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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

Summary 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–... Full description

Journal Title: Lancet (London England) 2015, Vol.386 (10009), p.2145-2191
Main Author: Murray, Christopher J L
Other Authors: Foreman, Kyle J , Abd-Allah, Foad , Abu-Rmeileh, Niveen M , Achoki, Tom , Alla, François , Almazroa, Mohammad A , Alsharif, Ubai , Ameh, Emmanuel A , Ammar, Walid , Antonio, Carl Abelardo T , Banerjee, Amitava , Basu, Arindam , Basulaiman, Mohammed O , Beghi, Ettore , Bertozzi-Villa, Amelia , Bhala, Neeraj , Bikbov, Boris , Blyth, Fiona M , Bourne, Rupert R A , Bulchis, Anne , Chang, Jung-Chen , Coppola, Luis M , Cuevas-Nasu, Lucia , Danawi, Hadi , Dandona, Rakhi , Davey, Gail , Degenhardt, Louisa , Del Pozo-Cruz, Borja , Deribe, Kebede , Dherani, Mukesh K , Duan, Leilei , Endres, Matthias , Erskine, Holly E , Eshrati, Babak , Felson, David T , Gessner, Bradford D , Giussani, Giorgia , González-Medina, Diego , Gosselin, Richard A , Gupta, Rahul , Hagan, Holly , Heuton, Kyle R , Husseini, Abdullatif , Huynh, Chantal , Iburg, Kim M , Islami, Farhad , Jarvis, Deborah L , Jiang, Guohong , Jonas, Jost B , Karema, Corine K , Khan, Ejaz A , Kim, Yunjin , Kinfu, Yohannes , Kinge, Jonas M , Defo, Barthelemy Kuate , Leung, Ricky , Logroscino, Giancarlo , Matzopoulos, Richard , Melaku, Yohannes A , Mitchell, Philip B , Montico, Marcella , Moturi, Wilkister N , Neupane, Sudan P , Ngalesoni, Frida N , Nisar, Muhammad I , Phillips, Michael R , Piel, Frédéric B , Poenaru, Dan , Prasad, Noela M , Qato, Dima M , Raju, Murugesan , Richardus, Jan Hendrik , Roberts, D Allen , Rojas-Rueda, David , Saeedi, Mohammad Y , Sahraian, Mohammad Ali , Scarborough, Peter , Schöttker, Ben , Shackelford, Katya A , Shaheen, Amira , Shiri, Rahman , Shishani, Kawkab , Sliwa, Karen , Stanaway, Jeffrey D , Stathopoulou, Vasiliki , Steiner, Caitlyn , Stovner, Lars J , Sunguya, Bruno F , Swaroop, Mamta , Tanner, Marcel , Ao, Braden J Te , Undurraga, Eduardo A , Wilkinson, James D , Williams, Thomas N , Xu, Gelin , Yonemoto, Naohiro , Yoon, Seok-Jun , Yu, Chuanhua , Vos, Theo
Format: Electronic Article Electronic Article
Language: English
Subjects:
Age
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
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title: 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
format: Article
creator:
  • Murray, Christopher J L
  • Foreman, Kyle J
  • Abd-Allah, Foad
  • Abu-Rmeileh, Niveen M
  • Achoki, Tom
  • Alla, François
  • Almazroa, Mohammad A
  • Alsharif, Ubai
  • Ameh, Emmanuel A
  • Ammar, Walid
  • Antonio, Carl Abelardo T
  • Banerjee, Amitava
  • Basu, Arindam
  • Basulaiman, Mohammed O
  • Beghi, Ettore
  • Bertozzi-Villa, Amelia
  • Bhala, Neeraj
  • Bikbov, Boris
  • Blyth, Fiona M
  • Bourne, Rupert R A
  • Bulchis, Anne
  • Chang, Jung-Chen
  • Coppola, Luis M
  • Cuevas-Nasu, Lucia
  • Danawi, Hadi
  • Dandona, Rakhi
  • Davey, Gail
  • Degenhardt, Louisa
  • Del Pozo-Cruz, Borja
  • Deribe, Kebede
  • Dherani, Mukesh K
  • Duan, Leilei
  • Endres, Matthias
  • Erskine, Holly E
  • Eshrati, Babak
  • Felson, David T
  • Gessner, Bradford D
  • Giussani, Giorgia
  • González-Medina, Diego
  • Gosselin, Richard A
  • Gupta, Rahul
  • Hagan, Holly
  • Heuton, Kyle R
  • Husseini, Abdullatif
  • Huynh, Chantal
  • Iburg, Kim M
  • Islami, Farhad
  • Jarvis, Deborah L
