Journal article
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
The Lancet (British edition), Vol.392(10159), pp.1859-1922
11/10/2018
DOI: 10.1016/S0140-6736(18)32335-3
PMCID: PMC6252083
PMID: 30415748
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 lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c 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 Sociodemographic 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 ?ve 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.
Details
- Title: Subtitle
- 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
- Creators
- Hmwe Hmwe Kyu - Institute for Health Metrics and EvaluationDegu Abate - Haramaya UniversityKalkidan Hassen Abate - Jimma UniversitySolomon M. Abay - Addis Ababa UniversityCristiana Abbafati - Sapienza University of RomeNooshin Abbasi - McGill UniversityHedayat Abbastabar - Tehran University of Medical SciencesFoad Abd-Allah - Cairo UniversityJemal Abdela - School of Pharmacy, United StatesAhmed Abdelalim - Cairo UniversityIbrahim Abdollahpour - Arak University of Medical SciencesRizwan Suliankatchi Abdulkader - Manonmaniam Sundaranar UniversityMolla Abebe - University of GondarZegeye Abebe - University of GondarOlifan Zewdie Abil - University of Medical Sciences, NigeriaVictor Aboyans - Hôpital DupuytrenAklilu Roba Abrham - Haramaya UniversityLaith J. Abu-Raddad - Weill Cornell MedicineNiveen M.E. Abu-Rmeileh - Birzeit UniversityManfred Mario Kokou Accrombessi - Bénin Clinical Research Institute, BeninDilaram Acharya - Dongguk UniversityPawan Acharya - Nepal Development Society, NepalIlana N. Ackerman - Monash UniversityAbdu A Adamu - Stellenbosch UniversityOladimeji M. Adebayo - University College Hospital, NigeriaVictor Adekanmbi - Cardiff UniversityZanfina Ademi - Monash UniversityOlatunji Adetokunboh - South African Medical Research Council (SAMRC)Mina G. Adib - Saint Mark Hospital, EgyptJose C. Adsuar - Sport Science Department, United StatesKossivi Agbelenko Afanvi - Ministry of Health and Social Protection, TogoMohsen Afarideh - Tehran University of Medical SciencesAshkan Afshin - Institute for Health Metrics and EvaluationGina Agarwal - McMaster UniversityKareha M. Agesa - Institute for Health Metrics and EvaluationRakesh Aggarwal - Sanjay Gandhi Postgraduate Institute of Medical Sciences, IndiaSargis Aghasi Aghayan - Scientific Center of Zoology and HydroecologyAnurag Agrawal - Baylor College of MedicineAlireza Ahmadi - Kermanshah University of Medical SciencesMehdi Ahmadi - Ahvaz Jundishapur University of Medical SciencesHamid Ahmadieh - Shahid Beheshti University of Medical SciencesMuktar Beshir Ahmed - Jimma UniversitySayem Ahmed - International Centre for Diarrhoeal Disease ResearchAmani Nidhal Aichour - University Ferhat Abbas of SetifIbtihel Aichour - University Ferhat Abbas of SetifMiloud Taki Eddine Aichour - High National School of Veterinary Medicine, AlgeriaTomi F. Akinyemiju - University of KentuckyNadia Akseer - University of TorontoZiyad Al-Aly - Washington University in St. LouisAyman Al-Eyadhy - Pediatric Intensive Care Unit, United StatesHesham M. Al-Mekhlafi - Jazan UniversityRajaa Al-Raddadi - King Abdulaziz UniversityFares Alahdab - Mayo ClinicKhurshid Alam - The University of Western AustraliaTahiya Alam - Institute for Health Metrics and EvaluationAlaa Alashi - Cleveland ClinicSeyed Moayed Alavian - Baqiyatallah University of Medical SciencesKefyalew Addis Alene - Australian National UniversityMehran Alijanzadeh - Qazvin University of Medical SciencesReza Alizadeh-Navaei - Cancer Research Center, United StatesSyed M. Aljunid - University of KuwaitAla'A Alkerwi - Luxembourg Institute of HealthFrançois Alla - University of BordeauxPeter Allebeck - Swedish Research Council for Health Working Life and WelfareJordi Alonso - Hospital Del MarUbai Alsharif - Universitätsklinikum Knappschaftskrankenhaus BochumKhalid Altirkawi - King Saud UniversityNelson Alvis-Guzman - University of CartagenaLeopold N. Aminde - School of Public Health, United StatesErfan Amini - Tehran University of Medical SciencesMohammadreza Amiresmaili - Kerman University of Medical SciencesWalid Ammar - American University of BeirutYaw Ampem Amoako - Komfo Anokye Teaching HospitalNahla Anber - Mansoura UniversityCatalina Liliana Andrei - Carol Davila University of Medicine and PharmacySofia Androudi - University of ThessalyMegbaru Debalkie Animut - Arba Minch UniversityMina Anjomshoa - Rafsanjan University of Medical SciencesMustafa Geleto Ansha - Debre Berhan UniversityCarl Abelardo T. Antonio - Hong Kong Polytechnic UniversityPalwasha Anwari - Afghanistan National Immunization Technical Advisory Group, AfghanistanJalal Arabloo - Health Management and Economics Research Center, United StatesOlatunde Aremu - Birmingham City UniversityJohan Ärnlöv - Dalarna UniversityAmit Arora - Oral Health Services, AustraliaMegha Arora - Institute for Health Metrics and EvaluationAl Artaman - University of ManitobaKrishna Kumar Aryal - Schulman, Ronca & BucuvalasHamid Asayesh - School of Paramedical, IranZerihun Ataro - Haramaya UniversityMarcel Ausloos - University of LeicesterLeticia Avila-Burgos - Center for Health Systems Research, United StatesEuripide Frinel G. Arthur Avokpaho - Laboratory of Studies and Research-Action in Health, BeninAshish Awasthi - Public Health Foundation of IndiaBeatriz Paulina Ayala Quintanilla - La Trobe UniversityRakesh Ayer - The University of TokyoPeter S. Azzopardi - Burnet InstituteArefeh Babazadeh - Center for Infectious Diseases Research, IranHamid Badali - Mazandaran University of Medical SciencesKalpana Balakrishnan - Canada Department of Environmental Health Engineering, IndiaMohsen Mazidi - Chalmers University of TechnologyGBD 2017 DALYs and HALE CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.392(10159), pp.1859-1922
- DOI
- 10.1016/S0140-6736(18)32335-3
- PMID
- 30415748
- PMCID
- PMC6252083
- NLM abbreviation
- Lancet
- ISSN
- 1474-547X
- eISSN
- 1474-547X
- Language
- English
- Date published
- 11/10/2018
- Academic Unit
- Research Administration
- Record Identifier
- 9984949464202771
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