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

Christopher Murray, R Barber, Kyle Foreman, Ayse Abbasoglu Ozgoren, Foad Abd-Allah, Semaw Ferede Abera, Victor Aboyans, Jerry Abraham, Ibrahim Abubakar, Laith Abu-Raddad, Niveen Abu-Rmeileh, Tom Achoki, Ilana Ackerman, Zanfina Ademi, Arsene Adou, Jose Adsuar, A Afshin, Emilie Agardh, Sayed Alam, Deena Alasfoor & 20 others Mohammed Albittar, Miguel Alegretti, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Raghib Ali, F Alla, Peter Allebeck, Mohammad AlMazroa, Ubai Alsharif, Elena Alvarez, Nelson Alvis-Guzman, Azmeraw Amare, E Ameh, Hassan Amini, Walid Ammar, H Anderson, Benjamin Anderson, et al.,, Yohannes Kinfu

    Research output: Contribution to journalArticle

    824 Citations (Scopus)

    Abstract

    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
    Original languageEnglish
    Pages (from-to)2145-2191
    Number of pages47
    JournalLancet
    Volume386
    Issue number10009
    DOIs
    Publication statusPublished - 28 Nov 2015

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    Quality-Adjusted Life Years
    Life Expectancy
    Wounds and Injuries
    Uncertainty
    Mothers
    Respiratory Tract Infections
    Infant, Newborn, Diseases
    Cardiovascular Diseases
    Parturition
    Nutrition Disorders
    Endocrine System Diseases
    Cerebrovascular Disorders
    Premature Mortality
    Leishmaniasis
    Dengue
    Mortality
    Hematologic Diseases
    Neck Pain
    Birth Rate
    Information Storage and Retrieval

    Cite this

    Murray, Christopher ; Barber, R ; Foreman, Kyle ; Ozgoren, Ayse Abbasoglu ; Abd-Allah, Foad ; Abera, Semaw Ferede ; Aboyans, Victor ; Abraham, Jerry ; Abubakar, Ibrahim ; Abu-Raddad, Laith ; Abu-Rmeileh, Niveen ; Achoki, Tom ; Ackerman, Ilana ; Ademi, Zanfina ; Adou, Arsene ; Adsuar, Jose ; Afshin, A ; Agardh, Emilie ; Alam, Sayed ; Alasfoor, Deena ; Albittar, Mohammed ; Alegretti, Miguel ; Alemu, Zewdie Aderaw ; Alfonso-Cristancho, Rafael ; Alhabib, Samia ; Ali, Raghib ; Alla, F ; Allebeck, Peter ; AlMazroa, Mohammad ; Alsharif, Ubai ; Alvarez, Elena ; Alvis-Guzman, Nelson ; Amare, Azmeraw ; Ameh, E ; Amini, Hassan ; Ammar, Walid ; Anderson, H ; Anderson, Benjamin ; al., et ; Kinfu, Yohannes. / 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. In: Lancet. 2015 ; Vol. 386, No. 10009. pp. 2145-2191.
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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",
    abstract = "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",
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    author = "Christopher Murray and R Barber and Kyle Foreman and Ozgoren, {Ayse Abbasoglu} and Foad Abd-Allah and Abera, {Semaw Ferede} and Victor Aboyans and Jerry Abraham and Ibrahim Abubakar and Laith Abu-Raddad and Niveen Abu-Rmeileh and Tom Achoki and Ilana Ackerman and Zanfina Ademi and Arsene Adou and Jose Adsuar and A Afshin and Emilie Agardh and Sayed Alam and Deena Alasfoor and Mohammed Albittar and Miguel Alegretti and Alemu, {Zewdie Aderaw} and Rafael Alfonso-Cristancho and Samia Alhabib and Raghib Ali and F Alla and Peter Allebeck and Mohammad AlMazroa and Ubai Alsharif and Elena Alvarez and Nelson Alvis-Guzman and Azmeraw Amare and E Ameh and Hassan Amini and Walid Ammar and H Anderson and Benjamin Anderson and et al., and Yohannes Kinfu",
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    Murray, C, Barber, R, Foreman, K, Ozgoren, AA, Abd-Allah, F, Abera, SF, Aboyans, V, Abraham, J, Abubakar, I, Abu-Raddad, L, Abu-Rmeileh, N, Achoki, T, Ackerman, I, Ademi, Z, Adou, A, Adsuar, J, Afshin, A, Agardh, E, Alam, S, Alasfoor, D, Albittar, M, Alegretti, M, Alemu, ZA, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Alla, F, Allebeck, P, AlMazroa, M, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, A, Ameh, E, Amini, H, Ammar, W, Anderson, H, Anderson, B, al., E & Kinfu, Y 2015, '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', Lancet, vol. 386, no. 10009, pp. 2145-2191. https://doi.org/10.1016/S0140-6736(15)61340-X

