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BMC Geriatrics

, 19:100 | Cite as

The burden of health conditions for middle-aged and older adults in the United States: disability-adjusted life years

  • Ryan McGrathEmail author
  • Soham Al Snih
  • Kyriakos Markides
  • Orman Hall
  • Mark Peterson
Open Access
Research article
Part of the following topical collections:
  1. Public health, nutrition and epidemiology

Abstract

Background

Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.

Methods

Data from the 1998–2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.

Results

There were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined over the study period.

Conclusions

The burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.

Keywords

Normative aging Epidemiology Longevity Morbidity 

Abbreviations

COPD

Chronic Obstructive Pulmonary Disease

DALY

Disability-Adjusted Life Year

HRS

Health and Retirement Study

YLD

Years Lived with Disease

YLL

Years of Life Lost

Background

Increased age is a hallmark risk factor for several health conditions [1]. Although approximately 86% of older adults in the United States are living with at least one health condition [2], life expectancy in the United States has generally continued to increase [3]. The advancements in life expectancy have been attributed to many factors including improvements in the prevention and treatment of morbidity. Given that the older adult population is projected to grow 112% by the year 2060 [4], healthcare providers and policy makers need to continue accommodating the emerging health demands of this population for helping them live longer, and with more quality years. For example, public health programs have been developed for improving the wellbeing and longevity of aging adults. Healthy People 2020 and 2030 includes initiatives to prevent morbidity, improve quality of care, and delay mortality for older adults in the United States [5].

Disability-adjusted life years (DALYs) are used globally to quantify the number of healthy years of life lost from the presence of a disease, disability, or injury [6]. The burden of chronic, non-fatal health loss and early mortality is evaluated separately and compared across populations. Information for DALYs in the United States and globally is often provided in Global Burden of Disease studies [7]. Such information is used to inform healthcare providers about the impact of a health condition and guide interventions seeking to improve the health and life expectancy of a given population [8]. Being that this time-based metric measures the burden of a health condition in a population and compares to a healthy population that reaches full life expectancy, the specific burden of common health conditions for middle-aged and older adults in the United States has yet to be calculated.

More studies are needed for understanding how aging is linked with disease [1]. Calculating the years lived with a disease (YLDs) and years of life lost (YLLs) from premature mortality will provide insights into the burden of common health conditions for the growing aging adult population. This information can help to identify which health conditions contribute most to the number of healthy years of life lost for aging adults, thereby informing how healthcare providers and interventions prioritize treatment and prevention efforts. Such prioritization will help to guide health policy, and increase the quality of life and longevity for aging adults. Therefore, the purpose of this study was to determine the burden of 10 common health conditions for a nationally-representative sample of middle-aged and older adults in the United States.

Methods

Participants

Data from 37,495 participants in the 1998–2014 waves of the Health and Retirement Study (HRS) were used. Individual data files were joined to the cleaned and standardized RAND HRS dataset. The purpose of the HRS is to understand the health and economic implications of advancing age that can threaten or promote health and wealth at individual- and population-levels [9]. Participants in the HRS have been re-interviewed biennially since 1992. Further, the HRS includes surveys from over 23,000 households and has provided data for a nationally-representative sample of Americans aged over 50 years since 1998 [10]. New cohorts of participants have been added to the original HRS sample to preserve national representation and participants are followed longitudinally until death [10]. A multi-stage probability design is used by the HRS, including geographical stratification and oversampling of certain demographic groups. Additional details for the HRS are described elsewhere [11].

Written informed consent was acquired from all participants before entering the study and protocols were approved by the University of Michigan Behavioral Sciences Committee Institutional Review Board. Participant anonymity was ensured because data used in this secondary analysis contained no direct identifiers.

Health conditions

Participants self-reported their date of birth and sex. Interviewers asked participants questions related to their physical health at each wave. Individuals who reported having cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes or high blood sugar, back pain, high blood pressure or hypertension, a fractured hip, a heart attack or myocardial infarction, rheumatism or arthritis, or a stroke were included. The date of interview for the wave a health condition was first confirmed by participants was treated as a proxy for the date of diagnosis. These health conditions were selected by investigators because they were identified as having a corresponding disability weight from the Global Burden of Disease [12, 13]. Example interviewer questions for each health condition that were asked to participants are listed in Additional file 1: Table S1.

Mortality

Date of death was obtained through linkage to the National Death Index. The HRS also conducted an interview with a surviving spouse, child, or other informant for each decedent, successfully obtaining study exit information [10].

