JAMA report finds wide health variations by state
A new JAMA report found huge differences among states in diseases, injuries and health risk factors.
The study authors said the variation in health outcomes and morbidity and mortality drivers shows the need for “greater investment in preventive and medical care across the life course.”
They added that data should inform national health priorities and the “intersection of risk, mortality and morbidity” by geographic area needs further study at the state level.
The study measured death rates, life expectancy, healthy life expectancy, years of life lost due to premature death, years lived with disability and disability-adjusted life-years (DALYs), which are the number of years lost due to ill health, disability or early death. They reviewed that data for 333 causes and 84 risk factors between 1990 and 2016.
The authors found that overall death rates declined in that time period from 745 per 100,000 people to 578 per 100,000. The probability of death among adults aged 20 and 55 years old declined in 31 states and Washington, D.C.
However, there were wide variations by state. Hawaii had the highest life expectancy at birth in 2016 (81.3 years) while Mississippi had the lowest (74.7 years). Minnesota had the highest healthy life expectancy (70.3 years) and West Virginia had the lowest (63.8 years).
The report found the leading causes of DALYs were ischemic heart disease and lung cancer. Opioid use disorders moved up from 11th cause of DALYs in 1990 to seventh in 2016 — a 75% increase. Tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose and high blood pressure each accounted for more than 5% of risk-attributable DALYs in 2016.
Top risk factors for DALYs were one of three causes: tobacco consumption (32 states), high BMI (10 states) or alcohol and drug use (eight states).
In a JAMA editorial about the report, Dr. Howard Koh of the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School and Dr. Anand Parekh of the Bipartisan Policy Center in Washington said the findings expand “societal understanding of U.S. health trends, not only over time but also by geography.”
The editorial pointed to the need to address the social determinants of health (SDoH), such as poverty, substandard housing and low educational attainment. “The United States, among the wealthiest but far from the healthiest in the world, ranks 43rd in life expectancy despite the highest per capita health spending rates. This disconnect, in turn, highlights US underspending on social services (relative to medical services) compared with peer countries,” they wrote.
Healthcare organizations and providers are increasingly turning to SDoH as a way to improve health. A recent Georgetown University Health Policy Institute brief highlighted how addressing SDoH can lower healthcare costs, improve health outcomes and reduce health disparities.
Another recent report by National Quality Forum suggested that Medicaid could play a key role in addressing social determinants. The report also created a plan that makes state Medicaid programs hubs that support the healthcare system in addressing SDoH. This program could allow state Medicaid programs to “better assess and address social needs in healthcare,” NQF said.