    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. / Murray, Christopher; Barber, R; Foreman, Kyle; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Aboyans, Victor; Abraham, Jerry; Abubakar, Ibrahim; Abu-Raddad, Laith; Abu-Rmeileh, Niveen; Achoki, Tom; Ackerman, Ilana; Ademi, Zanfina; Adou, Arsene; Adsuar, Jose; Afshin, A; Agardh, Emilie; Alam, Sayed; Alasfoor, Deena; Albittar, Mohammed; Alegretti, Miguel; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Alla, F; Allebeck, Peter; AlMazroa, Mohammad; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Amare, Azmeraw; Ameh, E; Amini, Hassan; Ammar, Walid; Anderson, H; Anderson, Benjamin; al., et; Kinfu, Yohannes.

    In: Lancet, Vol. 386, No. 10009, 28.11.2015, p. 2145-2191.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - 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

    AU - Murray, Christopher

    AU - Barber, R

    AU - Foreman, Kyle

    AU - Ozgoren, Ayse Abbasoglu

    AU - Abd-Allah, Foad

    AU - Abera, Semaw Ferede

    AU - Aboyans, Victor

    AU - Abraham, Jerry

    AU - Abubakar, Ibrahim

    AU - Abu-Raddad, Laith

    AU - Abu-Rmeileh, Niveen

    AU - Achoki, Tom

    AU - Ackerman, Ilana

    AU - Ademi, Zanfina

    AU - Adou, Arsene

    AU - Adsuar, Jose

    AU - Afshin, A

    AU - Agardh, Emilie

    AU - Alam, Sayed

    AU - Alasfoor, Deena

    AU - Albittar, Mohammed

    AU - Alegretti, Miguel

    AU - Alemu, Zewdie Aderaw

    AU - Alfonso-Cristancho, Rafael

    AU - Alhabib, Samia

    AU - Ali, Raghib

    AU - Alla, F

    AU - Allebeck, Peter

    AU - AlMazroa, Mohammad

    AU - Alsharif, Ubai

    AU - Alvarez, Elena

    AU - Alvis-Guzman, Nelson

    AU - Amare, Azmeraw

    AU - Ameh, E

    AU - Amini, Hassan

    AU - Ammar, Walid

    AU - Anderson, H

    AU - Anderson, Benjamin

    AU - al.,, et

    AU - Kinfu, Yohannes

    PY - 2015/11/28

    Y1 - 2015/11/28

    N2 - 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

    AB - 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

    KW - adult

    KW - aged

    KW - Alzheimer disease

    KW - Article

    KW - automutilation

    KW - brain disease

    KW - cardiovascular disease

    KW - cerebrovascular accident

    KW - cerebrovascular disease

    KW - chronic kidney disease

    KW - chronic obstructive lung disease

    KW - chronic respiratory tract disease

    KW - congenital malformation

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    KW - Human immunodeficiency virus infection

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    KW - ischemic heart disease

    KW - leishmaniasis

    KW - life expectancy

    KW - liver cirrhosis

    KW - low back pain

    KW - major clinical study

    KW - malaria

    KW - male

    KW - malignant neoplastic disease

    KW - maternal disease

    KW - measles

    KW - meningitis

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    KW - musculoskeletal disease

    KW - neck pain

    KW - neurologic disease

    KW - newborn disease

    KW - non communicable disease

    KW - nutritional deficiency

    KW - nutritional disorder

    KW - premature mortality

    KW - priority journal

    KW - protein calorie malnutrition

    KW - respiratory tract infection

    KW - substance abuse

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    KW - tuberculosis

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