The Relative Health Burden of Selected Social and
Behavioral Risk Factors in the United States: Implications for Policy
Peter Muennig, Kevin Fiscella, Daniel Tancredi,
Peter Franks. The Relative Health Burden of
Selected Social and Behavioral Risk Factors in
the United States: Implications for Policy. AJPH First Look, Dec 17, 2009.
Abstract
Objectives. We sought to quantify the potential
health impact of selected medical and nonmedical
policy changes within the United States.
Methods. Using data from the 19972000 National
Health Interview Surveys (linked to mortality
data through 2002) and the 19962002 Medical
Expenditure Panel Surveys, we calculated
age-specific health-related quality-of-life
scores and mortality probabilities for 8 social
and behavioral risk factors. We then used Markov
models to estimate the quality-adjusted life years lost.
Results. Ranked quality-adjusted life years lost
were income less than 200% of the poverty line
versus 200% or greater (464 million; 95%
confidence interval [CI]=368, 564);
current-smoker versus never-smoker (329 million;
95% CI=226, 382); body mass index 30 or higher
versus 20 to less than 25 (205 million; 95%
CI=159, 269); non-Hispanic Black versus
non-Hispanic White (120 million; 95% CI=83, 163);
and less than 12 years of school relative to 12
or more (74 million; 95% CI=52, 101). Binge
drinking, overweight, and health insurance have
relatively less influence on population health.
Conclusions. Poverty, smoking, and high-school
dropouts impose the greatest burden of disease in the United States.
Key Words: Epidemiology, Health Financing, Health
Policy, Obesity, Overweight, Underweight, African
Americans/Blacks, Socioeconomic Factors
http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.165019v1
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