Statistical analysis

Procedures from the World Health Organization for determining DALYs with an incidence-based calculation were used [14]. Participants were first stratified by sex, then by age categories (50–59 years, 60–69 years, 70–79 years, ≥80 years). The age at which a health condition occurred determined age categories for all participants.

YLDs were calculated by multiplying the number of incident cases for each health condition, corresponding disability weight, and average duration of years lived with the health condition until death, or truncation. For those who were still alive or lost to follow-up (i.e., truncation), the average duration of years lived with the health condition was determined using their estimated life expectancy at age of truncation [15]. Disability weights for each health condition were from the Global Burden of Disease (back pain = 0.020, cancer = 0.288, COPD = 0.019, congestive heart failure = 0.201, diabetes = 0.015, fractured hip = 0.058, hypertension = 0.246, myocardial infarction = 0.439, rheumatism or arthritis =0.199, stroke = 0.266) [12, 13]. For each sex, YLDs were summed across age categories to determine total YLDs.

YLLs were calculated by taking the product of the number of deaths that occurred by the mean life expectancy at age of death in years. The Period Life Table was used to determine life expectancy at each age for men and women [16]. The YLLs were summed across age categories to determine total YLLs.

For men and women, YLDs and YLLs were added across age categories to determine DALYs for each health condition. Then, the DALYs estimates were summed for calculating overall DALYs. Sample weights were utilized in the analyses so DALYs were nationally-representative. The YLLs, YLDs, and DALYs are reported in thousands. All analyses were performed with SAS 9.4 software (SAS Institute; Cary, NC).

Results

After exclusions (Fig. 1), there were 30,101 participants included (n = 16,591 women, n = 13,510 men) from the 1998–2014 waves who reported having at least one of the health conditions we examined. The non-weighted and weighted descriptive characteristics of the participants are presented in Table 1. Overall, participants entered the study at 63.3 ± 10.6 years of age. Of the 10,504 participants that died, the age at death was 79.6 ± 10.5 years. Table 2 provides person-level DALY estimates and 95% confidence intervals for each health outcome.
Fig. 1

Flow Chart for Exclusions. Exclusions occurred because races and ethnicities in the other category were stratified

Table 1

Non-Weighted and Weighted Descriptive Characteristics of the Participants

 

Overall (n = 30,101)

Weighted Overall (n = 114,610,740)

Women (n = 16,591)

Weighted Women (n = 59,183,770)

Men (n = 13,510)

Weighted Men (n = 55,426,970)

Age (years)

63.3 ± 10.6

60.9 ± 10.0

63.7 ± 11.1

61.8 ± 10.6

62.9 ± 10.0

60.1 ± 9.4

Age at Death (years)

79.6 ± 10.5

78.4 ± 11.0

81.2 ± 10.7

80.4 ± 10.8

77.9 ± 10.1

76.3 ± 10.9

Died (n (%))

10,504 (34.9%)

31,954,223 (27.8%)

5553 (52.8%)

16,504,100 (27.9%)

4951 (16.4%)

15,450,123 (27.8%)

Table 2

Person-Level Disability-Adjusted Life Year Means and 95% Confidence Intervals

 

Mean

95% Confidence Interval

Mean

95% Confidence Interval

Mean

95% Confidence Interval

 

Arthritis

Back Pain

Cancer

Males

 50–59 Years

20.4

20.1, 20.8

20.6

20.2, 21.0

21.9

21.4, 22.5

 60–69 Years

14.4

14.2, 14.6

13.4

13.2, 13.7

15.7

15.4, 16.0

 70–79 Years

9.1

9.0, 9.2

8.4

8.2, 8.6

10.1

10.0, 10.3

 ≥80 Years

5.4

5.3, 5.4

4.5

4.4, 4.7

5.8

5.7, 6.0

Total

11.0

10.9, 11.2

10.5

10.2, 10.7

11.2

10.9, 11.4

Females

 50–59 Years

23.0

22.7, 23.4

23.0

22.5, 23.5

24.8

24.2, 25.3

 60–69 Years

16.1

15.9, 16.3

15.1

14.8, 15.4

17.5

17.2, 17.8

 70–79 Years

9.9

9.8, 10.0

9.2

9.0, 9.4

11.1

10.9, 11.3

 ≥80 Years

5.8

5.7, 5.9

5.0

4.8, 5.1

6.5

6.4, 6.6

Total

11.0

10.8, 11.2

10.5

10.3, 10.7

12.5

12.2, 12.8

Overall

 50–59 Years

21.8

21.6, 22.1

21.8

21.4, 22.1

23.5

23.1, 24.0

 60–69 Years

15.2

15.1, 15.4

14.3

14.1, 14.5

16.6

16.4, 16.8

 70–79 Years

9.5

9.5, 9.6

8.8

8.7, 9.0

10.6

10.5, 10.7

 ≥80 Years

5.7

5.6, 5.7

4.8

4.7, 4.9

6.2

6.1, 6.3

Total

11.0

10.9, 11.2

10.5

10.3, 10.7

11.8

11.6, 12.1

 

