Cleaveland: A national survey on disease and disability

Cleaveland: A national survey on disease and disability

May 29th, 2018 by Dr. Clif Cleaveland in Life Entertainment

A report card on the nation's health from 1990 to 2016 was reported in last month's Journal of the American Medical Association (doi:101001/jama/2018.0158). Although the nation's overall health improved in that 26-year interval, some states lagged far behind the rest of the country, and some worrisome trends are evident.

Dr. Clif Cleaveland

Dr. Clif Cleaveland

Photo by Contributed Photo /Times Free Press.

The Global Burden of Disease study (GBD) analyzes masses of data from multiple sources to assess the state of the nation's health. From the data, increased threats to the nation's health can be identified and, hopefully, addressed. Legislators, political leaders and public-health officials should read this study.

» Life and death: Average life expectancy at birth increased during the interval from 75.5 to 78.9 years. The death rate per 100,000 population decreased from 745.2 in 1990 to 578 in 2016. The probability of death from birth to age 20 declined in all states and Washington, D.C. The probability of death for ages 20 to 55 actually increased in 21 states. In five states — Kentucky, New Mexico, Oklahoma, West Virginia and Wyoming — the mortality probability for this age group increased by more than 10 percent. Drug abuse, cirrhosis of the liver and self-harm account for much of the increase.

» Healthy life expectancy: The GBD study assesses healthy life expectancy (HALE) — years before disabling illness or injury. For 2016, the U.S. average is 67.7 years. Minnesota has the highest HALE at 70.3 years, compared to West Virginia's lowest HALE of 63.8 years. The HALE for Tennessee in 2016 is 66.9 years, ranking 45th among the states.

» Premature death: Another prominent feature of the GBD study is the calculation of years of life lost due to premature deaths. Ischemic heart disease, cancer of trachea, bronchus and lung, emphysema, Alzheimer and other dementias, and colon-rectal cancer topped the list of causes of premature death in 2016. Opioid-use disorders rose from 52nd in 1990 to 15th place (18,200 deaths) in 2016. Self-harm by firearms rose slightly from 14th to 13th place. Other violence from firearms fell from 15th to 18th place. Deaths related to firearms totaled 34.1 thousand in 1990 vs. 36.2 thousand in 2016.

» Disabilities: Disability adjusted life-years (DALYs) is a calculation of the number of years lived with a disability. The five leading causes for DALYs in 2016 were low back pain, major depression, diabetes mellitus, other musculoskeletal disorders and migraine. Each of the following disorders accounted for 5 percent or more of DALYs: tobacco use, obesity, poor diet, alcohol and/or illicit drug use and elevated fasting blood glucose. The incidence of all but tobacco use had increased from 1990 to 2016.

» Lowest rankings: Ten states in the GBD study had poor outcomes by most measurements of health. In order of worsening health, they are: New Mexico, South Carolina, Tennessee, Kentucky, Arkansas, Oklahoma, Louisiana, Alabama, West Virginia and Mississippi.

» Underlying causes: For all states, the top three factors undermining health were tobacco use, obesity and alcohol and illicit drug use. All three can be addressed by aggressive public-health campaigns. Tobacco remains a major risk factor for lung and other cancer and emphysema. Obesity raises the risks for Type 2 diabetes, cancer, sleep apnea and degenerative arthritis. Sudden death, accidents, violent behavior and, in the case of drugs, infections related to dirty needles are the consequence of substance abuse.

Public health is seldom mentioned in political campaigns. Prospects for a brighter, more prosperous future will be undermined for a growing number of Americans unless worsening health is addressed at all levels of government and society.

Next week: State and local variations in health.

Clif Cleaveland, M.D., is a retired internist and former president of the American College of Physicians. Email him at ccleaveland@timesfreepress.com.

Getting Started/Comments Policy

Getting started

  1. 1. If you frequently comment on news websites then you may already have a Disqus account. If so, click the "Login" button at the top right of the comment widget and choose whether you'd rather log in with Facebook, Twitter, Google, or a Disqus account.
  2. 2. If you've forgotten your password, Disqus will email you a link that will allow you to create a new one. Easy!
  3. 3. If you're not a member yet, Disqus will go ahead and register you. It's seamless and takes about 10 seconds.
  4. 4. To register, either go through the login process or just click in the box that says "join the discussion," type your comment, and either choose a social media platform to log you in or create a Disqus account with your email address.
  5. 5. If you use Twitter, Facebook or Google to log in, you will need to stay logged into that platform in order to comment. If you create a Disqus account instead, you'll need to remember your Disqus password. Either way, you can change your display name if you'd rather not show off your real name.
  6. 6. Don't be a huge jerk or do anything illegal, and you'll be fine.

Chattanooga Times Free Press Comments Policy

The Chattanooga Times Free Press web sites include interactive areas in which users can express opinions and share ideas and information. We cannot and do not monitor all of the material submitted to the website. Additionally, we do not control, and are not responsible for, content submitted by users. By using the web sites, you may be exposed to content that you may find offensive, indecent, inaccurate, misleading, or otherwise objectionable. You agree that you must evaluate, and bear all risks associated with, the use of the Times Free Press web sites and any content on the Times Free Press web sites, including, but not limited to, whether you should rely on such content. Notwithstanding the foregoing, you acknowledge that we shall have the right (but not the obligation) to review any content that you have submitted to the Times Free Press, and to reject, delete, disable, or remove any content that we determine, in our sole discretion, (a) does not comply with the terms and conditions of this agreement; (b) might violate any law, infringe upon the rights of third parties, or subject us to liability for any reason; or (c) might adversely affect our public image, reputation or goodwill. Moreover, we reserve the right to reject, delete, disable, or remove any content at any time, for the reasons set forth above, for any other reason, or for no reason. If you believe that any content on any of the Times Free Press websites infringes upon any copyrights that you own, please contact us pursuant to the procedures outlined in the Digital Millennium Copyright Act (Title 17 U.S.C. § 512) at the following address:

Copyright Agent
The Chattanooga Times Free Press
400 East 11th Street
Chattanooga, TN 37403
Phone: 423-757-6315
Email: webeditor@timesfreepress.com