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7.16.2013

Miller School Experts Contribute to JAMA Study on Growing U.S. Disease Burden

From ischemic heart disease to diabetes to interpersonal violence, the United States fares worse than its economic peers around the world in nearly every major cause of premature death, according to a study published online July 10 in the Journal of the American Medical Association by a global collaborative of scientists that includes three Miller School experts.

Led by the University of Washington’s Institute for Health Metrics and Evaluation, “The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors” demonstrates the impact of premature deaths in children and young adults, the significant and growing toll of disabling conditions, and the overall burden on health systems from a range of fatal and non-fatal health factors.

The Miller School’s Steven E. Lipshultz, M.D., James D. Wilkinson, M.D., M.P.H., and Ralph Sacco, M.D., M.S., are among the co-authors of the first comprehensive analysis of the disease burden in the United States in more than 15 years. Lipshultz, professor of pediatrics and epidemiology and the George E. Batchelor Professor of Pediatrics, and Wilkinson, professor of pediatrics and epidemiology who coordinates the NIH’s Pediatric Cardiomyopathy Registry, chaired the group that investigated the global burden of cardiomyopathy. Sacco, Miller Professor, Chair of Neurology, and Olemberg Family Chair in Neurological Disorders, served on the review committee for stroke, one of the few bright spots in the U.S. study.

Even though the U.S. leads the world on healthcare spending and in the quality and quantity of its health research, the study showed that health outcomes in the U.S. have not kept pace with those of other wealthy countries. Since 1990, there has been a steady shift from conditions that shorten life to chronic disabilities from mental and behavioral disorders, musculoskeletal problems, and neurological conditions. In 2010, chronic disability accounted for nearly half of all health loss in the U.S.

While the study showed a decline in stroke death rates since 1990, Sacco notes that stroke remains among the top three leading causes of death, behind ischemic heart disease and lung cancer, in the U.S., and a major and growing contributor to disability, with significant increases between 1990 and 2010 in age-standardized rates of years lived with disability.

“Diet has increased as a leading contributor to disability in the U.S., followed by smoking, obesity, and high blood pressure,” said Sacco, who is past president of the American Heart Association. “All of us need to take control of our own health and focus on wellness, as well as become advocates for policies to improve the health of our communities.”

Indeed, Lipshultz, the Director of the Batchelor Children’s Research Institute, said the JAMA paper provides a unique framework for the discussions needed to improve national health. That’s why JAMA conducted a rapid review of the paper and timed its release to policy discussions by the Institute of Medicine and First Lady Michelle Obama, who also on July 10 hosted a presentation of the JAMA findings to city and county officials as part of her Let’s Move! campaign. “Data should guide health policy and now, for the first time in the current era, we have meaningful data that can help ease the chronic disease burden by guiding policy on how best to use limited dollars to address the most pressing burdens,” Lipshultz said.

According to the report, the U.S.’s overall disease burden is now dominated by conditions that are more disabling than fatal. While the burdens from ischemic heart disease, lower respiratory infections, HIV/AIDS, and preterm birth complications are all falling, the burdens from depression, low back and neck pain, and diabetes are rising.

Mental and behavioral disorders alone make up 27 percent of years lived with disability, with depression, anxiety disorders, drug use disorders, and alcohol use disorders among the biggest contributors.

The U.S. did make some significant health gains over the past two decades, including a dramatic reduction in sudden infant death syndrome, lower mortality rates for people at every age, and significant reductions in death and disability from HIV/AIDS.

But other countries are improving at a faster rate. As a result, among 34 economic peer countries in Europe, Asia, and North America, the U.S. fell in the rankings between 1990 and 2010 on nearly every major health measure.

The researchers point to poor diet and inadequate physical activity as two of the driving forces. The U.S. has a greater disease burden associated with diet than the average of its peers. Among them, the U.S. ranked 27th in disease burden risk from dietary factors, 27th on high body mass index (BMI), and 29th on blood sugar.

It did significantly better than its peers – ranking first, second or third – in only four areas: occupational risks, low bone mineral density, unimproved sanitation, and iron deficiency.

To explore the U.S. trends in greater depth, visit the Institute for Health Metrics and Evaluation’s Global Burden of Disease Visualizations page.

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