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Cited by 2,083Insurance, Mortality, Demography, Risk ManagementGlobal Health Care IssuesGlobal Health and Epidemiology

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

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Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M +790 more·2017·The Lancet
DOI 10.1016/s0140-6736(17)32130-xPMC PMC5605707
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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 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. 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 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. 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 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. FUNDING: Bill & Melinda Gates Foundation.

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Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulkader, R. S., 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., Ahmed, M. B., Aichour, M. T. E., Aichour, A. N., Aichour, I., 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., Ärnlöv, J., Arora, M., Artaman, A., Aryal, K. K., Asgedom, S. W., Atey, T. M., Atnafu, N. T., Avila-Burgos, L., Avokpaho, E. F. G. A., Awasthi, A., Awasthi, S., Azarpazhooh, M. R., Azzopardi, P., Babalola, T. K., Bacha, U., Badawi, A., Balakrishnan, K., Bannick, M. S., Barac, A., Barker-Collo, S. L., Bärnighausen, T., Barquera, S., Barrero, L. H., Basu, S., Battista, R., Battle, K. E., Baune, B. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Béjot, Y., Bekele, B. B., Bell, M. L., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Benson, J., Berhane, A., Berhe, D. F., Bernabé, E., Betsu, B. D., Beuran, M., Beyene, A. S., Bhansali, A., Bhatt, S., Bhutta, Z. A., Biadgilign, S., Bicer, B. K., Bienhoff, K., Bikbov, B., Birungi, C., Biryukov, S., Bisanzio, D., Bizuayehu, H. M., Blyth, F. M., Boneya, D. J., Bose, D., Bou-Orm, I. R., Bourne, R. R. A., Brainin, M., Brayne, C., Brazinova, A., Breitborde, N. J. K., Briant, P. S., Britton, G., Brugha, T. S., Buchbinder, R., Bulto, L. N. B., Bumgarner, B. R., Butt, Z. A., Cahuana-Hurtado, L., Cameron, E., Campos-Nonato, I. R., Carabin, H., Cárdenas, R., Carpenter, D. O., Carrero, J. J., Carter, A., Carvalho, F., Casey, D., Castañeda-Orjuela, C. A., Castle, C. D., Catalá-López, F., Chang, J.-C., Charlson, F. J., Chaturvedi, P., Chen, H., Chibalabala, M., Chibueze, C. E., Chisumpa, V. H., Chitheer, A. A., Chowdhury, R., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Colombara, D., Cooper, L. T., Cooper, C., Cortesi, P. A., Cortinovis, M., Criqui, M. H., Cromwell, E. A., Cross, M., Crump, J. A., Dadi, A. F., Dalal, K., Damasceno, A., Dandona, L., Dandona, R., das Neves, J., Davitoiu, D. V., Davletov, K., de Courten, B., De Leo, D., De Steur, H., Defo, B. K., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deribew, A., Des Jarlais, D. C., Dey, S., Dharmaratne, S. D., Dhillon, P. K., Dicker, D., Djalainia, S., Do, H. P., Dokova, K., Doku, D. T., Dorsey, E. R., dos Santos, K. P. B., Driscoll, T. R., Dubey, M., Duncan, B. B., Ebel, B. E., Echko, M., El-Khatib, Z. Z., Enayati, A., Endries, A. Y., Ermakov, S. P., Erskine, H. 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ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2017-09
Volume
390
Issue
10100
Pages
1260-1344
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(17)32130-x
PMC
PMC5605707
OpenAlex
W3178295071
Cited by
2,083
References
63
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2026: 51 · 2025: 127 · 2024: 163 · 2023: 219 · 2022: 234 · 2021: 275 · 2020: 334 · 2019: 336 · 2018: 321 · 2017: 16 · 2016: 3 · 2015: 1 · 2013: 1
FWCI
711.67
Type
journal article
Language
en
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  • UCL Discovery (University College London) (submittedVersion)
  • Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion, cc-by)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • Espace ÉTS (ETS) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • Figshare (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Leicester Research Archive (University of Leicester) (submittedVersion, cc-by)
  • Lund University Publications (Lund University) (submittedVersion)
  • Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, cc-by)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
  • Opin vísindi (Opin vísindi) (submittedVersion, cc-by)
  • PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion, cc-by)
  • Scopus (Elsevier) (submittedVersion, other-oa)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
  • DSPACE System - Metalibrary (University of the Coast) (submittedVersion, cc-by-nc-sa)
  • CEU Repositorio Institucional (Fundación Universitaria San Pablo CEU) (submittedVersion, cc-by-nc-nd)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
  • Explore Bristol Research (submittedVersion, cc-by)
  • Griffith Research Online (submittedVersion, cc-by)
  • Swinburne figshare (Swinburne University of Technology) (submittedVersion, other-oa)
  • CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
  • Scholarship@Western (Western University) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • UNC Libraries
Funders
  • Sixth Framework Programme (RII-CT-2006-062193, CIT5-CT-2005-028857, CIT4-CT-2006-028812)
  • National Institute of Mental Health (R01MH110163)
  • Bundesministerium für Bildung und Forschung
  • European Commission
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
  • United States Agency for International Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Max-Planck-Gesellschaft
  • National Heart, Lung, and Blood Institute (N01-HC-25195)
  • University of Michigan (P01-HD31921)
  • National Institute on Aging (U01_AG09740-13S2, HHSN271201300071C, R21_AG025169, OGHA_04-064, P01_AG005842, IAG_BSR06-11, Y1-AG-4553-01, P01_AG08291, P30_AG12815, U01AG009740)
  • Bill and Melinda Gates Foundation
  • Seventh Framework Programme (227822, 261982, 211909)
  • Fifth Framework Programme (QLK6-CT-2001-00360)
  • National Institutes of Health (P30AG047845)
Topics
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
Keywords
disability-adjusted life years, healthy life expectancy, global burden of disease, years of life lost, years lived with disability, all-cause mortality, cause-specific mortality, socio-demographic index, sex differences in health, Global Burden of Disease Study 2016
MeSH terms
Global Burden of Disease, Noncommunicable Diseases, Adult, Aged, Aged, 80 and over, Cause of Death, Communicable Diseases, Female, Persons with Disabilities, Humans, Life Expectancy, Male, Middle Aged, Residence Characteristics, Global Health, Wounds and Injuries, Age Distribution, Sex Distribution, Quality-Adjusted Life Years

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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