TY - JOUR
T1 - Burden of disease scenarios by state in the USA, 2022–50
T2 - a forecasting analysis for the Global Burden of Disease Study 2021
AU - GBD 2021 US Burden of Disease and Forecasting Collaborators
AU - Mokdad, Ali H.
AU - Bisignano, Catherine
AU - Hsu, Johnathan M.
AU - Bryazka, Dana
AU - Cao, Shujin
AU - Bhattacharjee, Natalia V.
AU - Dalton, Bronte E.
AU - Lindstedt, Paulina A.
AU - Smith, Amanda E.
AU - Ababneh, Hazim S.
AU - Abbasgholizadeh, Rouzbeh
AU - Abdelkader, Atef
AU - Abdi, Parsa
AU - Abiodun, Olugbenga Olusola
AU - Aboagye, Richard Gyan
AU - Abukhadijah, Hana J.
AU - Abu-Zaid, Ahmed
AU - Acuna, Juan Manuel
AU - Addo, Isaac Yeboah
AU - Adekanmbi, Victor
AU - Adeyeoluwa, Temitayo Esther
AU - Adzigbli, Leticia Akua
AU - Afolabi, Aanuoluwapo Adeyimika
AU - Afrashteh, Fatemeh
AU - Agyemang-Duah, Williams
AU - Ahmad, Shahzaib
AU - Ahmadzade, Mohadese
AU - Ahmed, Ali
AU - Ahmed, Ayman
AU - Ahmed, Syed Anees
AU - Akkaif, Mohammed Ahmed
AU - Akkala, Sreelatha
AU - Akrami, Ashley E.
AU - Al Awaidy, Salah
AU - Al Hasan, Syed Mahfuz
AU - Al Ta'ani, Omar
AU - Al Zaabi, Omar Ali Mohammed
AU - Alahdab, Fares
AU - Al-Ajlouni, Yazan
AU - Al-Aly, Ziyad
AU - Alam, Manjurul
AU - Aldhaleei, Wafa A.
AU - Algammal, Abdelazeem M.
AU - Alhassan, Robert Kaba
AU - Ali, Mohammed Usman
AU - Ali, Rafat
AU - Ali, Waad
AU - Al-Ibraheem, Akram
AU - Almustanyir, Sami
AU - Alqahatni, Saleh A.
AU - Alrawashdeh, Ahmad
AU - Al-Rifai, Rami H.
AU - Alsabri, Mohammed A.
AU - Alshahrani, Najim Z.
AU - Al-Tawfiq, Jaffar A.
AU - Al-Wardat, Mohammad
AU - Aly, Hany
AU - Amindarolzarbi, Alireza
AU - Amiri, Sohrab
AU - Anil, Abhishek
AU - Anyasodor, Anayochukwu Edward
AU - Arabloo, Jalal
AU - Arafat, Mosab
AU - Aravkin, Aleksandr Y.
AU - Ardekani, Ali
AU - Areda, Demelash
AU - Asghariahmadabad, Mona
AU - Ayanore, Martin Amogre
AU - Ayyoubzadeh, Seyed Mohammad
AU - Azadnajafabad, Sina
AU - Azhar, Gulrez Shah
AU - Aziz, Shahkaar
AU - Azzam, Ahmed Y.
AU - Babu, Giridhara Rathnaiah
AU - Baghdadi, Soroush
AU - Bahreini, Razieh
AU - Bako, Abdulaziz T.
AU - Bärnighausen, Till Winfried
AU - Bastan, Mohammad Mahdi
AU - Basu, Sanjay
AU - Batra, Kavita
AU - Batra, Ravi
AU - Behnoush, Amir Hossein
AU - Bemanalizadeh, Maryam
AU - Benzian, Habib
AU - Bermudez, Amiel Nazer C.
AU - Bernstein, Robert S.
AU - Beyene, Kebede A.
