Abstract

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition

GBDDALYs Hale Collaborators Murray CJ Barber RM Foreman KJ Abbasoglu Ozgoren A Abd-Allah F Abera SF Aboyans V Abraham JP Abubakar I Abu-Raddad LJ Abu-Rmeileh NM Achoki T Ackerman IN Ademi Z Adou AK Adsuar JC Afshin A Agardh EE Alam SS Alasfoor D Albittar MI Alegretti MA Alemu ZA Alfonso-Cristancho R Alhabib S Ali R Alla F Allebeck P Almazroa MA Alsharif U Alvarez E Alvis-Guzman N Amare AT Ameh EA Amini H Ammar W Anderson HR Anderson BO Antonio CA Anwari P Arnlov J Arsic Arsenijevic VS Artaman A Asghar RJ Assadi R Atkins LS Avila MA Awuah B Bachman VF Badawi A Bahit MC Balakrishnan K Banerjee A Barker-Collo SL Barquera S Barregard L Barrero LH Basu A Basu S Basulaiman MO Beardsley J Bedi N Beghi E Bekele T Bell ML Benjet C Bennett DA Bensenor IM Benzian H Bernabe E Bertozzi-Villa A Beyene TJ Bhala N Bhalla A Bhutta ZA Bienhoff K Bikbov B Biryukov S Blore JD Blosser CD Blyth FM Bohensky MA Bolliger IW Bora Basara B Bornstein NM Bose D Boufous S Bourne RR Boyers LN Brainin M Brayne CE Brazinova A Breitborde NJ Brenner H Briggs AD Brooks PM Brown JC Brugha TS Buchbinder R Buckle GC Budke CM Bulchis A Bulloch AG Campos-Nonato IR Carabin H Carapetis JR Cardenas R Carpenter DO Caso V Castaneda-Orjuela CA Castro RE Catala-Lopez F Cavalleri F Cavlin A Chadha VK Chang JC Charlson FJ Chen H Chen W Chiang PP Chimed-Ochir O Chowdhury R Christensen H Christophi CA Cirillo M Coates MM Coffeng LE Coggeshall MS Colistro V Colquhoun SM Cooke GS Cooper C Cooper LT Coppola LM Cortinovis M Criqui MH Crump JA Cuevas-Nasu L Danawi H Dandona L Dandona R Dansereau E Dargan PI Davey G Davis A Davitoiu DV Dayama A De Leo D Degenhardt L Del Pozo-Cruz B Dellavalle RP Deribe K Derrett S Des Jarlais DC Dessalegn M Dharmaratne SD Dherani MK Diaz-Torne C Dicker D Ding EL Dokova K Dorsey ER Driscoll TR Duan L Duber HC Ebel BE Edmond KM Elshrek YM Endres M Ermakov SP Erskine HE Eshrati B Esteghamati A Estep K Faraon EJ Farzadfar F Fay DF Feigin VL Felson DT Fereshtehnejad SM Fernandes JG Ferrari AJ Fitzmaurice C Flaxman AD Fleming TD Foigt N Forouzanfar MH Fowkes FG Paleo UF Franklin RC Furst T Gabbe B Gaffikin L Gankpe FG Geleijnse JM Gessner BD Gething P Gibney KB Giroud M Giussani G Gomez Dantes H Gona P Gonzalez-Medina D Gosselin RA Gotay CC Goto A Gouda HN Graetz N Gugnani HC Gupta R Gupta R Gutierrez RA Haagsma J Hafezi-Nejad N Hagan H Halasa YA Hamadeh RR Hamavid H Hammami M Hancock J Hankey GJ Hansen GM Hao Y Harb HL Haro JM Havmoeller R Hay SI Hay RJ Heredia-Pi IB Heuton KR Heydarpour P Higashi H Hijar M Hoek HW Hoffman HJ Hosgood HD Hossain M Hotez PJ Hoy DG Hsairi M Hu G Huang C Huang JJ Husseini A Huynh C Iannarone ML Iburg KM Innos K Inoue M Islami F Jacobsen KH Jarvis DL Jassal SK Jee SH Jeemon P Jensen PN Jha V Jiang G Jiang Y Jonas JB Juel K Kan H Karch A Karema CK Karimkhani C Karthikeyan G Kassebaum NJ Kaul A Kawakami N Kazanjan K Kemp AH Kengne AP Keren A Khader YS Khalifa SE Khan EA Khan G Khang YH Kieling C Kim D Kim S Kim Y Kinfu Y Kinge JM Kivipelto M Knibbs LD Knudsen AK Kokubo Y Kosen S Krishnaswami S Kuate Defo B Kucuk Bicer B Kuipers EJ Kulkarni C Kulkarni VS Kumar GA Kyu HH Lai T Lalloo R Lallukka T Lam H Lan Q Lansingh VC Larsson A Lawrynowicz AE Leasher JL Leigh J Leung R Levitz CE Li B Li Y Li Y Lim SS Lind M Lipshultz SE Liu S Liu Y Lloyd BK Lofgren KT Logroscino G Looker KJ Lortet-Tieulent J Lotufo PA Lozano