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The statistical terms used in this study include: Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), Disability Adjusted Life Years (DALY), which combines YLL and YLD and, Healthy Life Expectancy (HALE). The article compares these attributes in the thirty-four countries between 1990 and 2010. This monumental study goes beyond all previous reports by including risk factors for disease. In 2010 in the US the big eight YLL were in order: Ischemic heart disease, lung cancer, stroke, COPD, road injury, self-harm, diabetes and cirrhosis. The first eight YLD, however, were: Low back pain, major depression, other musculo-skeletal, neck pain, anxiety disorder, COPD, disorders resulting from drug use, and diabetes.
The figure 4 illustration on page 604 reflects the US’s low YLL ranking compared with the thirty three other countries. The US is 7th from the bottom following the Check Republic and Chile in overall ranking. Our ranking by the raw longevity score, infant mortality and perinatal mortality reported elsewhere[4] are even worse.[5] The US comes in 38th in both longevity and infant mortality. The perinatal mortality rates are even worse.[6]
Figure 4.
Rank of Age-Standardized YLL Rates Relative to the 34 OECD Countries in 2010
Numbers in cells indicate the ranks of each country for each cause, with 1 representing the best-performing country. Countries are sorted on the basis of age-standardized all-cause years of life lost (YLLs) for 2010. Diseases and injuries contributing to YLLs are ordered by the difference between the US rate and the lowest rate in the Organization for Economic Co-operation and Development (OECD) countries for each cause. Colors indicate whether the age-standardized YLL rate for the country is significantly lower (green), indistinguishable (yellow), or higher (red) from the mean age-standardized YLL rate across the OECD countries. HIV indicates human immunodeficiency virus.[7]
[1] JAMA,2013;310(6):591-608. Doi:10.1001/jama.2013.13805
Lim, S. S. et al Lancet 380, 2224-2260 (2012)
[2] National Research Council; Institute of Medicine. US Health in International Perspective: Shorter Lives Poorer Health. National Academies Press; 2013
[3] Katz B. Bradley J. the Metropolitan Revolution. Brookings Institution; 2013
[4] http://www.enagic.com/enagic_life.php
[5] http://data.worldbank.org/indicator/SP.DYN.IMRT.IN
[6] http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf
[7] Figure 4 reproduced with permission JAMA RightsLink and Copyright Clearance Center Aug 14 JAMA, Christopher Murray et al; Copyright © 2013, American Medical Association
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JAMA published a seminal investigation documenting the
Health of America compared to other developed countries broken down by disease,
risk factors, morbidity and mortality. The massive undertaking involved
hundreds of collaborators in thirty-four countries and some highly
sophisticated statistics comparing the burden of disease. The report here
includes the developed countries participating in the Organization for Economic
Co-operation and Development. The State
of US Health, 1990-2010, Burden of Disease, Injuries and Risk Factors appears
in the August 14 issue of JAMA.[1]
If you have any interest in the shortcomings of our health care system or the
health of our own human resource, you should read this landmark study.
Harvey Fienberg’s editorial on page 585 observes the decline
in the US standing among developed nations.
Herein, “results for the United States are presented in detail for the
first time.” The statistics utilized in
the study were extremely complex and all inclusive. However, Fienberg points
out the fact that socioeconomic s was not included as a risk factor in this
study. The collaborators agree. The
difficulty was in equating socioeconomics across the many cultures in the
thirty-four nations that took part in this study. The editorial further reminds
us of the well-established fact that socioeconomic status relates strongly with
mortality[2]
Fienberg further observes that the assessment for the US as a whole does not
account for significant regional differences. On the plus side, the editorial suggests
that the framework for assessing the burden of disease is scalable and
applicable to states, counties and municipalities.[3]The statistical terms used in this study include: Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), Disability Adjusted Life Years (DALY), which combines YLL and YLD and, Healthy Life Expectancy (HALE). The article compares these attributes in the thirty-four countries between 1990 and 2010. This monumental study goes beyond all previous reports by including risk factors for disease. In 2010 in the US the big eight YLL were in order: Ischemic heart disease, lung cancer, stroke, COPD, road injury, self-harm, diabetes and cirrhosis. The first eight YLD, however, were: Low back pain, major depression, other musculo-skeletal, neck pain, anxiety disorder, COPD, disorders resulting from drug use, and diabetes.
The diseases causing premature mortality, YLL, differed dramatically
from those causing morbidity and disability, YLD. However, the risk factors
underlying the leading causes for both YLL and YLD diseases were almost the
same. The list of risk factors included: Dietary, tobacco, HBP, high BMI,
physical inactivity, high serum glucose, ambient particulate pollution,
alcohol, drug use and high cholesterol.
The figure 4 illustration on page 604 reflects the US’s low YLL ranking compared with the thirty three other countries. The US is 7th from the bottom following the Check Republic and Chile in overall ranking. Our ranking by the raw longevity score, infant mortality and perinatal mortality reported elsewhere[4] are even worse.[5] The US comes in 38th in both longevity and infant mortality. The perinatal mortality rates are even worse.[6]
Figure 4.
Rank of Age-Standardized YLL Rates Relative to the 34 OECD Countries in 2010
Numbers in cells indicate the ranks of each country for each cause, with 1 representing the best-performing country. Countries are sorted on the basis of age-standardized all-cause years of life lost (YLLs) for 2010. Diseases and injuries contributing to YLLs are ordered by the difference between the US rate and the lowest rate in the Organization for Economic Co-operation and Development (OECD) countries for each cause. Colors indicate whether the age-standardized YLL rate for the country is significantly lower (green), indistinguishable (yellow), or higher (red) from the mean age-standardized YLL rate across the OECD countries. HIV indicates human immunodeficiency virus.[7]
[1] JAMA,2013;310(6):591-608. Doi:10.1001/jama.2013.13805
Lim, S. S. et al Lancet 380, 2224-2260 (2012)
[2] National Research Council; Institute of Medicine. US Health in International Perspective: Shorter Lives Poorer Health. National Academies Press; 2013
[3] Katz B. Bradley J. the Metropolitan Revolution. Brookings Institution; 2013
[4] http://www.enagic.com/enagic_life.php
[5] http://data.worldbank.org/indicator/SP.DYN.IMRT.IN
[6] http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf
[7] Figure 4 reproduced with permission JAMA RightsLink and Copyright Clearance Center Aug 14 JAMA, Christopher Murray et al; Copyright © 2013, American Medical Association
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