The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors

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

Research output: Contribution to journalArticle

1256 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)591-608
Number of pages18
JournalJAMA - Journal of the American Medical Association
Volume310
Issue number6
DOIs
StatePublished - Aug 19 2013

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Life Expectancy
Quality-Adjusted Life Years
Health
Wounds and Injuries
Population
Health Status
Parturition
Somatoform Disorders
Premature Mortality
Mortality
Neck Pain
Kidney Neoplasms
Major Depressive Disorder
Health Policy
Low Back Pain
Anxiety Disorders
Chronic Renal Insufficiency
Developed Countries
Chronic Obstructive Pulmonary Disease
Substance-Related Disorders

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Murray, C. J. L., Abraham, J., Ali, M. K., Alvarado, M., Atkinson, C., Baddour, L. M., ... Lopez, A. D. (2013). The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors. JAMA - Journal of the American Medical Association, 310(6), 591-608. https://doi.org/10.1001/jama.2013.13805

The State of US health, 1990-2010 : Burden of diseases, injuries, and risk factors. / Murray, Christopher J L; Abraham, Jerry; Ali, Mohammed K.; Alvarado, Miriam; Atkinson, Charles; Baddour, Larry M.; Bartels, David H.; Benjamin, Emelia J.; Bhalla, Kavi; Birbeck, Gretchen; Bolliger, Ian; Burstein, Roy; Carnahan, Emily; Chen, Honglei; Chou, David; Chugh, Sumeet S.; Cohen, Aaron; Colson, K. Ellicott; Cooper, Leslie T.; Couser, William; Criqui, Michael H.; Dabhadkar, Kaustubh C.; Dahodwala, Nabila; Danaei, Goodarz; Dellavalle, Robert P.; Des Jarlais, Don C.; Dicker, Daniel; Ding, Eric L.; Dorsey, E. Ray; Duber, Herbert; Ebel, Beth E.; Engell, Rebecca E.; Ezzati, Majid; Felson, David T.; Finucane, Mariel M.; Flaxman, Seth; Flaxman, Abraham D.; Fleming, Thomas; Forouzanfar, Mohammad H.; Freedman, Greg; Freeman, Michael K.; Gabriel, Sherine E.; Gakidou, Emmanuela; Gillum, Richard F.; Gonzalez-Medina, Diego; Gosselin, Richard; Grant, Bridget; Gutierrez, Hialy R.; Hagan, Holly; Havmoeller, Rasmus; Hoffman, Howard; Jacobsen, Kathryn H.; James, Spencer L.; Jasrasaria, Rashmi; Jayaraman, Sudha; Johns, Nicole; Kassebaum, Nicholas; Khatibzadeh, Shahab; Knowlton, Lisa Marie; Lan, Qing; Leasher, Janet L.; Lim, Stephen; Lin, John Kent; Lipshultz, Steven E; London, Stephanie; Lozano, Rafael; Lu, Yuan; MacIntyre, Michael F.; Mallinger, Leslie; McDermott, Mary M.; Meltzer, Michele; Mensah, George A.; Michaud, Catherine; Miller, Ted R.; Mock, Charles; Moffitt, Terrie E.; Mokdad, Ali A.; Mokdad, Ali H.; Moran, Andrew E.; Mozaffarian, Dariush; Murphy, Tasha; Naghavi, Mohsen; Narayan, K. M Venkat; Nelson, Robert G.; Olives, Casey; Omer, Saad B.; Ortblad, Katrina; Ostro, Bart; Pelizzari, Pamela M.; Phillips, David; Pope, C. Arden; Raju, Murugesan; Ranganathan, Dharani; Razavi, Homie; Ritz, Beate; Rivara, Frederick P.; Roberts, Thomas; Sacco, Ralph L.; Sacco, Ralph L; Sampson, Uchechukwu; Sanman, Ella; Sapkota, Amir; Schwebel, David C.; Shahraz, Saeid; Shibuya, Kenji; Shivakoti, Rupak; Silberberg, Donald; Singh, Gitanjali M.; Singh, David; Singh, Jasvinder A.; Sleet, David A.; Steenland, Kyle; Tavakkoli, Mohammad; Taylor, Jennifer A.; Thurston, George D.; Towbin, Jeffrey A.; Vavilala, Monica S.; Vos, Theo; Wagner, Gregory R.; Weinstock, Martin A.; Weisskopf, Marc G.; Wilkinson, James D.; Wulf, Sarah; Zabetian, Azadeh; Lopez, Alan D.

