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Cited by 2,438Insurance, Mortality, Demography, Risk ManagementHealthcare Systems and Public HealthGlobal Health and Epidemiology

The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors

Open access
Murray, Christopher J. L.·2013·JAMA
DOI 10.1001/jama.2013.13805PMC PMC5436627
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Abstract

IMPORTANCE: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

AI snapshot

Written from the paper’s full text.

TL;DR

From 1990 to 2010, US life expectancy rose from 75.2 to 78.2 years and healthy life expectancy from 65.8 to 68.1 years, but morbidity and chronic disability accounted for nearly half of the US health burden. US improvements did not keep pace with other wealthy nations, with US ranks worsening across mortality-based OECD comparisons.

Key findings

  • US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; HALE increased from 65.8 to 68.1 years, and the gap between life expectancy and HALE increased from 9.4 to 10.1 years.
  • The diseases and injuries with the largest YLLs in 2010 were ischemic heart disease, lung cancer, stroke, COPD, and road injury; age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The largest YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders; YLDs rose from 40% of DALYs in 1990 to 45% in 2010.
  • Leading risk factors related to DALYs were dietary risks, tobacco smoking, high BMI, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Diet was associated with 26% of deaths and 14% of DALYs; BMI greater than 21.0-23.0 was associated with 14% of deaths and 11% of DALYs.
  • Among 34 OECD countries from 1990 to 2010, the US rank changed from 18th to 27th for age-standardized death rate, 23rd to 28th for age-standardized YLL rate, 5th to 6th for age-standardized YLD rate, 20th to 27th for life expectancy at birth, and 14th to 26th for HALE.

Methods

  • The study used the Global Burden of Disease 2010 framework to analyze 291 diseases and injuries, 1160 sequelae, and 67 risk factors or risk factor clusters for 187 countries from 1990 to 2010, comparing US outcomes with 34 OECD countries.
  • YLLs were computed by multiplying deaths at each age by a reference life expectancy at that age (86.0 years at birth); YLDs were calculated as prevalence multiplied by disability weight; DALYs were the sum of YLLs and YLDs; HALE summarized overall population health. Prevalence estimates used systematic reviews and DisMod-MR, and disability weights came from more than 30 000 respondents, including 3323 US telephone survey respondents and 7180 US Internet survey respondents.
  • Risk factor burden was estimated using convincing or probable risk-outcome evidence, exposure distributions, theoretical minimum risk exposure distributions, and 1000 draws for uncertainty; age-standardized rates used the WHO age standard, and OECD comparisons used a 1-sided test at P<.05.

Limitations

  • The paper states inherent data limitations for prevalence estimates and disability weights across countries, including no data for some sequelae in some or many countries; disability weights may be biased if lay descriptions were misunderstood and may vary across populations or subgroups.
  • The paper states that uncertainty intervals may be underestimated or exaggerated, country ranks may be affected by death certification and coding practices, and some Alzheimer disease increase may relate to changes in certification and coding; live birth definition differences could affect early neonatal comparisons but account for only 0.5% of deaths and 2.6% of YLLs.
  • The paper states that risk factor analysis excluded social determinants of health because of evidence criteria and data availability, and that this omission should not imply they are less important; the text also makes evident that diet components were analyzed separately, which may overestimate individual effects and not fully capture complex dietary relationships, and that many diet studies had limited follow-up.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jama.2013.13805

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 55 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    The correlation between results from the United States and from the combined sample was 0.97.

    “the correlation between results from the United States and from the combined sample was 0.97.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Salomon JA Vos T Hogan DR Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2129 2143 10.1016/S0140-6736(12)61680-8 23245605 PMC10782811

      Not checked in the free run.

  • Findingown data

    US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010.

    “US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010”
    Quote in the paperNot a substantial claim
  • Findingnone given

    All-cause death rates at all ages decreased in the United States from 1990 to 2010.

    “all-cause death rates at all ages decreased”
    Quote in the paperSubstantial claim
  • Findingnone given

    As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs.

