Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
Authors: Nicholas J Kassebaum, Megha Arora, Ryan M Barber, Zulfiqar A Bhutta, Jonathan Brown, Austin Carter, Daniel C Casey, Fiona J Charlson, Matthew M Coates, Megan Coggeshall, Leslie Cornaby, Lalit Dandona, Daniel J Dicker, Holly E Erskine, Alize J Ferrari, Christina Fitzmaurice, Kyle Foreman, Mohammad H Forouzanfar, Nancy Fullman, Peter W Gething, Ellen M Goldberg, Nicholas Graetz, Juanita A Haagsma, Simon I Hay, Catherine O Johnson, Laura Kemmer, Ibrahim A Khalil, Yohannes Kinfu, Michael J Kutz, Hmwe H Kyu, Janni Leung, Xiaofeng Liang, Stephen S Lim, Rafael Lozano, George A Mensah, Joe Mikesell, Ali H Mokdad, Meghan D Mooney, Mohsen Naghavi, Grant Nguyen, Elaine Nsoesie, David M Pigott, Christine Pinho, Zane Rankin, Nikolas Reinig, Joshua A Salomon, Logan Sandar, Alison Smith, Reed J D Sorensen, Jeffrey Stanaway, Caitlyn Steiner, Stephanie Teeple, Chris Troeger, Thomas Truelsen, Amelia VanderZanden, Joseph A Wagner, Valentine Wanga, Harvey A Whiteford, Maigeng Zhou, Leo Zoeckler, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Biju Abraham, Ibrahim Abubakar, Laith J Abu-Raddad, Niveen M E Abu-Rmeileh, Tom Achoki, Ilana N Ackerman, Akindele Olupelumi Adebiyi, Isaac Akinkunmi Adedeji, José C Adsuar, Kossivi Agbelenko Afanvi, Ashkan Afshin, Emilie Elisabet Agardh, Arnav Agarwal, Sanjay Kumar Agarwal, Muktar Beshir Ahmed, Aliasghar Ahmad Kiadaliri, Hamid Ahmadieh, Nadia Akseer, Ziyad Al-Aly, Khurshid Alam, Noore K M Alam, Saleh Fahed Aldhahri, Miguel Angel Alegretti, Alicia V Aleman, Zewdie Aderaw Alemu, Lily T Alexander, Raghib Ali, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine Allen, Ubai Alsharif, Khalid A Altirkawi, Elena Alvarez Martin, Nelson Alvis-Guzman, Azmeraw T Amare, Alemayehu Amberbir, Adeladza Kofi Amegah, Heresh Amini, Walid Ammar, Stephen Marc Amrock, Gregory M Anderson, Benjamin O Anderson, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Valentina S Arsic Arsenijevic, Al Artaman, Hamid Asayesh, Rana Jawad Asghar, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Peter Azzopardi, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Amitava Banerjee, Aleksandra Barac, Suzanne L Barker-Collo, Till Bärnighausen, Lars Barregard, Lope H Barrero, Sanjay Basu, Tigist Assefa Bayou, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Brent Bell, Michelle L Bell, Corina Benjet, Derrick A Bennett, Isabela M Bensenor, Adugnaw Berhane, Eduardo Bernabé, Balem Demtsu Betsu, Addisu Shunu Beyene, Neeraj Bhala, Anil Bhansali, Samir Bhatt, Sibhatu Biadgilign, Kelly Bienhoff, Boris Bikbov, Aref A Bin Abdulhak, Stan Biryukov, Donal Bisanzio, Espen Bjertness, Jed D Blore, Rohan Borschmann, Soufiane Boufous, Rupert R A Bourne, Michael Brainin, Alexandra Brazinova, Nicholas J K Breitborde, Traolach S Brugha, Rachelle Buchbinder, Geoffrey Colin Buckle, Zahid A Butt, Bianca Calabria, Ismael Ricardo Campos-Nonato, Julio Cesar Campuzano, Hélène Carabin, Jonathan R Carapetis, Rosario Cárdenas, Juan Jesus Carrero, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-López, Fiorella Cavalleri, Jung-Chen Chang, Peggy Pei-Chia Chiang, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Jee-Young Jasmine Choi, Lincoln Choudhury, Hanne Christensen, Liliana G Ciobanu, Valentina Colistro, Mercedes Colomar, Samantha M Colquhoun, Monica Cortinovis, John A Crump, Albertino Damasceno, Rakhi Dandona, Paul I Dargan, José das Neves, Gail Davey, Adrian C Davis, Diego De Leo, Louisa Degenhardt, Liana C Del Gobbo, Sarah Derrett, Don C Des Jarlais, Gabrielle A deVeber, Samath D Dharmaratne, Preet K Dhillon, Eric L Ding, Kerrie E Doyle, Tim R Driscoll, Leilei Duan, Manisha Dubey, Bruce Bartholow Duncan, Hedyeh Ebrahimi, Richard G Ellenbogen, Iqbal Elyazar, Aman Yesuf