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

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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 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 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). 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. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet

Topic

Insurance, Mortality, Demography, Risk Management

Field

Social Sciences

Canadian institutions

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Funders

Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institute on Deafness and Other Communication DisordersNational Institute of Mental HealthDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaErasmus Universitair Medisch Centrum RotterdamCenter for International HealthResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesQueensland Brain InstituteSydney Medical SchoolNational Health and Medical Research CouncilMedical Research CouncilDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthUniversity of California, Los AngelesSeqirusCollege of Engineering, Michigan State UniversityFriedrich Schiedel Stiftung für EnergietechnikWolkite UniversityUniwersytet OpolskiUniversidad de Ciencias Aplicadas y AmbientalesDebre Tabor UniversityAbbott DiagnosticsDirectorate for Biological SciencesDebre Markos UniversityUniversitair Ziekenhuis AntwerpenAlfaisal UniversityLaboratório Associado para a Química VerdeWestern Sydney UniversityMinistry of Health of the Russian FederationBispebjerg HospitalUniversidade Federal de SergipeUniversidad de ExtremaduraDuke Kunshan UniversityI.M. Sechenov First Moscow State Medical UniversityKurdistan University Of Medical SciencesWageningen University and ResearchSamara UniversityH. Lundbeck A/SUniversity of NamibiaLorestan University of Medical SciencesAlborz University of Medical SciencesSavitribai Phule Pune UniversityUniversity of ThessalyFakultet Medicinskih Nauka, Univerziteta U KragujevcuCharotar University of Science and TechnologyAlexandria UniversityHawassa UniversityNational Center of Neurology and PsychiatryMekelle UniversityMansoura UniversityGeorge Institute for Global HealthUniversity of PeradeniyaXiamen UniversityNSW Ministry of HealthTartu ÜlikoolUniversity of TabrizChungnam National University HospitalUniversity of the PhilippinesUrmia UniversityNational Research University Higher School of EconomicsUniversity of Cape TownUniversità degli Studi di SalernoServierWuhan UniversityUniversitas Muhammadiyah SurakartaUniversidade do PortoCentro de Investigación Biomédica en Red de Salud MentalUniversity of TsukubaUniversity of DhakaUniversity of Social Welfare and Rehabilitation SciencesFundação Oswaldo CruzNational Taiwan UniversityQazvin University of Medical SciencesUniversité de BordeauxHospital for Sick ChildrenBahir Dar UniversityGolestan University of Medical SciencesUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiShahid Beheshti University of Medical SciencesNIH Clinical CenterBaqiyatallah University of Medical SciencesHögskolan DalarnaUniversity of HailUniversitat de BarcelonaUniversity of Health and Allied SciencesUniversidade de LisboaGöteborgs UniversitetUniversity of HaifaMenzies Institute for Medical ResearchBabol University of Medical SciencesTechnische Universität MünchenUniversidade de São PauloGuilan University of Medical SciencesHacettepe ÜniversitesiUniversitetet i OsloNational and Kapodistrian University of AthensVersus ArthritisUniversitair Medisch Centrum GroningenMichigan State UniversityAstellas PharmaUmeå UniversitetNational Institute on AgingChinese University of Hong KongPublic Health Agency of CanadaKerman University of Medical SciencesEuratom Research and Training ProgrammeKuwait UniversityUniversidad Autónoma MetropolitanaSeoul National University HospitalAmerican University of BeirutVetenskapsrådetHebrew University of JerusalemNovo NordiskTsinghua UniversityKarolinska InstitutetUniversitat de ValènciaGeorg-August-Universität GöttingenUniversity of CanberraLunds UniversitetBundesministerium für GesundheitNational Institutes of HealthBanaras Hindu UniversityKyung Hee UniversityU.S. Department of Veterans AffairsKosin UniversityThe Wellcome Trust DBT India AllianceNanjing UniversityChungnam National UniversityAin Shams UniversityCochrane South AfricaUniversity of TorontoImperial College LondonPublic Health EnglandUniversiti Sains MalaysiaKing Khalid UniversityCurtin University of TechnologyHelsingin YliopistoRMIT UniversityDeakin UniversityYork UniversityUniversity of Technology SydneyUniversidad del ValleKermanshah University of Medical SciencesUniversity of New South WalesUniversitat Pompeu FabraSun Yat-sen UniversityInstitut National de la Santé et de la Recherche MédicalePublic Health AgencyMuhimbili University of Health and Allied SciencesApplied Molecular Biosciences UnitPublic Health Foundation of IndiaUniversidad de ChileDepartment of Biotechnology, Ministry of Science and Technology, IndiaUniversity of TasmaniaStudent Research Committee, Tabriz University of Medical SciencesFrankfurt University of Applied SciencesLa Trobe UniversityNational Heart Foundation of AustraliaAustralian Catholic UniversityUniversity of GlasgowMenzies Health Institute QueenslandSanofiUniversity of OxfordJackson State