Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Authors: Theo Vos, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J Abu-Raddad, Ilana N Ackerman, Abdu Abdullahi Adamu, Olatunji Adetokunboh, Mohsen Afarideh, Ashkan Afshin, Sanjay Kumar Agarwal, Rakesh Aggarwal, Anurag Agrawal, Sutapa Agrawal, Hamid Ahmadieh, Muktar Beshir Ahmed, Miloud Taki Eddine Aichour, Amani Nidhal Aichour, Ibtihel Aichour, Sneha Aiyar, Rufus Olusola Akinyemi, Nadia Akseer, Faris Hasan Al Lami, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Tahiya Alam, Deena Alasfoor, Kefyalew Addis Alene, Raghib Ali, Reza Alizadeh-Navaei, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine Allen, Fatma Al-Maskari, Rajaa Al-Raddadi, Ubai Alsharif, Shirina Alsowaidi, Khalid A Altirkawi, Azmeraw T Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Hjalte H Andersen, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Al Artaman, Krishna Kumar Aryal, Hamid Asayesh, Solomon W Asgedom, Reza Assadi, Tesfay Mehari Atey, Niguse Tadele Atnafu, Sachin R Atre, Leticia Avila-Burgos, Euripide Frinel G Arthur Avokphako, Ashish Awasthi, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Amitava Banerjee, Marlena S Bannick, Aleksandra Barac, Ryan M Barber, Suzanne L Barker-Collo, Till Bärnighausen, Simon Barquera, Lars Barregard, Lope H Barrero, Sanjay Basu, Bob Battista, Katherine E Battle, Bernhard T Baune, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Yannick Béjot, Bayu Begashaw Bekele, Michelle L Bell, Derrick A Bennett, Isabela M Bensenor, Jennifer Benson, Adugnaw Berhane, Derbew Fikadu Berhe, Eduardo Bernabé, Balem Demtsu Betsu, Mircea Beuran, Addisu Shunu Beyene, Neeraj Bhala, Anil Bhansali, Samir Bhatt, Zulfiqar A Bhutta, Sibhatu Biadgilign, Burcu Kucuk Bicer, Kelly Bienhoff, Boris Bikbov, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Dube Jara Boneya, Soufiane Boufous, Rupert R A Bourne, Alexandra Brazinova, Traolach S Brugha, Rachelle Buchbinder, Lemma Negesa Bulto Bulto, Blair R Bumgarner, Zahid A Butt, Lucero Cahuana-Hurtado, Ewan Cameron, Mate Car, Hélène Carabin, Jonathan R Carapetis, Rosario Cárdenas, David O Carpenter, Juan Jesus Carrero, Austin Carter, Felix Carvalho, Daniel C Casey, Valeria Caso, Carlos A Castañeda-Orjuela, Chris D Castle, Ferrán Catalá-López, Hsing-Yi Chang, Jung-Chen Chang, Fiona J Charlson, Honglei Chen, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal A Chitheer, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Cirillo, Danny Colombara, Cyrus Cooper, Paolo Angelo Cortesi, Michael H Criqui, John A Crump, Abel Fekadu Dadi, Koustuv Dalal, Lalit Dandona, Rakhi Dandona, José das Neves, Dragos V Davitoiu, Barbora de Courten, Diego De De Leo, Barthelemy Kuate Defo, Louisa Degenhardt, Selina Deiparine, Robert P Dellavalle, Kebede Deribe, Don C Des Jarlais, Subhojit Dey, Samath D Dharmaratne, Preet Kaur Dhillon, Daniel Dicker, Eric L Ding, Shirin Djalalinia, Huyen Phuc Do, E Ray Dorsey, Kadine Priscila Bender dos Santos, Dirk Douwes-Schultz, Kerrie E Doyle, Tim R Driscoll, Manisha Dubey, Bruce Bartholow Duncan, Ziad Ziad El-Khatib, Jerisha Ellerstrand, Ahmadali Enayati, Aman Yesuf Endries, Sergey Petrovich Ermakov, Holly E Erskine, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Fanuel Belayneh Bekele Fanuel, Carla Sofia E Sa Farinha, André