Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017

a systematic analysis for the Global Burden of Disease Study 2017

GBD 2017 DALYs and HALE Collaborators, Yohannes Kinfu

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods: We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings: Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). Interpretation: With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)1859-1922
Number of pages64
JournalThe Lancet
Volume392
Issue number10159
DOIs
Publication statusPublished - 10 Nov 2018

Fingerprint

Quality-Adjusted Life Years
Life Expectancy
Health
Wounds and Injuries
Demography
Parturition
Premature Mortality
Global Burden of Disease
Saint Vincent and the Grenadines
Communicable Diseases
Eritrea
Burundi
Central African Republic
Bahrain
Bosnia and Herzegovina
Algeria
Ukraine
Slovakia
Health Planning
Mortality

Cite this

@article{7a9002ef4cde4e0c9dc018dd90fd26af,
title = "Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017",
abstract = "Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods: We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings: Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95{\%} uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3{\%} (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7{\%} (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20{\%} of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3{\%} (38·8–43·5) for communicable diseases and by 49·8{\%} (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1{\%} (36·8–43·0), although age-standardised DALY rates decreased by 18·1{\%} (16·0–20·2). Interpretation: With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding: Bill & Melinda Gates Foundation.",
keywords = "Aged, Communicable Diseases/epidemiology, Disabled Persons/statistics & numerical data, Female, Global Burden of Disease/statistics & numerical data, Health Status, Healthy Lifestyle/physiology, Humans, Life Expectancy/trends, Male, Mortality/trends, Mortality, Premature/trends, Prevalence, Quality-Adjusted Life Years, Risk Factors, Socioeconomic Factors, Wounds and Injuries/epidemiology",
author = "{GBD 2017 DALYs and HALE Collaborators} and Kyu, {Hmwe Hmwe} and Degu Abate and Abate, {Kalkidan Hassen} and Abay, {Solomon M.} and Cristiana Abbafati and Nooshin Abbasi and Hedayat Abbastabar and Foad Abd-Allah and Jemal Abdela and Ahmed Abdelalim and Ibrahim Abdollahpour and Abdulkader, {Rizwan Suliankatchi} and Molla Abebe and Zegeye Abebe and Abil, {Olifan Zewdie} and Victor Aboyans and Abrham, {Aklilu Roba} and Abu-Raddad, {Laith Jamal} and Abu-Rmeileh, {Niveen M.E.} and Accrombessi, {Manfred Mario Kokou} and Dilaram Acharya and Pawan Acharya and Ackerman, {Ilana N.} and Adamu, {Abdu A.} and Adebayo, {Oladimeji M.} and Victor Adekanmbi and Zanfina Ademi and Adetokunboh, {Olatunji O.} and Adib, {Mina G.} and Adsuar, {Jose C.} and Afanvi, {Kossivi Agbelenko} and Mohsen Afarideh and Ashkan Afshin and Gina Agarwal and Agesa, {Kareha M.} and Rakesh Aggarwal and Aghayan, {Sargis Aghasi} and Anurag Agrawal and Alireza Ahmadi and Mehdi Ahmadi and Hamid Ahmadieh and Ahmed, {Muktar Beshir} and Sayem Ahmed and Aichour, {Amani Nidhal} and Ibtihel Aichour and Aichour, {Miloud Taki Eddine} and Tomi Akinyemiju and Nadia Akseer and Ziyad Al-Aly and Ayman Al-Eyadhy and Al-Mekhlafi, {Hesham M.} and Al-Raddadi, {Rajaa M.} and Fares Alahdab and Khurshid Alam and Tahiya Alam and Alaa Alashi and Alavian, {Seyed Moayed} and Alene, {Kefyalew Addis} and Mehran Alijanzadeh and Reza Alizadeh-Navaei and Aljunid, {Syed Mohamed} and Ala'a Alkerwi and Fran{\cc}ois Alla and Peter Allebeck and Jordi Alonso and Ubai Alsharif and Khalid Altirkawi and Nelson Alvis-Guzman and Aminde, {Leopold N.} and Erfan Amini and Mohammadreza Amiresmaili and Walid Ammar and Amoako, {Yaw Ampem} and Anber, {Nahla Hamed} and Andrei, {Catalina Liliana} and Sofia Androudi and Animut, {Megbaru Debalkie} and Mina Anjomshoa and Ansha, {Mustafa Geleto} and Antonio, {Carl Abelardo T.