R Lucas RM Lunevicius R Lyons RA Ma S Macintyre MF Mackay MT Majdan M Malekzadeh R Marcenes W Margolis DJ Margono C Marzan MB Masci JR Mashal MT Matzopoulos R Mayosi BM Mazorodze TT McGill NW McGrath JJ McKee M McLain A Meaney PA Medina C Mehndiratta MM Mekonnen W Melaku YA Meltzer M Memish ZA Mensah GA Meretoja A Mhimbira FA Micha R Miller TR Mills EJ Mitchell PB Mock CN Mohamed Ibrahim N Mohammad KA Mokdad AH Mola GL Monasta L Montanez Hernandez JC Montico M Montine TJ Mooney MD Moore AR Moradi-Lakeh M Moran AE Mori R Moschandreas J Moturi WN Moyer ML Mozaffarian D Msemburi WT Mueller UO Mukaigawara M Mullany EC Murdoch ME Murray J Murthy KS Naghavi M Naheed A Naidoo KS Naldi L Nand D Nangia V Narayan KM Nejjari C Neupane SP Newton CR Ng M Ngalesoni FN Nguyen G Nisar MI Nolte S Norheim OF Norman RE Norrving B Nyakarahuka L Oh IH Ohkubo T Ohno SL Olusanya BO Opio JN Ortblad K Ortiz A Pain AW Pandian JD Panelo CI Papachristou C Park EK Park JH Patten SB Patton GC Paul VK Pavlin BI Pearce N Pereira DM Perez-Padilla R Perez-Ruiz F Perico N Pervaiz A Pesudovs K Peterson CB Petzold M Phillips MR Phillips BK Phillips DE Piel FB Plass D Poenaru D Polinder S Pope D Popova S Poulton RG Pourmalek F Prabhakaran D Prasad NM Pullan RL Qato DM Quistberg DA Rafay A Rahimi K Rahman SU Raju M Rana SM Razavi H Reddy KS Refaat A Remuzzi G Resnikoff S Ribeiro AL Richardson L Richardus JH Roberts DA Rojas-Rueda D Ronfani L Roth GA Rothenbacher D Rothstein DH Rowley JT Roy N Ruhago GM Saeedi MY Saha S Sahraian MA Sampson UK Sanabria JR Sandar L Santos IS Satpathy M Sawhney M Scarborough P Schneider IJ Schottker B Schumacher AE Schwebel DC Scott JG Seedat S Sepanlou SG Serina PT Servan-Mori EE Shackelford KA Shaheen A Shahraz S Shamah Levy T Shangguan S She J Sheikhbahaei S Shi P Shibuya K Shinohara Y Shiri R Shishani K Shiue I Shrime MG Sigfusdottir ID Silberberg DH Simard EP Sindi S Singh A Singh JA Singh L Skirbekk V Slepak EL Sliwa K Soneji S Soreide K Soshnikov S Sposato LA Sreeramareddy CT Stanaway JD Stathopoulou V Stein DJ Stein MB Steiner C Steiner TJ Stevens A Stewart A Stovner LJ Stroumpoulis K Sunguya BF Swaminathan S Swaroop M Sykes BL Tabb KM Takahashi K Tandon N Tanne D Tanner M Tavakkoli M Taylor HR Te Ao BJ Tediosi F Temesgen AM Templin T Ten Have M Tenkorang EY Terkawi AS Thomson B Thorne-Lyman AL Thrift AG Thurston GD Tillmann T Tonelli M Topouzis F Toyoshima H Traebert J Tran BX Trillini M Truelsen T Tsilimbaris M Tuzcu EM Uchendu US Ukwaja KN Undurraga EA Uzun SB Van Brakel WH Van De Vijver S van Gool CH Van Os J Vasankari TJ Venketasubramanian N Violante FS Vlassov VV Vollset SE Wagner GR Wagner J Waller SG Wan X Wang H Wang J Wang L Warouw TS Weichenthal S Weiderpass E Weintraub RG Wenzhi W Werdecker A Westerman R Whiteford HA Wilkinson JD Williams TN Wolfe CD Wolock TM Woolf AD Wulf S Wurtz B Xu G Yan LL Yano Y Ye P Yentur GK Yip P Yonemoto N Yoon SJ Younis MZ Yu C Zaki ME Zhao Y Zheng Y Zonies D Zou X Salomon JA Lopez AD Vos T
Lancet. 2015;3862145-91

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BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6-6.6), from 65.3 years (65.0-65.6) in 1990 to 71.5 years (71.0-71.9) in 2013, HALE at birth rose by 5.4 years (4.9-5.8), from 56.9 years (54.5-59.1) to 62.3 years (59.7-64.8), total DALYs fell by 3.6% (0.3-7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6-29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.