Faro, Farshad Farzadfar, Mir Sohail Fazeli, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, João C Fernandes, Alize J Ferrari, Tesfaye Regassa Feyissa, Irina Filip, Florian Fischer, Christina Fitzmaurice, Abraham D Flaxman, Luisa Sorio Flor, Nataliya Foigt, Kyle J Foreman, Richard C Franklin, Nancy Fullman, Thomas Fürst, Joao M Furtado, Neal D Futran, Emmanuela Gakidou, Morsaleh Ganji, Alberto L Garcia-Basteiro, Teshome Gebre, Tsegaye Tewelde Gebrehiwot, Ayele Geleto, Bikila Lencha Gemechu, Hailay Abrha Gesesew, Peter W Gething, Alireza Ghajar, Katherine B Gibney, Paramjit Singh Gill, Richard F Gillum, Ibrahim Abdelmageem Mohamed Ginawi, Ababi Zergaw Giref, Melkamu Dedefo Gishu, Giorgia Giussani, William W Godwin, Audra L Gold, Ellen M Goldberg, Philimon N Gona, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Alessandra Carvalho Goulart, Max Griswold, Harish Chander Gugnani, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Nima Hafezi-Nejad, Gessessew Bugssa Hailu, Alemayehu Desalegne Hailu, Randah Ribhi Hamadeh, Samer Hamidi, Alexis J Handal, Graeme J Hankey, Sarah Wulf Hanson, Yuantao Hao, Hilda L Harb, Habtamu Abera Hareri, Josep Maria Haro, James Harvey, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Caitlin Hawley, Simon I Hay, Roderick J Hay, Nathaniel J Henry, Ileana Beatriz Heredia-Pi, Julio Montañez Hernandez, Pouria Heydarpour, Hans W Hoek, Howard J Hoffman, Nobuyuki Horita, H Dean Hosgood, Sorin Hostiuc, Peter J Hotez, Damian G Hoy, Aung Soe Htet, Guoqing Hu, Hsiang Huang, Chantal Huynh, Kim Moesgaard Iburg, Ehimario Uche Igumbor, Chad Ikeda, Caleb Mackay Salpeter Irvine, Kathryn H Jacobsen, Nader Jahanmehr, Mihajlo B Jakovljevic, Simerjot K Jassal, Mehdi Javanbakht, Sudha P Jayaraman, Panniyammakal Jeemon, Paul N Jensen, Vivekanand Jha, Guohong Jiang, Denny John, Sarah Charlotte Johnson, Catherine O Johnson, Jost B Jonas, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Ritul Kamal, Haidong Kan, Nadim E Karam, André Karch, Corine Kakizi Karema, Amir Kasaeian, Getachew Mullu Kassa, Nigussie Assefa Kassaw, Nicholas J Kassebaum, Anshul Kastor, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Peter Njenga Keiyoro, Andre Pascal Kengne, Andre Keren, Yousef Saleh Khader, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Ardeshir Khosravi, Jagdish Khubchandani, Aliasghar Ahmad Kiadaliri, Christian Kieling, Yun Jin Kim, Daniel Kim, Pauline Kim, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna A Kissimova-Skarbek, Mika Kivimaki, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Michael Kravchenko, Sanjay Krishnaswami, Kristopher J Krohn, G Anil Kumar, Pushpendra Kumar, Sanjiv Kumar, Hmwe H Kyu, Dharmesh Kumar Lal, Ratilal Lalloo, Nkurunziza Lambert, Qing Lan, Anders Larsson, Pablo M Lavados, Janet L Leasher, Paul H Lee, Jong-Tae Lee, James Leigh, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miriam Levi, Yichong Li, Yongmei Li, Darya Li Kappe, Xiaofeng Liang, Misgan Legesse Liben, Stephen S Lim, Shai Linn, Patrick Y Liu, Angela Liu, Shiwei Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Stephanie J London, Katharine J Looker, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Nicola Low, Rafael Lozano, Timothy C D Lucas, Erlyn Rachelle King Macarayan, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Mahdi