The Global Burden of Disease (GBD) concept, first published in 1996, constituted the most comprehensive and consistent set of estimates of mortality and morbidity yet produced [33] . A GBD study aims to quantify the burden of premature mortality and disability for major diseases or disease groups, and uses a summary measure of population health, the DALY (Disability-Adjusted Life Years), to combine estimates of the years of life lost and years lived with disabilities. A DALY is defined as an indicator to quantify the burden of the disease and the functional limitation and premature mortality [34] . It can be used across cultures to measure health gaps as opposed to health expectancies, and the difference between a current and an ideal situation where everyone lives up to the age of the standard life expectancy, and in perfect health. In developing the DALY indicator, Murray and Lopez (1996) , [33] 