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Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Authors
Hay, Simon I.Abajobir, Amanuel AlemuAbate, Kalkidan HassenAbbafati, CristianaAbbas, Kaja M.Abd-Allah, FoadAbdulle, Abdishakur M.Abebo, Teshome AbukaAbera, Semaw FeredeAboyans, VictorAbu-Raddad, Laith J.Ackerman, Ilana N.Adedeji, Isaac A.Adetokunboh, OlatunjiAfshin, AshkanAggarwal, RakeshAgrawal, SutapaAgrawal, AnuragKiadaliri, Aliasghar AhmadAhmed, Muktar BeshirAichour, Amani NidhalAichour, IbtihelAichour, Miloud Taki EddineAiyar, SnehaAkinyemiju, Tomi F.Akseer, NadiaAl Lami, Faris HasanAlahdab, FaresAl-Aly, ZiyadAlam, KhurshidAlam, NooreAlam, TahiyaAlasfoor, DeenaAlene, Kefyalew AddisAli, RaghibAlizadeh-Navaei, RezaAlkaabi, Juma M.Alkerwi, Ala'aAlla, FrancoisAllebeck, PeterAllen, ChristineAl-Maskari, FatmaAlMazroa, Mohammad AbdulAzizAl-Raddadi, RajaaAlsharif, UbaiAlsowaidi, ShirinaAlthouse, Benjamin M.Altirkawi, Khalid A.Alvis-Guzman, NelsonAmare, Azmeraw T.Amini, ErfanAmmar, WalidAmpem, Yaw AmoakoAnsha, Mustafa GeletoAntonio, Carl Abelardo T.Anwari, PalwashaArnlov, JohanArora, MeghaAl ArtamanAryal, Krishna KumarAsgedom, Solomon W.Atey, Tesfay MehariAtnafu, Niguse TadeleAvila-Burgos, LeticiaAvokpaho, Euripide Frinel G. ArthurAwasthi, AshishAwasthi, ShallyQuintanilla, Beatriz Paulina AyalaAzarpazhooh, Mahmoud RezaAzzopardi, PeterBabalola, Tesleem KayodeBacha, UmarBadawi, AlaaBalakrishnan, KalpanaBannick, Marlena S.Barac, AleksandraBarker-Collo, Suzanne L.Barnighausen, TillBarquera, SimonBarrero, Lope H.Basu, SanjayBattista, RobertBattle, Katherine E.Baune, Bernhard T.Bazargan-Hejazi, ShahrzadBeardsley, JustinBedi, NeerajBejot, YannickBekele, Bayu BegashawBell, Michelle L.Bennett, Derrick A.Bennett, James R.Bensenor, Isabela M.Benson, JenniferBerhane, AdugnawBerhe, Derbew FikaduBernabe, EduardoBetsu, Balem DemtsuBeuran, MirceaBeyene, Addisu ShunuBhansali, AnilBhatt, SamirBhutta, Zulfiqar A.Biadgilign, SibhatuBienhoff, KellyBikbov, BorisBirungi, CharlesBiryukov, StanBisanzio, DonalBizuayehu, Habtamu MellieBlyth, Fiona M.Boneya, Dube JaraBose, DipanBou-Orm, Ibrahim R.Bourne, Rupert R. A.Brainin, MichaelBrayne, Carol E. G.Brazinova, AlexandraBreitborde, Nicholas J. K.Briant, Paul S.Britton, GabrielleBrugha, Traolach S.Buchbinder, RachelleBulto, Lemma Negesa BultoBumgarner, BlairButt, Zahid A.Cahuana-Hurtado, LuceroCameron, EwanRicardo Campos-Nonato, IsmaelCarabin, HeleneCardenas, RosarioCarpenter, David O.Carrero, Juan JesusCarter, AustinCarvalho, FelixCasey, DanielCastaneda-Orjuela, Carlos A.Rivas, Jacqueline CastilloCastle, Chris D.Catala-Lopez, FerranChang, Jung-ChenCharlson, Fiona J.Chaturvedi, PankajChen, HongleiChibalabala, MirriamChibueze, Chioma EzinneChisumpa, Vesper HichilombweChitheer, Abdulaal A.Chowdhury, RajivChristopher, Devasahayam JesudasCiobanu, Liliana G.Cirillo, MassimoColombara, DannyCooper, Leslie