The State of US Health, 1990-2010: Burden of Diseases, Injuries, and
Risk Factors

doi:10.1001/jama.2013.13805

Table 1

Deaths and YLLs From the 30 Leading Diseases and Injuries Contributing to YLLs in the United States in 1990 and 2010 and Percentage Change From 1990 to 2010 in YLLs and Age-Standardized YLL Rates^a

Diseases and Injuries YLL Rank Deaths YLLs
1990 2010 No. (in Thousands) Median Change, % No. (in Thousands) Median Change, %
1990 2010 Deaths Age-Standardized Death Rate 1990 2010 YLLs Age-Standardized YLL Rate
Ischemic heart disease 1 (1-1) 1 (1-1) 648.2 (600.8-676.1) 562.9 (515.4-662.1) −14.4 (−20.6 to 2.6) −43.6 (−47.1 to −33.2) 8990.3 (8386.2-9451.4) 7164.5 (6706.6-8198.2) −21.2 (−25.6 to −9.1) −45.2 (−48.2 to −38.1)
Lung cancer 2 (2-3) 2 (2-2) 143.5 (116.8-178.5) 163.3 (128.1-200.8) 14.4 (−1.1 to 26.0) −22.5 (−31.8 to −14.7) 2871.9 (2325.8-3523.2) 2987.7 (2418.1-3731.2) 3.6 (−6.6 to 17.4) −30 (−36.1 to −18.9)
Stroke 4 (3-4) 3 (3-5) 177.8 (163.7-200.9) 172.3 (153.5-201.7) −3 (−13.6 to 8.2) −36.7 (−43.0 to −30.4) 2250.4 (2096.3-2543.6) 1945.3 (1741.8-2147.8) −13.2 (−21.5 to −6.2) −39.3 (−45.6 to −34.8)
Chronic obstructive pulmonary disease 5 (5-8) 4 (3-5) 97.5 (90.3-105.5) 154.5 (137.8-170.0) 58.3 (43.3 to 75.7) 5.6 (−3.0 to 16.3) 1416.1 (1308.5-1534.0) 1913.1 (1720.9-2067.9) 34.7 (24.7 to 47.1) −5.8 (−12.5 to 2.7)
Road injury 3 (2-4) 5 (3-6) 49.6 (43.4-59.2) 44.0 (36.2-53.5) −11.7 (−21.8 to 3.4) −30.2 (−37.5 to −17.7) 2336.5 (2022.5-2752.3) 1873.2 (1569.0-2280.1) −20.4 (−28.4 to −4.3) −33.3 (−39.7 to −19.4)
Self-harm 6 (5-10) 6 (5-10) 33.7 (25.6-43.7) 37.3 (27.6-47.1) 10.8 (−6.2 to 26.7) −12.9 (−27.2 to −1.6) 1393.8 (1068.6-1808.7) 1456.9 (1066.1-1779.0) 5.7 (−13.2 to 18.1) −13.2 (−28.3 to − −2.4)
Diabetes 15 (11-15) 7 (6-9) 50.2 (45.3-60.0) 86.1 (73.0-99.3) 71.8 (43.7 to 97.1) 17.3 (−1.3 to 32.4) 875.0 (788.0-1042.3) 1392.4 (1186.7-1568.1) 60.1 (34.5 to 78.3) 13.0 (−5.4 to 25.7)
Cirrhosis 14 (10-15) 8 (7-12) 35.5 (31.3-42.1) 49.5 (39.5-54.6) 43.3 (14.0 to 56.0) −2 (−22.5 to 6.4) 917.3 (808.7-1095.1) 1232.7 (966.2-1364.7) 37.9 (9.8 to 50.8) −5.3 (−23.8 to 3.3)
Alzheimer disease 32 (23-38) 9 (6-20) 27.0 (19.8-45.7) 158.3 (75.8-237.4) 524.3 (136.8 to 877.4) 289.6 (56.5 to 487.6) 257.4 (202.1-407.1) 1192.4 (637.0-1648.1) 391.6 (128.5 to 593.1) 209.5 (60.4 to 315.7)
