Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Abstract

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.

Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution.

Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI.

Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1

Global DALYs and age-standardised DALY rates, 1990–2019 Shaded sections indicate 95% uncertainty intervals. DALY=disability-adjusted life-year.

Figure 2

Leading 25 Level 3 causes of global DALYs and percentage of total DALYs (1990 and 2019), and percentage change in number of DALYs and age-standardised DALY rates from 1990 to 2019 for both sexes combined for all ages (A), children younger than 10 years (B), and ages 10–24 years (C), 25–49 years (D), 50–74 years (E), and 75 years and older (F) Causes are connected by lines between time periods; solid lines are increases in rank and dashed lines are decreases. Age-related hearing loss=age-related and other hearing loss. Alzheimer's disease=Alzheimer's disease and other dementias. Atrial fibrillation=atrial fibrillation and flutter. Cirrhosis=cirrhosis and other chronic liver diseases. COPD=chronic obstructive pulmonary disease. EMBID=endocrine, metabolic, blood, and immune disorders. DALY=disability-adjusted life-year. iNTS=invasive non-typhoidal salmonella. Haemoglobinopathies=haemoglobinopathies and haemolytic anaemias. Lung cancer=tracheal, bronchus, and lung cancer. Other musculoskeletal=other musculoskeletal disorders. Other unspecified infectious=other unspecified infectious diseases. Sudden infant death=sudden infant death syndrome. STI=sexually transmitted infections excluding HIV.

Figure 2

Leading 25 Level 3 causes of global DALYs and percentage of total DALYs (1990 and 2019), and percentage change in number of DALYs and age-standardised DALY rates from 1990 to 2019 for both sexes combined for all ages (A), children younger than 10 years (B), and ages 10–24 years (C), 25–49 years (D), 50–74 years (E), and 75 years and older (F) Causes are connected by lines between time periods; solid lines are increases in rank and dashed lines are decreases. Age-related hearing loss=age-related and other hearing loss. Alzheimer's disease=Alzheimer's disease and other dementias. Atrial fibrillation=atrial fibrillation and flutter. Cirrhosis=cirrhosis and other chronic liver diseases. COPD=chronic obstructive pulmonary disease. EMBID=endocrine, metabolic, blood, and immune disorders. DALY=disability-adjusted life-year. iNTS=invasive non-typhoidal salmonella. Haemoglobinopathies=haemoglobinopathies and haemolytic anaemias. Lung cancer=tracheal, bronchus, and lung cancer. Other musculoskeletal=other musculoskeletal disorders. Other unspecified infectious=other unspecified infectious diseases. Sudden infant death=sudden infant death syndrome. STI=sexually transmitted infections excluding HIV.

Figure 2

Leading 25 Level 3 causes of global DALYs and percentage of total DALYs (1990 and 2019), and percentage change in number of DALYs and age-standardised DALY rates from 1990 to 2019 for both sexes combined for all ages (A), children younger than 10 years (B), and ages 10–24 years (C), 25–49 years (D), 50–74 years (E), and 75 years and older (F) Causes are connected by lines between time periods; solid lines are increases in rank and dashed lines are decreases. Age-related hearing loss=age-related and other hearing loss. Alzheimer's disease=Alzheimer's disease and other dementias. Atrial fibrillation=atrial fibrillation and flutter. Cirrhosis=cirrhosis and other chronic liver diseases. COPD=chronic obstructive pulmonary disease. EMBID=endocrine, metabolic, blood, and immune disorders. DALY=disability-adjusted life-year. iNTS=invasive non-typhoidal salmonella. Haemoglobinopathies=haemoglobinopathies and haemolytic anaemias. Lung cancer=tracheal, bronchus, and lung cancer. Other musculoskeletal=other musculoskeletal disorders. Other unspecified infectious=other unspecified infectious diseases. Sudden infant death=sudden infant death syndrome. STI=sexually transmitted infections excluding HIV.

Figure 3

Proportion of total DALYs contributed by injury and non-communicable disease YLDs, by country or territory, 2019 Proportions were rounded to the nearest whole number. DALY=disability-adjusted life-year. YLD=year lived with disability.

Figure 4

Annualised rate of change in age-standardised DALY rates for all causes excluding HIV/AIDS, natural disasters, and war and conflict, and SDI by country or territory, for 1990–2010 (A) and 2010–19 (B) A simple linear regression line is shown in each figure for the relationship between annualised rate of change and the average SDI value of each country and territory for each time period. AFG=Afghanistan. AGO=Angola. ARE=United Arab Emirates. BDI=Burundi. BGD=Bangladesh. BLR=Belarus. BOL=Bolivia. BTN=Bhutan. CHN=China. CIV=Côte d'Ivoire. CMR=Cameroon. COD=Democratic Republic of the Congo. DALY=disability-adjusted life-year. DMA=Dominica. DOM=Dominican Republic. ERI=Eritrea. ETH=Ethiopia. GHA=Ghana. GNB=Guinea-Bissau. GNQ=Equatorial Guinea. GTM=Guatemala. GUM=Guam. IND=India. JAM=Jamaica. KAZ=Kazakhstan. KHM=Cambodia. KOR=South Korea. KNA=Saint Kitts and Nevis. LAO=Laos. LBR=Liberia. LCA=Saint Lucia. LSO=Lesotho. MDA=Moldova. MDV=Maldives. MMR=Myanmar. MOZ=Mozambique. MRT=Mauritania. MWI=Malawi. NER=Niger. NGA=Nigeria. NPL=Nepal. NRU=Nauru. OMN=Oman. PER=Peru. RUS=Russia. RWA=Rwanda. SDN=Sudan. SGP=Singapore. SLE=Sierra Leone. SOM=Somalia. SWZ=eSwatini. TGO=Togo. TLS=Timor-Leste. TUR=Turkey. UKR=Ukraine. UZB=Uzbekistan. VCT=Saint Vincent and the Grenadines. VEN=Venezuela. YEM=Yemen. ZAF=South Africa. ZWE=Zimbabwe. SDI=Socio-demographic Index.

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