In: JAMA - Journal of the American Medical Association, Vol. 310, No. 6, 19.08.2013, p. 591-608.

Research output: Contribution to journalArticle

Murray, CJL, Abraham, J, Ali, MK, Alvarado, M, Atkinson, C, Baddour, LM, Bartels, DH, Benjamin, EJ, Bhalla, K, Birbeck, G, Bolliger, I, Burstein, R, Carnahan, E, Chen, H, Chou, D, Chugh, SS, Cohen, A, Colson, KE, Cooper, LT, Couser, W, Criqui, MH, Dabhadkar, KC, Dahodwala, N, Danaei, G, Dellavalle, RP, Des Jarlais, DC, Dicker, D, Ding, EL, Dorsey, ER, Duber, H, Ebel, BE, Engell, RE, Ezzati, M, Felson, DT, Finucane, MM, Flaxman, S, Flaxman, AD, Fleming, T, Forouzanfar, MH, Freedman, G, Freeman, MK, Gabriel, SE, Gakidou, E, Gillum, RF, Gonzalez-Medina, D, Gosselin, R, Grant, B, Gutierrez, HR, Hagan, H, Havmoeller, R, Hoffman, H, Jacobsen, KH, James, SL, Jasrasaria, R, Jayaraman, S, Johns, N, Kassebaum, N, Khatibzadeh, S, Knowlton, LM, Lan, Q, Leasher, JL, Lim, S, Lin, JK, Lipshultz, SE, London, S, Lozano, R, Lu, Y, MacIntyre, MF, Mallinger, L, McDermott, MM, Meltzer, M, Mensah, GA, Michaud, C, Miller, TR, Mock, C, Moffitt, TE, Mokdad, AA, Mokdad, AH, Moran, AE, Mozaffarian, D, Murphy, T, Naghavi, M, Narayan, KMV, Nelson, RG, Olives, C, Omer, SB, Ortblad, K, Ostro, B, Pelizzari, PM, Phillips, D, Pope, CA, Raju, M, Ranganathan, D, Razavi, H, Ritz, B, Rivara, FP, Roberts, T, Sacco, RL, Sacco, RL, Sampson, U, Sanman, E, Sapkota, A, Schwebel, DC, Shahraz, S, Shibuya, K, Shivakoti, R, Silberberg, D, Singh, GM, Singh, D, Singh, JA, Sleet, DA, Steenland, K, Tavakkoli, M, Taylor, JA, Thurston, GD, Towbin, JA, Vavilala, MS, Vos, T, Wagner, GR, Weinstock, MA, Weisskopf, MG, Wilkinson, JD, Wulf, S, Zabetian, A & Lopez, AD 2013, 'The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors', JAMA - Journal of the American Medical Association, vol. 310, no. 6, pp. 591-608. https://doi.org/10.1001/jama.2013.13805
Murray, Christopher J L ; Abraham, Jerry ; Ali, Mohammed K. ; Alvarado, Miriam ; Atkinson, Charles ; Baddour, Larry M. ; Bartels, David H. ; Benjamin, Emelia J. ; Bhalla, Kavi ; Birbeck, Gretchen ; Bolliger, Ian ; Burstein, Roy ; Carnahan, Emily ; Chen, Honglei ; Chou, David ; Chugh, Sumeet S. ; Cohen, Aaron ; Colson, K. Ellicott ; Cooper, Leslie T. ; Couser, William ; Criqui, Michael H. ; Dabhadkar, Kaustubh C. ; Dahodwala, Nabila ; Danaei, Goodarz ; Dellavalle, Robert P. ; Des Jarlais, Don C. ; Dicker, Daniel ; Ding, Eric L. ; Dorsey, E. Ray ; Duber, Herbert ; Ebel, Beth E. ; Engell, Rebecca E. ; Ezzati, Majid ; Felson, David