Chronic Obstructive Pulmonary Disease

Congestive Heart Failure

Diabetes

Males

 50–59 Years

19.8

19.1, 20.4

21.7

20.9, 22.4

19.6

19.1, 20.1

 60–69 Years

13.5

13.2, 13.9

15.4

15.0, 15.8

13.4

13.1, 13.7

 70–79 Years

8.6

8.4, 8.8

9.8

9.6, 10.0

8.2

8.0, 8.4

 ≥80 Years

5.0

4.8, 5.1

5.2

5.1, 5.4

4.8

4.6, 5.0

Total

10.4

10.1, 10.7

10.4

10.0, 10.8

11.1

10.8, 11.3

Females

 50–59 Years

21.9

21.2, 22.6

24.5

23.7, 25.3

22.0

21.5, 22.6

 60–69 Years

15.6

15.2, 16.0

17.2

16.7, 17.7

15.0

14.7, 15.3

 70–79 Years

9.6

9.3, 9.8

11.0

10.7, 11.3

9.1

8.9, 9.3

 ≥80 Years

5.3

5.1, 5.5

5.8

5.6, 5.9

5.3

5.1, 5.4

Total

11.5

11.2, 11.9

10.4

10.2, 10.7

11.9

11.6, 12.2

Overall

      

 50–59 Years

20.9

20.4, 21.4

23.1

22.5, 23.7

20.8

20.4, 21.2

 60–69 Years

14.6

14.3, 14.8

16.3

16.0, 16.6

14.2

14.0, 14.4

 70–79 Years

9.1

8.9, 9.2

10.4

10.2, 10.6

8.6

8.5, 8.8

 ≥80 Years

5.1

5.0, 5.3

5.6

5.5, 5.7

5.1

4.9, 5.2

Total

11.0

10.7, 11.2

10.4

10.1, 10.6

11.5

11.3, 11.7

 

Fractured Hip

Hypertension

Myocardial Infarction

Males

 50–59 Years

21.3

21.0, 21.6

22.4

21.8, 22.9

 60–69 Years

13.6

12.6, 14.5

14.8

14.6, 15.0

16.5

16.2, 16.8

 70–79 Years

9.0

8.4, 9.5

9.5

9.4, 9.6

10.9

10.7, 11.1

 ≥80 Years

4.8

4.5, 5.1

5.7

5.6, 5.8

6.5

6.4, 6.7

Total

7.2

6.7, 7.7

11.9

11.8, 12.1

11.9

11.5, 12.2

Females

 50–59 Years

23.8

23.5, 24.1

25.0

24.1, 25.8

 60–69 Years

15.7

14.8, 16.6

16.6

16.4, 16.8

18.2

17.8, 18.7

 70–79 Years

10.1

9.6, 10.5

10.3

10.2, 10.4

12.0

11.8, 12.3

 ≥80 Years

5.0

4.8, 5.2

6.1

6.0, 6.2

6.9

6.7, 7.1

Total

6.8

6.5, 7.1

11.7

11.5, 11.9

11.8

11.4, 12.3

Overall

 50–59 Years

22.5

22.3, 22.7

23.5

22.9, 24.0

 60–69 Years

15.0

14.3, 15.7

15.7

15.6, 15.8

17.1

16.9, 17.4

 70–79 Years

9.7

9.3, 10.0

9.9

9.8, 10.0

11.4

11.2, 11.6

 ≥80 Years

5.0

4.8, 5.1

5.9

5.9, 6.0

6.7

6.6, 6.8

Total

6.9

6.7, 7.2

11.8

11.7, 12.0

11.8

11.6, 12.1

 

Stroke

  

Males

 50–59 Years

21.5

20.8, 22.1

    

 60–69 Years

15.8

15.4, 16.1

    

 70–79 Years

9.7

9.5, 9.8

    

 ≥80 Years

5.5

5.3, 5.6

    

Total

10.6

10.3, 10.9

    

Females

 50–59 Years

24.4

23.7, 25.1

    

 60–69 Years

17.4

17.0, 17.8

    

