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

GBD 2015 DALYs and HALE Collaborators

Abstract

Background: Healthy 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.

Methods: We 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.

Findings: Total 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.

Interpretation: Health 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.

Funding: Bill & Melinda Gates Foundation.

Figures

**Figure 1**
Trends from 1990 to 2015, by GBD Level 1 cause, in global DALYs (A), crude DALY rates (B), and age-standardised DALY rates (C) The difference in trends between (A) and (B) is caused by population growth and the difference between (B) and (C) is caused by changes in the percentage distribution of the population by age. Shaded areas show 95% uncertainty intervals. DALYs=disability-adjusted life-years.

**Figure 2**
Leading 30 Level 3 causes of global DALYs for both sexes combined, 1990, 2005, 2015, with percentage change in number of DALYs, and all-age, and age-standardised rates Causes are connected by lines between time periods; solid lines are increases and dashed lines are decreases. For the time period of 1990 to 2005 and for 2005 to 2015, three measures of change are shown: percent change in the number of DALYs, percent change in the all-age DALY rate, and percent change in the age-standardised DALY rate. Statistically significant changes are shown in bold. DALYs=disability-adjusted life-years. COPD=chronic obstructive pulmonary disease.

**Figure 3**
Leading ten Level 3 causes of global age-specific DALYs in 2015 Each cause is coloured by the percentage change in age-specific DALYs from 2005 to 2015. NN Preterm=neonatal preterm birth complications. NN Sepsis=neonatal sepsis and other neonatal infections. LRI=lower respiratory infections. Iron=iron-deficiency anaemia. HIV=HIV/AIDS. Back & neck=low back and neck pain. IHD=ischaemic heart disease. NN Enceph=neonatal encephalopathy due to birth asphyxia and trauma. Diarrhoea=diarrhoeal diseases. Skin=skin and subcutaneous diseases. Depression=depressive disorders. Stroke=cerebrovascular disease. Congenital=congenital anomalies. Diabetes=diabetes mellitus. COPD=chronic obstructive pulmonary disease. Alzheimer's=Alzheimer's disease and other dementias. PEM=protein-energy malnutrition. Conduct=conduct disorder. Sense=sense organ diseases. Other NN=other neonatal disorders. Intest inf=intestinal infectious diseases. Violence=interpersonal violence. NN Haemol=haemolytic disease and other neonatal jaundice. Anxiety=anxiety disorders. TB=tuberculosis. Lung C= lung, bronchial, and tracheal cancers. STD=sexually transmitted diseases excluding HIV. Haemog=haemoglobinopathies and haemolytic anaemias. CKD=chronic kidney disease. Other MSK=other musculoskeletal disorders. Drugs=drug use disorders. Stomach C=stomach cancer. HTN HD=hypertensive heart disease. GBD=Global Burden of Disease. DALYs=disability-adjusted life-years.

**Figure 4**
Co-evolution of HALE (A), functional health lost (life expectancy minus HALE; B), and life expectancy spent with disability (life expectancy minus HALE, divided by HALE; C) with SDI globally and for GBD regions, 1990 to 2015 Coloured lines show global and region values for each metric. Each point in a line represents 1 year starting at 1990 and ending at 2015. In all regions, SDI has increased year on year so progress in SDI is associated with later years for a given region. The black lines indicate trajectories for each geography expected on the basis of SDI alone. GBD=Global Burden of Disease. SDI=Socio-demographic Index. HALE=healthy life expectancy. DALYs=disability-adjusted life-years.

**Figure 5**
Expected relationship between age-standardised YLL and YLD rates and SDI (A) and all-age YLL and YLD rates (per 100 000) and SDI (B) for 21 GBD Level 2 causes These stacked curves represent the average relationship between SDI and each cause observed across all geographies over the time period 1990 to 2015. In each figure, the y axis goes from lowest SDI to highest SDI. The left side shows rates for YLLs and the right side shows rates for YLDs; higher rates are further from the midline. The difference between (A) and (B) is the effect of shifts in population age structure expected with SDI. GBD=Global Burden of Disease. SDI=Socio-demographic Index. YLDs=years lived with disability. YLLs=years of life lost.

