State of health: U.S. trails other wealthy countries

Between 1990 and 2010, significant improvements were made in U.S. healthcare, with life expectancy at birth and healthy life expectancy increasing alongside drops in all-cause death rates. However, despite these gains, the U.S. is failing to keep up with population health progress in the other Organisation for Economic Co-operation and Development (OECD) countries, according to a report published online July 10 in JAMA.

In 2010, the diseases and injuries with the most years of life lost (YLL) due to premature mortality in the U.S. were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injury.

“With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time,” read the report.

Findings were based on data from the Global Burden of Disease framework, an initiative conducted by the World Health Organization in partnership with a number of other international organizations. The report was authored by dozens of collaborators working in the U.S. and abroad.

Included in the systematic analysis were 291 diseases and injuries, 1,160 sequelae of these diseases and injuries and 67 risk factors from 1990 to 2010, according to the authors. Health status in the U.S. was compared with the rest of the 34 OECD countries.

Life expectancy in the U.S. for men and women combined rose from 75.2 years to 78.2 years over the course of the study period. Healthy life expectancy increased from 65.8 years to 68.1 years.

The researchers noted that while life spans in the U.S. have increased, age-specific years lived with disability have remained stable and the number of healthy years lost to disability have increased. “In other words, individuals in the United States are living longer but are not necessarily in good health.”

Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer and falls all had increased age-standardized YLL rates in 2010 compared with 1990. Disability-adjusted life-years (DALYs) related to elevated body mass index (BMI) rose 45 percent. “The increase in disease burden from diabetes and [chronic kidney disease] is particularly noteworthy,” wrote the authors. “We estimate in this study that in 2010, 23.5 percent of [chronic kidney disease] and 76.0 percent of diabetes DALYs were related to BMI, increases from 18.1 percent and 64.3 percent in 1990, respectively.”

On the positive side, road injury YLLs fell by one third over the 20-year period, though road injuries remained a top-five contributor to YLL for both men and women in 2010. The U.S. had the fourth most YLLs related to road injuries, trailing South Korea, Greece and Mexico.

In fact, in a number of categories the U.S. compares unfavorably with the 34 OECD countries, according to the report. Over the study period, the U.S. rank for age-standardized death rate fell from 18^th to 27^th, for age-standardized YLL rate from 23^rd to 28^th, for life expectancy at birth from 20^th to 27^th and for healthy life expectancy from 14^th to 26^th.

“In 2010, the United States had age-standardized rates above the mean for OECD countries for 16 of the top 30 diseases and injuries contributing to YLLs. At the same time, the US rates were below the mean in men for stroke, colorectal cancer, and falls and in women for stroke.”

In order to better focus public health efforts where they are needed, the report suggests the U.S. focus on health programs to address physical inactivity, diet, ambient particulate pollution and alcohol and tobacco consumption. To stem the number of road injuries, concerted efforts to implement anti-drunk driving measures, increase use of motorcycle helmets and increase seatbelt use should be conducted.

“Regular assessments of the local burden of disease and matching information on health expenditures for the same disease and injury categories could allow for a more direct assessment of how changes in health spending have affected or, indeed, not affected changes in the burden of disease and may provide insights into where the US health care system could most effectively invest its resources to obtain maximum benefits for the nation’s population health.”