    “As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized YLD rate changed from 5th to 6th.

    “for the age-standardized YLD rate from 5th to 6th”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 58
  • May combine two claims. 45

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, the diseases and injuries with the largest number of YLLs in the United States were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury.

    “The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls.

    “Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, the diseases with the largest number of YLDs in the United States were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders.

    “The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both ischemic heart disease and stroke are declining in terms of the number of YLLs and age-standardized rates.

    “but both are declining in terms of the number of YLLs and age-standardized rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Ambient particulate matter pollution remains in the top 10 risk factors associated with DALYs in the United States but declined by 35% since 1990.

    “Ambient particulate matter pollution remains in the top 10 risk factors associated with DALYs in the United States but declined by 35% since 1990.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Diabetes, cirrhosis, and Alzheimer disease all increased in rank and number of YLLs from 1990 to 2010.

    “The next 3 leading diseases contributing to YLLs, diabetes, cirrhosis and Alzheimer disease, all increased in rank and the number of YLLs from 1990 to 2010.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Chronic obstructive pulmonary disease was the fourth leading disease contributing to YLLs.

    “Lung cancer and chronic obstructive pulmonary disease (COPD) were the second and fourth leading diseases contributing to YLLs, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The PREDIMED trial reported significant benefits of healthful diet patterns on clinical cardiovascular events, and the magnitudes of benefits in that trial are highly consistent with our predicted risk estimates.

    “the recent PREDIMED54 trial reported significant benefits of healthful diet patterns on clinical cardiovascular events, and the magnitudes of benefits in that trial are highly consistent with our predicted risk estimates”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Estruch R Ros E Salas-Salvadó J PREDIMED Study Investigators Primary prevention of cardiovascular disease with a Mediterranean diet N Engl J Med 2013 368 14 1279 1290 10.1056/NEJMoa1200303 23432189

      Not checked in the free run.

    • The authors state this as an assumption: The overall relationship of diet with health outcomes assumes that the contribution of each dietary component is multiplicative and that the individual dietary contributions are independent.

  • May combine two claims.

    Findingown data

    Both lung cancer and COPD are increasing in absolute terms but have declining age-standardized rates.

    “Both diseases are increasing in absolute terms but have declining age-standardized rates”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The largest cluster of risk factors was the composition of diet, which was associated with 26% of deaths and 14% of DALYs.

    “The largest cluster of risk factors was the composition of diet, which was associated with 26% of deaths and 14% of DALYs”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Falls moved from 33rd to 29th in YLLs.

    “falls (from 33rd to 29th)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    YLLs related to HIV decreased by 64% and declined in rank from seventh to 23rd.

    “The YLLs related to HIV decreased by 64% and declined in rank from seventh to 23rd.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Pancreatic cancer was 18th among diseases and injuries contributing to premature death.

    “Colorectal cancer (10th), breast cancer (13th for both sexes combined and fifth in women), and pancreatic cancer (18th) are in the top 20 diseases and injuries contributing to premature death.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    High blood pressure, high fasting plasma glucose, and physical inactivity or low activity are the next leading risk factors.

    “High blood pressure (greater than 110-115 mm Hg), high fasting plasma glucose level (greater than 88-95 mg/dL [4.9-5.3 mmol/L]), and physical inactivity or low activity are the next leading risk factors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Lung cancer was the second leading disease contributing to YLLs.

    “Lung cancer and chronic obstructive pulmonary disease (COPD) were the second and fourth leading diseases contributing to YLLs, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Kidney cancer moved from 35th to 24th in YLLs.

    “kidney cancer (from 35th to 24th)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Mental and behavioral disorders, musculoskeletal disorders, vision and hearing loss, anemias, and neurological disorders all contribute to the increases in chronic disability.

    “Mental and behavioral disorders, musculoskeletal disorders, vision and hearing loss, anemias, and neurological disorders all contribute to the increases in chronic disability.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Poisonings moved from 31st to 26th in YLLs.

