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The Burden of Diseases, Injuries, and Risk Factors by State in the Usa, 1990–2021: A Systematic Analysis for the Global Burden of Disease Study 2021 Publisher Pubmed

Summary: Study finds US life expectancy dropped significantly from 1990-2021, with state disparities. #PublicHealth #GBDStudy

Mokdad AH1 ; Bisignano C1 ; Hsu JM1 ; Ababneh HS11 ; Abbasgholizadeh R18 ; Abdelkader A20 ; Abdelmasseh M22 ; Abiodun OO23 ; Aboagye RG24 ; Abuzaid A27, 29 ; Abukhadijah HJ30 ; Addo IY32, 35 ; Adeagbo OA36, 37 ; Adegboye OA38 Show All Authors
Authors
  1. Mokdad AH1
  2. Bisignano C1
  3. Hsu JM1
  4. Ababneh HS11
  5. Abbasgholizadeh R18
  6. Abdelkader A20
  7. Abdelmasseh M22
  8. Abiodun OO23
  9. Aboagye RG24
  10. Abuzaid A27, 29
  11. Abukhadijah HJ30
  12. Addo IY32, 35
  13. Adeagbo OA36, 37
  14. Adegboye OA38
  15. Adekanmbi V39
  16. Adeyeoluwa TE41, 43
  17. Adzigbli LA25
  18. Afolabi AA46
  19. Agyemangduah W47
  20. Ahmad S48, 50
  21. Ahmad D51, 52
  22. Ahmed A53, 55
  23. Ahmed SA56
  24. Akkaif MA60
  25. Akrami AE61, 62
  26. Akter E65
  27. Al Hasan SM66
  28. Al Taani O70
  29. Alajlouni Y71, 72
  30. Alaly Z67, 75
  31. Alrifai RH76
  32. Altawfiq JA77, 78
  33. Alwardat M79
  34. Alzyoud WA82
  35. Alam M83
  36. Albakri A85
  37. Aldhaleei WA86
  38. Aldridge RW1, 2, 88
  39. Ali MU90, 91
  40. Ali A93
  41. Ali R94
  42. Ali W95
  43. Almustanyir S28, 96
  44. Alqutaibi AY97, 98
  45. Alrawashdeh A80
  46. Alsabri MA99, 100
  47. Aly H101
  48. Amani R103, 104
  49. Amegbor PM108
  50. Amindarolzarbi A111
  51. Amiri S119
  52. Anil A121, 123
  53. Appiah F124, 125
  54. Arabloo J126
  55. Arafa EA21, 132
  56. Arafat M133
  57. Aravkin AY1, 2, 3
  58. Ardekani A104
  59. Areda D134, 135
  60. Ashina S136, 145
  61. Atreya A146
  62. Ayalew FB147
  63. Azzam AY148, 149
  64. Babu GR150
  65. Baghdadi S151
  66. Bagherieh S152
  67. Bahramian S152
  68. Bahreini R157
  69. Bako AT158
  70. Bansal K160, 161
  71. Barnighausen TW137, 162
  72. Barrow A163, 164
  73. Bastan MM127, 168
  74. Basu S138, 181
  75. Batra R183, 186
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  77. Bayati M105
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  79. Bell ML187
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  81. Bemanalizadeh M153, 169
  82. Bennitt FB195
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  143. Dewan SMR292, 293
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  201. Gholamrezanezhad A349
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  203. Gobolos L277, 350
  204. Goldust M189
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  214. Habibzadeh P362
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  216. Haile D1
  217. Hajmirzaian A13, 219
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  220. Haque OI365
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  227. Hebert JJ373, 374
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  230. Hidayana I378
  231. Hinneh TK113
  232. Hiraike Y380
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  234. Horita N382, 383
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  259. Karanth SD167
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  262. Katamreddy A420
  263. Kazemi F115
  264. Kerr JA421, 422
  265. Khader YS81
  266. Khamesipour F423, 424
  267. Khan MJ91
  268. Khan ZA425
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  271. Khatab K430, 431
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  273. Khatatbeh MM432
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  291. Kumar A456
  292. Kumar R457
  293. Kundu S459, 460
  294. Kurmi OP368, 461
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  296. Lai H463, 464
  297. Lan Q465
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  299. Le TDT472
  300. Le HH468, 474
  301. Le NHH468, 474
  302. Le TTT472
  303. Leasher JL475
  304. Lee SW476
  305. Lee WC40
  306. Li W190
  307. Libra M477
  308. Lim SS1, 2
  309. Lin J33
