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The Biggest Health Issue is Neuropsychiatric not Cardiovascular


by Richard Aiken MD, PhD @rcaiken

Picture11Heart 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].


Rank Cause Global 2015 YLLs (000s)
0 All Causes 1,948,759
1 Cardiovascular disease 184,787
2 Lower respiratory infections 141,844
3 Stroke 133,424
4 Preterm birth complications  97,212
5 Diarrheal diseases  79,201

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.

Rank Cause United States 2010 YLLs (000s)
1 Cardiovascular disease 7,164
2 Lung cancer 2,987
3 Stroke 1,945
4 COPD 1,913
5 Road Injury 1,873
6 Self-harm 1,457

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].

Rank Cause Global 2010 YLDs (000s)
0 All Causes 777,401
1 Mental disorders 176,626,
2 Musculoskeletal disorders 165,955
3 Neurological disorders 42,943
4 Cardiovascular disease 8,795
5 Cancers 4,483
6 Cerebrovascular disease 4,346

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.

Rank Cause United States 2010 YLD (000s)
1 Neuropsychiatric disorders
Major Depressive Disorder 3049
Anxiety Disorders 1866
Drug use disorders 1296
Alzheimer’s disease 830
Alcohol use disorders 836
Schizophrenia 825
Stroke 629
Bipolar disorder 578
Dysthymia 546
   Total Neuropsychiatric 10455
2 Muscular skeletal disorders
low back pain 3181
other 2602
neck pain 2134
osteoarthritis 994
Rheumatoid arthritis 403
 Total Musculoskeletal disorders  9314
3 COPD 1745
4 Diabetes 1165
8 Cardiovascular disease 685


[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