    “poisonings (from 31st to 26th)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Breast cancer was 13th for both sexes combined and fifth in women.

    “Colorectal cancer (10th), breast cancer (13th for both sexes combined and fifth in women), and pancreatic cancer (18th) are in the top 20 diseases and injuries contributing to premature death.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Body mass index greater than 21.0-23.0 is the third ranked risk factor, associated with 14% of deaths and 11% of DALYs.

    “In terms of DALYs, body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) greater than 21.0-23.0 is the third ranked risk factor, associated with 14% deaths and 11% of DALYs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In women, road injury and self-harm ranked eighth and 16th for YLLs.

    “and in women, eighth and 16th, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    4.3% of YLLs were related to stroke.

    “4.3% of YLLs were related to stroke”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Other disorders contributing to DALYs not in the top 30 that increased by more than 30% in the past 2 decades include liver cancer, atrial fibrillation, kidney cancers, eating disorders, and poisoning.

    “Other disorders contributing to DALYs not in the top 30 that have also increased by more than 30% in the past 2 decades include liver cancer, atrial fibrillation, kidney cancers, eating disorders, and poisoning.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    DALYs related to tobacco, including secondhand smoke, declined by 9% from 1990 to 2010.

    “Although the DALYs related to tobacco, including secondhand smoke, declined by 9% from 1990 to 2010”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In men, road injury and self-harm ranked third and fourth for YLLs.

    “in men, they are ranked third and fourth”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cardiovascular diseases, cancers, and chronic respiratory diseases are all related to YLDs, but the largest contributors are mental and behavioral disorders and musculoskeletal disorders.

    “Cardiovascular diseases, cancers, and chronic respiratory diseases are all related to YLDs, but the largest contributors are the mental and behavioral disorders and the musculoskeletal disorders”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The United States ranks toward the top for YLDs, fifth in 1990 and sixth in 2010, but wide uncertainty intervals mean that some countries have rates statistically indistinguishable from the United States.

    “In contrast, the United States ranks toward the top for YLDs, fifth in 1990 and sixth in 2010, but wide uncertainty intervals mean that some countries have rates that are statistically indistinguishable from the United States.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The number of YLDs from the top 18 diseases and injuries increased between 1990 and 2010, driven mostly by population increase and aging, as age-standardized rates largely remained unchanged.

    “The number of YLDs from the top 18 diseases and injuries increased between 1990 and 2010, driven mostly by the population increase and aging of the US population, as age-standardized rates have largely remain unchanged”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other examples of higher than mean rates with substantial potential to reduce YLLs include interpersonal violence, COPD, preterm birth complications, and diabetes, followed by drug use disorders, Alzheimer disease, and poisonings.

    “Other examples of higher than mean rates with substantial potential to reduce YLLs include interpersonal violence, COPD, preterm birth complications, and diabetes, followed by drug use disorders, Alzheimer disease, and poisonings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Liver cancer moved from 39th to 30th in YLLs.

    “liver cancer (from 39th to 30th) also increased.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although the mean value for high blood pressure related to DALYs in the United States is lower than the mean of all OECD countries, blood pressure is seventh on the list of potential targets for reducing disease burden in the population.

    “Although the mean value for high blood pressure related to DALYs in the United States is lower than the mean of all OECD countries, blood pressure is seventh on the list of potential targets for reducing disease burden in the population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    15.9% of YLLs were related to ischemic heart disease.

    “15.9% of YLLs were related to ischemic heart disease”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most important dietary risks in the United States are diets low in fruits, low in nuts and seeds, high in sodium, high in processed meats, low in vegetables, and high in trans fats.

    “The most important dietary risks in the United States are diets low in fruits, low in nuts and seeds, high in sodium, high in processed meats, low in vegetables, and high in trans fats.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The burden associated with drug use disorders increased by 64%.

