Top 7 most debilitating diseases in the US

By Naveed Saleh, MD, MS
Published November 6, 2020

Key Takeaways

As every physician knows, nothing is more valuable than health. Good health, however, can be undermined by disease and disability.

The impact of disability associated with disease can be quantified using a metric called disability-adjusted life years (DALYs). DALYs represent years lost to illness, disability, or premature death, and are calculated by adding the number of years of lost life to the number of years lived with disability secondary to an illness.

The WHO, which helped develop the DALY metric in 1992 along with the World Bank and the Harvard School of Public Health, offers this explanation of the DALYs: “The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.”

DALYs play an important role in public health by enabling a comparison of disease burden in a population, or across populations, and by helping to guide priorities for resource allocation, research, and more, according to the CDC.

The following are the top seven disease classes in the United States associated with the highest DALY measures in 2015 (the latest US-specific available data), according to an analysis of GBD study data by the Kaiser Family Foundation. 

7. Neurological diseases

DALYs rate per 100,000: 1,463

Neurological diseases affect an estimated 100 million Americans a year. The most common forms cost the United States a whopping $789 billion in 2014, according to a study commissioned by the American Neurological Association (ANA). The ANA estimated that the costs of dementia and stroke alone will amount to $600 billion by 2030.

Curiously, the large financial investments made into heart disease and cancer research starting in the 1970s have led to longer life—and that translates to an increase in the number of elderly people in the general population who are at risk for neurological disorders. 

Experts call for a much larger investment into neurology research akin to the $1.8 billion “Moonshot” that Congress approved in 2016 for cancer research.

"Neurological research, like cancer, needs its own 'Moonshot' to focus substantial research investment on the neurological diseases that are impacting the mortality and quality of life of more and more Americans every year," said Clifton L. Gooch, MD, former ANA marketing committee and public advocacy committee chair. 

6. Endocrine disorders

DALYs rate per 100,000: 1,827

This category of disabling conditions covers a swath of pathology, most notably metabolic disease

Unfortunately, the incidence of metabolic syndrome in the United States is on the rise, according to research published in Preventing Chronic Disease. In the study, the researchers mined data from the National Health and Nutrition Examination Survey from 1988 to 2012. They defined metabolic syndrome as the presence of at least three of the following: greater waist circumference, higher lipid levels, decreased high-density lipoprotein cholesterol levels, elevated blood pressure, and increased fasting blood sugars.

The investigators found that the prevalence of metabolic syndrome increased between 1988 to 2012 for every socio-demographic group, with more than a third of all American adults meeting criteria. Specifically, the prevalence of metabolic syndrome rose from 25.3% between 1988 and 1994, to 34.2% between 2007 and 2012.

“[E]fforts to increase awareness of prevention strategies must begin early, ideally when any 1 of the constituent components (eg, obesity) is present, before the development of all 3 components required for the formal definition of metabolic syndrome,” the authors wrote.

The researchers observed a strong link between low socioeconomic status and metabolic syndrome. In looking to decrease the prevalence of this disorder, they noted, lessons can be learned from public health strategies already recognized as key to prevention of chronic disease. These include increasing access to fresh fruits and vegetables—rather than fast foods—in poorer neighborhoods, “which are often food deserts and heavily targeted by purveyors of fat-dense and calorie-dense but nutritionally poor foods,” they wrote. Other public health strategies for chronic disease prevention include expanding access to safe, walkable places to engage in physical activity, and improving access to affordable healthcare, such as through the Affordable Care Act’s Medicaid expansion program, to ensure timely treatment, they concluded.

5. Musculoskeletal disorders

DALYs rate per 100,000 population: 2,357 

When compared with the gross domestic product (GDP), the costs of musculoskeletal disease are staggering, according to the United States Bone and Joint Initiative. Between 1996 and 1998, the GDP rose 32% from $11.5 trillion to $15.2 trillion, whereas direct and indirect costs of musculoskeletal conditions rose from $396.1 billion to $873.8 billion in the same period, or a rise of 121%. In other words, the rise in costs associated with musculoskeletal disorders was nearly four times more than the increase in GDP.

“To provide a basis for comparison, the economy is said to be in a recession when GDP declines by at least 1% for two or more consecutive quarters. Accordingly, the aggregate economic impact of the medical expenditures attributable to persons with musculoskeletal diseases is far in excess of the amount used to define a recession and, unlike a recession, occurs in perpetuity,” they wrote.

Musculoskeletal conditions and injuries limit mobility and dexterity, thus resulting in early retirement, decreases in wealth, and limited social interaction. Notably, the lion’s share of non-cancer persistent pain conditions is due to musculoskeletal conditions. Musculoskeletal conditions are common in multimorbidity states, and occur in one-third to one-half of all people with several medical conditions, including the elderly.

