Americans are living longer, but sicker lives

U. WASHINGTON (US) — Americans spend more years living with illness and disability than people in many countries, including Canada, Germany, and Israel.

A new study examining the causes of death and disability—across age groups and sexes—for 187 countries around the world also shows that health in the United States is being severely eroded by poor lifestyle choices such as unhealthy diets, lack of physical activity, smoking, and use of alcohol and drugs.

The Global Burden of Diseases, Injuries, and Risk Factors 2010 Study (GBD 2010) is a collaborative project led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

GBD 2010 encompasses researchers from 303 institutions and 50 countries, and the work, which generated 1 billion estimates for health challenges large and small, was funded by the Bill & Melinda Gates Foundation.

A full range of dynamic visualizations of GBD findings for the US and other countries will allow people everywhere to see the progress being made in health and the daunting challenges that remain.

And they will be updated regularly, meaning that policymakers and donors no longer will have to wait years or even decades to see the trends in their countries.

“We know that the world’s health can only improve if we are measuring the right problems and evaluating the right solutions,” says Christopher Murray, IHME director. “That’s why we are working hard to gather more and better data constantly and are challenging ourselves to improve our analytical methods.

“We also are expanding our network of collaborators. This extended network will improve the quality of the assessment but also provide a forum for ongoing reflection, learning, interpretation, and action based on the GBD results and future revisions.”

Short list of causes

Much of the illness and death in the US is caused by a short list of ailments. GBD researchers examined more than 300 diseases, injuries, and risk factors and found that just 17 distinct causes account for more than half of the American disease burden, measured as the number of years lost to disability and premature death.

The top cause is ischemic heart disease, followed by chronic obstructive pulmonary disease, low back pain, lung cancer, and major depressive disorders.

The types of illnesses and injuries causing death are changing. While ischemic heart disease, stroke, and lung cancer remained the top three causes of death in the US between 1990 and 2010, many of the other rankings in the top 10 causes changed. Diseases such as diabetes, chronic kidney disease, and Alzheimer’s disease moved up, and chronic obstructive pulmonary disease, lower respiratory infection, and colorectal and breast cancers moved down.

Health in the US is a mixed picture. American life expectancy is increasing, but these longer lives are also filled with more sickness and disability.

The average life expectancy of American women increased from 78.6 years in 1990 to 80.5 years in 2010, yet only 69.5 of those 80.5 years were lived in good health. Similarly, American men in 2010 lived, on average, to be 75.9 years old—up from 71.7 in 1990—but only 66.2 of those years are healthy. This is in keeping with a global shift to an older population that struggles with a complex combination of health problems.

Longer life spans have been accompanied by a tremendous increase in the disease burden due to Alzheimer’s disease. Alzheimer’s is now the number 12 cause of disease burden in the US, and the number four cause of death.

Its impact on health has become much more severe over the course of two decades; the number of years of life lost prematurely because of Alzheimer’s increased by 392 percent—far more than any other disease. Other wealthy countries have witnessed similar but not as dramatic increases.

US lags behind

In critical ways, the US is lagging behind many wealthy and middle-income countries in terms of health. Americans live shorter lives, and shorter healthy lives, than many other people.

For example, men in 39 other countries—including Greece, Lebanon, and South Korea—live longer, and men in 30 other countries—such as Costa Rica, New Zealand, and Portugal—enjoy more years of good health.

American women fare about the same; in terms of life expectancy they are ranked 36th in the world, and in terms of healthy life expectancy they are ranked 35th.

The scourge of HIV/AIDS continues to affect the US more than in most wealthy countries. The disease was much less of a cause of death and disability in 2010 than it was in 1990, when the US felt the greatest impact of HIV/AIDS, but it remains the nation’s number 33 cause of disease burden.

The disease’s impact in the US is nowhere near its devastating toll in parts of sub-Saharan Africa, where it is the number one cause of health loss, but HIV/AIDS is a much greater problem than in other developed countries. HIV/AIDS is the 134th cause of disease burden in Japan, 91st in the UK, and 84th in Australia.

Other ailments that represent a more serious threat to health in the US than in other countries include diabetes and chronic obstructive pulmonary disorder. These ailments have a less severe impact on the health of people in Australia, Japan, and the countries of Western Europe.

Neonatal complications such as premature lung development, infections, or pneumonia—problems that cause tremendous disease burden in South Asia, sub-Saharan Africa, and other parts of the developing world—also persist in the US at significantly higher rates than in other wealthy countries.

Lifestyle: obesity, smoking, alcohol

Health is being largely eroded because Americans make poor lifestyle choices that cause lung ailments, musculoskeletal stress, and obesity-related illnesses such as heart disease and diabetes.

Obesity’s impact is especially troubling, with the number of years of disability and premature death due to diabetes rising by 58 percent from 1990 to 2010. High body mass index as a risk factor rose by 45 percent over the same period and is now the third largest risk factor in the US, accounting for more than one-tenth of total disease burden in 2010.

Smoking is the number two risk factor in the US—behind poor diet—resulting in high rates of lung cancer, chronic obstructive pulmonary disorder (COPD), and other ailments.

Alcohol is the number seven risk to American health, and alcohol’s negative impact is increasing. Drugs are also a rising risk factor in the US; the disease burden attributable to drug use increased by 64 percent between 1990 and 2010.

Like many countries in the world, the US is struggling with a growing burden of disability as demographics and epidemiology evolve. Almost all of the top causes of disability—back and neck pains, depression, anxiety, migraine headaches—became greater threats to health from 1990 to 2010. These causes of disability are often not causes of death but their toll on health is dramatic.

Source: University of Washington