Colorectal cancer 11 (9-14) 10 (7-13) 60.2 (49.6-67.1) 63.9 (55.4-88.1) 1.6 (−9.4 to 49.7) −29.4 (−36.1 to 2.4) 1018.9 (855.4-1127.3) 1073.6 (946.9-1412.7) 1.6 (−7.6 to 41.8) −27.5 (−33.9 to −0.8)
Lower respiratory tract infections 10 (7-11) 11 (8-13) 90.4 (71.9-103.3) 85.4 (69.4-114.0) −8.1 (−27.8 to 34.7) −38.6 (−49.7 to −14.1) 1185.7 (996.4-1303.8) 1031.8 (905.9-1261.3) −14.3 (−26.1 to 8.4) −37.6 (−44.9 to −26.1)
Interpersonal violence 8 (5-13) 12 (7-16) 25.2 (17.7-30.9) 19.9 (15.9-28.3) −24.4 (−33.8 to 8.2) −34.4 (−42.7 to −7.9) 1344.3 (948.9-1660.1) 1019.1 (795.8-1427.6) −26.5 (−36.0 to 2.9) −33.9 (−42.8 to −8.9)
Breast cancer 12 (11-14) 13 (12-16) 43.2 (40.4-47.0) 42.6 (37.4-47.5) −1.2 (−12.6 to 10.0) −33.4 (−40.0 to −26.6) 953.7 (890.0-1020.1) 891.7 (804.6-980.7) −6.5 (−14.3 to 2.4) −35.9 (−41.0 to −29.8)
Preterm birth complications 9 (6-12) 14 (11-18) 14.1 (11.3-16.8) 10.0 (8.0-12.3) −29.6 (−45.9 to −5.1) −35.7 (−50.5 to −13.3) 1213.2 (970.1-1440.7) 858.4 (687.4-1061.3) −29.6 (−45.9 to −5.1) −35.7 (−50.5 to −13.3)
Drug use disorders 44 (24-49) 15 (8-28) 3.8 (2.6-8.5) 19.4 (9.3-28.6) 477.4 (105.1 to 699.8) 376.6 (69.3 to 559.6) 174.1 (118.4-399.1) 840.6 (387.6-1239.2) 448.4 (88.0 to 673.8) 376.6 (65.3 to 565.7)
Chronic kidney disease 21 (19-25) 16 (13-20) 30.4 (26.0-37.5) 60.3 (47.4-74.0) 99 (58.8 to 141.4) 33.9 (7.8 to 59.2) 425.2 (374.2-521.6) 780.2 (636.7-908.4) 85.8 (47.4 to 112.2) 32.4 (4.2 to 49.9)
Other cardiovascular/circulatory 16 (16-18) 17 (15-19) 40.9 (38.6-43.3) 56.6 (50.5-63.7) 38.2 (21.8 to 57.2) −8.7 (−17.8 to 1.0) 636.1 (611.3-662.0) 765.4 (709.1-824.0) 20.3 (10.2 to 30.2) −14.4 (−21.1 to −7.6)
Pancreatic cancer 19 (16-23) 18 (13-23) 28.6 (21.7-39.1) 39.0 (28.7-52.8) 37 (15.5 to 58.7) −4.9 (−19.0 to 8.4) 508.6 (391.5-669.5) 679.9 (500.1-908.3) 34.3 (15.2 to 51.4) −6.3 (−19.8 to 5.6)
Congenital anomalies 13 (11-15) 19 (15-22) 13.4 (11.2-15.8) 12.4 (10.8-15.1) −8.3 (−18.1 to 8.2) −32.3 (−39.0 to −14.7) 937.1 (762.0-1086.5) 660.8 (579.6-842.1) −31.3 (−39.0 to −6.8) −41.1 (−48.1 to −18.3)
Cardiomyopathy 18 (16-19) 20 (13-22) 30.7 (26.2-32.7) 36 (30.9-46.7) 15.4 (−1.0 to 71.3) −22.9 (−32.6 to 18.0) 622.7 (533.7-659.8) 659.4 (571.7-908.0) 3.3 (−9.8 to 63.1) −24.2 (−34.1 to 18.2)