  • Jiang, Guohong
  • Jonas, Jost B
  • Karema, Corine K
  • Khan, Ejaz A
  • Kim, Yunjin
  • Kinfu, Yohannes
  • Kinge, Jonas M
  • Defo, Barthelemy Kuate
  • Leung, Ricky
  • Logroscino, Giancarlo
  • Matzopoulos, Richard
  • Melaku, Yohannes A
  • Mitchell, Philip B
  • Montico, Marcella
  • Moturi, Wilkister N
  • Neupane, Sudan P
  • Ngalesoni, Frida N
  • Nisar, Muhammad I
  • Phillips, Michael R
  • Piel, Frédéric B
  • Poenaru, Dan
  • Prasad, Noela M
  • Qato, Dima M
  • Raju, Murugesan
  • Richardus, Jan Hendrik
  • Roberts, D Allen
  • Rojas-Rueda, David
  • Saeedi, Mohammad Y
  • Sahraian, Mohammad Ali
  • Scarborough, Peter
  • Schöttker, Ben
  • Shackelford, Katya A
  • Shaheen, Amira
  • Shiri, Rahman
  • Shishani, Kawkab
  • Sliwa, Karen
  • Stanaway, Jeffrey D
  • Stathopoulou, Vasiliki
  • Steiner, Caitlyn
  • Stovner, Lars J
  • Sunguya, Bruno F
  • Swaroop, Mamta
  • Tanner, Marcel
  • Ao, Braden J Te
  • Undurraga, Eduardo A
  • Wilkinson, James D
  • Williams, Thomas N
  • Xu, Gelin
  • Yonemoto, Naohiro
  • Yoon, Seok-Jun
  • Yu, Chuanhua
  • Vos, Theo
subjects:
  • Adjusted Life Years
  • Age
  • Aged
  • Article
  • Chair Nutrition and Disease
  • Chronic Disease
  • Chronic Disease - epidemiology
  • Clinical Medicine
  • Communicable Diseases
  • Communicable Diseases - epidemiology
  • Disease
  • Epidemiology
  • Female
  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
  • General & Internal Medicine
  • Global Health
  • Global Health - statistics & numerical data
  • Health and Welfare
  • Health aspects
  • Health Sciences
  • Health Transition
  • HNE Nutrition and Disease
  • HNE Voeding en Ziekte
  • Humans
  • Hälsa och välfärd
  • Hälsovetenskap
  • Hälsovetenskaper
  • Injuries
  • Internal Medicine
  • Klinisk medicin
  • Life Expectancy
  • Life Sciences
  • Male
  • Medical and Health Sciences
  • Medicin och hälsovetenskap
  • Medicine (all)
  • Middle Aged
  • Mortality
  • Mortality, Premature
  • Nutrition and Disease
  • Premature
  • Public Health, Global Health, Social Medicine and Epidemiology
  • Quality
  • Quality-Adjusted Life Years
  • Santé publique et épidémiologie
  • SDG 3 - Good Health and Well-being
  • Socioeconomic Factors
  • Studies
  • VLAG
  • Voeding en Ziekte
  • Wounds
  • Wounds and Injuries
  • Wounds and Injuries - epidemiology
ispartof: Lancet (London England), 2015, Vol.386 (10009), p.2145-2191
description: Summary 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 sp
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
url: Link


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titleGlobal, 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
sourceAlma/SFX Local Collection
creatorMurray, Christopher J L ; Foreman, Kyle J ; Abd-Allah, Foad ; Abu-Rmeileh, Niveen M ; Achoki, Tom ; Alla, François ; Almazroa, Mohammad A ; Alsharif, Ubai ; Ameh, Emmanuel A ; Ammar, Walid ; Antonio, Carl Abelardo T ; Banerjee, Amitava ; Basu, Arindam ; Basulaiman, Mohammed O ; Beghi, Ettore ; Bertozzi-Villa, Amelia ; Bhala, Neeraj ; Bikbov, Boris ; Blyth, Fiona M ; Bourne, Rupert R A ; Bulchis, Anne ; Chang, Jung-Chen ; Coppola, Luis M ; Cuevas-Nasu, Lucia ; Danawi, Hadi ; Dandona, Rakhi ; Davey, Gail ; Degenhardt, Louisa ; Del Pozo-Cruz, Borja ; Deribe, Kebede ; Dherani, Mukesh K ; Duan, Leilei ; Endres, Matthias ; Erskine, Holly E ; Eshrati, Babak ; Felson, David T ; Gessner, Bradford D ; Giussani, Giorgia ; González-Medina, Diego ; Gosselin, Richard A ; Gupta, Rahul ; Hagan, Holly ; Heuton, Kyle R ; Husseini, Abdullatif ; Huynh, Chantal ; Iburg, Kim M ; Islami, Farhad ; Jarvis, Deborah L ; Jiang, Guohong ; Jonas, Jost B ; Karema, Corine K ; Khan, Ejaz A ; Kim, Yunjin ; Kinfu, Yohannes ; Kinge, Jonas M ; Defo, Barthelemy Kuate ; Leung, Ricky ; Logroscino, Giancarlo ; Matzopoulos, Richard ; Melaku, Yohannes A ; Mitchell, Philip B ; Montico, Marcella ; Moturi, Wilkister N ; Neupane, Sudan P ; Ngalesoni, Frida N ; Nisar, Muhammad I ; Phillips, Michael R ; Piel, Frédéric B ; Poenaru, Dan ; Prasad, Noela M ; Qato, Dima M ; Raju, Murugesan ; Richardus, Jan Hendrik ; Roberts, D Allen ; Rojas-Rueda, David ; Saeedi, Mohammad Y ; Sahraian, Mohammad Ali ; Scarborough, Peter ; Schöttker, Ben ; Shackelford, Katya A ; Shaheen, Amira ; Shiri, Rahman ; Shishani, Kawkab ; Sliwa, Karen ; Stanaway, Jeffrey D ; Stathopoulou, Vasiliki ; Steiner, Caitlyn ; Stovner, Lars J ; Sunguya, Bruno F ; Swaroop, Mamta ; Tanner, Marcel ; Ao, Braden J Te ; Undurraga, Eduardo A ; Wilkinson, James D ; Williams, Thomas N ; Xu, Gelin ; Yonemoto, Naohiro ; Yoon, Seok-Jun ; Yu, Chuanhua ; Vos, Theo
creatorcontribMurray, Christopher J L ; Foreman, Kyle J ; Abd-Allah, Foad ; Abu-Rmeileh, Niveen M ; Achoki, Tom ; Alla, François ; Almazroa, Mohammad A ; Alsharif, Ubai ; Ameh, Emmanuel A ; Ammar, Walid ; Antonio, Carl Abelardo T ; Banerjee, Amitava ; Basu, Arindam ; Basulaiman, Mohammed O ; Beghi, Ettore ; Bertozzi-Villa, Amelia ; Bhala, Neeraj ; Bikbov, Boris ; Blyth, Fiona M ; Bourne, Rupert R A ; Bulchis, Anne ; Chang, Jung-Chen ; Coppola, Luis M ; Cuevas-Nasu, Lucia ; Danawi, Hadi ; Dandona, Rakhi ; Davey, Gail ; Degenhardt, Louisa ; Del Pozo-Cruz, Borja ; Deribe, Kebede ; Dherani, Mukesh K ; Duan, Leilei ; Endres, Matthias ; Erskine, Holly E ; Eshrati, Babak ; Felson, David T ; Gessner, Bradford D ; Giussani, Giorgia ; González-Medina, Diego ; Gosselin, Richard A ; Gupta, Rahul ; Hagan, Holly ; Heuton, Kyle R ; Husseini, Abdullatif ; Huynh, Chantal ; Iburg, Kim M ; Islami, Farhad ; Jarvis, Deborah L ; Jiang, Guohong ; Jonas, Jost B ; Karema, Corine K ; Khan, Ejaz A ; Kim, Yunjin ; Kinfu, Yohannes ; Kinge, Jonas M ; Defo, Barthelemy Kuate ; Leung, Ricky ; Logroscino, Giancarlo ; Matzopoulos, Richard ; Melaku, Yohannes A ; Mitchell, Philip B ; Montico, Marcella ; Moturi, Wilkister N ; Neupane, Sudan P ; Ngalesoni, Frida N ; Nisar, Muhammad I ; Phillips, Michael R ; Piel, Frédéric B ; Poenaru, Dan ; Prasad, Noela M ; Qato, Dima M ; Raju, Murugesan ; Richardus, Jan Hendrik ; Roberts, D Allen ; Rojas-Rueda, David ; Saeedi, Mohammad Y ; Sahraian, Mohammad Ali ; Scarborough, Peter ; Schöttker, Ben ; Shackelford, Katya A ; Shaheen, Amira ; Shiri, Rahman ; Shishani, Kawkab ; Sliwa, Karen ; Stanaway, Jeffrey D ; Stathopoulou, Vasiliki ; Steiner, Caitlyn ; Stovner, Lars J ; Sunguya, Bruno F ; Swaroop, Mamta ; Tanner, Marcel ; Ao, Braden J Te ; Undurraga, Eduardo A ; Wilkinson, James D ; Williams, Thomas N ; Xu, Gelin ; Yonemoto, Naohiro ; Yoon, Seok-Jun ; Yu, Chuanhua ; Vos, Theo ; GBD 2013 DALYs and HALE Collaborators ; Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa ; Göteborgs universitet ; Gothenburg University ; Institute of Medicine, School of Public Health and Community Medicine ; Sahlgrenska Academy ; Akademistatistik ; Sahlgrenska akademin ; Centre for Applied Biostatistics
descriptionSummary 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.
