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

Simon I. Hay, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M. Abbas, Foad Abd-Allah, 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, Aliasghar Ahmad Kiadaliri, Muktar Beshir AhmedAmani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine 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, Beatriz Paulina Ayala Quintanilla, 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, Zulfqar A. Bhutta, Sibhatu Biadgilign, Kelly Bienhof, 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 E.G. Brayne, Alexandra Brazinova, Nicholas J.K. Breitborde, Paul S. Briant, Gabrielle Britton, Traolach S. Brugha, Rachelle Buchbinder, Lemma Negesa Bulto Bulto, Blair 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, Jacqueline Castillo Rivas, 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, Louisa Degenhardt, Selina Deiparine, Robert P. Dellavalle, Kebede Deribe, Amare Deribew, Don C. Das Jarlais, Subhojit Dey, Samath D. Dharmaratne, Preet K. Dhillon, Daniel Dicker, Shirin Djalalinia, Huyen Phuc Do, 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 Sofa 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, Irina Filip, Florian Fischer, Christina Fitzmaurice, Abraham D. Flaxman, Nataliya Foigt, Kyle J. Foreman, Richard C. Franklin, Joseph J. Frostad, Nancy Fullman, Thomas Fürst, Joao M. Furtado, Neal D. Futran, Emmanuela Gakidou, Alberto L. Garcia-Basteiro, Teshome Gebre, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Johanna M. Geleijnse, Ayele Geleto, Bikila Lencha Gemechu, Hailay Abrha Gesesew, Peter W. Gething, Alireza Ghajar, Katherine B. Gibney, Richard F. Gillum, Ibrahim Abdelmageem Mohamed Ginawi, Melkamu Dedefo Gishu, Giorgia Giussani, William W. Godwin, Kashish Goel, Shifalika Goenka, Ellen M. Goldberg, Philimon N. Gona, Amador Goodridge, Sameer Vali Gopalani, Richard A. Gosselin, Carolyn C. Gotay, Atsushi Goto, Alessandra Carvalho Goulart, Nicholas Graetz, Harish Chander Gugnani, Rajeev Gupta, Prakash C. Gupta, Tanush Gupta, Vipin Gupta, Rahul Gupta, Reyna A. Gutiérrez, Vladimir Hachinski, Nima Hafezi-Nejad, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Randah Ribhi Hamadeh, Samer Hamidi, Mouhanad Hammami, Alexis J. Handal, Graeme J. Hankey, Yuantao Hao, Hilda L. Harb, Habtamu Abera Hareri, Josep Maria Haro, Kimani M. Harun, James Harvey, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Roderick J. Hay, Mohammad T. Hedayati, Delia Hendrie, Nathaniel J. Henry, Ileana Beatriz Heredia-Pi, Pouria Heydarpour, Hans W. Hoek, Howard J. Hofman, Masako Horino, Nobuyuki Horita, H. Dean Hosgood, Sorin Hostiuc, Peter J. Hotez, Damian G. Hoy, Aung Soe Htet, Guoqing Hu, John J. Huang, Chantal Huynh, Kim Moesgaard Iburg, Ehimario Uche Igumbor, Chad Ikeda, Caleb Mackay Salpeter Irvine, Kathryn H. Jacobsen, Nader Jahanmehr, Mihajlo B. Jakovljevic, Peter James, Simerjot K. Jassal, Mehdi Javanbakht, Sudha P. Jayaraman, Panniyammakal Jeemon, Paul N. Jensen, Vivekanand Jha, Guohong Jiang, Denny John, Catherine O. Johnson, Sarah Charlotte Johnson, Jost B. Jonas, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Ritul Kamal, Chittaranjan Kar, Nadim E. Karam, André Karch, Corine Kakizi Karema, Seyed M. Karimi, Chante Karimkhani, Amir Kasaeian, Getachew Mullu Kassa, Nicholas J. Kassebaum, Nigussie Assefa Kassaw, Anshul Kastor, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Peter Njenga Keiyoro, Laura Kemmer, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Ibrahim A. Khalil, Ejaz Ahmad Khan, Young Ho Khang, Abdullah T. Khoja, Ardeshir Khosravi, Jagdish Khubchandani, Christian Kieling, Yun Jin Kim, Daniel Kim, Ruth W. Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna A. Kissimova-Skarbek, Niranjan Kissoon, Mika Kivimaki, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A. Kopec, Soewarta Kosen, Georgios A. Kotsakis, Parvaiz A. Koul, Ai Koyanagi, Michael Kravchenko, Kristopher J. Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G. Anil Kumar, Pushpendra Kumar, Hmwe H. Kyu, Anton Carl Jonas Lager, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Nkurunziza Lambert, Qing Lan, Van C. Lansingh, Anders Larsson, Janet L. Leasher, Paul H. Lee, James Leigh, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miriam Levi, Yichong Li, Yongmei Li, Xiaofeng Liang, Misgan Legesse Liben, Stephen S. Lim, Shai Linn, Angela Liu, Patrick Y. Liu, Shiwei Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Katharine J. Looker, Alan D. Lopez, Stefan Lorkowski, Paulo A. Lotufo, Rafael Lozano, Timothy C.D. Lucas, Raimundas Lunevicius, Ronan A. Lyons, Erlyn Rachelle King Macarayan, Emilie R. Maddison, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Carlos Magis-Rodriguez, Mahdi Mahdavi, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Deborah Carvalho Malta, Abdullah A. Mamun, Helena Manguerra, Treh Manhertz, Lorenzo G. Mantovani, Chabila C. Mapoma, Lyn M. March, Laurie B. Marczak, Jose Martinez-Raga, Paulo Henrique Viegas Martins, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Winfried März, Manu Raj Mathur, Mohsen Mazidi, Colm McAlinden, Madeline McGaughey, John J. McGrath, Martin McKee, Suresh Mehata, Toni Meier, Kidanu Gebremariam Meles, Peter Memiah, Ziad A. Memish, Walter Mendoza, Melkamu Merid Mengesha, Mubarek Abera Mengistie, Desalegn Tadese Mengistu, George A. Mensah, Atte Meretoja, Tuomo J. Meretoja, Haftay Berhane Mezgebe, Renata Micha, Anoushka Millear, Ted R. Miller, Shawn Minnig, Mojde Mirarefn, Erkin M. 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    Research output: Contribution to journalArticlepeer-review

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    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.
    Original languageEnglish (US)
    Pages (from-to)1260-1344
    Number of pages85
    JournalThe Lancet
    Volume390
    Issue number10100
    DOIs
    StatePublished - Sep 16 2017

    ASJC Scopus subject areas

    • Medicine(all)

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