AU - Bhagavathula, Akshaya Srikanth
AU - Bhala, Neeraj
AU - Bharadwaj, Ravi
AU - Bhargava, Ashish
AU - Bhaskar, Sonu
AU - Bhat, Vivek
AU - Bhuyan, Soumitra S.
AU - Bodunrin, Aadam Olalekan
AU - Boxe, Christopher
AU - Boyko, Edward J.
AU - Braithwaite, Dejana
AU - Brauer, Michael
AU - Bugiardini, Raffaele
AU - Bustanji, Yasser
AU - Butt, Zahid A.
AU - Caetano dos Santos, Florentino Luciano
AU - Capodici, Angelo
AU - Castaldelli-Maia, Joao Mauricio
AU - Cembranel, Francieli
AU - Cenko, Edina
AU - Cerin, Ester
AU - Chan, Jeffrey Shi Kai
AU - Chattu, Vijay Kumar
AU - Chaudhary, Anis Ahmad
AU - Chen, An Tian
AU - Chen, Guangjin
AU - Chi, Gerald
AU - Ching, Patrick R.
AU - Cho, Daniel Youngwhan
AU - Chong, Bryan
AU - Choudhari, Sonali Gajanan
AU - Chukwu, Isaac Sunday
AU - Chung, Erin
AU - Chung, Sheng Chia
AU - Coker, David C.
AU - Columbus, Alyssa
AU - Conde, Joao
AU - Cortese, Samuele
AU - Criqui, Michael H.
AU - Cruz-Martins, Natalia
AU - Dai, Xiaochen
AU - Dai, Zhaoli
AU - Damiani, Giovanni
AU - D'Anna, Lucio
AU - Daoud, Farah
AU - Darcho, Samuel Demissie
AU - Das, Saswati
AU - Dash, Nihar Ranjan
AU - Dashtkoohi, Mohadese
AU - Degenhardt, Louisa
AU - Des Jarlais, Don C.
AU - Desai, Hardik Dineshbhai
AU - Devanbu, Vinoth Gnana Chellaiyan
AU - Dewan, Syed Masudur Rahman
AU - Dhama, Kuldeep
AU - Dhulipala, Vishal R.
AU - Diaz, Luis Antonio Antonio
AU - Ding, Delaney D.
AU - Do, Thanh Chi
AU - Do, Thao Huynh Phuong
AU - Dongarwar, Deepa
AU - D'Oria, Mario
AU - Dorsey, E. Ray
AU - Doshi, Ojas Prakashbhai
AU - Douiri, Abdel
AU - Dowou, Robert Kokou
AU - Dube, John
AU - Dziedzic, Arkadiusz Marian
AU - E'mar, Abdel Rahman
AU - Ebrahimi, Alireza
AU - Ehrlich, Joshua R.R.
AU - Ekundayo, Temitope Cyrus
AU - El Bayoumy, Ibrahim Farahat
AU - Elhadi, Muhammed
AU - Elhadi, Yasir Ahmed Mohammed
AU - Eltaha, Chadi
AU - Etaee, Farshid
AU - Ezenwankwo, Elochukwu Fortune
AU - Fadaka, Adewale Oluwaseun
AU - Fagbule, Omotayo Francis
AU - Fahim, Ayesha
AU - Fallahpour, Mahshid
AU - Fazylov, Timur
AU - Feigin, Valery L.
AU - Feizkhah, Alireza
AU - Fekadu, Ginenus
AU - Ferreira, Nuno
AU - Fischer, Florian
AU - Gadanya, Muktar A.
AU - Ganesan, Balasankar
AU - Ganiyani, Mohammad Arfat
AU - Gao, Xiang
AU - Gebregergis, Miglas Welay
AU - Gebrehiwot, Mesfin
AU - Gholami, Ehsan
AU - Gholamrezanezhad, Ali
AU - Ghotbi, Elena
AU - Ghozy, Sherief
AU - Gillum, Richard F.
