The relative health burden of selected social and behavioral risk factors in the United States: implications for policy.

Publisher: American Public Health Association Country of Publication: United States NLM ID: 1254074 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1541-0048 (Electronic) Linking ISSN: 00900036 NLM ISO Abbreviation: Am J Public Health Subsets: MEDLINE

Publication: Washington, DC : American Public Health Association
Original Publication: New York [etc.]

Quality-Adjusted Life Years*; Ethnicity/*statistics & numerical data ; Insurance, Health/*statistics & numerical data; Alcohol Drinking/epidemiology ; Body Mass Index ; Educational Status ; Health Expenditures/statistics & numerical data ; Health Policy ; Humans ; Income/statistics & numerical data ; Markov Chains ; Risk Factors ; Smoking/epidemiology ; United States/epidemiology

Objectives: We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States.
Methods: Using data from the 1997-2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996-2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost.
Results: Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI=159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health.
Conclusions: Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.

JAMA. 1999 Oct 27;282(16):1530-8. (PMID: 10546692)
Am J Public Health. 2007 Nov;97(11):2020-7. (PMID: 17901430)
N Engl J Med. 2007 Jul 26;357(4):370-9. (PMID: 17652652)
Public Health Rep. 1992 Jul-Aug;107(4):457-61. (PMID: 1641443)
Ann N Y Acad Sci. 1999;896:173-88. (PMID: 10681897)
Soc Sci Med. 2007 Apr;64(7):1355-62. (PMID: 17208343)
N Engl J Med. 1997 Dec 25;337(26):1889-95. (PMID: 9407157)
Health Aff (Millwood). 2002 Mar-Apr;21(2):13-30. (PMID: 11900153)
N Engl J Med. 1999 Feb 4;340(5):403-8. (PMID: 9929536)
Soc Sci Med. 2006 May;62(10):2469-78. (PMID: 16303221)
Eur Heart J. 2002 Nov;23(22):1727-8. (PMID: 12419288)
Biometrics. 1980 Jun;36(2):299-305. (PMID: 7407317)
Ann Intern Med. 2004 Oct 19;141(8):635-8. (PMID: 15492343)
J Gen Intern Med. 2008 May;23(5):672-7. (PMID: 18214626)
JAMA. 2003 Jan 8;289(2):187-93. (PMID: 12517229)
Health Aff (Millwood). 2002 Mar-Apr;21(2):48-59. (PMID: 11900186)
N Engl J Med. 2008 May 22;358(21):2249-58. (PMID: 18499567)
Soc Sci Med. 2005 Nov;61(9):2018-26. (PMID: 15913866)
JAMA. 1993 Nov 10;270(18):2207-12. (PMID: 8411605)
J Health Care Poor Underserved. 2008 May;19(2):574-9. (PMID: 18469427)
Med Care. 2005 Mar;43(3):203-20. (PMID: 15725977)
Am J Public Health. 2006 Sep;96(9):1662-8. (PMID: 16873748)
JAMA. 1998 Jun 3;279(21):1703-8. (PMID: 9624022)
J Health Soc Behav. 1995;Spec No:80-94. (PMID: 7560851)
JAMA. 2004 Mar 10;291(10):1238-45. (PMID: 15010446)
N Engl J Med. 1977 Mar 31;296(13):716-21. (PMID: 402576)
Br Med J. 1976 Dec 25;2(6051):1525-36. (PMID: 1009386)
J Epidemiol Community Health. 2003 Apr;57(4):254-8. (PMID: 12646539)
Ann N Y Acad Sci. 1999;896:3-15. (PMID: 10681884)
Health Policy. 1990 Dec;16(3):199-208. (PMID: 10109801)
Lancet. 1997 May 24;349(9064):1498-504. (PMID: 9167458)
Am J Prev Med. 2005 Jan;28(1):59-64. (PMID: 15626556)
Am J Public Health. 2009 Aug;99(8):1431-7. (PMID: 19542034)

Date Created: 20091219 Date Completed: 20100914 Latest Revision: 20211203

20250114

PMC2920959

10.2105/AJPH.2009.165019

20019300