    “In contrast, the burden associated with drug use disorders increased by 64%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Chronic kidney disease moved from 21st to 16th in YLLs.

    “chronic kidney disease (CKD) (from 21st to 16th)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    In 1990, 40% of DALYs were due to YLDs, increasing to 45% in 2010.

    “In 1990, 40% of DALYs were due to YLDs increasing to 45% in 2010.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Age-standardized rates increased by 20% or more from 1990 to 2010 for drug use disorders, stroke, and eating disorders.

    “Age-standardized rates increased by 20% or more from 1990 to 2010 for drug use disorders, stroke, and eating disorders”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Colorectal cancer was the 10th leading disease or injury contributing to premature death.

    “Colorectal cancer (10th), breast cancer (13th for both sexes combined and fifth in women), and pancreatic cancer (18th) are in the top 20 diseases and injuries contributing to premature death.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    DALYs related to high cholesterol declined by 36%, decreasing from the fifth to the eighth leading risk factor.

    “DALYs related to high cholesterol levels (greater than 145-155 mg/dL [3.8-4.0 mmol/L]) declined by 36%, decreasing from the fifth to the eighth leading risk factor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2010, US rates were below the mean in men for stroke, colorectal cancer, and falls and in women for stroke.

    “At the same time, the US rates were below the mean in men for stroke, colorectal cancer, and falls and in women for stroke.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Relative to other OECD nations, the United States has below-average age-standardized DALY rates for low back pain, stroke, falls, and colorectal cancer.

    “Relative to other OECD nations, the United States has below-average age-standardized DALY rates for low back pain, stroke, falls, and colorectal cancer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Neurological conditions increased from 2.0% of DALYs in 1990 to 3.0% in 2010.

    “Neurological conditions increased from 2.0% of DALYs in 1990 to 3.0% in 2010.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Age-standardized YLLs related to road injuries in the United States are exceeded only by those of South Korea, Greece, and Mexico.

    “Age-standardized YLLs related to road injuries in the United States are exceeded only by those of South Korea, Greece, and Mexico.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Road injuries remained the second and fifth disease or injury contributing to YLLs for males and females, respectively, in 2010.

    “Nevertheless, road injuries remained the second and fifth disease or injury contributing to YLLs for males and females, respectively, in 2010.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Migraine and epilepsy are ranked 14th and 30th as diseases contributing to YLDs, respectively.

    “Migraine and epilepsy are also ranked 14th and 30th as diseases contributing to YLDs, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2010, 23.5% of CKD DALYs and 76.0% of diabetes DALYs were related to BMI, increases from 18.1% and 64.3% in 1990, respectively.

    “We estimate in this study that in 2010, 23.5% of CKD and 76.0% of diabetes DALYs were related to BMI, increases from 18.1% and 64.3% in 1990, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Both Alzheimer disease and Parkinson disease are associated with large increases in DALYs.

    “Both Alzheimer disease and Parkinson disease are associated with large increases in DALYs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Life expectancy at birth and HALE have increased and all-cause death rates at all ages have decreased.

    “Life expectancy at birth and HALE have in-creased and all-cause death rates at all ages have decreased.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Risk-outcome pairs were included when evidence met the criteria for convincing or probable evidence.

    “risk-outcome pairs were included when evidence met the criteria for “convincing” or “probable” evidence.45”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] World Cancer Research Fund, American Institute for Cancer Research Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective Washington, DC American Institute for Cancer Research 2007

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Any outcome appears in the GBD cause and sequelae list only once to avoid double counting.

    “Any outcome appears in the GBD cause and sequelae list only once to avoid double counting.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Only risks with convincing or probable evidence for pairs of risk factors and specific outcomes and with sufficient epidemiological data to estimate risk factor-specific effect sizes were included.

    “We included only risks for which there was convincing or probable evidence for pairs of risk factors and specific outcomes and that had sufficient epidemiological data to estimate risk factor–specific effect sizes, eg, relative risks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.

