- Research
- Open Access
- Open Peer Review
The burden of disease and injury in the United States 1996
https://doi.org/10.1186/1478-7954-4-11
© Michaud et al; licensee BioMed Central Ltd. 2006
- Received: 14 November 2005
- Accepted: 18 October 2006
- Published: 18 October 2006
Abstract
Background
Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context.
Methods
We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world.
Results
In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.
Conclusion
Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.
Keywords
- Ischaemic Heart Disease
- Motor Vehicle Accident
- Hypertensive Heart Disease
- Disability Weight
- Mortality Burden
Background
This paper presents the results of a study conducted cooperatively by scientists from the Centers for Disease Control and Prevention (CDC) and the Harvard School of Public Health. The study essentially applied the methods used in the Global Burden of Disease analysis to data specific to the United States in order to calculate Disability-Adjusted Life Year (DALY) values for major health conditions and risk factors [1].
The genesis of the US Burden of Disease and Injury study (USBODI) was the release of the 1993 World Development Report: Investing in Health published by the World Bank. This landmark report in international health policy introduced a new summary measure of population health – the Disability-Adjusted Life Year (DALY) [2]. In contrast to the traditional reliance on death counts and rates to assess the burden of health events, the DALY attempted to combine the impact of non-fatal health outcomes with mortality. Though originally developed for comparative analyses of disease burden in different regions of the world, this perspective seemed particularly appropriate to inform policy in a country such as the United States. In industrialized country settings, where death rates are low relative to developing countries, the majority of deaths occur after the age of 75 years. Yet too many deaths still occur at younger ages and many could be prevented. Therefore, information for health policy deliberations needs to emphasize the burden of premature mortality as well as disability. As stated in a recent Institute of Medicine report on summary health measures, "Mortality measures, although important, provide decision makers incomplete and insensitive information about overall population health." [3].
From the outset, this study had three major goals. The first goal was to incorporate non-fatal conditions into assessments of health status in the United States. So far most discussions about the relative importance of various health conditions centered on the number of deaths attributed to specific diseases, injuries or risk factors [4]. The focus on deaths has important implications for policy and great influence on resource allocation. As the average life expectancy continues to rise in economically developed countries, more and more deaths are attributed to chronic conditions that are recalcitrant to treatment and may have limited preventability [5]. Prioritization of research and health care expenditures based on such data tends to result in a focus on rescue-oriented, life-saving, and technologically advanced approaches rather than adequate consideration of interventions that promote healthy life-styles and improve overall physical and emotional function [6]. The DALY offers a rational methodology for weighing the relative importance of fatal and non-fatal health events. Hence, a much broader range of health conditions that are rarely identified as causes of death, such as mental health disorders and musculoskeletal diseases, can be introduced into data-based deliberations on health policy.
The second major goal was to develop a comprehensive set of internally consistent and scientifically credible epidemiological estimates for the major health conditions in the United States. This is greatly facilitated by a plethora of population-based surveys, registries and administrative data systems that attempt to capture information on a wide range of health events [7]. The major challenge is to impose a consistent and conceptually rigorous analytic approach so that the estimates are internally consistent. Reviews of cost-effectiveness ratios that depend on epidemiologic data and statistical modeling have demonstrated that it is very difficult to compare results from one study to the next because of major variations in methods, underlying assumptions, data sources and conceptual frameworks [8]. A major source of these inconsistencies is that most such models are developed on a case by case, disease by disease basis, with little attention to conceptual consistency and integration of data from multiple sources [9]. Estimates developed with an adherence to conceptual consistency for the United States can serve not only as a useful source of epidemiologic information, but can also stimulate further analyses and refinements by other investigators.
The third and final goal of the US Burden of Disease and Injury study was to provide a set of internationally comparable health statistics that place the United States public health situation in a global context. World population growth and technological developments over the last few decades in telecommunications, industrial pollution and transportation have effectively made the earth a much smaller planet [10]. This dynamic has major implications for the importation and exportation of health related vectors that include infectious diseases, manufactured products (e.g. energy rich foods, tobacco), and health system organization and practices [11–13]. Given the emergence of this global public health "village," and the growing importance of the DALY as a metric for assessing population health, it seems critical to provide an analysis of the public health situation in the United States that uses methods being adopted by international organizations and health ministries throughout the world.
The Global Burden of Disease (GBD) study developed health statistics for 8 large regions of the world. It includes the United States, which possesses substantial intra- national racial, ethnic and cultural variability. Generating a set of estimates specific to the United States not only provides an opportunity to frame the major health problems in this country in a global context, but also facilitates explication of intra- national disparities. For example, a previously published monograph that resulted from this project identified differences between race, sex and county-specific life expectancies that rivaled differences seen between the nations with the highest (Japan) and lowest (Sierra Leone) life expectancy values in the world [14].
The overall purpose of this study is to expand the understanding of the major determinants of ill and good health in the United States. The ultimate goal of such understanding should be policies and programs that decrease the overall impact and disparities in disease, disability and premature death.
Methods
The study was patterned after the GBD and applied methods used in the GBD analysis to compute years of life lost due to premature mortality (YLL), years of life lost due to disability (YLD), and disability-adjusted life years (DALYs). The conceptual and computational details of how these parameters were estimated for individual conditions have been presented in the GBD. A summary overview of GBD methods is provided [see Additional file 1].
The detailed mortality data file for 1996 provided deaths by age, sex and race to compute YLL [15]. The National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), National Longitudinal Alcohol Epidemiologic Survey (NLAES), the National Hospital Discharge Database, disease registers, and epidemiological studies provided the epidemiological parameters needed to compute YLD for 72 conditions that account for at least 90 per cent of the DALY total in the United States. If data on race and gender specific subgroups were too sparse to derive reasonable epidemiological parameters for particular conditions, YLD were estimated for these subgroups using YLD to YLL ratios for the overall population. For the remaining 26 conditions, YLD were calculated using YLD to YLL ratios from Established Market Economies (EME) countries in the GBD, applied to US specific estimates of YLL. A detailed presentation of analytic methods, data sources, and data sets used to develop estimates for major causes of diseases and injuries is provided [see Additional file 2].
Below we describe adjustments that were made to GBD methods in the context of the United States. These were 1) the inclusion of race; 2) a revised list of causes; and 3) a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease (IHD).
Selection of population groups
Estimates of the burden of disease and injury were done by gender and seven age groups (0–4; 5–14; 15–24; 25–44; 45–64; 65–74 and 75+) for the total US population, as well as for each of the four official race groups specified by the Office of Management and Budget (OMB): White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Whites were the largest population group (82.8 per cent, or 219.7 million). Blacks represented 12.6 per cent of the population (33.5 million); American Indians – 0.9 per cent (2.3 million), and Asians – 3.7 per cent (9.7 million). Estimates by ethnicity were not included in this report because reliable estimates were only available for a subset of the Hispanic population.
The inclusion of race in the analysis posed particular challenges for minority populations because of race misclassification. Two independent data sets were combined to calculate death rates: the number of deaths in the numerator comes from the detailed mortality file, and population numbers in the denominator are from the census. There was no discrepancy in reporting of race in both data sets for Whites and Blacks, but race misclassification was found to be problematic for Asians and American Indians. Self-reporting of race in the census tended to be higher, particularly for American Indians, than was the attribution of race (by a third party) on death certificates – which will yield an underestimate of death rates [16]. However, we did not correct for race misclassification in American Indians and Asians because evaluations showed that discrepancies in race reporting varied from year to year and thus provided supportive evidence that there may be no systematic bias. Therefore race differentials expressed as rates may have been slightly overestimated. Death and DALY rates were age-standardized to the general population.
There were also important gaps in the available epidemiological data for Asians and American Indians. In order to fill information gaps, we assumed that ratios of YLL to YLD by cause, gender and age were similar to that of the total population. Such assumptions introduce a certain level of uncertainty in the estimates, and call for caution in the interpretation of rankings for causes that have small differences in the number of DALYs. For simplicity, American Indians or Alaskan Natives are referred to as "American Indians," and Asians or Pacific Islanders as "Asians" in the text, tables and figures below.
USBODI cause list
Even though essentially all deaths in the United States are registered and medically certified, a detailed assessment of mortality data was conducted as part of the USBODI. This was done to further explore and refine the utility of the adjustment procedures for misclassification that were used in the GBD, and to provide a contrast to the overall results using the DALY.
Global burden of disease classification system – main categories
Communicable, maternal, perinatal and nutritional conditions (Group I) |
A. Infectious and parasitic diseases |
B. Respiratory infections |
C. Maternal conditions |
D. Conditions arising during the perinatal period |
E. Nutritional deficiencies |
Noncommunicable diseases (Group II) |
A. Malignant neoplasms |
B. Other neoplasms |
C. Diabetes mellitus |
D. Endocrine disorders |
E. Neuro-psychiatric conditions |
F. Sense organ diseases |
G. Cardiovascular diseases |
H. Respiratory diseases |
I. Digestive diseases |
J. Genito-urinary diseases |
K. Skin diseases |
L. Musculo-skeletal diseases |
M. Congenital anomalies |
N. Oral conditions |
Injuries (Group III) |
A. Unintentional injuries |
B. Intentional injuries |
Redistribution algorithm for cardiovascular garbage codes
The most problematic aspect of cause of death coding pertains to coding of ischaemic heart disease (IHD) (ICD-9 codes 410–414), which is one of the leading causes of premature mortality. The wide cross-national variations that exist in IHD reported mortality rates were explored in the context of the GBD and were convincingly attributed to variations across countries in coding practices. Physicians may use several ICD-9 codes that are actually due to IHD when they assign the cause of death. These include heart failure (428), ventricular dysrhythmias (427.1, 427.4, 427.5), general atherosclerosis (440.9), and ill-defined descriptions and complications of heart disease (429.0, 429.1, 429.2 and 429.9). IHD deaths may be assigned to these ill-defined cardiovascular codes, or "garbage codes" because of insufficient clinical information at the time of death, local medical diagnostic practices or simply by error. The statistical approach developed to correct for likely undercoding resulting from different coding practices in the GBD included a two-step procedure comprising an ordinary least squares (OLS) regression equation predicting the proportion of cardiovascular death for each age group assigned to ill-defined codes as a function of the proportion of deaths assigned to IHD, and the correction of proportions for each country within set constraints, based on the assumption that the cluster of countries where ill-defined coding was low defined the standard coding practices.
Proportion of all cardiovascular deaths (except stroke) coded to cardiovascular "garbage codes" by state – United States 1996
State name | % CV garbage | State name | % CV garbage | State name | % CV garbage |
---|---|---|---|---|---|
Alabama | 37 | Kentucky | 25 | North Dakota | 19 |
Alaska | 22 | Louisiana | 23 | Ohio | 25 |
Arizona | 22 | Maine | 24 | Oklahoma | 18 |
Arkansas | 21 | Maryland | 24 | Oregon | 23 |
California | 18 | Massachusetts | 22 | Pennsylvania | 15 |
Colorado | 26 | Michigan | 19 | Rhode Island | 20 |
Connecticut | 29 | Minnesota | 35 | South Carolina | 21 |
Delaware | 29 | Mississippi | 17 | South Dakota | 19 |
DC | 28 | Missouri | 29 | Tennessee | 21 |
Florida | 16 | Montana | 31 | Texas | 24 |
Georgia | 30 | Nebraska | 34 | Utah | 24 |
Hawaii | 28 | Nevada | 20 | Vermont | 26 |
Idaho | 17 | New Hampshire | 17 | Virginia | 24 |
Illinois | 19 | New Jersey | 37 | Washington | 26 |
Indiana | 18 | New Mexico | 14 | West Virginia | 17 |
Iowa | 20 | New York | 19 | Wisconsin | 21 |
Kansas | 24 | North Carolina | 21 | Wyoming | 19 |
Proportion of cardiovascular disease deaths (excluding stroke) assigned to selected codes for ill-defined causes and directly assigned to ischemic heart disease in the United States.
This preliminary analysis confirmed the need to correct for under-registration of IHD in the US. To estimate the fraction of IHD deaths assigned to ill-defined cardiovasular codes, the regression equation applied in the GBD was revised. Age and sex specific lung cancer death rates were added to the model. Lung cancer mortality rates measure the cumulative effects of tobacco exposure as a risk factor for IHD [18].
