The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

doi:10.1001/jama.2018.0158

. 2018 Apr 10;319(14):1444-1472.

doi: 10.1001/jama.2018.0158.

The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

US Burden of Disease Collaborators; Ali H Mokdad¹, Katherine Ballestros¹, Michelle Echko¹, Scott Glenn¹, Helen E Olsen¹, Erin Mullany¹, Alex Lee¹, Abdur Rahman Khan², Alireza Ahmadi^{3

4}, Alize J Ferrari^{1

5

6}, Amir Kasaeian⁷, Andrea Werdecker⁸, Austin Carter¹, Ben Zipkin¹, Benn Sartorius^{9

10}, Berrin Serdar¹¹, Bryan L Sykes¹², Chris Troeger¹, Christina Fitzmaurice^{1

13}, Colin D Rehm¹⁴, Damian Santomauro^{1

5

6}, Daniel Kim¹⁵, Danny Colombara¹, David C Schwebel¹⁶, Derrick Tsoi¹, Dhaval Kolte¹⁷, Elaine Nsoesie¹, Emma Nichols¹, Eyal Oren¹⁸, Fiona J Charlson^{1

5

6}, George C Patton¹⁹, Gregory A Roth¹, H Dean Hosgood²⁰, Harvey A Whiteford^{1

5

6}, Hmwe Kyu¹, Holly E Erskine^{1

5

6}, Hsiang Huang²¹, Ira Martopullo¹, Jasvinder A Singh¹⁶, Jean B Nachega^{22

23

24}, Juan R Sanabria^{25

26}, Kaja Abbas²⁷, Kanyin Ong¹, Karen Tabb²⁸, Kristopher J Krohn¹, Leslie Cornaby¹, Louisa Degenhardt^{1

29}, Mark Moses¹, Maryam Farvid^{30

31}, Max Griswold¹, Michael Criqui³², Michelle Bell³³, Minh Nguyen¹, Mitch Wallin^{34

35}, Mojde Mirarefin^{1

36}, Mostafa Qorbani³⁷, Mustafa Younis³⁸, Nancy Fullman¹, Patrick Liu¹, Paul Briant¹, Philimon Gona³⁹, Rasmus Havmoller⁴, Ricky Leung⁴⁰, Ruth Kimokoti⁴¹, Shahrzad Bazargan-Hejazi^{42

43}, Simon I Hay^{1

44}, Simon Yadgir¹, Stan Biryukov¹, Stein Emil Vollset^{1

45}, Tahiya Alam¹, Tahvi Frank¹, Talha Farid², Ted Miller^{46

47}, Theo Vos¹, Till Bärnighausen^{48

49

50}, Tsegaye Telwelde Gebrehiwot⁵¹, Yuichiro Yano⁵², Ziyad Al-Aly⁵³, Alem Mehari⁵⁴, Alexis Handal⁵⁵, Amit Kandel⁵⁶, Ben Anderson⁵⁷, Brian Biroscak^{33

58}, Dariush Mozaffarian⁵⁹, E Ray Dorsey⁶⁰, Eric L Ding³⁰, Eun-Kee Park⁶¹, Gregory Wagner⁶², Guoqing Hu⁶³, Honglei Chen⁶⁴, Jacob E Sunshine⁵⁷, Jagdish Khubchandani⁶⁵, Janet Leasher⁶⁶, Janni Leung^{57

5}, Joshua Salomon⁴⁸, Jurgen Unutzer⁵⁷, Leah Cahill^{30

67}, Leslie Cooper⁶⁸, Masako Horino⁶⁹, Michael Brauer^{1

70}, Nicholas Breitborde⁷¹, Peter Hotez⁷², Roman Topor-Madry^{73

74}, Samir Soneji⁷⁵, Saverio Stranges^{76

77}, Spencer James¹, Stephen Amrock⁷⁸, Sudha Jayaraman⁷⁹, Tejas Patel⁸⁰, Tomi Akinyemiju¹⁶, Vegard Skirbekk^{81

