US Health Improves but Lags behind Other Wealthy Countries

Population health in the United States has improved, but the improvements have not kept pace with other wealthy nations, according to a new study that assessed the state of United States health from 1990 to 2010. The study measured the burden of diseases, injuries, and leading risk factors in the United States and 34 other countries. Results were published in JAMA [2013;310(6):591-608]. 

In this study, researchers used data from the Global Burden of Disease Study 2010 (GBD 2010), to examine ways diseases, injuries, and risk factors associated with the burden of disease have changed over 20 years and how these figures compare with 34 other Organisation for Economic Co-operation and Development (OECD) countries.

As part of the GBD 2010, researchers examined data from 187 countries from 1990 to 2010 and conducted an analysis that quantified health loss from 291 diseases and injuries, 1160 clinical sequelae of diseases and injuries, and 67 risk factors or clusters of risk factors.

In this recent investigation into the burden of disease in the United States, researchers evaluated the data using several metrics. They examined years of life lost due to premature mortality (YLL), years lived with disability (YLD), disability-adjusted life years (DALY), and healthy life expectancy (HALE). According to the researchers, HALE was used by the GBD 2010 to summarize the overall population health. Overall, the investigation found that health improved in the United States from 1990 to 2010. They reported that life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010. HALE was also on the rise and grew from 65.8 years in 1990 to 68.1 years in 2010.

In evaluating the YLL to premature mortality, the investigators found that over the past 2 decades, ischemic heart disease and lung cancer remained the top 2 diseases contributing to YLL; however, the number of YLL for heart disease was down 21.1% in 2010 compared with the figures from 1990. The number of YLL for lung cancer had risen 3.6% in 2010.

When investigators turned their attention to the number of years lived with disability, they reported that in 2010, low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders were linked with the largest number of YLDs. These were the same leading contributors in 1990, as well. Overall, they found that the number of YLDs from the top 18 diseases and injuries had increased over the 2-decade time span, but said that the increase was largely due to an increasing and aging population.

The investigators also found that the role YLD has played in DALYs increased from 40% in 1990 to 45% in 2010. When examining risk factors and their relation to DALYs, researchers said the largest cluster of risk factors associated with DALYs was diet, which contributed to 26% of the deaths in 2010 and 14% of the DALYs.

The second leading risk factor was tobacco, although there was a significant decrease (9%) in the DALYs related to tobacco in 2010 compared with 1990. Other top risk factors associated with DALYs in 2010 were high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use.

While the US health improved overall during the 2-decade time period of the study, the increases did not keep pace with other wealthy countries. When compared to 34 OECD countries, the United States HALE rank dropped from 14th in 1990 to 26th in 2010. The US rank for the age-standardized death rate also dropped from 18th in 1990 to 27th in 2010 and life expectancy at birth rank dropped to 27th from 20th.

When researchers examined the YLL and YLD rates of other countries, they noted that the United States had dropped in rank in those areas as well from 23rd to 28th for age-standardized YLL and from 5th to 6th in age-standardized YLD.

The biggest potential for reducing the health burden in the United States is by targeting high BMIs, an area where the United States has a greater associated burden than the OECD mean. Other areas where efforts could potentially reduce the burden in the United States are related to use of tobacco, dietary risks, alcohol use, and high fasting glucose levels.