Abstract

Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Murray CJ Vos T Lozano R Naghavi M Flaxman AD Michaud C Ezzati M Shibuya K Salomon JA Abdalla S Aboyans V Abraham J Ackerman I Aggarwal R Ahn SY Ali MK Alvarado M Anderson HR Anderson LM Andrews KG Atkinson C Baddour LM Bahalim AN Barker-Collo S Barrero LH Bartels DH Basanez MG Baxter A Bell ML Benjamin EJ Bennett D Bernabe E Bhalla K Bhandari B Bikbov B Bin Abdulhak A Birbeck G Black JA Blencowe H Blore JD Blyth F Bolliger I Bonaventure A Boufous S Bourne R Boussinesq M Braithwaite T Brayne C Bridgett L Brooker S Brooks P Brugha TS Bryan-Hancock C Bucello C Buchbinder R Buckle G Budke CM Burch M Burney P Burstein R Calabria B Campbell B Canter CE Carabin H Carapetis J Carmona L Cella C Charlson F Chen H Cheng AT Chou D Chugh SS Coffeng LE Colan SD Colquhoun S Colson KE Condon J Connor MD Cooper LT Corriere M Cortinovis M de Vaccaro KC Couser W Cowie BC Criqui MH Cross M Dabhadkar KC Dahiya M Dahodwala N Damsere-Derry J Danaei G Davis A De Leo D Degenhardt L Dellavalle R Delossantos A Denenberg J Derrett S Des Jarlais DC Dharmaratne SD Dherani M Diaz-Torne C Dolk H Dorsey ER Driscoll T Duber H Ebel B Edmond K Elbaz A Ali SE Erskine H Erwin PJ Espindola P Ewoigbokhan SE Farzadfar F Feigin V Felson DT Ferrari A Ferri CP Fevre EM Finucane MM Flaxman S Flood L Foreman K Forouzanfar MH Fowkes FG Fransen M Freeman MK Gabbe BJ Gabriel SE Gakidou E Ganatra HA Garcia B Gaspari F Gillum RF Gmel G Gonzalez-Medina D Gosselin R Grainger R Grant B Groeger J Guillemin F Gunnell D Gupta R Haagsma J Hagan H Halasa YA Hall W Haring D Haro JM Harrison JE Havmoeller R Hay RJ Higashi H Hill C Hoen B Hoffman H Hotez PJ Hoy D Huang JJ Ibeanusi SE Jacobsen KH James SL Jarvis D Jasrasaria R Jayaraman S Johns N Jonas JB Karthikeyan G Kassebaum N Kawakami N Keren A Khoo JP King CH Knowlton LM Kobusingye O Koranteng A Krishnamurthi R Laden F Lalloo R Laslett LL Lathlean T Leasher JL Lee YY Leigh J Levinson D Lim SS Limb E Lin JK Lipnick M Lipshultz SE Liu W Loane M Ohno SL Lyons R Mabweijano J MacIntyre MF Malekzadeh R Mallinger L Manivannan S Marcenes W March L Margolis DJ Marks GB Marks R Matsumori A Matzopoulos R Mayosi BM McAnulty JH McDermott MM McGill N McGrath J Medina-Mora ME Meltzer M Mensah GA Merriman TR Meyer AC Miglioli V Miller M Miller TR Mitchell PB Mock C Mocumbi AO Moffitt TE Mokdad AA Monasta L Montico M Moradi-Lakeh M Moran A Morawska L Mori R Murdoch ME Mwaniki MK Naidoo K Nair MN Naldi L Narayan KM Nelson PK Nelson RG Nevitt MC Newton CR Nolte S Norman P Norman R O'Donnell M O'Hanlon S Olives C Omer SB Ortblad K Osborne R Ozgediz D Page A Pahari B Pandian JD Rivero AP Patten SB Pearce N Padilla RP Perez-Ruiz F Perico N Pesudovs K Phillips D Phillips MR Pierce K Pion S Polanczyk GV Polinder S Pope CA, 3rd Popova S Porrini E Pourmalek F Prince M Pullan RL Ramaiah KD Ranganathan D Razavi H Regan M Rehm JT Rein DB Remuzzi G Richardson K Rivara FP Roberts T Robinson C De Leon FR Ronfani L Room R Rosenfeld LC Rushton L Sacco RL Saha S Sampson U Sanchez-Riera L Sanman E Schwebel DC Scott JG Segui-Gomez M Shahraz S Shepard DS Shin H Shivakoti R Singh D Singh GM Singh JA Singleton J Sleet DA Sliwa K Smith E Smith JL Stapelberg NJ Steer A Steiner T Stolk WA Stovner LJ Sudfeld C Syed S Tamburlini G Tavakkoli M Taylor HR Taylor JA Taylor WJ Thomas B Thomson WM Thurston GD Tleyjeh IM Tonelli M Towbin JA Truelsen T Tsilimbaris MK Ubeda C Undurraga EA van der Werf MJ van Os J Vavilala MS Venketasubramanian N Wang M Wang W Watt K Weatherall DJ Weinstock MA Weintraub R Weisskopf MG Weissman MM White RA Whiteford H Wiebe N Wiersma ST Wilkinson JD Williams HC Williams SR Witt E Wolfe F Woolf AD Wulf S Yeh PH Zaidi AK Zheng ZJ Zonies D Lopez AD AlMazroa MA Memish ZA
Lancet. 2012;3802197-223

Permenent descriptor

BACKGROUND: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. METHODS: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. FINDINGS: Global DALYs remained stable from 1990 (2.503 billion) to 2010 (2.490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. INTERPRETATION: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. FUNDING: Bill & Melinda Gates Foundation.