Endries, Sergey Petrovich Ermakov, Babak Eshrati, Alireza Esteghamati, Kara Estep, Saman Fahimi, Talha A Farid, Carla Sofia e Sa Farinha, André Faro, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Jefferson G Fernandes, Joao C Fernandes, Florian Fischer, Joseph R A Fitchett, Nataliya Foigt, F Gerry R Fowkes, Richard C Franklin, Joseph Friedman, Joseph Frostad, Thomas Fürst, Neal D Futran, Belinda Gabbe, Fortuné Gbètoho Gankpé, Alberto L Garcia-Basteiro, Tsegaye Tewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Johanna M Geleijnse, Katherine B Gibney, Richard F Gillum, Ibrahim Abdelmageem Mohamed Ginawi, Ababi Zergaw Giref, Maurice Giroud, Melkamu Dedefo Gishu, Giorgia Giussani, William W Godwin, Hector Gomez-Dantes, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Carolyn C Gotay, Atsushi Goto, Hebe N Gouda, Harish Gugnani, Yuming Guo, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Reyna A Gutiérrez, Nima Hafezi-Nejad, Demewoz Haile, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Yara A Halasa, Randah Ribhi Hamadeh, Samer Hamidi, Mouhanad Hammami, Alexis J Handal, Graeme J Hankey, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Mohammad Sadegh Hassanvand, Tahir Ahmed Hassen, Rasmus Havmoeller, Roderick J Hay, Mohammad T Hedayati, Ileana Beatriz Heredia-Pi, Pouria Heydarpour, Hans W Hoek, Daniel J Hoffman, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Damian G Hoy, Mohamed Hsairi, Hsiang Huang, John J Huang, Kim Moesgaard Iburg, Bulat T Idrisov, Kaire Innos, Manami Inoue, Kathryn H Jacobsen, Alejandra Jauregui, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Vivekanand Jha, Guohong Jiang, Ying Jiang, Tariku Jibat, Aida Jimenez-Corona, Ye Jin, Jost B Jonas, Zubair Kabir, Dan K Kajungu, Yogeshwar Kalkonde, Ritul Kamal, Haidong Kan, Amit Kandel, André Karch, Corine Kakizi Karema, Chante Karimkhani, Amir Kasaeian, Marzieh Katibeh, Anil Kaul, Norito Kawakami, Dhruv S Kazi, Peter Njenga Keiyoro, Andrew Haddon Kemp, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Abdur Rahman Khan, Ejaz Ahmad Khan, Young-Ho Khang, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Christian Kieling, Cho-il Kim, Daniel Kim, Yun Jin Kim, Niranjan Kissoon, Miia Kivipelto, Luke D Knibbs, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A Kopec, Parvaiz A Koul, Ai Koyanagi, Barthelemy Kuate Defo, Ricardo S Kuchenbecker, Burcu Kucuk Bicer, Ernst J Kuipers, G Anil Kumar, Gene F Kwan, Ratilal Lalloo, Tea Lallukka, Anders Larsson, Asma Abdul Latif, Pablo M Lavados, Alicia Elena Beatriz Lawrynowicz, Janet L Leasher, James Leigh, Ricky Leung, Yichong Li, Yongmei Li, Steven E Lipshultz, Patrick Y Liu, Yang Liu, Belinda K Lloyd, Giancarlo Logroscino, Katharine J Looker, Paulo A Lotufo, Robyn M Lucas, Raimundas Lunevicius, Ronan A Lyons, Hassan Magdy Abd El Razek, Mahdi Mahdavi, Marek Majdan, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Wagner Marcenes, Jose Martinez-Raga, Felix Masiye, Amanda J Mason-Jones, Richard Matzopoulos, Bongani M Mayosi, John J McGrath, Martin McKee, Peter A Meaney, Alem Mehari, Yohannes Adama Melaku, Peter Memiah, Ziad A Memish, Walter Mendoza, Atte Meretoja, Tuomo J Meretoja, Yonatan Moges Mesfin, Francis Apolinary Mhimbira, Anoushka Millear, Ted R Miller, Edward J Mills, Mojde Mirarefin, Erkin M Mirrakhimov, Philip B Mitchell, Charles N Mock, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Shafiu Mohammed, Lorenzo Monasta, Julio Cesar Montañez Hernandez, Marcella Montico, Maziar Moradi-Lakeh, Rintaro Mori, Ulrich O Mueller, John Everett Mumford, Michele E Murdoch, Gudlavalleti Venkata Satyanarayana Murthy, Jean B Nachega, Aliya Naheed, Luigi Naldi, Vinay Nangia, John N Newton, Marie Ng, Frida Namnyak Ngalesoni, Quyen Le Nguyen, Muhammad Imran Nisar, Patrick Martial Nkamedjie