T. ; Finucane, Mariel M. ; Flaxman, Seth ; Flaxman, Abraham D. ; Fleming, Thomas ; Forouzanfar, Mohammad H. ; Freedman, Greg ; Freeman, Michael K. ; Gabriel, Sherine E. ; Gakidou, Emmanuela ; Gillum, Richard F. ; Gonzalez-Medina, Diego ; Gosselin, Richard ; Grant, Bridget ; Gutierrez, Hialy R. ; Hagan, Holly ; Havmoeller, Rasmus ; Hoffman, Howard ; Jacobsen, Kathryn H. ; James, Spencer L. ; Jasrasaria, Rashmi ; Jayaraman, Sudha ; Johns, Nicole ; Kassebaum, Nicholas ; Khatibzadeh, Shahab ; Knowlton, Lisa Marie ; Lan, Qing ; Leasher, Janet L. ; Lim, Stephen ; Lin, John Kent ; Lipshultz, Steven E ; London, Stephanie ; Lozano, Rafael ; Lu, Yuan ; MacIntyre, Michael F. ; Mallinger, Leslie ; McDermott, Mary M. ; Meltzer, Michele ; Mensah, George A. ; Michaud, Catherine ; Miller, Ted R. ; Mock, Charles ; Moffitt, Terrie E. ; Mokdad, Ali A. ; Mokdad, Ali H. ; Moran, Andrew E. ; Mozaffarian, Dariush ; Murphy, Tasha ; Naghavi, Mohsen ; Narayan, K. M Venkat ; Nelson, Robert G. ; Olives, Casey ; Omer, Saad B. ; Ortblad, Katrina ; Ostro, Bart ; Pelizzari, Pamela M. ; Phillips, David ; Pope, C. Arden ; Raju, Murugesan ; Ranganathan, Dharani ; Razavi, Homie ; Ritz, Beate ; Rivara, Frederick P. ; Roberts, Thomas ; Sacco, Ralph L. ; Sacco, Ralph L ; Sampson, Uchechukwu ; Sanman, Ella ; Sapkota, Amir ; Schwebel, David C. ; Shahraz, Saeid ; Shibuya, Kenji ; Shivakoti, Rupak ; Silberberg, Donald ; Singh, Gitanjali M. ; Singh, David ; Singh, Jasvinder A. ; Sleet, David A. ; Steenland, Kyle ; Tavakkoli, Mohammad ; Taylor, Jennifer A. ; Thurston, George D. ; Towbin, Jeffrey A. ; Vavilala, Monica S. ; Vos, Theo ; Wagner, Gregory R. ; Weinstock, Martin A. ; Weisskopf, Marc G. ; Wilkinson, James D. ; Wulf, Sarah ; Zabetian, Azadeh ; Lopez, Alan D. / The State of US health, 1990-2010 : Burden of diseases, injuries, and risk factors. In: JAMA - Journal of the American Medical Association. 2013 ; Vol. 310, No. 6. pp. 591-608.
@article{19c9db223e2949cc9da74ab284ead830,
title = "The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors",
abstract = "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.",
author = "Murray, {Christopher J L} and Jerry Abraham and Ali, {Mohammed K.} and Miriam Alvarado and Charles Atkinson and Baddour, {Larry M.} and Bartels, {David H.} and Benjamin, {Emelia J.} and Kavi Bhalla and Gretchen Birbeck and Ian Bolliger and Roy Burstein and Emily Carnahan and Honglei Chen and David Chou and Chugh, {Sumeet S.} and Aaron Cohen and Colson, {K. Ellicott} and Cooper, {Leslie T.