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Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

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Truelsen, Thomas, Tsilimbaris, Miltiadis, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, Van De Vijver, Steven, van Gool, Coen H, Van Os, Jim, Vasankari, Tommi J, Venketasubramanian, N, Violante, Francesco S, Vlassov, Vasiliy V, Vollset, Stein Emil, Wagner, Gregory R, Wagner, Joseph, Waller, Stephen G, Wan, Xia, Wang, Haidong, Wang, Jianli, Wang, Linhong, Warouw, Tati S, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Wenzhi, Wang, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Wulf, Sarah, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L, Yano, Yuichiro, Ye, Pengpeng, Yentür, Gökalp K, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaki, Maysaa E, Zhao, Yong, Zheng, Yingfeng, Zonies, David, Zou, Xiaonong, Salomon, Joshua A, Lopez, Alan D, Vos, Theo·2015·The Lancet
DOI 10.1016/s0140-6736(15)61340-x
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Abstract

Summary Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

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Authors
Murray, C. J. L., Barber, R. M., Foreman, K. J., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Ackerman, I. N., Ademi, Z., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allebeck, P., Almazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, H., Ammar, W., Anderson, H. R., Anderson, B. O., Antonio, C. A. T., Anwari, P., Arnlöv, J., Arsenijevic, V. S. A., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Avila, M. A., Awuah, B., Bachman, V. F., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Basu, A., Basu, S., Basulaiman, M. O., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bernabé, E., Bertozzi-Villa, A., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bienhoff, K., Bikbov, B., Biryukov, S., Blore, J. D., Blosser, C. D., Blyth, F. M., Bohensky, M. A., Bolliger, I. W., Başara, B. B., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R. A., Boyers, L. N., Brainin, M., Brayne, C. E., Brazinova, A., Breitborde, N. J. K., Brenner, H., Briggs, A. D., Brooks, P. M., Brown, J. C., Brugha, T. S., Buchbinder, R., Buckle, G. C., Budke, C. M., Bulchis, A., Bulloch, A. G., Campos-Nonato, I. R., Carabin, H., Carapetis, J. R., Cárdenas, R., Carpenter, D. O., Caso, V., Castañeda-Orjuela, C. A., Castro, R. E., Catalá-López, F., Cavalleri, F., Çavlin, A., Chadha, V. K., Chang, J.-C., Charlson, F. J., Chen, H., Chen, W., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Cirillo, M., Coates, M. M., Coffeng, L. E., Coggeshall, M. S., Colistro, V., Colquhoun, S. M., Cooke, G. S., Cooper, C., Cooper, L. T., Coppola, L. M., Cortinovis, M., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Danawi, H., Dandona, L., Dandona, R., Dansereau, E., Dargan, P. I., Davey, G., Davis, A., Davitoiu, D. V., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Derrett, S., Jarlais, D. C. D., Dessalegn, M., Dharmaratne, S. D., Dherani, M. K., Diaz-Torné, C., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Duber, H. C., Ebel, B. E., Edmond, K. M., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Estep, K., Faraon, E. J. A., Farzadfar, F., Fay, D. F., Feigin, V. L., Felson, D. T., Fereshtehnejad, S.-M., Fernandes, J. G., Ferrari, A. J., Fitzmaurice, C., Flaxman, A. D., Fleming, T. D., Foigt, N., Forouzanfar, M. H., Fowkes, F. G. R., Paleo, U. F., Franklin, R. C., Fürst, T., Gabbe, B., Gaffikin, L., Gankpé, F. G., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Giroud, M., Giussani, G., Dantes, H. G., Gona, P., González-Medina, D., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Gugnani, H. C., Gupta, R., Gupta, R., Gutiérrez, R. A., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Halasa, Y. A., Hamadeh, R. R., Hamavid, H., Hammami, M., Hancock, J., Hankey, G. J., Hansen, G. M., Hao, Y., Harb, H. L., Haro, J. M., Havmoeller, R., Hay, S. I., Hay, R. J., Heredia-Pi, I. B., Heuton, K. R., Heydarpour, P., Higashi, H., Hijar, M., Hoek, H. W., Hoffman, H. J., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, C., Huang, J. J., Husseini, A., Huynh, C., Iannarone, M. L., Iburg, K. M., Innos, K., Inoue, M., Islami, F., Jacobsen, K. H., Jarvis, D. L., Jassal, S. K., Jee, S. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Juel, K., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Karthikeyan, G., Kassebaum, N. J., Kaul, A., Kawakami, N., Kazanjan, K., Kemp, A. H., Kengne, A. P., Keren, A., Khader, Y. S., Khalifa, S. E. A., Khan, E. A., Khan, G., Khang, Y.