• US Burden of Disease Collaborators, Ali H Mokdad, Katherine Ballestros, Michelle Echko, Scott Glenn, Helen E Olsen, Erin Mullany, Alex Lee, Abdur Rahman Khan, Alireza Ahmadi, Alize J Ferrari, Amir Kasaeian, Andrea Werdecker, Austin Carter, Ben Zipkin, Benn Sartorius, Berrin Serdar, Bryan L Sykes, Chris Troeger, Christina Fitzmaurice, Colin D Rehm, Damian Santomauro, Daniel Kim, Danny Colombara, David C Schwebel, Derrick Tsoi, Dhaval Kolte, Elaine Nsoesie, Emma Nichols, Eyal Oren, Fiona J Charlson, George C Patton, Gregory A Roth, H Dean Hosgood, Harvey A Whiteford, Hmwe Kyu, Holly E Erskine, Hsiang Huang, Ira Martopullo, Jasvinder A Singh, Jean B Nachega, Juan R Sanabria, Kaja Abbas, Kanyin Ong, Karen Tabb, Kristopher J Krohn, Leslie Cornaby, Louisa Degenhardt, Mark Moses, Maryam Farvid, Max Griswold, Michael Criqui, Michelle Bell, Minh Nguyen, Mitch Wallin, Mojde Mirarefin, Mostafa Qorbani, Mustafa Younis, Nancy Fullman, Patrick Liu, Paul Briant, Philimon Gona, Rasmus Havmoller, Ricky Leung, Ruth Kimokoti, Shahrzad Bazargan-Hejazi, Simon I Hay, Simon Yadgir, Stan Biryukov, Stein Emil Vollset, Tahiya Alam, Tahvi Frank, Talha Farid, Ted Miller, Theo Vos, Till Bärnighausen, Tsegaye Telwelde Gebrehiwot, Yuichiro Yano, Ziyad Al-Aly, Alem Mehari, Alexis Handal, Amit Kandel, Ben Anderson, Brian Biroscak, Dariush Mozaffarian, E Ray Dorsey, Eric L Ding, Eun-Kee Park, Gregory Wagner, Guoqing Hu, Honglei Chen, Jacob E Sunshine, Jagdish Khubchandani, Janet Leasher, Janni Leung, Joshua Salomon, Jurgen Unutzer, Leah Cahill, Leslie Cooper, Masako Horino, Michael Brauer, Nicholas Breitborde, Peter Hotez, Roman Topor-Madry, Samir Soneji, Saverio Stranges, Spencer James, Stephen Amrock, Sudha Jayaraman, Tejas Patel, Tomi Akinyemiju, Vegard Skirbekk, Yohannes Kinfu, Zulfiqar Bhutta, Jost B Jonas, and MurrayChristopher J LCJLInstitute for Health Metrics and Evaluation, University of Washington, Seattle..
• Institute for Health Metrics and Evaluation, University of Washington, Seattle.
• JAMA. 2018 Apr 10; 319 (14): 144414721444-1472.

IntroductionSeveral studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.ObjectiveTo use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.Design And SettingA systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.Main Outcomes And MeasuresPrevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.ResultsBetween 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).Conclusions And RelevanceThere are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

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