Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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Abstract

BACKGROUND: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS: Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet

Topic

COVID-19 and healthcare impacts

Field

Medicine

Canadian institutions

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Funders

Precursory Research for Embryonic Science and TechnologyNational Institute of Child Health and Human DevelopmentNational Institute on AgingDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaFundamental Research Funds for the Central UniversitiesErasmus Universitair Medisch Centrum RotterdamResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesUniversiti MalayaNational Drug and Alcohol Research CentreSalahaddin University-ErbilGastrointestinal and Liver Diseases Research CenterKing Abdullah University of Science and TechnologySydney Medical SchoolJapan Aerospace Exploration AgencyTamilnadu State Council For Science And TechnologyJapan Science and Technology AgencyFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilDirectorate for Computer and Information Science and EngineeringCanadian Institutes of Health ResearchDepartment of Epidemiology, Biostatistics and Occupational Health, McGill UniversityUniversità di CataniaAalborg UniversitetUniversity of California, San DiegoUniversidade Federal do Espírito SantoRussian Academy of SciencesUniversity of West AtticaImam Abdulrahman Bin Faisal UniversityNational Science and Technology CouncilMedical Research CouncilNational Institute of Pharmaceutical Education and Research, RaebareliNovo NordiskIntas PharmaceuticalsVirginia Commonwealth UniversityHumanitas Research HospitalInternational Association for Suicide PreventionImperial College LondonUniversity of NicosiaLovely Professional UniversityLaboratório Associado para a Química VerdeAXA Research FundIstituto Superiore di SanitàHubei UniversityNational Science FoundationCentro de Investigação em Tecnologias e Serviços de SaúdeUniversidade Federal de SergipeUniwersytet Śląski w KatowicachChongqing University of Science and TechnologyEuropean Regional Development FundLingnan UniversityFrankfurt University of Applied SciencesHubei University of MedicineMenzies Institute for Medical ResearchHellenic Foundation for Research and InnovationAjman UniversityUniversitas Gadjah MadaUniversity of PatrasNazarbayev UniversityServierPeking Union Medical CollegeEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentUniversity of BernUmweltbundesamtUniversitas HasanuddinMonash University MalaysiaEnvironmental Defense FundAustralian Catholic UniversityŚląski Uniwersytet Medyczny w KatowicachWestfälische Wilhelms-Universität MünsterGeorge Institute for Global HealthShahid Beheshti University of Medical SciencesMinistry of Science and ICT, South KoreaUniversity of PeradeniyaAgenzia Sanitaria e Sociale Regionale, Regione Emilia-RomagnaUniversidade Federal do Rio de JaneiroTarbiat Modares UniversityUniversità degli Studi di UdineEmory UniversityNanjing UniversityFondation BotnarNational Nutrition and Food Technology Research InstituteMinistry of Science and Higher Education of the Russian FederationTanta UniversityPeking UniversityTartu ÜlikoolEuropean Stroke OrganisationUniversity of NamibiaUniversitas MataramShaqra UniversityUniversity of AlbertaAllerganUniversidade Federal de Minas GeraisUniversity of PennsylvaniaChina Medical UniversityUniversity of Cape TownUniversity of JohannesburgSouthern Medical UniversityZagazig UniversityUniversidade Federal de Santa CatarinaCarolina Population Center, University of North Carolina at Chapel HillUniversidade do PortoUniversity College LondonCooperativa de Ensino Superior Politécnico e UniversitárioUmm Al-Qura UniversityFundação Oswaldo CruzHelsingin YliopistoAristotle University of ThessalonikiNational Research, Development and Innovation OfficeUniversitas IndonesiaSanofiUniversity of ThessalyUnited Arab Emirates UniversityBangladesh University of Health SciencesBahir Dar UniversityNational Heart, Lung, and Blood InstituteDire Dawa UniversityUniversidad de ChileUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversity of Health and