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

The DOI matches its Crossref record; 66 of the 66 references it cites were found in a registry or an index; none of the 55 sources its claims cite is checked for support yet.

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

Open access

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.

Overview

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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.

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Integrity signals

Registry

Crossref · 10.1001/jama.2013.13805

Cites

66 of 66 references verified0 citation errors · 0 not checkable

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  • Probably not a substantial claim. 58
  • It may state two separate claims as one. 45
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”
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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

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Metadata

Authors
Murray, C. J. L.
Affiliations
Institute for Health Metrics and Evaluation (US)
Corresponding author
Murray, Christopher J. L.
Venue
JAMA
Published
2013-08-14
Volume
310
Issue
6
Pages
591
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W2121393149
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
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 › Medicine › Public Health, Environmental and Occupational Health › 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

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