The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States
The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States
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DOI：
10.1001/jama.2018.0158
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发表时间：
2018-04-10
影响因子：
120.7
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Mokdad, Ali H.;Ballestros, Katherine;Murray, Christopher J. L.
引言几项研究已经衡量了美国的健康结果，但没有一项研究提供了一个全面的评估模式的健康状态。目的使用的结果，全球疾病负担研究（6 BD）报告的趋势，疾病，伤害，和风险因素在国家一级从1990年至2016年。设计和设置一个系统的分析发表的研究和现有的数据来源估计疾病负担的年龄，主要结果和测量流行率、发病率、死亡率、预期寿命、健康预期寿命（黑尔）、由于过早死亡而损失的寿命年数（YLLs）、残疾生活年数（YLDs）、333种病因和84种危险因素的残疾调整生命年（DADs），95%不确定区间（Uls）结果1990年至2016年，美国的总体死亡率从每10万人745.2（95% UI，740.6至749.8）下降至每10万人578.0（95% UI，569.4至587.1）。1990年至2016年，31个州和华盛顿特区20至55岁成年人的死亡概率下降。2016年，夏威夷的出生时预期寿命最高（81. 3岁），密西西比最低（74. 7岁），相差6. 6岁。明尼苏达州出生时的黑尔最高（70.3岁），西弗吉尼亚州最低（63.8岁），相差6.5岁。1990年和2016年美国糖尿病的主要原因是缺血性心脏病和肺癌，而1990年的第三大原因是腰痛，2016年的第三大原因是慢性阻塞性肺病。阿片类药物使用障碍从1990年的第11位主要原因变为2016年的第7位主要原因，占74.5%（95% UI，42.8%至93.9%）。2016年，以下6种风险中的每一种都占风险归因的5%以上：烟草消费，高体重指数（BMI），不良饮食，酒精和药物使用，高空腹血糖和高血压。在美国所有州，归因于糖尿病的最高风险因素是由于以下3个原因之一：烟草消费（32个州），高BMI（10个州），或酒精和药物使用（8个州）。特定疾病和风险因素，如药物使用障碍、高BMI、不良饮食、高空腹血糖水平和酒精使用障碍正在增加，需要更多关注。这些数据可用于为研究，临床护理和政策提供国家卫生优先事项。
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 (6 BD) 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 (Uls) 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.