The relative health burden of selected social and behavioral risk factors in the United States: implications for policy

Am J Public Health. 2010 Sep;100(9):1758-64. doi: 10.2105/AJPH.2009.165019. Epub 2009 Dec 17.


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 1997-2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996-2002 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.

MeSH terms

  • Alcohol Drinking / epidemiology
  • Body Mass Index
  • Educational Status
  • Ethnicity / statistics & numerical data*
  • Health Expenditures / statistics & numerical data
  • Health Policy
  • Humans
  • Income / statistics & numerical data
  • Insurance, Health / statistics & numerical data*
  • Markov Chains
  • Quality-Adjusted Life Years*
  • Risk Factors
  • Smoking / epidemiology
  • United States / epidemiology