The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.
The US Burden of Disease Collaborators; Mokdad, Ali H. PhD 1; Ballestros, Katherine PhD 1; Echko, Michelle BS 1; Glenn, Scott MSc 1; Olsen, Helen E. MA 1; Mullany, Erin BA 1; Lee, Alex BS 1; Khan, Abdur Rahman MD 2; Ahmadi, Alireza MD 3,4; Ferrari, Alize J. PhD 1,5,6; Kasaeian, Amir PhD 7; Werdecker, Andrea PhD 8; Carter, Austin BS 1; Zipkin, Ben BS 1; Sartorius, Benn PhD 9,10; Serdar, Berrin PhD 11; Sykes, Bryan L. PhD 12; Troeger, Chris MPH 1; Fitzmaurice, Christina MD 1,13; Rehm, Colin D. PhD 14; Santomauro, Damian PhD 1,5,6; Kim, Daniel DrPH 15; Colombara, Danny PhD 1; Schwebel, David C. PhD 16; Tsoi, Derrick BS 1; Kolte, Dhaval MD 17; Nsoesie, Elaine PhD 1; Nichols, Emma BA 1; Oren, Eyal PhD 18; Charlson, Fiona J. PhD 1,5,6; Patton, George C. MD 19; Roth, Gregory A. MD 1; Hosgood, H. Dean PhD 20; Whiteford, Harvey A. PhD 1,5,6; Kyu, Hmwe PhD 1; Erskine, Holly E. PhD 1,5,6; Huang, Hsiang MD 21; Martopullo, Ira MPH 1; Singh, Jasvinder A. MD 16; Nachega, Jean B. PhD 22,23,24; Sanabria, Juan R. MD 25,26; Abbas, Kaja PhD 27; Ong, Kanyin PhD 1; Tabb, Karen PhD 28; Krohn, Kristopher J. MPH 1; Cornaby, Leslie BS 1; Degenhardt, Louisa PhD 1,29; Moses, Mark MHS 1; Farvid, Maryam PhD 30,31; Griswold, Max MA 1; Criqui, Michael MD 32; Bell, Michelle PhD 33; Nguyen, Minh BS 1; Wallin, Mitch MD 34,35; Mirarefin, Mojde MPH 1,36; Qorbani, Mostafa PhD 37; Younis, Mustafa DrPH 38; Fullman, Nancy MPH 1; Liu, Patrick MPH 1; Briant, Paul BS 1; Gona, Philimon PhD 39; Havmoller, Rasmus PhD 4; Leung, Ricky PhD 40; Kimokoti, Ruth MD 41; Bazargan-Hejazi, Shahrzad PhD 42,43; Hay, Simon I. DSc 1,44; Yadgir, Simon BS 1; Biryukov, Stan BS 1; Vollset, Stein Emil DrPH 1,45; Alam, Tahiya MPH 1; Frank, Tahvi BS 1; Farid, Talha MD 2; Miller, Ted PhD 46,47; Vos, Theo PhD 1; Barnighausen, Till MD 48,49,50; Gebrehiwot, Tsegaye Telwelde MPH 51; Yano, Yuichiro MD 52; Al-Aly, Ziyad MD 53; Mehari, Alem MD 54; Handal, Alexis PhD 55; Kandel, Amit MBBS 56; Anderson, Ben MD 57; Biroscak, Brian PhD 33,58; Mozaffarian, Dariush MD 59; Dorsey, E. Ray MD 60; Ding, Eric L. ScD 30; Park, Eun-Kee PhD 61; Wagner, Gregory MD 62; Hu, Guoqing PhD 63; Chen, Honglei PhD 64; Sunshine, Jacob E. MD 57; Khubchandani, Jagdish PhD 65; Leasher, Janet OD 66; Leung, Janni PhD 57,67; Salomon, Joshua PhD 48; Unutzer, Jurgen MD 57; Cahill, Leah PhD 30,68; Cooper, Leslie MD 69; Horino, Masako MPH 70; Brauer, Michael ScD 1,71; Breitborde, Nicholas PhD 72; Hotez, Peter PhD 73; Topor-Madry, Roman PhD 74,75; Soneji, Samir PhD 76; Stranges, Saverio PhD 77,78; James, Spencer MD 1; Amrock, Stephen MD 79; Jayaraman, Sudha MD 80; Patel, Tejas MD 81; Akinyemiju, Tomi PhD 16; Skirbekk, Vegard PhD 82,83; Kinfu, Yohannes PhD 84; Bhutta, Zulfiqar PhD 85,86; Jonas, Jost B. MD 87; Murray, Christopher J. L. DPhil 1
[Article]
JAMA.
319(14):1444-1472, April 10, 2018.
(Format: HTML, PDF)
Introduction: Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.
Objective: To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.
Design and Setting: A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.
Main Outcomes and Measures: Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.
Results: Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), 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 DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).
Conclusions and Relevance: 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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