Hypertensive heart disease 17 (16-19) 21 (16-23) 41.4 (33.2-51.4) 44.7 (34.8-59.6) 7.4 (−10.5 to 30.6) −29.1 (−39.2 to −15.7) 625.8 (522.0-768.2) 641.9 (531.5-800.8) 2.2 (−10.3 to 18.1) −28.1 (−37.2 to −18.7)
Leukemia 20 (19-24) 22 (21-29) 20.3 (16.4-25.3) 25.5 (20.0-31.6) 25.9 (3.3 to 45.1) −13 (−25.2 to −2.7) 458.3 (373.9-562.8) 493.6 (402.2-611.1) 7.8 (−3.7 to 19.3) −20.5 (−28.9 to −11.1)
Human immunodeficiency virus/AIDS 7 (5-9) 23 (22-27) 28.6 (25.6-31.9) 12.1 (10.6-13.7) −57.7 (−63.5 to −50.5) −67.7 (−72.1 to −62.3) 1351.1 (1201.1-1508.5) 479.2 (417.4-542.2) −64.5 (−69.6 to −58.1) −71.6 (−75.8 to −66.5)
Kidney cancers 35 (28-45) 24 (16-31) 10.7 (7.5-14.2) 24.4 (17.1-39.8) 114.9 (60.0 to 262.5) 47 (9.7 to 146.3) 216.9 (152.7-282.0) 475.7 (334.5-796.4) 104.7 (53.1 to 247.1) 40.9 (5.7 to 144.0)
Non-Hodgkin lymphoma 22 (20-26) 25 (22-30) 20 (16.8-23.5) 25.2 (20.3-30.2) 25.4 (2.4 to 52.4) −14.6 (−28.0 to 3.5) 407.8 (339.9-465.4) 451.6 (375.7-541.7) 8.6 (−5.7 to 38.5) −23.6 (−33.4 to −0.2)
Poisonings 31 (22-38) 26 (18-45) 5.9 (4.5-9.6) 11.4 (4.2-16.2) 117.1 (−34.4 to 229.4) 76.1 (−46.7 to 173.3) 263.6 (201.7-433.8) 485.7 (172.9-693.0) 108.1 (−39.3 to 220.0) 74.3 (−48.1 to 173.5)
Prostate cancer 23 (18-35) 27 (16-35) 30.8 (16.6-44.3) 35.9 (20.8-65.4) 9.7 (−30.0 to 89.7) −25.2 (−49.5 to 26.6) 417.9 (223.7-599.7) 445.6 (250.9-787.1) −1.6 (−30.1 to 62.4) −29.6 (−48.8 to 15.5)
Brain cancer 24 (19-31) 28 (21-34) 14 (9.8-21.1) 16.5 (10.9-24.4) 18 (−8.1 to 45.3) −18 (−33.4 to −3.4) 383.3 (262.8-551.6) 411.2 (279.8-611.0) 7.1 (−9.9 to 26.9) −22 (−33.8 to −7.5)
Falls 33 (26-36) 29 (24-35) 14.5 (12.1-19.7) 31.6 (18.7-41.7) 136.4 (11.3 to 220.9) 52 (−25.4 to 96.0) 245.4 (215.5-321.9) 400.2 (265.4-489.2) 79.3 (−3.6 to 117.3) 20.9 (−30.3 to 42.9)
Liver cancer 39 (33-43) 30 (25-35) 9.3 (8.3-11.9) 19.5 (13.3-22.7) 118.4 (36.1 to 151.3) 55.3 (−4.9 to 76.4) 184.7 (167.7-235.4) 398.9 (260.6-461.5) 125.5 (34.9 to 156.5) 58.5 (−6.4 to 80.5)

^aDiseases and injuries contributing to years of life lost due to premature mortality (YLLs) are ranked by the magnitude of YLLs in 2010. 95% uncertainty intervals are shown in parentheses for all data.

