An analysis entitled “The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States” published on April 10, 2018 in JAMA Network reported on trends in the burden of diseases, injuries, and risk factors at the state level in the United States from 1990 to 2016.
The investigators undertook a systematic analysis of published studies and available data sources to estimate the burden of disease by age, sex, geography, and year. They looked at prevalence, incidence, mortality, life expectancy, healthy life expectancy, years of life lost due to premature mortality, years lived with disability, and disability-adjusted life-years for 333 causes and 84 risk factors.
The analysis found that from 1990 to 2016, the overall death rates in the United States declined from 745.2 per 100 000 persons to 578.0 per 100 000 persons, and the probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC.
In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years). Minnesota had the highest healthy life expectancy at birth (70.3 years), and West Virginia had the lowest (63.8 years).
“Disability-adjusted life-years” (“DALY”) is a summary metric of population health. DALYs represent a health gap and, as such, measure the state of a population’s health compared to a normative goal. The goal is for individuals to live the standard life expectancy in full health. DALYs are the sum of 2 components: years of life lost and years lived with disability.
The leading causes of disability-adjusted life-years in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, The third leading cause in 1990 was low back pain while the third leading cause in 2016 was chronic obstructive pulmonary disease.
In 2016, each of the following six risks individually accounted for more than 5% of risk-attributable disability-adjusted life-years: tobacco consumption, high body mass index, poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable disability-adjusted life-years were due to one of the three following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).
Opioid use disorders moved from the 11th leading cause of disability-adjusted life-years in 1990 to the 7th leading cause in 2016 (a 74.5% change).
The report concluded: “There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.”
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