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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

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
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

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.

0140-6736
1260-1344
Hay, Simon I.
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Abajobir, Amanuel Alemu
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Cooper, Cyrus
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Liu, Yang
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Rahman, Mohammad Hifz Ur
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Thompson, Robert
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Wang, Yuan Pang
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GBD 2016 DALYs and HALE Collaborators
Hay, Simon I.
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Abajobir, Amanuel Alemu
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Abate, Kalkidan Hassen
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Abbafati, Cristiana
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Abbas, Kaja M.
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Abd-Allah, Foad
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Abdulle, Abdishakur M.
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Abebo, Teshome Abuka
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Abera, Semaw Ferede
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Aboyans, Victor
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Abu-Raddad, Laith J.
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Ackerman, Ilana N.
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Adedeji, Isaac A.
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Adetokunboh, Olatunji
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Afshin, Ashkan
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Aggarwal, Rakesh
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Agrawal, Sutapa
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Agrawal, Anurag
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Kiadaliri, Aliasghar Ahmad
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Ahmed, Muktar Beshir
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Bennett, James R.
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Cooper, Cyrus
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GBD 2016 DALYs and HALE Collaborators (2017) 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. The Lancet, 390 (10100), 1260-1344. (doi:10.1016/S0140-6736(17)32130-X).

Record type: Article

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.

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More information

Published date: 16 September 2017
Additional Information: Funding Information: Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the National Institute on Aging of the National Institutes of Health (award P30AG047845), and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Bill & Melinda Gates Foundation or the National Institutes of Health. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with licence number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law - 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. We thank the Russia Longitudinal Monitoring Survey, RLMS-HSE, conducted by the National Research University Higher School of Economics and ZAO “Demoscope” together with the Carolina Population Center, University of North Carolina at Chapel Hill, and the Institute of Sociology RAS for making these data available. This study has been realised using the data collected by the Swiss Household Panel (SHP), which is based at the Swiss Centre of Expertise in the Social Sciences FORS. The project is financed by the Swiss National Science Foundation from the Framingham Heart Study of the National Heart Lung and Blood Institute of the National Institutes of Health and Boston University School of Medicine. This work was supported by the National Heart, Lung and Blood Institute's Framingham Heart Study (contract number N01-HC-25195). The Health and Retirement Study (HRS) is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This research used data from the National Health Survey 2003. We are grateful to the Ministry of Health, Survey copyright owner, allowing him to have the database. All results of the study are those of the authors and in no way committed to the Ministry. This research used data from the National Health Survey 2009–10. All results of the study are those of the authors and in no way committed to the Ministry. This research uses data from Add Health, a programme project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. People interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 West Franklin Street, Chapel Hill, NC 27516-2524, USA ( addhealth@unc.edu ). No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the US Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US Government. HBSC is an international study carried out in collaboration with WHO/EURO. The International Coordinator of the 1997–98, 2001–02, 2005–06 and 2009–10 surveys was Candace Currie and the Data Bank Manager for the 1997–98 survey was Bente Wold, whereas for the following survey, Oddrun Samdal was the Databank Manager. A list of principal investigators in each country can be found at http://www.hbsc.org . Data used in the preparation of this article were obtained from the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) Database. In 2011, Prize4Life, in collaboration with the Northeast ALS Consortium, and with funding from the ALS Therapy Alliance, formed the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) Consortium. The data available in the PRO-ACT Database has been volunteered by PRO-ACT Consortium members. This paper uses data from SHARE Waves 1, 2, 3 (SHARELIFE), 4, 5, and 6 (DOIs: 10.6103/SHARE.w1.600, 10.6103/SHARE.w2.600, 10.6103/SHARE.w3.600, 10.6103/SHARE.w4.600, 10.6103/SHARE.w5.600, 10.6103/SHARE.w6.600); see Börsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), and FP7 (SHARE-PREP: 211909, SHARE-LEAP: 227822, SHARE M4: 261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and various national funding sources is gratefully acknowledged (see www.share-project.org ). This manuscript is based on data collected and shared by the International Vaccine Institute (IVI). This manuscript was not prepared in collaboration with investigators of IVI and does not necessarily reflect the opinions or views of IVI. Collection of these data was made possible by the US Agency for International Development (USAID) under the terms of cooperative agreement GPO-A-00-08-000_D3-00. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID or the US Government. Data for this research was provided by MEASURE Evaluation, funded by the US Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. Publisher Copyright: © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Identifiers

Local EPrints ID: 471208
URI: http://eprints.soton.ac.uk/id/eprint/471208
ISSN: 0140-6736
PURE UUID: c99549ed-4bfb-4fde-8584-b387fb6e77dc
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 31 Oct 2022 18:02
Last modified: 18 Mar 2024 02:47

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Contributors

Author: Simon I. Hay
Author: Amanuel Alemu Abajobir
Author: Kalkidan Hassen Abate
Author: Cristiana Abbafati
Author: Kaja M. Abbas
Author: Foad Abd-Allah
Author: Abdishakur M. Abdulle
Author: Teshome Abuka Abebo
Author: Semaw Ferede Abera
Author: Victor Aboyans
Author: Laith J. Abu-Raddad
Author: Ilana N. Ackerman
Author: Isaac A. Adedeji
Author: Olatunji Adetokunboh
Author: Ashkan Afshin
Author: Rakesh Aggarwal
Author: Sutapa Agrawal
Author: Anurag Agrawal
Author: Aliasghar Ahmad Kiadaliri
Author: Muktar Beshir Ahmed
Author: Amani Nidhal Aichour
Author: Ibtihel Aichour
Author: Miloud Taki Eddine Aichour
Author: Sneha Aiyar
Author: Tomi F. Akinyemiju
Author: Nadia Akseer
Author: Faris Hasan Al Lami
Author: Fares Alahdab
Author: Ziyad Al-Aly
Author: Khurshid Alam
Author: Noore Alam
Author: Tahiya Alam
Author: Deena Alasfoor
Author: Kefyalew Addis Alene
Author: Raghib Ali
Author: Reza Alizadeh-Navaei
Author: James R. Bennett
Author: Cyrus Cooper ORCID iD
Author: João C. Fernandes
Author: Peter W. Gething
Author: Sarah Charlotte Johnson
Author: Yongmei Li
Author: Stephen S. Lim
Author: Yang Liu
Author: Mohammad Hifz Ur Rahman
Author: Stephen R. Robinson
Author: Joshua A. Salomon
Author: David L. Smith
Author: Robert Thompson
Author: Yuan Pang Wang
Corporate Author: GBD 2016 DALYs and HALE Collaborators

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