ArticlesGlobal, 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
Introduction
The Global Burden of Disease study 2013 (GBD 2013) seeks to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to allow comparisons of health loss to be made over time and across causes, age–sex groups, and geographies. The GBD 2013 data for disease and injury incidence and prevalence, years lived with disability (YLDs), causes of death, and years of life lost because of premature mortality (YLLs) for 188 countries provide an opportunity to assess the effect of recent changes in population health by examining summary measures of health loss attributed to specific causes, expressed in DALYs, and summary measures of average population health, expressed as HALE.1, 2 These measures are crucial to track health progress, strengthen policy decisions, assess programme effects and results, and inform health service and research priorities. Such holistic measures of population health, encompassing both disability and mortality levels and patterns in populations, are also attracting interest as part of the discussion around the Sustainable Development Goals .3, 4, 5
A hallmark of the GBD approach is an emphasis on making national data easier to compare by taking into account the extensive variation that exists in national medical certification and cause of death coding practices and widely varying case definitions and measurement methods used to track the incidence and prevalence of diseases and injuries.1, 2 The GBD not only provides detailed metrics for specific causes, but also generates summary measures, such as DALYs and HALE, which enable comparative assessments of broad epidemiological patterns across countries and different time periods. HALE is a useful summary of overall health for a country and DALYs allow assessment of both premature mortality and non-fatal outcomes by cause. These broad summary measures allow quantification of general trends, such as the epidemiological transition, while also making clear how countries and regions deviate from general patterns.6, 7, 8, 9 The unfolding of the HIV epidemic and the rise of adult mortality, especially among men in Eastern Europe and Central Asia, have called into question the notion of a universal pattern of epidemiological change that occurs with sociodemographic development.2, 10, 11, 12, 13 However, the general notion of a shift from communicable to non-communicable causes of disease burden and injuries remains a powerful framework for global and regional health policy debates.9, 14, 15, 16, 17, 18 The GBD provides an opportunity to quantify these patterns and explore the extent to which epidemiological change is driven by sociodemographic change, reduction of health risks, improvement of health management, or other local factors.
GBD 2013 results for deaths, YLLs, incidence, prevalence, and YLDs by cause for 1990 to 2013 for 188 countries have already been published.1, 2 In this study we use these GBD 2013 results to calculate DALYs and HALE. These summary metrics are used to characterise broad patterns of lost healthy life and cross-country variations within these patterns. The GBD 2013 provides a complete re-analysis of each country's data from 1990 to 2013 and thus supersedes all previously published GBD analyses of DALYs and HALE.
Section snippets
Study design
GBD 2013 uses a hierarchy of causes that organises 306 diseases and injuries into four levels of classification, the rationale for which has been described previously.2, 19 The first level distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level 2 has 21 mutually exclusive and collectively exhaustive categories, level 3 has 163 categories, and level 4 has 254 categories. The full cause
Global
Global life expectancy at birth for both sexes combined increased from 65·3 years (95% UI 65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, whereas during the same interval, HALE at birth for both sexes combined increased from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8). The survivorship curves shift up and to the right with increasing quintiles of country sociodemographic status (figure 1). In the three groups of countries, defined as the lowest, middle three, and highest quintiles of
Discussion
Global health is improving: life expectancy at birth rose by 6·2 years between 1990 and 2013, while HALE at birth increased by 5·4 years during the same interval; worldwide, age-standardised DALY rates fell by 27%. Global progress has accelerated since 2005 because of major reductions in HIV/AIDS and malaria, in addition to continued progress against other major communicable, maternal, neonatal, and nutritional disorders. Although the total volume of DALYs is down by only 3·6% over the 23 year
References (60)
- et al.
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) - et al.
Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010
Lancet
(2012) - et al.
Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
(2014) - et al.
Emergence of chronic non-communicable diseases in China
Lancet
(2008) - et al.
Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010
Lancet
(2013) - et al.
GBD 2010: design, definitions, and metrics
Lancet
(2012) - 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) - et al.
Mortality trends and setbacks: global convergence or divergence?
Lancet
(2004) - et al.
Late stages of epidemiological transition: health status in the developed world
Health Place
(1999) - et al.
Trends and heterogeneity of cardiovascular disease and risk factors across Latin American and Caribbean countries
Prog Cardiovasc Dis
(2014)
Low socioeconomic status of a patient's residential area is associated with worse prognosis after acute myocardial infarction in Sweden
Int J Cardiol
Inequalities in non-communicable diseases and effective responses
Lancet
Inequalities in death—specific explanations of a general pattern?
Lancet
Health inequalities among British civil servants: the Whitehall II study
Lancet
Low socioeconomic status increases short-term mortality of acute myocardial infarction despite universal health coverage
Int J Cardiol
Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis
Lancet
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
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
Healthy planet, healthy people: The NCD alliance vision for health in the post-2015 development agenda
Open working group proposal for Sustainable development goals
Sustainable Development Goals and indicators for a small planet—Part II: Measuring sustainability
A critical examination of summary measures of population health
Bull World Health Organ
The development and experience of epidemiological transition theory over four decades: a systematic review
Glob Health Action
Epidemiologic transition interrupted: a reassessment of mortality trends in Thailand, 1980–2000
Int J Epidemiol
Is public health between East and West? Analysis of wealth, health and mortality in Austria, Central and Eastern European Countries and Croatia relative to the European Union
Croat Med J
Mortality trends in a new South Africa: hard to make a fresh start
Scand J Public Health Suppl
Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity
Public Health Nutr
Prevention and control of non-communicable diseases: Report of the Secretary General
2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases : Prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes
Integrated Metaregression Framework for Descriptive Epidemiology
Cited by (0)
- *
Collaborators listed at the end of the Article
- *
Authors listed alphabetically.
- †
Joint senior authors.