Mahdavi, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Deborah Carvalho Malta, Abdullah A Mamun, Helena Manguerra, Treh Manhertz, Ana Mantilla, Lorenzo G Mantovani, Chabila C Mapoma, Laurie B Marczak, Jose Martinez-Raga, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Winfried März, Manu Raj Mathur, Mohsen Mazidi, Colm McAlinden, Madeline McGaughey, John J McGrath, Martin McKee, Claire McNellan, Suresh Mehata, Man Mohan Mehndiratta, Tefera Chane Mekonnen, Peter Memiah, Ziad A Memish, Walter Mendoza, Mubarek Abera Mengistie, Desalegn Tadese Mengistu, George A Mensah, Tuomo J Meretoja, Atte Meretoja, Haftay Berhane Mezgebe, Renata Micha, Anoushka Millear, Ted R Miller, Edward J Mills, Mojde Mirarefin, Erkin M Mirrakhimov, Awoke Misganaw, Shiva Raj Mishra, Philip B Mitchell, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Kedir Endris Mohammed, Shafiu Mohammed, Sanjay K Mohanty, Ali H Mokdad, Sarah K Mollenkopf, Lorenzo Monasta, Marcella Montico, Maziar Moradi-Lakeh, Paula Moraga, Rintaro Mori, Chloe Morozoff, Shane D Morrison, Mark Moses, Cliff Mountjoy-Venning, Kalayu Birhane Mruts, Ulrich O Mueller, Kate Muller, Michele E Murdoch, Gudlavalleti Venkata Satyanarayana Murthy, Kamarul Imran Musa, Jean B Nachega, Gabriele Nagel, Mohsen Naghavi, Aliya Naheed, Kovin S Naidoo, Luigi Naldi, Vinay Nangia, Gopalakrishnan Natarajan, Dumessa Edessa Negasa, Ruxandra Irina Negoi, Ionut Negoi, Charles R Newton, Josephine Wanjiku Ngunjiri, Trang Huyen Nguyen, Quyen Le Nguyen, Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Emma Nichols, Dina Nur Anggraini Ningrum, Sandra Nolte, Vuong Minh Nong, Bo Norrving, Jean Jacques N Noubiap, Martin J O'Donnell, Felix Akpojene Ogbo, In-Hwan Oh, Anselm Okoro, Olanrewaju Oladimeji, Tinuke Oluwasefunmi Olagunju, Andrew Toyin Olagunju, Helen E Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin Ong, John Nelson Opio, Eyal Oren, Alberto Ortiz, Aaron Osgood-Zimmerman, Majdi Osman, Mayowa O Owolabi, Mahesh PA, Rosana E Pacella, Adrian Pana, Basant Kumar Panda, Christina Papachristou, Eun-Kee Park, Charles D Parry, Mahboubeh Parsaeian, Scott B Patten, George C Patton, Katherine Paulson, Neil Pearce, David M Pereira, Norberto Perico, Konrad Pesudovs, Carrie Beth Peterson, Max Petzold, Michael Robert Phillips, David M Pigott, Julian David Pillay, Christine Pinho, Dietrich Plass, Martin A Pletcher, Svetlana Popova, Richie G Poulton, Farshad Pourmalek, Dorairaj Prabhakaran, Noela M Prasad, Narayan Prasad, Carrie Purcell, Mostafa Qorbani, Reginald Quansah, Beatriz Paulina Ayala Quintanilla, Rynaz H S Rabiee, Amir Radfar, Anwar Rafay, Kazem Rahimi, Afarin Rahimi-Movaghar, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Mahfuzar Rahman, Rajesh Kumar Rai, Sasa Rajsic, Usha Ram, Chhabi Lal Ranabhat, Zane Rankin, Puja C Rao, Paturi Vishnupriya Rao, Salman Rawaf, Sarah E Ray, Robert C Reiner, Nikolas Reinig, Marissa B Reitsma, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Satar Rezaei, Antonio L Ribeiro, Luca Ronfani, Gholamreza Roshandel, Gregory A Roth, Ambuj Roy, Enrico Rubagotti, George Mugambage Ruhago, Soheil Saadat, Nafis Sadat, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Ramesh Sahathevan, Joseph Salama, Huda Omer Ba Saleem, Joshua A Salomon, Sundeep Santosh Salvi, Abdallah M Samy, Juan R Sanabria, Damian