The United States made gains in overall population health during the past generation but failed to keep pace with other developed nations, as more Americans live with disease and chronic disability.

Researchers compared the disease burden for America with 34 other countries in the Organisation for Economic Co-operation and Development, which include a global sampling from Afghanistan to Zimbabwe, reporting Wednesday in JAMA.

"The [U.S.] spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures," the researchers reported, releasing their findings in conjunction with a "Let's Move" event at the White House. "High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups."

Dr. Christopher J.L. Murray, of the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, led the study, which looked at population health from 1990 to 2010. "With increasing focus on population health outcomes that can be achieved through better public health, multisectorial action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time."

In the analysis, Murray and his colleagues looked at 67 risk factors for health problems as well as 291 diseases and injuries along with their secondary pathologies and conditions, data collected as part of the Global Burden of Disease 2010 study analyzing 187 countries of the world.

Among good news, U.S. life expectancy rose for both men and women from a combined 75.2 years in 1990 to 78.2 years in 2010, while expectancy for healthy years of living rose from 65.8 years to 68.1 years — a decade-long denouement of decline for most.

The number of years of life lost to premature death was calculated by multiplying the number of deaths at each age against life expectancy at that age. Similarly, researchers determined the number of years a person might spend living with disability by multiplying the prevalence of certain diseases and ailments by the disability weight, information gleaned by health surveys of the population. For every age, they figured the number of remaining years a person might expect to live healthy without disability.

By 2010, the biggest contributors to premature death were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and injuries sustained on roadways — whether driving a riding a motorcycle or getting hit by a car. For older people, premature death rates increased rom Alzheimer disease, chronic kidney disease, kidney cancer, injuries from falls, and drug use disorders.

Americans Living Longer But With Chronic Disability

Among diseases with the longest-living suffers were major depressive disorder, musculoskeletal disorders causing lower back pain and neck pain, and anxiety disorders. In mixed news, Americans are living longer but many are living longer with disability.

The leading factors related to living longer with disability include dietary risks, tobacco and alcohol use, hypertension, lack of exercise, and high fasting plasma glucose. Disease and chronic disability now account for nearly half of America's health burden, with mental and behavioral health disorders, musculoskeletal disorders, vision and hearing loss, anemia, and brain disorders contributing to the increase.

While medical science has proven successful in beating heart disease and some cancers, along with associated secondary conditions, these other health ailments have led to a rise in disability. "The progressive and likely irreversible shift in the disease burden profile to these causes also has implications for the type of resources needed in the U.S. health system," the researchers wrote.

Speaking at the National Press Club, Murray recommended that government regularly assess the local burden of disease with regard to health expenditures for insight into how the country may best invest health care money into improving population health, which in many cases would involve public health programs to address air pollution as well as drinking and smoking, diet, and exercise.

Below is video of the White House press conference related to JAMA's health report:


Source: Murray CJL. Major Study Finds That Overall Population Health In U.S. Has Improved, But Has Not Kept Pace With Other Wealthy Nations. JAMA. 2013.