identifier
0ISSN: 0140-6736
1ISSN: 1474-547X
2EISSN: 1474-547X
3DOI: 10.1016/S0140-6736(15)61340-X
4PMID: 26321261
5CODEN: LANCAO
languageeng
publisherEngland: Elsevier Ltd
subjectAdjusted Life Years ; Age ; Aged ; Article ; Chair Nutrition and Disease ; Chronic Disease ; Chronic Disease - epidemiology ; Clinical Medicine ; Communicable Diseases ; Communicable Diseases - epidemiology ; Disease ; Epidemiology ; Female ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; General & Internal Medicine ; Global Health ; Global Health - statistics & numerical data ; Health and Welfare ; Health aspects ; Health Sciences ; Health Transition ; HNE Nutrition and Disease ; HNE Voeding en Ziekte ; Humans ; Hälsa och välfärd ; Hälsovetenskap ; Hälsovetenskaper ; Injuries ; Internal Medicine ; Klinisk medicin ; Life Expectancy ; Life Sciences ; Male ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Medicine (all) ; Middle Aged ; Mortality ; Mortality, Premature ; Nutrition and Disease ; Premature ; Public Health, Global Health, Social Medicine and Epidemiology ; Quality ; Quality-Adjusted Life Years ; Santé publique et épidémiologie ; SDG 3 - Good Health and Well-being ; Socioeconomic Factors ; Studies ; VLAG ; Voeding en Ziekte ; Wounds ; Wounds and Injuries ; Wounds and Injuries - epidemiology
ispartofLancet (London England), 2015, Vol.386 (10009), p.2145-2191
rights
0Elsevier Ltd
12015 Elsevier Ltd
2info:eu-repo/semantics/restrictedAccess
3Copyright © 2015 Elsevier Ltd. All rights reserved.
4COPYRIGHT 2015 Elsevier B.V.
5Copyright Elsevier Limited Nov 28, 2015
6Distributed under a Creative Commons Attribution 4.0 International License
7Wageningen University & Research
lds50peer_reviewed
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creatorcontrib
0Murray, Christopher J L
1Foreman, Kyle J
2Abd-Allah, Foad
3Abu-Rmeileh, Niveen M
4Achoki, Tom
5Alla, François
6Almazroa, Mohammad A
7Alsharif, Ubai
8Ameh, Emmanuel A
9Ammar, Walid
10Antonio, Carl Abelardo T
11Banerjee, Amitava
12Basu, Arindam
13Basulaiman, Mohammed O
14Beghi, Ettore
15Bertozzi-Villa, Amelia
16Bhala, Neeraj
17Bikbov, Boris
18Blyth, Fiona M
19Bourne, Rupert R A
20Bulchis, Anne
21Chang, Jung-Chen
22Coppola, Luis M
23Cuevas-Nasu, Lucia
24Danawi, Hadi
25Dandona, Rakhi
26Davey, Gail
27Degenhardt, Louisa
28Del Pozo-Cruz, Borja
29Deribe, Kebede
30Dherani, Mukesh K
31Duan, Leilei
32Endres, Matthias
33Erskine, Holly E
34Eshrati, Babak
35Felson, David T
36Gessner, Bradford D
37Giussani, Giorgia
38González-Medina, Diego
39Gosselin, Richard A
40Gupta, Rahul
41Hagan, Holly
42Heuton, Kyle R
43Husseini, Abdullatif
44Huynh, Chantal
45Iburg, Kim M
46Islami, Farhad
47Jarvis, Deborah L
48Jiang, Guohong
49Jonas, Jost B
50Karema, Corine K
51Khan, Ejaz A
52Kim, Yunjin
53Kinfu, Yohannes
54Kinge, Jonas M
55Defo, Barthelemy Kuate
56Leung, Ricky
57Logroscino, Giancarlo
58Matzopoulos, Richard
59Melaku, Yohannes A
60Mitchell, Philip B
61Montico, Marcella
62Moturi, Wilkister N
63Neupane, Sudan P
64Ngalesoni, Frida N
65Nisar, Muhammad I
66Phillips, Michael R
67Piel, Frédéric B
68Poenaru, Dan
69Prasad, Noela M
70Qato, Dima M
71Raju, Murugesan
72Richardus, Jan Hendrik
73Roberts, D Allen
74Rojas-Rueda, David
75Saeedi, Mohammad Y
76Sahraian, Mohammad Ali
77Scarborough, Peter
78Schöttker, Ben
79Shackelford, Katya A