    “High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups.5,6”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Williams DR Collins C US socioeconomic and racial differences in health: patterns and explanations Annu Rev Sociol 1995 21 349

      Not checked in the free run.

    • cites [6] Lantz PMHJ House JS Lepkowski JM Williams DR Mero RP Chen J Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults JAMA 1998 279 21 1703 1708 10.1001/jama.279.21.1703 9624022

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Results from population surveys in developing countries and the United States were highly consistent, suggesting a common construct of health.

    “Results from population surveys in developing countries and the United States were highly consistent, suggesting a common construct of health”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.

    “Although overall life expectancy has slowly risen, the increase has been slower than for many other high-income countries.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Wang H Dwyer-Lindgren L Lofgren KT Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2071 2094 10.1016/S0140-6736(12)61719-X 23245603

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Individuals in the United States are living longer but are not necessarily in good health.

    “In other words, individuals in the United States are living longer but are not necessarily in good health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The higher prevalence of sickle cell disorders in the United States is likely related to a higher birth prevalence than in other OECD countries.

    “The higher prevalence of sickle cell disorders in the United States is also likely related to a higher birth prevalence than in other OECD countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Levels of physical activity may be improving at the same time that overweight and obesity rates are increasing.

    “These same assessments suggest that levels of physical activity may be improving at the same time that overweight and obesity rates are increasing.58”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Dwyer-Lindgren L Freedman GD Engell RE Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action Popul Health Metr 2013 11 7 23842197 PMC3718620

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The pooling studies reported a stronger and more consistent relationship across a range of BMI values than the Flegal meta-analysis, with excess mortality increasing steadily beginning at a BMI of 21.0 to 23.0.

    “These pooling studies reported a stronger and more consistent relationship across a range of BMI values than did the Flegal meta-analysis, with excess mortality increasing steadily beginning at a BMI of 21.0 to 23.0.63-65”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [63] Calle EE Thun MJ Petrelli JM Rodriguez C Heath CW Jr Body-mass index and mortality in a prospective cohort of US adults N Engl J Med 1999 341 15 1097 1105 10.1056/NEJM199910073411501 10511607

      Not checked in the free run.

    • cites [64] Peto R Whitlock G Jha P Effects of obesity and smoking on US life expectancy N Engl J Med 2010 362 9 855 856 10.1056/NEJMc1000079 20200394

      Not checked in the free run.

    • cites [65] Willett WCHF Hu FB Thun M Overweight, obesity, and all-cause mortality JAMA 2013 309 16 1681 1682 10.1001/jama.2013.3075 23613066

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The results for diet are limited by difficulties in measurement, various levels of conflicting evidence, and potential influence of unmeasured confounders and mediators.

    “The results for diet are limited by difficulties in measurement, various levels of conflicting evidence, and potential influence of unmeasured confounders and mediators.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Because each component of diet is analyzed separately, the complex relationships among components of diet may not be fully considered or understood, which might overestimate the effects of each component.

    “In addition, because each component of diet is analyzed separately, the complex relationships among components of diet may not be fully considered or understood, which might overestimate the effects of each component.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The overall relationship of diet with health outcomes assumes that the contribution of each dietary component is multiplicative and that the individual dietary contributions are independent.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The progressive and likely irreversible shift in the disease burden profile to these causes has implications for the type of resources needed in the US health system.

    “The progressive and likely irreversible shift in the disease burden profile to these causes also has implications for the type of resources needed in the US health system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Many studies of diet have limited periods of follow-up, whereas chronic diseases related to diet develop over decades.

    “Another limitation of the evidence on diet is that many studies have limited periods of follow-up, whereas the chronic diseases related to diet develop over decades.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The increase in YLLs associated with liver cancer may be related to a hepatitis C cohort effect.

    “The increase in YLLs associated with liver cancer may be related to a hepatitis C cohort effect.50”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] El-Serag HB Mason AC Risk factors for the rising rates of primary liver cancer in the United States Arch Intern Med 2000 160 21 3227 3230 11088082

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Improved survival among persons with diabetes through effective management of major cardiovascular and renal risks may improve overall population health but will likely increase costs.