Santomauro, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Benn Sartorius, Maheswar Satpathy, Monika Sawhney, Sonia Saxena, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, David C Schwebel, Falk Schwendicke, Soraya Seedat, Sadaf G Sepanlou, Edson E Servan-Mori, Tesfaye Setegn, Katya Anne Shackelford, Amira Shaheen, Masood Ali Shaikh, Mansour Shamsipour, Sheikh Mohammed Shariful Islam, Jayendra Sharma, Rajesh Sharma, Jun She, Peilin Shi, Chloe Shields, Girma Temam Shifa, Mika Shigematsu, Yukito Shinohara, Rahman Shiri, Reza Shirkoohi, Shreya Shirude, Kawkab Shishani, Mark G Shrime, Abla Mehio Sibai, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, João Pedro Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Narinder Pal Singh, Dhirendra Narain Sinha, Eirini Skiadaresi, Vegard Skirbekk, Erica Leigh Slepak, Amber Sligar, David L Smith, Mari Smith, Badr H A Sobaih, Eugene Sobngwi, Reed J D Sorensen, Tatiane Cristina Moraes Sousa, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Jeffrey D Stanaway, Vasiliki Stathopoulou, Nicholas Steel, Murray B Stein, Dan J Stein, Timothy J Steiner, Caitlyn Steiner, Sabine Steinke, Mark Andrew Stokes, Lars Jacob Stovner, Bryan Strub, Michelle Subart, Muawiyyah Babale Sufiyan, Bruno F Sunguya, Patrick J Sur, Soumya Swaminathan, Bryan L Sykes, Dillon O Sylte, Rafael Tabarés-Seisdedos, Getachew Redae Taffere, Jukka S Takala, Nikhil Tandon, Mohammad Tavakkoli, Nuno Taveira, Hugh R Taylor, Arash Tehrani-Banihashemi, Tesfalidet Tekelab, Abdullah Sulieman Terkawi, Dawit Jember Tesfaye, Belay Tesssema, Ornwipa Thamsuwan, Katie E Thomas, Amanda G Thrift, Tenaw Yimer Tiruye, Ruoyan Tobe-Gai, Mette C Tollanes, Marcello Tonelli, Roman Topor-Madry, Miguel Tortajada, Mathilde Touvier, Bach Xuan Tran, Suryakant Tripathi, Christopher Troeger, Thomas Truelsen, Derrick Tsoi, Kald Beshir Tuem, Emin Murat Tuzcu, Stefanos Tyrovolas, Kingsley N Ukwaja, Eduardo A Undurraga, Chigozie Jesse Uneke, Rachel Updike, Olalekan A Uthman, Benjamin S Chudi Uzochukwu, Job F M van Boven, Santosh Varughese, Tommi Vasankari, S Venkatesh, Narayanaswamy Venketasubramanian, Ramesh Vidavalur, Francesco S Violante, Sergey K Vladimirov, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Fiseha Wadilo, Tolassa Wakayo, Yuan-Pang Wang, Marcia Weaver, Scott Weichenthal, Elisabete Weiderpass, Robert G Weintraub, Andrea Werdecker, Ronny Westerman, Harvey A Whiteford, Tissa Wijeratne, Charles Shey Wiysonge, Charles D A Wolfe, Rachel Woodbrook, Anthony D Woolf, Abdulhalik Workicho, Denis Xavier, Gelin Xu, Simon Yadgir, Mohsen Yaghoubi, Bereket Yakob, Lijing L Yan, Yuichiro Yano, Pengpeng Ye, Hassen Hamid Yimam, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Zoubida Zaidi, Maysaa El Sayed Zaki, Elias Asfaw Zegeye, Zerihun Menlkalew Zenebe, Xueying Zhang, Maigeng Zhou, Ben Zipkin, Sanjay Zodpey, Liesl Joanna Zuhlke, Christopher J L Murray
Journal: The Lancet (2017)

<h2>Summary</h2><h3>Background</h3> As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. <h3>Methods</h3> We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). <h3>Findings</h3> Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). <h3>Interpretation</h3> The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. <h3>Funding</h3> Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.