**Figure 6**
Ratio of observed versus expected age-standardised DALY rates (per 100 000) on the basis of SDI alone for both sexes combined, 2015 Ratios are colour-coded in terms of the magnitude of differences between observed and expected all-ages DALY rates. Blues indicate much lower observed DALYs than expected levels based on SDI, whereas reds reflect that observed DALYs far exceed expected levels given SDI. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste. FSM=Federated States of Micronesia. SDI=Socio-demographic Index. DALY=disability-adjusted life-years.

**Figure 7**
Leading ten causes of DALYs with the ratio of observed DALYs to DALYs expected on the basis of SDI in 2015, by location The ratio of observed DALYs to DALYs expected based on SDI is provided in brackets for each cause and cells are colour coded by ratio ranges (calculated to place a roughly equal number of cells into each bin). Shades of blue represent much lower observed DALYs than expected levels based on SDI, whereas red shows observed DALYs that exceed expected levels. IHD=ischaemic heart disease. Back & neck=low back and neck pain. Diabetes=diabetes mellitus. Stroke=Cerebrovascular disease. Lung C=lung, bronchus, and trachea cancers. Sense=sense organ diseases. Depression=depressive disorders. Alzheimer's=Alzheimer's disease and other dementias. Oth MSK=other musculoskeletal disorders. COPD=chronic obstructive pulmonary disease. NN Preterm=neonatal preterm birth complications. Diarrhoea=diarrhoeal diseases. Skin=skin and subcutaneous diseases. NN Enceph=neonatal encephalopathy due to birth asphyxia and trauma. Drugs=drug use disorders. Congenital=congenital anomalies. Liver C=liver cancer. Stomach C=stomach cancer. CKD=chronic kidney disease. Anxiety=anxiety disorders. Iron=iron-deficiency anaemia. HIV=HIV/AIDS. Colorect C=colon and rectum cancer. LRI=lower respiratory infections. Cirr HepC=cirrhosis due to hepatitis C. CMP=cardiomyopathy and myocarditis. Cirr alc=cirrhosis due to alcohol use. Other Cardio=other cardiovascular and circulatory diseases. Alcohol=alcohol use disorders. Violence=interpersonal violence. HTN HD=hypertensive heart disease. Haemog=haemoglobinopathies and haemolytic anaemias. TB=tuberculosis. Prostate C=prostate cancer. War=collective violence and legal intervention. Other Unint= other unintentional injuries. Oth trans=other transport injuries. Other NN=Other neonatal disorders. NN Sepsis=neonatal sepsis and other neonatal infections. PEM=protein-energy malnutrition. STD=sexually transmitted diseases excluding HIV. Ebola=Ebola virus disease. Other NTD=other neglected tropical diseases. GBD=Global Burden of Disease. SDI=Socio-demographic Index. DALYs=disability-adjusted life-years.

