Impact of Preventable Diseases Varies Widely by State, Study Finds

 Tala Salem

The burden of disease can vary significantly at the state level, according to a study published this week in JAMA. The study details the extent of those differences and what causes them in terms of risk factors, diseases and injuries.

The study, which examined health indicators across states from 1990 to 2016, found overall death rates in the United States declined from approximately 745 deaths per 100,000 persons to 578 deaths over that time period. However, within the U.S., health disparities have increased with time in some states and counties, according to Dr. Christopher Murray, the study's lead author.

"The nature of what we're seeing is not explained by one thing," Murray says. "The main drivers are, on the one hand, the rise of obesity, and that's important because it's driving up diabetes. The other factor is the rise of drug use in certain states and that's driving up opioid prescriptions."

Life expectancy was an area with great discrepancy among states, according to the study. In 2016, Hawaii had the highest life expectancy at birth at 81.3 years, while Mississippi had the lowest at 74.7 years.

Researchers analyzed probabilities of death among three different age groups over the 27-year period: 0 to 20 years, 20 to 55 years and 55 to 90 years. In both children and adolescents 20 and under and adults 55 and over, all 50 states experienced a decline in the probabilities people within those age ranges would die.

However, for the middle age group, there was substantial divergence among states. The largest reductions in probability of death for people aged 20 to 55 years were observed in New York and California at 3.5 and 2.5 point declines, respectively. On the other hand, the highest increases were observed in West Virginia, at 2.6 points, and Oklahoma at 2 points.

During the 27-year period studied, the probability of death from birth to age 20 declined in all states, according to the study. The states with the highest declines were South Carolina, Georgia, Alaska and New York, each with a 0.9 percent decrease. Meanwhile, Maine had the lowest decline of probability with a 0.3 percent decrease in child mortality.

All states experienced the highest reduction in probabilities of death for people aged 55 to 90 years, largely associated with reductions in deaths from cardiovascular diseases. The highest decline was observed in California at 12.6 points, compared with the lowest decline of 3.5 points for Mississippi.

The best measures used to identify the healthiest states in the study were life expectancy and healthy life expectancy at birth, Murray says.

"The top slot for life expectancy is Minnesota, Hawaii is in the second slot, followed by California," Murray says. "I think it's pretty interesting because 25 years ago, California was in the middle (in terms of life expectancy rankings), so they're doing really well. Minnesota is also interesting because its neighboring states don't do as well."

Overall, from 1990 to 2016, ischemic heart disease was the top cause of years of life lost in the U.S., with lung cancer ranking second at each end of the time frame consistently. High body mass index, smoking and high fasting plasma glucose are the three most important risk factors in the U.S., according to the study. Although smoking as a risk factor has decreased, BMI and fasting plasma glucose increased sharply.

Although general life expectancy in the U.S. has increased, the study's findings point to a need to address pressing issues like mental health disabilities and drug use disorders. Specifically, opioid disorders rose from the 52nd to the 15th-leading cause of years of life lost between 1990 and 2016.

Given the discrepancies in disease and life expectancy at the state level, Murray says policymakers must take action to alleviate prevalent risk factors that exacerbate these divergences.

"One thing is for people in each state, and ideally even more local communities, to be aware of the trends in their communities," Murray says. "That way, NGOs and local health planners can focus on the biggest problems in their communities. A big thing is awareness of where you live."

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Tala Salem
20 May, 2018