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(Dalys) for 359 Diseases and Injuries and Healthy Life Expectancy

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(Dalys) for 359 Diseases and Injuries and Healthy Life Expectancy Europe PMC Funders Group Author Manuscript Lancet. Author manuscript; available in PMC 2018 November 24. Published in final edited form as: Lancet. 2018 November 10; 392(10159): 1859–1922. doi:10.1016/S0140-6736(18)32335-3. Europe PMC Funders Author Manuscripts 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 GBD 2017 DALYs and HALE Collaborators Summary This is an Open Access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA, [email protected]. Contributors Please see appendix 1 for more detailed information about individual authors’ contributions to the research, divided into the following categories: managing the estimation process; writing the first draft of the manuscript; providing data or critical feedback on data sources; developing methods or computational machinery; applying analytical methods to produce estimates; providing critical feedback on methods or results; drafting the work or revising it critically for important intellectual content; extracting, cleaning, or cataloguing data; designing or coding figures and tables; and managing the overall research enterprise. Declaration of interests Carl Abelardo Antonio reports personal fees from Johnson & Johnson (Philippines). Cyrus Cooper reports personal fees from Alliance Europe PMC Funders Author Manuscripts for Better Bone Health, Amgen, Eli Lilly, GlaxoSmithKline (GSK), Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. Louisa Degenhardt reports grants from Indivior, Mundipharma, and Seqirus. Seana Gall reports grants from the National Health and Medical Research Council and the National Heart Foundation of Australia. Panniyammakal Jeemon reports a Clinical and Public Health Intermediate Fellowship from the Wellcome Trust-DBT India Alliance (2015–20). Jacek Jóźwiak reports a grant from Valeant; personal fees from Valeant, ALAB Laboratoria, and Amgen; and non-financial support from Microlife and Servier. Nicholas Kassebaum reports personal fees and other support from Vifor Pharmaceuticals. Srinivasa Vittal Katikireddi reports grants from UK NHS Research Scotland (SCAF/15/02), UK Medical Research Council (MC_UU_12017/13 and MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13 and SPHSU15). Jeffrey Lazarus reports personal fees from Janssen and Cepheid, and grants and personal fees from AbbVie, Gilead Sciences, and MSD. Stefan Lorkowski reports personal fees from Amgen, Berlin-Chemie, MSD Sharp & Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, and Unilever; and non-financial support from Preventicus. Winfried März reports grants and personal fees from Siemens Diagnostics, Aegerion Pharmaceuticals, Amgen, AstraZeneca, Danone Research, Pfizer, BASF, Numares AG, and Berline-Chemie; personal fees from Hoffmann LaRoche, MSD, Sanofi, and Synageva; grants from Abbott Diagnostics; and other from Synlab Holding Deutschland GmbH. Walter Mendoza is currently a Program Analyst for Population and Development at the Peru Country Office of the United Nations Population Fund-UNFPA, which does not necessarily endorse this study. Ted Miller reports an evaluation contract from AB InBev Foundation. Maarten Postma reports grants from Mundipharma, Bayer, BMS, AstraZeneca, Arteg, and AscA; grants and personal fees from Sigma Tau, MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, Ingress Health, AbbVie, and Sanofi; personal fees from Quintiles, Astellas, Mapi, OptumInsight, Novartis, Swedish Orphan, Innoval, Janssen, Intercept, and Pharmerit; and stock ownership in Ingress Health and Pharmacoeconomics Advice Groningen. Kazem Rahimi reports grants from National Institute for Health Research Biomedical Research Centres, the Economic and Social Research Council, and Oxford Martin School. Kenji Shibuya reports grants from the Ministry of Health, Labour, and Welfare, Japan, and from the Ministry of Education, Culture, Sports, Science, and Technology, Japan. Mark Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation. Jasvinder Singh reports consulting for Horizon, Fidia, UBM, Medscape, WebMD, the National Institutes of Health, and the American College of Rheumatology; they serve as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to Dinora, a 501c3 entity; they are on the steering committee of OMERACT. Jeffrey Stanaway reports a grant from Merck. Cassandra Szoeke reports a grant from the National Medical Health Research Council, Lundbeck, Alzheimer’s Association, and the Royal Australasian College of Practicioners; and she holds patent PCT/AU2008/001556. Muthiah Vaduganathan receives research support from the US National Institute of Health National Heart, Lung, and Blood Institute and serves as a consultant for Bayer AG and Baxter Healthcare. Denis Xavier reports grants from Cadila Pharmaceuticals, Boehringer Ingelheim, Sanofi Aventis, Pfizer, and Bristol-Myers Squibb. Data sharing To download the data used in these analyses, please visit the Global Health Data Exchange at http://ghdx.healthdata.org/gbd-2017. Page 2 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 Europe PMC Funders Author Manuscripts 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 Europe PMC Funders Author Manuscripts 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). Lancet. Author manuscript; available in PMC 2018 November 24. Page 3 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 Europe PMC Funders Author Manuscripts quintiles and between sexes.
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