80Shaheen, Amira
81Shiri, Rahman
82Shishani, Kawkab
83Sliwa, Karen
84Stanaway, Jeffrey D
85Stathopoulou, Vasiliki
86Steiner, Caitlyn
87Stovner, Lars J
88Sunguya, Bruno F
89Swaroop, Mamta
90Tanner, Marcel
91Ao, Braden J Te
92Undurraga, Eduardo A
93Wilkinson, James D
94Williams, Thomas N
95Xu, Gelin
96Yonemoto, Naohiro
97Yoon, Seok-Jun
98Yu, Chuanhua
99Vos, Theo
100GBD 2013 DALYs and HALE Collaborators
101Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
102Göteborgs universitet
103Gothenburg University
104Institute of Medicine, School of Public Health and Community Medicine
105Sahlgrenska Academy
106Akademistatistik
107Sahlgrenska akademin
108Centre for Applied Biostatistics
title
0Global, 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
1Lancet (London England)
addtitleLancet
descriptionSummary 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.
subject
0Adjusted Life Years
1Age
2Aged
3Article
4Chair Nutrition and Disease
5Chronic Disease
6Chronic Disease - epidemiology
7Clinical Medicine
8Communicable Diseases
9Communicable Diseases - epidemiology
10Disease
11Epidemiology
12Female
13Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
14General & Internal Medicine
15Global Health
16Global Health - statistics & numerical data
17Health and Welfare
18Health aspects
19Health Sciences
20Health Transition
21HNE Nutrition and Disease
22HNE Voeding en Ziekte
23Humans
24Hälsa och välfärd
25Hälsovetenskap
26Hälsovetenskaper
27Injuries
28Internal Medicine
29Klinisk medicin
30Life Expectancy
31Life Sciences
32Male
33Medical and Health Sciences
34Medicin och hälsovetenskap
35Medicine (all)
36Middle Aged
37Mortality
38Mortality, Premature
39Nutrition and Disease
40Premature
41Public Health, Global Health, Social Medicine and Epidemiology
42Quality
43Quality-Adjusted Life Years
44Santé publique et épidémiologie
45SDG 3 - Good Health and Well-being
46Socioeconomic Factors
47Studies
48VLAG
49Voeding en Ziekte
50Wounds
51Wounds and Injuries
52Wounds and Injuries - epidemiology
issn
00140-6736
11474-547X
21474-547X
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0Murray, Christopher J L
1Foreman, Kyle J
2Abd-Allah, Foad
3Abu-Rmeileh, Niveen M
4Achoki, Tom
5Alla, François
6Almazroa, Mohammad A
7Alsharif, Ubai
8Ameh, Emmanuel A
9Ammar, Walid
10Antonio, Carl Abelardo T
11Banerjee, Amitava
12Basu, Arindam
13Basulaiman, Mohammed O
14Beghi, Ettore
15Bertozzi-Villa, Amelia
16Bhala, Neeraj
17Bikbov, Boris
18Blyth, Fiona M
19Bourne, Rupert R A
20Bulchis, Anne
21Chang, Jung-Chen
22Coppola, Luis M
23Cuevas-Nasu, Lucia
24Danawi, Hadi
25Dandona, Rakhi
26Davey, Gail
27Degenhardt, Louisa
28Del Pozo-Cruz, Borja
29Deribe, Kebede
30Dherani, Mukesh K
31Duan, Leilei
32Endres, Matthias
33Erskine, Holly E
34Eshrati, Babak
35Felson, David T
36Gessner, Bradford D
37Giussani, Giorgia
38González-Medina, Diego
39Gosselin, Richard A
40Gupta, Rahul
41Hagan, Holly
42Heuton, Kyle R
43Husseini, Abdullatif
44Huynh, Chantal
45Iburg, Kim M
46Islami, Farhad
47Jarvis, Deborah L
48Jiang, Guohong
49Jonas, Jost B
50Karema, Corine K
51Khan, Ejaz A
52Kim, Yunjin
53Kinfu, Yohannes
54Kinge, Jonas M
55Defo, Barthelemy Kuate
56Leung, Ricky
57Logroscino, Giancarlo
58Matzopoulos, Richard
59Melaku, Yohannes A
60Mitchell, Philip B
61Montico, Marcella
62Moturi, Wilkister N
63Neupane, Sudan P
