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
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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.
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The record
- Venue
- The Lancet
- Topic
- Health disparities and outcomes
- Field
- Social Sciences
- Canadian institutions
- —
- Funders
- Institute of Infection and ImmunityNational Institute on Minority Health and Health DisparitiesNational Institute of Environmental Health SciencesNational Drug and Alcohol Research CentreWarwick Medical SchoolRussian Academy of SciencesEconomic and Social Research CouncilPlan Nacional sobre DrogasUniversity of Oklahoma Health Sciences CenterMinistry of Health of the Russian FederationINCLIVA Instituto de Investigación SanitariaArak University of Medical SciencesDuke Kunshan UniversityAfrican Population and Health Research CenterMansoura UniversityUniversidade do PortoUniversity of HailNanjing UniversityUniversity of GondarMedical Research CouncilSri Ramachandra UniversityUppsala UniversitetCentro de Investigación Biomédica en Red de Salud MentalJames Cook UniversityAristotle University of ThessalonikiNational Center for Child Health and DevelopmentBahir Dar UniversityRijksuniversiteit GroningenWuhan UniversityHögskolan DalarnaGöteborgs UniversitetUniversidade de São PauloRigshospitaletAustralian National UniversityUniversitair Medisch Centrum GroningenUniversitetet i BergenUniversidade Federal de SergipeQueen Mary University of LondonHaramaya UniversityTehran University of Medical Sciences and Health ServicesUniversity of OklahomaNational Taiwan UniversityUniversity of CreteAddis Ababa UniversityUniversidad Autónoma MetropolitanaMinistry of Health and Medical EducationMazandaran University of Medical SciencesUniversitetet i OsloUniversitat de ValènciaUniversidad Nacional de ColombiaUniversity of Massachusetts BostonSeoul National UniversitySamfundet FolkhälsanMcGill UniversityUniversity of North Carolina at Chapel HillPublic Health AgencyUniversität BielefeldUniversiteit MaastrichtPublic Health EnglandWageningen University and ResearchPublic Health Foundation of IndiaUniversity of OxfordRMIT UniversityUniversity of WarwickUniversity of LeicesterQueen Elizabeth Hospital Birmingham CharityUniversitat de BarcelonaPublic Health Agency of CanadaWellcome TrustMekelle UniversityLa Trobe UniversityUniversidade Federal do Rio Grande do SulArabian Gulf UniversityNational Research University Higher School of EconomicsUniversidad de Costa RicaOttawa Hospital Research InstituteImperial College LondonKing's College LondonSree Chitra Tirunal Institute for Medical Sciences and TechnologyPostgraduate Institute of Medical Education and Research, ChandigarhDeutsches KrebsforschungszentrumAuckland University of Technology, New ZealandUniversity of OtagoUniversity of DelhiBrandeis UniversityUniversity of PeradeniyaGeorgetown UniversityNational Institute for Health and Care ResearchUniversity of LouisvilleSanjay Gandhi Postgraduate Institute of Medical SciencesIstituto di Ricerche Farmacologiche Mario Negri - IRCCSBrien Holden Vision InstituteUniversity of California, San FranciscoUniversitetet i TromsøAarhus UniversitetUniversity of the PhilippinesLeibniz-GemeinschaftUniversität BaselBill and Melinda Gates FoundationUniversità di BolognaNational Institute on AgingJackson State UniversitySouth Australian Health and Medical Research InstituteAnglia Ruskin UniversityU.S. Department of Health and Human ServicesKurdistan University Of Medical SciencesUnited States Agency for International DevelopmentOhio State UniversityMassachusetts General HospitalChildren's Hospital of MichiganUniversity of New South WalesYale University
- Keywords
- Life expectancyBurden of diseaseEpidemiological transitionYears of potential life lostEpidemiologyDisability-adjusted life yearDisease burdenEnvironmental healthDemographyPer capitaGlobal healthPopulationMedicineNon-communicable diseaseQuality-adjusted life yearPublic healthCost effectiveness
- Has abstract in OpenAlex
- yes