AU - Göbölös, Laszlo
AU - Goldust, Mohamad
AU - Golechha, Mahaveer
AU - Gouravani, Mahdi
AU - Grada, Ayman
AU - Grover, Ashna
AU - Guha, Avirup
AU - Guicciardi, Stefano
AU - Gupta, Rahul
AU - Gupta, Rajat Das
AU - Habibzadeh, Parham
AU - Haep, Nils
AU - Hajj Ali, Ali
AU - Haj-Mirzaian, Arvin
AU - Haq, Zaim Anan
AU - Hasaballah, Ahmed I.
AU - Hasan, Ikramul
AU - Hasan, Md Kamrul
AU - Hasan, S. M.Mahmudul
AU - Hasani, Hamidreza
AU - Hasnain, Md Saquib
AU - Havmoeller, Rasmus J.
AU - Hay, Simon I.
AU - He, Jiawei
AU - Hebert, Jeffrey J.
AU - Hemmati, Mehdi
AU - Hiraike, Yuta
AU - Hoan, Nguyen Quoc
AU - Horita, Nobuyuki
AU - Hosseinzadeh, Mehdi
AU - Hostiuc, Sorin
AU - Hu, Chengxi
AU - Huang, Junjie
AU - Hushmandi, Kiavash
AU - Hussain, M. Azhar
AU - Huynh, Hong Han
AU - Iftikhar, Pulwasha Maria
AU - Ikiroma, Adalia
AU - Islam, Md Rabiul
AU - Islam, Sheikh Mohammed Shariful
AU - Iyasu, Assefa N.
AU - Jacob, Louis
AU - Jairoun, Ammar Abdulrahman
AU - Jaka, Sanobar
AU - Jakovljevic, Mihajlo
AU - Jalilzadeh Yengejeh, Reza
AU - Jamil, Safayet
AU - Javaheri, Tahereh
AU - Jeswani, Bijay Mukesh
AU - Kalani, Rizwan
AU - Kamarajah, Sivesh Kathir
AU - Kamireddy, Arun
AU - Kanmodi, Kehinde Kazeem
AU - Kantar, Rami S.
AU - Karaye, Ibraheem M.
AU - Katamreddy, Adarsh
AU - Kazemi, Foad
AU - Kazemian, Sina
AU - Kempen, John H.
AU - Khamesipour, Faham
AU - Khan, Ajmal
AU - Pereira, Gavin
AU - Schlaich, Markus P.
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/12
Y1 - 2024/12
N2 - Background: The capacity to anticipate future health issues is important for both policy makers and practitioners in the USA, as such insights can facilitate effective planning, investment, and implementation strategies. Forecasting trends in disease and injury burden is not only crucial for policy makers but also garners substantial interest from the general populace and leads to a better-informed public. Through the integration of new data sources, the refinement of methodologies, and the inclusion of additional causes, we have improved our previous forecasting efforts within the scope of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to produce forecasts at the state and national levels for the USA under various possible scenarios. Methods: We developed a comprehensive framework for forecasting life expectancy, healthy life expectancy (HALE), cause-specific mortality, and disability-adjusted life-years (DALYs) due to 359 causes of disease and injury burden from 2022 to 2050 for the USA and all 50 states and Washington, DC. Using the GBD 2021 Future Health Scenarios modelling framework, we forecasted drivers of disease, demographic drivers, risk factors, temperature and particulate matter, mortality and years of life lost (YLL), population, and non-fatal burden. In addition to a reference scenario (representing the most probable future trajectory), we explored various future scenarios and their potential impacts over the next several decades on human health. These alternative scenarios comprised four risk elimination scenarios (including safer environment, improved behavioural and metabolic risks, improved childhood nutrition and vaccination, and a combined scenario) and three USA-specific scenarios based on risk exposure or attributable burden in the best-performing US states (improved high adult BMI and high fasting plasma glucose [FPG], improved smoking, and improved drug use [encompassing opioids, cocaine, amphetamine, and others]). Findings: