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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…

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Title
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
Published in
The Lancet, September 2017
DOI 10.1016/s0140-6736(17)32130-x
Pubmed ID
Authors

GBD 2016 DALYs and HALE Collaborators, Simon I Hay, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J Abu-Raddad, Ilana N Ackerman, Isaac A Adedeji, Olatunji Adetokunboh, Ashkan Afshin, Rakesh Aggarwal, Sutapa Agrawal, Anurag Agrawal, Muktar Beshir Ahmed, Miloud Taki Eddine Aichour, Amani Nidhal Aichour, Ibtihel Aichour, Sneha Aiyar, Tomi F Akinyemiju, Nadia Akseer, Faris Hasan Al Lami, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Tahiya Alam, Deena Alasfoor, Kefyalew Addis Alene, Raghib Ali, Reza Alizadeh-Navaei, Juma M Alkaabi, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine Allen, Fatma Al-Maskari, Mohammad AbdulAziz AlMazroa, Rajaa Al-Raddadi, Ubai Alsharif, Shirina Alsowaidi, Benjamin M Althouse, Khalid A Altirkawi, Nelson Alvis-Guzman, Azmeraw T Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Mustafa Geleto Ansha, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Megha Arora, Al Artaman, Krishna Kumar Aryal, Solomon W Asgedom, Tesfay Mehari Atey, Niguse Tadele Atnafu, Leticia Avila-Burgos, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Shally Awasthi, Mahmoud Reza Azarpazhooh, Peter Azzopardi, Tesleem Kayode Babalola, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Marlena S Bannick, Aleksandra Barac, Suzanne L Barker-Collo, Till Bärnighausen, Simon Barquera, Lope H Barrero, Sanjay Basu, Robert Battista, Katherine E Battle, Bernhard T Baune, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Yannick Béjot, Bayu Begashaw Bekele, Michelle L Bell, Derrick A Bennett, James R Bennett, Isabela M Bensenor, Jennifer Benson, Adugnaw Berhane, Derbew Fikadu Berhe, Eduardo Bernabé, Balem Demtsu Betsu, Mircea Beuran, Addisu Shunu Beyene, Anil Bhansali, Samir Bhatt, Zulfiqar A Bhutta, Sibhatu Biadgilign, Burcu Kucuk Bicer, Kelly Bienhoff, Boris Bikbov, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Fiona M Blyth, Dube Jara Boneya, Dipan Bose, Ibrahim R Bou-Orm, Rupert R A Bourne, Michael Brainin, Carol Brayne, Alexandra Brazinova, Nicholas J K Breitborde, Paul S Briant, Gabrielle Britton, Traolach S Brugha, Rachelle Buchbinder, Lemma Negesa Bulto Bulto, Blair R Bumgarner, Zahid A Butt, Lucero Cahuana-Hurtado, Ewan Cameron, Ismael Ricardo Campos-Nonato, Hélène Carabin, Rosario Cárdenas, David O Carpenter, Juan Jesus Carrero, Austin Carter, Felix Carvalho, Daniel Casey, Carlos A Castañeda-Orjuela, Chris D Castle, Ferrán Catalá-López, Jung-Chen Chang, Fiona J Charlson, Pankaj Chaturvedi, Honglei Chen, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal A Chitheer, Rajiv Chowdhury, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Cirillo, Danny Colombara, Leslie Trumbull Cooper, Cyrus Cooper, Paolo Angelo Cortesi, Monica Cortinovis, Michael H Criqui, Elizabeth A Cromwell, Marita Cross, John A Crump, Abel Fekadu Dadi, Koustuv Dalal, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, José das Neves, Dragos V Davitoiu, Kairat Davletov, Barbora de Courten, Diego De Leo, Hans De Steur, Barthelemy Kuate Defo, Louisa Degenhardt, Selina Deiparine, Robert P Dellavalle, Kebede Deribe, Amare Deribew, Don C Des Jarlais, Subhojit Dey, Samath D Dharmaratne, Preet K Dhillon, Daniel Dicker, Shirin Djalainia, Huyen Phuc, Klara Dokova, David Teye Doku, E Ray Dorsey, Kadine Priscila Bender dos Santos, Tim R Driscoll, Manisha Dubey, Bruce Bartholow Duncan, Beth E Ebel, Michelle Echko, Ziad Ziad El-Khatib, Ahmadali Enayati, Aman Yesuf Endries, Sergey Petrovich Ermakov, Holly E Erskine, Setegn Eshetie, Babak Eshrati, Alireza Esteghamati, Kara Estep, Fanuel Belayneh Bekele Fanuel, Tamer Farag, Carla Sofia e Sa Farinha, André Faro, Farshad Farzadfar, Mir Sohail Fazeli, Valery L Feigin, Andrea B Feigl, Seyed-Mohammad Fereshtehnejad, João C Fernandes, Alize J Ferrari, Tesfaye Regassa Feyissa, 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Abstract

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). 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. 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. 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. Bill & Melinda Gates Foundation.

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Geographical breakdown

Country Count As %
Unknown 3565 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 547 15%
Researcher 449 13%
Student > Ph. D. Student 318 9%
Student > Bachelor 294 8%
Student > Postgraduate 168 5%
Other 693 19%
Unknown 1096 31%
Readers by discipline Count As %
Medicine and Dentistry 885 25%
Nursing and Health Professions 336 9%
Social Sciences 149 4%
Agricultural and Biological Sciences 130 4%
Psychology 111 3%
Other 635 18%
Unknown 1319 37%
Attention Score in Context

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This research output has an Altmetric Attention Score of 529. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 September 2023.
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