} and Palwasha Anwari and Jalal Arabloo and Olatunde Aremu and Johan {\"A}rnl{\"o}v and Amit Arora and Megha Arora and Al Artaman and Aryal, {Krishna K.} and Hamid Asayesh and Zerihun Ataro and Marcel Ausloos and Leticia Avila-Burgos and Avokpaho, {Euripide F.G.A.} and Ashish Awasthi and {Ayala Quintanilla}, {Beatriz Paulina} and Rakesh Ayer and Azzopardi, {Peter S.} and Arefeh Babazadeh and Hamid Badali and Kalpana Balakrishnan and Bali, {Ayele Geleto} and Maciej Banach and Banoub, {Joseph Adel Mattar} and Aleksandra Barac and Barboza, {Miguel A.} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Simon Barquera and Barrero, {Lope H.} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Ettore Beghi and Masoud Behzadifar and Meysam Behzadifar and Bekele, {Bayu Begashaw} and Bekru, {Eyasu Tamru} and Belachew, {Abate Bekele} and Belay, {Yihalem Abebe} and Bell, {Michelle L.} and Bello, {Aminu K.} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Adugnaw Berhane and Eduardo Bernabe and Bernstein, {Robert S.} and Mircea Beuran and Tina Beyranvand and Neeraj Bhala and Samir Bhatt and Soumyadeep Bhaumik and Bhutta, {Zulfiqar A.} and Belete Biadgo and Biehl, {Molly H.} and Ali Bijani and Boris Bikbov and Ver Bilano and Nigus Bililign and {Bin Sayeed}, {Muhammad Shahdaat} and Donal Bisanzio and Tone Bj{\o}rge and Archie Bleyer and Bobasa, {Eshetu Mulisa} and Bou-Orm, {Ibrahim R.} and Soufiane Boufous and Rupert Bourne and Brady, {Oliver J.} and Brant, {Luisa C.} and Carol Brayne and Alexandra Brazinova and Breitborde, {Nicholas J.K.} and Hermann Brenner and Briant, {Paul Svitil} and Briko, {Andrey Nikolaevich} and Gabrielle Britton and Traolach Brugha and Rachelle Buchbinder and Reinhard Busse and Butt, {Zahid A.} and Lucero Cahuana-Hurtado and {Campuzano Rincon}, {Julio Cesar} and Jorge Cano and Rosario C{\'a}rdenas and Carrero, {Juan J.} and Austin Carter and F{\'e}lix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and {Castillo Rivas}, Jacqueline and Franz Castro and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Cercy, {Kelly M.} and Ester Cerin and Yazan Chaiah and Chang, {Jung Chen} and Charlson, {Fiona J.} and Chattu, {Vijay Kumar} and Chiang, {Peggy Pei Chia} and Abdulaal Chitheer and Choi, {Jee Young J.} and Hanne Christensen and Christopher, {Devasahayam J.} and Chung, {Sheng Chia} and Cicuttini, {Flavia M.} and Massimo Cirillo and Daniel Collado-Mateo and Cyrus Cooper and Cortesi, {Paolo Angelo} and Monica Cortinovis and Ewerton Cousin and Criqui, {Michael H.} and Cromwell, {Elizabeth A.} and Marita Cross and Crump, {John A.} and Daba, {Alemneh Kabeta} and Dachew, {Berihun Assefa} and Dadi, {Abel Fekadu} and Lalit Dandona and Rakhi Dandona and Dargan, {Paul I.} and Ahmad Daryani and {Das Gupta}, Rajat and {Das Neves}, Jos{\'e} and Dasa, {Tamirat Tesfaye} and Davitoiu, {Dragos Virgil} and {De La Hoz}, {Fernando Pio} and {De Leo}, Diego and {De Neve}, {Jan Walter} and {De Steur}, Hans and Degefa, {Meaza Girma} and Louisa Degenhardt and Selina Deiparine and Demoz, {Gebre Teklemariam} and Edgar Denova-Guti{\'e}rrez and Kebede Deribe and Nikolaos Dervenis and {Des Jarlais}, {Don C.} and Subhojit Dey and Dharmaratne, {Samath D.} and Meghnath Dhimal and Dinberu, {Mesfin Tadese} and Dirac, {M. Ashworth} and Shirin Djalalinia and Linh Doan and Klara Dokova and Doku, {David Teye} and Dorsey, {E. Ray} and Doyle, {Kerrie E.} and Driscoll, {Tim Robert} and Manisha Dubey and Eleonora Dubljanin and Duken, {Eyasu Ejeta} and Duncan, {Bruce B.} and Duraes, {Andre R.} and Hedyeh Ebrahimi and Soheil Ebrahimpour and Echko, {Michelle M.} and Dumessa Edessa and David Edvardsson and Andem Effiong and Eggen, {Anne Elise} and Ehrlich, {Joshua R.} and {El Bcheraoui}, Charbel and Islam, {Sheikh Mohammed Shariful} and Yohannes Kinfu and McGrath, {John J.} and Nguyen, {Anh Quynh} and Nguyen, {Huong Lan Thi} and Minh Nguyen and Rahman, {Mohammad Hifz Ur} and Stokes, {Mark A.}",
year = "2018",
month = "11",
day = "10",
doi = "10.1016/S0140-6736(18)32335-3",
language = "English",
volume = "392",
pages = "1859--1922",
journal = "Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10159",

