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While the importance of cardiovascular health is well-recognized, even more devastating are disorders associated with neuropsychiatric health.

The University of Washington’s Institute for Health Metrics and Evaluation has created the world’s first and largest catalog of health-related data, the Global Health Data Exchange. Here’s the data that appeared in a JAMA article April of 2018 referenced toward the bottom of this slide.

The impact that diseases have on one’s life can be illustrated by the years of life lost (abbreviated YLL) due to death by various diseases, shown on this slide on the ordinate. YLL is calculated by multiplying the numbers of death at each age by the difference between that age and a reference life expectancy.
To get an idea of the numbers here, YLL for heart disease per year is 1651 per 100,000 people.

As expected, heart disease is the number one cause of years of life lost with lung cancer second. Less expected is road injuries as third, suicide fourth, cerebrovascular disease fifth, drug use sixth, and dementia seventh.

Note the last four categories of YLL are neuropsychiatric in nature. Therefore, if they are aggregated as a single category -click- , the YLL becomes as illustrated here. From this perspective, the number one category of years of life lost is due to neuropsychiatric illness, not heart disease.
But we wish to not only increase years in our lives, we also want to have life in our years.

A measure of this is “years lost to disability” (abbreviated YLD) calculated by multiplying prevalence by the disability weight (based on population-based surveys); “disability” refers to any significant short- or long-term loss of health and function.

The graph shows the leading global YLD in 2010, reference given at the bottom of the slide.

Over three-quarters of a billion years are lost annually due to disabilities. Of these, mental disorders are the major cause of disability in the world.

If one includes neurologic and cerebrovascular diseases, – click – the importance of this category is further magnified.

Cardiovascular diseases contributed less than 5% of global YLDs, mental disorders being 20 times as important.

Therefore neuropsychiatric disorders are both leading causes of death and of disability in the world.

by Richard Aiken MD, PhD @rcaiken

Heart disease is well-known as the leading cause of death in the United States as in other developed countries of the western world.   The impact of this might be best understood by examining the years of life lost (YLL) to this disease.

Years of Life Lost due to Death: World

YLL due to premature mortality is calculated by multiplying the number of deaths at each age by a reference life expectancy at that age. The table below indicates a total of about two billion years of life lost globally to disease states. The diseases and injuries with the largest number of YLLs in 2015 were cardiovascular disease, lower respiratory infections, stroke, preterm birth complications, and diarrheal disease, shown in the following table[1].

Years of Life Lost due to Death: United States

In the United States, by far the leading cause of YLL is cardiovascular disease, followed by lung cancer, stroke, chronic obstructive pulmonary disease (COPD), road injury, and self-harm, as shown in the following table[2].  The reason why road injury and self-harm (suicide)  are so high on the list is that the cause of death occurs across the age spectrum – not just in older age.

Despite declines over the past ten years, 15.9% of YLLs were related to cardiovascular disease and 4.3% were related to stroke – cerebrovascular – highlighting the continued dominance of vascular diseases in premature death.

Years of Life Lost to Disability: World

While the goal is to increase years in our lives, an associated need is to have life in our years.

Non-fatal health outcomes from diseases are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level[3]. This information has raised awareness about a range of disorders that primarily cause ill health but not death, such as unipolar major depression, bipolar disorder, asthma, and osteoarthritis.

A measure of this is “years lost to disability” (YLD) calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; “disability” refers to any significant short- or long-term loss of health and function.

The following shows the leading global YLD[4].

Note that over three-quarters of a billion years are lost annually due to disabilities. Of these, mental disorders are the major cause of disability in the world, accounting for 22·7% of all YLDs. YLDs for this category as a whole have increased by 37% from 1990 to 2010. If one includes neurological and cerebrovascular diseases, directly related to mental, cognitive, and behavioral disorders – psychoneurological disorders – the importance of this category is further magnified.

Cardiovascular diseases did not contribute more than 5% of global YLDs, mental disorders being 20 times as important and neurological disorders about 5 times as important when considering years lost to disability.

Years of Life Lost to Disability: United States

YLD in the United States is similar to the global trend except COPD and diabetes outranks cancer and cardiovascular disease., as indicated in the following table[5]  Again mental or neuropsychiatric disorders, most prominently clinical depression, are the largest cause of years lost to disability.

References

[1] Global Health Estimates 2015: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva, World Health Organization; 2016.

[2] Murray, C. J. (2013). The State of US Health, 1990-2010. Jama, 310(6), 591. doi:10.1001/jama.2013.13805.

[3] Murray CJ, Ezzati M, Flaxman AD, et al. GBD 2010: design, definitions, and metrics. Lancet. 2012;380(9859):2063-2066.

[4] Voss, T. et al.,  Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

[5] Murray ibid