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.

Authors:
Christopher J L Murray Ryan M Barber Kyle J Foreman Ayse Abbasoglu Ozgoren Foad Abd-Allah Semaw F Abera Victor Aboyans Jerry P Abraham Ibrahim Abubakar Laith J Abu-Raddad Niveen M Abu-Rmeileh Tom Achoki Ilana N Ackerman Zanfina Ademi Arsène K Adou José C Adsuar Ashkan Afshin Emilie E Agardh Sayed Saidul Alam Deena Alasfoor Mohammed I Albittar Miguel A Alegretti Zewdie A Alemu Rafael Alfonso-Cristancho Samia Alhabib Raghib Ali François Alla Peter Allebeck Mohammad A Almazroa Ubai Alsharif Elena Alvarez Nelson Alvis-Guzman Azmeraw T Amare Emmanuel A Ameh Heresh Amini Walid Ammar H Ross Anderson Benjamin O Anderson Carl Abelardo T Antonio Palwasha Anwari Johan Arnlöv Valentina S Arsic Arsenijevic Al Artaman Rana J Asghar Reza Assadi Lydia S Atkins Marco A Avila Baffour Awuah Victoria F Bachman Alaa Badawi Maria C Bahit Kalpana Balakrishnan Amitava Banerjee Suzanne L Barker-Collo Simon Barquera Lars Barregard Lope H Barrero Arindam Basu Sanjay Basu Mohammed O Basulaiman Justin Beardsley Neeraj Bedi Ettore Beghi Tolesa Bekele Michelle L Bell Corina Benjet Derrick A Bennett Isabela M Bensenor Habib Benzian Eduardo Bernabé Amelia Bertozzi-Villa Tariku J Beyene Neeraj Bhala Ashish Bhalla Zulfiqar A Bhutta Kelly Bienhoff Boris Bikbov Stan Biryukov Jed D Blore Christopher D Blosser Fiona M Blyth Megan A Bohensky Ian W Bolliger Berrak Bora Başara Natan M Bornstein Dipan Bose Soufiane Boufous Rupert R A Bourne Lindsay N Boyers Michael Brainin Carol E Brayne Alexandra Brazinova Nicholas J K Breitborde Hermann Brenner Adam D Briggs Peter M Brooks Jonathan C Brown Traolach S Brugha Rachelle Buchbinder Geoffrey C Buckle Christine M Budke Anne Bulchis Andrew G Bulloch Ismael R Campos-Nonato Hélène Carabin Jonathan R Carapetis Rosario Cárdenas David O Carpenter Valeria Caso Carlos A Castañeda-Orjuela Ruben E Castro Ferrán Catalá-López Fiorella Cavalleri Alanur Çavlin Vineet K Chadha Jung-Chen Chang Fiona J Charlson Honglei Chen Wanqing Chen Peggy P Chiang Odgerel Chimed-Ochir Rajiv Chowdhury Hanne Christensen Costas A Christophi Massimo Cirillo Matthew M Coates Luc E Coffeng Megan S Coggeshall Valentina Colistro Samantha M Colquhoun Graham S Cooke Cyrus Cooper Leslie T Cooper Luis M Coppola Monica Cortinovis Michael H Criqui John A Crump Lucia Cuevas-Nasu Hadi Danawi Lalit Dandona Rakhi Dandona Emily Dansereau Paul I Dargan Gail Davey Adrian Davis Dragos V Davitoiu Anand Dayama Diego De Leo Louisa Degenhardt Borja Del Pozo-Cruz Robert P Dellavalle Kebede Deribe Sarah Derrett Don C Des Jarlais Muluken Dessalegn Samath D Dharmaratne Mukesh K Dherani Cesar Diaz-Torné Daniel Dicker Eric L Ding Klara Dokova E Ray Dorsey Tim R Driscoll Leilei Duan Herbert C Duber Beth E Ebel Karen M Edmond Yousef M Elshrek Matthias Endres Sergey P Ermakov Holly E Erskine Babak Eshrati Alireza Esteghamati Kara Estep Emerito Jose A Faraon Farshad Farzadfar Derek F Fay Valery L Feigin David T Felson Seyed-Mohammad Fereshtehnejad Jefferson G Fernandes Alize J Ferrari Christina Fitzmaurice Abraham D Flaxman Thomas D Fleming Nataliya Foigt Mohammad H Forouzanfar F Gerry R Fowkes Urbano Fra Paleo Richard C Franklin Thomas Fürst Belinda Gabbe Lynne Gaffikin Fortuné G Gankpé Johanna M Geleijnse Bradford D Gessner Peter Gething Katherine B Gibney Maurice Giroud Giorgia