 70–79 Years

11.0

10.8, 11.2

    

 ≥80 Years

6.1

6.0, 6.2

    

Total

10.1

9.8, 10.4

    

Overall

 50–59 Years

22.9

22.3, 23.4

    

 60–69 Years

16.5

16.2, 16.8

    

 70–79 Years

10.3

10.2, 10.5

    

 ≥80 Years

5.9

5.8, 6.0

    

Total

10.3

10.1, 10.5

    
Figure 2 presents the weighted YLDs and YLLs for each health condition stratified by sex. DALY estimates for men were: 4092 for hip fractures, 28,707 for congestive heart failure, 36,688 for myocardial infarction, 42,413 for COPD, 45,197 for stroke, 59,006 for diabetes, 68,237 for cancer, 86,392 for back pain, 144,991 for arthritis, and 178,055 for hypertension. Likewise, DALY estimates for women were: 13,621 for hip fractures, 27,855 for myocardial infarction, 33,874 for congestive heart failure, 47,802 for COPD, 48,587 for stroke, 58,101 for diabetes, 73,529 for cancer, 99,736 for back pain, 188,177 for arthritis, and 200,794 for hypertension. Of the ten health conditions examined herein, the number of DALYs for diabetes and myocardial infarction were only higher in men than women. In total, the 10 health conditions accounted for an estimated 693,778 DALYs in men and 792,076 DALYs in women.
Fig. 2

The Burden of the Health Outcomes for Middle-Aged and Older Adults Stratified by Sex. Note: Green Bars = Years of Life Lost; Yellow Bars = Years Lived with Disease. COPD = Chronic Obstructive Pulmonary Disease; DALYs = Disability-Adjusted Life Years

The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 117,534 for diabetes, 142,012 for cancer, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. Detailed information for the weighted burden of each health condition by sex and overall is presented in Table 3. As a whole, there were an estimated 347,274 YLDs, 1,140,457 YLLs, and 1,487,734 DALYs for the 10 health conditions.
Table 3

Disability-Adjusted Life Years for Each Health Outcome

 

Cases

Number Dead

YLLs (in thousands)

YLDs (in thousands)

DALYs (in thousands)

