Print

ABSTRACT

The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardized 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 socio-demographic 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 capita 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 socio-demographic status, which we constructed from income per capita, average years of schooling after age 15, 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 socio-demographic 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-standardized 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-standardized 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-standardized 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 ischemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Socio-demographic status explained more than 50% of the variance between countries and over time for diarrhea, 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, socio-demographic 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 socio-demographic 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 aging 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 socio-demographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with socio-demographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions 

Citation: 

Murray CJL, Barber RM, Foreman KJ, Abbasoglu Ozgoren A*, Abd-Allah F*, Abera SF*, Aboyans V*, Abraham JP*, Abubakar I*, Abu-Raddad LJ*, Abu-Rmeileh NM*, Achoki T*, Ackerman IN*, Ademi Z*, Adou AK*, Adsuar JC*, Afshin A*, Agardh EE*, Alam S*, Alasfoor D*, Albittar MI*, Alegretti MA*, Alemu ZA*, Alfonso-Cristancho R*, Alhabib S*, Ali R*, Alla F*, Allebeck P*, AlMazroa MA*, Alsharif U*, Alvarez E*, Alvis-Guzman N*, Amare AT*, Ameh EA*, Amini H*, Ammar W*, Anderson BO*, Anderson H*, Antonio CAT*, Anwari P*, Arnlöv J*, Arsic Arsenijevic VS*, Artaman A*, Asghar RJ*, Assadi R*, Atkins LS*, Avila MA*, Awuah B*, Bachman VF*, Badawi A*, Bahit MC*, Balakrishnan K*, Banerjee A*, Barker-Collo SL*, Barquera S*, Barregard L*, Barrero LH*, Basu A*, Basu S*, Basulaiman MO*, Beardsley J*, Bedi N*, Beghi E*, Bekele T*, Bell ML*, Benjet C*, Bennett DA*, Bensenor IM*, Benzian H*, Bernabé E*, Bertozzi-Villa A*, Beyene TJ*, Bhala N*, Bhalla A*, Bhutta ZA*, Bienhoff K*, Bikbov B*, Biryukov S*, Blore JD*, Blosser CD*, Blyth FM*, Bohensky MA*, Bolliger IW*, Bora Başara B*, Bornstein NM*, Bose D*, Boufous S*, Bourne RR*, Boyers LN*, Brainin M*, Brayne CE*, Brazinova A*, Breitborde NJ*, Brenner H*, Briggs AD*, Brooks PM*, Brown JC*, Brugha TS*, Buchbinder R*, Buckle GC*, Budke CM*, Bulchis A*, Bulloch AG*, Campos-Nonato IR*, Carabin H*, Carapetis JR*, Cárdenas R*, Carpenter DO*, Caso V*, Castañeda-Orjuela CA*, Castro RE*, Catalá-López F*, Cavalleri F*, Çavlin A*, Chadha VK*, Chang J*, Charlson FJ*, Chen H*, Chiang PP*, Chimed-Ochir O*, Chowdhury R*, Christensen H*, Christophi CA*, Cirillo M*, Coates MM*, Coffeng LE*, Coggeshall MS*, Colistro V*, Colquhoun SM*, Cooke