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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

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
Authors: Kyu, HH
Abate, D
Abate, KH
Abay, SM
Abbafati, C
Abbasi, N
Abbastabar, H
Abd-Allah, F
Abdela, J
Abdelalim, A
Abdollahpour, I
Abdulkader, RS
Abebe, M
Abebe, Z
Abil, OZ
Aboyans, V
Abrham, AR
Abu-Raddad, LJ
Abu-Rmeileh, NME
Accrombessi, MMK
Acharya, D
Acharya, P
Ackerman, IN
Adamu, AA
Adebayo, OM
Adekanmbi, V
Ademi, Z
Adetokunboh, OO
Adib, MG
Adsuar, JC
Afanvi, KA
Afarideh, M
Afshin, A
Agarwal, G
Agesa, KM
Aggarwal, R
Aghayan, SA
Agrawal, A
Ahmadi, A
Ahmadi, M
Ahmadieh, H
Ahmed, MB
Ahmed, S
Aichour, AN
Aichour, I
Aichour, MTE
Akinyemiju, T
Akseer, N
Ayman, ZA-A
Al-Eyadhy, A
Al-Mekhlafi, HM
Al-Raddadi, RM
Alahdab, F
Alam, K
Alam, T
Alashi, A
Alavian, SM
Alene, KA
Alijanzadeh, M
Alizadeh-Navaei, R
Aljunid, SM
Alkerwi, A
Alla, F
Allebeck, P
Alonso, J
Alsharif, U
Altirkawi, K
Alvis-Guzman, N
Aminde, LN
Amini, E
Amiresmaili, M
Ammar, W
Amoako, YA
Anber, NH
Andrei, CL
Androudi, S
Animut, MD
Anjomshoa, M
Ansha, MG
Antonio, CAT
Anwari, P
Arabloo, J
Aremu, O
Arnlov, J
Arora, A
Arora, M
Artaman, A
Aryal, KK
Asayesh, H
Ataro, Z
Ausloos, M
Avila-Burgos, L
Avokpaho, EFGA
Awasthi, A
Quintanilla, BPA
Ayer, R
Azzopardi, PS
Babazadeh, A
Badali, H
Balakrishnan, K
Bali, AG
Banach, M
Banoub, JAM
Barac, A
Barboza, MA
Barker-Collo, SL
Bamighausen, TW
Barquera, S
Barrero, LH
Bazargan-Hejazi, S
Bedi, N
Beghi, E
Behzadifar, M
Behzadifar, M
Bekele, BB
Bekru, ET
Belachew, AB
Belay, YA
Bell, ML
Bello, AK
Bennett, DA
Bensenor, IM
Berhane, A
Bernabe, E
Bernstein, RS
Beuran, M
Beyranvand, F
Bhala, N
Bhatt, S
Bhaumik, S
Bhutta, ZA
Biadgo, B
Biehl, MH
Bijani, A
Bikbov, B
Bilano, V
Bililign, N
Bin Sayeed, MS
Bisanzio, D
Bjorge, T
Bleyer, A
Bobasa, EM
Bou-Orm, IR
Boufous, S
Bourne, R
Brady, OJ
Brant, LC
Brayne, C
Brazinova, A
Breitborde, NJK
Brenner, H
Briant, PS
Briko, AN
Britton, G
Brugha, T
Buchbinder, R
Busse, R
Butt, ZA
Cahuana-Hurtado, L
Rincon, JCC
Cano, J
Cardenas, R
Carrero, JJ
Carter, A
Carvalho, F
Castaneda-Orjuela, CA
Rivas, JC
Castro, F
Catala-Lopez, F
Cercy, KM
Cerin, E
Chaiah, Y
Chang, J-C
Charlson, FJ
Chattu, VK
Chiang, PP-C
Chitheer, A
Choi, J-YJ
Christensen, H
Christopher, DJ
Chung, S-C
Cicuttini, FM
Cirillo, M
Collado-Mateo, D
Cooper, C
Cortesi, PA
Cortinovis, M
Cousin, E
Criqui, MH
Cromwell, EA
Cross, M
Crump, JA
Daba, AK
Dachew, BA
Dadi, AF
Dandona, L
Dandona, R
Dargan, PI
Daryani, A
Das Gupta, R
Das Neves, J
Dasa, TT
Davitoiu, DV
De la Hoz, FP
De Leo, D
De Neve, J-W
De Steur, H
Degefa, MG
Degenhardt, L
Deiparine, S
Demoz, GT
