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ABSTRACT

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

METHODS

Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35,620 distinct sources of data were used and documented to calculate estimates for 301 diseases and injuries and 2,337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.

FINDINGS

Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrheal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2.4 billion and 1.6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537.6 million in 1990 to 764.8 million in 2013 due to population growth and ageing, whereas the age-standardized rate decreased little from 114.87 per 1,000 people to 110.31 per 1,000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21.1% in 1990 to 31.2% in 2013.

INTERPRETATION

Aging of the world’s population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The nonfatal dimensions of disease and injury will require more and more attention from health systems. The transition to nonfatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

Citation: 

Global Burden of Disease Study 2013 Collaborators: Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis A, Degenhardt L, Dicker D, Duan L, Erskine H, Feigin VL, Ferrari AJ, Fitzmaurice C, Fleming T, Graetz N, Guinovart C, Haagsma J, Hansen GM, Hanson SW, Heuton KR, Higashi H, Kassebaum N, Kyu H, Laurie E, Liang X, Lofgren K, Lozano R, MacIntyre MF, Moradi-Lakeh M, Naghavi M, Nguyen G, Odell S, Ortblad K, Roberts DA, Roth GA, Sandar L, Serina PT, Stanaway JD, Steiner C, Thomas B, Vollset SE, Whiteford H, Wolock TM, Ye P, Zhou M, Avila MA*, Aasvang GM*, Abbafati C*, Abbasoglu Ozgoren A*, Abd-Allah F*, Abdel Aziz MI*, Abera SF*, Aboyans V*, Abraham JP*, Abraham B*, Abubakar I*, Abu-Raddad LJ*, Abu-Rmeileh NME*, Aburto TC*, Achoki T*, Ackerman IN*, Adelekan A*, Ademi Z*, Adou AK*, Adsuar JC*, Arnlov J*, Agardh EE*, Al Khabouri MJ*, Alam SS*, Alasfoor D*, Albittar MI*, Alegretti MA*, Aleman AV*, Alemu ZA*, Alfonso-Cristancho R*, Alhabib S*, Ali R*, Alla F*, Allebeck P*, Allen PJ*, AlMazroa MA*, Alsharif U*, Alvarez E*, Alvis-Guzman N*, Ameli O*, Amini H*, Ammar W*, Anderson BO*, Anderson HR*, Antonio CAT*, Anwari P*, Apfel H*, Arsenijevic VSA*, Artaman A*, Asghar RJ*, Assadi R*, Atkins LS*, Atkinson C*, Badawi A*, Bahit MC*, Bakfalouni T*, Balakrishnan K*, Balalla S*, Banerjee A*, Barker-Collo SL, Barquera S*, Barregard L*, Barrero LH*, Basu S*, Basu A*, Baxter A*, Beardsley J*, Bedi N*, Beghi E*, Bekele T*, Bell ML*, Benjet C*, Bennett DA*, Bensenor IM*, Benzian H*, Bernabe E*, Beyene TJ*, Bhala N*, Bhalla A*, Bhutta Z*, Bienhoff K*, Bikbov B*, Bin Abdulhak A*, Blore JD*, Blyth FM*, Bohensky MA*, Basara BB*, Borges G*, Bornstein NM*, Bose D*, Boufous S*, Bourne RR*, Boyers LN*, Brainin M*, Brauer M*, Brayne CEG*, Brazinova A*, Breitborde NJK*, Brenner H*, Briggs ADM*, Brooks PM*, Brown J*, Brugha TS*, Buchbinder R*, Buckle GC*, Bukhman G*, Bulloch AG*, Burch M*, Burnett R*, Cardenas R*, Cabral NL*, Campos Nonato IR*, Campuzano JC*, Carapetis JR*, Carpenter DO*, Caso V*, Castaneda-Orjuela CA*, Catala-Lopez F*, Chadha VK*, Chang JC*, Chen H*, Chen W*, Chiang PP*, Chimed-Ochir