The regression model for the US included age and sex specific lung cancer death rates, and ill-defined cardiovascular disease (CVD) rates for Blacks and Whites. These regression equations predicted the proportion of ill-defined CVD deaths by age and sex for Whites and Blacks. We applied results of regression equations for Whites to American Indians and Asians, which were not included in the regressions due their small population size.
R-squared values applied to the redistribution of cardiovascular garbage codes
WHITES | |||||
---|---|---|---|---|---|
Male | Lung Cancer | CVGarbageCodes | R-squared | ||
Coefficient | Pvalue | Coefficient | Pvalue | ||
15 | -0.499 | 0.273 | 0.557 | .000 | 26.17% |
30 | 2.396 | .000 | -0.193 | 0.424 | 52.10% |
45 | 1.495 | .000 | -0.741 | .000 | 77.77% |
65 | 1.235 | .000 | -0.833 | .000 | 69.02% |
75 | 2.73 | .000 | -1.122 | .000 | 47.64% |
Female | |||||
15 | 0.348 | 0.0324 | 0.097 | 0.395 | 3.53% |
30 | 0.727 | .000 | 0.539 | 0.008 | 37.82% |
45 | 0.869 | .000 | -0.315 | 0.283 | 31.41% |
65 | -0.459 | 0.206 | 0.752 | 0.018 | 11.47% |
75 | 2.011 | 0.123 | -0.679 | 0.021 | 12.25% |
BLACKS | |||||
Male | Lung Cancer | CV GarbageCodes | R-squared | ||
Coefficient | Pvalue | Coefficient | Pvalue | ||
15 | 0.592 | 0.314 | -0.0393 | 0.792 | 4.13% |
30 | 1.575 | 0.013 | 0.0735 | 0.785 | 23.40% |
45 | 1.211 | .000 | -0.403 | 0.025 | 47.27% |
65 | 0.435 | 0.082 | -0.551 | .000 | 40.73% |
75 | 0.183 | 0.769 | -0.7207 | 0.005 | 26.34% |
Female | |||||
15 | -0.829 | 0.042 | 0.256 | 0.047 | 16.06% |
30 | -0.846 | 0.0127 | 0.532 | 0.03 | 12.85% |
45 | 0.02 | 0.942 | -0.11 | 0.634 | 8.30% |
65 | 0.695 | 0.42 | -1.369 | 0.059 | 13.60% |
75 | 1.015 | 0.524 | -0.772 | 0.013 | 16.67% |
International comparisons
Ten countries with comparable levels of development and a population greater than 10 million: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom, were selected for international comparisons. YLL by cause were obtained directly from the World Health Organization (WHO). YLD and DALY estimates were only available at the regional level, with the exception of Australia, where a national burden of disease study applying the GBD methodology had been conducted [21].
International comparisons may address two sets of issues – the difference in the magnitude of YLL (expressed as YLL rates), or differences in the distribution of major causes of YLL. We examined differences in rankings of major causes of YLL and YLL rates between the United States and other comparable countries.
Rankings for the twenty leading causes of mortality burden in the United States were compared to rankings for these conditions in the ten selected countries. We made one change in the list of conditions adopted for the United States to ensure comparability among countries, which was to combine mortality burden due to lymphomas and multiple myelomas. These two conditions are different forms of reticuloendothelial malignancies. Estimates were not available for these conditions separately in several of the selected countries. This change slightly altered rankings in the United States for several conditions, as the two conditions combined had a higher mortality burden than lymphomas alone. Lymphomas and multiple myelomas ranked 14th for males and 13th for females, and the mortality burden for lymphomas ranked 19th and 17th respectively. We plotted the rankings for each of the twenty leading causes of mortality burden in the United States (horizontal bars) against the range of rankings observed for each of these conditions in the selected countries (vertical bars), for each sex. The lowest and highest rankings observed in the countries other than the US define the bounds of vertical bars for each condition. Rankings, from one to twenty, are inversely related to the magnitude of mortality burden. Thus, IHD, which caused the largest number of YLL in the United States, ranked 1st. We also compared YLL rankings for the twenty leading causes of YLL for each race and sex against the ranges observed in the ten selected countries.
Results
Detailed tabulations of deaths, YLL, YLD and DALYs for the 73 causes included in the USBODI by age, gender and race are provided [see Additional file 4]. Epidemiological parameters (incidence, prevalence, age at onset, duration, remission rates) and disability weights for each condition are provided [see Additional file 5].
Below we report key findings for the burden of disease and injury (DALYs); the mortality burden due to premature deaths (YLL); and the disability burden due to non-fatal health outcomes (YLD).
Burden of disease and injury
Leading causes of DALYs
Burden of Disease (DALYs) by sex and major disease groups, US, 1996.
Twenty leading causes of DALYs and deaths, US 1996
DALY | % of total | Deaths | % of total | ||
---|---|---|---|---|---|
Total DALYs | 33,090,212 | Total Deaths | 2,314,689 | ||
Ischemic heart disease | 3,134,732 | 9.5 | Ischemic heart disease | 536,314 | 23.17 |
Cerebrovascular Disease | 1,510,287 | 4.6 | Lung trachea or bronchial cancer | 168,206 | 7.27 |
Motor vehicle accidents | 1,393,278 | 4.2 | Cerebrovascular Disease | 161,678 | 6.98 |
Unipolar major depression | 1,370,285 | 4.1 | COPD | 99,982 | 4.32 |
Lung trachea or bronchial cancer | 1,362,712 | 4.1 | Lower respiratory infections | 84,319 | 3.64 |
COPD | 1,253,491 | 3.8 | Diabetes mellitus | 62,452 | 2.70 |
Alcohol use | 1,141,193 | 3.4 | Cancer colon or rectum | 61,189 | 2.64 |
HIV | 956,418 | 2.9 | Breast cancer | 46,649 | 2.02 |
Diabetes mellitus | 946,291 | 2.9 | Motor vehicle accidents | 43,735 | 1.89 |
Osteoarthritis | 942,682 | 2.8 | Dementia and other degenerative and hereditary CNS disorders | 43,190 | 1.87 |
Dementia and other degenerative and hereditary CNS disorders | 889,242 | 2.7 | Hypertension and hypertensive heart disease | 39,589 | 1.71 |
Congenital Abnomalities | 761,951 | 2.3 | Prostate cancer | 36,667 | 1.58 |
Homicide and Violence | 714,621 | 2.2 | Self-inflicted | 31,725 | 1.37 |
Self-inflicted | 674,443 | 2.0 | HIV | 31,188 | 1.35 |
Asthma | 665,103 | 2.0 | Cancer pancreas | 29,494 | 1.27 |
Drug use | 543,841 | 1.6 | Inflammatory Cardiac | 29,066 | 1.26 |
Breast cancer | 514,786 | 1.6 | Lymphomas | 26,443 | 1.14 |
Conditions arising during the perinatal period | 493,958 | 1.5 | Cirrhosis of the liver | 25,488 | 1.10 |
Cancer colon or rectum | 483,931 | 1.5 | Nephritis or nephrosis | 24,569 | 1.06 |
Cirrhosis of the liver | 411,539 | 1.2 | Homicide and Violence | 22,351 | 0.01 |
Sex and age patterns
Twenty leading causes of DALYs, by sex, US 1996
Males | |||
---|---|---|---|
Cause list | DALY | % total | |
Total DALY | 17,860,393 | ||
1 | Ischaemic heart disease | 1,958,184 | 11.0% |
2 | Motor vehicle accidents | 933,798 | 5.2% |
3 | Lung trachea or bronchial cancer | 812,804 | 4.6% |
4 | HIV | 763,816 | 4.3% |
5 | Alcohol use | 731,890 | 4.1% |
6 | Cerebrovascular Disease | 673,928 | 3.8% |
7 | COPD | 641,701 | 3.6% |
8 | Homicide and Violence | 567,717 | 3.2% |
9 | Self-inflicted | 541,399 | 3.0% |
10 | Unipolar major depression | 469,929 | 2.6% |
11 | Diabetes mellitus | 442,051 | 2.5% |
12 | Osteoarthritis | 434,856 | 2.4% |
13 | Drug use | 411,780 | 2.3% |
14 | Congenital Abnomalities | 410,388 | 2.3% |
15 | Dementia and other degenerative and hereditary CNS disorders | 382,392 | 2.1% |
16 | Asthma | 303,088 | 1.7% |
17 | Cirrhosis of the liver | 280,632 | 1.6% |
18 | Conditions arising during the perinatal period | 273,577 | 1.5% |
19 | Cancer colon or rectum | 249,462 | 1.4% |
20 | Prostate cancer | 238,889 | 1.3% |
sub-total | 11,522,281 | 64.5% | |
Females | |||
Cause list | DALY | % total | |
Total DALY | 15,229,819 | ||
1 | Ischaemic heart disease | 1,176,548 | 7.7% |
2 | Unipolar major depression | 900,356 | 5.9% |
3 | Cerebrovascular Disease | 836,359 | 5.5% |
4 | COPD | 611,790 | 4.0% |
5 | Lung trachea or bronchial cancer | 549,908 | 3.6% |
6 | Breast cancer | 514,786 | 3.4% |
7 | Osteoarthritis | 507,826 | 3.3% |
8 | Dementia and other degenerative and hereditary CNS disorders | 506,849 | 3.3% |
9 | Diabetes mellitus | 504,240 | 3.3% |
10 | Motor vehicle accidents | 459,480 | 3.0% |
11 | Alcohol use | 409,303 | 2.7% |
12 | Asthma | 362,015 | 2.4% |
13 | Congenital Abnomalities | 351,563 | 2.3% |
14 | Cancer colon or rectum | 234,469 | 1.5% |
15 | Conditions arising during the perinatal period | 220,382 | 1.4% |
16 | Lower respiratory infections | 195,448 | 1.3% |
17 | PTSD | 193,533 | 1.3% |
18 | HIV | 192,602 | 1.3% |
19 | Panic disorder | 182,218 | 1.2% |
20 | Bipolar disorder | 165,236 | 1.1% |
Ten leading causes of DALYs by age, US 1996
Rank | All ages | DALYs | % of total | 0–4 | DALYs | % of total |
---|---|---|---|---|---|---|
Total | 33,090,212 | Total | 2,123,767 | |||
1 | Ischaemic heart disease | 3,134,732 | 9.5 | Congenital abnomalities | 679,542 | 32.0 |
2 | Cerebrovascular disease | 1,510,287 | 4.6 | Perinatal conditions | 492,486 | 23.2 |
3 | Motor vehicle accidents | 1,393,278 | 4.2 | Sudden infant death syndrome | 102,255 | 4.8 |
4 | Unipolar major depression | 1,370,285 | 4.1 | Asthma | 77,323 | 3.6 |
5 | Lung, trachea or bronchial cancer | 1,362,712 | 4.1 | Diarrhoeal diseases | 60,438 | 2.8 |
6 | COPD | 1,253,491 | 3.8 | Motor vehicle accidents | 48,630 | 2.3 |
7 | Alcohol use | 1,141,193 | 3.4 | Falls | 41,289 | 1.9 |
8 | HIV | 956,418 | 2.9 | Homicide and violence | 35,055 | 1.7 |
9 | Diabetes mellitus | 946,291 | 2.9 | Lower respiratory infections | 30,640 | 1.4 |
10 | Osteoarthritis | 942,682 | 2.8 | Fires | 22,090 | 1.0 |
Rank | 5–14 | DALYs | % of total | 15–24 | DALYs | % of total |
Total | 1,136,989 | Total | 3,884,235 | |||
1 | Asthma | 236,494 | 20.8 | Motor vehicle accidents | 499,505 | 12.9 |
2 | Motor vehicle accidents | 128,357 | 11.3 | Alcohol use | 433,515 | 11.2 |
3 | Unipolar major depression | 61,622 | 5.4 | Drug use | 291,844 | 7.5 |
4 | Epilepsy | 42,461 | 3.7 | Homicide and violence | 282,746 | 7.3 |
5 | Schizophrenia | 41,254 | 3.6 | Schizophrenia | 237,967 | 6.1 |
