What do we know about the burden of disease in the U.S.?


This chart collection explores trends in the burden of disease in the U.S. and comparable countries. Disease burden (measured in disability adjusted life years, or DALYs) is a measure that takes into account years of life lost due to premature death as well as years of productive life lost to poor health or disability. While disease burden has declined in the U.S. and comparable countries since 1990, the U.S. continues to have higher age-adjusted disease burden rates than comparable countries. We define comparable countries as those that are similarly sizable and wealthy.

Lower rates of premature death have driven reduction in disease burden in the U.S., after adjusting for age


A Disability Adjusted Life Year (DALY) is a measure of burden of disease that takes into account years of life lost due to premature death as well as years of productive life lost to poor health or disability. For a given population, DALYs are calculated by summing the Years of Life Lost (YLL) prematurely and weighted Years Lived with Disability (YLD). Improvements in the U.S.’s age-standardized disease burden (DALY) rate since 1995 have largely come from improvements in premature death (years of life lost), as opposed to improvements in the years lived with disability.

Disease burden is higher in the U.S. than in comparable countries


Though DALYs have declined in the U.S. and comparable countries since 1995, the U.S. continues to have higher age-adjusted rates of years of life lost to disability and premature death than comparable countries.

Though disease burden is decreasing in the U.S. and other countries, the gap has widened slightly


Since 1990, the age-adjusted burden of disease (DALY) rate has dropped by 16%, while comparable countries have seen an average decrease of 24% (ranging from a 20% decline in Canada and Japan to a 28% drop in Switzerland).

Cancer and circulatory diseases are the leading causes of death in the U.S.


In the U.S. in 2015, the leading causes of death were circulatory diseases and cancers. When analyzing health outcomes, we often look at mortality rates. However, as a measure of the health of the population, mortality statistics only tell us about diseases that can lead to death and do not show the burden of disease that arises from disabilities that may not ultimately cause death. Mortality rates also do not account for age at the time of death.

Mental health disorders are the leading cause of disease burden in the U.S.


When the burden of disease is defined more broadly to include disability as well as mortality, mental health and substance use disorders emerge as the leading causes of DALYs in the U.S., in addition to circulatory conditions and cancer.

Mental health and musculoskeletal disorders are the leading causes of years lost to disability in the U.S.


In the U.S. in 2015, the leading causes of years lived with disability (YLD) were mental health conditions and musculoskeletal disorders. This represents one part of the DALY calculation, and is a product of the number of cases of illnesses and the duration of the illness before it resolves or leads to death. YLDs account for the severity of the disability, and are typically weighted so that young adult ages are valued higher than infants or the very elderly.

Cancer and circulatory diseases are the leading causes of years of life lost in the U.S.


The leading causes of years of life lost (YLL) in the U.S. are cancers, circulatory conditions, and injuries. In addition to years lived with disability (YLD), the calculation of DALYs also involves calculating years of life lost (YLL), a measure of premature death. YLL is a product of the number of deaths and life expectancy at age of death.

U.S. disease burden has decreased in past 25 years for circulatory, cancer, and injuries


Over time, the diseases that cause the most DALYs in the U.S. have changed. In 1990, circulatory illnesses were the leading cause, but have since declined significantly, particularly driven by a reduction in the years of life lost from coronary heart disease (which includes angina and heart attack). DALYs caused by injuries have also decreased significantly since 1990, as have DALYs from cancers. 

 

Other countries have seen improvement in similar areas as U.S., but some at faster rates


Since 1990, the age-adjusted burden of disease (DALY) rate caused by circulatory conditions has dropped by 40% in the U.S., while the rate in comparable countries has dropped by 51% on average. Circulatory diseases are the leading cause of death and the third-leading cause of DALYs in the U.S., so improvements in these conditions can have a significant effect on the overall disease burden and death rates. However, the U.S. saw the slowest improvement of any comparable country relative to 1990, and as of 2015 has the highest rate of disease burden caused by circulatory conditions among these countries.

Disease burden rates caused by cancer, though, have dropped at larger rates in the U.S. (down 23%) relative to other comparable countries (which ranged from a decrease of 16% in France to a decrease of 26% in Switzerland).

For males, disease burden most caused by circulatory diseases; for females, mental health is leading cause


Although mental health and substance abuse conditions are among the leading contributors to DALYs for both sexes, males have higher rates of disease burden caused by circulatory diseases, cancers and tumors, and injuries.