  310. Lin JC338
  311. Lioutas VA478, 480
  312. Liu X13, 102, 191, 279
  313. Liu RT14
  314. Liu X13, 102, 191, 279
  315. Liu J68
  316. Lopezgil JF481
  317. Lopukhov PD482
  318. Lucchetti G483
  319. Lunevicius R484, 485
  320. Lusk JB447
  321. Mafhoumi A173
  322. Malakan Rad E174
  323. Manla Y486
  324. Mansouri V175
  325. Manu E26
  326. Marconi AM487, 488
  327. Marino M489
  328. Martin RV69, 490
  329. Martinezpiedra R491
  330. Marx W359
  331. Marzo RR492, 493
  332. Mathangasinghe Y494, 495
  333. Matozinhos FP496
  334. Mcphail SM453, 497
  335. Mekene Meto TM498
  336. Meles HN345, 499
  337. Melese EB118
  338. Mensah GA384, 501
  339. Mensah LG502
  340. Meo SA503
  341. Mestrovic T1, 505
  342. Mhlanga L64, 506
  343. Mhlanga A507
  344. Michalek IM508, 509
  345. Miller TR510, 511
  346. Mirzaaghazadehattari M285, 512
  347. Mishra AK513
  348. Moberg ME1
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  350. Mohamed MFH199
  351. Mohamed J516
  352. Mohammadzadeh I221
  353. Mohammed S517, 518
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  355. Molavi Vardanjani H106
  356. Momtazmanesh S168, 176
  357. Moni MA522, 523
  358. Montazeri F435, 524
  359. Moradi Y525
  360. Moradilakeh M129, 130
  361. Moraga P526
  362. Morrison SD7
  363. Motappa R527
  364. Mougin V1
  365. Murillozamora E530, 531
  366. Naghavi M1, 2
  367. Naghavi P532
  368. Naik G533
  369. Najdaghi S154, 155
  370. Nanavaty DP535
  371. Narimani Davani D154
  372. Nascimento GG536
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  379. Nguyen TT469, 543
  380. Nguyen DH15, 271
  381. Nguyen HQ544
  382. Nguyen AH545
  383. Nguyen VT470
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  387. Novotney A1
  388. Nugen F541, 548
  389. Nutor JJ549
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  402. Ortegaaltamirano DV561
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  404. Padukudru MPA562
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  408. Park EK570
  409. Park S569
  410. Pashaei A231
  411. Pasovic M1
  412. Patel JR573, 574
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  414. Pawar S192
  415. Peprah EK108
  416. Pereira G578, 579
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  469. Shaikh A288
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Source: The Lancet Published:2024


Abstract

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states. Methods: GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk–outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimate's distribution). Uncertainty was propagated at each step of the estimation process. Findings: We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USA's ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia—the lowest-ranked state that year—ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1–57·2] decline), lung cancer (41·9% [39·7–44·6]), and breast cancer (40·9% [38·7–43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1–1015·5]), chronic kidney disease (158·3% [149·6–167·9]), and falls (89·7% [79·8–95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6–493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6–975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2–47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8–13·0) from 1990. Depressive disorders (56·0% increase [48·2–64·3]) and drug use disorders (287·6% [247·9–329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6–68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8–15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9–18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4–52·5) and for tobacco use by 5·1% (48·3%–54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4–18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15–49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50–69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI. Interpretation: GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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