WASHINGTON – Americans are increasingly living with disabling conditions rather than dying from fatal diseases, while their nation lags behind its economic peers in addressing risk factors that contribute to poor health and premature death.
That’s according to several studies highlighted at the briefing.
"We’ve identified substantial areas where the U.S. can make progress and hopefully narrow the gap between what we’ve observed in the U.S. and the [peer] countries," Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, and the lead author of the studies, said at an Institute of Medicine briefing July 10. "There’s also a role, we believe, for enhanced primary care – management of blood pressure, cholesterol, and encouragement of physical activity of patients."
The main study, published on July 10 in JAMA, is "an extraordinary publication," said Dr. Howard Bauchner, the journal’s editor in chief. "This is the first comprehensive box score of American health that’s ever been published."
The JAMA study, along with two companions, adds to the growing body of evidence that diet and physical activity – as well as smoking – are among the most important determinants of health, outside of socioeconomic factors.
Both Dr. Murray and Dr. Bauchner said that it was critical for physicians to discuss these lifestyle issues with patients, but also to monitor risk factors like hypertension, cholesterol, and blood sugar, especially in women, who are, in some areas of the country, facing rising death rates from heart disease in particular.
The United States has succeeded in reducing deaths from ischemic heart disease, HIV/AIDS, sudden infant death syndrome, and certain cancers, according to researchers from the U.S. Burden of Disease Collaborators, a group of academic, private, and government researchers from around the world.
But chronic disability from lung cancer, musculoskeletal pain, neurologic conditions, diabetes, and mental health/substance-use disorders – in particular, opioid abuse – is growing rapidly (JAMA 2013 July 10 [doi: 10.1001/jama.2013.13805]).
Substance abuse is not only disabling, but also contributes to premature death, the investigators found. More years of life lost were lost due to drug use disorders in 2010 than from prostate cancer and ovarian cancer combined, rising 448% between 1990 and 2010. Drug use went from 44th on the list of leading causes of years of life lost to 15th.
Alzheimer’s disease, liver cancer, Parkinson’s disease, and kidney cancer are also gaining among the causes of premature death.
"The United States spends more than the rest of the world on health care and leads the world in the quality and quantity of its health research, but that doesn’t add up to better health outcomes," Dr. Murray said in a statement. "The country has done a good job of preventing premature deaths from stroke, but when it comes to lung cancer, preterm birth complications, and a range of other causes, the country isn’t keeping pace with high-income countries in Europe, Asia, and elsewhere."
The study looked at death and disability from 291 diseases, conditions, and injuries, and also examined 67 risk factors for death and disability. The authors used the same methodology as that employed in the Global Burden of Disease Study 2010 (Lancet 2012:380;2055-2058).
Alicia Ault/IMNG Medical Media
Dr. Christopher Murray
In the U.S. study, the top 10 causes of years of life lost in 2010 were ischemic heart disease (16%), lung cancer (7%), stroke (4%), chronic obstructive pulmonary disease (4%), road injury (4%), self-harm (3%), diabetes (3%), cirrhosis (3%), Alzheimer’s disease (3%), and colorectal cancer (2%).
From 1990 to 2010, the average life expectancy for Americans increased from 75.2 to 78.2 years. But the "healthy life expectancy" – the number of years someone can expect to live in good health – went from 65.8 years to 68.1 years during the same period. The gap between average life expectancy and healthy life expectancy rose from 9.4 years in 1990 to 10.1 years in 2010.
When compared with 34 nations in Europe, Asia, and North America, the United States fell in rankings on almost every health measure from 1990 to 2010. For life expectancy at birth, the U.S. dropped from 20th to 27th.
Poor diet and not enough physical activity, along with smoking and uncontrolled blood pressure and cholesterol, were behind the drops, according to the investigators. The United States ranked 27th in disease burden risk from dietary factors and was also ranked 27th for body mass index. For healthy blood sugar, the United States was ranked 29th.
The United States is near the bottom when it comes to death rates. America ranks 27th among the 34 comparator countries. Only the Czech Republic, Poland, Estonia, Mexico, Turkey, Slovakia, and Hungary had higher death rates.