O*, Chowdhury R*, Christensen H*, Christophi CA*, Chugh SS*, Cirillo M*, Coggeshall M*, Cohen A*, Colistro V*, Colquhoun SM*, Contreras AG*, Cooper LT*, Cooper C*, Cooperrider K*, Coresh J*, Cortinovis M*, Criqui MH*, Crump JA*, Cuevas-Nasu L*, Dandona R*, Dandona L*, Dansereau E*, Dantes HG*, Dargan PI*, Davey G*, Davitoiu DV*, Dayama A*, De la Cruz-Gongora V*, de la Vega SF*, De Leo D*, del Pozo-Cruz B, Dellavalle RP*, Deribe K*, Derrett S*, Des Jarlais DC*, Dessalegn M*, deVeber GA*, Dharmaratne SD*, Diaz-Torne C*, Ding EL*, Dokova K*, ER*, Driscoll TR*, Duber H*, Durrani AM*, Edmond KM*, Ellenbogen RG*, Endres M*, Ermakov SP*, Eshrati B*, Esteghamati A*, Estep K*, Fahimi S*, Farzadfar F*, Fay DFJ*, Felson DT*, Fereshtehnejad SM*, Fernandes JG*, Ferri CP*, Flaxman A*, Foigt N*, Foreman KJ*, Fowkes FGR*, Franklin RC*, Furst T*, Futran ND*, Gabbe BJ*, Gankpe FG*, Garcia-Guerra FA*, Geleijnse JM*, Gessner BD*, Gibney KB*, Gillum RF*, Ginawi IA*, Giroud M*, Giussani G*, Goenka S*, Goginashvili K*, Gona P*, Gonzalez de Cosio T*, Gosselin RA*, Gotay CC*, Goto A*, Gouda HN*, Guerrant RI*, Gugnani HC*, Gunnell D*, Gupta R*, Gupta R*, Gutierrez RA*, Hafezi-Nejad N*, Hagan H*, Halasa Y*, Hamadeh RR*, Hamavid H*, Hammami M*, Hankey GJ*, Hao Y*, Harb HL*, Haro JM*, Havmoeller R*, Hay RJ*, Hay S*, Hedayati MT*, Heredia Pi IB*, Heydarpour P*, Hijar M*, Hoek HW*, Hoffman HJ*, Hornberger JC*, Hosgood HD*, Hossain M*, Hotez PJ*, Hoy*, Hsairi M*, Hu H*, Hu G*, Huang JJ*, Huang C*, Huiart L*, Husseini A*, Iannarone M*, Iburg KM*, Innos K*, Inoue M*, Jacobsen KH*, Jassal SK*, Jeemon P*, Jensen PN*, Jha V*, Jiang G*, Jiang Y*, Jonas JB*, Joseph J*, Juel K*, Kan H*, Karch A*, Karimkhani C*, Karthikeyan G*, Katz R*, Kaul A*, Kawakami N*, Kazi DS*, Kemp AH*, Kengne AP*, Khader YS*, Khalifa SEAH*, Khan EA*, Khan G*, Khang YH*, Khonelidze I*, Kieling C*, Kim D*, Kim S*, Kimokoti RW*, Kinfu Y*, Kinge JM*, Kissela BM*, Kivipelto M*, Knibbs L*, Knudsen AK*, Kokubo Y*, Kosen S*, Kramer A*, Kravchenko M*, Krishnamurthi RV*, Krishnaswami S*, Kuate Defo B*, Kucuk Bicer B*, Kuipers EJ*, Kulkarni VS*, Kumar K*, Kumar GA*, Kwan GF*, Lai T*, Lalloo R*, Lam H*, Lan Q*, Lansingh VC*, Larson H*, Larsson A*, Lawrynowicz AEB*, Leasher JL*, Lee JT*, Leigh J*, Leung R*, Levi M*, Li B*, Li Y*, Li Y*, Liang J*, Lim S*, Lin HH*, Lind M*, Lindsay MP*, Lipshultz SE*, Liu S*, Lloyd BK*, Ohno SL*, Logroscino G*, Looker KJ*, Lopez AD*, Lopez-Olmedo N*, Lortet-Tieulent J*, Lotufo PA*, Low N*, Lucas RM*, Lunevicius R*, Lyons RA*, Ma J*, Ma S*, Mackay MT*, Majdan M*, Malekzadeh R*, Mapoma CC*, Marcenes W*, March LM*, Margono C*, Marks GB*, Marzan MB*, Masci JR*, Mason-Jones AJ*, Matzopoulos RG*, Mayosi BM*, Mazorodze TT*, McGill NW*, McGrath JJ*, McKee M*, McLain A*, McMahon BJ*, Meaney PA*, Mehndiratta MM*, Mejia-Rodriguez F*, Mekonnen W*, Melaku YA*, Meltzer M*, Memish ZA*, Mensah G*, Meretoja A*, Mhimbira FA*, Micha R*, Miller TR*, Mills EJ*, Mitchell PB*, Mock CN*, Moffitt TE*, Mohamed Ibrahim N*, Mohammad KA*, Mokdad AH*, Mola GL*, Monasta L*, Montico M*, Montine TJ*, Moore AR*, Moran AE*, Morawska L*, Mori R*, Moschandreas J*, Moturi WN*, Moyer M*, Mozaffarian D*, Mueller UO*, Mukaigawara M*, Murdoch ME*, Murray