Arthritis

 Males

  50–59 Years

13,140,604

1,767,444

33,628

19,243

52,871

  60–69 Years

9,293,034

2,465,646

31,798

14,254

46,053

  70–79 Years

5,768,620

3,415,221

26,344

8051

34,396

  ≥80 Years

2,600,532

2,069,681

9260

2411

11,671

Total

30,802,790

9,717,992

101,030

43,959

144,991

 Females

  50–59 Years

16,094,235

1,583,622

34,047

25,641

59,688

  60–69 Years

11,064,877

2,422,174

35,011

18,417

53,428

  70–79 Years

8,296,633

4,304,371

36,176

13,157

49,333

  ≥80 Years

5,291,347

4,199,135

20,000

5728

25,728

Total

40,747,092

12,509,302

125,234

62,943

188,177

 Overall

  50–59 Years

29,234,839

3351,066

68,226

44,842

113,068

  60–69 Years

20,357,911

4,887,820

66,848

32,557

99,405

  70–79 Years

14,065,253

7,719,592

62,446

21,085

83,532

  ≥80 Years

7,891,879

6,268,816

29,270

8145

37,415

Total

71,549,882

22,227,294

226,790

106,629

333,420

Back Pain

 Males

  50–59 Years

15,686,707

1,740,053

35,669

1980

37,648

  60–69 Years

6,832,356

1,653,968

22,088

932

23,021

  70–79 Years

4,396,870

2,113,526

17,575

530

18,105

  ≥80 Years

2,184,198

1,645,791

7424

194

7618

Total

29,100,131

7,153,338

82,756

3636

86,392

 Females

  50–59 Years

15,354,395

1,241,525

28,443

2126

30,569

  60–69 Years

8,568,148

1,788,250

26,819

1221

28,040

  70–79 Years

6,382,777

2,705,337

24,726

881

25,607

  ≥80 Years

4,351,801

3,076,734

15,084

436

15,520

Total

34,657,121

8,811,846

95,072

4664

99,736

 Overall

  50–59 Years

31,041,102

2,981,578

64,644

4104

68,747

  60–69 Years

15,400,504

3,442,218

48,969

2151

51,120

  70–79 Years

10,779,647

4,818,863

42,198

1400

43,598

  ≥80 Years

6,535,999

4,722,525

22,493

628

23,121

Total

63,757,252

15,965,184

178,304

8283

186,586

Cancer

 Males

  50–59 Years

2,522,588

636,050

12,994

3863

16,857

  60–69 Years

3,755,041

1,213,733

17,078

6250

23,328

  70–79 Years

3,472,371

1,731,529

14,875

5443

20,318

  ≥80 Years

1,618,157

1,236,842

5880

1854

7734

Total

11,368,157

4,818,154

50,827

17,410

68,237

 Females

  50–59 Years

3,700,463

591,564

13,619

6663

20,282

  60–69 Years

3,429,015

1,027,035

16,203

6220

22,423

  70–79 Years

3,072,482

1,655,490

15,535

5413

20,948

  ≥80 Years

1,988,047

1385,791

7186

2690

9876

Total

12,190,007

4,659,880

52,543

20,986

73,529

 Overall

  50–59 Years

6,223,051

1,227,614

26,898

10,487

37,385

  60–69 Years

7,184,056

2,240,768

33,349

12,469

45,818

  70–79 Years

6544,853

3,387,019

30,372

10,862

41,234

  ≥80 Years

3,606,204

2,622,633

13,055

4520

17,575

Total

23,558,164

9,478,034

103,674

38,338

142,012

Chronic Obstructive Pulmonary Disease

 Males

  50–59 Years

2,580,113

632,447

12,445

316

12,762

  60–69 Years

2,591,636

986,541

13,276

324

13,600

  70–79 Years

2,108,494

1,366,288

11,661

208

11,869

  ≥80 Years

1,039,325

830,476

4116

67

4182

Total

8,319,568

3,815,752

41,498

915

42,413

 Females

  50–59 Years

3,470,551

624,008

13,626

478

14,104

  60–69 Years

2,847,547

906,558

14,095

375

14,469

  70–79 Years

2,563,061

1,422,684

13,507

298

13,805

  ≥80 Years

1,407,161

1,011,150

5312

112

5424

Total

10,288,320

3,964,400

46,540

1263

47,802

 Overall

  50–59 Years

6,050,664

1,256,455

26,209

792

27,001

  60–69 Years

5,439,183

1,893,099

27,426

697

28,124

  70–79 Years

4,671,555

2,788,972

25,102

501

25,604

  ≥80 Years

2,446,486

1,841,626

9430

178

9608

Total

18,607,888

7,780,152

88,167

2168

90,337

Congestive Heart Failure

 Males

  50–59 Years

901,813

309,556

6407

928

7335

  60–69 Years

1,093,609

452,061

6563

1020

7584

  70–79 Years

1,359,220

924,139

8239

1249

9487

  ≥80 Years

956,151

794,466

3742

559

4301

  Total

4,310,793

2,480,222

24,951

3756

28,707

 Females

  50–59 Years

783,103

218,141

5114

880

5994

  60–69 Years

1,004,064

434,919

7028

1083

8111

  70–79 Years

1,449,735

979,321

9791

1535

11,325

  ≥80 Years

1,716,177

1,411,609

7293

1151

8444

Total

4,953,079

3,043,990

29,226

4649

33,874

 Overall

  50–59 Years

1,684,916

527,697

11,634

1813

13,447

  60–69 Years

2,097,673

886,980

13,590

2107

15,697

  70–79 Years

2,808,955

1,903,460

17,972

2772

20,744

  ≥80 Years

2,672,328

2,206,075

11,033

1709

12,742

Total

9,263,872

5,524,212

54,229

8401

62,630

Diabetes

 Males

  50–59 Years

6,357,757

1,136,872

22,201

652

22,853

  60–69 Years

5,109,121

1,327,408

17,770

535

18,305

  70–79 Years

3,110,939

1,702,148

13,938

291

14,229

  ≥80 Years

1,111,108

743,942

3546

73

3619

Total

15,688,925

4,910,370

57,455

1551

59,006

 Females

  50–59 Years

5,545,897

856,217

18,801

