In a major study that includes data on the status of population health from 34 countries from 1990 through 2010, overall population health improved in the United States during this period, including an increase in life expectancy.
However, illness and chronic disability account for nearly half the health burden, and improvements in the U.S. have not kept pace with advances in population health in other wealthy nations, according to the study, published July 10 on the website of the Journal of the American Medical Association.
Christopher J.L. Murray, MD, DPhil, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and the U.S. Burden of Disease Collaborators, and colleagues found that U.S. life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, healthy life expectancy increased from 65.8 years to 68.1 years.
In 2010, diseases and injuries with the largest number of years of life lost due to premature death were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injury (which includes bicycle, motorcycle, motor vehicle and pedestrian injury). Age-standardized rates of years of life lost increased for Alzheimers disease, drug use disorders, chronic kidney disease, kidney cancer and falls during the study period.
In 2010, diseases with the largest number of years lived with disability were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain and anxiety disorders.
“As the U.S. population has aged, years lived with disability have comprised a larger share of disability-adjusted life-years than have [years of life lost],” the authors wrote. They added that the leading risk factors related to disability-adjusted life-years were dietary risks, tobacco smoking, high body mass index, hypertension, high fasting plasma glucose, physical inactivity and alcohol use.
With an increase in life expectancy and the number of years lived with disability for the average American, “individuals in the United States are living longer but are not necessarily in good health,” the authors wrote.
Morbidity and chronic disability account for nearly half the health burden in the United States, the authors wrote. Contributing to the increases in chronic disability are mental and behavioral disorders, musculoskeletal disorders, vision and hearing loss, anemias and neurological disorders.
“Research and development has been much more successful at finding solutions for cardiovascular diseases and some cancers and their associated risk factors than for these leading causes of disability,” the authors wrote. “The progressive and likely irreversible shift in the disease burden profile to these causes also has implication for the type of resources needed in the U.S. health system.”
In the last two decades, improvements in population health in the United States did not keep pace with advances in population health in other wealthy nations. Among 34 OECD countries between 1990 and 2010, the U.S. rank dropped from 18th to 27th for the age-standardized death rate; from 23rd to 28th for age-standardized years of life lost; from 5th to 6th for age-standardized years lived with disability; from 20th to 27th for life expectancy at birth; and from 14th to 26th for healthy life expectancy.
“In many cases, the best investments for improving population health would likely be public health programs and multisectoral action to address risks such as physical inactivity, diet, ambient particulate pollution and alcohol and tobacco consumption,” the authors concluded.
Read the study: http://jama.jamanetwork.com/article.aspx?articleid=1710486.