Scientists analyze the causes of deaths and disabilities in Colorado over a 29-year period

Scientists at Colorado State University used one of the most comprehensive global health datasets in the world to analyze the causes of deaths and disabilities in Colorado over a 29-year period, from 1990 to 2019. The analysis included risk factors for poor health and deaths, making the study unique, according to Dr. David Rojas-Rueda, senior author of the study and an assistant professor of epidemiology in CSU's Department of Environmental and Radiological Health Sciences.

Cardiovascular disease and neoplasms, or cancers, accounted for half of the deaths in Colorado during this time frame. In relative numbers, Colorado has seen an improvement in health indicators observed in the study over the last 29 years, with mortality and disability rates accounting for an aging population.

Researchers estimated that the number of deaths in the state nearly doubled, from 21,171 to 40,724 deaths in 1990 and 2019, respectively.

In addition:

• Premature deaths due to HIV/AIDS decreased by 82%, and transportation injuries dropped by 40%
• Top risk factors for premature deaths were use of tobacco, drug use, high body-mass index, alcohol use and high blood sugar
• Substance use increased by 140%, while diabetes and kidney disease climbed by 30%
• Top causes for disability and deaths combined were low back pain, opioid use disorders, ischemic heart disease, musculoskeletal disorders and chronic obstructive pulmonary disease.

The research was published Dec. 28 in the International Journal of Environmental Research and Public Health. Researchers used data from the Global Burden of Disease Study produced by the Institute for Health Metrics and Evaluation at the University of Washington.

Rojas-Rueda teamed up on the research with Jen Roux, who recently completed a master's degree from the Colorado School of Public Health at CSU. The analysis provides a big-picture look at the health status of residents in Colorado, just prior to the pandemic.

Need to address musculoskeletal disorders, tobacco and drug use

Of all the findings, Rojas-Rueda said that seeing tobacco at the top of the risk factors list was a little surprising.

It should be less of a problem, compared with years ago before people were aware of the health risks. But when you connect the idea that tobacco exposure will not become a disability or health concern until many years later -; causing lung cancer, respiratory and cardiovascular problems -; it makes sense. It's a reminder that we should still pay attention to public health messaging related to tobacco."

Dr. David Rojas-Rueda, senior author of the study and assistant professor of epidemiology, CSU's Department of Environmental and Radiological Health Sciences

Like the rest of the country, drug and opioid use have an important impact in the health of Coloradans. Rojas-Rueda said that this is a challenging area to address, and that public health practitioners and government officials should work more closely together to tackle these issues.

The most surprising finding? Roux said that was the impact of musculoskeletal disorders, especially low back pain, on overall disability in Colorado.

"When I think about debilitating diseases, low back pain doesn't come to mind," she said. "It is interesting to seeing the broad impact in Colorado and within the U.S. as well."

On a global scale, low back pain is the leading cause of disability.

'We need to do better'

Rojas-Rueda said that the findings could help policymakers target public health issues in a more comprehensive way. He was recently named as a member of the state's new Environmental Justice Advisory Board, part of the Colorado Department of Public Health and Environment.

The epidemiologist said that the state can also adopt new strategies based on the public health measures that are doing well.

"With decreases in premature deaths related to HIV and transportation injuries, we can learn about those approaches, how we are managing those risk factors, and apply them in areas that need more help," he said.

Roux said that the risk factors offer opportunities to try and change behaviors.

"Once you identify a risk factor, you can assess what intervention needs to be implemented to improve health outcomes," she said.

Data for 2020 will not be available until spring 2022, but Rojas-Rueda said that although COVID-19 will be among the top diagnoses, he does not believe the findings will change much since the start of the pandemic.

"These health problems will remain when the pandemic lessens," he said. "And we also need to be prepared for what we're facing after the pandemic lifts, to some degree, in the future. This study is another reminder that we need to do better."