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Lancet. 2017 Sep 16;390(10100):1260-1344. doi: 10.1016/S0140-6736(17)32130-X.

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Collaborators (798)

Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adedeji IA, Adetokunboh O, Afshin A, Aggarwal R, Agrawal S, Agrawal A, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemiju TF, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali R, Alizadeh-Navaei R, Alkaabi JM, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Maskari F, AlMazroa MA, Al-Raddadi R, Alsharif U, Alsowaidi S, Althouse BM, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Ansha MG, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asgedom SW, Atey TM, Atnafu NT, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awasthi S, Azarpazhooh MR, Azzopardi P, Babalola TK, Bacha U, Badawi A, Balakrishnan K, Bannick MS, Barac A, Barker-Collo SL, Bärnighausen T, Barquera S, Barrero LH, Basu S, Battista R, Battle KE, Baune BT, Bazargan-Hejazi S, Beardsley J, Bedi N, Béjot Y, Bekele BB, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhansali A, Bhatt S, Bhutta ZA, Biadgilign S, Bicer BK, Bienhoff K, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Blyth FM, Boneya DJ, Bose D, Bou-Orm IR, Bourne RRA, Brainin M, Brayne C, Brazinova A, Breitborde NJK, Briant PS, Britton G, Brugha TS, Buchbinder R, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Campos-Nonato IR, Carabin H, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Carvalho F, Casey D, Castañeda-Orjuela CA, Castle CD, Catalá-López F, Chang JC, Charlson FJ, Chaturvedi P, Chen H, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christopher DJ, Ciobanu LG, Cirillo M, Colombara D, Cooper LT, Cooper C, Cortesi PA, Cortinovis M, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dalal K, Damasceno A, Dandona L, Dandona R, das Neves J, Davitoiu DV, Davletov K, de Courten B, De Leo D, De Steur H, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dhillon PK, Dicker D, Djalainia S, Do HP, Dokova K, Doku DT, Dorsey ER, Dos Santos KPB, Driscoll TR, Dubey M, Duncan BB, Ebel BE, Echko M, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshetie S, Eshrati B, Esteghamati A, Estep K, Fanuel FBB, Farag T, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Franklin RC, Frostad JJ, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Garcia-Basteiro AL, Gebre T, Gebregergs GB, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gillum RF, Ginawi IAM, Gishu MD, Giussani G, Godwin WW, Goel K, Goenka S, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Gosselin RA, Gotay CC, Goto A, Goulart AC, Graetz N, Gugnani HC, Gupta PC, Gupta R, Gupta T, Gupta V, Gupta R, Gutiérrez RA, Hachinski V, Hafezi-Nejad N, Hailu AD, Hailu GB, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Harun KM, Harvey J, Hassanvand MS, Havmoeller R, Hay RJ, Hedayati MT, Hendrie D, Henry NJ, Heredia-Pi IB, Heydarpour P, Hoek HW, Hoffman HJ, Horino M, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Htet AS, Hu G, Huang JJ, Huynh C, Iburg KM, Igumbor EU, Ikeda C, Irvine CMS, Islam SMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Jassal SK, Javanbakht M, Jayaraman SP, Jeemon P, Jensen PN, Jha V, Jiang G, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Kar C, Karam NE, Karch A, Karema CK, Karimi SM, Karimkhani C, Kasaeian A, Kassa GM, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Keiyoro PN, Kemmer L, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khoja AT, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kissoon N, Kivimaki M, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kumar GA, Kumar P, Kyu HH, Lager ACJ, Lal DK, Lalloo R, Lallukka T, Lambert N, Lan Q, Lansingh VC, Larsson A, Leasher JL, Lee PH, Leigh J, Leshargie CT, Leung J, Leung R, Levi M, Li Y, Li Y, Liang X, Liben ML, Lim SS, Linn S, Liu PY, Liu A, Liu S, Liu Y, Lodha R, Logroscino G, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Lyons RA, Macarayan ERK, Maddison ER, Magdy Abd El Razek HMA, Magdy Abd El Razek M, Magis-Rodriguez C, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Manhertz T, Mantovani LG, Mapoma CC, March LM, Marczak LB, Martinez-Raga J, Martins PHV, Martins-Melo FR, Martopullo I, März W, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, Mehata S, Meier T, Meles KG, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mengistu DT, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammadi A, Mohammed MSK, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Mollenkopf SK, Monasta L, Montañez Hernandez JC, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Morrison SD, Moses M, Mountjoy-Venning C, Mruts KB, Mueller UO, Muller K, Murdoch ME, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naghavi M, Naheed A, Naidoo KS, Nangia V, Nasher JT, Natarajan G, Negasa DE, Negoi RI, Negoi I, Newton CR, Ngunjiri JW, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyandwi A, Obermeyer CM, O'Donnell MJ, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olagunju TO, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osborne RH, Osgood-Zimmerman A, Osman M, Ota E, Owolabi MO, Pa M, Pacella RE, Panda BK, Pandian JD, Papachristou C, Park EK, Parry CD, Parsaeian M, Patil ST, Patten SB, Patton GC, Paudel D, Paulson K, Pearce N, Pereira DM, Perez KM, Perico N, Pesudovs K, Peterson CB, Petri WA, Petzold M, Phillips MR, Phipps G, Pigott DM, Pillay JD, Pinho C, Piradov MA, Plass D, Pletcher MA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad N, Purcell C, Purwar M, Qorbani M, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rangaswamy T, Rankin Z, Rao PV, Rao PC, Rawaf S, Ray SE, Reiner RC, Reinig N, Reitsma M, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Ribeiro AL, Rivas JC, Roba HS, Robinson SR, Rojas-Rueda D, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Ruhago GM, Saadat S, Safdarian M, Safiri S, Sagar R, Sahathevan R, Sahraian MA, Salama J, Saleh MM, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Sanchez-Niño MD, Santomauro D, Santos JV, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schelonka K, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Shaheen A, Shaikh MA, Shamsipour M, Sharma R, Sharma J, She J, Shi P, Shibuya K, Shields C, Shifa GT, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shoman H, Siabani S, Sibai AM, Sigfusdottir ID, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh OP, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Soljak M, Sorensen RJD, Sousa TCM, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Stovner LJ, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte D, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Taffere GR, Takala JS, Tandon N, Tanne D, Tarekegn YL, Tavakkoli M, Taveira N, Taylor HR, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Terkawi AS, Tesfaye DJ, Tesssema B, Thakur JS, Thamsuwan O, Theadom AM, Theis AM, Thomas KE, Thomas N, Thompson R, Thrift AG, Tobe-Gai R, Tobollik M, Tonelli M, Topor-Madry R, Tortajada M, Touvier M, Traebert J, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuzcu EM, Tymeson H, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Varughese S, Vasankari T, Veerman LJ, Venkatesh S, Venketasubramanian N, Vidavalur R, Vijayakumar L, Violante FS, Vishnu A, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Williams HC, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Woolf AD, Workicho A, Xavier D, Xu G, Yadgir S, Yaghoubi M, Yakob B, Yan LL, Yano Y, Ye P, Yihdego MG, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zhang X, Zheng Y, Zhou M, Zipkin B, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL.

Erratum in

Abstract

BACKGROUND:

Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).

METHODS:

We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.

FINDINGS:

The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.

INTERPRETATION:

At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.

FUNDING:

Bill & Melinda Gates Foundation.

PMID:
28919118
PMCID:
PMC5605707
DOI:
10.1016/S0140-6736(17)32130-X
[Indexed for MEDLINE]
Free PMC Article

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