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Preventable risk factors cut life short in US

Smoking, high blood pressure, high blood sugar, and being overweight drive disparities in health outcomes

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March 23, 2010–Life expectancy in the US is shortened by more than four years because of preventable risk factors such as smoking and being overweight, according to a new study by researchers at the Institute for Health Metrics and Evaluation (IHME) and the Harvard School of Public Health.

In the first nationwide study to look at the effects on life expectancy of smoking, high blood pressure, high blood glucose, and being overweight, researchers estimate that those risk factors cut life expectancy by 4.9 years in men and 4.1 years in women.

The study appears in the March 23, 2010, issue of the journal PLoS Medicine.

When looking at eight subgroups of the US population – known as the Eight Americas – researchers found that these risk factors account for 20% of the disparities in health outcomes overall. These four factors also accounted for three-quarters of disparities in cardiovascular mortality and up to half of disparities in cancer mortality.

The Eight Americas are defined by race, county location, and the socioeconomic features of each county. Southern rural blacks had the largest loss of life expectancy at 6.7 years for men and 5.7 years for women. Asians had the smallest drop in life expectancy – 4.1 years for men and 3.6 years for women.

“If we could find local approaches to target some of these risk factors that took into account race and economics, we could have an enormous impact,” said Dr. Christopher Murray, IHME Director and a co-author of the study.

Murray and the other researchers used 2005 data from the National Center for Health Statistics, the National Health and Nutrition Examination Survey, the Behavioral Risk Factor Surveillance System, and an extensive review of epidemiologic studies on the effects of these factors. They compiled a list of the number of years that would be gained in life expectancy in the US if each risk factor were reduced to its optimal level:

• Blood pressure: 1.5 years (men), 1.6 years (women)
• Obesity (measured by body mass index): 1.3 years (men), 1.3 years (women)
• Blood glucose: 0.5 years (men), 0.3 years (women)
• Smoking: 2.5 years (men), 1.8 years (women)

Within the Eight Americas subgroups, researchers found that ethnicity and where people live are predictors of life expectancy and of specific risk factors:

• Asian American men and women had the lowest body mass index (BMI), blood glucose levels, and prevalence of smoking.
• Blacks, especially those in the rural South, had the highest blood pressure.
• Whites had the lowest blood pressure.
• Western Native American men and Southern low-income rural black women had the highest BMI.
• Western Native American and low-income whites in Appalachia and the Mississippi Valley had the highest prevalence of smoking.

“It’s important that public health policymakers understand that these behavioral and metabolic risk factors are not just personal choices or the responsibility of doctors,” said Dr. Goodarz Danaei, a postdoctoral research fellow at Harvard and the lead author of the study. “To improve the nation’s overall health and reduce health disparities, both population-based and personal interventions that reduce these preventable risk factors must be identified, implemented, and rigorously evaluated.”

This research was supported by a cooperative agreement from the US Centers for Disease Control and Prevention through the Association of Schools of Public Health.

Full Citation: Danaei G, Rimm EB, Oza S, Kulkarni C, Murray CJL, Ezzati M. The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States. PLoS Medicine. 2010 Mar 23; 7(3):e1000248.

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