The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States.
Open accessAbstract
BACKGROUND: There has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk factors. We estimated the effects of smoking, high blood pressure, elevated blood glucose, and adiposity on national life expectancy and on disparities in life expectancy and disease-specific mortality among eight subgroups of the US population (the "Eight Americas") defined on the basis of race and the location and socioeconomic characteristics of county of residence, in 2005. METHODS AND FINDINGS: We combined data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to estimate unbiased risk factor levels for the Eight Americas. We used data from the National Center for Health Statistics to estimate age-sex-disease-specific number of deaths in 2005. We used systematic reviews and meta-analyses of epidemiologic studies to obtain risk factor effect sizes for disease-specific mortality. We used epidemiologic methods for multiple risk factors to estimate the effects of current exposure to these risk factors on death rates, and life table methods to estimate effects on life expectancy. Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP). SBP was highest in blacks, especially in the rural South--5-7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley. Nationally, these four risk factors reduced life expectancy at birth in 2005 by an estimated 4.9 y in men and 4.1 y in women. Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y). Standard deviation of life expectancies in the Eight Americas would decline by 0.50 y (18%) in men and 0.45 y (21%) in women if these risks had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%-80%; the corresponding reduction for probabilities of dying from cancers would be 29%-50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities. CONCLUSIONS: Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US. Please see later in the article for the Editors' Summary.
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The impact of serious mental illness on life expectancy is marked and generally higher than similarly calculated impacts of well-recognised adverse exposures such as smoking, diabetes and obesity.
“The impact of serious mental illness on life expectancy is marked and generally higher than similarly calculated impacts of well-recognised adverse exposures such as smoking, diabetes and obesity.”
From Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London (2011) · cites this paper as [17]
The Methods (Risk Factors in the Analysis; page unavailable) identify smoking, high blood glucose and adiposity as risks studied, and the Results (Effects of Risk Factors on Life Expectancy in the Eight Americas; page unavailable) report life-expectancy gains from reducing them. The paper does not assess serious mental illness or compare its life-expectancy impact with those risks; it studies high blood glucose rather than diabetes as an exposure. (LLM, conf=0.87)
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- Authors
- Danaei, G., Rimm, E. B., Oza, S., Kulkarni, S. C., Murray, C. J. L., & Ezzati, M.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- University of California, San Francisco (US)
- University of Washington (US)
- Corresponding author
- Ezzati, Majid
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2010-03-23
- Volume
- 7
- Issue
- 3
- Pages
- e1000248
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC2843596
- OpenAlex
- W2151901868
- Cited by
- 191
- References
- 77
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 14 · 2019: 9 · 2018: 9 · 2017: 12 · 2016: 16 · 2015: 16 · 2014: 21 · 2013: 20 · 2012: 24
- FWCI
- 13.61
- Type
- journal article
- Language
- en
- Update notices
- correction (2011-02-01)
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Centers for Disease Control and Prevention
- U.S. Public Health Service (U36 CCU300430-23)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- life expectancy, life expectancy disparities, modifiable risk factors, smoking, hypertension, hyperglycemia, adiposity, body mass index, racial disparities, socioeconomic disparities, rural health, cardiovascular mortality, diabetes mortality, cancer mortality, life tables, Appalachia, Mississippi Valley, Southern United States, Native Americans
- MeSH terms
- Disease, Female, Geography, Humans, Life Expectancy, Male, Mortality, Preventive Health Services, Risk Factors, United States, Age Distribution, Racial Groups, Healthcare Disparities
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