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.

Authors:
Dr. Lorenzo Monasta, DSc Epidemiology, MSc Health Sciences, MSc+BSc Statistics & Demography
Dr. Lorenzo Monasta, DSc Epidemiology, MSc Health Sciences, MSc+BSc Statistics & Demography
Institute for Maternal and Child Health -
Epidemiology and Biostatistics
Trieste, TS | Italy
Dr. David Sleet, MA, Ph.D
Dr. David Sleet, MA, Ph.D
Health Promotion Assoc, San Diego State U, Emory University;Centers for Disease Control and Prevention
Consultant, Injury Prevention; Bizzell Group; CDC
Injury Prevention
Atlanta and San Diego, Georgia and California | United States
Christopher J L Murray Theo Vos Rafael Lozano Mohsen Naghavi Abraham D Flaxman Catherine Michaud Majid Ezzati Kenji Shibuya Joshua A Salomon Safa Abdalla Victor Aboyans Jerry Abraham Ilana Ackerman Rakesh Aggarwal Stephanie Y Ahn Mohammed K Ali Miriam Alvarado H Ross Anderson Laurie M Anderson Kathryn G Andrews Charles Atkinson Larry M Baddour Adil N Bahalim Suzanne Barker-Collo Lope H Barrero David H Bartels Maria-Gloria Basáñez Amanda Baxter Michelle L Bell Emelia J Benjamin Derrick Bennett Eduardo Bernabé Kavi Bhalla Bishal Bhandari Boris Bikbov Aref Bin Abdulhak Gretchen Birbeck James A Black Hannah Blencowe Jed D Blore Fiona Blyth Ian Bolliger Audrey Bonaventure Soufiane Boufous Rupert Bourne Michel Boussinesq Tasanee Braithwaite Carol Brayne Lisa Bridgett Simon Brooker Peter Brooks Traolach S Brugha Claire Bryan-Hancock Chiara Bucello Rachelle Buchbinder Geoffrey Buckle Christine M Budke Michael Burch Peter Burney Roy Burstein Bianca Calabria Benjamin Campbell Charles E Canter Hélène Carabin Jonathan Carapetis Loreto Carmona Claudia Cella Fiona Charlson Honglei Chen Andrew Tai-Ann Cheng David Chou Sumeet S Chugh Luc E Coffeng Steven D Colan Samantha Colquhoun K Ellicott Colson John Condon Myles D Connor Leslie T Cooper Matthew Corriere Monica Cortinovis Karen Courville de Vaccaro William Couser Benjamin C Cowie Michael H Criqui Marita Cross Kaustubh C Dabhadkar Manu Dahiya Nabila Dahodwala James Damsere-Derry Goodarz Danaei Adrian Davis Diego De Leo Louisa Degenhardt Robert Dellavalle Allyne Delossantos Julie Denenberg Sarah Derrett Don C Des Jarlais Samath D Dharmaratne Mukesh Dherani Cesar Diaz-Torne Helen Dolk E Ray Dorsey Tim Driscoll Herbert Duber Beth Ebel Karen Edmond Alexis Elbaz Suad Eltahir Ali Holly Erskine Patricia J Erwin Patricia Espindola Stalin E Ewoigbokhan Farshad Farzadfar Valery Feigin David T Felson Alize Ferrari Cleusa P Ferri Eric M Fèvre Mariel M Finucane Seth Flaxman Louise Flood Kyle Foreman Mohammad H Forouzanfar Francis Gerry R Fowkes Marlene Fransen Michael K Freeman Belinda J Gabbe Sherine E Gabriel Emmanuela Gakidou Hammad A Ganatra Bianca Garcia Flavio Gaspari Richard F Gillum Gerhard Gmel Diego Gonzalez-Medina Richard Gosselin Rebecca Grainger Bridget Grant Justina Groeger Francis Guillemin David Gunnell Ramyani Gupta Juanita Haagsma Holly Hagan Yara A Halasa Wayne Hall Diana Haring Josep Maria Haro James E Harrison Rasmus Havmoeller Roderick J Hay Hideki Higashi Catherine Hill Bruno Hoen Howard Hoffman Peter J Hotez Damian Hoy John J Huang Sydney E Ibeanusi Kathryn H Jacobsen Spencer L James Deborah Jarvis Rashmi Jasrasaria Sudha Jayaraman Nicole Johns Jost B Jonas Ganesan Karthikeyan Nicholas Kassebaum