Denova-Gutierrez, E
Deribe, K
Dervenis, N
Jarlais, DCD
Dey, S
Dharmaratne, SD
Dhimal, M
Dinberu, MT
Dirac, MA
Djalalinia, S
Doan, L
Dokova, K
Doku, DT
Dorsey, ER
Doyle, KE
Driscoll, TR
Dubey, M
Dubljanin, E
Duken, EE
Duncan, BB
Duraes, AR
Ebrahimi, H
Ebrahimpour, S
Echko, MM
Edessa, D
Edvardsson, D
Effiong, A
Eggen, AE
Ehrlich, JR
El Bcheraoui, C
El-Khatib, Z
Elyazar, IRF
Enayati, A
Endalifer, ML
Endries, AY
Er, B
Erskine, HE
Eskandarieh, S
Esteghamati, A
Esteghamati, S
Fakhim, H
Faramarzi, M
Fareed, M
Farhadi, F
Farid, TA
Farinha, CSES
Farioli, A
Faro, A
Farzadfar, F
Fazaeli, AA
Feigin, VL
Fentahun, N
Fereshtehnejad, S-M
Fernandes, E
Fernandes, JC
Ferrari, AJ
Ferreira, ML
Filip, I
Fischer, F
Fitzmaurice, C
Foigt, NA
Foreman, KJ
Frank, TD
Fukumoto, T
Pullman, N
Furst, T
Furtado, JM
Gakidou, E
Gall, S
Gallus, S
Ganji, M
Garcia-Basteiro, AL
Gardner, WM
Gebre, AK
Gebremedhin, AT
Gebremichael, TG
Gelano, TF
Geleijnse, JM
Genova-Maleras, R
Geramo, YCD
Gething, PW
Gezae, KE
Ghadami, MR
Ghadiri, K
Ghasemi-Kasman, M
Ghimire, M
Ghoshal, AG
Gill, PS
Gill, TK
Ginawi, IA
Giussani, G
Gnedovskaya, EV
Goldberg, EM
Goli, S
Gomez-Dantes, H
Gona, PN
Gopalani, SV
Gorman, TM
Goulart, AC
Goulart, BNG
Grada, A
Grosso, G
Gugnani, HC
Guillemin, F
Guo, Y
Gupta, PC
Gupta, R
Gupta, R
Gupta, T
Gutierrez, RA
Gyawali, B
Haagsma, JA
Hachinski, V
Hafezi-Nejad, N
Bidgoli, HH
Hagos, TB
Hailegiyorgis, TT
Haj-Mirzaian, A
Haj-Mirzaian, A
Hamadeh, RR
Hamidi, S
Handal, AJ
Hankey, GJ
Hao, Y
Harb, HL
Harikrishnan, S
Haririan, H
Haro, JM
Hassankhani, H
Hassen, HY
Havmoeller, R
Hay, RJ
Hay, SI
Hedayatizadeh-Omran, A
Heibati, B
Hendrie, D
Henok, A
Heredia-Pi, I
Herteliu, C
Heydarpour, F
Heydarpour, P
Hibstu, DT
Hoek, HW
Hoffman, HJ
Hole, MK
Rad, EH
Hoogar, P
Hosgood, HD
Hosseini, SM
Hosseinzadeh, M
Hostiuc, M
Hostiuc, S
Hotez, PJ
Hoy, DG
Hsairi, M
Htet, AS
Huang, JJ
Iburg, KM
Ikeda, CT
Ilesanmi, OS
Irvani, SSN
Irvine, CMS
Islam, SMS
Islami, F
Jacobsen, KH
Jahangiry, L
Jahanmehr, N
Jain, SK
Jakovljevic, M
James, SL
Jayatilleke, AU
Jeemon, P
Jha, RP
Jha, V
Ji, JS
Johnson, CO
Jonas, JB
Jonnagaddala, J
Shushtari, ZJ
Joshi, A
Jozwiak, JJ
Jungari, SB
Jurisson, M
Kabir, Z
Kadel, R
Kahsay, A
Kalani, R
Kanchan, T
Kar, C
Karami, M
Matin, BK
Karch, A
Karema, C
Karimi, N
Karimi, SM
Kasaeian, A
Kassa, DH
Kassa, GM
Kassa, TD
Kassebaum, NJ
Katikireddi, SV
Kaul, A
Kawakami, N
Kazemi, Z
Karyani, AK
Keighobadi, MM
Keiyoro, PN
Kemmer, L
Kemp, GR
Kengne, AP
Keren, A
Khader, YS
Khafaei, B
Khafaie, MA
Khajavi, A
Khalid, N
Khalil, IA
Khan, EA
Khan, MS
Khan, MA
Khang, Y-H
Khater, MM
Khazaei, M
Khoja, AT
Khosravi, A
Khosravi, MH