6 | Falls | 39,886 | 3.5 | Bipolar disorder | 221,134 | 5.7 |
7 | Homicide and violence | 28,242 | 2.5 | Unipolar major depression | 197,309 | 5.1 |
8 | Fires | 19,514 | 1.7 | Panic disorder | 158,379 | 4.1 |
9 | Congenital abnomalities | 17,860 | 1.6 | Asthma | 157,997 | 4.1 |
10 | Drowning | 16,472 | 1.4 | Self-inflicted | 157,281 | 4.0 |
Rank | 25–44 | DALYs | % of total | 45–64 | DALYs | % of total |
Total | 8,364,608 | Total | 8,478,954 | |||
1 | Unipolar major depression | 823,548 | 9.8 | Ischaemic heart disease | 1,154,002 | 13.6 |
2 | HIV | 751,598 | 9.0 | Lung, trachea or bronchial cancer | 630,224 | 7.4 |
3 | Alcohol use | 549,949 | 6.6 | COPD | 504,418 | 5.9 |
4 | Motor vehicle accidents | 523,203 | 6.3 | Cerebrovascular Disease | 492,918 | 5.8 |
5 | Self-inflicted | 352,241 | 4.2 | Diabetes mellitus | 395,612 | 4.7 |
6 | Homicide and violence | 308,550 | 3.7 | Osteoarthritis | 361,774 | 4.3 |
7 | Ischaemic heart disease | 274,704 | 3.3 | Breast cancer | 250,963 | 3.0 |
8 | Diabetes mellitus | 238,472 | 2.9 | Unipolar major depression | 237,590 | 2.8 |
9 | COPD | 234,552 | 2.8 | Cirrhosis of the liver | 208,861 | 2.5 |
10 | Drug use | 222,535 | 2.7 | Cancer colon or rectum | 190,453 | 2.2 |
Rank | 65–74 | DALYs | % of total | 75+ | DALYs | % of total |
Total | 4,710,335 | Total | 4,391,323 | |||
1 | Ischaemic heart disease | 820,583 | 17.4 | Ischaemic heart disease | 876,239 | 20.0 |
2 | Lung, trachea or bronchial cancer | 448,452 | 9.5 | Dementias | 469,035 | 10.7 |
3 | Cerebrovascular disease | 373,629 | 7.9 | Cerebrovascular disease | 420,278 | 48.0 |
4 | COPD | 282,397 | 6.0 | Lung, trachea or bronchial cancer | 200,620 | 4.6 |
5 | Osteoarthritis | 266,685 | 5.7 | COPD | 186,379 | 4.2 |
6 | Dementias | 224,484 | 4.8 | Osteoarthritis | 161,077 | 3.7 |
7 | Diabetes mellitus | 168,605 | 3.6 | Lower respiratory infections | 146,631 | 3.3 |
8 | Cancer colon or rectum | 138,630 | 2.9 | Cancer colon or rectum | 106,111 | 2.4 |
9 | Prostate cancer | 97,033 | 2.1 | Diabetes mellitus | 106,061 | 2.4 |
10 | Breast cancer | 94,919 | 2.0 | Prostate cancer | 81,456 | 1.9 |
Distribution of burden of disease (DALYs) by age group and sex, US, 1996
Total | Males | Females | ||||
---|---|---|---|---|---|---|
Age Group | DALYs | % of total | DALYs | % of total | DALYs | % of total |
0–4 years | 2,123,767 | 6.4% | 1,164,600 | 6.5% | 959,167 | 6.3% |
5–14 years | 1,136,989 | 3.4% | 623,416 | 3.5% | 513,573 | 3.4% |
15–24 years | 3,884,235 | 11.7% | 2,279,895 | 12.8% | 1,604,340 | 10.5% |
25–44 years | 8,364,608 | 25.3% | 4,800,710 | 26.9% | 3,563,898 | 23.4% |
45–64 years | 8,478,954 | 25.6% | 4,754,166 | 26.6% | 3,724,788 | 24.5% |
65–74 years | 4,710,335 | 14.2% | 2,455,407 | 13.7% | 2,254,928 | 14.8% |
75 years and over | 4,391,323 | 13.3% | 1,782,198 | 10.0% | 2,609,125 | 17.1% |
Total | 33,090,212 | 17,860,393 | 15,229,819 |
Patterns by race
Groups I, II, and III as a percentage of total burden of disease (DALY) by race, US, 1996.
Ten leading causes of DALYs by race, US 1996
Whites | DALYs | % total | American Indians | DALYs | % total | ||
---|---|---|---|---|---|---|---|
Rank | Total | 26,510,011 | Rank | Total | 294,474 | ||
1 | Ischaemic heart disease | 2,710,918 | 10.2% | 1 | Alcohol use | 46,419 | 15.8% |
2 | Cerebrovascular Disease | 1,201,246 | 4.5% | 2 | Motor vehicle accidents | 23,112 | 7.8% |
3 | Lung trachea or bronchial cancer | 1,170,492 | 4.4% | 3 | Ischaemic heart disease | 14,598 | 5.0% |
4 | Motor vehicle accidents | 1,148,293 | 4.3% | 4 | Unipolar major depression | 11,815 | 4.0% |
5 | Unipolar major depression | 1,127,045 | 4.3% | 5 | Cirrhosis of the liver | 9,293 | 3.2% |
6 | COPD | 1,111,489 | 4.2% | 6 | Diabetes mellitus | 9,070 | 3.1% |
7 | Alcohol use | 857,509 | 3.2% | 7 | Self-inflicted | 8,336 | 2.8% |
8 | Osteoarthritis | 820,284 | 3.1% | 8 | Cerebrovascular Disease | 8,241 | 2.8% |
9 | Dementia and other degenerative and hereditary CNS disorders | 791,780 | 3.0% | 9 | Homicide and Violence | 7,754 | 2.6% |
10 | Diabetes mellitus | 727,575 | 2.7% | 10 | Congenital Abnormalities | 7,489 | 2.5% |
Sub-total | 11,666,630 | 44.0% | sub-total | 146,128 | 49.6% | ||
Blacks | DALYs | % total | Asians | DALYs | % total | ||
Rank | Total | 5,552,448 | Rank | Total | 733,279 | ||
1 | HIV/AIDS | 429,383 | 7.7% | 1 | Unipolar major depression | 54,264 | 7.4% |
2 | Ischaemic heart disease | 370,170 | 6.7% | 2 | Ischaemic heart disease | 39,046 | 5.3% |
3 | Homicide and Violence | 336,215 | 6.1% | 3 | Cerebrovascular Disease | 33,883 | 4.6% |
4 | Cerebrovascular Disease | 266,918 | 4.8% | 4 | COPD | 29,040 | 4.0% |
5 | Alcohol use | 230,780 | 4.2% | 5 | Osteoarthritis | 29,027 | 4.0% |
6 | Motor vehicle accidents | 193,159 | 3.5% | 6 | Motor vehicle accidents | 28,714 | 3.9% |
7 | Diabetes mellitus | 189,656 | 3.4% | 7 | Congenital Abnormalities | 28,238 | 3.9% |
8 | Unipolar major depression | 177,162 | 3.2% | 8 | Asthma | 26,137 | 3.6% |
9 | Conditions arising during the perinatal period | 174,558 | 3.1% | 9 | Diabetes mellitus | 19,989 | 2.7% |
10 | Lung trachea or bronchial cancer | 172,425 | 3.1% | 10 | Dementia and other degenerative and hereditary CNS disorders | 17,831 | 2.4% |
sub-total | 2,540,426 | 45.8% | sub-total | 306,170 | 41.8% |
Distribution of YLL and YLD by sex and race, US, 1996.
HIV/AIDS: distribution of DALY rates/100,000 by age, race and sex, US 1996.
IHD and cerebrovascular diseases: distribution of DALY rates/100,000 by age, race and sex, US 1996.
Hypertension and inflammatory cardiac diseases: distribution of DALY rates/100,000 by age, race and sex, US 1996.
Major causes of injuries: distribution of DALY rates/100,000 by age, race and sex, US 1996.
Mortality burden
Leading causes of YLL
Distribution of deaths and YLL by age, US 1996.
Ten leading causes of mortality burden and death, as per cent of total, both sexes, US 1996.
Leading causes of death and YLL, both sexes, all races combined
Deaths | %total | ||
---|---|---|---|
2,314,689 | |||
1 | Ischaemic heart disease | 536,314 | 23.2% |
2 | Lung trachea or bronchial cancer | 168,206 | 7.3% |
3 | Cerebrovascular Disease | 161,678 | 7.0% |
4 | COPD | 99,982 | 4.3% |
5 | Lower respiratory infections | 84,319 | 3.6% |
6 | Diabetes mellitus | 62,452 | 2.7% |
7 | Cancer colon or rectum | 61,189 | 2.6% |
8 | Breast cancer | 46,649 | 2.0% |
9 | Motor vehicle accidents | 43,735 | 1.9% |
10 | Dementia and other degenerative and hereditary CNS disorders | 43,190 | 1.9% |
11 | Hypertension and hypertensive heart disease | 39,589 | 1.7% |
12 | Prostate cancer | 36,667 | 1.6% |
13 | Self-inflicted | 31,725 | 1.4% |
14 | HIV | 31,188 | 1.3% |
15 | Cancer pancreas | 29,494 | 1.3% |
16 | Inflammatory Cardiac | 29,066 | 1.3% |
17 | Lymphomas | 26,443 | 1.1% |
18 | Cirrhosis of the liver | 25,488 | 1.1% |
19 | Nephritis or nephrosis | 24,569 | 1.1% |
20 | Homicide and Violence | 22,351 | 1.0% |
Sub-total | 1,604,297 | 69.3% | |
YLL | % total | ||
Total YLL | 18,066,099 | ||
1 | Ischaemic heart disease | 2,858,744 | 15.8% |
2 | Lung trachea or bronchial cancer | 1,301,182 | 7.2% |
3 | Motor vehicle accidents | 1,027,005 | 5.7% |
4 | Cerebrovascular Disease | 784,443 | 4.3% |
5 | HIV | 718,975 | 4.0% |
6 | Self-inflicted | 660,917 | 3.7% |
7 | Homicide and Violence | 615,332 | 3.4% |
8 | COPD | 526,219 | 2.9% |
9 | Conditions arising during the perinatal period | 464,131 | 2.6% |
10 | Diabetes mellitus | 450,913 | 2.5% |
11 | Breast cancer | 450,327 | 2.5% |
12 | Cancer colon or rectum | 409,534 | 2.3% |
13 | Lower respiratory infections | 388,441 | 2.2% |
14 | Cirrhosis of the liver | 321,588 | 1.8% |
15 | Congenital Abnomalities | 318,948 | 1.8% |
16 | Inflammatory Cardiac | 258,328 | 1.4% |
17 | Hypertension and hypertensive heart disease | 241,073 | 1.3% |
18 | Lymphomas | 233,048 | 1.3% |
19 | Poisoning | 221,906 | 1.2% |
20 | Cancer pancreas | 205,972 | 1.1% |
Sub-total | 12,457,024 | 69.0% |
Sex and age patterns
Leading causes of YLL, by sex, all races combined
Cause list | YLL | % total | |
---|---|---|---|
All males | 10,529,540 | ||
1 | Ischaemic heart disease | 1,806,420 | 17.2% |
2 | Lung trachea or bronchial cancer | 777,726 | 7.4% |
3 | Motor vehicle accidents | 701,111 | 6.7% |
4 | HIV | 575,297 | 5.5% |
5 | Self-inflicted | 533,874 | 5.1% |
6 | Homicide and Violence | 486,129 | 4.6% |
7 | Cerebrovascular Disease | 356,563 | 3.4% |
8 | COPD | 268,774 | 2.6% |
9 | Conditions arising during the perinatal period | 259,581 | 2.5% |
10 | Diabetes mellitus | 220,494 | 2.1% |
11 | Cirrhosis of the liver | 219,876 | 2.1% |
12 | Cancer colon or rectum | 212,958 | 2.0% |
13 | Lower respiratory infections | 202,668 | 1.9% |
14 | Congenital Abnomalities | 172,399 | 1.6% |
15 | Poisoning | 168,131 | 1.6% |
16 | Inflammatory Cardiac | 167,316 | 1.6% |
17 | Prostate cancer | 160,019 | 1.5% |
18 | Lymphomas | 134,145 | 1.3% |
19 | Hypertension and hypertensive heart disease | 127,968 | 1.2% |
20 | Leukemias | 114,710 | 1.1% |
Sub-total | 7,666,158 | 72.8% | |
Cause list | YLL | % total | |
All females | 7,536,559 | ||
1 | Ischaemic heart disease | 1,052,325 | 14.0% |
2 | Lung trachea or bronchial cancer | 523,456 | 6.9% |
3 | Breast cancer | 450,327 | 6.0% |
4 | Cerebrovascular Disease | 427,881 | 5.7% |
5 | Motor vehicle accidents | 325,894 | 4.3% |
6 | COPD | 257,445 | 3.4% |
7 | Diabetes mellitus | 230,419 | 3.1% |
8 | Conditions arising during the perinatal period | 204,550 | 2.7% |
9 | Cancer colon or rectum | 196,575 | 2.6% |
10 | Lower respiratory infections | 185,774 | 2.5% |
11 | Congenital Abnomalities | 146,548 | 1.9% |
12 | HIV | 143,678 | 1.9% |
13 | Homicide and Violence | 129,202 | 1.7% |
14 | Self-inflicted | 127,043 | 1.7% |
15 | Ovarian cancer | 122,350 | 1.6% |
16 | Hypertension and hypertensive heart disease | 113,105 | 1.5% |
17 | Cirrhosis of the liver | 101,712 | 1.3% |
18 | Cancer pancreas | 99,766 | 1.3% |
19 | Lymphomas | 98,902 | 1.3% |
20 | Inflammatory Cardiac | 91,012 | 1.2% |
Sub-total | 5,027,963 | 66.7% |
Leading causes of mortality burden (YLL) by sex, US, 1996.