64Ngalesoni, Frida N
65Nisar, Muhammad I
66Phillips, Michael R
67Piel, Frédéric B
68Poenaru, Dan
69Prasad, Noela M
70Qato, Dima M
71Raju, Murugesan
72Richardus, Jan Hendrik
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74Rojas-Rueda, David
75Saeedi, Mohammad Y
76Sahraian, Mohammad Ali
77Scarborough, Peter
78Schöttker, Ben
79Shackelford, Katya A
80Shaheen, Amira
81Shiri, Rahman
82Shishani, Kawkab
83Sliwa, Karen
84Stanaway, Jeffrey D
85Stathopoulou, Vasiliki
86Steiner, Caitlyn
87Stovner, Lars J
88Sunguya, Bruno F
89Swaroop, Mamta
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91Ao, Braden J Te
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93Wilkinson, James D
94Williams, Thomas N
95Xu, Gelin
96Yonemoto, Naohiro
97Yoon, Seok-Jun
98Yu, Chuanhua
99Vos, Theo
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creationdate2015
titleGlobal, 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
authorMurray, Christopher J L ; Foreman, Kyle J ; Abd-Allah, Foad ; Abu-Rmeileh, Niveen M ; Achoki, Tom ; Alla, François ; Almazroa, Mohammad A ; Alsharif, Ubai ; Ameh, Emmanuel A ; Ammar, Walid ; Antonio, Carl Abelardo T ; Banerjee, Amitava ; Basu, Arindam ; Basulaiman, Mohammed O ; Beghi, Ettore ; Bertozzi-Villa, Amelia ; Bhala, Neeraj ; Bikbov, Boris ; Blyth, Fiona M ; Bourne, Rupert R A ; Bulchis, Anne ; Chang, Jung-Chen ; Coppola, Luis M ; Cuevas-Nasu, Lucia ; Danawi, Hadi ; Dandona, Rakhi ; Davey, Gail ; Degenhardt, Louisa ; Del Pozo-Cruz, Borja ; Deribe, Kebede ; Dherani, Mukesh K ; Duan, Leilei ; Endres, Matthias ; Erskine, Holly E ; Eshrati, Babak ; Felson, David T ; Gessner, Bradford D ; Giussani, Giorgia ; González-Medina, Diego ; Gosselin, Richard A ; Gupta, Rahul ; Hagan, Holly ; Heuton, Kyle R ; Husseini, Abdullatif ; Huynh, Chantal ; Iburg, Kim M ; Islami, Farhad ; Jarvis, Deborah L ; Jiang, Guohong ; Jonas, Jost B ; Karema, Corine K ; Khan, Ejaz A ; Kim, Yunjin ; Kinfu, Yohannes ; Kinge, Jonas M ; Defo, Barthelemy Kuate ; Leung, Ricky ; Logroscino, Giancarlo ; Matzopoulos, Richard ; Melaku, Yohannes A ; Mitchell, Philip B ; Montico, Marcella ; Moturi, Wilkister N ; Neupane, Sudan P ; Ngalesoni, Frida N ; Nisar, Muhammad I ; Phillips, Michael R ; Piel, Frédéric B ; Poenaru, Dan ; Prasad, Noela M ; Qato, Dima M ; Raju, Murugesan ; Richardus, Jan Hendrik ; Roberts, D Allen ; Rojas-Rueda, David ; Saeedi, Mohammad Y ; Sahraian, Mohammad Ali ; Scarborough, Peter ; Schöttker, Ben ; Shackelford, Katya A ; Shaheen, Amira ; Shiri, Rahman ; Shishani, Kawkab ; Sliwa, Karen ; Stanaway, Jeffrey D ; Stathopoulou, Vasiliki ; Steiner, Caitlyn ; Stovner, Lars J ; Sunguya, Bruno F ; Swaroop, Mamta ; Tanner, Marcel ; Ao, Braden J Te ; Undurraga, Eduardo A ; Wilkinson, James D ; Williams, Thomas N ; Xu, Gelin ; Yonemoto, Naohiro ; Yoon, Seok-Jun ; Yu, Chuanhua ; Vos, Theo
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languageeng
creationdate2015
topic
0Adjusted Life Years
1Age
2Aged
3Article
4Chair Nutrition and Disease
5Chronic Disease
6Chronic Disease - epidemiology
7Clinical Medicine
8Communicable Diseases
9Communicable Diseases - epidemiology
10Disease
11Epidemiology
12Female
13Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
14General & Internal Medicine
15Global Health
16Global Health - statistics & numerical data
17Health and Welfare