} and William Couser and Criqui, {Michael H.} and Dabhadkar, {Kaustubh C.} and Nabila Dahodwala and Goodarz Danaei and Dellavalle, {Robert P.} and {Des Jarlais}, {Don C.} and Daniel Dicker and Ding, {Eric L.} and Dorsey, {E. Ray} and Herbert Duber and Ebel, {Beth E.} and Engell, {Rebecca E.} and Majid Ezzati and Felson, {David T.} and Finucane, {Mariel M.} and Seth Flaxman and Flaxman, {Abraham D.} and Thomas Fleming and Forouzanfar, {Mohammad H.} and Greg Freedman and Freeman, {Michael K.} and Gabriel, {Sherine E.} and Emmanuela Gakidou and Gillum, {Richard F.} and Diego Gonzalez-Medina and Richard Gosselin and Bridget Grant and Gutierrez, {Hialy R.} and Holly Hagan and Rasmus Havmoeller and Howard Hoffman and Jacobsen, {Kathryn H.} and James, {Spencer L.} and Rashmi Jasrasaria and Sudha Jayaraman and Nicole Johns and Nicholas Kassebaum and Shahab Khatibzadeh and Knowlton, {Lisa Marie} and Qing Lan and Leasher, {Janet L.} and Stephen Lim and Lin, {John Kent} and Lipshultz, {Steven E} and Stephanie London and Rafael Lozano and Yuan Lu and MacIntyre, {Michael F.} and Leslie Mallinger and McDermott, {Mary M.} and Michele Meltzer and Mensah, {George A.} and Catherine Michaud and Miller, {Ted R.} and Charles Mock and Moffitt, {Terrie E.} and Mokdad, {Ali A.} and Mokdad, {Ali H.} and Moran, {Andrew E.} and Dariush Mozaffarian and Tasha Murphy and Mohsen Naghavi and Narayan, {K. M Venkat} and Nelson, {Robert G.} and Casey Olives and Omer, {Saad B.} and Katrina Ortblad and Bart Ostro and Pelizzari, {Pamela M.} and David Phillips and Pope, {C. Arden} and Murugesan Raju and Dharani Ranganathan and Homie Razavi and Beate Ritz and Rivara, {Frederick P.} and Thomas Roberts and Sacco, {Ralph L.} and Sacco, {Ralph L} and Uchechukwu Sampson and Ella Sanman and Amir Sapkota and Schwebel, {David C.} and Saeid Shahraz and Kenji Shibuya and Rupak Shivakoti and Donald Silberberg and Singh, {Gitanjali M.} and David Singh and Singh, {Jasvinder A.} and Sleet, {David A.} and Kyle Steenland and Mohammad Tavakkoli and Taylor, {Jennifer A.} and Thurston, {George D.} and Towbin, {Jeffrey A.} and Vavilala, {Monica S.} and Theo Vos and Wagner, {Gregory R.} and Weinstock, {Martin A.} and Weisskopf, {Marc G.} and Wilkinson, {James D.} and Sarah Wulf and Azadeh Zabetian and Lopez, {Alan D.}",
year = "2013",
month = "8",
day = "19",
doi = "10.1001/jama.2013.13805",
language = "English",
volume = "310",
pages = "591--608",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - The State of US health, 1990-2010