Giussani Hector Gomez Dantes Philimon Gona Diego González-Medina Richard A Gosselin Carolyn C Gotay Atsushi Goto Hebe N Gouda Nicholas Graetz Harish C Gugnani Rahul Gupta Rajeev Gupta Reyna A Gutiérrez Juanita Haagsma Nima Hafezi-Nejad Holly Hagan Yara A Halasa Randah R Hamadeh Hannah Hamavid Mouhanad Hammami Jamie Hancock Graeme J Hankey Gillian M Hansen Yuantao Hao Hilda L Harb Josep Maria Haro Rasmus Havmoeller Simon I Hay Roderick J Hay Ileana B Heredia-Pi Kyle R Heuton Pouria Heydarpour Hideki Higashi Martha Hijar Hans W Hoek Howard J Hoffman H Dean Hosgood Mazeda Hossain Peter J Hotez Damian G Hoy Mohamed Hsairi Guoqing Hu Cheng Huang John J Huang Abdullatif Husseini Chantal Huynh Marissa L Iannarone Kim M Iburg Kaire Innos Manami Inoue Farhad Islami Kathryn H Jacobsen Deborah L Jarvis Simerjot K Jassal Sun Ha Jee Panniyammakal Jeemon Paul N Jensen Vivekanand Jha Guohong Jiang Ying Jiang Jost B Jonas Knud Juel Haidong Kan André Karch Corine K Karema Chante Karimkhani Ganesan Karthikeyan Nicholas J Kassebaum Anil Kaul Norito Kawakami Konstantin Kazanjan Andrew H Kemp Andre P Kengne Andre Keren Yousef S Khader Shams Eldin A Khalifa Ejaz A Khan Gulfaraz Khan Young-Ho Khang Christian Kieling Daniel Kim Sungroul Kim Yunjin Kim Yohannes Kinfu Jonas M Kinge Miia Kivipelto Luke D Knibbs Ann Kristin Knudsen Yoshihiro Kokubo Soewarta Kosen Sanjay Krishnaswami Barthelemy Kuate Defo Burcu Kucuk Bicer Ernst J Kuipers Chanda Kulkarni Veena S Kulkarni G Anil Kumar Hmwe H Kyu Taavi Lai Ratilal Lalloo Tea Lallukka Hilton Lam Qing Lan Van C Lansingh Anders Larsson Alicia E B Lawrynowicz Janet L Leasher James Leigh Ricky Leung Carly E Levitz Bin Li Yichong Li Yongmei Li Stephen S Lim Maggie Lind Steven E Lipshultz Shiwei Liu Yang Liu Belinda K Lloyd Katherine T Lofgren Giancarlo Logroscino Katharine J Looker Joannie Lortet-Tieulent Paulo A Lotufo Rafael Lozano Robyn M Lucas Raimundas Lunevicius Ronan A Lyons Stefan Ma Michael F Macintyre Mark T Mackay Marek Majdan Reza Malekzadeh Wagner Marcenes David J Margolis Christopher Margono Melvin B Marzan Joseph R Masci Mohammad T Mashal Richard Matzopoulos Bongani M Mayosi Tasara T Mazorodze Neil W Mcgill John J Mcgrath Martin Mckee Abigail Mclain Peter A Meaney Catalina Medina Man Mohan Mehndiratta Wubegzier Mekonnen Yohannes A Melaku Michele Meltzer Ziad A Memish George A Mensah Atte Meretoja Francis A Mhimbira Renata Micha Ted R Miller Edward J Mills Philip B Mitchell Charles N Mock Norlinah Mohamed Ibrahim Karzan A Mohammad Ali H Mokdad Glen L D Mola Lorenzo Monasta Julio C Montañez Hernandez Marcella Montico Thomas J Montine Meghan D Mooney Ami R Moore Maziar Moradi-Lakeh Andrew E Moran Rintaro Mori Joanna Moschandreas Wilkister N Moturi Madeline L Moyer Dariush Mozaffarian William T Msemburi Ulrich O Mueller Mitsuru Mukaigawara Erin C Mullany Michele E Murdoch Joseph Murray Kinnari S Murthy Mohsen Naghavi Aliya Naheed Kovin S Naidoo Luigi Naldi Devina Nand Vinay Nangia K M Venkat Narayan Chakib Nejjari Sudan P Neupane Charles R Newton Marie Ng Frida N Ngalesoni Grant Nguyen Muhammad I Nisar Sandra Nolte Ole F Norheim Rosana E Norman Bo Norrving Luke Nyakarahuka In-Hwan Oh Takayoshi Ohkubo Summer L Ohno Bolajoko O Olusanya John Nelson Opio Katrina Ortblad Alberto Ortiz Amanda W Pain Jeyaraj D Pandian Carlo Irwin A Panelo Christina Papachristou