18Health aspects
19Health Sciences
20Health Transition
21HNE Nutrition and Disease
22HNE Voeding en Ziekte
23Humans
24Hälsa och välfärd
25Hälsovetenskap
26Hälsovetenskaper
27Injuries
28Internal Medicine
29Klinisk medicin
30Life Expectancy
31Life Sciences
32Male
33Medical and Health Sciences
34Medicin och hälsovetenskap
35Medicine (all)
36Middle Aged
37Mortality
38Mortality, Premature
39Nutrition and Disease
40Premature
41Public Health, Global Health, Social Medicine and Epidemiology
42Quality
43Quality-Adjusted Life Years
44Santé publique et épidémiologie
45SDG 3 - Good Health and Well-being
46Socioeconomic Factors
47Studies
48VLAG
49Voeding en Ziekte
50Wounds
51Wounds and Injuries
52Wounds and Injuries - epidemiology
toplevel
0peer_reviewed
1online_resources
creatorcontrib
0Murray, Christopher J L
1Foreman, Kyle J
2Abd-Allah, Foad
3Abu-Rmeileh, Niveen M
4Achoki, Tom
5Alla, François
6Almazroa, Mohammad A
7Alsharif, Ubai
8Ameh, Emmanuel A
9Ammar, Walid
10Antonio, Carl Abelardo T
11Banerjee, Amitava
12Basu, Arindam
13Basulaiman, Mohammed O
14Beghi, Ettore
15Bertozzi-Villa, Amelia
16Bhala, Neeraj
17Bikbov, Boris
18Blyth, Fiona M
19Bourne, Rupert R A
20Bulchis, Anne
21Chang, Jung-Chen
22Coppola, Luis M
23Cuevas-Nasu, Lucia
24Danawi, Hadi
25Dandona, Rakhi
26Davey, Gail
27Degenhardt, Louisa
28Del Pozo-Cruz, Borja
29Deribe, Kebede
30Dherani, Mukesh K
31Duan, Leilei
32Endres, Matthias
33Erskine, Holly E
34Eshrati, Babak
35Felson, David T
36Gessner, Bradford D
37Giussani, Giorgia
38González-Medina, Diego
39Gosselin, Richard A
40Gupta, Rahul
41Hagan, Holly
42Heuton, Kyle R
43Husseini, Abdullatif
44Huynh, Chantal
45Iburg, Kim M
46Islami, Farhad
47Jarvis, Deborah L
48Jiang, Guohong
49Jonas, Jost B
50Karema, Corine K
51Khan, Ejaz A
52Kim, Yunjin
53Kinfu, Yohannes
54Kinge, Jonas M
55Defo, Barthelemy Kuate
56Leung, Ricky
57Logroscino, Giancarlo
58Matzopoulos, Richard
59Melaku, Yohannes A
60Mitchell, Philip B
61Montico, Marcella
62Moturi, Wilkister N
63Neupane, Sudan P
64Ngalesoni, Frida N
65Nisar, Muhammad I
66Phillips, Michael R
67Piel, Frédéric B
68Poenaru, Dan
69Prasad, Noela M
70Qato, Dima M
71Raju, Murugesan
72Richardus, Jan Hendrik
73Roberts, D Allen
74Rojas-Rueda, David
75Saeedi, Mohammad Y
76Sahraian, Mohammad Ali
77Scarborough, Peter
78Schöttker, Ben
79Shackelford, Katya A
80Shaheen, Amira
81Shiri, Rahman
82Shishani, Kawkab
83Sliwa, Karen
84Stanaway, Jeffrey D
85Stathopoulou, Vasiliki
86Steiner, Caitlyn
87Stovner, Lars J
88Sunguya, Bruno F
89Swaroop, Mamta
90Tanner, Marcel
91Ao, Braden J Te
92Undurraga, Eduardo A
93Wilkinson, James D
94Williams, Thomas N
95Xu, Gelin
96Yonemoto, Naohiro
97Yoon, Seok-Jun
98Yu, Chuanhua
99Vos, Theo
100GBD 2013 DALYs and HALE Collaborators
101Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
102Göteborgs universitet
103Gothenburg University
104Institute of Medicine, School of Public Health and Community Medicine
105Sahlgrenska Academy
106Akademistatistik
107Sahlgrenska akademin
108Centre for Applied Biostatistics
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fulltextfulltext
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au
0Murray, Christopher J L
1Foreman, Kyle J
2Abd-Allah, Foad
3Abu-Rmeileh, Niveen M
4Achoki, Tom
5Alla, François
6Almazroa, Mohammad A
7Alsharif, Ubai
8Ameh, Emmanuel A
9Ammar, Walid