GS*, Cooper C*, Cooper LT*, Coppola LM*, Cortinovis M*, Criqui MH*, Crump JA*, Cuevas-Nasu L*, Danawi H*, Dandona L*, Dandona R*, Dansereau E*, Dargan PI*, Davey G*, Davis A*, Davitoiu DV*, Dayama A*, De Leo D*, Degenhardt L*, del Pozo-Cruz B*, Dellavalle RP*, Deribe K*, Derrett S*, Des Jarlais DC*, Dessalegn M*, Dharmaratne SD*, Dherani MK*, Diaz-Torné C*, Dicker D*, Ding EL*, Dokova K*, Dorsey ER*, Driscoll TR*, Duber HC*, Ebel BE*, Edmond KM*, Elshrek YM*, Endres M*, Ermakov SP*, Erskine HE*, Eshrati B*, Esteghamati A*, Estep K*, Faraon EA*, Farzadfar F*, Fay DF*, Feigin VL*, Felson DT*, Fereshtehnejad S*, Fernandes JG*, Ferrari AJ*, Fitzmaurice C*, Flaxman AD*, Fleming TD*, Foigt N*, Fowkes FR*, Fra.Paleo U*, Franklin RC*, Fürst T*, Gabbe B*, Gaffikin L*, Gankpé FG*, Geleijnse JM*, Gessner BD*, Gething P*, Gibney KB*, Giroud M*, Giussani G*, Gomez Dantes H*, Gona P*, González-Medina D*, Gosselin RA*, Gotay CC*, Goto A*, Gouda HN*, Graetz N*, Gugnani HC*, Gupta R*, Gupta R*, Gutiérrez RA*, Haagsma J*, Hafezi-Nejad N*, Hagan H*, Halasa YA*, Hamadeh RR*, Hamavid H*, Hammami M*, Hancock J*, Hankey GJ*, Hansen GM*, Hao Y*, Harb HL*, Haro J*, Havmoeller R*, Hay RJ*, Hay SI*, Heredia-Pi IB*, Heuton KR*, Heydarpour P*, Higashi H*, Hijar M*, Hoek HW*, Hoffman HJ*, Hosgood H*, Hossain M*, Hotez PJ*, Hoy DG*, Hsairi M*, Hu G*, Huang JJ*, Huang C*, Husseini A*, Huynh C*, Iannarone ML*, Iburg KM*, Innos K*, Inoue M*, Islami F*, Jacobsen KH*, Jarvis DL*, Jassal SK*, Jee S*, Jeemon P*, Jensen PN*, Jha V*, Jiang G*, Jiang Y*, Jonas JB*, Juel K*, Kan H*, Karch A*, Karema CK*, Karimkhani C*, Karthikeyan G*, Kassebaum NJ*, Kaul A*, Kawakami N*, Kazanjan K*, Kemp AH*, Kengne AP*, Keren A*, Khader YS*, Khalifa SA*, Khan EA*, Khan G*, Khang Y*, Kieling C*, Kim D*, Kim S*, Kim Y*, Kinfu Y*, Kinge JM*, Kivipelto M*, Knibbs LD*, Knudsen A*, Kokubo Y*, Kosen S*, Krishnaswami S*, Kuate Defo B*, Kucuk Bicer B*, Kuipers EJ*, Kulkarni C*, Kulkarni VS*, Kumar G*, Kyu HH*, Lai T*, Lalloo R*, Lallukka T*, Lam H*, Lan Q*, Lansingh VC*, Larsson A*, Lawrynowicz AEB*, Leasher JL*, Leigh J*, Leung R*, Levitz CE*, Li B*, Li Y*, Li Y*, Lim SS*, Lind M*, Lipshultz SE*, Liu S*, Liu Y*, Lloyd BK*, Lofgren KT*, Logroscino G*, Looker KJ*, Lortet-Tieulent J*, Lotufo PA*, Lozano R*, Lucas RM*, Lunevicius R*, Lyons RA*, Ma S*, MacIntyre MF*, Mackay MT*, Majdan M*, Malekzadeh R*, Marcenes W*, Margolis DJ*, Margono C*, Marzan MB*, Masci JR*, Mashal MT*, Matzopoulos R*, Mayosi BM*, Mazorodze TT*, McGill NW*, McGrath JJ*, McLain A*, Meaney PA*, Medina C*, Mehndiratta M*, Mekonnen W*, Melaku YA*, Meltzer M*, Memish ZA*, Mensah GA*, Meretoja A*, Mhimbira FA*, Micha R*, Miller TR*, Mills EJ*, Mitchell PB*, Mock CN*, Mohamed Ibrahim N*, Mohammad KA*, Mokdad AH*, Mola GL*, Monasta L*, Montañez Hernandez JC*, Montico M*, Montine TJ*, Mooney MD*, Moore AR*, Moradi-Lakeh M*, Moran AE*, Mori R*, Moschandreas J*, Moturi WN*, Moyer ML*, Mozaffarian D*, Msemburi