The principal findings of this investigation revealed that over 1-million years of healthy life were lost for middle-aged and older Americans from the 10 health conditions evaluated over the 16 year study period. Although aging adults were impacted by each health condition, hypertension accounted for the greatest burden; whereas, hip fractures had the lowest number of DALYs. These results were similar when evaluating the DALY estimates for each of the health conditions by sex. Our findings should be used to inform healthcare providers and interventions seeking to prevent morbidity and extend life expectancy in aging adults. Using DALYs to guide healthcare policy will also help to improve quality of life during aging through continued evolutions of disease prevention and treatment.

The Global Burden of Disease studies have identified hypertension as the leading risk factor by attributable disease burden [17]. The prevalence of hypertension increases with age, and is highest in older adults [18]. Of the ten health conditions evaluated in this investigation, hypertension had both the highest number of cases and DALYs. Likewise, those with hypertension had a large amount of YLDs, thereby indicating middle-aged and older adults are living with this disease for long periods of time after diagnosis. The large number of years lived with hypertension can be attributed to the evolution and adherence to hypertension medications [19, 20]. Like all medications, persons considering usage of promising hypertension medications should have discussions with a healthcare provider, and other non-pharmacological modes of treatment and prevention such as engaging in healthy behaviors remains a critical factor for reducing hypertension [18, 21]. Like hypertension, participants indicating they had arthritis or rheumatism also lived with this health condition for long periods of time after diagnosis as demonstrated by the large number of YLDs. These results align with another investigation that revealed rheumatoid arthritis causes significant YLDs and high overall disease burden [22]. It is projected that as smoking rates decline, the number of healthy years of life lost from rheumatoid arthritis will also decrease [22]. Future studies monitoring DALYs for arthritis in middle-aged and older adults are needed to confirm such projections and assess if arthritis medications lower the burden of arthritis in aging adults.

Back pain is generally a prevalent health condition all adults experience as they age and pain management is often challenging [23]. The health implications of back pain are also pronounced, as the Global Burden of Disease project demonstrated that back pain has a large burden in the United States, and is relatively lower in Asian countries [24, 25]. Although our results also suggest the burden of back pain is high for middle-aged and older adults in the United States, our findings for YLDs are lower compared to those of other similar investigations [24, 25]. We believe that this result is attributed to participants reporting back pain before entering the HRS, as indicated by the large number of cases for those aged 50–59 years. Cancer is also a leading cause of morbidity and mortality in older adults [26]. The rise of cancer rates for the older adult population in the United States is projected to increase, thereby posing challenges to healthcare systems and cancer patients [27]. Our results show that the burden of cancer in aging adults is high. Future investigations should continue monitoring DALYs for cancer and specific cancer types in aging adults to assess advancements in cancer treatment, care, and prevention.

About 33% of adults aged at least 65 years in the United States have diabetes and older adults with diabetes are at an elevated risk for mortality than those without diabetes [28]. According to the Global Burden of Disease, diabetes is a leading cause of DALYs in the United States [29], and men are more frequently diagnosed with diabetes than women at younger ages [30]. Our findings indicate the number of diabetes cases were higher in men than women, particularly at ages 50–59 and 60–69 years, which may explain why the burden of diabetes was higher for men than women. While our DALY estimates for diabetes were large, other countries in the Global Burden of Disease, such as Mexico, may have a higher burden from diabetes [25]. Similarly, our results revealed the number myocardial infarction cases and DALYs from this health condition were higher in men compared to women. These results align with another investigation that suggests the prevalence of myocardial infarctions is higher in men than women [31].

Stroke is a leading cause of disability and death for aging adults that is also responsible for billions of dollars in healthcare costs [32]. Persons that sustain a stroke have reduced mobility and are at an increased risk of experiencing another stroke [33]. Therefore, it is not unusual that the burden of stroke has remained high in the United States and globally [24, 25]. Our DALY results for stroke also indicate many healthy years of life lost in middle-aged and older adults. Although advancements in COPD prevention and treatment have been made [34], COPD remains a leading cause of death [35], and the Global Burden of Disease suggests COPD has a tremendous disease burden in the United States [29]. Given that COPD is progressive, persons living with this disease have a large amount of health-related costs [36]. While our findings indicate that the burden of COPD is already high, the burden of COPD is projected to increase [37]. As smoking cessation remains important for preventing and limiting the health effects of COPD, the burden of DALYs should continue to be monitored for helping to inform COPD treatments.

Heart failure is a worldwide health problem that is linked to high morbidity, mortality, and costs of care [38]. As the older adult population increases, the prevalence of heart diseases such as congestive heart failure has also risen [39]. Our results indicating the high burden of congestive heart failure are similar to those of other investigations evaluating DALYs [40]. Although hip fractures are common during aging, the incidence of hip fractures and mortality rates associated with hip fractures have declined in the United States [41, 42]. Another study evaluating DALYs for hip fractures determined that over 200,000 years of healthy life were lost from hip fractures in older adults [43]. While the burden of hip fractures was lowest of the ten health conditions for this investigation, prevention and treatment for hip fractures should remain a priority for aging adults.

Some limitations should be noted. Those who were lost from follow-up or died may have had a health condition that was not recorded before this event, thereby creating underestimations for our results. Moreover, the date of interview served as a proxy for diagnosis date, thereby allowing our results to be further underestimated. The use of an incidence-driven DALY calculation allowed us to determine how the burden of specific health conditions impacted middle-aged and older adults longitudinally; however, we were unable to control for multimorbiditiy in our disability weights. It is also possible that participants may have disputed their records for having a diagnosis or were no longer living with a health condition after initial diagnosis. Self-report biases may have occurred for participant responses. The HRS only includes adults aged 50 years and over; therefore, some participants may have had health conditions at younger ages before entering the study. Statistical tests of inference were not used for making comparisons between DALY estimates because DALYs are often used as a stand-alone statistic.

Likewise, our DALY estimates were influenced by cases, and YLD does not confirm that quality of life was compromised. Future investigations should examine the impact of a health condition on YLD because a smaller YLD may imply that a health condition exacerbates time to death; whereas, a larger YLD may suggest treatment and management of a health condition delays early mortality (depending on age of diagnosis and other important factors). As such, social and policy concerns for aging adults including living arrangements, finances, completion of autonomous living and basic self-care tasks, and care giving should be considered based on disease and health status. Comparing our findings with those of other burden of disease investigations performed in the United States and globally will be helpful for making comparisons across populations and diseases [44]. Moreover, expanding parts of the DALY calculation to other important health outcomes during aging and examining prevalence-based DALYs will help to advance our understanding of health burden.