UniversityUniversity of SouthamptonLomonosov Moscow State UniversityUniversity of QueenslandNational Institute for Health and Care ResearchUniversity College LondonUniversiti Kebangsaan MalaysiaKorea Health Industry Development InstituteNovavaxUniversity of ChichesterUniversitas Negeri SemarangKing's College LondonSree Chitra Tirunal Institute for Medical Sciences and TechnologyBrien Holden Vision InstituteKrishna Institute Of Medical Sciences Deemed To Be UniversityUniversity of EmbuEuropean CommissionEUROfusionAhmadu Bello UniversityInyuvesi Yakwazulu-NataliAnglia Ruskin UniversityQueen Elizabeth Hospital Birmingham CharityUniversität BielefeldFlinders UniversityOklahoma State UniversityInvasive Fungi Research Center, Mazandaran University of Medical SciencesIndiviorMurdoch Children's Research InstituteNorges Teknisk-Naturvitenskapelige UniversitetLawson Health Research InstituteScottish GovernmentKing Abdulaziz UniversityCase Western Reserve UniversityFudan UniversityValeant Pharmaceuticals InternationalAn-Najah National UniversityAksum UniversityUniversity of WarwickOhio State UniversityJohns Hopkins UniversityKorea UniversityWellcome TrustUniversity of OttawaNIHR Oxford Biomedical Research CentreUniversität UlmHorizon PharmaceuticalsTampereen YliopistoTabriz University of Medical SciencesDuke Global Health Institute, Duke UniversityUniversitetet i BergenNova Southeastern UniversityChest Research FoundationJordan University of Science and TechnologyNational Cerebral and Cardiovascular CenterNational Health Research InstitutesUniversity of West FloridaUniversity of LeicesterMcMaster UniversitySeoul National UniversityBurnet InstituteUniversity of Massachusetts BostonUniversity of ColomboUniversidade Federal do Rio Grande do SulSeattle Children's Research InstituteArabian Gulf UniversityLondon School of Economics and Political ScienceFaculty of Medicine and Health, University of SydneyUniversiti Brunei DarussalamNorwegian Institute of Public HealthUnited Nations Population FundRafsanjan University of Medical SciencesUniwersytet Jagielloński Collegium MedicumUniversity of California, IrvineUniversität BaselSveučilište u ZagrebuUniversité de LorraineUniversity of South FloridaHarvard UniversityDeutsches KrebsforschungszentrumTaipei Medical UniversityTel Aviv UniversityInternational Medical UniversityAristotle University of ThessalonikiIslamic Azad UniversityWest Virginia UniversityBournemouth UniversityUniwersytet ŁódzkiMaragheh University of Medical SciencesUniversity of RochesterNanyang Technological UniversityAuckland University of Technology, New ZealandPomorski Uniwersytet Medyczny W SzczecinieBayerUniversità degli Studi di MilanoUniversity of OtagoQueensland University of TechnologyUniversidad de Costa RicaUniversità di BolognaDrexel UniversityUniversitetet i TromsøEconomic and Social Research CouncilSanjay Gandhi Postgraduate Institute of Medical SciencesUniversity of LouisvilleIran University of Medical SciencesJazan UniversityAhvaz Jundishapur University of Medical SciencesGriffith UniversityRede de Química e TecnologiaTulane UniversityUniversity of OklahomaBrandeis UniversityNational Center for Global Health and MedicineUniversiteit GentBill and Melinda Gates FoundationInjury Prevention Research CenterHáskólinn í ReykjavíkPfizerUniversity of BristolUniversity of WashingtonUniverzita Komenského v BratislaveKing Fahd University of Petroleum and MineralsDurban University of TechnologySaint Paul's Hospital Millennium Medical CollegeAarhus UniversitetWashington University in St. LouisSouthern University of Science and TechnologyBristol-Myers SquibbDelhi Technological UniversityUniversità degli Studi di FirenzeDanoneLee Kong Chian School of Medicine, Nanyang Technological UniversityMedical University - VarnaSchool of Medicine, Boston UniversityUniversiti MalayaIsfahan University of Medical SciencesInstituto de Salud Carlos IIISan Diego State UniversityNational Drug and Alcohol Research CentreFriedrich-Schiller-Universität JenaAmgenNational Heart, Lung, and Blood InstituteAstraZenecaMoscow Institute of Physics and TechnologyEmory UniversityChildren’s Hospital of Wisconsin Research InstituteYale UniversityBirmingham City UniversityNorth-West UniversityKing Saud UniversitySimmons CollegeNational Center for Child Health and DevelopmentMazandaran University of Medical SciencesMinistry of Health and Medical EducationUniversity of AlbertaKaiser PermanenteUniversidade Federal de Santa CatarinaUniversity of the PunjabMashhad University of Medical SciencesBiomedical Research CouncilGilead SciencesChinese Center for Disease Control and PreventionGeorge Mason UniversityShanghai Jiao Tong UniversityUniversity College CorkCleveland ClinicUniversidad Nacional de ColombiaNorthwestern UniversityUniversity of California, San DiegoHamadan University of Medical SciencesSouth Australian Health and Medical Research InstituteHamad Medical CorporationTrường Đại học Nguyễn Tất ThànhUniversidade Federal de Minas GeraisAlzheimer's AssociationDamon Runyon Cancer Research Foundation

Keywords

Life expectancyGlobal healthQuality-adjusted life yearMedicineEnvironmental healthGerontologyDemographyGeographySocioeconomicsEconomic growthPublic healthEconomicsSociologyCost effectivenessPopulation

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