Allied SciencesUniversidade de LisboaDeutsche ForschungsgemeinschaftUniversità Cattolica del Sacro CuoreNational Research University Higher School of EconomicsUniversidad Nacional Autónoma de MéxicoUniversity of KelaniyaUniversity of HaifaUniversity of Florida HealthUniversity of JordanUniversidade de São PauloGuilan University of Medical SciencesTehran Heart CenterSocialdepartementetNanjing University of Science and TechnologyInjury Prevention Research CenterBirjand University of Medical SciencesUniversitair Medisch Centrum GroningenFondazione CariploDirektorat Jenderal Pendidikan TinggiAstellas PharmaHouston Methodist HospitalUniversidade Federal do Rio Grande do SulChinese University of Hong KongCurtin University of TechnologyZahedan University of Medical SciencesNova Southeastern UniversityUniversität RegensburgHaramaya UniversityUniversity of South AfricaRijksuniversiteit GroningenTaipei Medical UniversityInyuvesi Yakwazulu-NataliUniversity of WaterlooKuwait UniversityUniversiteit StellenboschDalhousie UniversityChinese Center for Disease Control and PreventionTabriz University of Medical SciencesDivision of Mathematical SciencesQatar UniversityUniversitatea SapientiaMax-Planck-GesellschaftWarszawski Uniwersytet MedycznyKhalifa University of Science, Technology and ResearchScottish GovernmentKing Abdulaziz UniversityAmerican Association for the Study of Liver DiseasesKarolinska InstitutetEmerging Pathogens Institute, University of FloridaJordan University of Science and TechnologyUniversità di BolognaIsfahan University of Medical SciencesLinköpings UniversitetHjärt-LungfondenHangzhou Normal UniversityNational Research Foundation of KoreaChinese Academy of Medical SciencesFundación Valle del LiliWorld Health OrganizationUniversity of CanberraCairo UniversityCancer Institute NSWSaveetha Dental CollegeAmerican University of SharjahLunds UniversitetMinistry of Trade, Industry and EnergyGovernment of Jiangsu ProvinceMinistero della SaluteCentral South UniversityNational University of IrelandUniversiti Tun Hussein Onn MalaysiaStudent Research Committee, Tabriz University of Medical SciencesWashington University in St. LouisUniversity of AberdeenUniversidad Nacional de ColombiaAOSpineWellcome TrustChandigarh UniversityKorea UniversityGachon UniversityMongolian National University of Medical SciencesSeoul National UniversityUniversidad Autónoma de MadridBundesministerium für Bildung und ForschungUniversity of MichiganCooperative Research Centre for Contamination Assessment and Remediation of the EnvironmentTribhuvan UniversityQueensland University of TechnologyNorth Dakota State UniversitySemmelweis EgyetemJames Cook UniversityNanjing University of Chinese MedicineSungkyunkwan UniversityAhvaz Jundishapur University of Medical SciencesJazan UniversityChongqing UniversityGriffith UniversityUniversity of CreteAkademiska SjukhusetAhmadu Bello UniversityUniversity of South AustraliaInternational Hepato-Pancreato-Biliary AssociationMinistry of Education, Culture, Sports, Science and TechnologyQueensland GovernmentMinistry of Health and Family WelfareUniversitatea din BucureștiUniversity of New EnglandAmerican Diabetes AssociationUniversity College CorkIndian Council of Medical ResearchNational Institutes of HealthPfizerNational University of SingaporeNorges Teknisk-Naturvitenskapelige UniversitetNational Research FoundationMadda Walabu UniversityUniversity of ReadingRoyal Australian College of General PractitionersMinistry of EducationTeesside UniversityFresenius Medical Care North AmericaSocial Science Research CouncilUniversity of GlasgowDefense Threat Reduction AgencyUniversity of NottinghamApplied Molecular Biosciences UnitInternational Association for the Study of PainPublic Health Foundation of IndiaUniversity of LeedsKing's College LondonUniversity of TorontoJohns Hopkins UniversityUniversity of WarwickGillings School of Public HealthUniversity of QueenslandNational Institute for Health and Care ResearchMashhad University of Medical SciencesUniversity of New South WalesUniversity of PretoriaBGI GroupAfrican Population and Health Research CenterTechnische Universität BerlinAjou UniversityDirectorate for Biological SciencesSchweizerischer