The state of US health, 1990-2010: burden of diseases, injuries, and risk factors

Published July 10, 2013, in Journal of the American Medical Association (opens in a new window)


To better inform national health policy, it is critical to understand the major health problems in the United States and how they are changing over time. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), researchers compared health outcomes in the US with those of the 34 countries in the Organization for Economic Co-operation and Development (OECD).

Analytical approach

GBD 2010 was a systematic analysis of 291 different causes of premature death and disability across 187 countries, 20 age groups, and both sexes for the period from 1990 to 2010. It generated nearly 1 billion estimates of health outcomes, and provided an in-depth view of population health at the country, regional, and global levels. Its results are presented in terms of metrics that were specifically developed to assess the burden of disease: disability-adjusted life years (DALYs), a time-based measure that combines years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs).


In the most recent two decades, life expectancy in the US, for both sexes combined, increased from 75.2 years in 1990 to 78.2 years in 2010. During that same period, healthy life expectancy, or HALE, which is the number of years that a person can expect to live in good health, increased from 65.8 to 68.1 years. Compared to the 34 countries in the OECD, the US performed relatively well in terms of YLDs, with a rank of fifth in 1990 and sixth in 2010. When using mortality-based metrics, however, researchers determined that the US rank declined to 27th or 28th between 1990 and 2010 in relation to the OECD countries. Citizens living in countries with substantially lower gross domestic product and health expenditure per capita, such as Chile, Portugal, Slovenia, and South Korea, had lower mortality rates than those in the US in 2010. Higher mortality and lower disability rates in the US resulted in a comparatively poor rank of 26th in terms of HALE compared to OECD countries.


The US made notable progress in improving health in the two decades from 1990 to 2010. Two key indicators – life expectancy at birth and healthy life expectancy, or HALE – have improved. All-cause death rates at all ages, however, and age-specific rates of years lived with disability, or YLDs, have remained stable during the same period. In a marked shift, non-fatal disease and disability accounted for almost half of all health burden in the US in 2010. Despite progress in extending lifespans, population health in the US has not kept pace with advances in other wealthy countries.
Click here to download a list of major risk factors and their definitions.
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Murray CJL, Abraham J, Ali MK, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors [published online July 10, 2013]. Journal of the American Medical Association. DOI: 10.1001/jama.2013.13805.


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