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Smoking, high blood pressure, high body mass index are top risks associated with American deaths; health loss attributable to high fasting plasma glucose increases in the US 

SEATTLE — Fewer Americans are dying from diseases attributable to high systolic blood pressure and high total cholesterol, but more lives are being claimed by ailments associated with high body mass index, high fasting plasma glucose, and smoking, according to a new analysis of 79 risks in 188 countries.

Smoking was the number-one individual risk factor associated with US deaths in 2013 – up from number two in 1990 – contributing to 443,824 American deaths. This increase was largely fueled by changing patterns of behavior among American women. Smoking’s impact on women’s mortality grew by 26.3% between 1990 and 2013, while it essentially remained stagnant for men. Smoking was associated with the deaths of 193,578 American women in 2013.

In all, avoidable risk factors were tied to 30.8 million deaths worldwide in 2013. The top risks associated with the deaths of both men and women around the world are high blood pressure, smoking, high body mass index, and high fasting plasma glucose. The greatest cumulative impact on health comes from poor diet. A combination of 14 dietary risk factors contribute to the highest number of deaths worldwide through ailments like ischemic heart disease, stroke, and diabetes. In 2013, 21% of total deaths in the US were attributed to the full set of dietary risks, including diets low in fruit, whole grains, and vegetables, and diets high in red meat and sugar-sweetened beverages.

“Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013,” examines the extent, pattern, and trends of risk factors’ contributions to death and health loss across countries. Published in The Lancet on September 11, the study was conducted by an international consortium of researchers working on the Global Burden of Disease project and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

On a global level, the impact of all risk factors has increased since 1990, with high body mass index, high fasting plasma glucose, and high systolic blood pressure rising significantly. All three risks are strongly associated with cardiovascular diseases and diabetes. In the US, the increasing effects of high body mass index and high fasting glucose have been pronounced, growing by 29.5% and 22.1%, respectively. At the same time, high blood pressure has decreased by 7.5% and high total cholesterol has gone down by 32.1%, bucking global trends. Americans are also grappling with leading risk factors such as low physical activity that are not among the top-10 global risks.

“Many of the leading causes of death in the US are preventable,” said Dr. Ali Mokdad, Professor of Global Health at IHME and an author of the study. “It is important to remember that we need to focus on preventing these risk factors such as smoking, obesity, poor diet.”

The study examines which risk factors contribute to health loss as well as death. Researchers use DALYs, or disability-adjusted life years, to measure health loss. One DALY equals one lost year of healthy life and is measured by the sum of years of life lost to early death and years lived with disability.

High fasting plasma glucose is among the leading risk factors that have contributed to health loss in the US, up 40.8% for both since 1990, and up slightly higher for American men during that time period (44.6%) and slightly lower for women in the US (35.3%).

The leading risk factors associated with health loss in the US in 2013 were high body mass index, smoking, and high blood pressure. While these were also the top three risk factors in 1990, their rankings have shuffled, with high body mass index’s impact on health loss increasing by 43%, smoking’s growing by just 3.2% (fueled by increases among females), and high systolic blood pressure’s decreasing by 7.6%.

The US is part of a global landscape with tremendous regional variations. In much of the Middle East and Latin America, high body mass index is the number one risk associated with health loss. In South and Southeast Asia, household air pollution is a leading risk, and India also grapples with high risks of unsafe water and childhood undernutrition. Alcohol is the number-two risk in Russia, and smoking is the number-one risk in many high-income countries, including the United Kingdom. The most marked differences are found in sub-Saharan Africa, which unlike other regions is dominated by a deadly combination of childhood undernutrition, unsafe water and sanitation, unsafe sex, and alcohol use.

The study includes several risk factors – wasting, stunting, unsafe sex, no hand-washing with soap – in its analysis for the first time. Another first is the factoring of HIV into the calculation of intimate partner violence. Unsafe sex took a huge toll on global health, contributing to 82.3% of HIV/AIDS deaths, and 94% of HIV/AIDS deaths among 15-19 year olds in 2013. The global burden of unsafe sex grew from 1990 and peaked in 2005.

“There’s great potential to improve health by avoiding certain risks like smoking and poor diet as well as tackling environmental risks like air pollution,” said IHME Director Dr. Christopher Murray. “The challenge for policymakers will be to use what we know to guide prevention efforts and health policies.”

Risks associated with the highest number of deaths in the US for both sexes, 2013

1

Smoking

2

High systolic blood pressure

3

High body mass index

4

High fasting plasma glucose

5

High total cholesterol

6

Low physical activity

7

Low glomerular filtration rate

8

Diet low in fruits

9

Diet high in sodium

10

Alcohol use

Risks associated with the highest number of deaths in the US for men, 2013

1

Smoking

2

High systolic blood pressure

3

High body mass index

4

High fasting plasma glucose

5

High total cholesterol

6

Low physical activity

7

Alcohol use

8

Diet low in fruits

9

Diet high in sodium

10

Low glomerular filtration rate

Risks associated with the highest number of deaths in the US for women, 2013

1

High systolic blood pressure

2

Smoking

3

High body mass index

4

High fasting plasma glucose

5

High total cholesterol

6

Low physical activity

7

Low glomerular filtration rate

8

Diet high in sodium

9

Diet low in fruits

10

Diet low in vegetables

Download the study abstract at http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-188-countries-2013.

The full study is available by contacting the Lancet press office at [email protected].

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.
 

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