Diseases and Injuries	YLL Rank		Deaths				YLLs
	1990	2010	No. (in Thousands)		Median Change, %		No. (in Thousands)		Median Change, %
	1990	2010	1990	2010	Deaths	Age-Standardized Death Rate	1990	2010	YLLs	Age-Standardized YLL Rate
Ischemic heart disease	1 (1-1)	1 (1-1)	648.2 (600.8-676.1)	562.9 (515.4-662.1)	−14.4 (−20.6 to 2.6)	−43.6 (−47.1 to −33.2)	8990.3 (8386.2-9451.4)	7164.5 (6706.6-8198.2)	−21.2 (−25.6 to −9.1)	−45.2 (−48.2 to −38.1)
Lung cancer	2 (2-3)	2 (2-2)	143.5 (116.8-178.5)	163.3 (128.1-200.8)	14.4 (−1.1 to 26.0)	−22.5 (−31.8 to −14.7)	2871.9 (2325.8-3523.2)	2987.7 (2418.1-3731.2)	3.6 (−6.6 to 17.4)	−30 (−36.1 to −18.9)
Stroke	4 (3-4)	3 (3-5)	177.8 (163.7-200.9)	172.3 (153.5-201.7)	−3 (−13.6 to 8.2)	−36.7 (−43.0 to −30.4)	2250.4 (2096.3-2543.6)	1945.3 (1741.8-2147.8)	−13.2 (−21.5 to −6.2)	−39.3 (−45.6 to −34.8)
Chronic obstructive pulmonary disease	5 (5-8)	4 (3-5)	97.5 (90.3-105.5)	154.5 (137.8-170.0)	58.3 (43.3 to 75.7)	5.6 (−3.0 to 16.3)	1416.1 (1308.5-1534.0)	1913.1 (1720.9-2067.9)	34.7 (24.7 to 47.1)	−5.8 (−12.5 to 2.7)
Road injury	3 (2-4)	5 (3-6)	49.6 (43.4-59.2)	44.0 (36.2-53.5)	−11.7 (−21.8 to 3.4)	−30.2 (−37.5 to −17.7)	2336.5 (2022.5-2752.3)	1873.2 (1569.0-2280.1)	−20.4 (−28.4 to −4.3)	−33.3 (−39.7 to −19.4)
Self-harm	6 (5-10)	6 (5-10)	33.7 (25.6-43.7)	37.3 (27.6-47.1)	10.8 (−6.2 to 26.7)	−12.9 (−27.2 to −1.6)	1393.8 (1068.6-1808.7)	1456.9 (1066.1-1779.0)	5.7 (−13.2 to 18.1)	−13.2 (−28.3 to − −2.4)
Diabetes	15 (11-15)	7 (6-9)	50.2 (45.3-60.0)	86.1 (73.0-99.3)	71.8 (43.7 to 97.1)	17.3 (−1.3 to 32.4)	875.0 (788.0-1042.3)	1392.4 (1186.7-1568.1)	60.1 (34.5 to 78.3)	13.0 (−5.4 to 25.7)
Cirrhosis	14 (10-15)	8 (7-12)	35.5 (31.3-42.1)	49.5 (39.5-54.6)	43.3 (14.0 to 56.0)	−2 (−22.5 to 6.4)	917.3 (808.7-1095.1)	1232.7 (966.2-1364.7)	37.9 (9.8 to 50.8)	−5.3 (−23.8 to 3.3)
Alzheimer disease	32 (23-38)	9 (6-20)	27.0 (19.8-45.7)	158.3 (75.8-237.4)	524.3 (136.8 to 877.4)	289.6 (56.5 to 487.6)	257.4 (202.1-407.1)	1192.4 (637.0-1648.1)	391.6 (128.5 to 593.1)	209.5 (60.4 to 315.7)