    “Improved survival among persons with diabetes by effective management of major cardiovascular and renal risks such as hyperglycemia, hypertension, and high cholesterol may improve overall population health but will likely increase costs as well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The increase in Alzheimer disease may be confounded by changes in ascertainment and coding practice.

    “Although the increase in Alzheimer disease may be confounded by changes in ascertainment and coding practice, these increases suggest an important trend.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Concerns have been raised that in some countries, variable implementation of the World Health Organization's definition of a live birth may affect comparisons of early neonatal death rates across countries.

    “Concerns have been raised that in some countries, variable implementation of the World Health Organization's definition of a live birth may affect comparisons of early neonatal death rates76 across countries”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Kramer MS Platt RW Yang H Haglund B Cnattingius S Bergsjo P Registration artifacts in international comparisons of infant mortality Paediatr Perinat Epidemiol 2002 16 1 16 22 11862950

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The reporting of 95% uncertainty intervals that incorporate both sampling error and error from model estimation provides some information on the extent and quality of the information available for the United States.

    “The reporting of 95% uncertainty intervals that incorporate both sampling error and error from model estimation provides some information on the extent and quality of the information available for the United States.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The nature of the estimation process both for causes of death and the prevalence of sequelae more generally exaggerate uncertainty intervals in a high-income country such as the United States.

    “However, the nature of the estimation process both for causes of death and the prevalence of sequelae more generally exaggerate uncertainty intervals in a high-income country such as the United States.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Age-standardized YLD rates are measured with wider uncertainty intervals than age-standardized YLL rates.

    “although age-standardized YLD rates are measured with wider uncertainty intervals than age-standardized YLL rates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    How much of the US advantage for these conditions is related to risk factors and how much is related to health care cannot be determined from the GBD data alone.

    “How much of the US advantage for these conditions is related to risk factors and how much is related to health care cannot be determined from the GBD data alone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Five-year survival for breast cancer and colorectal cancer are higher in the United States than in many OECD countries.

    “Five-year survival for breast cancer and colorectal cancer are higher in the United States than in many OECD countries.75”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Coleman MP Quaresma M Berrino F CONCORD Working Group Cancer survival in five continents: a worldwide population-based study (CONCORD) Lancet Oncol 2008 9 8 730 756 10.1016/S1470-2045(08)70179-7 18639491

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Disability weights may vary across different populations or across socioeconomic or race and ethnicity groups within populations.

    “it is possible that disability weights may vary across different populations or across socioeconomic or race and ethnicity groups within populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Both aging and increasing age-standardized prevalence rates are contributing to a growing challenge of neurological disease.

    “Both aging and increasing age-standardized prevalence rates are contributing to a growing challenge of neurological disease.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Country ranks across age-standardized YLL rates could still be affected by differences in national death certification practice.

    “Country ranks across age-standardized YLL rates could still be affected by differences in national death certification practice”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Problems related to how countries define and count diseases, injuries, and risk factors could affect estimates of other diseases included in these analyses.

    “However, the same problems related to how countries define and count diseases, injuries, and risk factors could affect estimates of other diseases included in these analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Salomon et al found little evidence of variation in disability weights as a function of population or educational status.

    “Although Salomon et al26 found little evidence of variation in disability weights as a function of population or educational status”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Salomon JA Vos T Hogan DR Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2129 2143 10.1016/S0140-6736(12)61680-8 23245605 PMC10782811

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Exposure in terms of miles driven per capita may be higher in the United States than in Sweden and Iceland.

    “although exposure in terms of miles driven per capita may be higher in the United States.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    A study of this scope has many limitations, including most of those of the GBD 2010.

    “A study of this scope has many limitations, including most of those of the GBD 2010.3,19,25-27,29-31”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [3] Wang H Dwyer-Lindgren L Lofgren KT Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2071 2094 10.1016/S0140-6736(12)61719-X 23245603

      Not checked in the free run.