Five leading causes of mortality burden (YLL) by sex and age, US, 1996
Males | ||||||
---|---|---|---|---|---|---|
Rank | All ages | YLL | % of total | 0–4 | YLL | % of total |
Total | 10,529,540 | Total | 652,949 | |||
1 | Ischaemic heart disease | 1,806,420 | 17.16% | Perinatal conditions | 258,750 | 39.63% |
2 | Lung/Trachea/Bronchial cancer | 777,726 | 7.39% | Congenital abnormalities | 127,080 | 19.46% |
3 | Motor vehicle accidents | 701,111 | 6.66% | Sudden infant death syndrome | 61,101 | 9.36% |
4 | HIV/AIDS | 575,297 | 5.46% | Motor vehicle accidents | 17,505 | 2.68% |
5 | Suicide | 1,028,947 | 9.77% | Lower respiratory infections | 17,259 | 2.64% |
Rank | 5–14 | YLL | % of total | 15–24 | YLL | % of total |
Total | 185,702 | Total | 845,157 | |||
1 | Motor vehicle accidents | 42,534 | 22.90% | Motor vehicle accidents | 263,631 | 31.19% |
2 | Homicide and violence | 15,729 | 8.47% | Homicide and violence | 210,534 | 24.91% |
3 | Drowning | 12,290 | 6.62% | Suicide | 131,075 | 15.51% |
4 | Congenital abnormalities | 10,634 | 5.73% | Drowning | 20,807 | 2.46% |
5 | Suicide | 8,483 | 4.57% | Poisoning | 18,087 | 2.14% |
Rank | 25–44 | YLL | % of total | 45–64 | YLL | % of total |
Total | 2,548,913 | Total | 3,150,157 | |||
1 | HIV/AIDS | 444,123 | 17.42% | Ischaemic heart disease | 763,334 | 24.23% |
2 | Motor vehicle accidents | 279,389 | 10.96% | Lung/Trachea/Bronchial cancer | 372,984 | 11.84% |
3 | Suicide | 277,467 | 10.89% | Cerebrovascular disease | 115,851 | 3.68% |
4 | Homicide and violence | 207,217 | 8.13% | Cirrhosis of the liver | 113,739 | 3.61% |
5 | Ischaemic heart disease | 171,437 | 6.73% | HIV/AIDS | 111,874 | 3.55% |
Rank | 65–74 | YLL | % of total | 75+ | YLL | % of total |
Total | 1,786,501 | Total | 1,360,161 | |||
1 | Ischaemic heart disease | 484,267 | 27.11% | Ischaemic heart disease | 382,495 | 28.12% |
2 | Lung/Trachea/Bronchial cancer | 253,281 | 14.18% | Lung/Trachea/Bronchial cancer | 104,020 | 7.65% |
3 | Chronic obstructive pulmonary disease | 103,012 | 5.77% | Cerebrovascular disease | 99,208 | 7.29% |
4 | Cerebrovascular disease | 84,904 | 4.75% | Chronic obstructive pulmonary disease | 85,031 | 6.25% |
5 | Colon/Rectum cancer | 62,395 | 3.49% | Prostate cancer | 64,236 | 4.72% |
Five leading causes of mortality burden (YLL) by sex and age, US, 1996
Females | ||||||
---|---|---|---|---|---|---|
Rank | All ages | YLL | % of total | 0–4 | YLL | % of total |
Total | 7,536,559 | Total | 512,861 | |||
1 | Ischaemic heart disease | 1,052,325 | 13.96% | Perinatal conditions | 203,909 | 39.76% |
2 | Lung/Trachea/Bronchial cancer | 523,456 | 6.95% | Congenital abnormalities | 109,458 | 21.34% |
3 | Breast cancer | 450,327 | 5.98% | Sudden infant death syndrome | 41,154 | 8.02% |
4 | Cerebrovascular disease | 427,881 | 5.68% | Motor vehicle accidents | 14,795 | 2.88% |
5 | Motor vehicle accidents | 325,894 | 4.32% | Homicide and violence | 13,612 | 2.65% |
Rank | 5–14 | YLL | % of total | 15–24 | YLL | % of total |
Total | 123,888 | Total | 285,089 | |||
1 | Motor vehicle accidents | 28,952 | 23.37% | Motor vehicle accidents | 117,878 | 41.35% |
2 | Homicide and violence | 8,134 | 6.57% | Homicide and violence | 32,799 | 11.50% |
3 | Congenital abnormalities | 7,226 | 5.83% | Suicide | 22,517 | 7.90% |
4 | Leukemias | 6,120 | 4.94% | Leukemias | 6,726 | 2.36% |
5 | Brain cancer | 5,611 | 4.53% | HIV/AIDS | 5,830 | 2.05% |
Rank | 25–44 | YLL | % of total | 45–64 | YLL | % of total |
Total | 1,192,947 | Total | 2,053,395 | |||
1 | Motor vehicle accidents | 117,878 | 9.88% | Ischaemic heart disease | 524,172 | 25.53% |
2 | HIV/AIDS | 109,310 | 9.16% | Lung/Trachea/Bronchial cancer | 234,241 | 11.41% |
3 | Breast cancer | 95,818 | 8.03% | Breast cancer | 220,350 | 10.73% |
4 | Suicide | 67,035 | 5.62% | Cerebrovascular disease | 99,565 | 4.85% |
5 | Homicide and violence | 60,074 | 5.04% | Diabetes mellitus | 81,366 | 3.96% |
Rank | 65–74 | YLL | % of total | 75+ | YLL | % of total |
Total | 1,503,549 | Total | 1,864,830 | |||
1 | Ischaemic heart disease | 277,053 | 18.43% | Ischaemic heart disease | 459,396 | 24.63% |
2 | Lung/Trachea/Bronchial cancer | 172,116 | 11.45% | Cerebrovascular disease | 186,468 | 10.00% |
3 | Chronic obstructive pulmonary disease | 97,759 | 6.50% | Chronic obstructive pulmonary disease | 88,838 | 4.76% |
4 | Cerebrovascular disease | 90,698 | 6.03% | Lung/Trachea/Bronchial cancer | 84,492 | 4.53% |
5 | Breast cancer | 82,227 | 5.47% | Lower respiratory infections | 83,467 | 4.48% |
Leading causes of YLL by sex and race – Whites
Cause list | YLL | % total | |
---|---|---|---|
Total White males | 8,293,920 | ||
1 | Ischaemic heart disease | 1,584,087 | 19.1% |
2 | Lung trachea or bronchial cancer | 656,850 | 7.9% |
3 | Road Traffic Accidents | 573,953 | 6.9% |
4 | Self-inflicted | 469,430 | 5.7% |
5 | HIV | 334,425 | 4.0% |
6 | Cerebrovascular Disease | 276,544 | 3.3% |
7 | COPD | 244,401 | 2.9% |
8 | Homicide and Violence | 221,000 | 2.7% |
9 | Cirrhosis of the liver | 183,600 | 2.2% |
10 | Cancer colon or rectum | 180,184 | 2.2% |
11 | Diabetes mellitus | 173,405 | 2.1% |
12 | Conditions arising during the perinatal period | 158,462 | 1.9% |
13 | Lower respiratory infections | 158,231 | 1.9% |
14 | Congenital Abnomalities | 135,970 | 1.6% |
15 | Poisoning | 134,929 | 1.6% |
16 | Prostate cancer | 128,058 | 1.5% |
17 | Inflammatory Cardiac | 121,438 | 1.5% |
18 | Lymphomas | 116,804 | 1.4% |
19 | Leukemias | 99,137 | 1.2% |
20 | Cancer pancreas | 89,780 | 1.1% |
Sub-total | 6,040,688 | 72.8% | |
Cause list | YLL | % total | |
Total White females | 6,018,361 | ||
1 | Ischaemic heart disease | 895,819 | 14.9% |
2 | Lung trachea or bronchial cancer | 460,651 | 7.7% |
3 | Breast cancer | 370,855 | 6.2% |
4 | Cerebrovascular Disease | 342,620 | 5.7% |
5 | Road Traffic Accidents | 268,996 | 4.5% |
6 | COPD | 240,803 | 4.0% |
7 | Diabetes mellitus | 169,449 | 2.8% |
8 | Cancer colon or rectum | 163,068 | 2.7% |
9 | Lower respiratory infections | 153,465 | 2.5% |
10 | Conditions arising during the perinatal period | 124,599 | 2.1% |
11 | Congenital Abnomalities | 112,925 | 1.9% |
12 | Self-inflicted | 112,621 | 1.9% |
13 | Ovarian cancer | 108,262 | 1.8% |
14 | Lymphomas | 87,677 | 1.5% |
15 | Cancer pancreas | 83,238 | 1.4% |
16 | Cirrhosis of the liver | 81,843 | 1.4% |
17 | Dementia and other degenerative and hereditary CNS disorders | 76,867 | 1.3% |
18 | Leukemias | 74,069 | 1.2% |
19 | Homicide and Violence | 72,469 | 1.2% |
20 | Hypertension and hypertensive heart disease | 72,258 | 1.2% |
Sub-total | 4,072,553 | 67.7% |
Leading causes of YLL by sex and race – Blacks
Cause list | YLL | % total | |
---|---|---|---|
Total Black males | 1,978,704 | ||
1 | Homicide and Violence | 250,257 | 12.6% |
2 | HIV | 234,400 | 11.8% |
3 | Ischaemic heart disease | 189,031 | 9.6% |
4 | Lung trachea or bronchial cancer | 109,191 | 5.5% |
5 | Motor vehicle accidents | 99,734 | 5.0% |
6 | Conditions arising during the perinatal period | 92,854 | 4.7% |
7 | Cerebrovascular Disease | 69,225 | 3.5% |
8 | Self-inflicted | 47,940 | 2.4% |
9 | Hypertension and hypertensive heart disease | 44,841 | 2.3% |
10 | Inflammatory Cardiac | 41,409 | 2.1% |
11 | Diabetes mellitus | 40,795 | 2.1% |
12 | Lower respiratory infections | 38,675 | 2.0% |
13 | Congenital Abnomalities | 30,182 | 1.5% |
14 | Cirrhosis of the liver | 30,182 | 1.5% |
15 | Poisoning | 30,101 | 1.5% |
16 | Prostate cancer | 30,075 | 1.5% |
17 | Cancer colon or rectum | 28,380 | 1.4% |
18 | COPD | 21,382 | 1.1% |
19 | Sudden Infant Death Syndrome | 19,017 | 1.0% |
20 | Nephritis or nephrosis | 17,092 | 0.9% |
Sub-total | 1,464,762 | 74.0% | |
Cause list | YLL | % total | |
Total Black females | 1,342,205 | ||
1 | Ischaemic heart disease | 141,305 | 10.5% |
2 | HIV | 89,973 | 6.7% |
3 | Cerebrovascular Disease | 74,323 | 5.5% |
4 | Conditions arising during the perinatal period | 73,969 | 5.5% |
5 | Breast cancer | 70,421 | 5.2% |
6 | Lung trachea or bronchial cancer | 55,561 | 4.1% |
7 | Diabetes mellitus | 54,669 | 4.1% |
8 | Homicide and Violence | 52,280 | 3.9% |
9 | Motor vehicle accidents | 42,499 | 3.2% |
10 | Hypertension and hypertensive heart disease | 39,005 | 2.9% |
11 | Cancer colon or rectum | 28,896 | 2.2% |
12 | Congenital Abnomalities | 28,218 | 2.1% |
13 | Lower respiratory infections | 28,108 | 2.1% |
14 | Inflammatory Cardiac | 25,707 | 1.9% |
15 | Nephritis or nephrosis | 15,811 | 1.2% |
16 | Cirrhosis of the liver | 15,701 | 1.2% |
17 | COPD | 14,858 | 1.1% |
18 | Cancer pancreas | 14,132 | 1.1% |
19 | Sudden Infant Death Syndrome | 13,841 | 1.0% |
20 | Cancer cervix | 13,786 | 1.0% |
Sub-total | 893,064 | 66.5% |
Leading causes of YLL by sex and race – American Indians
Cause list | YLL | % total | |
---|---|---|---|
Total American Indian males | 83,713 | ||
1 | Motor vehicle accidents | 13,665 | 16.3% |
2 | Ischaemic heart disease | 8,804 | 10.5% |
3 | Self-inflicted | 6,472 | 7.7% |
4 | Homicide and Violence | 5,287 | 6.3% |
5 | Cirrhosis of the liver | 3,982 | 4.8% |
6 | Alcohol use | 2,849 | 3.4% |
7 | Lung trachea or bronchial cancer | 2,792 | 3.3% |
8 | Diabetes mellitus | 2,610 | 3.1% |
9 | Lower respiratory infections | 2,168 | 2.6% |
10 | Conditions arising during the perinatal period | 2,078 | 2.5% |
11 | Poisoning | 2,009 | 2.4% |
12 | HIV | 1,952 | 2.3% |
13 | Cerebrovascular Disease | 1,919 | 2.3% |
14 | Congenital Abnomalities | 1,658 | 2.0% |
15 | Drowning | 1,489 | 1.8% |
16 | Sudden Infant Death Syndrome | 1,239 | 1.5% |