635

19,436

  60–69 Years

4,846,946

1,185,951

17,734

543

18,276

  70–79 Years

3,287,663

1,603,639

14,515

340

14,855

  ≥80 Years

1,588,280

1,035,687

5430

104

5534

Total

15,268,786

4,681,494

56,480

1622

58,101

 Overall

  50–59 Years

11,903,654

1,993,089

41,352

1292

42,644

  60–69 Years

9,956,067

2,513,359

35,588

1078

36,666

  70–79 Years

6,398,602

3,305,787

28,432

629

29,061

  ≥80 Years

2,699,388

1,779,629

8986

177

9163

Total

30,957,711

9,591,864

114,358

3176

117,534

Fractured Hip

 Males

  50–59 Years

0

0

  60–69 Years

146,403

41,458

554

39

593

  70–79 Years

380,325

226,413

1969

118

2087

  ≥80 Years

441,705

287,456

1343

70

1412

Total

968,433

555,327

3866

227

4092

 Females

  50–59 Years

0

0

  60–69 Years

324,722

115,798

1791

88

1879

  70–79 Years

894,606

501,588

4931

267

5198

  ≥80 Years

1,814,079

1,272,571

6168

376

6544

Total

3,033,407

1,889,957

12,890

731

13,621

 Overall

  50–59 Years

0

0

  60–69 Years

471,125

157,256

2324

127

2451

  70–79 Years

1,274,931

728,001

6868

386

7254

  ≥80 Years

2,255,784

1,560,027

7509

446

7955

Total

4,001,840

2,445,284

16,701

959

17,660

Hypertension

 Males

  50–59 Years

17,589,184

2,219,853

43,583

30,454

74,037

  60–69 Years

10,044,721

2,652,896

34,384

18,925

53,310

  70–79 Years

6,329,398

3,587,473

27,980

10,942

38,922

  ≥80 Years

2,551,064

1,933,743

8767

3018

11,786

Total

36,514,367

10,393,965

114,714

63,339

178,055

 Females

  50–59 Years

15,159,062

1,560,757

34,321

28,232

62,554

  60–69 Years

10,942,927

2,570,377

37,670

21,718

59,388

  70–79 Years

8,588,794

4,388,589

36,871

16,804

53,674

  ≥80 Years

5,024,558

3,838,927

18,314

6864

25,178

Total

39,715,341

12,358,650

127,176

73,618

200,794

 Overall

  50–59 Years

32,748,246

3,780,610

77,904

58,686

136,591

  60–69 Years

20,987,648

5,223,273

72,054

40,643

112,698

  70–79 Years

14,918,192

7,976,062

64,851

27,746

92,596

  ≥80 Years

7,575,622

5,772,670

27,081

9882

36,964

Total

76,229,708

22,752,615

241,890

136,957

378,849

Myocardial Infarction

 Males

  50–59 Years

1,477,509

311,855

6054

4451

10,505

  60–69 Years

1,472,041

555,368

7866

3466

11,332

  70–79 Years

1,322,100

781,906

6584

3304

9888

  ≥80 Years

844,074

721,969

3578

1385

4963

Total

5,115,724

2,371,098

24,082

12,606

36,688

 Females

  50–59 Years

648,934

147,456

3181

2242

5422

  60–69 Years

850,883

350,042

5548

2080

7628

  70–79 Years

1,021,117

656,615

6217

2686

8903

  ≥80 Years

999,380

803,335

4090

1811

5902

Total

3,520,314

1,957,448

19,036

8819

27,855

 Overall

     

  50–59 Years

2126,443

459,311

9333

6800

16,133

  60–69 Years

2,322,924

905,410

13,392

5548

18,940

  70–79 Years

2,343,217

1,438,521

12,783

5993

18,776

  ≥80 Years

1,843,454

1,525,304

7669

3193

10,861

  Total

8,636,038

4,328,546

43,177

21,534

64,710

Stroke

 Males

  50–59 Years

1,566,132

450,841

8890

2850

11,739

  60–69 Years

1,849,572

736,604

10,615

2581

13,195

  70–79 Years

2,200,265

1,326,626

10,864

3351

14,215

  ≥80 Years

1,464,604

1,019,878

4668

1380

6048

Total

7,080,573

3,533,949

35,037

10,162

45,197

 Females

  50–59 Years

1,257,018

250,971

5758

1891

7648

  60–69 Years

1,644,126

581,634

9217

2658

11,875

  70–79 Years

2,222,147

1,289,628

12,337

3357

15,694

  ≥80 Years

2,782,176

2,064,287

10,575

2794

13,370

Total

7,905,467

4,186,520

37,887

10,700

48,587

 Overall

  50–59 Years

2,823,150

701,812

14,901

4718

19,619

  60–69 Years

3,493,698

1,318,238

19,853

5224

25,077

  70–79 Years

4,422,412

2,616,254

23,174

6709

29,883

  ≥80 Years

4,246,780

3,084,165

15,239

4178

19,417

Total

14,986,040

7,720,469

73,167

20,829

93,996

Note: DALYs Disability-Adjusted Life Years, YLDs Years Lived with Disease, YLLs Years of Life Lost

Discussion

The principal findings of this investigation revealed that over 1-million years of healthy life were lost for middle-aged and older Americans from the 10 health conditions evaluated over the 16 year study period. Although aging adults were impacted by each health condition, hypertension accounted for the greatest burden; whereas, hip fractures had the lowest number of DALYs. These results were similar when evaluating the DALY estimates for each of the health conditions by sex. Our findings should be used to inform healthcare providers and interventions seeking to prevent morbidity and extend life expectancy in aging adults. Using DALYs to guide healthcare policy will also help to improve quality of life during aging through continued evolutions of disease prevention and treatment.