}

TY - JOUR

T1 - Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017

T2 - a systematic analysis for the Global Burden of Disease Study 2017

AU - GBD 2017 DALYs and HALE Collaborators

AU - Kyu, Hmwe Hmwe

AU - Abate, Degu

AU - Abate, Kalkidan Hassen

AU - Abay, Solomon M.

AU - Abbafati, Cristiana

AU - Abbasi, Nooshin

AU - Abbastabar, Hedayat

AU - Abd-Allah, Foad

AU - Abdela, Jemal

AU - Abdelalim, Ahmed

AU - Abdollahpour, Ibrahim

AU - Abdulkader, Rizwan Suliankatchi

AU - Abebe, Molla

AU - Abebe, Zegeye

AU - Abil, Olifan Zewdie

AU - Aboyans, Victor

AU - Abrham, Aklilu Roba

AU - Abu-Raddad, Laith Jamal

AU - Abu-Rmeileh, Niveen M.E.

AU - Accrombessi, Manfred Mario Kokou

AU - Acharya, Dilaram

AU - Acharya, Pawan

AU - Ackerman, Ilana N.

AU - Adamu, Abdu A.

AU - Adebayo, Oladimeji M.

AU - Adekanmbi, Victor

AU - Ademi, Zanfina

AU - Adetokunboh, Olatunji O.

AU - Adib, Mina G.

AU - Adsuar, Jose C.

AU - Afanvi, Kossivi Agbelenko

AU - Afarideh, Mohsen

AU - Afshin, Ashkan

AU - Agarwal, Gina

AU - Agesa, Kareha M.

AU - Aggarwal, Rakesh

AU - Aghayan, Sargis Aghasi

AU - Agrawal, Anurag

AU - Ahmadi, Alireza

AU - Ahmadi, Mehdi

AU - Ahmadieh, Hamid

AU - Ahmed, Muktar Beshir

AU - Ahmed, Sayem

AU - Aichour, Amani Nidhal

AU - Aichour, Ibtihel

AU - Aichour, Miloud Taki Eddine

AU - Akinyemiju, Tomi

AU - Akseer, Nadia

AU - Al-Aly, Ziyad

AU - Al-Eyadhy, Ayman

AU - Al-Mekhlafi, Hesham M.

AU - Al-Raddadi, Rajaa M.

