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.


disablility-adjusted life

quality-adjusted life years

mortality rate


Hmwe Hmwe Kyu

Institute for Health Metrics and Evaluation

University of Washington

Degu Abate

Haramaya University

Haramaya University

Kalkidan Hassen Abate

Jimma University

Solomon M. Abay

Addis Ababa University

Cristiana Abbafati

Sapienza University of Rome

Nooshin Abbasi

McGill University

Tehran University of Medical Sciences

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

University of Medical Sciences

Wollega University

Victor Aboyans

Hopital Dupuytren

University of Limoges

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

Dongguk University

Kathmandu University

Pawan Acharya

Nepal Development Society

Ilana N. Ackerman

Monash University

Abdu A Adamu

Stellenbosch University

South African Medical Research Council

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

Ministry of Health and Social Protection

University of Lomé

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

Scientific Center of Zoology and Hydroecology

Yerevan State University

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

International Centre for Diarrhoeal Disease Research Bangladesh

Karolinska Institutet

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

University of Kuwait

National University of Malaysia

Ala'A Alkerwi

Luxembourg Institute of Health

François Alla

University of Bordeaux

Peter Allebeck


Karolinska Institutet

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

Dalarna university

Karolinska Institutet

Amit Arora

Oral Health Services

School of Science and Health

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

Burnet Institute

Australia Bahir Dar University

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 1859-1922

Subject Categories

Environmental Health and Occupational Health

Gerontology, specialising in Medical and Health Sciences

Public Health, Global Health, Social Medicine and Epidemiology





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