References

1. UN Sustainable development goals. Oct 29, 2015. (accessed Oct 29, 2015).
1. Murray CJL. Choosing indicators for the health-related SDG targets. Lancet. 2015;386:1314–1317.
1. Murray CJL. Shifting to Sustainable Development Goals—Implications for global health. N Engl J Med. 2015;373:1390–1393.
1. Nilsson M, Griggs D, Visbeck M. Policy: Map the interactions between Sustainable Development Goals. Nature News. 2016;534:320.
1. UN United Nations Sustainable Development. (accessed June 26, 2016).
1. Murray CJL, Salomon JA, Mathers CD, Lopez AD. Summary Measures in Population Health: Concepts, Ethics, Measurement, and Applications. World Health Organization; Geneva: 2002.
1. Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep. 1971;86:347–354.
1. Mathers CD, Sadana R, Salomon JA, Murray CJ, Lopez AD. Healthy life expectancy in 191 countries, 1999. Lancet. 2001;357:1685–1691.
1. Murray CJ, Vos T, Lozano R. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223.
1. Murray CJ, Barber RM, Foreman KJ. 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;386:2145–2191.
1. Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72:429–445.
1. GBD 2015 Mortality and Causes of Death Collaborators Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–1544.
1. WHO . WHO methods and data sources for global burden of disease estimates 2000–2011. World Health Organization; Geneva: 2013.
1. WHO . WHO methods and data sources for life tables 1990–2015. World Health Organization; Geneva: 2016.
1. EHLEIS Bibliography on Health Expectancy in Europe. April 2015. (accessed June 7, 2016).
1. WHO . WHO methods and data sources for country-level causes of death 2000–2012. World Health Organization; Geneva: 2014.
1. WHO Estimates for 2000–2012. (accessed June 11, 2016).
1. European Commission Healthy Life Years (HLY) (accessed June 7, 2016).
1. OECD . Health at a Glance: Europe 2012. Organisation for Economic Co-operation and Development; Paris: 2012. (accessed June 7, 2016).
1. GBD 2015 Risk Factors Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–1604.
1. Murray CJ, Ezzati M, Flaxman AD. GBD 2010: design, definitions, and metrics. Lancet. 2012;380:2063–2066.
1. Stevens GA, Alkema L, Black RE. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet. 2016 published online June 28.
1. Stevens GA, Alkema L, Black RE. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. PLoS Med. 2016;13:e1002056.
1. Stanaway JD, Shepard DS, Undurraga EA. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016;16:712–723.
1. Salomon JA, Vos T, Hogan DR. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380:2129–2143.
1. Salomon JA, Haagsma JA, Davis A. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3:e712–e723.
1. Salomon JA, Wang H, Freeman MK. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380:2144–2162.
1. Calculating the Indices Human Development Reports. (accessed April 27, 2016).
1. WHO Ebola Response Team West African Ebola epidemic after one year— slowing but not yet under control. N Engl J Med. 2015;372:584–587.
1. Fries JF. The compression of morbidity. Milbank Q. 2005;83:801–823.
1. Langa KM, Larson EB, Karlawish JH. Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity? Alzheimers Dement. 2008;4:134–144.
1. Bardenheier BH, Lin J, Zhuo X. Compression of disability between two birth cohorts of US adults with diabetes, 1992–2012: a prospective longitudinal analysis. Lancet Diabetes Endocrinol. 2016;4:686–694.
1. Beltran-Sanchez H, Preston S, Canudas-Romo V. An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy. Demogr Res. 2008;19:1323–1350.
1. Jagger C, Matthews R, Matthews F. The burden of diseases on disability-free life expectancy in later life. J Gerontol A Biol Sci Med Sci. 2007;62:408–414.
1. van Gool CH, Picavet HSJ, Deeg DJ. Trends in activity limitations: the Dutch older population between 1990 and 2007. Int J Epidemiol. 2011;40:1056–1067.
1. King G, Murray CJL, Salomon JA, Tandon A. Enhancing the validity and cross-cultural comparability of measurement in survey research. Am Polit Sci Rev. 2004;98:191–207.
1. Salomon JA, Tandon A, Murray CJL. Comparability of self rated health: cross sectional multi-country survey using anchoring vignettes. BMJ. 2004;328:258.
1. Tandon A, Murray CJL, Salomon JA, King G. Statistical Models for Enhancing Cross-Population Comparability. World Health Organization; Geneva: 2002.
