Americans are living longer, but that longevity includes more aches, pains, and disability compared with comparably wealthy nations, a study of population health in 34 countries found.
The overall life expectancy in the U.S. increased from 75 to 78 years during the period of 1990 to 2010, but with an increase in expected years lost to disability (9.4 to 10.1 years), according to Christopher Murray, MD, DPhil, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.
Compared with other countries, the U.S. dropped in its rankings in terms of life expectancy at birth (going from No. 20 to No. 27), life years lost to premature death (moving from 23rd to 28th), healthy life expectancy (jumping from 14th on the list to 26th), and age-standardized death rate (18th to 27th) between 1990 and 2010, they wrote in the study published in the July 10 issue of the Journal of the American Medical Association
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"Despite a level of health expenditures that would have seemed unthinkable a generation ago, the health of the U.S. population has improved only gradually and has fallen behind the pace of progress in many other wealthy nations," Harvey Fineberg, MD, PhD, president of the Institute of Medicine, wrote in an accompanying editorial.
The U.S. also lost a little ground in years living with disability, moving from fifth to sixth out of 34 comparable countries.
Only Japan (No. 1), Mexico, (2), South Korea (3), Spain (4), and Chile (5) scored a better rank for people living with disability.
Low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders -- in that order -- are the five conditions topping the disability list of 30 items. That ranking did not change from 1990 to 2010.
Here's how other major disabilities placed: diabetes (8th on the list), asthma (10th), Alzheimer's disease (12th), ischemic heart disease (16th), stroke (17th), diarrheal diseases (29th), and epilepsy (30th).
The U.S. saw declines of 5 to 9 ranks in various mortality-based metrics, while other countries with a lower gross domestic product -- such as Chile, Portugal, and South Korea -- had better mortality-based metrics than the U.S.
Murray's research team consisted of 488 scientists from 50 countries who quantified the health loss from 291 diseases and injuries, 1,160 clinical sequelae, and 67 risk factors from 1990 to 2010 for 34 countries.
"This is the first comprehensive box score of American health that's ever been published," JAMA
Editor-in-Chief Howard Bauchner, MD, said at a press conference Wednesday, calling the study a "landmark paper."
The researchers hope the report -- called the Global Burden of Disease 2010 -- can outline which diseases, injuries, and risk factors result in the greatest losses of health and life to better target public health and medical care.
To that end, the study found heart disease -- despite significant gains in reduced mortality -- was still the leading cause of reducing life years in 2010. Lung cancer, stroke, chronic obstructive pulmonary disease, and road injuries such as motor vehicle crashes followed suit.
Rates of premature death increased for drug use, chronic kidney disease, kidney cancer, and diabetes -- which jumped from the 15th to 7th leading cause of life years lost. Alzheimer's disease moved from 32th to 9th in premature death.
"As the U.S. population has aged, years lived with disability have comprised a larger share of disability-adjusted life-years than have [years of life lost to premature death]," the authors wrote.
They found avoidable risk factors -- such as poor diet, tobacco and alcohol use, obesity, high blood pressure, high blood sugar, and physical inactivity -- contributed greatly to the rising disease burden.
In an accompanying report, researchers provided county-by-county breakdowns of some of their U.S. data.
They found that physical activity increased, but, in contrast, obesity rates rose. In fact, obesity declined in only nine U.S. counties between 2001 and 2009, and none were statistically significant.
"There's also a role for enhanced primary care with management of blood pressure, cholesterol, and encouragement of physical activity," Murray said.
The life expectancy in women worsened or remained static in nearly 40% of U.S. counties compared with only 5% for men -- a finding Murray couldn't explain.
First Lady Michelle Obama was set to host a briefing at the White House Wednesday afternoon with mayors and other local leaders to raise awareness about the findings.
Fineberg -- who noted a number of limitations in his editorial such as over simplifying the complexity of issues like obesity and social determinants of health -- called on local leaders to take an initiative on making their communities healthier.
