The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
Level 3 - non-randomized controlled study
Comparative observational epidemiological modeling and population-level burden analysis (by design analogy)
PubMed 23842577 · doi:10.1001/jama.2013.13805
What was done
Using descriptive epidemiological data from the Global Burden of Disease 2010 Study, researchers evaluated changes in health outcomes, premature mortality, disability, and risk factors in the United States from 1990 to 2010. The analysis covered 291 diseases and injuries, 1,160 sequelae, and 67 risk factors or clusters. Key metrics included years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). US metrics and time trends were benchmarked against the 34 member countries of the Organisation for Economic Co-operation and Development (OECD).
What was found
From 1990 to 2010, US life expectancy increased from 75.2 to 78.2 years, and HALE increased from 65.8 to 68.1 years. Leading causes of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury; age-standardized YLL rates increased specifically for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The leading causes of YLDs were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. The top risk factors for DALYs were dietary risks, smoking, high BMI, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, US relative ranks dropped: life expectancy fell from 20th to 27th, HALE fell from 14th to 26th, age-standardized death rate fell from 18th to 27th, age-standardized YLL rate fell from 23rd to 28th, and age-standardized YLD rate fell from 5th to 6th.
Why it matters
Despite absolute gains in US life expectancy, the relative health performance of the US deteriorated markedly compared to other high-income nations. Furthermore, the overall US disease burden increasingly shifted toward chronic, non-fatal disabling conditions.
Limits
The study relies on epidemiological modeling and secondary syntheses of registries, surveys, and meta-analyses rather than direct longitudinal cohorts. The abstract does not provide uncertainty intervals, statistical confidence bounds, or subgroup stratifications by socioeconomic status, race, or geographic region within the US.
Cited by
- partial The United States has the largest gap between healthspan and lifespan and the worst healthspan statistics globally among peer nations.