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
Journal article, 2018
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 lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c 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 Sociodemographic 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 ?ve 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.
mortality rate
disease
disablility-adjusted life
quality-adjusted life years
Author
Hmwe Hmwe Kyu
University of Washington
Institute for Health Metrics and Evaluation
Degu Abate
Haramaya University
Kalkidan Hassen Abate
Jimma University
Solomon M. Abay
Addis Ababa University
Cristiana Abbafati
Sapienza University of Rome
Nooshin Abbasi
Tehran University of Medical Sciences
McGill University
Hedayat Abbastabar
Tehran University of Medical Sciences
Foad Abd-Allah
Cairo University
Jemal Abdela
School of Pharmacy
Ahmed Abdelalim
Cairo University
Ibrahim Abdollahpour
Multiple Sclerosis Research Center
Arak University of Medical Sciences
Rizwan Suliankatchi Abdulkader
Manonmaniam Sundaranar University
Molla Abebe
University of Gondar
Zegeye Abebe
University of Gondar
Olifan Zewdie Abil
Wollega University
University of Medical Sciences
Victor Aboyans
University of Limoges
Hopital Dupuytren
Aklilu Roba Abrham
Haramaya University
Laith J. Abu-Raddad
Weill Cornell Medicine-Qatar
Niveen M.E. Abu-Rmeileh
Birzeit University
Manfred Mario Kokou Accrombessi
Bénin Clinical Research Institute
Dilaram Acharya
Kathmandu University
Dongguk University
Pawan Acharya
Nepal Development Society
Ilana N. Ackerman
Monash University
Abdu A Adamu
South African Medical Research Council
Stellenbosch University
Oladimeji M. Adebayo
University College Hospital
Victor Adekanmbi
Cardiff University
Zanfina Ademi
Monash University
Olatunji Adetokunboh
Stellenbosch University
South African Medical Research Council
Mina G. Adib
Saint Mark Hospital
Jose C. Adsuar
Sport Science Department
Kossivi Agbelenko Afanvi
University of Lomé
Ministry of Health and Social Protection
Mohsen Afarideh
Tehran University of Medical Sciences
Ashkan Afshin
Institute for Health Metrics and Evaluation
Gina Agarwal
McMaster University
Kareha M. Agesa
Institute for Health Metrics and Evaluation
Rakesh Aggarwal
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Sargis Aghasi Aghayan
Yerevan State University
Scientific Center of Zoology and Hydroecology
Anurag Agrawal
Institute of Genomics and Integrative Biology
Baylor College of Medicine
Alireza Ahmadi
Kermanshah University of Medical Sciences
Mehdi Ahmadi
Ahvaz, Jundishapur University of Medical Sciences
Hamid Ahmadieh
Shahid Beheshti University of Medical Sciences
Muktar Beshir Ahmed
Jimma University
Sayem Ahmed
Karolinska Institutet
International Centre for Diarrhoeal Disease Research Bangladesh
Amani Nidhal Aichour
University Ferhat Abbas of Setif
Ibtihel Aichour
University Ferhat Abbas of Setif
Miloud Taki Eddine Aichour
High National School of Veterinary Medicine
Tomi F. Akinyemiju
University of Kentucky
Nadia Akseer
Hospital for Sick Children University of Toronto
Ziyad Al-Aly
VA St Louis Health Care System
Washington University in St. Louis
Ayman Al-Eyadhy
Pediatric Intensive Care Unit
Hesham M. Al-Mekhlafi
Sana'a University
Jazan University
Rajaa Al-Raddadi
King Abdulaziz University
Fares Alahdab
Mayo Clinic
Khurshid Alam
University of Western Australia
Tahiya Alam
Institute for Health Metrics and Evaluation
Alaa Alashi
Cleveland Clinic Foundation
Seyed Moayed Alavian
Baqiyatallah University of Medical Sciences
Kefyalew Addis Alene
University of Gondar
Australian National University
Mehran Alijanzadeh
Qazvin University of Medical Sciences
Reza Alizadeh-Navaei
Cancer Research Center
Syed M. Aljunid
National University of Malaysia
University of Kuwait
Ala'A Alkerwi
Luxembourg Institute of Health
François Alla
University of Bordeaux
Peter Allebeck
Karolinska Institutet
Forte
Jordi Alonso
University Pompeu Fabra
Hospital del Mar Medical Research Institute
Ubai Alsharif
Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH
Khalid Altirkawi
King Saud University
Nelson Alvis-Guzman
University of the Coast
University of Cartagena
Leopold N. Aminde
School of Public Health
Erfan Amini
Tehran University of Medical Sciences
Mohammadreza Amiresmaili
Kerman University of Medical Sciences
Walid Ammar
Federal Ministry of Health
American University of Beirut
Yaw Ampem Amoako
Komfo Anokye Teaching Hospital
Nahla Anber
Mansoura University
Catalina Liliana Andrei
Carol Davila University of Medicine and Pharmacy
Sofia Androudi
University of Thessaly
Megbaru Debalkie Animut
Arba Minch University
Mina Anjomshoa
Tehran University of Medical Sciences
Rafsanjan University of Medical Sciences
Mustafa Geleto Ansha
Debre Berhan University
Carl Abelardo T. Antonio
University of the Philippines Manila
Hong Kong Polytechnic University
Palwasha Anwari
Afghanistan National Immunization Technical Advisory Group
Jalal Arabloo
Health Management and Economics Research Center
Olatunde Aremu
Birmingham City University
Johan Ärnlöv
Karolinska Institutet
Dalarna university
Amit Arora
School of Science and Health
Oral Health Services
Megha Arora
Institute for Health Metrics and Evaluation
Al Artaman
University of Manitoba
Krishna Kumar Aryal
Abt Associates Nepal
Hamid Asayesh
School of Paramedical
Zerihun Ataro
Haramaya University
Marcel Ausloos
University Of Leicester
Leticia Avila-Burgos
Center for Health Systems Research
Euripide Frinel G. Arthur Avokpaho
Laboratory of Studies and Research-Action in Health
Ashish Awasthi
Indian Institute of Public Health
Public Health Foundation of India
Beatriz Paulina Ayala Quintanilla
National Institutes of Health, Bethesda
La Trobe University
Rakesh Ayer
University of Tokyo
Peter S. Azzopardi
Australia Bahir Dar University
Burnet Institute
Arefeh Babazadeh
Center for Infectious Diseases Research
Hamid Badali
Mazandaran University of Medical Sciences
Kalpana Balakrishnan
Canada Department of Environmental Health Engineering
Mohsen Mazidi
Chalmers, Biology and Biological Engineering, Food and Nutrition Science
The Lancet
0140-6736 (ISSN) 1474-547X (eISSN)
Vol. 392 10159 1859-1922Subject Categories
Environmental Health and Occupational Health
Gerontology, specialising in Medical and Health Sciences
Public Health, Global Health, Social Medicine and Epidemiology
DOI
10.1016/S0140-6736(18)32335-3
PubMed
30415748