82}, Yohannes Kinfu⁸³, Zulfiqar Bhutta^{84

85}, Jost B Jonas⁸⁶, Christopher J L Murray¹

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle.
² University of Louisville, Louisville, Kentucky.
³ Kermanshah University of Medical Sciences, Kermanshah, Iran.
⁴ Karolinska Institutet, Stockholm, Sweden.
⁵ School of Public Health, University of Queensland, Brisbane, Australia.
⁶ Queensland Centre for Mental Health Research, Brisbane, Australia.
⁷ Hematology-Oncology and Stem Cell Transplantation Research Center, and Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁸ Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Hessen, Germany.
⁹ Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa.
¹¹ University of Colorado, Aurora.
¹² Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine.
¹³ Division of Hematology, Department of Medicine, University of Washington, Seattle, and Fred Hutchinson Cancer Research Center, Seattle.
¹⁴ Montefiore Medical Center, Bronx, New York.
¹⁵ Department of Health Sciences, Northeastern University, Boston, Massachusetts.
¹⁶ University of Alabama at Birmingham.
¹⁷ Division of Cardiology, Brown University, Providence, Rhode Island.
¹⁸ Division of Epidemiology & Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California.
¹⁹ Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
²⁰ Albert Einstein College of Medicine, Bronx, New York.
²¹ Cambridge Health Alliance, Cambridge, Massachusetts.
²² Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
²³ Stellenbosch University, Cape Town, Western Cape, South Africa.
²⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
²⁵ Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
²⁶ Case Western Reserve University, Cleveland, Ohio.
²⁷ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England.
²⁸ School of Social Work, University of Illinois at Urbana-Champaign.
²⁹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
³⁰ Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
³¹ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston.
³² University of California, San Diego, La Jolla, California.
³³ Yale University, New Haven, Connecticut.
³⁴ VA Medical Center, Washington, DC.
³⁵ Neurology Department, Georgetown University, Washington, DC.
³⁶ Hunger Action Los Angeles, Los Angeles, California.
³⁷ Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Alborz, Iran.
³⁸ Jackson State University, Jackson, Mississippi.
³⁹ University of Massachusetts, Boston.
⁴⁰ State University of New York, Albany, Rensselaer, New York.
⁴¹ Simmons College, Boston, Massachusetts.
⁴² College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.
⁴³ David Geffen School of Medicine, University of California at Los Angeles.
⁴⁴ Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.
⁴⁵ Center for Disease Burden, Norwegian Institute of Public Health, and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁴⁶ Pacific Institute for Research & Evaluation, Calverton, Maryland.
⁴⁷ School of Public Health, Curtin University, Perth, Australia.
⁴⁸ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁴⁹ Africa Health Research Institute, Mtubatuba, South Africa.
⁵⁰ Institute of Public Health, Heidelberg University, Heidelberg, Germany.
⁵¹ Jimma University, Jimma, Oromia, Ethiopia.
⁵² Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
⁵³ Washington University in St Louis, St Louis, Missouri.
⁵⁴ College of Medicine, Howard University, Washington, DC.
⁵⁵ University of New Mexico, Albuquerque.
⁵⁶ University at Buffalo, Buffalo, New York.
⁵⁷ University of Washington, Seattle.
⁵⁸ University of South Florida, Tampa.
⁵⁹ Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
⁶⁰ University of Rochester Medical Center, Rochester, New York.
⁶¹ Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
⁶² Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁶³ Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China.
⁶⁴ Michigan State University, East Lansing.
⁶⁵ Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
⁶⁶ College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida.
⁶⁷ Dalhousie University, Halifax, Canada.
⁶⁸ Mayo Clinic, Jacksonville, Florida.
⁶⁹ Bureau of Child, Family & Community Wellness, Nevada Division of Public and Behavioral Health, Carson City.
⁷⁰ University of British Columbia, Vancouver, Canada.
⁷¹ The Ohio State University, Columbus.
⁷² College of Medicine, Baylor University, Houston, Texas.
⁷³ Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
⁷⁴ Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
⁷⁵ Dartmouth College, Hanover, New Hampshire.
⁷⁶ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
⁷⁷ Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
⁷⁸ Oregon Health & Science University, Portland.
⁷⁹ Department of Surgery, Virginia Commonwealth University, Richmond.
⁸⁰ White Plains Hospital, White Plains, New York.
⁸¹ Norwegian Institute of Public Health, Oslo, Norway.
⁸² Columbia University, New York, New York.
⁸³ Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia.
⁸⁴ Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
⁸⁵ Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
⁸⁶ Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.

