The state of US health, 1990-2016: Burden of diseases, injuries, and risk factors among US states

JAMA Apr 16, 2018

Murray CJL, et al. - Using the results of the Global Burden of Disease Study (GBD), authors attempted to report the trends in the burden of diseases, injuries, and risk factors in the United States from 1990 to 2016. Findings illustrated broad variations in the burden of disease at the state level. A rise was noted in the specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders and required additional attention. Yielded results could aid in informing the national health priorities for research, clinical care, and policy.


  • The plot of this study was a systematic analysis of published studies and available data sources.
  • An estimation was performed of the burden of disease by age, sex, geography, and year.
  • The measurement of prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) served as the primary outcome.


  • A decline was reported between 1990 and 2016 in the overall death rates in the United States from 745.2 (95% UI, 740.6 to 749.8) per 100,000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100,000 persons.
  • A decline was also discovered in the probability of death among adults aged 20 to 55 years in 31 states and Washington, DC from 1990 to 2016.
  • In 2016, Hawaii presented with the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference.
  • As per the data, Minnesota reported the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference.
  • Ischemic heart disease and lung cancer were found to be the leading causes of DALYs in the United States for 1990 and 2016, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease.
  • Findings demonstrated that the opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change.
  • It was determined that each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: Tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure in 2016.
  • Across all US states, the top risk factors with regard to attributable DALYs appeared to be the result of 1 of the 3 following causes: Tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).

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