Obesity is the leading cause of preventable life-years lost in the United States, outranking preventable life-years lost due to diabetes, tobacco use, high BP and high cholesterol, according to 2014 data presented at the 2017 Society of General Internal Medicine Annual Meeting.
“The reality is, while we may know the proximate cause of a patient’s death, for example, breast cancer or heart attack, we don’t always know the contributing factor(s), such as tobacco use, obesity, alcohol and family history,” Glen B. Taksler, PhD, an internal medicine researcher from the Medicine Institute at Cleveland Clinic, said in a press release. “For each major cause of death, we identified a root cause to understand whether there was a way a person could have lived longer.”
To determine the number of life-years lost to preventable risk factors in 2014, researchers developed a microsimulation model based on data from the National Vital Statistics System. They simulated 2014 life expectancy in the U.S. population aged 15 years and older based on 28 competing risk factors — 17 of which were modifiable, such as hypertension, and 11 of which were nonmodifiable, such as genetics — that contributed to 19 leading causes of death. The investigators examined the change in mortality for a series of hypothetical U.S. populations that each eliminated a single risk factor, then compared the results with the change in life-years lost for an “optimal” population that eliminated all modifiable risk factors. Additionally, they estimated life expectancy gained in individuals with each modifiable risk factor to assess less common factors that may have placed substantial burden on small population subgroups.
The results revealed that, in 2014, the greatest number of preventable life-years were lost to obesity (303 million life-years; 22.2% of total preventable life-years), diabetes (267 million; 19.6%), hypertension (209 million; 15.4%), tobacco use (206 million; 15.1%) and hyperlipidemia (> 130 million; 9.5%). Alcohol misuse, HPV, sexual behavior, bipolar disease, anxiety, vaccines, hepatitis B/C, illicit drug use, head trauma and environmental toxins each accounted for 1% to 3% of total life-years lost. However, the researchers found that for affected individuals, a substantial number of years were lost due to alcohol misuse (> 17.5 years per individual), tobacco use (> 10 years per individual), hepatitis B/C (> 7.6 years per individual) and bipolar disease (> 7.3 years per individual). According to a press release accompanying the abstract, physicians should prioritize preventive care in clinical practice to help patients understand treatment options and approaches for treatable leading causes of death like diabetes, hypertension and high cholesterol.
These findings also show that some individuals have needs that are different than those of the broader U.S. population; certain patients experiencing multiple risk factors, like obesity and tobacco use, may need to address lesser impactful risk factors first (tobacco use) even if the other factor (obesity) has a greater impact on the total population.
“Modifiable behavioral risk factors pose a substantial mortality burden in the U.S.,” Taksler said. “The preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population.”
A recent study in Health Affairs suggested that even modest increases in physical activity would save $22 billion in lost wages and medical costs and could lead to decreases in the number of youths who are obese or overweight, and lead to fewer strokes, coronary heart disease cases, type 2 diabetes cases; and cancer cases. – by Savannah Demko
Reference: Taksler GB, et al. Life-years lost to preventable causes-of-death in the U.S., 2014. Presented at: The Society of General Internal Medicine 2017 Annual Meeting; April 19-22, 2017; Washington, D.C.
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