author={Christopher J. Murray and Charles Atkinson and Kavi S Bhalla and Gretchen Lano Birbeck and Roy Burstein and David P Chou and Robert P. Dellavalle and Goodarz Danaei and Majid Ezzati and Atefeh Fahimi and Debbie Flaxman and Foreman and Sherine E. Gabriel and Emmanuela E. Gakidou and Nicholas J. Kassebaum and Shahab Khatibzadeh and Stephen S. Lim and Steven E. Lipshultz and Stephanie J London and L{\'o}pez and Michael F Macintyre and Ali H. Mokdad and Andrew E Moran and Dariush Mozaffarian and Tasha B. Murphy and Moshen Naghavi and Charlene A. Pope and Thomas Roberts and Joshua A . Salomon and David C. Schwebel and Saeid Shahraz and David A . Sleet and C Murray and Jerry Puthenpurakal Abraham and Mohammed Khairy Ali and David H Bartels and Honglei Chen and Michael H . Criqui and Dahodwala and Jarlais and Eric L. Ding and E. Ray Dorsey and Beth Ebel and Fahami and Seth Flaxman and Abraham D. Flaxman and Diego Gonz{\'a}lez-Medina and Bridget F. Grant and Holly Hagan and Howard J . Hoffman and Janet L Leasher and John Kent Lin and Rafael Lozano and Yuan Lu and Leslie Mallinger and Mary Mcgrae McDermott and Renata Micha and Ted R Miller and Ali A Mokdad and Mohsen Naghavi and K. M. Venkat Narayan and Saad B Omer and Pamela M Pelizzari and David E. Phillips and Dharani Ranganathan and Frederick P. Rivara and Uchechukwu Sampson and Ella Sanman and Amir Sapkota and Saeid Sharaz and Rupak Shivakoti and Gitanjali M. Singh and David K Singh and Mohammad B. Tavakkoli and Jeffrey Allen Towbin and James Dean Wilkinson and Azadeh Zabetian and Mohammad Kutub Ali and Miriam Alvardo and Larry Baddour and Emelia J Benjamin and Ian Bolliger and Emily Carnahan and Sumeet S Chugh and Aaron J. Cohen and Katherine Ellicott Colson and Leslie Trumbull Cooper and William G. Couser and Kaustubh C Dabhadkar and Daniel J Dicker and Herbert C Duber and Rebecca E. Engell and David T. Felson and Mariel M. Finucane and Thomas D Fleming and Mohammad Hossein Forouzanfar and Greg D. Freedman and Michael K. Freeman and Richard Frank Gillum and Richard Andre Gosselin and Hialy R Gutierrez and Rasmus Havmoeller and Kathryn H Jacobsen and Spencer L James and Rashmi Jasrasaria and Sudha Jayarman and Nicole E. Johns and Qing Lan and Michele Meltzer and George A . Mensah and Catherine M. Michaud and Charles N. Mock and Terrie E Moffitt and Robert G Nelson and Casey Olives and Katrina F. Ortblad and Bart David Ostro and M . Bhagavan Raju and Homie Razavi and Beate R. Ritz and Ralph L. Sacco and Kenji Shibuya and Donald Silberberg and Jasvinder A Singh and Kyle N. Steenland and Jennifer A Taylor and George Thurston and Monica S. Vavilala and Theo Vos and G. R. Wagner and Martin A. Weinstock and Marc G. Weisskopf and Sarah K Wulf}, journal={JAMA}, year={2013}, volume={310 6}, pages={591-608} }