AU - Alahdab, Fares

AU - Alam, Khurshid

AU - Alam, Tahiya

AU - Alashi, Alaa

AU - Alavian, Seyed Moayed

AU - Alene, Kefyalew Addis

AU - Alijanzadeh, Mehran

AU - Alizadeh-Navaei, Reza

AU - Aljunid, Syed Mohamed

AU - Alkerwi, Ala'a

AU - Alla, François

AU - Allebeck, Peter

AU - Alonso, Jordi

AU - Alsharif, Ubai

AU - Altirkawi, Khalid

AU - Alvis-Guzman, Nelson

AU - Aminde, Leopold N.

AU - Amini, Erfan

AU - Amiresmaili, Mohammadreza

AU - Ammar, Walid

AU - Amoako, Yaw Ampem

AU - Anber, Nahla Hamed

AU - Andrei, Catalina Liliana

AU - Androudi, Sofia

AU - Animut, Megbaru Debalkie

AU - Anjomshoa, Mina

AU - Ansha, Mustafa Geleto

AU - Antonio, Carl Abelardo T.

AU - Anwari, Palwasha

AU - Arabloo, Jalal

AU - Aremu, Olatunde

AU - Ärnlöv, Johan

AU - Arora, Amit

AU - Arora, Megha

AU - Artaman, Al

AU - Aryal, Krishna K.

AU - Asayesh, Hamid

AU - Ataro, Zerihun

AU - Ausloos, Marcel

AU - Avila-Burgos, Leticia

AU - Avokpaho, Euripide F.G.A.

AU - Awasthi, Ashish

AU - Ayala Quintanilla, Beatriz Paulina

AU - Ayer, Rakesh

AU - Azzopardi, Peter S.

AU - Babazadeh, Arefeh

AU - Badali, Hamid

AU - Balakrishnan, Kalpana

AU - Bali, Ayele Geleto

AU - Banach, Maciej

AU - Banoub, Joseph Adel Mattar

AU - Barac, Aleksandra

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Barquera, Simon

AU - Barrero, Lope H.

AU - Bazargan-Hejazi, Shahrzad

AU - Bedi, Neeraj

AU - Beghi, Ettore

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Bekele, Bayu Begashaw

AU - Bekru, Eyasu Tamru

AU - Belachew, Abate Bekele

AU - Belay, Yihalem Abebe

AU - Bell, Michelle L.

AU - Bello, Aminu K.

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhane, Adugnaw

AU - Bernabe, Eduardo

AU - Bernstein, Robert S.

AU - Beuran, Mircea

AU - Beyranvand, Tina

AU - Bhala, Neeraj

AU - Bhatt, Samir

AU - Bhaumik, Soumyadeep

AU - Bhutta, Zulfiqar A.

AU - Biadgo, Belete

AU - Biehl, Molly H.

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Bilano, Ver

AU - Bililign, Nigus

AU - Bin Sayeed, Muhammad Shahdaat

AU - Bisanzio, Donal

AU - Bjørge, Tone

AU - Bleyer, Archie

AU - Bobasa, Eshetu Mulisa

AU - Bou-Orm, Ibrahim R.

AU - Boufous, Soufiane

AU - Bourne, Rupert

AU - Brady, Oliver J.

AU - Brant, Luisa C.

AU - Brayne, Carol

AU - Brazinova, Alexandra

AU - Breitborde, Nicholas J.K.

AU - Brenner, Hermann

AU - Briant, Paul Svitil

AU - Briko, Andrey Nikolaevich

AU - Britton, Gabrielle

AU - Brugha, Traolach

AU - Buchbinder, Rachelle

AU - Busse, Reinhard

AU - Butt, Zahid A.

AU - Cahuana-Hurtado, Lucero

AU - Campuzano Rincon, Julio Cesar

AU - Cano, Jorge

AU - Cárdenas, Rosario

AU - Carrero, Juan J.

AU - Carter, Austin

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Castillo Rivas, Jacqueline

AU - Castro, Franz

AU - Catalá-López, Ferrán

AU - Cercy, Kelly M.

