Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

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Abstract

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet

Topic

Health disparities and outcomes

Field

Social Sciences

Canadian institutions

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Funders

Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIH Clinical CenterNational Institute on Deafness and Other Communication DisordersNational Institute of Mental HealthNational Heart, Lung, and Blood InstituteFaculty of Medicine and Health, University of SydneyDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaNIHR Oxford Biomedical Research CentreBiomedical Research CouncilNational Institute of Diabetes and Digestive and Kidney DiseasesInstituto de Salud Carlos IIIQueensland Brain InstituteSydney Medical SchoolMedical Research CouncilDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthUniversity of Colorado DenverUniversity of California, IrvineJohns Hopkins Bloomberg School of Public HealthUniversity of North Carolina at Chapel HillUniformed Services University of the Health SciencesUniversity of California, Los AngelesCollege of Engineering, Michigan State UniversityCenters for Disease Control and PreventionUniwersytet OpolskiDebre Tabor UniversityDirectorate for Biological SciencesDebre Markos UniversityDamietta UniversityUniversity of PeradeniyaGeorge Institute for Global HealthAlfaisal UniversityUniversidade do PortoUniversitas Muhammadiyah SurakartaI.M. Sechenov First Moscow State Medical UniversityKurdistan University Of Medical SciencesLorestan University of Medical SciencesUniversity of ThessalyMcGill UniversityAlexandria UniversityUniversidade Federal do Rio Grande do SulUniversity of ColomboMansoura UniversityInternational Centre for Diarrhoeal Disease Research, BangladeshUniversity of Social Welfare and Rehabilitation SciencesChungnam National UniversityNanjing UniversityWestern Sydney UniversityTartu ÜlikoolShiraz University of Medical SciencesFakultet Medicinskih Nauka, Univerziteta U KragujevcuUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiChungnam National University HospitalUniversity of the PhilippinesUniversity of OtagoUniversità degli Studi di MilanoPomorski Uniwersytet Medyczny W SzczecinieUniversidade Federal de Minas GeraisCarolina Population Center, University of North Carolina at Chapel HillUniversity of OxfordMenzies Health Institute QueenslandNational Research University Higher School of EconomicsUniversity of Cape TownAddis Ababa UniversityUniversità degli Studi di SalernoCentro de Investigación Biomédica en Red de Salud MentalUniversity of DhakaAristotle University of ThessalonikiLee Kong Chian School of Medicine, Nanyang Technological UniversityMedical University - VarnaUniversità di BolognaUniversity of Health and Allied SciencesUniversidade de LisboaFlinders UniversityUniversität BielefeldUniversidade de São PauloHacettepe ÜniversitesiQueensland University of TechnologyUniversidad de Costa RicaUmeå UniversitetNational Institute on AgingChinese University of Hong KongMinistry of Health and Medical EducationHaramaya UniversityXiamen UniversityTechnische Universität MünchenUniversité de BourgogneNational Taiwan UniversityTehran University of Medical Sciences and Health ServicesChinese Center for Disease Control and PreventionTel Aviv UniversityAmerican University of BeirutVetenskapsrådetUniversidad Autónoma MetropolitanaSeoul National University HospitalUniversità degli Studi di FirenzeBispebjerg HospitalTsinghua UniversityKing Fahd University of Petroleum and MineralsKarolinska InstitutetUniversiti MalayaIsfahan University of Medical SciencesUniversity College LondonKorea Health Industry Development InstituteKarl-Franzens-Universität GrazUniversitat de ValènciaHebrew University of JerusalemUniversity of CanberraCairo UniversityLunds UniversitetBundesministerium für GesundheitWolkite UniversityDonau-Universität KremsNorthwestern UniversityUniversity of WashingtonUniversity of BristolUniversidad Nacional de ColombiaAin Shams UniversityNational Drug and Alcohol Research CentreFriedrich-Schiller-Universität JenaNational and Kapodistrian University of AthensThomas Jefferson UniversityLaboratório Associado para a Química VerdeUniversity of MelbourneUniversity of New South WalesCleveland ClinicUniversity College CorkSwansea UniversityTrường Đại học Nguyễn Tất ThànhNational Institutes of HealthBanaras Hindu UniversityNational University of SingaporeStudent Research Committee, Tabriz University of Medical SciencesFrankfurt University of Applied SciencesLa Trobe UniversityCochrane South AfricaImperial College LondonPublic Health EnglandAustralian Catholic UniversityChalmers Tekniska HögskolaUniwersytet Jagielloński Collegium MedicumShiraz UniversityKing's College LondonUniversity of LeicesterBritish Heart FoundationUniversity of QueenslandNational Institute for Health and Care ResearchUniversity of South FloridaUniversity of NamibiaUniwersytet ŁódzkiMaragheh University of Medical SciencesNational Center of Neurology and PsychiatryTribhuvan UniversityWorld Health OrganizationUrmia UniversityUniversity of EmbuUniversitas Negeri SemarangAhmadu Bello UniversityInyuvesi Yakwazulu-NataliAnglia Ruskin UniversityQueen Elizabeth Hospital Birmingham CharityJackson State UniversityUniversity of SouthamptonIstituto di Ricerche Farmacologiche Mario Negri - IRCCSUniversiti Sains MalaysiaUniversity of CreteCurtin University of TechnologyBill and Melinda Gates FoundationWuhan UniversityHögskolan DalarnaDuke Kunshan UniversityRede de Química e TecnologiaTulane UniversityArak University of Medical SciencesKorea UniversityWellcome TrustOhio State UniversityJohns Hopkins UniversityNational Center for Global Health and MedicineGriffith UniversityMuhimbili University of Health and Allied SciencesApplied Molecular Biosciences UnitIran University of Medical SciencesSaint Paul's Hospital Millennium Medical CollegeLondon School of Economics and Political SciencePublic Health Agency of CanadaAksum UniversityUniversidade Federal de SergipeUniversity of California, San DiegoHamadan University of Medical SciencesSouth Australian Health and Medical Research InstituteSamara UniversityJordan University of Science and TechnologyNational Cerebral and Cardiovascular CenterNational Health Research InstitutesUniversity of West FloridaU.S. Department of Veterans AffairsNorwegian Institute of Public HealthUnited Nations Population FundRafsanjan University of Medical SciencesSeattle Children's Research InstituteYale UniversityJimma UniversityHarvard UniversityDeutsches KrebsforschungszentrumKyung Hee UniversitySeoul National UniversityBurnet InstituteUniversity of RochesterNanyang Technological UniversityAuckland University of Technology, New ZealandPublic Health AgencyUniverzita Komenského v BratislaveKaiser PermanenteUniversity of AlbertaUniversity of LouisvilleTampereen YliopistoDuke Global Health Institute, Duke UniversityUniversitetet i BergenNova Southeastern UniversityInstitut National de la Santé et de la Recherche MédicaleArizona State UniversityBrandeis UniversityUniversidad de ChileUniversity of BernEmory UniversityHelsingin YliopistoRMIT UniversityMedizinische Universität GrazBahir Dar UniversityNational Center for Child Health and DevelopmentSimmons CollegeBirmingham City UniversitySavitribai Phule Pune UniversityBabol University of Medical SciencesMichigan State UniversityUniversity of GlasgowTrường Đại học Duy Tân

Keywords

Incidence (geometry)Burden of diseaseMedicineDiseaseEnvironmental healthDemographyGeographyPathology

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yes

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