The burden of diseases, injuries, and risk factors by state in the USA, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.
Level 4 - case-series / case-control
Ecological and population-level comparative modeling study based on vital registration, survey, and administrative health data.
PubMed 39645376 · doi:10.1016/S0140-6736(24)01446-6
What was done
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 evaluated trends in mortality, morbidity, and 88 risk factors across all 50 US states and the District of Columbia from 1990 to 2021. Using a standardized computational framework, the authors calculated years lived with disability (YLDs), disability-adjusted life-years (DALYs), years of life lost (YLLs), healthy life expectancy (HALE), and life expectancy across 371 diseases and injuries for 25 age groups and both sexes. Uncertainty intervals (95% UIs) were computed from 500 posterior draws.
What was found
The US global ranking for life expectancy fell from 35th to 46th for males and 19th to 47th for females among 204 countries and territories between 1990 and 2021. Fourteen states experienced absolute declines in life expectancy over this period, led by West Virginia (a loss of 2.7 years). Substantial state disparities emerged: age-standardized mortality in 2021 ranged from 433.2 per 100,000 in Hawaii (95% UI 380.6–493.4) to 867.5 per 100,000 in Mississippi (95% UI 772.6–975.7). Although age-standardized mortality dropped significantly for ischemic heart disease (-56.1%), lung cancer (-41.9%), and breast cancer (-40.9%), mortality surged for drug use disorders (+878.0%), chronic kidney disease (+158.3%), and falls (+89.7%). In 2021, only six countries had higher age-standardized YLD rates than the USA, and eight individual US states had higher YLD rates than any country globally, driven heavily by mental health, substance use, and musculoskeletal disorders.
Why it matters
This study provides a comprehensive benchmark of state-level US health performance over three decades, revealing that despite reductions in major cardiovascular and cancer deaths, surging drug mortality and chronic morbidity have caused US life expectancy and healthy life expectancy to fall behind international peers.
Limits
The analysis relies on modeled estimates and aggregate registry data, which are subject to variations in state-level death certification, coding practices, and survey reporting. Individual-level socioeconomic, clinical, or behavioral factors were not directly evaluated, and the abstract text terminates prematurely before reporting full risk-factor data.