Dietary risks are leading cause of disease burden in the US and contributed to more health loss in 2010 than smoking, high blood pressure, and high blood sugar

Published July 10, 2013

In nearly every major cause of premature death – from ischemic heart disease to diabetes to interpersonal violence – the United States trails its economic peers, according to new research from a global collaborative of scientists led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Mental conditions, substance abuse, and musculoskeletal disorders cause more disability than cancers. Diet, blood pressure, smoking top risk factors for poor health.

July 10, 2013 — According to new research from a global collaborative of scientists led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, poor diet and inadequate physical activity are two of the driving forces behind our nation’s health.  

The top 10 risk factors for health loss in 2010 and the number of deaths attributable to each were:

Dietary risks678,282
High blood pressure442,656
High body mass index363,991
Physical inactivity234,022
High blood sugar213,669
High total cholesterol158,431
Ambient air pollution103,027
Alcohol use88,587
Drug use25,430

“If the US can make progress with dietary risk factors, physical activity, and obesity, it will see massive reductions in death and disability,” said Dr. Ali Mokdad, head of the US County Health Performance team for IHME and former director of the Behavior Risk Factors and Surveillance Survey at the US Centers for Disease Control and Prevention. “Unhealthy diets and a lack of physical activity in the US cause more health loss than alcohol or drug use.”

The findings will be presented today by Dr. Christopher Murray, IHME Director and one of the lead authors on the study at an event for mayors and other local officials hosted by First Lady Michelle Obama as part of the Let’s Move! Cities, Towns, and Counties anniversary convening.

In a study published in the Journal of the American Medical Association today – “The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors” – researchers show the impact of premature deaths in children and young adults, the significant toll of disabling conditions, and the overall burden on health systems from a range of fatal and non-fatal health factors. This is the first comprehensive analysis of disease burden in the United States in more than 15 years. It includes estimates for death and disability from 291 diseases, conditions, and injuries as well as 67 risk factors.

To explore the trends for the United States in depth, go to our Global Burden of Disease visualization page and search for the US in any of our tools:

“The U.S., particularly in certain communities, has shown what it can do about addressing risk factors such as smoking, and if we can see that same type of energy put into dietary risk factors, physical inactivity and other key areas of concern, we will see real progress in health outcomes,”  Dr. Murray said.

To see county-by-county assessments of life expectancy, physical activity, obesity, and blood pressure, go to:

Additional findings show that road traffic injuries, self-harm, cirrhosis, and drug use disorders all are causing more years of life lost due to premature death than previously thought. There were more years of life lost due to drug use disorders in 2010 than prostate cancer and ovarian cancer combined, up 448% between 1990 and 2010. Alzheimer’s, liver cancer, Parkinson’s disease, and kidney cancer also are rising rapidly as causes of premature death.

The report also shows that there has been a steady shift since 1990 from conditions that shorten life to chronic disability from mental and behavioral disorders, musculoskeletal problems, and neurological conditions. Chronic disability in 2010 now accounts for nearly half of all health loss in the US. 

Mental and behavioral disorders alone make up 27% of what researchers call “years lived with disability,” meaning the time spent in less than optimal health. The biggest contributors are depression, anxiety disorders, drug use disorders, and alcohol use disorders.

“The United States has spent a good amount of time and money on finding successful solutions for cardiovascular diseases and even some cancers, but like a lot of countries, it still needs to make that same kind of effort with these leading causes of disability,” said Dr. Alan Lopez, Chair of Global Health and Burden of Disease Measurement in the School of Population and Global Health at the University of Melbourne in Australia and one of the study’s authors. 

Overall disease burden in the United States is now dominated by conditions that are more disabling than fatal. The burdens from ischemic heart disease, lower respiratory infections, HIV/AIDS, and preterm birth complications are all falling, while the burdens from depression, low back and neck pain, and diabetes are rising. In 2010, the top 10 causes of disability-adjusted life years (DALYs), which measure health loss, were:

Ischemic heart disease9.6%
Chronic obstructive pulmonary disease4.7%
Low back pain3.9%
Lung cancer3.7%
Major depressive disorder3.7%
Other musculoskeletal disorders3.5%
Road injury2.8%
Drug use disorders2.6%


The United States has made significant health improvements over the past two decades, but there is still much work to be done. Specific US improvements include:

  • Lower disease burden rates since 1990 of many childhood diseases and conditions, including a dramatic reduction in sudden infant death syndrome (SIDS). 
  • Lower mortality rates for people at every age since 1990.
  • Significant reductions in death and disability from HIV/AIDS.

Click here to download a list of major risk factors and their definitions.

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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