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Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Hmwe Hmwe Kyu, Degu Abate, Kalkidan Hassen Abate and 97 more

The Lancet · 2018 · CC BY-NC-ND

Abstract

Background. How long one lives, how many years of life are spent in good and poor health, and how the population’s state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.

Methods. We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.

Findings. Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2).

Interpretation. With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.

Funding. Bill & Melinda Gates Foundation.

References 54

1.
Sustainable development goal 3.
Not in our library
2.
Shetty P. Grey matter: ageing in developing countries. Lancet. 2012;379:1285-87.
Not in our library10.1016/s0140-6736(12)60541-8
3.
Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016 · 2017
No notice
4.
Ageing well: a global priority. Lancet. 2012;379:1274.
Not in our library10.1016/s0140-6736(12)60518-2
5.
Marmot M, Allen JJ. Social determinants of health equity. Am J Public Health. 2014;104(suppl 4):S517-19.
Not in our library10.2105/ajph.2014.302200
6.
Salomon JA, Wang H, Freeman MK, et al. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380:2144-62.
Not in our library10.1016/s0140-6736(12)61690-0
7.
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. Lancet. 2015;386:2145-91.
Not in our library10.1016/s0140-6736(15)61340-x
8.
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 · 2016
Corrected
9.
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 · 2017
No notice
10.
Beltrán-Sánchez H, Soneji S, Crimmins EM. Past, present, and future of healthy life expectancy. Cold Spring Harb Perspect Med. 2015;5.
Not in our library10.1101/cshperspect.a025957
11.
Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017 · 2018
No notice
12.
Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 · 2018
No notice
13.
Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017 · 2018
No notice
14.
Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement · 2016
Corrected
15.
Murray CJ, Ezzati M, Flaxman AD, et al. GBD 2010: design, definitions, and metrics. Lancet. 2012;380:2063-66.
Not in our library10.1016/s0140-6736(12)61899-6
16.
Modeling causes of death: an integrated approach using CODEm · 2012
No notice
17.
Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017 · 2018
No notice
18.
Flaxman AD, Vos T, Murray CJ. An integrative metaregression framework for descriptive epidemiology. 2015.
Not in our library
19.
Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380:2129-43.
Not in our library10.1016/s0140-6736(12)61680-8
20.
Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3:e712-23.
Not in our library10.1016/s2214-109x(15)00069-8
21.
Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep. 1971;86:347-54.
Not in our library
22.
Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci. 2000;50:1385-401.
Not in our library10.1016/s0277-9536(99)00390-1
23.
Committee on Understanding the Biology of Sex and Gender Differences. Exploring the biological contributions to human health: does sex matter? 2001.
Not in our library
24.
Barbeau EM, Leavy-Sperounis A, Balbach ED. Smoking, social class, and gender: what can public health learn from the tobacco industry about disparities in smoking? Tob Control. 2004;13:115-20.
Not in our library10.1136/tc.2003.006098
25.
Slade T, Chapman C, Swift W, Keyes K, Tonks Z, Teesson M. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ Open. 2016;6.
Not in our library10.1136/bmjopen-2016-011827
26.
Treaster DE, Burr D. Gender differences in prevalence of upper extremity musculoskeletal disorders. Ergonomics. 2004;47:495-526.
Not in our library10.1080/00140130310001638171
27.
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 · 2017
No notice
28.
van Rijn RM, Robroek SJW, Brouwer S, Burdorf A. Influence of poor health on exit from paid employment: a systematic review. Occup Environ Med. 2014;71:295-301.
Not in our library10.1136/oemed-2013-101591
29.
Lahelma E, Pietiläinen O, Rahkonen O, Lallukka T. Common mental disorders and cause-specific disability retirement. Occup Environ Med. 2015;72:181-87.
Not in our library10.1136/oemed-2014-102432
30.
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 · 2017
No notice
31.
Begg S, Vos T, Goss J, Mann N. An alternative approach to projecting health expenditure in Australia. Aust Health Rev. 2008;32:148-55.
Not in our library10.1071/ah080148
32.
Universal health care, worldwide, is within reach. The Economist. 2018.
Not in our library
33.
Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet. 2017;389:1431-41.
Not in our library10.1016/s0140-6736(17)30398-7
34.
Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the united states, 1999–2016. NCHS Data Brief. 2017;294:1-8.
Not in our library
35.
Prekupec MP, Mansky PA, Baumann MH. Misuse of novel synthetic opioids: a deadly new trend. J Addict Med. 2017;11:256-65.
Not in our library10.1097/adm.0000000000000324
36.
The health of the people: what works. The African regional health report. 2014.
Not in our library
37.
Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371:417-40.
Not in our library10.1016/s0140-6736(07)61693-6
38.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
Not in our library10.1056/nejmoa012512
39.
Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343-50.
Not in our library10.1056/nejm200105033441801
40.
Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677-86.
Not in our library10.1016/s0140-6736(09)61457-4
41.
Soleymani T, Daniel S, Garvey WT. Weight maintenance: challenges, tools and strategies for primary care physicians. Obes Rev. 2016;17:81-93.
Not in our library10.1111/obr.12322
42.
Double-duty actions for nutrition: policy brief. 2017.
Not in our library
43.
Hawkes C, Demaio AR, Branca F. Double-duty actions for ending malnutrition within a decade. Lancet Glob Health. 2017;5:e745-46.
Not in our library10.1016/s2214-109x(17)30204-8
44.
Thachil J. Iron deficiency: still under-diagnosed? Br J Hosp Med (Lond). 2015;76:528-32.
Not in our library10.12968/hmed.2015.76.9.528
45.
Nutrition and weight status. NWS-21 Reduce iron deficiency among young children and females of childbearing age. 2020.
Not in our library
46.
Ramsay LC, Charles CV. Review of iron supplementation and fortification. Topics in Public Health. 2015.
Not in our library
47.
Baltussen R, Knai C, Sharan M. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world. J Nutr. 2004;134:2678-84.
Not in our library10.1093/jn/134.10.2678
48.
Finkelstein JL, Haas JD, Mehta S. Iron-biofortified staple food crops for improving iron status: a review of the current evidence. Curr Opin Biotechnol. 2017;44:138-45.
Not in our library10.1016/j.copbio.2017.01.003
49.
Dengue and severe dengue. 2018.
Not in our library
50.
Revised SAGE recommendation on use of dengue vaccine. 2018.
Not in our library
51.
Sommerfeld J, Kroeger A. Innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America: introduction to the special issue. Trans R Soc Trop Med Hyg. 2015;109:85-88.
Not in our library10.1093/trstmh/tru176
52.
Idele P, Gillespie A, Porth T, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66(suppl 2):S144-53.
Not in our library10.1097/qai.0000000000000176
53.
Immunization. UNICEF DATA. 2018.
Not in our library
54.
Mahy M, Penazzato M, Ciaranllo A, et al. Improving estimates of children living with HIV from the spectrum AIDS impact model. AIDS. 2017;31:S13-22.
Not in our library10.1097/qad.0000000000001306

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