PMID: 29634829
PMCID: PMC5933332
DOI: 10.1001/jama.2018.0158

The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

US Burden of Disease Collaborators et al. JAMA. 2018.

. 2018 Apr 10;319(14):1444-1472.

doi: 10.1001/jama.2018.0158.

Authors

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle.
² University of Louisville, Louisville, Kentucky.
³ Kermanshah University of Medical Sciences, Kermanshah, Iran.
⁴ Karolinska Institutet, Stockholm, Sweden.
⁵ School of Public Health, University of Queensland, Brisbane, Australia.
⁶ Queensland Centre for Mental Health Research, Brisbane, Australia.
⁷ Hematology-Oncology and Stem Cell Transplantation Research Center, and Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁸ Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Hessen, Germany.
⁹ Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa.
¹¹ University of Colorado, Aurora.
¹² Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine.
¹³ Division of Hematology, Department of Medicine, University of Washington, Seattle, and Fred Hutchinson Cancer Research Center, Seattle.
¹⁴ Montefiore Medical Center, Bronx, New York.
¹⁵ Department of Health Sciences, Northeastern University, Boston, Massachusetts.
¹⁶ University of Alabama at Birmingham.
¹⁷ Division of Cardiology, Brown University, Providence, Rhode Island.
¹⁸ Division of Epidemiology & Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California.
¹⁹ Murdoch Childrens Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
²⁰ Albert Einstein College of Medicine, Bronx, New York.
²¹ Cambridge Health Alliance, Cambridge, Massachusetts.
²² Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
²³ Stellenbosch University, Cape Town, Western Cape, South Africa.
²⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
²⁵ Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
²⁶ Case Western Reserve University, Cleveland, Ohio.
²⁷ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England.
²⁸ School of Social Work, University of Illinois at Urbana-Champaign.
²⁹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
³⁰ Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
³¹ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston.
³² University of California, San Diego, La Jolla, California.
³³ Yale University, New Haven, Connecticut.
³⁴ VA Medical Center, Washington, DC.
³⁵ Neurology Department, Georgetown University, Washington, DC.
³⁶ Hunger Action Los Angeles, Los Angeles, California.
³⁷ Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Alborz, Iran.
³⁸ Jackson State University, Jackson, Mississippi.
³⁹ University of Massachusetts, Boston.
⁴⁰ State University of New York, Albany, Rensselaer, New York.
⁴¹ Simmons College, Boston, Massachusetts.
⁴² College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.
⁴³ David Geffen School of Medicine, University of California at Los Angeles.
⁴⁴ Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.
⁴⁵ Center for Disease Burden, Norwegian Institute of Public Health, and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁴⁶ Pacific Institute for Research & Evaluation, Calverton, Maryland.
⁴⁷ School of Public Health, Curtin University, Perth, Australia.
⁴⁸ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁴⁹ Africa Health Research Institute, Mtubatuba, South Africa.
⁵⁰ Institute of Public Health, Heidelberg University, Heidelberg, Germany.
⁵¹ Jimma University, Jimma, Oromia, Ethiopia.
⁵² Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
⁵³ Washington University in St Louis, St Louis, Missouri.
⁵⁴ College of Medicine, Howard University, Washington, DC.
⁵⁵ University of New Mexico, Albuquerque.
⁵⁶ University at Buffalo, Buffalo, New York.
⁵⁷ University of Washington, Seattle.
⁵⁸ University of South Florida, Tampa.
⁵⁹ Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
⁶⁰ University of Rochester Medical Center, Rochester, New York.
⁶¹ Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
⁶² Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁶³ Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China.
⁶⁴ Michigan State University, East Lansing.
⁶⁵ Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
⁶⁶ College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida.
⁶⁷ Dalhousie University, Halifax, Canada.
⁶⁸ Mayo Clinic, Jacksonville, Florida.
⁶⁹ Bureau of Child, Family & Community Wellness, Nevada Division of Public and Behavioral Health, Carson City.
⁷⁰ University of British Columbia, Vancouver, Canada.
⁷¹ The Ohio State University, Columbus.
⁷² College of Medicine, Baylor University, Houston, Texas.
⁷³ Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
⁷⁴ Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
⁷⁵ Dartmouth College, Hanover, New Hampshire.
⁷⁶ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
⁷⁷ Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
⁷⁸ Oregon Health & Science University, Portland.
⁷⁹ Department of Surgery, Virginia Commonwealth University, Richmond.
⁸⁰ White Plains Hospital, White Plains, New York.
⁸¹ Norwegian Institute of Public Health, Oslo, Norway.
⁸² Columbia University, New York, New York.
⁸³ Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia.
⁸⁴ Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
⁸⁵ Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
⁸⁶ Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.