J*, Murthy KS*, Naghavi P*, Nahas Z*, Naheed A*, Naidoo KS*, Naldi L*, Nand D*, Nangia V*, Narayan KMV*, Nash D*, Nejjari C*, Neupane SP*, Newman LM*, Newton CR*, Ng M*, Ngalesoni FN*, Nhung NT*, Nisar MI*, Nolte S*, Norheim OF*, Norman RE*, Norrving B*, Nyakarahuka L*, Oh IH*, Ohkubo T*, Omer SB*, Opio JN*, Ortiz A*, Pandian JD*, Panelo CIA*, Papachristou C*, Park EK*, Parry CD*, Paternina Caicedo AJ*, Patten SB*, Paul VK*, Pavlin BI*, Pearce N*, Pedraza LS*, Pellegrini CA*, Pereira DM*, Perez-Ruiz FP*, Perico N*, Pervaiz A*, Pesudovs K*, Peterson CB*, Petzold M*, Phillips MR*, Phillips D*, Phillips B*, Piel FB*, Plass D*, Poenaru D*, Polanczyk GV*, Polinder S*, Pope CA*, Popova S*,  Poulton RG*, Pourmalek F*, Prabhakaran D*, Prasad NM*, Qato D*, Quistberg DA*, Rafay A*, Rahimi K*, Rahimi-Movaghar V*, Rahman S*, Raju M*, Rakovac I*, Rana SM*, Razavi H*, Refaat A*, Rehm J*, Remuzzi G*, Resnikoff S*, Ribeiro AL*, Riccio PM*, Richardson L*, Richardus JH*, Riederer AM*, Robinson M*, Roca A*, Rodriguez A*, Rojas-Rueda D*, Ronfani L*, Rothenbacher D*, Roy N*, Ruhago GM*, Sabin N*, Sacco RL*, Ksoreide K*, Saha S*, Sahathevan R*, Sahraian MA*, Sampson U*, Sanabria JR*, Sanchez-Riera L*, Santos IS*, Satpathy M*, Saunders JE*, Sawhney M*, Saylan MI*, Scarborough P*, Schoettker B*, Schneider IJC*, Schwebel DC*, Scott JG*, Seedat S*, Sepanlou SG*, Serdar B*, Servan-Mori EE*, Shackelford K*, Shaheen A*, Shahraz S*, Shamah Levy T*, Shangguan S*, She J*, Sheikhbahaei S*, Shepard DS*, Shi P*, Shibuya K*, Shinohara Y*, Shiri R*, Shishani K*, Shiue I*, Shrime MG*, Sigfusdottir ID*, Silberberg DH*, Edgar P Simard EP*, Sindi S*, Singh JA*, Singh L*, Skirbekk V*, Sliwa K*, Soljak M*, Soneji S*, Soshnikov SS*, Speyer P*, Sposato LA*, Sreeramareddy CT*, Stoeckl H*, Stathopoulou VK*, Steckling N*, Stein MB*, Stein DJ*, Steiner TJ*, Stewart A*, Stork E*, Stovner LJ*, Stroumpoulis K*, Sturua L*, Sunguya BF*, Swaroop M*, Sykes BL*, Tabb KM*, Takahashi K*, Tan F*, Tandon N*, Tanne D*, Tanner M*, Tavakkoli M*, Taylor HR*, Te Ao BJ*, Temesgen AM*, Ten Have M*, Tenkorang EY*, Terkawi AS*, Theadom AM*, Thomas E*, Thorne-Lyman AL*, Thrift AG*, Tleyjeh IM*, Tonelli M*, Topouzis F*, Towbin JA*, Toyoshima H*, Traebert J*, Tran BX*, Trasande L*, Trillini M*, Truelsen T*, Trujillo U*, Tsilimbaris M*, Tuzcu EM*, Ukwaja KN*, Undurraga EA*, Uzun SB*, van Brakel WH*, van de Vijver S*, Van Dingenen R*, van Gool CH*, Varakin YY*, Vasankari TJ*, Vavilala MS*,  Veerman LJ*, Velasquez-Melendez G*, Venketasubramanian N*, Vijayakumar L*, Villalpando S*, Violante FS*, Vlassov VV*, Waller S*, Wallin MT*, Wan X*, Wang L*, Wang J*, Wang Y*, Warouw TS*, Weichenthal S*, Weiderpass E*, Weintraub RG*, Werdecker A*, Wessells KRR*, Westerman R*, Wilkinson JD*, Williams HC*, Williams TN*, Woldeyohannes SM*, Wolfe CDA*, Wong JQ*, Wong H*, Woolf AD*, Wright JL*, Wurtz B*, Xu G*, Yang G*, Yano Y*, Yenesew MA*, Yentur GK*, Yip P*, Yonemoto N*, Yoon SJ*, Younis M*, Yu C*, Kim KY*, Zaki MES*, Zhang Y*, Zhao Z*, Zhao Y*, Zhu J*, Zonies D, Zunt JR*, Salomon JA†, Murray CJL.† Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015 June 8. doi: 10.1016/S0140-6736(15)60692-4.

*Authors listed alphabetically
†Joint senior authors