Colorectal cancer	11 (9-14)	10 (7-13)	60.2 (49.6-67.1)	63.9 (55.4-88.1)	1.6 (−9.4 to 49.7)	−29.4 (−36.1 to 2.4)	1018.9 (855.4-1127.3)	1073.6 (946.9-1412.7)	1.6 (−7.6 to 41.8)	−27.5 (−33.9 to −0.8)
Lower respiratory tract infections	10 (7-11)	11 (8-13)	90.4 (71.9-103.3)	85.4 (69.4-114.0)	−8.1 (−27.8 to 34.7)	−38.6 (−49.7 to −14.1)	1185.7 (996.4-1303.8)	1031.8 (905.9-1261.3)	−14.3 (−26.1 to 8.4)	−37.6 (−44.9 to −26.1)
Interpersonal violence	8 (5-13)	12 (7-16)	25.2 (17.7-30.9)	19.9 (15.9-28.3)	−24.4 (−33.8 to 8.2)	−34.4 (−42.7 to −7.9)	1344.3 (948.9-1660.1)	1019.1 (795.8-1427.6)	−26.5 (−36.0 to 2.9)	−33.9 (−42.8 to −8.9)
Breast cancer	12 (11-14)	13 (12-16)	43.2 (40.4-47.0)	42.6 (37.4-47.5)	−1.2 (−12.6 to 10.0)	−33.4 (−40.0 to −26.6)	953.7 (890.0-1020.1)	891.7 (804.6-980.7)	−6.5 (−14.3 to 2.4)	−35.9 (−41.0 to −29.8)
Preterm birth complications	9 (6-12)	14 (11-18)	14.1 (11.3-16.8)	10.0 (8.0-12.3)	−29.6 (−45.9 to −5.1)	−35.7 (−50.5 to −13.3)	1213.2 (970.1-1440.7)	858.4 (687.4-1061.3)	−29.6 (−45.9 to −5.1)	−35.7 (−50.5 to −13.3)
Drug use disorders	44 (24-49)	15 (8-28)	3.8 (2.6-8.5)	19.4 (9.3-28.6)	477.4 (105.1 to 699.8)	376.6 (69.3 to 559.6)	174.1 (118.4-399.1)	840.6 (387.6-1239.2)	448.4 (88.0 to 673.8)	376.6 (65.3 to 565.7)
Chronic kidney disease	21 (19-25)	16 (13-20)	30.4 (26.0-37.5)	60.3 (47.4-74.0)	99 (58.8 to 141.4)	33.9 (7.8 to 59.2)	425.2 (374.2-521.6)	780.2 (636.7-908.4)	85.8 (47.4 to 112.2)	32.4 (4.2 to 49.9)
Other cardiovascular/circulatory	16 (16-18)	17 (15-19)	40.9 (38.6-43.3)	56.6 (50.5-63.7)	38.2 (21.8 to 57.2)	−8.7 (−17.8 to 1.0)	636.1 (611.3-662.0)	765.4 (709.1-824.0)	20.3 (10.2 to 30.2)	−14.4 (−21.1 to −7.6)
Pancreatic cancer	19 (16-23)	18 (13-23)	28.6 (21.7-39.1)	39.0 (28.7-52.8)	37 (15.5 to 58.7)	−4.9 (−19.0 to 8.4)	508.6 (391.5-669.5)	679.9 (500.1-908.3)	34.3 (15.2 to 51.4)	−6.3 (−19.8 to 5.6)
Congenital anomalies	13 (11-15)	19 (15-22)	13.4 (11.2-15.8)	12.4 (10.8-15.1)	−8.3 (−18.1 to 8.2)	−32.3 (−39.0 to −14.7)	937.1 (762.0-1086.5)	660.8 (579.6-842.1)	−31.3 (−39.0 to −6.8)	−41.1 (−48.1 to −18.3)
