• Richard Aiken

The Biggest Health Issue is Neuropsychiatric not Cardiovascular

by Richard Aiken MD, PhD @rcaiken


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, producing an annual Global Burden of Disease Study (GBD). This figure is based on that data and appeared in a JAMA article April of 2018.


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 the above figure. This is calculated by multiplying the numbers of death at each age by the difference between that age and a reference life expectancy. To calibrate the ordinate, 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 (CVA is cerebrovascular Accidents such as strokes; note that even Rd injury - road injury - could have a significant suicidal or substance abuse element). Therefore, if they are aggregated as a single category, the YLL becomes as illustrated in the figure below.

From this perspective, the number one category of years of life lost is due to neuropsychiatric illness, not heart disease.

For more details, see the video below.



[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.


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