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
Journal
The Lancet
Journal Volume
390
Journal Issue
10100
Pages
1260-1344
Date Issued
2017
Author(s)
Hay S.I.
Abajobir A.A.
Abate K.H.
Abbafati C.
Abbas K.M.
Abd-Allah F.
Abdulle A.M.
Abebo T.A.
Abera S.F.
Aboyans V.
Abu-Raddad L.J.
Ackerman I.N.
Adedeji I.A.
Adetokunboh O.
Afshin A.
Aggarwal R.
Agrawal S.
Agrawal A.
Kiadaliri A.A.
Ahmed M.B.
Aichour A.N.
Aichour I.
Aichour M.T.E.
Aiyar S.
Akinyemiju T.F.
Akseer N.
Al Lami F.H.
Alahdab F.
Al-Aly Z.
Alam K.
Alam N.
Alam T.
Alasfoor D.
Alene K.A.
Ali R.
Alizadeh-Navaei R.
Alkaabi J.M.
Alkerwi A.
Alla F.
Allebeck P.
Allen C.
Al-Maskari F.
Almazroa M.A.
Al-Raddadi R.
Alsharif U.
Alsowaidi S.
Althouse B.M.
Altirkawi K.A.
Alvis-Guzman N.
Amare A.T.
Amini E.
Ammar W.
Amoako Y.A.
Ansha M.G.
Antonio C.A.T.
Anwari P.
?rnl?v J.
Arora M.
Artaman A.
Aryal K.K.
Asgedom S.W.
Atey T.M.
Atnafu N.T.
Avila-Burgos L.
Arthur Avokpaho E.F.G.
Awasthi A.
Awasthi S.
Quintanilla B.P.A.
Azarpazhooh M.R.
Azzopardi P.
Babalola T.K.
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Bryane C.E.G.
GBD 2016 DALYs and HALE Collaborators
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 difered 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 ofset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the fve 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 ofset 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 eforts, and development assistance for health, including fnancial 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. ? The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Other Subjects
abdominal wall hernia; abortion; accommodation disorder; acne vulgaris; acquired immune deficiency syndrome; acute glomerulonephritis; acute hepatitis A; acute hepatitis e; acute lymphoblastic leukemia; acute myeloid leukemia; adolescent; adult; African trypanosomiasis; aged; alcoholic cardiomyopathy; alcoholism; all cause mortality; alopecia areata; Alzheimer disease; amphetamine dependence; anorexia nervosa; anxiety disorder; aortic aneurysm; appendicitis; Article; asbestosis; ascariasis; Asperger syndrome; asthma; atrial fibrillation; attention deficit disorder; autism; automutilation; biliary tract cancer; biliary tract disease; bipolar disorder; bladder cancer; brain cancer; brain hemorrhage; brain ischemia; breast cancer; bronchus cancer; bulimia; cardiomyopathy; cataract; cause of death; cellulitis; cerebrovascular disease; Chagas disease; chickenpox; child; chlamydiasis; chronic kidney failure; chronic liver disease; chronic lymphatic leukemia; chronic myeloid leukemia; chronic obstructive lung disease; coal workers' pneumoconiosis; cocaine dependence; colon cancer; conduct disorder; congenital disorder; cysticercosis; decubitus; dengue; dental caries; dermatitis; diabetes mellitus; diarrhea; diphtheria; disability-adjusted life year; disease course; diseases; Down syndrome; dracunculiasis; drowning; drug dependence; drug resistant tuberculosis; duodenitis; dysthymia; eating disorder; Ebola hemorrhagic fever; echinococcosis; ectopic pregnancy; encephalitis; endocarditis; endometriosis; epidemic meningitis; epilepsy; esophagus cancer; falling; female; female infertility; femoral hernia; food borne trematodiasis; foreign body; fungal skin disease; gallbladder cancer; gallbladder disease; gastritis; genital herpes; glaucoma; global disease burden; glucose 6 phosphate dehydrogenase deficiency; gonorrhea; gout; gross national product; groups by age; gunshot injury; haemophilus influenzae type b meningitis; health care policy; healthy life expectancy; hearing impairment; heart atrium flutter; 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mucocutaneous leishmaniasis; multiple myeloma; multiple sclerosis; myocarditis; nasopharynx cancer; neck pain; neglected disease; nematodiasis; neonatal encephalopathy; neural tube defect; newborn disease; newborn jaundice; newborn sepsis; nonhodgkin lymphoma; onchocerciasis; opiate addiction; osteoarthritis; otitis media; ovary cancer; pancreas cancer; pancreatitis; paralytic ileus; paratyphoid fever; Parkinson disease; pelvic organ prolapse; peptic ulcer; perinatal asphyxia; periodontal disease; peripheral occlusive artery disease; pertussis; physical violence; pneumococcal meningitis; pneumoconiosis; premature labor; premenstrual syndrome; priority journal; prostate cancer; prostate hypertrophy; protein calorie malnutrition; pruritus; psoriasis; pulmonary aspiration; pyoderma; rectum cancer; refraction error; retinol deficiency; rheumatic heart disease; rheumatoid arthritis; risk factor; scabies; schistosomiasis; schizophrenia; sickle cell trait; silicosis; skin leishmaniasis; spontaneous abortion; 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