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What I have been reading: Burden of Diseases (2018)

Recently, JAMA published a thought provoking article concerning the "State of US Health, 1990-2016. In other words, what has been happening overall in the US to health over the last 16 years. One must consider this in perspective that the US has the most expensive health care in the world, costing roughly twice as much as any similar large country, mainly due to drug costs and insurance where the "sky is the limit".

The good news is that mortality has been declining over these 16 years -- from 745/100K to 578/100K. As everybody has to die sometimes, one would think that this statistic would reflect that people are living longer.

The disturbing thing is that the distribution of deaths is uneven. People in Hawaii and Minnesota live the longest, while people in Mississippi and West Virginia appear to be the quickest to die.

This article also discussed disability-adjusted-life-years -- basically impairments to life. The main cause of DALYS is heart disease and lung cancer, followed by low back pain. Disability from diabetes has increased considerably between 2016 and 1990. DALYS from Opiod use disorders, falls and Alzheimer's have increased, relatively to HIV and motor vehicle injuries, which have greatly decreased.

Risk factors for deaths are the usual ones -- diet, tobacco, and blood pressure. There are a large number of risk factors related to diet as well including high BMI, high glucose, high cholesterol. So these are deaths that have to do with life choices. Although the there is considerable media exposure about deaths from overdoses, these are far down the list. Basically, modifiable risk appears to be mainly eating too much, smoking too much, ignoring high blood pressure, and ignoring diabetes. I guess people make choices.

The lesson that I take from this paper is that as a physician, paying attention and commenting on patient's diet, tobacco use, blood pressure, and diabetes may have a much bigger impact than care for the patient's presenting problem.


  • The State of US Health, 1990-2016... US Burden of Disease Collaborators. JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158


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