AU - Cerin, Ester

AU - Chaiah, Yazan

AU - Chang, Jung Chen

AU - Charlson, Fiona J.

AU - Chattu, Vijay Kumar

AU - Chiang, Peggy Pei Chia

AU - Chitheer, Abdulaal

AU - Choi, Jee Young J.

AU - Christensen, Hanne

AU - Christopher, Devasahayam J.

AU - Chung, Sheng Chia

AU - Cicuttini, Flavia M.

AU - Cirillo, Massimo

AU - Collado-Mateo, Daniel

AU - Cooper, Cyrus

AU - Cortesi, Paolo Angelo

AU - Cortinovis, Monica

AU - Cousin, Ewerton

AU - Criqui, Michael H.

AU - Cromwell, Elizabeth A.

AU - Cross, Marita

AU - Crump, John A.

AU - Daba, Alemneh Kabeta

AU - Dachew, Berihun Assefa

AU - Dadi, Abel Fekadu

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Dargan, Paul I.

AU - Daryani, Ahmad

AU - Das Gupta, Rajat

AU - Das Neves, José

AU - Dasa, Tamirat Tesfaye

AU - Davitoiu, Dragos Virgil

AU - De La Hoz, Fernando Pio

AU - De Leo, Diego

AU - De Neve, Jan Walter

AU - De Steur, Hans

AU - Degefa, Meaza Girma

AU - Degenhardt, Louisa

AU - Deiparine, Selina

AU - Demoz, Gebre Teklemariam

AU - Denova-Gutiérrez, Edgar

AU - Deribe, Kebede

AU - Dervenis, Nikolaos

AU - Des Jarlais, Don C.

AU - Dey, Subhojit

AU - Dharmaratne, Samath D.

AU - Dhimal, Meghnath

AU - Dinberu, Mesfin Tadese

AU - Dirac, M. Ashworth

AU - Djalalinia, Shirin

AU - Doan, Linh

AU - Dokova, Klara

AU - Doku, David Teye

AU - Dorsey, E. Ray

AU - Doyle, Kerrie E.

AU - Driscoll, Tim Robert

AU - Dubey, Manisha

AU - Dubljanin, Eleonora

AU - Duken, Eyasu Ejeta

AU - Duncan, Bruce B.

AU - Duraes, Andre R.

AU - Ebrahimi, Hedyeh

AU - Ebrahimpour, Soheil

AU - Echko, Michelle M.

AU - Edessa, Dumessa

AU - Edvardsson, David

AU - Effiong, Andem

AU - Eggen, Anne Elise

AU - Ehrlich, Joshua R.

AU - El Bcheraoui, Charbel

AU - Islam, Sheikh Mohammed Shariful

AU - Kinfu, Yohannes

AU - McGrath, John J.

AU - Nguyen, Anh Quynh

AU - Nguyen, Huong Lan Thi

AU - Nguyen, Minh

AU - Rahman, Mohammad Hifz Ur

AU - Stokes, Mark A.

PY - 2018/11/10

Y1 - 2018/11/10

N2 - Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods: We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings: Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). Interpretation: With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding: Bill & Melinda Gates Foundation.

AB - Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods: We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings: Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2). Interpretation: With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Funding: Bill & Melinda Gates Foundation.

KW - Aged

KW - Communicable Diseases/epidemiology

KW - Disabled Persons/statistics & numerical data

KW - Female

KW - Global Burden of Disease/statistics & numerical data

KW - Health Status

KW - Healthy Lifestyle/physiology

KW - Humans

KW - Life Expectancy/trends

KW - Male

KW - Mortality/trends

KW - Mortality, Premature/trends

KW - Prevalence

KW - Quality-Adjusted Life Years

KW - Risk Factors

KW - Socioeconomic Factors

KW - Wounds and Injuries/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85056187313&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(18)32335-3

DO - 10.1016/S0140-6736(18)32335-3

M3 - Article

VL - 392

SP - 1859

EP - 1922

JO - Lancet

JF - Lancet

SN - 0140-6736

IS - 10159

ER -