Wide Health Disparities Seen Between States in Preventable Disease, Study Finds

Which state you reside in in the United States is a factor in your risk of suffering from disease, disability, and cause of death, according to the latest annual study that looks at 195 locations around the world. And while health has improved across much of the nation, some states saw stark rises in “diseases of despair,” with large increases in drug and alcohol use disorders, obesity, high body mass index (BMI), poor diet, and diabetes.

The overall death rate fell to 578 per 100,000 people from 745 per 100,000 in 1990, according to a study published today in JAMA.

The authors said more action is needed to address health disparities, risk factors, and social determinants of health, and that the nation needs to focus more on disease prevention, including an effort to include such measures in payment systems.

The study was released as CMS turned over more control of health insurance handled through the exchanges created through Affordable Care Act­ (ACA) back to the states. The ACA has been credited with lowering the uninsurance rate in the United States to historic lows and providing insurance to people who did not have it before.

The Global Burden of Disease (GBD) 2016 study results were used to estimate change in disease, injuries, and risk factors from 1990 to 2016 by state. The study examined 333 causes and 84 risk factors. The study measured such things as healthy life expectancy (HALE) and years of life lost (YLL), as well as disability-adjusted life years (DALY).

“The bad news is that when you compare the United States to the rest of the world we are falling behind,” said Ali Mokdad, PhD, professor of global health at the University of Washington and one of the authors of the study.

“When you put it in perspective, these are conditions that are preventable,” he said, speaking of conditions like diabetes and obesity, in an interview with The American Journal of Managed Care^®.

In 5 states (Kentucky, Oklahoma, West Virginia, New Mexico, and Wyoming) the probability of death between ages 20 and 55 years has increased more than 10% between 1990 and 2016. Another 16 states also saw increases in the probability of death.

But the probability of death fell in 31 states for adults between the ages of 20 and 55.

Opioid use disorders were the 7th leading cause of DALY in 2016, up from 11 in 1990, a 74.5% rise. Diabetes moved up 5 spots to number 3 in YLY from 1990 to 2016.

Minnesota had the highest HALE at birth, while West Virginia had the lowest (70.3 versus 63.8). Hawaii had the highest life expectancy (81.3) and Mississippi had the lowest (74.7).

The 5 leading causes of death were:

• Ischemic heart disease
• Cancers of the trachea, bronchus, and lung
• Chronic obstructive pulmonary disease
• Alzheimer disease and other dementias
• Cancer of the colon and rectum

Mokdad pointed out that the population of adults in the study comprises the country’s workforce. “This is the workforce in the United States,” he said. “This is scary. If this study doesn’t wake everybody up, the future is not bright.”

As another example, Mokdad pointed to a woman’s risk of dying in childbirth or shortly thereafter in the United States, which is higher than in not only Western countries but also Vietnam, Thailand, Turkey, Lebanon, and other places around the globe.

Referring to changes in the ACA and Medicaid work requirements, which some advocates fear will cause patients to lose health insurance coverage, he said he would predict even worse outcomes if access to healthcare is lost.

For the states that rose in the rankings—California, for example, moved from 24 in life expectancy in 1990 to 2, and from 19 to 3 in HALY, they did certain things right, Mokdad said, such as focusing on preventable risk factors of disease. California undertook aggressive tobacco control and anti-smoking measures, he added.

According to Mokdad, addressing risk factors levels the playing field.

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
• High blood pressure

Across all 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)
• Alcohol and drug use (8 states)

Reference

Mokdad A, Ballestros K, Echklo M, et al. The US burden of disease collaborators. The State of US health, 1990-2016. Burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158