The burden of disease and injury in the United States 1996

Abstract

Background: Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context.

Methods: We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world.

Results: In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.

Conclusion: Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.

Figure 1

Proportion of cardiovascular disease deaths (excluding stroke) assigned to selected codes for ill-defined causes and directly assigned to ischemic heart disease in the United States.

Figure 2

Burden of Disease (DALYs) by sex and major disease groups, US, 1996.

Figure 3

Groups I, II, and III as a percentage of total burden of disease (DALY) by race, US, 1996.

Figure 4

Distribution of YLL and YLD by sex and race, US, 1996.

Figure 5

HIV/AIDS: distribution of DALY rates/100,000 by age, race and sex, US 1996.

Figure 6

IHD and cerebrovascular diseases: distribution of DALY rates/100,000 by age, race and sex, US 1996.

Figure 7

Hypertension and inflammatory cardiac diseases: distribution of DALY rates/100,000 by age, race and sex, US 1996.

Figure 8

Major causes of injuries: distribution of DALY rates/100,000 by age, race and sex, US 1996.

Figure 9

Distribution of deaths and YLL by age, US 1996.

Figure 10

Ten leading causes of mortality burden and death, as per cent of total, both sexes, US 1996.

Figure 11

Leading causes of mortality burden (YLL) by sex, US, 1996.

Figure 12

Ten leading causes of mortality burden (YLL) and death, as a per cent of total, by race, US, 1996.

Figure 13

Ten leading causes of mortality burden (YLL) and death, as a per cent of total, by race, US, 1996.

Figure 14

Comparative rankings for the twenty leading causes of YLL for males, US compared with selected non-US OECD countries. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected non-US OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom.

Figure 15

Comparative rankings for the twenty leading causes of YLL for females, US compared with selected non-US OECD countries. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom.

Figure 16

YLL rankings by race in the US compared with selected non-US OECD countries, males. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom

Figure 17

YLL rankings by race in the US compared with non-US OECD countries, females. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom

Figure 18

Distribution of YLD for non-communicable cause groupings.

Figure 19

Age patterns of mental disorders and diseases of the nervous system.

Figure 20

Patterns of YLD by age and race, US 1996.