    • cites [19] Murray CJ Ezzati M Flaxman AD GBD 2010: design, definitions, and metrics Lancet 2012 380 9859 2063 2066 23245602

      Not checked in the free run.

    • cites [25] Vos T Flaxman AD Naghavi M Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2163 2196 10.1016/S0140-6736(12)61729-2 23245607 PMC6350784

      Not checked in the free run.

    • cites [26] Salomon JA Vos T Hogan DR Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010 Lancet 2012 380 9859 2129 2143 10.1016/S0140-6736(12)61680-8 23245605 PMC10782811

      Not checked in the free run.

    • cites [27] Salomon JA Wang H Freeman MK Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010 Lancet 2012 380 9859 2144 2162 10.1016/S0140-6736(12)61690-0 23245606

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Evidence has accumulated that diabetes can be substantially prevented or postponed in people with prediabetes through focused lifestyle or drug therapy.

    “Evidence that diabetes can be substantially prevented or postponed in people with prediabetes through focused lifestyle or drug therapy has accumulated over the past few years.70”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Knowler WC Barrett-Connor E Fowler SE Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin N Engl J Med 2002 346 6 393 403 10.1056/NEJMoa012512 11832527 PMC1370926

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductreasoning

    To the extent that the general population did not understand the lay descriptions used to elicit judgments about levels of health, disability weights may be biased.

    “to the extent that the general population did not understand the lay descriptions used to elicit judgments about levels of health, disability weights may be biased.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The analysis of risk factors in this study focused on behavioral, environmental, and metabolic risks and did not evaluate the social determinants of health.

    “Third, the analysis of risk factors in this study focused on behavioral, environmental, and metabolic risks and did not evaluate the social determinants of health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    There are limitations related to the extent, quality, and consistency of some information used in the analyses and estimates in this study.

    “Second, there are limitations related to the extent, quality, and consistency of some information used in the analyses and estimates in this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Some of the increase in Alzheimer disease from 1990 to 2010 may be related to changes in certification and coding.

    “However, some of the increase in Alzheimer disease from 1990 to 2010 may be related to changes in certification and coding.72”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Izquierdo FA Ramírez BA McWilliams JMM Ayuso JP The endurance of the effects of the penalty point system in Spain 3 years after: main influencing factors Accid Anal Prev 2011 43 3 911 922 10.1016/j.aap.2010.11.014 21376883

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent data indicate improvements in the quality of care for diabetes.

    “Recent data indicate improvements in the quality of care for diabetes.69”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Ali MK Bullard KM Saaddine JB Cowie CC Imperatore G Gregg EW Achievement of goals in US diabetes care, 1999-2010 N Engl J Med 2013 368 17 1613 1624 10.1056/NEJMsa1213829 23614587

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Uncertainty could be underestimated for a range of reasons, such as unrecognized bias in published studies.

    “Uncertainty could be underestimated for a range of reasons, such as unrecognized bias in published studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sweden is pursuing Vision Zero, which seeks to eliminate all road injury deaths through a range of interventions.

    “Sweden is pursuing Vision Zero, which seeks to eliminate all road injury deaths through a range of interventions.71”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Whitelegg J Haq G Vision zero: adopting a target of zero for road traffic fatalities and serious injuries 2006 http://www.sei-international.org/mediamanager/documents/Publications/Future/vision_zero_FinalReportMarch06.pdf Accessed April 30, 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Important sources of data may not have been identified or been available or these data may not have been collected.

    “Important sources of data may not have been identified or been available or these data may not have been collected.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Much of the substantial body of evidence on the important influence of socioeconomic factors relates determinants such as income, education, and inequality to all-cause outcomes.

    “Much of the substantial body of evidence on the important influence of socioeconomic factors relates determinants such as income, education, and inequality to all-cause outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The absence of social determinants in this current assessment should not be taken as implying that they are less important than the more proximal factors studied here.