T2 - Burden of diseases, injuries, and risk factors

AU - Murray, Christopher J L

AU - Abraham, Jerry

AU - Ali, Mohammed K.

AU - Alvarado, Miriam

AU - Atkinson, Charles

AU - Baddour, Larry M.

AU - Bartels, David H.

AU - Benjamin, Emelia J.

AU - Bhalla, Kavi

AU - Birbeck, Gretchen

AU - Bolliger, Ian

AU - Burstein, Roy

AU - Carnahan, Emily

AU - Chen, Honglei

AU - Chou, David

AU - Chugh, Sumeet S.

AU - Cohen, Aaron

AU - Colson, K. Ellicott

AU - Cooper, Leslie T.

AU - Couser, William

AU - Criqui, Michael H.

AU - Dabhadkar, Kaustubh C.

AU - Dahodwala, Nabila

AU - Danaei, Goodarz

AU - Dellavalle, Robert P.

AU - Des Jarlais, Don C.

AU - Dicker, Daniel

AU - Ding, Eric L.

AU - Dorsey, E. Ray

AU - Duber, Herbert

AU - Ebel, Beth E.

AU - Engell, Rebecca E.

AU - Ezzati, Majid

AU - Felson, David T.

AU - Finucane, Mariel M.

AU - Flaxman, Seth

AU - Flaxman, Abraham D.

AU - Fleming, Thomas

AU - Forouzanfar, Mohammad H.

AU - Freedman, Greg

AU - Freeman, Michael K.

AU - Gabriel, Sherine E.

AU - Gakidou, Emmanuela

AU - Gillum, Richard F.

AU - Gonzalez-Medina, Diego

AU - Gosselin, Richard

AU - Grant, Bridget

AU - Gutierrez, Hialy R.

AU - Hagan, Holly

AU - Havmoeller, Rasmus

AU - Hoffman, Howard

AU - Jacobsen, Kathryn H.

AU - James, Spencer L.

AU - Jasrasaria, Rashmi

AU - Jayaraman, Sudha

AU - Johns, Nicole

AU - Kassebaum, Nicholas

AU - Khatibzadeh, Shahab

AU - Knowlton, Lisa Marie

AU - Lan, Qing

AU - Leasher, Janet L.

AU - Lim, Stephen

AU - Lin, John Kent

AU - Lipshultz, Steven E

AU - London, Stephanie

AU - Lozano, Rafael

AU - Lu, Yuan

AU - MacIntyre, Michael F.

AU - Mallinger, Leslie

AU - McDermott, Mary M.

AU - Meltzer, Michele

AU - Mensah, George A.

AU - Michaud, Catherine

AU - Miller, Ted R.

AU - Mock, Charles

AU - Moffitt, Terrie E.

AU - Mokdad, Ali A.

AU - Mokdad, Ali H.

AU - Moran, Andrew E.

AU - Mozaffarian, Dariush

AU - Murphy, Tasha

AU - Naghavi, Mohsen

AU - Narayan, K. M Venkat

AU - Nelson, Robert G.

AU - Olives, Casey

AU - Omer, Saad B.

AU - Ortblad, Katrina

AU - Ostro, Bart

AU - Pelizzari, Pamela M.

AU - Phillips, David

AU - Pope, C. Arden

AU - Raju, Murugesan

AU - Ranganathan, Dharani

AU - Razavi, Homie

AU - Ritz, Beate

AU - Rivara, Frederick P.

AU - Roberts, Thomas

AU - Sacco, Ralph L.

AU - Sacco, Ralph L

AU - Sampson, Uchechukwu

AU - Sanman, Ella

AU - Sapkota, Amir

AU - Schwebel, David C.

AU - Shahraz, Saeid

AU - Shibuya, Kenji

AU - Shivakoti, Rupak

AU - Silberberg, Donald

AU - Singh, Gitanjali M.

AU - Singh, David

AU - Singh, Jasvinder A.

AU - Sleet, David A.

AU - Steenland, Kyle

AU - Tavakkoli, Mohammad

AU - Taylor, Jennifer A.

AU - Thurston, George D.

AU - Towbin, Jeffrey A.

AU - Vavilala, Monica S.

AU - Vos, Theo

AU - Wagner, Gregory R.

AU - Weinstock, Martin A.

AU - Weisskopf, Marc G.

AU - Wilkinson, James D.

AU - Wulf, Sarah

AU - Zabetian, Azadeh

AU - Lopez, Alan D.

PY - 2013/8/19

Y1 - 2013/8/19

N2 - 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.

AB - 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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U2 - 10.1001/jama.2013.13805

DO - 10.1001/jama.2013.13805

M3 - Article

C2 - 23842577

AN - SCOPUS:84881425599

VL - 310

SP - 591

EP - 608

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 6

ER -