17 | Inflammatory Cardiac | 1,193 | 1.4% |
18 | Cancer colon or rectum | 816 | 1.0% |
19 | Falls | 755 | 0.9% |
20 | COPD | 719 | 0.9% |
Sub-total | 64,456 | 77.0% | |
Cause list | YLL | % total | |
Total Amerian Indian females | 54,732 | ||
1 | Motor vehicle accidents | 6,429 | 11.7% |
2 | Ischaemic heart disease | 4,247 | 7.8% |
3 | Cirrhosis of the liver | 3,311 | 6.0% |
4 | Diabetes mellitus | 2,970 | 5.4% |
5 | Cerebrovascular Disease | 2,057 | 3.8% |
6 | Breast cancer | 1,901 | 3.5% |
7 | Lung trachea or bronchial cancer | 1,788 | 3.3% |
8 | Self-inflicted | 1,786 | 3.3% |
9 | Homicide and Violence | 1,534 | 2.8% |
10 | Conditions arising during the perinatal period | 1,531 | 2.8% |
11 | Lower respiratory infections | 1,523 | 2.8% |
12 | Congenital Abnomalities | 1,182 | 2.2% |
13 | Alcohol use | 1,156 | 2.1% |
14 | Sudden Infant Death Syndrome | 907 | 1.7% |
15 | Cancer colon or rectum | 851 | 1.6% |
16 | Poisoning | 809 | 1.5% |
17 | COPD | 731 | 1.3% |
18 | Ovarian cancer | 678 | 1.2% |
19 | Inflammatory Cardiac | 651 | 1.2% |
20 | Drowning | 633 | 1.2% |
Sub-total | 36,675 | 67.0% |
Leading causes of YLL by sex and race – Asians
Cause list | YLL | % total | |
---|---|---|---|
Total Asian males | 173,201 | ||
1 | Ischaemic heart disease | 24,497 | 14.1% |
2 | Motor vehicle accidents | 13,759 | 7.9% |
3 | Self-inflicted | 10,032 | 5.8% |
4 | Homicide and Violence | 9,584 | 5.5% |
5 | Lung trachea or bronchial cancer | 8,892 | 5.1% |
6 | Cerebrovascular Disease | 8,875 | 5.1% |
7 | Cancer liver | 6,330 | 3.7% |
8 | Conditions arising during the perinatal period | 6,188 | 3.6% |
9 | Congenital Abnomalities | 4,590 | 2.7% |
10 | HIV | 4,520 | 2.6% |
11 | Diabetes mellitus | 3,684 | 2.1% |
12 | Lower respiratory infections | 3,593 | 2.1% |
13 | Cancer colon or rectum | 3,578 | 2.1% |
14 | Inflammatory Cardiac | 3,276 | 1.9% |
15 | Drowning | 3,256 | 1.9% |
16 | Cancer stomach | 2,935 | 1.7% |
17 | Leukemias | 2,601 | 1.5% |
18 | Hypertension and hypertensive heart disease | 2,365 | 1.4% |
19 | COPD | 2,272 | 1.3% |
20 | Cirrhosis of the liver | 2,113 | 1.2% |
Sub-total | 126,941 | 73.3% | |
Cause list | YLL | % total | |
Total Asian females | 121,261 | ||
1 | Ischaemic heart disease | 10,953 | 9.0% |
2 | Cerebrovascular Disease | 8,881 | 7.3% |
3 | Road Traffic Accidents | 7,970 | 6.6% |
4 | Breast cancer | 7,150 | 5.9% |
5 | Lung trachea or bronchial cancer | 5,455 | 4.5% |
6 | Conditions arising during the perinatal period | 4,451 | 3.7% |
7 | Congenital Abnomalities | 4,223 | 3.5% |
8 | Self-inflicted | 4,112 | 3.4% |
9 | Cancer colon or rectum | 3,761 | 3.1% |
10 | Diabetes mellitus | 3,331 | 2.7% |
11 | Homicide and Violence | 2,920 | 2.4% |
12 | Cancer stomach | 2,873 | 2.4% |
13 | Ovarian cancer | 2,776 | 2.3% |
14 | Lower respiratory infections | 2,677 | 2.2% |
15 | Cancer liver | 2,210 | 1.8% |
16 | Leukemias | 2,126 | 1.8% |
17 | Cancer cervix | 1,892 | 1.6% |
18 | Cancer pancreas | 1,888 | 1.6% |
19 | Inflammatory Cardiac | 1,602 | 1.3% |
20 | Lymphomas | 1,479 | 1.2% |
Sub-total | 82,729 | 68.2% |
Patterns by race
The share of YLL due to communicable diseases (which include HIV/AIDS), maternal causes, perinatal and nutritional conditions was twofold larger for Blacks (20 per cent) than it was for any of the other races. Injuries predominated among American Indians, causing one third of the total mortality burden, and one fifth or less in the other races.
Ten leading causes of mortality burden (YLL) and death, as a per cent of total, by race, US, 1996.
Ten leading causes of mortality burden (YLL) and death, as a per cent of total, by race, US, 1996.
Comparative rankings of mortality burden in the United States and selected industrialized countries
Comparative rankings for the twenty leading causes of YLL for males, US compared with selected non-US OECD countries. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected non-US OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom.
Comparative rankings for the twenty leading causes of YLL for females, US compared with selected non-US OECD countries. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom.
US YLL rankings by race compared to selected industrialized countries
YLL rankings by race in the US compared with selected non-US OECD countries, males. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom
YLL rankings by race in the US compared with non-US OECD countries, females. Note: Vertical red bars indicate the range between minimum and maximum rankings observed in the selected OECD countries (excluding the US). Blue horizontal lines indicate rankings for the US. The ten selected OECD countries are: Australia, Canada, France, Germany, Greece, Italy, Japan, Netherlands, Spain and the United Kingdom
Twenty leading causes of YLL in the United States: comparison of YLL rates per 100,000 between the United States and selected countries – Male
Twenty leading causes of YLL in the United States | United States | Australia | Canada | France | Germany | Greece | Italy | Japan | Netherlands | Spain | United Kingdom |
---|---|---|---|---|---|---|---|---|---|---|---|
IHD | 1,392 | 269 | 950 | 578 | 1,249 | 1,337 | 974 | 504 | 942 | 826 | 2,154 |
Trachea, bronchus, lung cancer | 599 | 105 | 469 | 666 | 611 | 756 | 683 | 387 | 595 | 638 | 714 |
MVA | 547 | 106 | 292 | 515 | 325 | 690 | 438 | 242 | 233 | 550 | 350 |
HIV/AIDS | 443 | 9 | 62 | 60 | 26 | 11 | 67 | 1 | 31 | 176 | 18 |
Self-inflicted | 411 | 140 | 414 | 459 | 367 | 101 | 184 | 582 | 221 | 218 | 410 |
homicide and violence | 375 | 15 | 57 | 21 | 19 | 37 | 38 | 14 | 38 | 35 | 55 |
Cerebroavascular disease | 275 | 72 | 205 | 307 | 377 | 723 | 421 | 546 | 319 | 356 | 566 |
COPD | 207 | 51 | 145 | 142 | 182 | 88 | 168 | 57 | 234 | 247 | 371 |
Perinatal conditions | 200 | 43 | 115 | 120 | 87 | 115 | 90 | 39 | 116 | 78 | 215 |
Diabetes | 170 | 33 | 146 | 97 | 125 | 54 | 144 | 76 | 120 | 93 | 99 |
Cirrhosis of the liver | 169 | 25 | 104 | 281 | 372 | 85 | 228 | 161 | 85 | 195 | 258 |
Colon and rectum | 164 | 68 | 187 | 213 | 267 | 160 | 225 | 231 | 220 | 235 | 338 |
Lower respiratory infections | 156 | 19 | 66 | 134 | 99 | 49 | 80 | 281 | 152 | 97 | 524 |
Congenital anomalies | 133 | 33 | 95 | 101 | 78 | 104 | 78 | 66 | 113 | 86 | 125 |
poisonings | 130 | 51 | 87 | 12 | 28 | 104 | 11 | 12 | 30 | 71 | 111 |
Inflammatory heart disease | 129 | 21 | 52 | 68 | 116 | 3 | 67 | 45 | 65 | 87 | 84 |
Prostate | 123 | 41 | 118 | 145 | 142 | 119 | 110 | 50 | 151 | 121 | 241 |
Lymphoma and multiple myeloma | 103 | 36 | 125 | 114 | 108 | 92 | 130 | 77 | 128 | 106 | 176 |
Hypertesive heart disease | 99 | 7 | 21 | 51 | 77 | 48 | 117 | 15 | 24 | 38 | 54 |
Leukemia | 88 | 25 | 82 | 91 | 87 | 105 | 100 | 70 | 78 | 86 | 115 |
Twenty leading causes of YLL in the United States: comparison of YLL rates per 100,000 between the United States and selected countries – Female
Twenty leading causes of YLL in the United States | United States | Australia | Canada | France | Germany | Greece | Italy | Japan | Netherlands | Spain | United Kingdom |
---|---|---|---|---|---|---|---|---|---|---|---|
IHD | 777 | 462 | 475 | 228 | 753 | 570 | 491 | 562 | 466 | 383 | 868 |
Trachea, bronchus, lung cancer | 386 | 186 | 354 | 140 | 201 | 125 | 154 | 328 | 288 | 86 | 357 |
Breast cancer | 332 | 285 | 326 | 389 | 404 | 313 | 363 | 396 | 457 | 288 | 492 |
Cerebroavascular disease | 316 | 253 | 213 | 253 | 405 | 826 | 426 | 943 | 378 | 362 | 510 |
MVA | 241 | 125 | 124 | 157 | 105 | 178 | 117 | 167 | 71 | 151 | 73 |
COPD | 190 | 108 | 114 | 67 | 90 | 41 | 66 | 39 | 152 | 57 | 227 |
Diabetes | 170 | 80 | 109 | 76 | 123 | 55 | 151 | 102 | 115 | 108 | 66 |
Perinatal conditions | 151 | 108 | 87 | 89 | 64 | 75 | 70 | 70 | 94 | 63 | 115 |
Colon and rectum | 145 | 164 | 145 | 155 | 217 | 153 | 171 | 381 | 189 | 174 | 201 |
Lower respiratory infections | 137 | 50 | 56 | 91 | 79 | 34 | 61 | 418 | 147 | 71 | 412 |
Congenital anomalies | 108 | 89 | 73 | 71 | 64 | 76 | 59 | 136 | 100 | 73 | 84 |
HIV/AIDS | 106 | 2 | 13 | 16 | 6 | 2 | 17 | 0 | 8 | 43 | 4 |
homicide and violence | 95 | 32 | 21 | 12 | 16 | 11 | 11 | 25 | 19 | 13 | 20 |
sel-inflicted | 94 | 120 | 119 | 155 | 106 | 27 | 55 | 473 | 107 | 63 | 90 |
Ovarian cancer | 90 | 69 | 79 | 90 | 114 | 82 | 88 | 148 | 99 | 74 | 144 |
Hypertesive heart disease | 83 | 27 | 21 | 50 | 94 | 50 | 137 | 34 | 27 | 53 | 32 |
Cirrhosis of the liver | 75 | 32 | 45 | 113 | 156 | 28 | 115 | 99 | 44 | 71 | 113 |
Cancer pancreas | 74 | 56 | 67 | 66 | 94 | 73 | 85 | 187 | 78 | 62 | 84 |
Lymphoma and multiple myeloma | 73 | 88 | 97 | 80 | 83 | 71 | 103 | 126 | 90 | 84 | 110 |
Inflammatory heart disease | 67 | 31 | 29 | 24 | 44 | 3 | 30 | 53 | 42 | 45 | 32 |
The largest differentials between races for males pertained to COPD, cirrhosis of the liver, poisoning, hypertension and hypertensive heart disease. Rankings indicate a higher mortality burden due to COPD and cirrhosis of the liver in American Indians; hypertension and hypertensive heart disease in Blacks; and a lower mortality burden for poisoning in Asians. The largest rank differentials between races were observed in females for HIV/AIDS, self-inflicted injuries, COPD, hypertension and hypertensive heart disease, and cirrhosis of the liver. Rankings for Black females pointed to a higher mortality burden for HIV/AIDS, hypertension and hypertensive heart disease, and a lower mortality burden for self-inflicted injuries and ovarian cancer compared to White, American Indian and Asian females.
