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. 2021 Jan 4;4(1):e2034890.
doi: 10.1001/jamanetworkopen.2020.34890.

Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019

Jeromie M Ballreich  1 , Cary P Gross  2 , Neil R Powe  3 , Gerard F Anderson  1
Affiliations

Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019

Jeromie M Ballreich et al. JAMA Netw Open. .

Abstract

Importance: Prior research suggests an association between burden of disease and National Institutes of Health (NIH) funding. The allocation of NIH funding should reflect, to some extent, the health needs of the population, along with other factors.

Objective: To examine the factors associated with NIH funding in 2019 for 46 diseases.

Design, setting, and participants: This cohort study used disability-adjusted life-years to measure the 2008 and 2019 US burden of disease and compared them with NIH categoric funding for 46 diseases.

Exposures: Disability-adjusted life-years to measure the 2008 and 2019 US burden of disease, 2016 health spending, and 2008 NIH funding levels for 46 diseases.

Main outcomes and measures: 2019 NIH funding levels for 46 diseases.

Results: The 46 diseases accounted for 62 392 713 of 94 399 784 disability-adjusted life-years (66.1%) in 2008 and 75 706 718 of 111 074 472 disability-adjusted life-years (68.2%) in 2019, representing more than 66% of all disability-adjusted life-years in both years. By dollar volume, Alzheimer and dementia increased the most, with approximately $1.8 billion more funding in 2019 than 2008 (from $530 million in 2008 to $2398 million in 2019, a 352% increase), whereas interpersonal violence had the greatest decrease, $95 million, in 2019 NIH funding (from $236 million in 2008 to $141 million in 2019, a 40% decrease). For the 46 diseases in this study, the variable with the greatest association with NIH funding in 2019 was the level of NIH funding in 2008, with a simple correlation of 0.88. Burden of disease and changes in burden of disease were not statistically significantly associated with NIH funding levels once the prior level of funding was included in the model. The models suggested that a 1% higher level of NIH funding in 2008 was associated with a 0.91% higher level of NIH funding in 2019.

Conclusions and relevance: In this study, NIH spending for most diseases seemed to be based primarily on the level of NIH spending more than 10 years earlier, despite changes in burden of disease. Congress and the NIH should examine the allocation process to ensure NIH investments are responsive to changes in the health of the population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gross reported receiving grants from National Comprehensive Cancer Network (Pfizer/AstraZeneca), grants from Johnson and Johnson, and personal fees from Flatiron, Inc, as well as travel and speaking fees outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. National Institutes of Health (NIH) Funding and Burden of Disease
Funding and disease burden in 2008 (A) and 2019 (B). The dashed lines indicate the fitted association between burden of disease and NIH spending. COPD indicates chronic obstructive pulmonary disease and STI, sexually transmitted infection.
Figure 2.
Figure 2.. Changes in Burden of Disease and National Institutes of Health (NIH) Funding, 2008-2019
COPD indicates chronic obstructive pulmonary disease and STI, sexually transmitted infection.
See this image and copyright information in PMC

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