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
Creators: name: Nguyen, Grant
name: Alahdab, Fares
name: Yu, Chuanhua
name: Jassal, Simerjot K.
name: Mori, Rintaro
name: Sylte, Dillon
name: Foreman, Kyle J.
name: Hankey, Graeme J.
name: Goenka, Shifalika
name: Ngunjiri, Josephine Wanjiku
name: Li, Yichong
name: Olsen, Helen E.
name: Poulton, Richie G.
name: Mueller, Ulrich O.
name: Truelsen, Thomas
name: Okoro, Anselm
name: Jayaraman, Sudha P.
name: Sawhney, Monika
name: Nasher, Jamal T.
name: Driscoll, Tim R.
name: Lucas, Timothy C. D.
name: Bulto, Lemma Negesa Bulto
name: Kassebaum, Nicholas J.
name: Murdoch, 
name: Ray, Sarah E.
name: Berhane, Adugnaw
name: Millear, Anoushka
name: Soljak, Michael
name: Ronfani, Luca
name: Karam, Nadim E.
name: Kim, Daniel
name: Takala, Jukka S.
name: Linn, Shai
name: Smith, David L.
name: Bikbov, Boris
name: Pinho, Christine
name: Amare, Azmeraw T.
name: Asgedom, Solomon W.
name: Reitsma, Marissa
name: Mokdad, Ali H.
name: Montico, Marcella
name: Nichols, Emma
name: Harb, Hilda L.
name: Chitheer, Abdulaal A.
name: Schutte, Aletta E.
name: Tanne, David
name: Frostad, Joseph J.
name: Fischer, Florian
name: Majdan, Marek
name: Gebre, Teshome
name: Newton, Charles R.
name: Mathur, Manu Raj
name: Hofman, Howard J.
name: Mendoza, Walter
name: Silveira, Dayane Gabriele Alves
name: Srinivasan, Vinay
name: Negasa, Dumessa Edessa
name: Werdecker, Andrea
name: Ahmed, Muktar Beshir
name: Kokubo, Yoshihiro
name: Berhe, Derbew Fikadu
name: Lotufo, Paulo A.
name: Mengesha, Melkamu Merid
name: Rahimi-Movaghar, Afarin
name: Tobollik, Myriam
name: Leshargie, Cheru Tesema
name: Sartorius, Benn
name: Pacella, Rosana E.
name: Atey, Tesfay Mehari
name: Yoon, Seok-Jun
name: Fazeli, Mir Sohail
name: Béjot, Yannick
name: Moses, Mark
name: Aggarwal, Rakesh
name: Heredia-Pi, Ileana Beatriz
name: Birungi, Charles
name: Nguyen, Quyen Le
name: Rao, Paturi Vishnupriya
name: Silva, Diego Augusto Santos
name: Geleto, Ayele
name: Leigh, James
name: Kisa, Adnan
name: Dharmaratne, Samath D.
name: Ningrum, Dina Nur Anggraini
name: Phillips, Michael Robert
name: Haro, Josep Maria
name: Stein, Dan J.
name: Montañez Hernandez, Julio Cesar
name: Zipkin, Ben
name: Pletcher, Martin A.
name: Rahman, Muhammad Aziz
name: Leung, Janni
name: Thrift, Amanda G.
name: Battista, Robert
name: Liang, Xiaofeng
name: Singh, Jasvinder A.
name: Osgood-Zimmerman, Aaron
name: Sahathevan, Ramesh
name: Amini, Erfan
name: Rojas-Rueda, David
name: Abera, Semaw Ferede
name: Rahimi-Movaghar, Vafa
name: Moradi-Lakeh, Maziar
name: Huynh, Chantal
name: Nachega, Jean B.
name: Martins-Melo, Francisco Rogerlândio
name: Williams, Hywel C.
name: Uthman, Olalekan A.
name: Pandian, Jeyaraj D.
name: Bannick, Marlena S.
name: Artaman, Al
name: Liu, Yang
name: Rothenbacher, Dietrich
name: Arora, Megha
name: Ciobanu, Liliana G.
name: Ortiz, Alberto
name: Kesavachandran, Chandrasekharan Nair
name: Papachristou, Christina
name: El-Khatib, Ziad Ziad
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name: Santos, Itamar S.
name: Flaxman, Abraham D.
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name: Panda, Basant Kumar
name: Kopec, Jacek A.
name: Rankin, Zane
name: Aryal, Krishna Kumar
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name: Petzold, Max
name: Djalalinia, Shirin
name: Murthy, Gudlavalleti Venkata Satyanarayana
name: Brugha, Traolach S.
name: Dandona, Lalit
name: Bryane, 
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name: Cooper, Leslie Trumbull
name: Hareri, Habtamu Abera
name: Zheng, Yingfeng
name: Dokova, Klara
name: Murthy, Srinivas
name: Johnson, Catherine O.
name: Reinig, Nikolas
name: Lee, Paul H.
name: Ginawi, Ibrahim Abdelmageem Mohamed
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name: Tymeson, Hayley
name: Azzopardi, Peter
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name: Szoeke, Cassandra E. I.
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name: Quintanilla, Beatriz Paulina Ayala
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name: Perico, Norberto
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name: Taylor, Hugh R.
name: Prabhakaran, Dorairaj
name: Meles, Kidanu Gebremariam
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name: Esteghamati, Alireza
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name: Saxena, Sonia
name: Sreeramareddy, Chandrashekhar T.
name: Dos Santos, Kadine Priscila Bender
name: Schmidt, Maria Inês
name: Malta, Deborah Carvalho
name: Remuzzi, Giuseppe
name: Shirkoohi, Reza
name: Eshetie, Setegn
name: Tran, Bach Xuan
name: Singh, Narinder Pal
name: Parry, Charles D.
name: Logroscino, Giancarlo
name: Tabarés-Seisdedos, Rafael
name: Yakob, Bereket
name: Giussani, Giorgia
name: Karimi, Seyed M.
name: Sur, Patrick J.
name: Obermeyer, Carla Makhlouf
name: Rezaei, Satar
name: Hedayati, Mohammad T.
name: James, Peter
name: Chang, Jung-Chen
name: Liu, Patrick Y.
name: Ghajar, Alireza
name: Jonas, Jost B.
name: Carter, Austin
name: Badawi, Alaa
name: Sorensen, Reed J. D.
name: Kabir, Zubair
name: Ferrari, Alize J.
name: Steel, Nicholas
name: Shibuya, Kenji
name: Wijeratne, Tissa
name: Xu, Gelin
name: Kassa, Getachew Mullu
name: Traebert, Jeferson
name: Barac, Aleksandra
name: Kissimova-Skarbek, Katarzyna A.
name: Ota, Erika
name: Stathopoulou, Vasiliki
name: Jakovljevic, Mihajlo B.
name: Khoja, Abdullah T.
name: Zaki, Maysaa El Sayed
name: Singh, Virendra
name: Barker-Collo, Suzanne L.
name: Gutiérrez, Reyna A.
name: Nong, Vuong Minh
name: Shamsipour, Mansour
name: März, Winfried
name: Rai, Rajesh Kumar
name: Horino, Masako
name: Paudel, Deepak
name: Veerman, Lennert J.
name: Jacobsen, Kathryn H.
name: Dandona, Rakhi
name: Sharma, Rajesh
name: Santomauro, Damian
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: 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.