The Global Burden of Disease studies have identified hypertension as the leading risk factor by attributable disease burden [17]. The prevalence of hypertension increases with age, and is highest in older adults [18]. Of the ten health conditions evaluated in this investigation, hypertension had both the highest number of cases and DALYs. Likewise, those with hypertension had a large amount of YLDs, thereby indicating middle-aged and older adults are living with this disease for long periods of time after diagnosis. The large number of years lived with hypertension can be attributed to the evolution and adherence to hypertension medications [19, 20]. Like all medications, persons considering usage of promising hypertension medications should have discussions with a healthcare provider, and other non-pharmacological modes of treatment and prevention such as engaging in healthy behaviors remains a critical factor for reducing hypertension [18, 21]. Like hypertension, participants indicating they had arthritis or rheumatism also lived with this health condition for long periods of time after diagnosis as demonstrated by the large number of YLDs. These results align with another investigation that revealed rheumatoid arthritis causes significant YLDs and high overall disease burden [22]. It is projected that as smoking rates decline, the number of healthy years of life lost from rheumatoid arthritis will also decrease [22]. Future studies monitoring DALYs for arthritis in middle-aged and older adults are needed to confirm such projections and assess if arthritis medications lower the burden of arthritis in aging adults.

Back pain is generally a prevalent health condition all adults experience as they age and pain management is often challenging [23]. The health implications of back pain are also pronounced, as the Global Burden of Disease project demonstrated that back pain has a large burden in the United States, and is relatively lower in Asian countries [24, 25]. Although our results also suggest the burden of back pain is high for middle-aged and older adults in the United States, our findings for YLDs are lower compared to those of other similar investigations [24, 25]. We believe that this result is attributed to participants reporting back pain before entering the HRS, as indicated by the large number of cases for those aged 50–59 years. Cancer is also a leading cause of morbidity and mortality in older adults [26]. The rise of cancer rates for the older adult population in the United States is projected to increase, thereby posing challenges to healthcare systems and cancer patients [27]. Our results show that the burden of cancer in aging adults is high. Future investigations should continue monitoring DALYs for cancer and specific cancer types in aging adults to assess advancements in cancer treatment, care, and prevention.

About 33% of adults aged at least 65 years in the United States have diabetes and older adults with diabetes are at an elevated risk for mortality than those without diabetes [28]. According to the Global Burden of Disease, diabetes is a leading cause of DALYs in the United States [29], and men are more frequently diagnosed with diabetes than women at younger ages [30]. Our findings indicate the number of diabetes cases were higher in men than women, particularly at ages 50–59 and 60–69 years, which may explain why the burden of diabetes was higher for men than women. While our DALY estimates for diabetes were large, other countries in the Global Burden of Disease, such as Mexico, may have a higher burden from diabetes [25]. Similarly, our results revealed the number myocardial infarction cases and DALYs from this health condition were higher in men compared to women. These results align with another investigation that suggests the prevalence of myocardial infarctions is higher in men than women [31].

Stroke is a leading cause of disability and death for aging adults that is also responsible for billions of dollars in healthcare costs [32]. Persons that sustain a stroke have reduced mobility and are at an increased risk of experiencing another stroke [33]. Therefore, it is not unusual that the burden of stroke has remained high in the United States and globally [24, 25]. Our DALY results for stroke also indicate many healthy years of life lost in middle-aged and older adults. Although advancements in COPD prevention and treatment have been made [34], COPD remains a leading cause of death [35], and the Global Burden of Disease suggests COPD has a tremendous disease burden in the United States [29]. Given that COPD is progressive, persons living with this disease have a large amount of health-related costs [36]. While our findings indicate that the burden of COPD is already high, the burden of COPD is projected to increase [37]. As smoking cessation remains important for preventing and limiting the health effects of COPD, the burden of DALYs should continue to be monitored for helping to inform COPD treatments.