PMID: 29634829
PMCID: PMC5933332
DOI: 10.1001/jama.2018.0158

Abstract

Introduction: Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.

Objective: To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.

Design and setting: A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.

Main outcomes and measures: Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.

Results: Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).

Conclusions and relevance: There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Singh reports receipt of grants and personal fees from Savient, Takeda, and Crealta/Horizon; personal fees from Regeneron, Merz, Iroko, Bioiberica, Allergan, UBM LLC, WebMD, and the American College of Rheumatology during the conduct of the study; personal fees from DINORA; and nonfinancial support from Outcomes Measures in Rheumatology outside the submitted work. Dr Degenhardt reports receipt of grants from Mundipharma, Indivior, and Seqirus outside the submitted work. Dr Bell reports receipt of grants from the US Environmental Protection Agency and the National Institutes of Health (NIH) during the conduct of the study, and honorarium and/or travel reimbursement from NIH, the American Journal of Public Health, Columbia University, Washington University, Statistical Methods and Analysis of Environmental Health Data Workshop, North Carolina State University, and Global Research Laboratory and Seoul National University. Dr Mozaffarian reports receipt of personal fees from Acasti Pharma, GOED, DSM, Haas Avocado Board, Nutrition Impact, Pollock Communications, Boston Heart Diagnostics, and Bunge; other for serving on a scientific advisory board from Omada Health and Elysium Health; a grant from NIH and the National Heart, Lung, and Blood Institute; a grant from the Bill and Melinda Gates Foundation; and royalties from UpToDate outside the submitted work.

Figures

**Figure 1.. Top 25 Causes of Disability-Adjusted Life-Years (DALYs) and % Change in Number of DALYs, All-Age DALYs, and Age-Standardized DALYs, 1990-2016**
Dotted lines: a leading cause has decreased in rank between 1990 and 2016; solid lines, a cause has maintained or ascended to a higher ranking. Causes in white boxes were not among the top 25 in either 1990 or in 2016. COPD, indicates chronic obstructive pulmonary disease. ^aIncludes tracheal, bronchus, and lung cancer. ^bIndicates HIV/AIDS resulting in other diseases. ^cIndicates chronic kidney disease (CKD) due to diabetes.

**Figure 2.. Number of Deaths and Percentage of Disability-Adjusted Life-Years Related to the 17 Leading Risk Factors in the United States, 2016**
Negative values (where bars extend left of zero) indicate a protective effect.

**Figure 3.. Change in the Probability of Death Between Birth and Age 20 Years, 1990-2016, Reported Showing Major Causes of Death for the United States Overall and the 50 States**
States are listed in descending order according to probability of death in 2016. Data for Washington, DC, were not included in this analysis.