Pete, Joan M Nolla, Ole F Norheim, Rosana E Norman, Bo Norrving, Carla Makhlouf Obermeyer, Felix Akpojene Ogbo, In-Hwan Oh, Olanrewaju Oladimeji, Pedro R Olivares, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Eyal Oren, Alberto Ortiz, Erika Ota, Abayomi Samuel Oyekale, Mahesh PA, Eun-Kee Park, Mahboubeh Parsaeian, Scott B Patten, George C Patton, João Mário Pedro, David M Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael Robert Phillips, Frédéric B Piel, Julian David Pillay, Farhad Pishgar, Dietrich Plass, Suzanne Polinder, Svetlana Popova, Richie G Poulton, Farshad Pourmalek, Noela M Prasad, Mostafa Qorbani, Rynaz H S Rabiee, Amir Radfar, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Sajjad Ur Rahman, Dheeraj Rai, Rajesh Kumar Rai, Sasa Rajsic, Murugesan Raju, Usha Ram, Kavitha Ranganathan, Amany H Refaat, Marissa B Reitsma, Giuseppe Remuzzi, Serge Resnikoff, Alex Reynolds, Antonio L Ribeiro, Stefano Ricci, Hirbo Shore Roba, David Rojas-Rueda, Luca Ronfani, Gholamreza Roshandel, Gregory A Roth, Ambuj Roy, Ben Benasco Sackey, Rajesh Sagar, Juan R Sanabria, Maria Dolores Sanchez-Niño, Itamar S Santos, João Vasco Santos, Rodrigo Sarmiento-Suarez, Benn Sartorius, Maheswar Satpathy, Miloje Savic, Monika Sawhney, Maria Inês Schmidt, Ione J C Schneider, Aletta E Schutte, David C Schwebel, Soraya Seedat, Sadaf G Sepanlou, Edson E Servan-Mori, Saeid Shahraz, Masood Ali Shaikh, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Kevin N Sheth, Kenji Shibuya, Mika Shigematsu, Min-Jeong Shin, Rahman Shiri, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Jonathan I Silverberg, Edgar P Simard, Abhishek Singh, Jasvinder A Singh, Prashant Kumar Singh, Vegard Skirbekk, Jens Christoffer Skogen, Michael Soljak, Kjetil Søreide, Reed J D Sorensen, Chandrashekhar T Sreeramareddy, Vasiliki Stathopoulou, Nicholas Steel, Dan J Stein, Murray B Stein, Timothy J Steiner, Lars Jacob Stovner, Saverio Stranges, Konstantinos Stroumpoulis, Bruno F Sunguya, Patrick J Sur, Soumya Swaminathan, Bryan L Sykes, Cassandra E I Szoeke, Rafael Tabarés-Seisdedos, Nikhil Tandon, David Tanne, Mohammad Tavakkoli, Bineyam Taye, Hugh R Taylor, Braden J Te Ao, Teketo Kassaw Tegegne, Dejen Yemane Tekle, Abdullah Sulieman Terkawi, Gizachew Assefa Tessema, J S Thakur, Alan J Thomson, Andrew L Thorne-Lyman, Amanda G Thrift, George D Thurston, Ruoyan Tobe-Gai, Marcello Tonelli, Roman Topor-Madry, Fotis Topouzis, Bach Xuan Tran, Thomas Truelsen, Zacharie Tsala Dimbuene, Miltiadis Tsilimbaris, Abera Kenay Tura, Emin Murat Tuzcu, Stefanos Tyrovolas, Kingsley N Ukwaja, Eduardo A Undurraga, Chigozie Jesse Uneke, Olalekan A Uthman, Coen H van Gool, Jim van Os, Tommi Vasankari, Ana Maria Nogales Vasconcelos, Narayanaswamy Venketasubramanian, Francesco S Violante, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Gregory R Wagner, Mitchell T Wallin, Linhong Wang, Scott Weichenthal, Elisabete Weiderpass, Robert G Weintraub, Andrea Werdecker, Ronny Westerman, Tissa Wijeratne, James D Wilkinson, Hywel C Williams, Charles Shey Wiysonge, Solomon Meseret Woldeyohannes, Charles D A Wolfe, Sungho Won, Gelin Xu, Ajit Kumar Yadav, Bereket Yakob, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Pengpeng Ye, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Hajo Zeeb, Sanjay Zodpey, David Zonies, Liesl Joanna Zuhlke, Theo Vos, Alan D Lopez, Christopher J L Murray
Journal: The Lancet (2016)

BackgroundHealthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) 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 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.FindingsTotal global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.InterpretationHealth is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.FundingBill & Melinda Gates Foundation.