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Health Aff (Millwood). 2017 Apr 1;36(4):626-635. doi: 10.1377/hlthaff.2016.1281.

Preventing Disability: The Influence Of Modifiable Risk Factors On State And National Disability Prevalence.

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Neil K. Mehta ( is an assistant professor of health management and policy at the School of Public Health, University of Michigan, in Ann Arbor.
Shivani A. Patel is a Rollins Assistant Professor in the Hubert Department of Global Health, Rollins School of Public Health, Emory University, in Atlanta, Georgia.
Mohammed K. Ali is an associate professor in the Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University.
K. M. Venkat Narayan is the Ruth and O. C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, Emory University.


Disability levels in the United States declined during the 1980s and 1990s, but these declines stalled more recently. Using data for 2013 from the Behavioral Risk Factor Surveillance System, we estimated the percentages of national and state disability that could be prevented through reductions in five modifiable health risk factors associated with disability: cigarette smoking, obesity, diabetes, high cholesterol, and hypertension. Taking into account risk-factor prevalence and the association between each risk factor and disability, we evaluated the fraction of disability preventable if risk factors were reduced under two scenarios: complete elimination of risk factors and reduction in all states to the lowest levels observed in states. If all five risk factors were eliminated, 53 percent of disability could be prevented nationally. The largest contributors were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). If all states reduced risk-factor levels to the lowest observed levels, up to 7 percent of disability could be prevented nationally. Many states in the South and Midwest could experience disability reductions of more than 10 percent by attaining the same risk-factor levels as in states that had the lowest levels. Improved risk-factor prevention could result in the resumption of longer-term declines in US disability.


Disability; Disparities; Health Promotion/Disease Prevention

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