Morbidity burden
Leading causes of YLD
Distribution of YLD for non-communicable cause groupings.
Age patterns of mental disorders and diseases of the nervous system.
Twenty leading causes of YLD, both sexes and all races combined
Rank | YLD | % of total | |
---|---|---|---|
Total | 15,024,113 | ||
1 | Unipolar major depression | 1,370,070 | 9.1% |
2 | Alcohol use | 1,037,529 | 6.9% |
3 | Osteoarthritis | 940,612 | 6.3% |
4 | Dementia and other degenerative and hereditary CNS disorders | 755,925 | 5.0% |
5 | COPD | 727,272 | 4.8% |
6 | Cerebrovascular Disease | 725,844 | 4.8% |
7 | Asthma | 593,233 | 3.9% |
8 | Drug use | 504,718 | 3.4% |
9 | Diabetes mellitus | 495,377 | 3.3% |
10 | Congenital Abnomalities | 443,004 | 2.9% |
11 | Motor vehicle accidents | 366,273 | 2.4% |
12 | Bipolar disorder | 363,298 | 2.4% |
13 | Schizophrenia | 315,720 | 2.1% |
14 | Ischaemic heart disease | 275,988 | 1.8% |
15 | PTSD | 260,337 | 1.7% |
16 | Panic disorder | 259,904 | 1.7% |
17 | HIV | 237,443 | 1.6% |
18 | Falls | 221,036 | 1.5% |
19 | Rheumatoid arthritis | 189,421 | 1.3% |
20 | Obsessive-compulsive disorders | 169,067 | 1.1% |
Sub-total | 10,252,070 | 68.2% |
Sex and age patterns
Twenty leading causes of YLD by sex, US 1996
MALES | |||
---|---|---|---|
Rank | YLD | % total YLD | |
Total | 7,330,853 | ||
1 | Alcohol use | 651,223 | 8.9% |
2 | Unipolar major depression | 469,861 | 6.4% |
3 | Osteoarthritis | 434,200 | 5.9% |
4 | Drug use | 384,319 | 5.2% |
5 | COPD | 372,927 | 5.1% |
6 | Dementia and other degenerative and hereditary CNS disorders | 332,046 | 4.5% |
7 | Cerebrovascular Disease | 317,366 | 4.3% |
8 | Asthma | 272,898 | 3.7% |
9 | Congenital Abnomalities | 237,988 | 3.2% |
10 | Motor vehicle accidents | 232,687 | 3.2% |
11 | Diabetes mellitus | 221,557 | 3.0% |
12 | Bipolar disorder | 198,308 | 2.7% |
13 | HIV | 188,519 | 2.6% |
14 | Schizophrenia | 166,988 | 2.3% |
15 | Ischaemic heart disease | 151,764 | 2.1% |
16 | Falls | 132,485 | 1.8% |
17 | Obsessive-compulsive disorders | 88,623 | 1.2% |
18 | Homicide and Violence | 81,588 | 1.1% |
19 | Prostate cancer | 78,870 | 1.1% |
20 | Panic disorder | 77,701 | 1.1% |
sub-total | 5,091,918 | 69.5% | |
FEMALES | |||
Rank | YLD | % total YLD | |
Total | 7,693,260 | ||
1 | Unipolar major depression | 900,209 | 11.7% |
2 | Osteoarthritis | 506,412 | 6.6% |
3 | Dementia and other degenerative and hereditary CNS disorders | 423,878 | 5.5% |
4 | Cerebrovascular Disease | 408,478 | 5.3% |
5 | Alcohol use | 386,306 | 5.0% |
6 | COPD | 354,345 | 4.6% |
7 | Asthma | 320,336 | 4.2% |
8 | Diabetes mellitus | 273,821 | 3.6% |
9 | Congenital Abnomalities | 205,015 | 2.7% |
10 | PTSD | 193,533 | 2.5% |
11 | Panic disorder | 182,203 | 2.4% |
12 | Bipolar disorder | 164,990 | 2.1% |
13 | Schizophrenia | 148,732 | 1.9% |
14 | Motor vehicle accidents | 133,586 | 1.7% |
15 | Rheumatoid arthritis | 131,758 | 1.7% |
16 | STD's excluding HIV | 125,418 | 1.6% |
17 | Ischaemic heart disease | 124,224 | 1.6% |
18 | Drug use | 120,399 | 1.6% |
19 | Maternal Conditions | 105,155 | 1.4% |
20 | Falls | 88,551 | 1.2% |
sub-total | 5,297,349 | 68.9% |
The largest sex differentials pertained to the leading cause of YLD: alcohol use for males and unipolar major depression for females. The burden due to unipolar depression was almost double for females (900 thousand YLD) than it was for males (470 thousand YLD), whereas the burden due to alcohol was double for males (651 thousand YLD) than it was for females (386 thousand YLD). Together, alcohol use and unipolar depression caused 15 per cent of total YLD for males, and 17 per cent for females.
The share of total YLD due to neuropsychiatric conditions for males exceeded that for females. Morbidity due to substance abuse (alcohol and drug) in males was not entirely offset by the preponderance of mood and anxiety disorders in females. The slightly higher share of dementia and other degenerative and hereditary CNS disorders in females resulted from their higher life expectancy.
Major causes contributing to the morbidity burden changed with age. Mental disorders and injuries affected mostly young adults, whereas nervous system disorders, musculoskeletal conditions, cardiovascular diseases, and diabetes increased with age and were predominant among older adults. Chronic respiratory conditions affected all age groups. Congenital anomalies represented half of the non-fatal burden below age 5.