Cardiomyopathy	18 (16-19)	20 (13-22)	30.7 (26.2-32.7)	36 (30.9-46.7)	15.4 (−1.0 to 71.3)	−22.9 (−32.6 to 18.0)	622.7 (533.7-659.8)	659.4 (571.7-908.0)	3.3 (−9.8 to 63.1)	−24.2 (−34.1 to 18.2)
Hypertensive heart disease	17 (16-19)	21 (16-23)	41.4 (33.2-51.4)	44.7 (34.8-59.6)	7.4 (−10.5 to 30.6)	−29.1 (−39.2 to −15.7)	625.8 (522.0-768.2)	641.9 (531.5-800.8)	2.2 (−10.3 to 18.1)	−28.1 (−37.2 to −18.7)
Leukemia	20 (19-24)	22 (21-29)	20.3 (16.4-25.3)	25.5 (20.0-31.6)	25.9 (3.3 to 45.1)	−13 (−25.2 to −2.7)	458.3 (373.9-562.8)	493.6 (402.2-611.1)	7.8 (−3.7 to 19.3)	−20.5 (−28.9 to −11.1)
Human immunodeficiency virus/AIDS	7 (5-9)	23 (22-27)	28.6 (25.6-31.9)	12.1 (10.6-13.7)	−57.7 (−63.5 to −50.5)	−67.7 (−72.1 to −62.3)	1351.1 (1201.1-1508.5)	479.2 (417.4-542.2)	−64.5 (−69.6 to −58.1)	−71.6 (−75.8 to −66.5)
Kidney cancers	35 (28-45)	24 (16-31)	10.7 (7.5-14.2)	24.4 (17.1-39.8)	114.9 (60.0 to 262.5)	47 (9.7 to 146.3)	216.9 (152.7-282.0)	475.7 (334.5-796.4)	104.7 (53.1 to 247.1)	40.9 (5.7 to 144.0)
Non-Hodgkin lymphoma	22 (20-26)	25 (22-30)	20 (16.8-23.5)	25.2 (20.3-30.2)	25.4 (2.4 to 52.4)	−14.6 (−28.0 to 3.5)	407.8 (339.9-465.4)	451.6 (375.7-541.7)	8.6 (−5.7 to 38.5)	−23.6 (−33.4 to −0.2)
Poisonings	31 (22-38)	26 (18-45)	5.9 (4.5-9.6)	11.4 (4.2-16.2)	117.1 (−34.4 to 229.4)	76.1 (−46.7 to 173.3)	263.6 (201.7-433.8)	485.7 (172.9-693.0)	108.1 (−39.3 to 220.0)	74.3 (−48.1 to 173.5)
Prostate cancer	23 (18-35)	27 (16-35)	30.8 (16.6-44.3)	35.9 (20.8-65.4)	9.7 (−30.0 to 89.7)	−25.2 (−49.5 to 26.6)	417.9 (223.7-599.7)	445.6 (250.9-787.1)	−1.6 (−30.1 to 62.4)	−29.6 (−48.8 to 15.5)
Brain cancer	24 (19-31)	28 (21-34)	14 (9.8-21.1)	16.5 (10.9-24.4)	18 (−8.1 to 45.3)	−18 (−33.4 to −3.4)	383.3 (262.8-551.6)	411.2 (279.8-611.0)	7.1 (−9.9 to 26.9)	−22 (−33.8 to −7.5)
Falls	33 (26-36)	29 (24-35)	14.5 (12.1-19.7)	31.6 (18.7-41.7)	136.4 (11.3 to 220.9)	52 (−25.4 to 96.0)	245.4 (215.5-321.9)	400.2 (265.4-489.2)	79.3 (−3.6 to 117.3)	20.9 (−30.3 to 42.9)
Liver cancer	39 (33-43)	30 (25-35)	9.3 (8.3-11.9)	19.5 (13.3-22.7)	118.4 (36.1 to 151.3)	55.3 (−4.9 to 76.4)	184.7 (167.7-235.4)	398.9 (260.6-461.5)	125.5 (34.9 to 156.5)	58.5 (−6.4 to 80.5)