Life expectancy in the USA is projected to increase from 78·3 years (95% uncertainty interval 78·1–78·5) in 2022 to 79·9 years (79·5–80·2) in 2035, and to 80·4 years (79·8–81·0) in 2050 for all sexes combined. This increase is forecasted to be modest compared with that in other countries around the world, resulting in the USA declining in global rank over the 2022–50 forecasted period among the 204 countries and territories in GBD, from 49th to 66th. There is projected to be a decline in female life expectancy in West Virginia between 1990 and 2050, and little change in Arkansas and Oklahoma. Additionally, after 2023, we projected almost no change in female life expectancy in many states, notably in Oklahoma, South Dakota, Utah, Iowa, Maine, and Wisconsin. Female HALE is projected to decline between 1990 and 2050 in 20 states and to remain unchanged in three others. Drug use disorders and low back pain are projected to be the leading Level 3 causes of age-standardised DALYs in 2050. The age-standardised DALY rate due to drug use disorders is projected to increase considerably between 2022 and 2050 (19·5% [6·9–34·1]). Our combined risk elimination scenario shows that the USA could gain 3·8 additional years (3·6–4·0) of life expectancy and 4·1 additional years (3·9–4·3) of HALE in 2050 versus the reference scenario. Using our USA-specific scenarios, we forecasted that the USA could gain 0·4 additional years (0·3–0·6) of life expectancy and 0·6 additional years (0·5–0·8) of HALE in 2050 under the improved drug use scenario relative to the reference scenario. Life expectancy and HALE are likewise projected to be 0·4–0·5 years higher in 2050 under the improved adult BMI and FPG and improved smoking scenarios compared with the reference scenario. However, the increases in these scenarios would not substantially improve the USA's global ranking in 2050 (from 66th of 204 in life expectancy in the reference scenario to 63rd–64th in each of the three USA-specific scenarios), indicating that the USA's best-performing states are still lagging behind other countries in their rank throughout the forecasted period. Regardless, an estimated 12·4 million (11·3–13·5) deaths could be averted between 2022 and 2050 if the USA were to follow the combined scenario trajectory rather than the reference scenario. There would also be 1·4 million (0·7–2·2) fewer deaths over the 28-year forecasted period with improved adult BMI and FPG, 2·1 million (1·3–2·9) fewer deaths with improved exposure to smoking, and 1·2 million (0·9–1·5) fewer deaths with lower rates of drug use deaths. Interpretation: Our findings highlight the alarming trajectory of health challenges in the USA, which, if left unaddressed, could lead to a reversal of the health progress made over the past three decades for some US states and a decline in global health standing for all states. The evidence from our alternative scenarios along with other published studies suggests that through collaborative, evidence-based strategies, there are opportunities to change the trajectory of health outcomes in the USA, such as by investing in scientific innovation, health-care access, preventive health care, risk exposure reduction, and education. Our forecasts clearly show that the time to act is now, as the future of the country's health and wellbeing—as well as its prosperity and leadership position in science and innovation—are at stake. Funding: Bill & Melinda Gates Foundation.
