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JAMA. 2018 Apr 10;319(14):1444-1472. doi: 10.1001/jama.2018.0158.

The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.

US Burden of Disease Collaborators, Mokdad AH1, Ballestros K1, Echko M1, Glenn S1, Olsen HE1, Mullany E1, Lee A1, Khan AR2, Ahmadi A3,4, Ferrari AJ1,5,6, Kasaeian A7, Werdecker A8, Carter A1, Zipkin B1, Sartorius B9,10, Serdar B11, Sykes BL12, Troeger C1, Fitzmaurice C1,13, Rehm CD14, Santomauro D1,5,6, Kim D15, Colombara D1, Schwebel DC16, Tsoi D1, Kolte D17, Nsoesie E1, Nichols E1, Oren E18, Charlson FJ1,5,6, Patton GC19, Roth GA1, Hosgood HD20, Whiteford HA1,5,6, Kyu H1, Erskine HE1,5,6, Huang H21, Martopullo I1, Singh JA16, Nachega JB22,23,24, Sanabria JR25,26, Abbas K27, Ong K1, Tabb K28, Krohn KJ1, Cornaby L1, Degenhardt L1,29, Moses M1, Farvid M30,31, Griswold M1, Criqui M32, Bell M33, Nguyen M1, Wallin M34,35, Mirarefin M1,36, Qorbani M37, Younis M38, Fullman N1, Liu P1, Briant P1, Gona P39, Havmoller R4, Leung R40, Kimokoti R41, Bazargan-Hejazi S42,43, Hay SI1,44, Yadgir S1, Biryukov S1, Vollset SE1,45, Alam T1, Frank T1, Farid T2, Miller T46,47, Vos T1, Bärnighausen T48,49,50, Gebrehiwot TT51, Yano Y52, Al-Aly Z53, Mehari A54, Handal A55, Kandel A56, Anderson B57, Biroscak B33,58, Mozaffarian D59, Dorsey ER60, Ding EL30, Park EK61, Wagner G62, Hu G63, Chen H64, Sunshine JE57, Khubchandani J65, Leasher J66, Leung J57,5, Salomon J48, Unutzer J57, Cahill L30,67, Cooper L68, Horino M69, Brauer M1,70, Breitborde N71, Hotez P72, Topor-Madry R73,74, Soneji S75, Stranges S76,77, James S1, Amrock S78, Jayaraman S79, Patel T80, Akinyemiju T16, Skirbekk V81,82, Kinfu Y83, Bhutta Z84,85, Jonas JB86, Murray CJL1.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
2
University of Louisville, Louisville, Kentucky.
3
Kermanshah University of Medical Sciences, Kermanshah, Iran.
4
Karolinska Institutet, Stockholm, Sweden.
5
School of Public Health, University of Queensland, Brisbane, Australia.
6
Queensland Centre for Mental Health Research, Brisbane, Australia.
7
Hematology-Oncology and Stem Cell Transplantation Research Center, and Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
8
Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Hessen, Germany.
9
Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
10
UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa.
11
University of Colorado, Aurora.
12
Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine.
13
Division of Hematology, Department of Medicine, University of Washington, Seattle, and Fred Hutchinson Cancer Research Center, Seattle.
14
Montefiore Medical Center, Bronx, New York.
15
Department of Health Sciences, Northeastern University, Boston, Massachusetts.
16
University of Alabama at Birmingham.
17
Division of Cardiology, Brown University, Providence, Rhode Island.
18
Division of Epidemiology & Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California.
19
Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
20
Albert Einstein College of Medicine, Bronx, New York.
21
Cambridge Health Alliance, Cambridge, Massachusetts.
22
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
23
Stellenbosch University, Cape Town, Western Cape, South Africa.
24
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
25
Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
26
Case Western Reserve University, Cleveland, Ohio.
27
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England.
28
School of Social Work, University of Illinois at Urbana-Champaign.
29
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
30
Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
31
Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston.
32
University of California, San Diego, La Jolla, California.
33
Yale University, New Haven, Connecticut.
34
VA Medical Center, Washington, DC.
35
Neurology Department, Georgetown University, Washington, DC.
36
Hunger Action Los Angeles, Los Angeles, California.
37
Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Alborz, Iran.
38
Jackson State University, Jackson, Mississippi.
39
University of Massachusetts, Boston.
40
State University of New York, Albany, Rensselaer, New York.
41
Simmons College, Boston, Massachusetts.
42
College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.
43
David Geffen School of Medicine, University of California at Los Angeles.
44
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.
45
Center for Disease Burden, Norwegian Institute of Public Health, and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
46
Pacific Institute for Research & Evaluation, Calverton, Maryland.
47
School of Public Health, Curtin University, Perth, Australia.
48
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
49
Africa Health Research Institute, Mtubatuba, South Africa.
50
Institute of Public Health, Heidelberg University, Heidelberg, Germany.
51
Jimma University, Jimma, Oromia, Ethiopia.
52
Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
53
Washington University in St Louis, St Louis, Missouri.
54
College of Medicine, Howard University, Washington, DC.
55
University of New Mexico, Albuquerque.
56
University at Buffalo, Buffalo, New York.
57
University of Washington, Seattle.
58
University of South Florida, Tampa.
59
Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
60
University of Rochester Medical Center, Rochester, New York.
61
Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
62
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
63
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China.
64
Michigan State University, East Lansing.
65
Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
66
College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida.
67
Dalhousie University, Halifax, Canada.
68
Mayo Clinic, Jacksonville, Florida.
69
Bureau of Child, Family & Community Wellness, Nevada Division of Public and Behavioral Health, Carson City.
70
University of British Columbia, Vancouver, Canada.
71
The Ohio State University, Columbus.
72
College of Medicine, Baylor University, Houston, Texas.
73
Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
74
Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
75
Dartmouth College, Hanover, New Hampshire.
76
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
77
Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
78
Oregon Health & Science University, Portland.
79
Department of Surgery, Virginia Commonwealth University, Richmond.
80
White Plains Hospital, White Plains, New York.
81
Norwegian Institute of Public Health, Oslo, Norway.
82
Columbia University, New York, New York.
83
Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia.
84
Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
85
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
86
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.

Abstract

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.

PMID:
29634829
PMCID:
PMC5933332
DOI:
10.1001/jama.2018.0158
[Indexed for MEDLINE]
Free PMC Article

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