Comparative Disease Burden and Trends in the United States

Critics of the United States’ health system delight in making comparisons to cost and quality measures in other developed countries.  But as a recent Kaiser Family Foundation post makes clear, these comparisons aren’t appropriate without taking into account certain cultural, demographic, economic and other factors in the United States and comparator countries.  These factors have led to a greater disease burden in the US.   (KFF Blog Post)   The analysis uses the “diseases adjusted life year” metric, which includes years lost to premature death and productive life years lost to disease and disability.  In absolute terms, in 2010 the US was 21956 DALYs per 100,000 population, the highest by a significant margin among the comparator nations.  The UK was second at 20384 and Japan was way down at 15922.  The average was 19071.

All the developed countries in the analysis have seen an improvement in this measure from 1990 to 2010, by an average of 18% fewer DALYs (not including the US), but America lagged with only a 14% decline.  Germany, for example, had a much higher 23% decrease.  Almost all of the decline over this time period in the US came from decreases in premature deaths.  In 2010 in the United States the diseases contributing most to DALYs are mental health, circulatory, cancer and musculoskeletal.  In 1990, circulatory was first and injuries were in the top group of causes.  For women, mental health issues are the leading cause of DALYs and for men circulatory conditions are.  What the post reveals is that there have been significant improvements in disease treatment and avoidance of unnecessary deaths in the US over the last two decades, but we still have a higher burden of disease.  Since our burden of disease is almost 40% higher than Japan’s, we might expect our health spending to be at least that much greater.  If we want lower health spending in the US, what we really need to tackle are the underlying causes of poor health.