-H., Kieling, C., Kim, D., Kim, S., Kim, Y., Kinfu, Y., Kinge, J. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kosen, S., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kyu, H. H., Lai, T., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larsson, A., Lawrynowicz, A. E. B., Leasher, J. L., Leigh, J., Leung, R., Levitz, C. E., Li, B., Li, Y., Li, Y., Lim, S. S., Lind, M., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lofgren, K. T., Logroscino, G., Looker, K. J., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., Macintyre, M. F., Mackay, M. T., Majdan, M., Malekzadeh, R., Marcenes, W., Margolis, D. J., Margono, C., Marzan, M. B., Masci, J. R., Mashal, M. T., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., Mcgill, N. W., Mcgrath, J. J., Mckee, M., Mclain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mitchell, P. B., Mock, C. N., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L. D., Monasta, L., Hernandez, J. C. M., Montico, M., Montine, T. J., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moran, A. E., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M. L., Mozaffarian, D., Msemburi, W. T., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murdoch, M. E., Murray, J., Murthy, K. S., Naghavi, M., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M. V., Nejjari, C., Neupane, S. P., Newton, C. R., Ng, M., Ngalesoni, F. N., Nguyen, G., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I.-H., Ohkubo, T., Ohno, S. L., Olusanya, B. O., Opio, J. N., Ortblad, K., Ortiz, A., Pain, A. W., Pandian, J. D., Panelo, C. I. A., Papachristou, C., Park, E.-K., Park, J.-H., Patten, S. B., Patton, G. C., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phillips, B. K., Phillips, D. E., Piel, F. B., Plass, D., Poenaru, D., Polinder, S., Pope, D., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Pullan, R. L., Qato, D. M., Quistberg, D. A., Rafay, A., Rahimi, K., Rahman, S. U., Raju, M., Rana, S. M., Razavi, H., Reddy, K. S., Refaat, A., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Richardson, L., Richardus, J. H., Roberts, D. A., Rojas-Rueda, D., Ronfani, L., Roth, G. A., Rothenbacher, D., Rothstein, D. H., Rowley, J. T., Roy, N., Ruhago, G. M., Saeedi, M. Y., Saha, S., Sahraian, M. A., Sampson, U. K. A., Sanabria, J. R., Sandar, L., Santos, I. S., Satpathy, M., Sawhney, M., Scarborough, P., Schneider, I. J., Schöttker, B., Schumacher, A. E., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serina, P. T., Servan-Mori, E. E., Shackelford, K. A., Shaheen, A., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shi, P., Shibuya, K., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, L., Skirbekk, V., Slepak, E. L., Sliwa, K., Soneji, S., Søreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stanaway, J. D., Stathopoulou, V., Stein, D. J., Stein, M. B., Steiner, C., Steiner, T. J., Stevens, A., Stewart, A., Stovner, L. J., Stroumpoulis, K., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Taylor, H. R., Ao, B. J. T., Tediosi, F., Temesgen, A. M., Templin, T., Ten Have, M., Tenkorang, E. Y., Terkawi, A. S., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tonelli, M., Topouzis, F., Toyoshima, H., Traebert, J., Tran, B. X., Trillini, M., Truelsen, T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Van Brakel, W. H., Van De Vijver, S., van Gool, C. H., Van Os, J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Wagner, J., Waller, S. G., Wan, X., Wang, H., Wang, J., Wang, L., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Wenzhi, W., Werdecker, A., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, T. N., Wolfe, C. D., Wolock, T. M., Woolf, A. D., Wulf, S., Wurtz, B., Xu, G., Yan, L. L., Yano, Y., Ye, P., Yentür, G. K., Yip, P., Yonemoto, N., Yoon, S.-J., Younis, M. Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zonies, D., Zou, X., Salomon, J. A., Lopez, A. D., & Vos, T.
Venue
The Lancet
Publisher
Elsevier BV
Published
2015-11
Volume
386
Issue
10009
Pages
2145-2191
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(15)61340-x
OpenAlex
W2142472354
Cited by
1,964
References
5
FWCI
724.72
Type
journal article
Language
en
Open access
green
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Funders
  • Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876)
  • National Natural Science Foundation for Young Scholars of China (number 81200051)
  • Science Foundation for Young Scholars in Zhongshan Hospital (number 2012ZSQN04)
  • Scientific Project for Fudan University (number 20520133474)

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.