Acomparative study of U.S. population health, hailed by JAMA as having landmark status, demonstrated that despite significant improvements on several fronts, the United States is falling behind most industrialized nations in terms of life expectancy and other critical health measures.

The study used data from the massive Global Burden of Disease (GBD) effort, which quantified disease burden (morbidity and mortality data) in 187 countries from 1990 to 2010. The GBD 2010 Study was a collaborative effort of 488 scientists who analyzed data on 291 diseases and injuries, 1,160 sequelae of these conditions, and 67 risk factors or clusters of risk factors. The primary metrics used included life expectancy at birth, age-standardized years lived with disability (YLD), age-standardized years of life lost prematurely to disease (YLL), and healthy life expectancy (HALE).

Significant improvements in U.S. health included an increase in overall life expectancy from 75.2 years to 78.2 years. HALE increased from 65.8 years to 68.1 years, rates of death from all causes decreased, and the number of YLD remained stable.

In contrast, however, among the 34 countries that make up the Organisation for Economic Co-operation and Development, the United States fell from 18th to 27th in age-standardized mortality, from fifth to sixth in YLD, from 20th to 27th in life expectancy at birth, from 23rd to 28th in YLL, and from 14th to 26th in HALE.

The study identified several areas that can more easily be addressed in efforts to reduce U.S. mortality, including ischemic heart disease, lung cancer, and "road injury" (vehicle and pedestrian injury). The areas showing the greatest promise for decreasing U.S. morbidity, according to the report, are body mass index, tobacco use, dietary risks, alcohol use, and high fasting glucose levels.

The study shows that, "as the population ages, chronic conditions and disability account for nearly half of the U.S. health burden," says Linda C. Baumann, professor emerita at the University of Wisconsin-Madison School of Nursing. Baumann points out that the best outcome of chronic disease management isn't necessarily cure but improved quality of life, and that "nurses are the health professionals best suited to provide this care."

But improving outcomes goes beyond care delivery, says Baumann. Nurses can advocate policies that strengthen public health and address chronic disease management and risk factor prevention.-David Carter

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