TrumbullCooper, CyrusCortesi, Paolo AngeloCortinovis, MonicaCriqui, Michael H.Cromwell, Elizabeth A.Cross, MaritaCrump, John A.Dadi, Abel FekaduDalal, KoustuvDamasceno, AlbertinoDandona, LalitDandona, Rakhidas Neves, JoseDavitoiu, Dragos V.Davletov, Kairatde Courten, Barborade Leo, DiegoDe Steur, HansDegenhardt, LouisaDeiparine, SelinaDellavalle, Robert P.Deribe, KebedeDeribew, AmareDes Jarlais, Don C.Dey, SubhojitDharmaratne, Samath D.Dhillon, Preet K.Dicker, DanielDjalalinia, ShirinHuyen Phuc DoDokova, KlaraDoku, David TeyeDorsey, E. RayBender dos Santos, Kadine PriscilaDriscoll, Tim R.Dubey, ManishaDuncan, Bruce BartholowEbel, Beth E.Echko, MichelleEl-Khatib, Ziad ZiadEnayati, AhmadaliEndries, Aman YesufErmakov, Sergey PetrovichErskine, Holly E.Eshetie, SetegnEshrati, BabakEsteghamati, AlirezaEstep, KaraFanuel, Fanuel Belayneh BekeleFarag, TamerSofia, CarlaFarinha, SaFaro, AndreFarzadfar, FarshadFazeli, Mir SohailFeigin, Valery L.Feigl, Andrea B.Fereshtehnejad, Seyed-MohammadFernandes, Joao C.Ferrari, Alize J.Feyissa, Tesfaye RegassaFilip, IrinaFischer, FlorianFitzmaurice, ChristinaFlaxman, Abraham D.Foigt, NataliyaForeman, Kyle J.Franklin, Richard C.Frostad, Joseph J.Fullman, NancyFurst, ThomasFurtado, Joao M.Futran, Neal D.Gakidou, EmmanuelaGarcia-Basteiro, Alberto L.Gebre, TeshomeGebregergs, Gebremedhin BerheGebrehiwot, Tsegaye TeweldeGeleijnse, Johanna M.Geleto, AyeleGemechu, Bikila LenchaGesesew, Hailay AbrhaGething, Peter W.Ghajar, AlirezaGibney, Katherine B.Gillum, Richard F.Ginawi, Ibrahim Abdelmageem MohamedGishu, Melkamu DedefoGiussani, GiorgiaGodwin, William W.Goel, KashishGoenka, ShifalikaGoldberg, Ellen M.Gona, Philimon N.Goodridge, AmadorGopalani, Sameer ValiGosselin, Richard A.Gotay, Carolyn C.Goto, AtsushiGoulart, Alessandra CarvalhoGraetz, NicholasGugnani, Harish ChanderGupta, RajeevGupta, Prakash C.Gupta, TanushGupta, VipinGupta, RahulGutierrez, Reyna A.Hachinski, VladimirHafezi-Nejad, NimaHailu, Alemayehu DesalegneHailu, Gessessew BugssaHamadeh, Randah RibhiHamidi, SamerHammami, MouhanadHandal, Alexis J.Hankey, Graeme J.Hao, YuantaoHarb, Hilda L.Hareri, Habtamu AberaHaro, Josep MariaHarun, Kimani M.Harvey, JamesHassanvand, Mohammad SadeghHavmoeller, RasmusHay, Roderick J.Hedayati, Mohammad T.Hendrie, DeliaHenry, Nathaniel J.Heredia-Pi, Ileana BeatrizHeydarpour, PouriaHoek, Hans W.Hoffman, Howard J.Horino, MasakoHorita, NobuyukiHosgood, H. DeanHostiuc, SorinHotez, Peter J.Hoy, Damian G.Htet, Aung SoeHu, GuoqingHuang, John J.Huynh, ChantalIburg, Kim MoesgaardIgumbor, Ehimario UcheIkeda, ChadIrvine, Caleb Mackay SalpeterJacobsen, Kathryn H.Jahanmehr, NaderJakovljevic, Mihajlo B.James, PeterJassal, Simerjot K.Javanbakht, MehdiJayaraman, Sudha P.Jeemon, PanniyammakalJensen, Paul N.Jha, VivekanandJiang, GuohongJohn, DennyJohnson, Catherine O.Johnson, Sarah CharlotteJonas, Jost