Patterns by race
Leading causes of YLD – Whites
WHITE MALES | |||
---|---|---|---|
Rank | Cause list | YLD | % total YLD |
Total YLD | 5,963,710 | ||
1 | Alcohol use | 488,341 | 8.2% |
2 | Unipolar major depression | 390,121 | 6.5% |
3 | Osteoarthritis | 378,589 | 6.3% |
4 | Drug use | 324,878 | 5.4% |
5 | COPD | 319,049 | 5.3% |
6 | Dementia and other degenerative and hereditary CNS disorders | 293,857 | 4.9% |
7 | Cerebrovascular Disease | 258,909 | 4.3% |
8 | Asthma | 216,831 | 3.6% |
9 | Motor vehicle accidents | 195,590 | 3.3% |
10 | Congenital Abnomalities | 189,083 | 3.2% |
11 | Diabetes mellitus | 174,663 | 2.9% |
12 | Bipolar disorder | 161,700 | 2.7% |
13 | Schizophrenia | 134,190 | 2.3% |
14 | Ischaemic heart disease | 130,502 | 2.2% |
15 | Falls | 113,345 | 1.9% |
16 | HIV | 111,533 | 1.9% |
17 | Obsessive-compulsive disorders | 71,313 | 1.2% |
18 | Prostate cancer | 68,023 | 1.1% |
19 | Panic disorder | 63,735 | 1.1% |
20 | PTSD | 55,968 | 0.9% |
sub-total | 4,140,220 | 69.4% | |
WHITE FEMALES | |||
Rank | Cause list | YLD | % total YLD |
Total YLD | 6,234,020 | ||
1 | Unipolar major depression | 736,746 | 11.8% |
2 | Osteoarthritis | 439,876 | 7.1% |
3 | Dementia and other degenerative and hereditary CNS disorders | 375,458 | 6.0% |
4 | Cerebrovascular Disease | 323,173 | 5.2% |
5 | COPD | 307,237 | 4.9% |
6 | Alcohol use | 291,334 | 4.7% |
7 | Asthma | 253,904 | 4.1% |
8 | Diabetes mellitus | 210,058 | 3.4% |
9 | Congenital Abnomalities | 162,162 | 2.6% |
10 | PTSD | 159,120 | 2.6% |
11 | Panic disorder | 145,888 | 2.3% |
12 | Bipolar disorder | 131,835 | 2.1% |
13 | Schizophrenia | 118,134 | 1.9% |
14 | Rheumatoid arthritis | 110,674 | 1.8% |
15 | Motor vehicle accidents | 109,754 | 1.8% |
16 | STD's excluding HIV | 101,298 | 1.6% |
17 | Ischaemic heart disease | 100,510 | 1.6% |
18 | Drug use | 98,319 | 1.6% |
19 | Maternal Conditions | 82,750 | 1.3% |
20 | Falls | 76,404 | 1.2% |
Sub-total | 4,334,635 | 69.5% |
Leading causes of YLD – Blacks
BLACK MALES | |||
---|---|---|---|
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 1,086,407 | ||
1 | Alcohol use | 135,346 | 12.5% |
2 | HIV | 73,292 | 6.7% |
3 | Unipolar major depression | 57,653 | 5.3% |
4 | Cerebrovascular Disease | 49,191 | 4.5% |
5 | Drug use | 44,504 | 4.1% |
6 | Asthma | 42,295 | 3.9% |
7 | Diabetes mellitus | 39,783 | 3.7% |
8 | COPD | 38,739 | 3.6% |
9 | Osteoarthritis | 38,641 | 3.6% |
10 | Congenital Abnomalities | 36,030 | 3.3% |
11 | Road Traffic Accidents | 31,173 | 2.9% |
12 | Dementia and other degenerative and hereditary CNS disorders | 28,292 | 2.6% |
13 | Homicide and Violence | 26,846 | 2.5% |
14 | Bipolar disorder | 26,799 | 2.5% |
15 | Schizophrenia | 24,323 | 2.2% |
16 | Ischaemic heart disease | 18,148 | 1.7% |
17 | Falls | 15,894 | 1.5% |
18 | Diarrhoeal diseases | 15,602 | 1.4% |
19 | Inflammatory Cardiac | 13,178 | 1.2% |
20 | Obsessive-compulsive disorders | 12,818 | 1.2% |
sub-total | 768,546 | 70.7% | |
BLACK FEMALES | |||
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 1,145,131 | ||
1 | Unipolar major depression | 119,471 | 10.4% |
2 | Alcohol use | 74,248 | 6.5% |
3 | Cerebrovascular Disease | 74,179 | 6.5% |
4 | Diabetes mellitus | 54,409 | 4.8% |
5 | Asthma | 50,869 | 4.4% |
6 | Osteoarthritis | 48,521 | 4.2% |
7 | Dementia and other degenerative and hereditary CNS disorders | 37,519 | 3.3% |
8 | HIV | 31,719 | 2.8% |
9 | Congenital Abnomalities | 31,654 | 2.8% |
10 | COPD | 31,132 | 2.7% |
11 | PTSD | 27,508 | 2.4% |
12 | Panic disorder | 26,916 | 2.4% |
13 | Bipolar disorder | 24,649 | 2.2% |
14 | Schizophrenia | 22,823 | 2.0% |
15 | Ischaemic heart disease | 21,685 | 1.9% |
16 | Road Traffic Accidents | 19,754 | 1.7% |
17 | STD's excluding HIV | 17,688 | 1.5% |
18 | Drug use | 17,686 | 1.5% |
19 | Maternal Conditions | 16,770 | 1.5% |
20 | Rheumatoid arthritis | 15,521 | 1.4% |
sub-total | 764,722 | 66.8% |
Leading causes of YLD – American Indians
AMERICAN INDIAN MALES | |||
---|---|---|---|
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 77,508 | ||
1 | Alcohol use | 22,997 | 29.7% |
2 | Unipolar major depression | 4,160 | 5.4% |
3 | Drug use | 3,042 | 3.9% |
4 | Osteoarthritis | 2,940 | 3.8% |
5 | Asthma | 2,745 | 3.5% |
6 | COPD | 2,708 | 3.5% |
7 | Congenital Abnomalities | 2,467 | 3.2% |
8 | Cerebrovascular Disease | 2,014 | 2.6% |
9 | Bipolar disorder | 1,948 | 2.5% |
10 | Road Traffic Accidents | 1,902 | 2.5% |
11 | Schizophrenia | 1,796 | 2.3% |
12 | Dementia and other degenerative and hereditary CNS disorders | 1,775 | 2.3% |
13 | Diabetes mellitus | 1,595 | 2.1% |
14 | HIV | 1,190 | 1.5% |
15 | Cirrhosis of the liver | 1,082 | 1.4% |
16 | Fires | 1,027 | 1.3% |
17 | Obsessive-compulsive disorders | 940 | 1.2% |
18 | Falls | 921 | 1.2% |
19 | Ischaemic heart disease | 881 | 1.1% |
20 | Panic disorder | 743 | 1.0% |
sub-total | 58,874 | 76.0% | |
AMERICAN INDIAN FEMALES | |||
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 78,522 | ||
1 | Alcohol use | 19,417 | 24.7% |
2 | Unipolar major depression | 7,655 | 9.7% |
3 | Asthma | 3,233 | 4.1% |
4 | Osteoarthritis | 3,020 | 3.8% |
5 | COPD | 2,692 | 3.4% |
6 | Cerebrovascular Disease | 2,251 | 2.9% |
7 | Congenital Abnomalities | 2,182 | 2.8% |
8 | Dementia and other degenerative and hereditary CNS disorders | 2,006 | 2.6% |
9 | Diabetes mellitus | 1,895 | 2.4% |
10 | Panic disorder | 1,851 | 2.4% |
11 | Bipolar disorder | 1,717 | 2.2% |
12 | Schizophrenia | 1,625 | 2.1% |
13 | PTSD | 1,251 | 1.6% |
14 | Maternal Conditions | 1,178 | 1.5% |
15 | STD's excluding HIV | 1,157 | 1.5% |
16 | Road Traffic Accidents | 1,115 | 1.4% |
17 | Rheumatoid arthritis | 958 | 1.2% |
18 | Drug use | 925 | 1.2% |
19 | Cirrhosis of the liver | 918 | 1.2% |
20 | Obsessive-compulsive disorders | 865 | 1.1% |
Sub-total | 57,910 | 73.8% |
Leading causes of YLD – Asians
ASIAN MALES | |||
---|---|---|---|
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 203,229 | ||
1 | Unipolar major depression | 17,926 | 8.8% |
2 | Osteoarthritis | 14,029 | 6.9% |
3 | COPD | 12,431 | 6.1% |
4 | Drug use | 11,895 | 5.9% |
5 | Asthma | 11,027 | 5.4% |
6 | Congenital Abnomalities | 10,408 | 5.1% |
7 | Dementia and other degenerative and hereditary CNS disorders | 8,122 | 4.0% |
8 | Bipolar disorder | 7,862 | 3.9% |
9 | Cerebrovascular Disease | 7,251 | 3.6% |
10 | Schizophrenia | 6,679 | 3.3% |
11 | Diabetes mellitus | 5,516 | 2.7% |
12 | Alcohol use | 4,539 | 2.2% |
13 | Road Traffic Accidents | 4,022 | 2.0% |
14 | Obsessive-compulsive disorders | 3,552 | 1.7% |
15 | Panic disorder | 2,994 | 1.5% |
16 | HIV | 2,505 | 1.2% |
17 | Epilepsy | 2,470 | 1.2% |
18 | Falls | 2,325 | 1.1% |
19 | Ischaemic heart disease | 2,234 | 1.1% |
20 | Diarrhoeal diseases | 2,057 | 1.0% |
Sub-total | 139,843 | 68.8% | |
ASIAN FEMALES | |||
Rank | Simple cause list | YLD | % total YLD |
Total YLD | 235,588 | ||
1 | Unipolar major depression | 36,337 | 15.4% |
2 | Osteoarthritis | 14,995 | 6.4% |
3 | COPD | 13,285 | 5.6% |
4 | Asthma | 12,329 | 5.2% |
5 | Congenital Abnomalities | 9,018 | 3.8% |
6 | Dementia and other degenerative and hereditary CNS disorders | 8,896 | 3.8% |
7 | Cerebrovascular Disease | 8,876 | 3.8% |
8 | Panic disorder | 7,548 | 3.2% |
9 | Diabetes mellitus | 7,458 | 3.2% |
10 | Bipolar disorder | 6,788 | 2.9% |
11 | Schizophrenia | 6,150 | 2.6% |
12 | PTSD | 5,654 | 2.4% |
13 | STD's excluding HIV | 5,275 | 2.2% |
14 | Rheumatoid arthritis | 4,605 | 2.0% |
15 | Maternal Conditions | 4,456 | 1.9% |
16 | Drug use | 3,469 | 1.5% |
17 | Obsessive-compulsive disorders | 3,347 | 1.4% |
18 | Road Traffic Accidents | 2,963 | 1.3% |
19 | Epilepsy | 2,222 | 0.9% |
20 | Diarrhoeal diseases | 1,745 | 0.7% |
Sub-total | 165,417 | 70.2% |
Differentials in patterns of neuropsychiatric disorders by race were dominated by the large excess morbidity burden caused by substance abuse among American Indians, which accounted for half of total YLD, compared to approximately one third in the other race groups.
Patterns of YLD by age and race, US 1996.
Discussion
Quantifying the burden of disease is not a morally neutral exercise. All summary measures of health include several value choices. A strength of the GBD was to make value choices incorporated in the calculation of DALYs transparent. These include a standard duration of life at each age, an age weighting function, and discounting for time preference. GBD values for these parameters were not changed to ensure the international comparability of the USBODI.
The validation of GBD disability weights in different national contexts is particularly important to enhance the confidence of decision-makers in key findings of national disease burden estimates. The instrument used to derive the disability weights is called the Person Trade-Off (PTO). In the GBD the full PTO was executed for a set of 22 indicator conditions.
Disability weights from person trade-off exercise conducted in Atlanta compared to composite scores from other exercises conducted at various international sites
Indicator Condition | Atlanta PTO (N = 35) | Composite scores (N = 192) | ||||||
---|---|---|---|---|---|---|---|---|
Median | Mean | S.D.* | C.V.+ | Median | Mean | S.D.* | C.V.+ | |
Vitiligo on Face | 0 | 0.04 | 0.11 | 2.75 | 0 | 0.04 | 0.1 | 2.5 |
Watery Diarrhea | 0.02 | 0.06 | 0.08 | 1.33 | 0.05 | 0.1 | 0.16 | 1.60 |
Fracture of Radius | 0.06 | 0.1 | 0.11 | 1.10 | 0.09 | 0.13 | 0.16 | 1.23 |
Infertility | 0.03 | 0.11 | 0.16 | 1.45 | 0.09 | 0.16 | 0.19 | 1.19 |
Erectile Dysfunction | 0.09 | 0.19 | 0.22 | 1.16 | 0.17 | 0.22 | 0.23 | 1.05 |
Severe Sore Throat | 0.13 | 0.19 | 0.18 | 0.95 | 0.13 | 0.23 | 0.26 | 1.13 |
Rheumatoid Arthritis | 0.17 | 0.26 | 0.24 | 0.92 | 0.29 | 0.32 | 0.22 | 0.69 |
Below Knee Amputation | 0.29 | 0.32 | 0.20 | 0.63 | 0.29 | 0.34 | 0.22 | 0.65 |
Deafness | 0.44 | 0.43 | 0.28 | 0.65 | 0.36 | 0.4 | 0.24 | 0.60 |
Recto-vaginal Fistula | 0.29 | 0.38 | 0.33 | 0.87 | 0.41 | 0.44 | 0.28 | 0.64 |
Angina | 0.38 | 0.39 | 0.23 | 0.59 | 0.43 | 0.46 | 0.26 | 0.57 |
Mental Retardation | 0.64 | 0.55 | 0.28 | 0.51 | 0.5 | 0.5 | 0.25 | 0.50 |
Blindness | 0.5 | 0.53 | 0.25 | 0.47 | 0.63 | 0.58 | 0.21 | 0.36 |
Paraplegia | 0.67 | 0.6 | 0.25 | 0.42 | 0.71 | 0.68 | 0.2 | 0.29 |
Major Depression | 0.89 | 0.79 | 0.23 | 0.29 | 0.81 | 0.75 | 0.2 | 0.27 |
Severe Migraine | 0.96 | 0.89 | 0.18 | 0.20 | 0.88 | 0.8 | 0.2 | 0.25 |
Dementia | 0.9 | 0.85 | 0.16 | 0.19 | 0.9 | 0.86 | 0.13 | 0.15 |
Active Psychosis | 0.95 | 0.9 | 0.12 | 0.13 | 0.91 | 0.87 | 0.14 | 0.16 |
Quadriplegia | 0.93 | 0.9 | 0.09 | 0.10 | 0.91 | 0.87 | 0.14 | 0.16 |
Pearson's correlation coefficients for median disability weights for each exercise based on 19 conditions common to all person trade-off exercises
Group | |||||||||
International I | International I | ||||||||
Netherlands | 0.96 | Netherlands | |||||||
Maghreb-8 | 0.94 | 0.95 | Maghreb | ||||||
Japan | 0.90 | 0.82 | 0.85 | Japan | |||||
GBD | 0.97 | 0.95 | 0.97 | 0.88 | GBD | ||||
International II | 0.99 | 0.97 | 0.94 | 0.89 | 0.97 | International II | |||
CDC | 0.97 | 0.98 | 0.92 | 0.84 | 0.95 | 0.98 | CDC | ||
Brazil | 0.90 | 0.91 | 0.87 | 0.83 | 0.87 | 0.90 | 0.90 | Brazil | |
Mexico | 0.95 | 0.93 | 0.92 | 0.90 | 0.93 | 0.96 | 0.96 | 0.95 | Mexico |
Composite | 0.99 | 0.98 | 0.96 | 0.89 | 0.98 | 0.99 | 0.99 | 0.94 | 0.97 |
Based on the above results it seemed reasonable to use the set of disability weights from the GBD study for the US evaluation. In a few instances more detailed data on health conditions were available in the US on the distribution of severity for certain health conditions such as depression [see Additional file 2]. Disability weights for severity-specific stages were developed for many of these conditions as part of a burden of disease and injury study implemented in the Netherlands [20]. Therefore, the Dutch weights were used when stage specific information on severity was available.