Lower back pain is the single leading cause of disability worldwide. Fortunately, certain exercises can help strengthen the back to curb risk of these debilitating conditions. Here are some tips from the US Department of Health and Human Services.

  • Stand and sit up straight

  • Engage in back-strengthening/stretching exercises at least twice a week 

  • Avoid heavy lifting; but if lifting is necessary, keep the back straight while bending at the knees

  • Maintain a healthy weight and diet

4. Injury

DALYs rate per 100,000 population: 2,419

Every year in the US, millions survive injury, with 2.5 million hospitalized and 26.9 million treated in the emergency department. Many who survive injury deal with lifelong medical and psychiatric issues, as well as financial distress. The cost of injury in both medical bills and lost wages was $671 billion in 2013. According to the CDC, falls and motor vehicle accidents topped the list of top 10 causes of death in the US last year.

The CDC offers the following tips for injury prevention: 

  • Wear activity-appropriate helmets

  • Wear a life jacket

  • Receive vision checks

  • Clear the home of tripping hazards

  • Take swim lessons

  • Place medications out of the reach of children

  • Take drugs only as prescribed

  • Secure children in booster/car seats

  • Buckle up

  • Choose the sidewalk over the road when walking

3. Circulatory diseases

DALYs rate per 100,000 population: 3,065

In the United States, about 1.5 million heart attacks and strokes occur each year, with these two problems costing an estimated $316.6 billion in healthcare costs and lost productivity in 2011. In addition to death, stroke can lead to paralysis, speech difficulties, and emotional problems. Heart attack can result in fatigue and depression, and can make it difficult to perform physical activities. Moreover, families of those experiencing stroke and heart attack deal with mounds of medical bills, lost wages, and decreased standard of living. 

Keeping a healthy diet, maintaining a healthy weight, keeping lipid levels in check, and treating metabolic disease can all help prevent heart disease. Other interventions include curbing stress and getting more sleep.

As advised by the NIH, “Stress is linked to heart disease in many ways. It can raise your blood pressure. Extreme stress can be a ‘trigger’ for a heart attack. Also, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are bad for your heart. Some ways to help manage your stress include exercise, listening to music, focusing on something calm or peaceful, and meditating.”

With respect to sleep, the NIH advocates for the following, “If you don't get enough sleep, you raise your risk of high blood pressure, obesity, and diabetes. Those three things can raise your risk for heart disease. Most adults need 7 to 9 hours of sleep per night. Make sure that you have good sleep habits.”

In particular, the experts warn about the dangers of sleep apnea as a risk factor for heart disease, and encourage participating in sleep studies as needed.

2. Cancers and tumors

DALYs rate per 100,000 population: 3,131

The incidence of cancer cases among Americans in 2019 was estimated to be approximately 1.8 million, with deaths amounting to 606,880, according to research cited by the American Cancer Society. In 2015, the costs of cancer in the US was $80.2 billion, with ambulatory care accounting for 52% of this total, and inpatient care, 38%. The costs of cancer care are compounded by lack of insurance, with the uninsured more likely to be diagnosed at later stages of cancer. Moreover, at these later stages, treatment is less successful and more extensive. In 2016, 98% of the US population, or 28 million people, were uninsured

Disability associated with cancer varies widely, according to an article published in the Journal of Oncology Navigation & Survivorship. Between 5% and 99% of cancer patients experience some form of related disability, with between 10% and 38% having difficulties with activities of daily living.

Certain steps can be taken to decrease cancer risk, including a number that are often overlooked, such as radon testing, vegetable consumption, decreased intake of grilled meats, and sunscreen use.

1. Mental health disorders and substance misuse

DALYs rate per 100,000 population: 3,355

An estimated 18.1%, or 43.6 million American adults, experience mental illness, with 4.2% suffering from the most debilitating forms. 

“Mental health and physical health are closely connected,” according to the US Department of Health and Human Services. “Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery.” 

The brain is ineffably complex, nevertheless, over the past 20 years, our knowledge of its workings has progressed through research, and prevention of mental illness has become a focus. 

Here are some key takeaways regarding preventive interventions:

  • The greatest opportunity for prevention is among young people

  • Multiple preventive interventions can combine to reduce the burden of substance misuse, conduct disorder, antisocial behavior, child maltreatment, and aggression by many years

  • Potential preventive interventions exist for schizophrenia.

  • School-based interventions that focus on social/emotional outcomes enhance academic outcomes

  • Early adulthood mental-health interventions can have benefits that outweigh costs

  • The frequency of depression among adolescents and pregnant women can be reduced

Importantly, the implementation of preventive strategies is complex, and it is important that such strategies fit the target patient population.

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