**Figure 4.. Change in the Probability of Death Between Ages 20 and 55 Years, 1990-2016, Reported Showing Major Causes of Death for the United States Overall and the 50 States**
States are listed in descending order according to probability of death in 2016. Data for Washington, DC, were not included in this analysis.

**Figure 5.. Change in the Probability of Death Between Ages 55 and 90 Years, 1990-2016, Reported Showing Major Causes of Death for the United States Overall and the 50 States**
States are listed in descending order according to probability of death in 2016. Data for Washington, DC, were not included in this analysis.

Figure 6.. Age-Standardized Rates of Years of Life Lost per 100 000 Persons for the 20 Leading Causes of Years of Life Lost in 2016 for the United States Overall, the 50 States, and the District of Columbia
Boxes are colored green if significantly less than the US rate (P <.05), red if significantly more than the US rate (P <.05), and yellow if not significantly different from the US rate (P ≥.05).

Figure 7.. Ratio of Observed Years of Life Lost (YLLs) to Expected YLLs Based on the Sodiodemographic Index (SDI) for the United States Overall, the 50 States, and the District of Columbia in 2016 for the 10 Leading Causes in Each Jurisdiction
Ratio details: Alabama’s, stroke ratio (eg, 1.0 [observed and expected rates were similar]; diabetes [2.85 × above expected]). See Appendix Table 2 in Supplement 2 for explanation of terms.

Figure 8.. Ratio of Observed Years Lived With Disability (YLDs) to Expected YLDs Based on the Sociodemographic Index (SDI) for the United States Overall, the 50 States, and the District of Columbia in 2016 for the 10 Leading Causes in Each Jurisdiction
See Figure 7 caption for details. See Appendix Table 2 in Supplement 2 for explanation of terms.

Figure 9.. Ratio of Observed Disability-Adjusted Life-Years (DALYs) to Expected DALYs Based on the Sociodemographic Index (SDI) for the United States Overall, the 50 States, and the District of Columbia in 2016 for the 10 Leading Causes in Each Jurisdiction
See Figure 7 caption for details. See Appendix Table 2 in Supplement 2 for explanation of terms.

Figure 10.. Ranking of Risk Factors in 2016 for the United States Overall, the 50 States, and the District of Columbia According to the Number of Disability-Adjusted Life-Years Related to Each Risk Factor

See this image and copyright information in PMC

Comment in

Toward a United States of Health: Implications of Understanding the US Burden of Disease.
Koh HK, Parekh AK. Koh HK, et al. JAMA. 2018 Apr 10;319(14):1438-1440. doi: 10.1001/jama.2018.0157. JAMA. 2018. PMID: 29634816 No abstract available.

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[1] Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and undiagnosed diabetes prevalence by county in the US, 1999-2012. Diabetes Care. 2016;39(9):1556-1562. - PubMed

[2] Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and undiagnosed diabetes prevalence by county in the US, 1999-2012. Diabetes Care. 2016;39(9):1556-1562. - PubMed

[3] Wang H, Schumacher AE, Levitz CE, Mokdad AH, Murray CJ. Left behind: widening disparities for males and females in US county life expectancy, 1985-2010. Popul Health Metr. 2013;11(1):8. - PMC - PubMed

[4] Wang H, Schumacher AE, Levitz CE, Mokdad AH, Murray CJ. Left behind: widening disparities for males and females in US county life expectancy, 1985-2010. Popul Health Metr. 2013;11(1):8. - PMC - PubMed

[5] Case A, Deaton A. Mortality and morbidity in the 21st century. https://www.brookings.edu/bpea-articles/mortality-and-morbidity-in-the-2.... Accessed October 19, 2017. - PMC - PubMed

[6] Case A, Deaton A. Mortality and morbidity in the 21st century. https://www.brookings.edu/bpea-articles/mortality-and-morbidity-in-the-2.... Accessed October 19, 2017. - PMC - PubMed

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The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

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The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States

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