Nonfatal diseases including depression and diabetes pose an increasing threat to health in the US

Since 1990, diabetes and Alzheimer’s disease have replaced asthma and falls as leading causes of years lived with disability, or YLDs, for women; diabetes now ranks higher for men.

SEATTLE – People across the US are living longer but spending more time in ill health as rates of nonfatal diseases and injuries – including low back pain, major depressive disorder, and diabetes – decline more slowly than death rates, according to a new analysis of 301 acute and chronic diseases and injuries in 188 countries.

Years lived with disability (YLDs) quantifies the impact of health problems that impair mobility, hearing, or vision, or cause pain in some way but aren’t fatal. In 2013, diabetes, neck pain, and age-related and other hearing loss were among the 10 leading causes of YLDs in the US. Other leading causes included anxiety disorders, migraine, and chronic obstructive pulmonary disease. For both sexes combined, the leading causes of years lived with disability have remained largely the same during this time period, but they take an increased toll on health due to population growth and aging. 

For women in the US, diabetes and Alzheimer’s have replaced asthma and falls as leading causes of years lived with disability. Between 1990 and 2013, YLDs from diabetes increased by 112%, and Alzheimer’s YLDs increased by 58%. Migraine had the smallest percent increase in YLDs at 15%. 

Diabetes YLDs also increased for men in the US between 1990 and 2013, climbing 182%. Other musculoskeletal disorders – which include shoulder injuries and fractures from osteoporosis – increased by 70%, and anxiety disorders had some of the lowest percent increases in YLDs at 29%.

 “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013” is the first study to examine the extent, pattern, and trends of nonfatal health loss across countries. Published in The Lancet on June 8, 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. 

“The impact of nonfatal illnesses and injuries in the US has often been overlooked,” said Professor Theo Vos of IHME, lead author of the study. “The US has made great progress in addressing fatal diseases but must step up efforts to address these disabling conditions.”

Between 1990 and 2013, YLDs increased globally from 537.6 million in 1990 to 764.8 million in 2013 for both sexes. Men and women around the world share the same leading causes of YLDs, with the exception of schizophrenia as a leading cause for men and other musculoskeletal disorders for women. Musculoskeletal disorders, mental and substance use disorders, neurological disorders, and chronic respiratory conditions were the main drivers of YLDs in 2013. The disease burdens of both low back pain and depression have increased more than 50% since 1990. 

Researchers found that as people aged they experienced a greater number of ailments resulting from nonfatal diseases and injuries. Many people also suffered from multiple conditions at the same time. The number of people who suffered from 10 or more ailments increased by 52% in developed countries. And it’s not just the elderly who are affected. Although the impact of YLDs increases with age, of the 2.3 billion people who suffered from more than five ailments, 81% of them were younger than 65 years old.

A relatively small number of diseases have a massive impact, researchers found. Just two acute diseases – affecting people for less than three months – caused more than 20 billion new cases of disease globally in 2013: upper respiratory infections (18.8 billion) and diarrheal diseases (2.7 billion). And just eight causes of chronic diseases – affecting people for three months or longer – impacted more than 10% of the world’s population. These included tension-type headaches and iron-deficiency anemia. 

In 2013, war and conflict was a leading cause of YLDs in several countries as well, including El Salvador, Guatemala, Lebanon, Peru, and Syria. In three countries – Cambodia, Nicaragua, and Rwanda – war was the top cause of years lived with disability. Other notable causes of YLDs in different regions included falls (Central Europe), asthma (a top-10 cause in many Latin American countries), and opioid dependence (a top-five cause in several Middle Eastern countries). Nonfatal conditions are not yet becoming the dominant source of disease burden in sub-Saharan Africa as they are in other parts of the world, but their impact has grown since 1990.

“What ails you isn’t necessarily what kills you,” said IHME Director Dr. Christopher Murray. “As nonfatal illnesses and related ailments affect more people of all ages, countries must look closely at health policy and spending to target these conditions.”

Leading causes of YLDs in the United States for both sexes, 2013

Leading causes of YLDs in the United States for men, 2013

Leading causes of YLDS in the United States for women, 2013

Download the study at: http://www.healthdata.org/research-article/global-regional-and-national-incidence-prevalence-and-years-lived-disability-2013.

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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