WT*, Mueller UO*, Mukaigawara M*, Murdoch ME*, Murray J*, Murthy KS*, Naghavi M*, Naheed A*, Naidoo KS*, Naldi L*, Nand D*, Nangia V*, Narayan KMV*, Nejjari C*, Neupane SP*, Newton CR*, Ng M*, Ngalesoni FN*, Nguyen G*, Nisar MI*, Nolte S*, Norheim OF*, Norman RE*, Norrving B*, Nyakarahuka L*, Oh I*, Ohkubo T*, Ohno SL*, Olusanya BO*, Opio J*, Ortblad K*, Ortiz A*, Pain AW*, Pandian JD*, Papachristou C*, Park E*, Park J*, Patten SB*, Patton GC*, Paul VK*, Pavlin BI*, Pearce N*, Pereira DM*, Perez-Padilla R*, Perez-Ruiz F*, Perico N*, Pervaiz A*, Pesudovs K*, Peterson CB*, Petzold M*, Phillips BK*, Phillips DE*, Phillips MR*, Piel FB*, Plass D*, Poenaru D*, Polinder S*, Pope D*, Popova S*, Poulton RG*, Pourmalek F*, Prabhakaran D*, Prasad NM*, Pullan RL*, Qato DM*, Quistberg D*, Rafay A*, Rahimi K*, Rahman SU*, Raju M*, Rana SM*, Razavi H*, Reddy KS*, Refaat A*, Remuzzi G*, Resnikoff S*, Ribeiro AL*, Richardson L*, Richardus J*, Roberts DA*, Rojas-Rueda D*, Ronfani L*, Roth GA*, Rothenbacher D*, Rothstein DH*, Rowley JT*, Roy N*, Ruhago GM*, Saeedi MY*, Saha S*, Sahraian M*, Sampson UK*, Sanabria JR*, Sandar L*, Santos IS*, Satpathy M*, Sawhney M*, Scarborough P*, Schneider IJ*, Schöttker B*, Schumacher AE*, Schwebel DC*, Scott JG*, Seedat S*, Sepanlou SG*, Serina PT*, Servan-Mori EE*, Shackelford KA*, Shaheen A*, Shahraz S*, Shamah Levy T*, Shangguan S*, She J*, Sheikhbahaei S*, Shi P*, Shibuya K*, Shinohara Y*, Shiri R*, Shishani K*, Shiue I*, Shrime MG*, Sigfusdottir ID*, Silberberg DH*, Simard EP*, Sindi S*, Singh A*, Singh JA*, Singh L*, Skirbekk V*, Slepak EL*, Sliwa K*, Soneji S*, Søreide K*, Soshnikov S*, Sposato LA*, Sreeramareddy CT*, Stanaway JD*, Stathopoulou V*, Stein MB*, Stein DJ*, Steiner C*, Steiner TJ*, Stevens A*, Stewart A*, Stovner LJ*, Stroumpoulis K*, Sunguya BF*, Swaroop M*, Sykes BL*, Tabb KM*, Takahashi K*, Tandon N*, Tanne D*, Tanner M*, Tavakkoli M*, Taylor HR*, Te Ao BJ*, Tediosi F*, Temesgen AM*, Templin T*, Ten Have M*, Tenkorang EY*, Terkawi AS*, Thomson B*, Thorne-Lyman AL*, Thrift AG*, Thurston GD*, Tillmann T*, Tonelli M*, Topouzis F*, Toyoshima H*, Traebert J*, Tran BX*, Trillini M*, Truelsen T*, Tsilimbaris M*, Tuzcu EM*, Uchendu US*, Ukwaja KN*, Undurraga EA*, Uzun SB*, van Brakel WH*, van de Vijver S*, van Gool CH*, van Os J*, Vasankari TJ*, Venketasubramanian N*, Violante FS*, Vlassov VV*, Vollset S*, Wagner GR*, Wagner J*, Waller SG*, Wang H*, Wang J*, Warouw TS*, Weichenthal S*, Weiderpass E*, Weintraub RG*, Wenzhi W*, Werdecker A*, Westerman R*, Whiteford HA*, Wilkinson JD*, Williams TN*, Wolfe CD*, Wolock TM*, Woolf AD*, Wulf S*, Wurtz B*, Xu G*, Yan LL*, Yano Y*, Yentür GK*, Yip P*, Yonemoto N*, Yoon S*, Younis MZ*, Yu C*, Zaki ME*, Zhao Y*, Zheng Y*, Zonies D*, Zou X*, Salomon JA†, Lopez AD†, Vos T† 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. The Lancet. 2015 Aug 27. doi: 10.1016/S0140-6736(15)61340-X.

*Authors listed alphabetically
†Joint senior authors