AB - Background: The capacity to anticipate future health issues is important for both policy makers and practitioners in the USA, as such insights can facilitate effective planning, investment, and implementation strategies. Forecasting trends in disease and injury burden is not only crucial for policy makers but also garners substantial interest from the general populace and leads to a better-informed public. Through the integration of new data sources, the refinement of methodologies, and the inclusion of additional causes, we have improved our previous forecasting efforts within the scope of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to produce forecasts at the state and national levels for the USA under various possible scenarios. Methods: We developed a comprehensive framework for forecasting life expectancy, healthy life expectancy (HALE), cause-specific mortality, and disability-adjusted life-years (DALYs) due to 359 causes of disease and injury burden from 2022 to 2050 for the USA and all 50 states and Washington, DC. Using the GBD 2021 Future Health Scenarios modelling framework, we forecasted drivers of disease, demographic drivers, risk factors, temperature and particulate matter, mortality and years of life lost (YLL), population, and non-fatal burden. In addition to a reference scenario (representing the most probable future trajectory), we explored various future scenarios and their potential impacts over the next several decades on human health. These alternative scenarios comprised four risk elimination scenarios (including safer environment, improved behavioural and metabolic risks, improved childhood nutrition and vaccination, and a combined scenario) and three USA-specific scenarios based on risk exposure or attributable burden in the best-performing US states (improved high adult BMI and high fasting plasma glucose [FPG], improved smoking, and improved drug use [encompassing opioids, cocaine, amphetamine, and others]). Findings: Life expectancy in the USA is projected to increase from 78·3 years (95% uncertainty interval 78·1–78·5) in 2022 to 79·9 years (79·5–80·2) in 2035, and to 80·4 years (79·8–81·0) in 2050 for all sexes combined. This increase is forecasted to be modest compared with that in other countries around the world, resulting in the USA declining in global rank over the 2022–50 forecasted period among the 204 countries and territories in GBD, from 49th to 66th. There is projected to be a decline in female life expectancy in West Virginia between 1990 and 2050, and little change in Arkansas and Oklahoma. Additionally, after 2023, we projected almost no change in female life expectancy in many states, notably in Oklahoma, South Dakota, Utah, Iowa, Maine, and Wisconsin. Female HALE is projected to decline between 1990 and 2050 in 20 states and to remain unchanged in three others. Drug use disorders and low back pain are projected to be the leading Level 3 causes of age-standardised DALYs in 2050. The age-standardised DALY rate due to drug use disorders is projected to increase considerably between 2022 and 2050 (19·5% [6·9–34·1]). Our combined risk elimination scenario shows that the USA could gain 3·8 additional years (3·6–4·0) of life expectancy and 4·1 additional years (3·9–4·3) of HALE in 2050 versus the reference scenario. Using our USA-specific scenarios, we forecasted that the USA could gain 0·4 additional years (0·3–0·6) of life expectancy and 0·6 additional years (0·5–0·8) of HALE in 2050 under the improved drug use scenario relative to the reference scenario. Life expectancy and HALE are likewise projected to be 0·4–0·5 years higher in 2050 under the improved adult BMI and FPG and improved smoking scenarios compared with the reference scenario. However, the increases in these scenarios would not substantially improve the USA's global ranking in 2050 (from 66th of 204 in life expectancy in the reference scenario to 63rd–64th in each of the three USA-specific scenarios), indicating that the USA's best-performing states are still lagging behind other countries in their rank throughout the forecasted period. Regardless, an estimated 12·4 million (11·3–13·5) deaths could be averted between 2022 and 2050 if the USA were to follow the combined scenario trajectory rather than the reference scenario. There would also be 1·4 million (0·7–2·2) fewer deaths over the 28-year forecasted period with improved adult BMI and FPG, 2·1 million (1·3–2·9) fewer deaths with improved exposure to smoking, and 1·2 million (0·9–1·5) fewer deaths with lower rates of drug use deaths. Interpretation: Our findings highlight the alarming trajectory of health challenges in the USA, which, if left unaddressed, could lead to a reversal of the health progress made over the past three decades for some US states and a decline in global health standing for all states. The evidence from our alternative scenarios along with other published studies suggests that through collaborative, evidence-based strategies, there are opportunities to change the trajectory of health outcomes in the USA, such as by investing in scientific innovation, health-care access, preventive health care, risk exposure reduction, and education. Our forecasts clearly show that the time to act is now, as the future of the country's health and wellbeing—as well as its prosperity and leadership position in science and innovation—are at stake. Funding: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85210667166&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(24)02246-3
DO - 10.1016/S0140-6736(24)02246-3
M3 - Article
C2 - 39645377
AN - SCOPUS:85210667166
SN - 0140-6736
VL - 404
SP - 2341
EP - 2370
JO - The Lancet
JF - The Lancet
IS - 10469
ER -