B.Jurisson, MikkKabir, ZubairKadel, RajendraKahsay, AmahaKamal, RitulKar, ChittaranjanKaram, Nadim E.Karch, AndreKarema, Corine KakiziKarimi, Seyed M.Karimkhani, ChanteKasaeian, AmirKassa, Getachew MulluKassebaum, Nicholas J.Kassaw, Nigussie AssefaKastor, AnshulKatikireddi, Srinivasa VittalKaul, AnilKawakami, NoritoKeiyoro, Peter NjengaKemmer, LauraKengne, Andre PascalKeren, AndreKesavachandran, Chandrasekharan NairKhader, Yousef SalehKhalil, Ibrahim A.Khan, Ejaz AhmadKhang, Young-HoKhoja, Abdullah T.Khosravi, ArdeshirKhubchandani, JagdishKieling, ChristianKim, Yun JinKim, DanielKimokoti, Ruth W.Kinfu, YohannesKisa, AdnanKissimova-Skarbek, Katarzyna A.Kissoon, NiranjanKivimaki, MikaKnudsen, Ann KristinKokubo, YoshihiroKolte, DhavalKopec, Jacek A.Kosen, SoewartaKotsakis, Georgios A.Koul, Parvaiz A.Koyanagi, AiKravchenko, MichaelKrohn, Kristopher J.Defo, Barthelemy KuateBicer, Burcu KucukKumar, G. AnilKumar, PushpendraKyu, Hmwe H.Lager, Anton Carl JonasLal, Dharmesh KumarLalloo, RatilalLallukka, TeaLambert, NkurunzizaLan, QingLansingh, Van C.Larsson, AndersLeasher, Janet L.Lee, Paul H.Leigh, JamesLeshargie, Cheru TesemaLeung, JanniLeung, RickyLevi, MiriamLi, YichongLi, YongmeiLiang, XiaofengLiben, Misgan LegesseLim, Stephen S.Linn, ShaiLiu, AngelaLiu, Patrick Y.Liu, ShiweiLiu, YangLodha, RakeshLogroscino, GiancarloLooker, Katharine J.Lopez, Alan D.Lorkowski, StefanLotufo, Paulo A.Lozano, RafaelLucas, Timothy C. D.Lunevicius, RaimundasLyons, Ronan A.Macarayan, Erlyn Rachelle KingMaddison, Emilie R.Abd el Razek, Hassan MagdyMagis-Rodriguez, CarlosMahdavi, MahdiMajdan, MarekMajdzadeh, RezaMajeed, AzeemMalekzadeh, RezaMalhotra, RajeshMalta, Deborah CarvalhoMamun, Abdullah A.Manguerra, HelenaManhertz, TrehMantovani, Lorenzo G.Mapoma, Chabila C.March, Lyn M.Marczak, Laurie B.Martinez-Raga, JoseHenrique, PauloMartins, ViegasMartins-Melo, Francisco RogerlndioMartopullo, IraMarz, WinfriedMathur, Manu RajMazidi, MohsenMcAlinden, ColmMcGaughey, MadelineMcGrath, John J.Mckee, MartinMehata, SureshMeier, ToniMeles, Kidanu GebremariamMemiah, PeterMemish, Ziad A.Mendoza, WalterMengesha, Melkamu MeridMengistie, Mubarek AberaMengistu, Desalegn TadeseMensah, George A.Meretoja, AtteMeretoja, Tuomo J.Mezgebe, Haftay BerhaneMicha, RenataMillear, AnoushkaMiller, Ted R.Minnig, ShawnMirarefin, MojdeMirrakhimov, Erkin M.Misganaw, AwokeMishra, Shiva RajMitchell, Philip B.Mohammad, Karzan AbdulmuhsinMohammadi, AlirezaMohammed, ShafiuMohammed, Kedir EndrisMohammed, Muktar Sano KedirMohan, Murali B. V.Mokdad, Ali H.Mollenkopf, Sarah K.Monasta, LorenzoMontanez Hernandez, Julio CesarMontico, MarcellaMoradi-Lakeh, MaziarMoraga, PaulaMorawska, LidiaMori, RintaroMorrison, Shane D.Moses, MarkMountjoy-Venning, CliffMruts, Kalayu BirhaneMueller, Ulrich O.Muller, KateMudoch, Michele E.Murthy, SrinivasMurthy, Gudlavalleti Venkata SatyanarayanaMusa, Kamarul ImranNachega, Jean B.Nagel, GabrieleNaghavi, MohsenNaheed, AliyaNaidoo, Kovin