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Americans are dying sooner and living with more illness than residents of Slovenia and other less prosperous countries, according to the latest study showing the U.S. is getting a poor return on money it spends on care.

Life expectancy in the United States is going up, but chronic disabilities, including many caused by bad food choices, smoking, obesity, physical inactivity and alcohol abuse, account for a larger portion of health issues in the United States compared with its economic peers around the world, according to “The State of U.S. Health, 1990-2010,” published by the Journal of the American Medical Association on Wednesday.

The “State of U.S. Health” study is the first comprehensive analysis of disease burden in the country in more than 15 years. It said chronic disabilities in 2010 accounted for nearly half of all life-shortening health issues. Mental and behavioral disorders alone made up 27 percent of what researchers call “years lived with disability,” meaning the time spent in less-than-optimal health. The biggest contributors are depression, anxiety, drug use and alcoholism.

Since 1990, many childhood diseases are less prevalent, and there has been a dramatic reduction in sudden infant death syndrome, according to the study. There has also been a significant drop in death and disability from HIV/AIDS, and there are lower mortality rates for people of every age.

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But other countries are improving faster. Americans in 2010 could expect to live 78.2 years, up from 75.2 years in 1990, but that was 27th among the 34 nations considered its economic peers. The United States also ranked 27th in high body mass index, an indicator of obesity, and 29th on blood sugar.

“The United States spends more than the rest of the world on health care and leads the world in the quality and quantity of its health research, but that doesn’t add up to better health outcomes,” said Christopher Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, and one of the study’s lead authors.

In a related study examining each county in the United States, researchers at the UW found that more people are running, biking and exercising. But so many others are becoming obese that the increased physical activity has had little impact on the average health of Americans.

Washington state residents continue to live longer and be more active and less obese than the nation as a whole. However, bucking national trends, the percent of Washingtonians getting sufficient exercise did not increase in the past decade.

It decreased 2.6 percentage points to 63.2 for men and increased 0.9 percentage points to 49.0 for women. Obesity rates ranged from 25.1 and 26.0 percent for San Juan County, which also had the highest level of exercise, to 44.6 and 45.1 for Adams County, which had the lowest levels of exercise.

In King County, about six more people out of every hundred are obese compared to 2001. Male obesity prevalence was 28.1 percent and female 29.4 percent in 2011. Initial obesity rates were higher in Snohomish County, which also saw slightly higher increases to an ultimate 35.1 percent for men and 36.0 percent for women in 2011.

The U.S. failed to keep up with other nations in improving population health over the two decades despite spending the most per capita on health care, the study said. The U.S. death rate, after being standardized by age, fell to 27th in 2010 from 18th in 1990. Citizens of poorer countries that spend less on health services, including Chile, Portugal, Slovenia, and South Korea, had lower mortality rates than Americans.

In 2010, 678,282 Americans died because of dietary risks, the study said, outpacing the 465,651 who died that year of smoking-related diseases. High blood pressure, obesity, physical inactivity, high blood sugar and high cholesterol claimed 1.4 million others.

Compiled from The Washington Post, Bloomberg News, and Tribune Washington bureau

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