Heart failure is a worldwide health problem that is linked to high morbidity, mortality, and costs of care [38]. As the older adult population increases, the prevalence of heart diseases such as congestive heart failure has also risen [39]. Our results indicating the high burden of congestive heart failure are similar to those of other investigations evaluating DALYs [40]. Although hip fractures are common during aging, the incidence of hip fractures and mortality rates associated with hip fractures have declined in the United States [41, 42]. Another study evaluating DALYs for hip fractures determined that over 200,000 years of healthy life were lost from hip fractures in older adults [43]. While the burden of hip fractures was lowest of the ten health conditions for this investigation, prevention and treatment for hip fractures should remain a priority for aging adults.

Some limitations should be noted. Those who were lost from follow-up or died may have had a health condition that was not recorded before this event, thereby creating underestimations for our results. Moreover, the date of interview served as a proxy for diagnosis date, thereby allowing our results to be further underestimated. The use of an incidence-driven DALY calculation allowed us to determine how the burden of specific health conditions impacted middle-aged and older adults longitudinally; however, we were unable to control for multimorbiditiy in our disability weights. It is also possible that participants may have disputed their records for having a diagnosis or were no longer living with a health condition after initial diagnosis. Self-report biases may have occurred for participant responses. The HRS only includes adults aged 50 years and over; therefore, some participants may have had health conditions at younger ages before entering the study. Statistical tests of inference were not used for making comparisons between DALY estimates because DALYs are often used as a stand-alone statistic.

Likewise, our DALY estimates were influenced by cases, and YLD does not confirm that quality of life was compromised. Future investigations should examine the impact of a health condition on YLD because a smaller YLD may imply that a health condition exacerbates time to death; whereas, a larger YLD may suggest treatment and management of a health condition delays early mortality (depending on age of diagnosis and other important factors). As such, social and policy concerns for aging adults including living arrangements, finances, completion of autonomous living and basic self-care tasks, and care giving should be considered based on disease and health status. Comparing our findings with those of other burden of disease investigations performed in the United States and globally will be helpful for making comparisons across populations and diseases [44]. Moreover, expanding parts of the DALY calculation to other important health outcomes during aging and examining prevalence-based DALYs will help to advance our understanding of health burden.

Conclusions

The burden of the health conditions evaluated for this investigation accounted for over a million years of healthy life lost for middle-aged and older Americans during the study period. Overall, participants experienced different levels of non-fatal health loss and early mortality for each health condition. These results should be used to help improve the efficiency and effectiveness of disease prevention and treatment strategies for aging adults. Trends in DALYs should continue to be monitored for middle-aged and older adults so that health-related policies and resources match DALY trends, and for informing healthcare providers so they can accommodate the health needs of the growing aging population in the United States. Encouraging healthcare providers to continue evolving prevention, treatment, and early detection for disease, and healthcare policy makers to invest in promising solutions will help to reduce health-related costs, improve quality of life, and extend life expectancy for the aging adults in the United States.

Notes

Acknowledgements

Not applicable.

Funding

This study was funded by a grant (P2CHD065702) from the National Institutes of Health – National Institute of Child Health and Human Development (National Center for Medical Rehabilitation Research), the National Institute for Neurological Disorders and Stroke, and the National Institute of Biomedical Imaging and Bioengineering. Funds were utilized for all aspects of the manuscript including design of the study, statistical analyses, and dissemination.

Availability of data and materials

Data from the Health and Retirement Study are publicly available online (https://hrs.isr.umich.edu/data-products).

Authors’ contributions

RM conceived and designed the study, participated in statistical analyses, and wrote the manuscript. SAS conceived and designed the study, participated in statistical analyses, and revised the manuscript. KM conceived and designed the study, and revised the manuscript. OH conceived the study and revised the manuscript. MP conceived and designed the study, and revised the manuscript. All authors have read and approved the manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors have no conflicts of interest to disclose.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary material

12877_2019_1110_MOESM1_ESM.docx (15 kb)
Additional file 1: Table S1. Example Interviewer Questions for Each Health Condition (DOCX 13 kb)

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Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Ryan McGrath
    • 1
    Email author
  • Soham Al Snih
    • 2
  • Kyriakos Markides
    • 3
  • Orman Hall
    • 4
  • Mark Peterson
    • 4
  1. 1.Department of Health, Nutrition, and Exercise SciencesNorth Dakota State UniversityFargoUSA
  2. 2.Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonUSA
  3. 3.Department of Preventive Medicine and Community HealthUniversity of Texas Medical BranchGalvestonUSA
  4. 4.Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborUSA

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