S.Nangia, VinayNasher, Jamal T.Natarajan, GopalakrishnanNegasa, Dumessa EdessaNegoi, IonutNegoi, Ruxandra IrinaNewton, Charles R.Ngunjiri, Josephine WanjikuCuong Tat NguyenQuyen Le NguyenGrant NguyenTrang Huyen NguyenMinh NguyenNichols, EmmaNingrum, Dina Nur AnggrainiVuong Minh NongNorheim, Ole F.Norrving, BoNoubiap, Jean Jacques N.Nyandwi, AlypioObermeyer, Carla MakhloufO'Donnell, Martin J.Ogbo, Felix AkpojeneOh, In-HwanOkoro, AnselmOladimeji, OlanrewajuOlagunju, Andrew ToyinOlagunju, Tinuke OluwasefunmiOlsen, Helen E.Olusanya, Bolajoko OlubukunolaOlusanya, Jacob OlusegunOng, KanyinOpio, John NelsonOren, EyalOrtiz, AlbertoOsborne, Richard H.Osgood-Zimmerman, AaronOsman, MajdiOta, ErikaOwolabi, Mayowa O.Pa, MaheshPacella, Rosana E.Panda, Basant KumarPandian, Jeyaraj D.Papachristou, ChristinaPark, Eun-KeeParry, Charles D.Parsaeian, MahboubehPatil, Snehal T.Patten, Scott B.Patton, George C.Paudel, DeepakPaulson, KatherinePearce, NeilPereira, David M.Perez, Krystle MariePerico, NorbertoPesudovs, KonradPeterson, Carrie BethPetri, William ArthurPetzold, MaxPhillips, Michael RobertPhipps, GeoffreyPigott, David M.Pillay, Julian DavidPinho, ChristinePiradov, Michael A.Plass, DietrichPletcher, Martin A.Popova, SvetlanaPoulton, Richie G.Pourmalek, FarshadPrabhakaran, DorairajPrasad, NarayanPurcell, CarriePurwar, ManoramaQorbani, MostafaRabiee, Rynaz H. 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M.Varughese, SantoshVasankari, TommiVeerman, Lennert J.Venkatesh, S.Venketasubramanian, NarayanaswamyVidavalur, RameshVijayakumar, LakshmiViolante, Francesco S.Vishnu, AbhishekVladimirov, Sergey K.Vlassov, Vasiliy VictorovichVollset, Stein EmilVos, TheoWadilo, FisehaWakayo, TolassaWallin, Mitchell T.Wang, Yuan-PangWeichenthal, ScottWeiderpass, ElisabeteWeintraub, Robert G.Weiss, Daniel J.Werdecker, AndreaWesterman, RonnyWhiteford, Harvey A.Wijeratne, TissaWilliams, Hywel C.Wiysonge, Charles SheyWoldeyes, Belete GetahunWolfe, Charles D. A.Woodbrook, RachelWoolf, Anthony D.Workicho, AbdulhalikXavier, DenisXu, GelinYadgir, SimonYaghoubi, MohsenYakob, BereketYan, Lijing L.Yano, YuichiroYe, PengpengYihdego, Mahari GideyYimam, Hassen HamidYip, PaulYonemoto, NaohiroYoon, Seok-JunYotebieng, MarcelYounis, Mustafa Z.Yu, ChuanhuaZaidi, ZoubidaZaki, Maysaa El SayedZegeye, Elias AsfawZenebe, Zerihun MenlkalewZhang, XueyingZheng, YingfengZhou, MaigengZipkin, BenZodpey, SanjayZoeckler, LeoZuhlke, Liesl JoannaMurray, Christopher J. L.
Issue Date
16-9월-2017
Publisher
ELSEVIER SCIENCE INC
Citation
LANCET, v.390, no.10100, pp.1260 - 1344
Indexed
SCIE
SCOPUS
Journal Title
LANCET
Volume
390
Number
10100
Start Page
1260
End Page
1344
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/82218
DOI
10.1016/S0140-6736(17)32130-X
ISSN
0140-6736
Abstract
Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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