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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