Kiadaliri, AA
Kidanemariam, ZT
Kiirithio, DN
Kim, C-I
Kim, D
Kim, Y-E
Kim, YJ
Kimokoti, RW
Kinfu, Y
Kisa, A
Kissimova-Skarbek, K
Knudsen, AKS
Kocarnik, JM
Kochhar, S
Kokubo, Y
Kolola, T
Kopec, JA
Kosen, S
Kotsakis, GA
Koul, PA
Koyanagi, A
Krishan, K
Krishnaswami, S
Krohn, KJ
Defo, BK
Bicer, BK
Kumar, GA
Kumar, M
Kuzin, I
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Lad, SD
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Lalloo, R
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Lami, FH
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Langan, SM
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Lazarus, JV
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Ledesma, JR
Lee, PH
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Leshargie, CT
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Levi, M
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Liang, X
Liao, Y
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Limenih, MA
Linn, S
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Lopez, AD
Lorkowski, S
Lotufo, PA
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Lucas, TCD
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Weldegwergs, KG
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Zar, HJ
Zenebe, ZM
Zipkin, B
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Zodpey, S
Zucker, I
Zuhlke, LJ
Murray, CJL
Item Type: Journal Article
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.
Issue Date: 10-Nov-2018
Date of Acceptance: 1-Oct-2018
URI: http://hdl.handle.net/10044/1/65186
DOI: https://dx.doi.org/10.1016/S0140-6736(18)32335-3
ISSN: 0140-6736
Publisher: Elsevier
Start Page: 1859
End Page: 1922
Journal / Book Title: The Lancet
Volume: 392
Issue: 10159
Copyright Statement: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/)
Sponsor/Funder: Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Funder's Grant Number: MR/K010174/1B
1606H5002/JH6
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
IRON-DEFICIENCY
INTERVENTIONS
PREVENTION
GENDER
DISORDERS
OUTCOMES
WEIGHTS
STYLE
AIDS
HIV
Aged
Communicable Diseases
Disabled Persons
Female
Global Burden of Disease
Health Status
Healthy Lifestyle
Humans
Life Expectancy
Male
Mortality
Mortality, Premature
Prevalence
Quality-Adjusted Life Years
Risk Factors
Socioeconomic Factors
Wounds and Injuries
GBD 2017 DALYs and HALE Collaborators
11 Medical And Health Sciences
Publication Status: Published
Online Publication Date: 2018-11-08
Appears in Collections:Department of Medicine
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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