Health, Life Expectancy Vary Widely Among US States

Nicola M. Parry, DVM

April 10, 2018

How long you live may depend in part on where you live, according to new data from the US Burden of Disease Collaborators.

Although health in the United States improved between 1990 and 2016, a few risk factors accounted for many years lost to poor health, disability, or early death. And the differences in both health and life expectancy between states were substantial.

In order to determine whether the burden of diseases, injuries, and risk factors in the United States changed during the study period, Christopher J. L. Murray, MD, DPhil, University of Washington, Seattle, and colleagues analyzed data from the Global Burden of Disease 2016 study. The study evaluated 333 diseases and 84 risk factors, measuring factors such as healthy life expectancy (HALE), years of life lost (YLL), and disability-adjusted life-years (DALYs).

They reported their findings today in the Journal of the American Medical Association (JAMA).

The collaborators found that overall death rates in the United States dropped from 745.2 (95% uncertainty level (UI); 740.6 - 749.8) per 100,000 persons in 1990, to 578 (95% UI; 569.4 - 587.1) per 100,000 persons in 2016.

In addition, the overall drop in mortality was accompanied by a change in the leading drivers of death.

While ischemic heart disease and lung cancer were the leading causes of YLL in both 1990 and 2016, other causes such as Alzheimer's disease and other dementias, diabetes, self-harm, and opioid use disorder have increasingly added to YLL and mortality rates.

The collaborators found that six risk factors ­­— tobacco use, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure  ­­—  were prominent health issues across all states in 2016, with each individually accounting for more than 5% of risk-attributable DALYs in 2016.

"Top risk factors in terms of attributable DALYs were due to one of the three following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states)," the authors emphasize.

In particular, opioid use disorders rose from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, they note.

In 2016, life expectancy varied across the states, ranking highest in Hawaii (81.3 years), and lowest in Mississippi (74.7 years). And, Minnesota had the highest HALE at birth, at 70.3 years, while West Virginia had the lowest, at 63.8 years.

From 1990 to 2016, the probability of death among adults aged 20 to 55 years decreased in 31 states and Washington, DC, but increased by more than 10% in five states (Kentucky, Oklahoma, New Mexico, West Virginia, and Wyoming). In descending order, the highest probability of death for adults in this age group was reported in West Virginia, Mississippi, and Alabama, while the lowest was reported in New York, California, and Minnesota.

In addition, the greatest reductions in probability of death among adults aged 20 to 55 years during the study period occurred in New York and California, while the greatest increases occurred in West Virginia and Oklahoma.

"Decreases in the probability of death in US states were influenced by declines in HIV/AIDS across all state groups, as well as declines in road injuries and neoplasms, while increases in probability of death were influenced by increased burden of drug use disorders, alcohol use disorders, and chronic kidney disease, among others," write Murray and colleagues.

"Differences in health outcomes and drivers of morbidity and mortality at the state level indicate the need for greater investment in preventive and medical care across the life course," they write.

The results of this study markedly increase understanding of US health trends, both over time and across the states, note Howard K. Koh, MD, MPH, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Anand K. Parekh, MD, MPH, Bipartisan Policy Center, Washington, DC, in an accompanying editorial.

As such, these findings should motivate clinicians and policy makers in many ways, they say.

Clinicians can guide patients through evidence-based disease prevention and early intervention. "Such efforts have helped decrease death rates from cancer and cardiovascular disease (including stroke) over the past 26 years," they explain.

Similarly, policy makers should reconsider the "current dismal national stance toward disease prevention," Koh and Parekh add, especially because previous studies have shown that many preventable and modifiable conditions drive high healthcare spending.

"Clinicians and policy makers can use these analyses and rankings to reexamine why so many individuals still experience preventable injury, disease, and death," they conclude. "Doing so could move the entire nation closer toward a United States of health."

This study was supported by the Intramural Program of the National Institutes of Health, the National Institute of Environmental Health Sciences, and the Bill and Melinda Gates Foundation. Several authors have reported receiving grants, personal fees, royalties and/or travel support from one or more of the following entities: Savient, Takeda, Crealta/Horizon, Mundipharma, Indivior, Seqirus, the Bill and Melinda Gates Foundation, Regeneron, Merz, Iroko, Bioiberica, Allergan, UBM LLC, DINORA, WebMD, Acasti Pharma, GOED, DSM, Haas Avocado Board, Nutrition Impact, Pollock Communications, Boston Heart Diagnostics, Bunge, and UpToDate. One or more coauthor reported serving on a scientific advisory board from Omada Health and Elysium Health.

JAMA. Published online April 9, 2018. Full text, Editorial

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