Research

The burden of disease and injury in the United States 1996

Catherine M Michaud¹ , Matthew T McKenna² , Stephen Begg³ , Niels Tomijima⁴ , Meghna Majmudar⁵ , Maria T Bulzacchelli⁶ , Shahul Ebrahim² , Majid Ezzati¹ , Joshua A Salomon¹ , Jessica Gaber Kreiser , Mollie Hogan³ and Christopher JL Murray¹

¹  Harvard Initiative for Global Health, Harvard University, 104 Mt Auburn Street, Cambridge, MA 02138, USA

²  Centers for Disease Control and Prevention,1600 Clifton Road MS E-47, Atlanta, Georgia 30333, USA

³  School of Population Health, The University of Queensland, Brisbane, Australia

⁴  Columbia University in the City of New York, 2960 Broadway, New York, NY 10027-6902, USA

⁵  Haas School of Business, 545 Student Services #1900, University of California, Berkeley, CA 94720-1900, USA

⁶  Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA

author email corresponding author email

Population Health Metrics 2006, 4:11doi:10.1186/1478-7954-4-11

Published:	18 October 2006

Abstract

Background

Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context.

Methods

We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world.

Results

In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.

Conclusion

Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.