10Antonio, Carl Abelardo T
11Banerjee, Amitava
12Basu, Arindam
13Basulaiman, Mohammed O
14Beghi, Ettore
15Bertozzi-Villa, Amelia
16Bhala, Neeraj
17Bikbov, Boris
18Blyth, Fiona M
19Bourne, Rupert R A
20Bulchis, Anne
21Chang, Jung-Chen
22Coppola, Luis M
23Cuevas-Nasu, Lucia
24Danawi, Hadi
25Dandona, Rakhi
26Davey, Gail
27Degenhardt, Louisa
28Del Pozo-Cruz, Borja
29Deribe, Kebede
30Dherani, Mukesh K
31Duan, Leilei
32Endres, Matthias
33Erskine, Holly E
34Eshrati, Babak
35Felson, David T
36Gessner, Bradford D
37Giussani, Giorgia
38González-Medina, Diego
39Gosselin, Richard A
40Gupta, Rahul
41Hagan, Holly
42Heuton, Kyle R
43Husseini, Abdullatif
44Huynh, Chantal
45Iburg, Kim M
46Islami, Farhad
47Jarvis, Deborah L
48Jiang, Guohong
49Jonas, Jost B
50Karema, Corine K
51Khan, Ejaz A
52Kim, Yunjin
53Kinfu, Yohannes
54Kinge, Jonas M
55Defo, Barthelemy Kuate
56Leung, Ricky
57Logroscino, Giancarlo
58Matzopoulos, Richard
59Melaku, Yohannes A
60Mitchell, Philip B
61Montico, Marcella
62Moturi, Wilkister N
63Neupane, Sudan P
64Ngalesoni, Frida N
65Nisar, Muhammad I
66Phillips, Michael R
67Piel, Frédéric B
68Poenaru, Dan
69Prasad, Noela M
70Qato, Dima M
71Raju, Murugesan
72Richardus, Jan Hendrik
73Roberts, D Allen
74Rojas-Rueda, David
75Saeedi, Mohammad Y
76Sahraian, Mohammad Ali
77Scarborough, Peter
78Schöttker, Ben
79Shackelford, Katya A
80Shaheen, Amira
81Shiri, Rahman
82Shishani, Kawkab
83Sliwa, Karen
84Stanaway, Jeffrey D
85Stathopoulou, Vasiliki
86Steiner, Caitlyn
87Stovner, Lars J
88Sunguya, Bruno F
89Swaroop, Mamta
90Tanner, Marcel
91Ao, Braden J Te
92Undurraga, Eduardo A
93Wilkinson, James D
94Williams, Thomas N
95Xu, Gelin
96Yonemoto, Naohiro
97Yoon, Seok-Jun
98Yu, Chuanhua
99Vos, Theo
aucorp
0GBD 2013 DALYs and HALE Collaborators
1Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
2Göteborgs universitet
3Gothenburg University
4Institute of Medicine, School of Public Health and Community Medicine
5Sahlgrenska Academy
6Akademistatistik
7Sahlgrenska akademin
8Centre for Applied Biostatistics
formatjournal
genrearticle
ristypeJOUR
atitleGlobal, 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
jtitleLancet (London England)
addtitleLancet
date2015
risdate2015
volume386
issue10009
spage2145
epage2191
pages2145-2191
issn
00140-6736
11474-547X
eissn1474-547X
codenLANCAO
notes
0PMCID: PMC4673910
1TV, ADL, JAS, and CJLM prepared the first draft. CJLM and TV finalised the draft based on comments from other authors and reviewer feedback. TV, ADL, JAS, and CJLM conceived of the study and provided overall guidance. RB and KF performed final statistical analyses. All other authors provided data, developed models, reviewed results, provided guidance on methodology, and reviewed the manuscript.
2Contributors
3Collaborators listed at the end of the Article
abstractSummary 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.
copEngland
pubElsevier Ltd
pmid26321261
doi10.1016/S0140-6736(15)61340-X
orcidid
0https://orcid.org/0000-0001-9573-0505
1https://orcid.org/0000-0001-5458-2075
2https://orcid.org/0000-0002-9805-9523
3https://orcid.org/0000-0002-8015-9470
4https://orcid.org/0000-0002-8816-7475
5https://orcid.org/0000-0001-8037-742X
6https://orcid.org/0000-0002-6409-3504
7https://orcid.org/0000-0003-3161-0402
8https://orcid.org/0000-0001-8104-6462
oafree_for_read