Nationalfonds zur Förderung der Wissenschaftlichen ForschungShanghai Jiao Tong UniversityKasturba Medical College, ManipalUniversitetet i BergenVistagen TherapeuticsUniversity of OxfordUniversidad de ColimaAin Shams UniversityBudapesti Corvinus EgyetemChalmers Tekniska HögskolaUniversity of EmbuSRM Institute of Science and TechnologyTehran University of Medical Sciences and Health ServicesU.S. Department of DefenseUniversity of Technology SydneyAgios PharmaceuticalsYork UniversityAmerican Heart AssociationUnited Nations Population FundBaqiyatallah University of Medical SciencesUK Research and InnovationBeni-Suef UniversityEuropean CommissionConselho Nacional de Desenvolvimento Científico e TecnológicoAnglia Ruskin UniversityQueen Elizabeth Hospital Birmingham CharityDuke-NUS Medical SchoolKorea Institute for Advancement of TechnologyLegal Aid New South WalesWarwick Medical SchoolDeutsches KrebsforschungszentrumNational Cancer InstituteAmicus TherapeuticsDepartment of Health and Social CareQueen's UniversityIstituto di Ricerche Farmacologiche Mario Negri - IRCCSCharotar University of Science and TechnologyTomsk Polytechnic UniversityEli Lilly and CompanyFlinders UniversityBoston Scientific CorporationMonash UniversityKing Saud UniversityHealth CanadaSultan Qaboos UniversityInternational Society of Travel MedicineUniversitas PadjadjaranUniversity of TabrizBadan Riset dan Inovasi NasionalICAR-Indian Veterinary Research InstituteAmgenYonsei UniversityYale UniversityBirzeit UniversityMcMaster UniversityUniversiti Kebangsaan MalaysiaConquer Cancer FoundationUniversity of Nevada, Las VegasFaculty of Medicine and Health, University of SydneySanofi GenzymeNational Taiwan Normal UniversityUniversiti Sains MalaysiaUniversity of South FloridaUniversity of WindsorHarvard UniversityIdorsia PharmaceuticalsGeneralitat de CatalunyaAlexandria UniversityMcGill UniversityUniwersytet WarszawskiKeio UniversityAuckland University of Technology, New ZealandUniversità degli Studi di MilanoBayerHamad Medical CorporationUniversity of OtagoKorean Diabetes AssociationIndian Council of Agricultural ResearchUniversity of RochesterUniwersytet OpolskiSchool of Public Health and Family Medicine, University of Cape TownUniversitas AirlanggaCentre International de Recherche sur le CancerMassachusetts General HospitalUniversity of MontanaBiogenChildren's Hospital of PhiladelphiaRede de Química e TecnologiaBrigham and Women's HospitalJapan Society for the Promotion of ScienceUniversity of MinnesotaFlorida International UniversityAlexion PharmaceuticalsDurban University of TechnologyUniversidade Federal de PernambucoWest Virginia UniversityUniversità degli Studi di GenovaHarvard Business SchoolHouston Methodist Research InstituteIran University of Medical SciencesKurdistan University Of Medical SciencesUniversidade de PernambucoBundesministerium für GesundheitU.S. Department of Veterans AffairsMansoura UniversityWayne State UniversityFlorida Department of HealthFudan UniversityCase Western Reserve UniversityCity University of Hong KongNorwegian Institute of Public HealthUniversity of TasmaniaTeva Pharmaceutical IndustriesAstraZenecaEdwards LifesciencesWestern Sydney UniversityBrown UniversityEkiti State UniversityUniversitat Politècnica de CatalunyaU.S. Environmental Protection AgencyDepartment of Radiology and Biomedical Imaging, University of California, San FranciscoH. Lundbeck A/SCoventry UniversityLondon School of Economics and Political ScienceUniversiti Brunei DarussalamSouth African Medical Research CouncilNew Zealand GovernmentHelmholtz Zentrum MünchenBristol-Myers SquibbUppsala UniversitetUniversity of the Western CapeJamia Millia IslamiaUnited States Agency for International DevelopmentJimma UniversityUniversity of PortsmouthBill and Melinda Gates FoundationUniversità degli Studi dell'AquilaUniversity of WashingtonSt. Baldrick's FoundationInternational Society for Infectious DiseasesIndiviorAarhus UniversitetUniversidad El BosqueGAVI AllianceMoscow Institute of Physics and Technology

Keywords

Life expectancyIncidence (geometry)MedicineDemographyYears of potential life lostGerontologyEnvironmental healthPopulation

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