Top twenty leading causes of Disability Adjusted Life Years (DALY), Years Lost to Disability (YLD), Years of Life Lost (YLL) and Deaths for Males – US 1996*
Cause | DALY (%) | YLD (%) | YLL (%) | Death (%) | |
---|---|---|---|---|---|
1 | Ischaemic heart disease | 1,958 (11.0) | 152 (2.1) | 1,806(17.2) | 287 (24.7) |
2 | Road traffic accidents | 934 (5.2) | 233 (3.2) | 701 (6.7) | 29 (2.5) |
3 | Lung trachea or bronchial cancer | 813 (4.6) | 35 (0.5) | 778 (7.4) | 102 (8.8) |
4 | HIV/AIDS | 764 (4.3) | 189 (2.6) | 575 (5.5) | 25 (2.2) |
5 | Alcohol use | 732 (4.1) | 651 (8.9) | 81 (0.8) | 5 (0.4) |
6 | Cerebrovascular Disease | 674 (3.8) | 317 (4.3) | 357 (3.4) | 63 (5.4) |
7 | COPD | 642 (3.6) | 373 (5.1) | 269 (2.6) | 52 (4.5) |
8 | Homicide and Violence | 568 (3.2) | 82 (1.1) | 486 (4.6) | 17 (1.5) |
9 | Self-inflicted injuries | 541 (3.0) | 8 (0.1) | 534 (5.1) | 26 (2.2) |
10 | Unipolar major depression | 470 (2.6) | 470 (6.4) | 0 (0.0) | 0 (0) |
11 | Diabetes mellitus | 442 (2.5) | 222 (3.0) | 220 (2.1) | 28 (2.4) |
12 | Osteoarthritis | 435 (2.4) | 434 (5.9) | 1 (0.0) | 0 (0) |
13 | Drug use | 412 (2.3) | 384 (5.2) | 27 (0.3) | 1 (0.1) |
14 | Congenital Abnormalities | 410 (2.3) | 238 (3.2) | 172 (1.6) | 6 (0.5) |
15 | Dementia and other degenerative and hereditary CNS disorders | 382 (2.1) | 332 (4.5) | 50 (0.5) | 14 (1.2) |
16 | Asthma | 303 (1.7) | 273 (3.7) | 30 (0.3) | 2 (0.2) |
17 | Cirrhosis of the liver | 281 (1.6) | 61 (0.8) | 220 (2.1) | 17 (1.4) |
18 | Conditions arising during the perinatal period | 274 (1.5) | 14 (0.2) | 260 (2.5) | 8 (0.7) |
19 | Cancer colon or rectum | 249 (1.4) | 37 (0.5) | 213 (2.0) | 30 (2.6) |
20 | Prostate cancer | 239 (1.3) | 79 (1.1) | 160 (1.5) | 37 (3.2) |
- | Total number for each measure in the top 20 causes | 11,523 (64.5) | 4,584 (62.5) | 6,940 (65.9) | 749 (64.5) |
- | Total number for each measure | 17,861(100) | 7,331(100) | 10,530 (100) | 1,164 (100) |
Top twenty leading causes of Disability Adjusted Life Years (DALY), Years Lost to Disability (YLD), Years of Life Lost (YLL) and Deaths for Females – US 1996*
Cause | DALY (%) | YLD (%) | YLL (%) | Death (%) | |
---|---|---|---|---|---|
1 | Ischaemic heart disease | 1,177 (7.7) | 124 (1.6) | 1,052(14.0) | 249 (21.7) |
2 | Unipolar major depression | 900 (5.9) | 900 (11.7) | 0 (0.0) | 0 (0.0) |
3 | Cerebrovascular disease | 836 (5.5) | 408 (5.3) | 428 (5.7) | 99 (8.6) |
4 | COPD | 612 (4.0) | 354 (4.6) | 257 (3.4) | 48 (4.1) |
5 | Lung trachea or bronchial cancer | 550 (3.6) | 26 (0.3) | 523 (6.9) | 66 (5.7) |
6 | Breast cancer | 515 (3.4) | 64 (0.8) | 450 (6.0) | 47 (4.1) |
7 | Osteoarthritis | 508 (3.3) | 506 (6.6) | 1 (0.0) | 1(0.0) |
8 | Dementia and other degenerative and hereditary CNS disorders | 507 (3.3) | 424 (5.5) | 83 (1.1) | 29 (2.5) |
9 | Diabetes mellitus | 504 (3.3) | 274 (3.6) | 230 (3.1) | 34 (3.0) |
10 | Road traffic accidents | 459 (3.0) | 134 (1.7) | 326 (4.3) | 15 (1.3) |
11 | Alcohol use | 409 (2.7) | 386 (5.0) | 23 (0.3) | 1 (0.1) |
12 | Asthma | 362 (2.4) | 320 (4.2) | 42 (0.6) | 4 (0.3) |
13 | Congenital abnormalities | 352 (2.3) | 205 (2.7) | 147 (1.9) | 6 (0.5) |
14 | Cancer colon or rectum | 234 (1.5) | 38 (0.5) | 197 (2.6) | 31 (2.7) |
15 | Conditions arising during the perinatal period | 220 (1.4) | 16 (0.2) | 205 (2.7) | 6 (0.5) |
16 | Lower respiratory infections | 195 (1.3) | 10 (0.1) | 186 (2.5) | 46 (4.0) |
17 | PTSD | 194 (1.3) | 194 (2.5) | 0 (0.0) | 0 (0.0) |
18 | HIV/AIDS | 193 (1.3) | 49 (0.6) | 144 (1.9) | 6 (0.5) |
19 | Panic disorder | 182 (1.2) | 182 (2.4) | 0 (0.0) | 0 (0.0) |
20 | Bipolar disorder | 165 (1.1) | 165 (2.1) | 0 (0.0) | 0 (0.0) |
Total number for each measure in the top 20 causes | 9,074 (59.6) | 4,779 (62.1) | 4,294 (57.0) | 688 (59.7) | |
Total number for each measure | 15,230 (100) | 7,693 (100) | 7,537 (100) | 1,151 (100) |
The juxtaposition of the twenty leading causes of death, YLL, YLD and DALYs illustrates the extent to which an assessment of the relative importance of various causes based simply on total number of deaths differs from the assessment of leading causes of YLL, YLD and DALYs. For example, the total number of years lived with a disability resulting from unipolar major depression (1.3 million YLD) was equal to the number of years lost due to premature death from lung cancer (1.3 million YLL); and the burden resulting from osteoarthritis and motor vehicle accidents were similar (940.6 million YLD and 1 billion YLL respectively).
Osteoarthritis of the hip and knee (OA) and rheumatoid arthritis (RA) were the two leading musculoskeletal disorders. OA is an important public health problem that affects mostly older adults causing great pain and disability, and is one of the most rapidly growing causes of disability. The estimated 40 million prevalent cases in 1996 is projected to increase to 60 million cases by 2020 [22].
Substantial differences were found in the relative impact of individual conditions by gender and race. HIV/AIDS, alcohol dependence, as well as violent and unintentional injuries accounted for most of the worse health outcomes observed among Black and American Indian populations compared to White and Asian populations. Blacks fared much worse than the other race groups with regard to pregnancy outcomes. Blacks were the only group for which perinatal conditions ranked among the top ten causes of DALYs. Relatively high perinatal mortality rates persist in this population due to the combined effect of premature delivery and poor perinatal care.
Conditions associated with social issues in younger ages were much more common among Blacks and American Indians. For instance, YLL rates for HIV/AIDS were fivefold larger for Blacks than they were for any of the other races. YLL rates for homicide and violence were seven times higher for American Indians and twice as high for Blacks than they were for Whites and Asians.
One important objective of the study was to place the United States public health situation in a global context. Non-communicable diseases are the leading causes of deaths in all industrialized countries, where child and adult mortality are low. In developing regions, where child and adult mortality are still high, Group I represents a much larger share of the total. The dominance of HIV/AIDS observed in Blacks in the United States was akin to that in developing regions of the world. It was the third leading cause among black women in the US and the fifth leading cause among females in developing regions. HIV/AIDS accounted for a much smaller proportion of DALYs in other races in the US and did not figure among the top ten causes of DALYs in developed countries. Alcohol use for males in most racial subgroups in the United States exacted a high burden. This condition also ranked among the top five in other developed regions. Only Asian males and people living in developing countries did not have a large number of DALYs attributed to alcohol use.
US rankings clearly fell outside of the range observed elsewhere for a few causes: homicide and violence, HIV/AIDS, and perinatal conditions stand out regardless of race and gender. The United States has not been as successful in reducing the mortality burden due to violent injuries and perinatal conditions as were other industrialized countries with comparable levels of development.
In spite of the extensive population-based data available in the United States, there were limitations particularly in estimating disease burden by race due to smaller populations – Asians and American Indians. The major methodological limitations pertained to the different methods used to assign race and ethnicity in the census compared to death certificates; and to the limited population-based information that was available for many conditions for Asians and American Indians. For these last two groups, ratios of YLL to YLD for the overall US population were generally used to estimate the burden due to non-fatal health conditions. Such assumptions introduce a certain level of uncertainty in the estimates and call for caution in the interpretation of small absolute differences in the number of DALYs between different causes. This study provides a benchmark against which to assess future trends in health differentials in the United States and underscores the importance of further research to improve methods, provide stronger empirical evidence and better understanding of major risk factors for poor health outcomes.
Conclusion
This study provides a comprehensive picture of conditions that contribute most to poor health outcomes, and yields new evidence to the discussion of racial health inequalities in the United States. The existence of health inequalities is widely acknowledged and lies at the core of public health policy: reducing health inequalities is the major focus of Healthy People 2010 [23]. Previous studies have documented differentials in mortality by cause and have examined socio-economic determinants – income and education – of population health outcomes and health outcomes mediated through the health system: the utilization of health services, access, and quality of care [24–26].
The main policy message emerging from this study is that cost-effective public health interventions are available to reduce the burden of the three conditions that contributed most to racial inequalities. It adds new evidence that greater investments of public health interventions have a much greater potential to reduce large health inequalities in the United States than do technology driven curative interventions. The fact that other countries, which have lower expenditures per capita have achieved better health outcomes than the United States indicates that the major goal of reducing health disparities by 2010 can be achieved.
Declarations
Acknowledgements
We wish to acknowledge:
James S. Marks for initiating the study and for his support throughout the study; Lee Anneston, George Cauthen and Ted Thompson who developed estimates for selected causes; William Eaton, Charles Helmick, Ronald Kessler, Alan Lopez, Colin Mathers, Wayne Rosamond, Richard Seelik and Bedirhan Ustun who contributed invaluable technical guidance and critically reviewed estimates; Yuliya Popova and J.A. Kurichety who contributed to the preparation of the final document; Emmanuela Gakidou and Stanislava Nikolova who edited the final document.
Disclaimer: "The views and opinions in this report represent those of the authors and not the Centers for Disease Control and Prevention."
This study was funded by an Association of Schools of Public Health; ASPH/Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Cooperative Agreement. The funding source had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Authors’ Affiliations
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