Comprehensive analysis of disease burden in US

Mental conditions, substance abuse, and musculoskeletal disorders cause more disability than cancers. Diet, blood pressure, smoking top risk factors for poor health

In nearly every major cause of premature death - from ischemic heart disease to diabetes to interpersonal violence - the United States trails its economic peers, according to new research from a global collaborative of scientists led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

In a study published in the Journal of the American Medical Association today - -The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors- - researchers show the impact of premature deaths in children and young adults, the significant toll of disabling conditions, and the overall burden on health systems from a range of fatal and non-fatal health factors. This is the first comprehensive analysis of disease burden in the United States in more than 15 years. It includes estimates for death and disability from 291 diseases, conditions, and injuries as well as 67 risk factors.

-The United States spends more than the rest of the world on health care and leads the world in the quality and quantity of its health research, but that doesn-t add up to better health outcomes,- said Dr. Christopher Murray, IHME Director and one of the lead authors on the study. -The country has done a good job of preventing premature deaths from stroke, but when it comes to lung cancer, preterm birth complications, and a range of other causes, the country isn-t keeping pace with high-income countries in Europe, Asia, and elsewhere.-

The findings will be presented by Dr. Murray today to city and county officials at an event hosted by First Lady Michelle Obama as part of her Let-s Move! campaign.

Road traffic injuries, self-harm, cirrhosis, and drug use disorders all are causing more years of life lost due to premature death than previously thought. There were more years of life lost due to drug use disorders in 2010 than prostate cancer and brain cancer combined, up 448% between 1990 and 2010. Alzheimer-s, liver cancer, Parkinson-s disease, and kidney cancer also are rising rapidly as causes of premature death.

The top 10 causes of years of life lost in 2010 and their percentage of all years of life lost were:

Ischemic heart disease 15.9%
Lung cancer6.6%
Stroke4.3%

Chronic obstructive pulmonary disease4.2%
Road injury4.2%
Self-harm3.2%
Diabetes3.1%
Cirrhosis2.7%
Alzheimer-s disease2.6%
Colorectal cancer2.4%

Since 1990, there has been a steady shift from conditions that shorten life to chronic disability from mental and behavioral disorders, musculoskeletal problems, and neurological conditions. Chronic disability in 2010 now accounts for nearly half of all health loss in the US.

Mental and behavioral disorders alone make up 27% of what researchers call -years lived with disability,- meaning the time spent in less than optimal health. The biggest contributors are depression, anxiety disorders, drug use disorders, and alcohol use disorders.

-The United States has spent a good amount of time and money on finding successful solutions for cardiovascular diseases and even some cancers, but like a lot of countries, it has yet to make that same kind of effort with these leading causes of disability,- said Dr. Alan Lopez, Chair of Global Health and Burden of Disease Measurement in the School of Population and Global Health at the University of Melbourne in Australia and one of the study-s authors. -That-s a real problem with a population as large as the US has, and there are few good options for dealing with a massive amount of health loss.-

The top 10 causes of years lived with disability in 2010 and their percentage of all years lived with disability were:

Low back pain8.7%
Major depressive disorder8.4%
Other musculoskeletal disorders7.1%
Neck pain5.8%
Anxiety disorders5.1%
Chronic obstructive pulmonary disease 4.7%
Drug use disorders3.5%
Diabetes3.2%
Osteoarthritis2.7%
Asthma2.5%

Overall disease burden in the United States is now dominated by conditions that are more disabling than fatal. The burdens from ischemic heart disease, lung cancer, lower respiratory infections, HIV/AIDS, and preterm birth complications are all falling, while the burdens from depression, low back and neck pain, and diabetes are rising.

In 2010, the top 10 causes of disability-adjusted life years (DALYs), which measure health loss, were:

Ischemic heart disease 9.6%
Chronic obstructive pulmonary disease 4.7%
Low back pain3.9%
Lung cancer3.7%
Major depressive disorder3.7%
Other musculoskeletal disorders3.5%
Stroke3.2%
Diabetes3.1%
Road injury2.8%
Drug use disorders2.6%

The United States has made significant health improvements over the past two decades, including:

• Lower disease burden rates since 1990 of nearly all childhood diseases and conditions, including a dramatic reduction in sudden infant death syndrome (SIDS).
• Lower mortality rates for people at every age since 1990.
• Significant reductions in death and disability from HIV/AIDS.

But other countries are improving at a faster rate. As a result, among its 34 economic peer countries in Europe, Asia, and North America, the US fell in the rankings between 1990 and 2010 on nearly every major health measure.

• The US rank for the age-standardized death rate fell from 18th to 27th.
• The life expectancy at birth rank fell from 20th to 27th.
• The healthy life expectancy (HALE) rank fell from 14th to 26th.

What is making the US less healthy than its peers? The researchers point to poor diet and inadequate physical activity as two of the driving forces. The US has a greater associated disease burden from diet than the average of its peer countries. Out of its 34 peer countries, the US ranked 27th in disease burden risk from dietary factors, 27th on high body mass index (BMI), and 29th on blood sugar. It did better than its peers in only four areas: occupational risks, low bone mineral density, unimproved sanitation, and iron deficiency.

While the science around dietary risks continues to improve, there is stronger evidence about the connection between dietary risks and health than there is for obesity, alcohol, or drug use.

The top 10 risk factors for health loss in 2010 and the number of deaths attributable to each were:

Dietary risks678,282
Smoking465,651
High blood pressure442,656
High body mass index363,991
Physical inactivity234,022
High blood sugar213,669
High total cholesterol158,431
Ambient air pollution103,027
Alcohol use88,587
Drug use25,430

-If the US can make progress with dietary risk factors, physical activity, and obesity, it will see massive reductions in death and disability,- said Dr. Ali Mokdad, head of the US County Health Performance team for IHME and former director of the Behavior Risk Factors and Surveillance Survey at the US Centers for Disease Control and Prevention. -Unhealthy diets and a lack of physical activity in the US cause more health loss than smoking, alcohol, or drug use.-