Eun-Kee Park Jae-Hyun Park Scott B Patten George C Patton Vinod K Paul Boris I Pavlin Neil Pearce David M Pereira Rogelio Perez-Padilla Fernando Perez-Ruiz Norberto Perico Aslam Pervaiz Konrad Pesudovs Carrie B Peterson Max Petzold Michael R Phillips Bryan K Phillips David E Phillips Frédéric B Piel Dietrich Plass Dan Poenaru Suzanne Polinder Daniel Pope Svetlana Popova Richie G Poulton Farshad Pourmalek Dorairaj Prabhakaran Noela M Prasad Rachel L Pullan Dima M Qato D Alex Quistberg Anwar Rafay Kazem Rahimi Sajjad U Rahman Murugesan Raju Saleem M Rana Homie Razavi K Srinath Reddy Amany Refaat Giuseppe Remuzzi Serge Resnikoff Antonio L Ribeiro Lee Richardson Jan Hendrik Richardus D Allen Roberts David Rojas-Rueda Luca Ronfani Gregory A Roth Dietrich Rothenbacher David H Rothstein Jane T Rowley Nobhojit Roy George M Ruhago Mohammad Y Saeedi Sukanta Saha Mohammad Ali Sahraian Uchechukwu K A Sampson Juan R Sanabria Logan Sandar Itamar S Santos Maheswar Satpathy Monika Sawhney Peter Scarborough Ione J Schneider Ben Schöttker Austin E Schumacher David C Schwebel James G Scott Soraya Seedat Sadaf G Sepanlou Peter T Serina Edson E Servan-Mori Katya A Shackelford Amira Shaheen Saeid Shahraz Teresa Shamah Levy Siyi Shangguan Jun She Sara Sheikhbahaei Peilin Shi Kenji Shibuya Yukito Shinohara Rahman Shiri Kawkab Shishani Ivy Shiue Mark G Shrime Inga D Sigfusdottir Donald H Silberberg Edgar P Simard Shireen Sindi Abhishek Singh Jasvinder A Singh Lavanya Singh Vegard Skirbekk Erica Leigh Slepak Karen Sliwa Samir Soneji Kjetil Søreide Sergey Soshnikov Luciano A Sposato Chandrashekhar T Sreeramareddy Jeffrey D Stanaway Vasiliki Stathopoulou Dan J Stein Murray B Stein Caitlyn Steiner Timothy J Steiner Antony Stevens Andrea Stewart Lars J Stovner Konstantinos Stroumpoulis Bruno F Sunguya Soumya Swaminathan Mamta Swaroop Bryan L Sykes Karen M Tabb Ken Takahashi Nikhil Tandon David Tanne Marcel Tanner Mohammad Tavakkoli Hugh R Taylor Braden J Te Ao Fabrizio Tediosi Awoke M Temesgen Tara Templin Margreet Ten Have Eric Y Tenkorang Abdullah S Terkawi Blake Thomson Andrew L Thorne-Lyman Amanda G Thrift George D Thurston Taavi Tillmann Marcello Tonelli Fotis Topouzis Hideaki Toyoshima Jefferson Traebert Bach X Tran Matias Trillini Thomas Truelsen Miltiadis Tsilimbaris Emin M Tuzcu Uche S Uchendu Kingsley N Ukwaja Eduardo A Undurraga Selen B Uzun Wim H Van Brakel Steven Van De Vijver Coen H van Gool Jim Van Os Tommi J Vasankari N Venketasubramanian Francesco S Violante Vasiliy V Vlassov Stein Emil Vollset Gregory R Wagner Joseph Wagner Stephen G Waller Xia Wan Haidong Wang Jianli Wang Linhong Wang Tati S Warouw Scott Weichenthal Elisabete Weiderpass Robert G Weintraub Wang Wenzhi Andrea Werdecker Ronny Westerman Harvey A Whiteford James D Wilkinson Thomas N Williams Charles D Wolfe Timothy M Wolock Anthony D Woolf Sarah Wulf Brittany Wurtz Gelin Xu Lijing L Yan Yuichiro Yano Pengpeng Ye Gökalp K Yentür Paul Yip Naohiro Yonemoto Seok-Jun Yoon Mustafa Z Younis Chuanhua Yu Maysaa E Zaki Yong Zhao Yingfeng Zheng David Zonies Xiaonong Zou Joshua A Salomon Alan D Lopez Theo Vos

Lancet 2015 Nov 28;386(10009):2145-91. Epub 2015 Aug 28.

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.

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November 2015
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