The relative health burden of selected social and behavioral risk factors in the United States: implications for policy.
OBJECTIVE
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.
Muennig
Peter
P
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 W 168th St, 6th Floor, New York, NY 10032, USA. pm124@columbia.edu
Fiscella
Kevin
K
Tancredi
Daniel
D
Franks
Peter
P
D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology