Health burden varies significantly by state in the US

1. In the US Burden of Disease Report, the leading causes of death were ischemic heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), Alzheimer’s disease, and colorectal cancer while the leading causes of disability were low back pain, major depressive disorder (MDD), and diabetes.

2. The state with the highest life expectancy was Hawaii while the state with the lowest life expectancy was Mississippi.

Evidence Rating Level: 2 (Good)

Study Rundown: The Global Burden of Disease (GBD) study is a massive undertaking that systematically analyzes multiple data source, accounts for error, and estimates broad health trends in large populations. Now conducted annually, the 2016 US Burden of Disease Report through the GBD has estimated mortality and morbidity trends on a state-by-state basis. Overall, the leading causes of death in 2016 were ischemic heart disease, lung cancer, COPD, Alzheimer’s disease, and colorectal cancer. In terms of years lived with disability, the leading causes were low back pain, major depressive disorder (MDD), and diabetes. Diet, tobacco use, and high systolic blood pressure were the leading risk factors influencing mortality while tobacco use, high BMI, and diet were the leading risk factors for disability adjusted life years (DALYs) lost. On a state-by-state basis, Hawaii had the highest life expectancy while Mississippi had the lowest. In addition, those in Minnesota had the highest healthy life expectancy (HALE) while those in West Virginia had the lowest. Among all states, there was wide variation in rates of mortality and morbidity.

Overall, this study continues to suggest that while US health outcomes are improving, the rate of improvement and level of improvement is not similar for every state. Though some limitations due to measurement error and different patterns of data availability by state are important to note, the high rigor and multiple data sources strengthen the estimates present in this report. The data from this study will be helpful as national and state policy makers continue to create legislation to improve the overall health of the US.

Click to read the study in JAMA

Relevant Reading: Left behind: widening disparities for males and females in US county life expectancy, 1985–2010

In-Depth [epidemiological report]: The GBD used data from multiple sources from 1990 to 2016 to estimate multiple endpoints, including cause of death, DALYs, HALE, years lived with disabilities (YLD) and years of life lost (YLL) as well as risk factors associated with these endpoints. The leading causes of death in 2016 were ischemic heart disease (YLL CI₉₅ 7409.6 to 7802.4), lung cancer (CI₉₅ 3493.4 to 3681.9), COPD (CI₉₅ 2267.8 to 2463.5), Alzheimer’s disease (CI₉₅ 1690.2 to 2076.6), and colorectal cancer (CI₉₅ 1393.5 to 1482.4). In terms of YLDs, the leading causes were low back pain (CI₉₅ 2211.0 to 3989.6), MDD (CI₉₅ 1507.6 to 2990.5), and diabetes (CI₉₅ 1496.1 to 2932.8). Diet, tobacco use, and high systolic blood pressure were the leading risk factors influencing mortality while tobacco use, high BMI, and diet were the leading risk factors for DALYs. Overall, 44.9% of DALYs were attributable to identifiable risk factors. Hawaii had the highest life expectancy (81.3yrs; CI₉₅ 80.6 to 81.9) while Mississippi had the lowest (74.7; CI₉₅ 73.5 to 76.1). Minnesota had the highest HALE (77.8; CI₉₅ 77.4-78.2) while West Virginia had the lowest (74.3; CI₉₅ 74.0-74.7).

Image: PD

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