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Am J Public Health. 2010 Sep;100(9):1758-64. doi: 10.2105/AJPH.2009.165019. Epub 2009 Dec 17.

The relative health burden of selected social and behavioral risk factors in the United States: implications for policy.

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  • 1Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 W 168th St, 6th Floor, New York, NY 10032, USA.



We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States.


Using data from the 1997-2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996-2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost.


Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI=159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health.


Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.

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