1. Bowling A. Commentary: Trends in activity limitation. Int J Epidemiol. 2011;40:1068–1070.
1. Jamison DT, Summers LH, Alleyne G. Global health 2035: a world converging within a generation. Lancet. 2013;382:1898–1955.
1. GBD 2015 SDG Collaborators Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet. 2016;388:1815–1852.
1. Engineer MH, Roy N, Fink S. ‘Healthy’ Human Development Indices. Soc Indic Res. 2009;99:61–80.
1. National Institutes of Health (NIH) NIH unveils FY2016–2020 Strategic Plan. Dec 15, 2015. (accessed March 26, 2016).
1. Gillum LA, Gouveia C, Dorsey ER. NIH disease funding levels and burden of disease. PLoS One. 2011;6:e16837.
1. Emdin CA, Odutayo A, Hsiao AJ. Association between randomised trial evidence and global burden of disease: cross sectional study (Epidemiological Study of Randomized Trials—ESORT) BMJ. 2015;350:h117.
1. Catalá-López Ferrán. García-Altés Anna. Álvarez-Martín E, Gènova-Maleras R, Morant-Ginestar C. Does the development of new medicinal products in the European Union address global and regional health concerns? Popul Health Metr. 2010;8:34.
1. WHO Investing in health research and development. (accessed June 11, 2016).
1. Chalmers I, Bracken MB, Djulbegovic B. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383:156–165.
1. GBD 2015 Risk Factors Collaborators Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1661–1736.
1. Leigh JP, Sheetz RM. Prevalence of back pain among fulltime United States workers. Br J Ind Med. 1989;46:651–657.
1. Leino-Arjas P, Hänninen K, Puska P. Socioeconomic variation in back and joint pain in Finland. Eur J Epidemiol. 1998;14:79–87.
1. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med (Lond) 2001;51:124–135.
1. Haddon W. Advances in the epidemiology of injuries as a basis for public policy. Public Health Rep. 1980;95:411–421.
1. Moore L, Evans D, Hameed SM. Mortality in Canadian trauma systems: a multicenter cohort Study. Ann Surg. 2016 published online Jan 7.
1. Uthkarsh PS, Gururaj G, Reddy SS, Rajanna MS. Assessment and availability of trauma care services in a district hospital of south India: a field observational study. Bull Emerg Trauma. 2016;4:93–100.
1. Ghajar J. Traumatic brain injury. Lancet. 2000;356:923–929.
1. Cheatham ML, Malbrain ML, Kirkpatrick A. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–962.
1. Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE. Prehospital spine immobilization for penetrating trauma—review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma. 2011;71:763–769.
1. Rickard JL, Ntakiyiruta G, Chu KM. Associations with perioperative mortality rate at a major referral hospital in Rwanda. World J Surg. 2015;40:784–790.
1. Odhiambo FO, Beynon CM, Ogwang S. Trauma-related mortality among adults in rural western Kenya: characterising deaths using data from a Health and Demographic Surveillance System. PLoS One. 2013;8:e79840.
1. Naish S, Dale P, Mackenzie JS, McBride J, Mengersen K, Tong S. Climate change and dengue: a critical and systematic review of quantitative modelling approaches. BMC Infect Dis. 2014;14:167.
1. GBD 2015 Child Mortality Collaborators Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1727–1776.
1. GBD 2015 Maternal Mortality Collaborators Maternal mortality 1990 to 2015: a systematic analysis of the Global Burden of Disease 2015 Study. Lancet. 2016;388:1777–1814.
1. Murray CJL, Ferguson BD, Lopez AD, Guillot M, Salomon JA, Ahmad O. Modified logit life table system: principles, empirical validation, and application. Popul Stud. 2003;57:165–182.
1. Wang H, Dwyer-Lindgren L, Lofgren KT. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2071–2094.
1. GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–171.
1. Stouthard ME, Essink-Bot M, Bonsel G, Barendregt J, Kramers P. Disability weights for diseases in the Netherlands. Department of Public Health, Erasmus University; Rotterdam: 1997.
1. UN. Department of Economic and Social Affairs. Population Division . World Population Prospects: The 2012 Revision, Key Findings and Advance Tables. Working Paper number ESA/P/WP.227. United Nations; New York: 2013.

Source: PubMed

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

Abstract

Figures

References

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