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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
Journal article   Open access   Peer reviewed

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

Ali H. Mokdad, Catherine Bisignano, Johnathan M. Hsu, Hazim S. Ababneh, Rouzbeh Abbasgholizadeh, Atef Abdelkader, Michael PubMed, Olugbenga Olusola Abiodun, Richard Gyan Aboagye, Ahmed Abu-Zaid, …
The Lancet (British edition), v 404(10469), pp 2314-2340
07 Dec 2024
DOI: https://doi.org/10.1016/S0140-6736(24)01446-6
PMID: 39645376
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/S0140-6736(24)01446-6View
Published, Version of Record (VoR) Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology ESI Highly Cited Paper (Incites)
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 center dot 5th and 97 center dot 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 center dot 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 yearranked 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 center dot 1% [95% UI 55 center dot 1-57 center dot 2] decline), lung cancer (41 center dot 9% [39 center dot 7-44 center dot 6]), and breast cancer (40 center dot 9% [38 center dot 7-43 center dot 7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878 center dot 0% [770 center dot 1-1015 center dot 5]), chronic kidney disease (158 center dot 3% [149 center dot 6-167 center dot 9]), and falls (89 center dot 7% [79 center dot 8-95 center dot 8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433 center dot 2 per 100 000 [380 center dot 6-493 center dot 4]) in 2021 and Mississippi having the highest (867 center dot 5 per 100 000 [772 center dot 6-975 center dot 7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40 center dot 7% decline [33 center dot 2-47 center dot 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 center dot 9% (1 center dot 8-13 center dot 0) from 1990. Depressive disorders (56 center dot 0% increase [48 center dot 2-64 center dot 3]) and drug use disorders (287 center dot 6% [247 center dot 9-329 center dot 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 center dot 8% (50 center dot 6-68 center dot 5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085 center dot 3 per 100 000 [9090 center dot 8-15 557 center dot 1]), whereas West Virginia had the highest (14 832 center dot 9 per 100 000 [11 226 center dot 9-18 882 center dot 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 center dot 8% (43 center dot 4-52 center dot 5) and for tobacco use by 5 center dot 1% (48 center dot 3%-54 center dot 1%), but rates increased for high fasting plasma glucose by 9 center dot 3% (0 center dot 4-18 center dot 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. Copyright (c) 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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