    “The absence of these in this current assessment should not be taken as implying that they are less important than the more proximal factors studied here.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The evidence suggests that interventions to reduce behavioral, environmental, and metabolic risks can have substantial benefits across diverse socioeconomic groups.

    “Despite their omission, the evidence suggests that interventions to reduce behavioral, environmental, and metabolic risks can have substantial benefits across diverse socioeconomic groups.70,83,84”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [70] Knowler WC Barrett-Connor E Fowler SE Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin N Engl J Med 2002 346 6 393 403 10.1056/NEJMoa012512 11832527 PMC1370926

      Not checked in the free run.

    • cites [83] Fisher ES Paying for performance–risks and recommendations N Engl J Med 2006 355 18 1845 1847 10.1056/NEJMp068221 17079757

      Not checked in the free run.

    • cites [84] Volpp KG Troxel AB Pauly MV A randomized, controlled trial of financial incentives for smoking cessation N Engl J Med 2009 360 7 699 709 10.1056/NEJMsa0806819 19213683

      Not checked in the free run.

90 of 90

  • The authors state this as an assumption.

    The overall relationship of diet with health outcomes assumes that the contribution of each dietary component is multiplicative and that the individual dietary contributions are independent.

    “The overall relationship of diet with health outcomes assumes the contribution of each component is multiplicative; that is, that the individual dietary contributions are independent.”

  • The paper relies on this without support.

    The United States lacks universal health coverage.

    “lacks universal health coverage”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting sex-specific rankings for road injury YLLs

    Major

    The Results rank road injury third for men and eighth for women, while the Discussion ranks it second for males and fifth for females in 2010.

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 3

  1. [4]Woolf SH Aron L US Health in International Perspective: Shorter Lives, Poorer Health Washington, DC National Academies Press 2013 http://www.nap.edu/openbook.php?record_id=13497 24006554
  2. [11]Crawford D Jeffery RW Ball K Obesity Epidemiology: From Aetiology to Public Health Oxford, England Oxford University Press 2010
  3. [46]Mathers CD Salomon JA Ezzati M Begg S Hoorn SV Lopez AD Sensitivity and uncertainty analyses for burden of disease and risk factor estimates Lopez AD Mathers CD Ezzati M Jamison DT Murray CJ Global Burden of Disease and Risk Factors Washington, DC World Bank 2006 21250370

Cited by

Sorted by citations

Related

Authors
Murray, C. J. L.
Affiliations
Institute for Health Metrics and Evaluation (US)
Corresponding author
Murray, Christopher J. L.
ORCID
Murray, Christopher J. L.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2013-08-14
Volume
310
Issue
6
Pages
591
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.13805
PMC
PMC5436627
OpenAlex
W2121393149
Semantic Scholar
ca486a7cc542ef9dfa3eac6ff20e1f82c1480e96
Cited by
2,438
References
65
Citations by year
2026: 63 · 2025: 100 · 2024: 127 · 2023: 137 · 2022: 145 · 2021: 195 · 2020: 217 · 2019: 237 · 2018: 255 · 2017: 231 · 2016: 239 · 2015: 252 · 2014: 196 · 2013: 39 · 2012: 1
FWCI
654.13
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • NSUWorks (Nova Southeastern University) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • National Institutes of Health (CC999999)
  • National Institute of Environmental Health Sciences (Z01ES043012)
Topics
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
Keywords
disease burden, years of life lost, years lived with disability, disability-adjusted life years, healthy life expectancy, premature mortality, life expectancy, ischemic heart disease, road traffic injuries, low back pain, depression, musculoskeletal disorders, population aging, health policy, OECD comparison, 1990-2010 trends
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Chronic Disease, Female, Persons with Disabilities, Health Status, Humans, Infant, Life Expectancy, Male, Middle Aged, Morbidity, Risk Factors, United States, Global Health, Wounds and Injuries, Cost of Illness, Developed Countries, Mortality, Premature

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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