Norito Kawakami Andre Keren Jon-Paul Khoo Charles H King Lisa Marie Knowlton Olive Kobusingye Adofo Koranteng Rita Krishnamurthi Francine Laden Ratilal Lalloo Laura L Laslett Tim Lathlean Janet L Leasher Yong Yi Lee James Leigh Daphna Levinson Stephen S Lim Elizabeth Limb John Kent Lin Michael Lipnick Steven E Lipshultz Wei Liu Maria Loane Summer Lockett Ohno Ronan Lyons Jacqueline Mabweijano Michael F MacIntyre Reza Malekzadeh Leslie Mallinger Sivabalan Manivannan Wagner Marcenes Lyn March David J Margolis Guy B Marks Robin Marks Akira Matsumori Richard Matzopoulos Bongani M Mayosi John H McAnulty Mary M McDermott Neil McGill John McGrath Maria Elena Medina-Mora Michele Meltzer George A Mensah Tony R Merriman Ana-Claire Meyer Valeria Miglioli Matthew Miller Ted R Miller Philip B Mitchell Charles Mock Ana Olga Mocumbi Terrie E Moffitt Ali A Mokdad Marcella Montico Maziar Moradi-Lakeh Andrew Moran Lidia Morawska Rintaro Mori Michele E Murdoch Michael K Mwaniki Kovin Naidoo M Nathan Nair Luigi Naldi K M Venkat Narayan Paul K Nelson Robert G Nelson Michael C Nevitt Charles R Newton Sandra Nolte Paul Norman Rosana Norman Martin O'Donnell Simon O'Hanlon Casey Olives Saad B Omer Katrina Ortblad Richard Osborne Doruk Ozgediz Andrew Page Bishnu Pahari Jeyaraj Durai Pandian Andrea Panozo Rivero Scott B Patten Neil Pearce Rogelio Perez Padilla Fernando Perez-Ruiz Norberto Perico Konrad Pesudovs David Phillips Michael R Phillips Kelsey Pierce Sébastien Pion Guilherme V Polanczyk Suzanne Polinder C Arden Pope Svetlana Popova Esteban Porrini Farshad Pourmalek Martin Prince Rachel L Pullan Kapa D Ramaiah Dharani Ranganathan Homie Razavi Mathilda Regan Jürgen T Rehm David B Rein Guiseppe Remuzzi Kathryn Richardson Frederick P Rivara Thomas Roberts Carolyn Robinson Felipe Rodriguez De Leòn Luca Ronfani Robin Room Lisa C Rosenfeld Lesley Rushton Ralph L Sacco Sukanta Saha Uchechukwu Sampson Lidia Sanchez-Riera Ella Sanman David C Schwebel James Graham Scott Maria Segui-Gomez Saeid Shahraz Donald S Shepard Hwashin Shin Rupak Shivakoti David Singh Gitanjali M Singh Jasvinder A Singh Jessica Singleton David A Sleet Karen Sliwa Emma Smith Jennifer L Smith Nicolas J C Stapelberg Andrew Steer Timothy Steiner Wilma A Stolk Lars Jacob Stovner Christopher Sudfeld Sana Syed Giorgio Tamburlini Mohammad Tavakkoli Hugh R Taylor Jennifer A Taylor William J Taylor Bernadette Thomas W Murray Thomson George D Thurston Imad M Tleyjeh Marcello Tonelli Jeffrey A Towbin Thomas Truelsen Miltiadis K Tsilimbaris Clotilde Ubeda Eduardo A Undurraga Marieke J van der Werf Jim van Os Monica S Vavilala N Venketasubramanian Mengru Wang Wenzhi Wang Kerrianne Watt David J Weatherall Martin A Weinstock Robert Weintraub Marc G Weisskopf Myrna M Weissman Richard A White Harvey Whiteford Natasha Wiebe Steven T Wiersma James D Wilkinson Hywel C Williams Sean R M Williams Emma Witt Frederick Wolfe Anthony D Woolf Sarah Wulf Pon-Hsiu Yeh Anita K M Zaidi Zhi-Jie Zheng David Zonies Alan D Lopez Mohammad A AlMazroa Ziad A Memish

Lancet 2012 Dec;380(9859):2197-223

Institute for Health Metrics and Evaluation, Seattle 98121, WA, USA.

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.

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December 2012
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