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

Kyu, H. H. and Abate, D. and Abate, K. H. and Abay, S. M. and Abbafati, C. and Abbasi, N. and Abbastabar, H. and Abd-Allah, F. and Abdela, J. and Abdelalim, A. and Abdollahpour, I. and Abdulkader, R. S. and Abebe, M. and Abebe, Z. and Abil, O. Z. and Aboyans, V. and Abrham, A. R. and Abu-Raddad, L. J. and Abu-Rmeileh, N. M. E. and Accrombessi, M. M. K. and Acharya, D. and Acharya, P. and Ackerman, I. N. and Adamu, A. A. and Adebayo, O. M. and Adekanmbi, V. and Ademi, Z. and Adetokunboh, O. O. and Adib, M. G. and Adsuar, J. C. and Afanvi, K. A. and Afarideh, M. and Afshin, A. and Agarwal, G. and Agesa, K. M. and Aggarwal, R. and Aghayan, S. A. and Agrawal, A. and Ahmadi, A. and Ahmadi, M. and Ahmadieh, H. and Ahmed, M. B. and Ahmed, S. and Aichour, A. N. and Aichour, I. and Aichour, M. T. E. and Akinyemiju, T. and Akseer, N. and Al-Aly, Z. and Al-Eyadhy, A. and Al-Mekhlafi, H. M. and Al-Raddadi, R. M. and Alahdab, F. and Alam, K. and Alam, T. and Alashi, A. and Alavian, S. M. and Alene, K. A. and Alijanzadeh, M. and Alizadeh-Navaei, R. and Aljunid, S. M. and Alkerwi, A. and Alla, F. and Allebeck, P. and Alonso, J. and Alsharif, U. and Altirkawi, K. and Alvis-Guzman, N. and Aminde, L. N. and Amini, E. and Amiresmaili, M. and Ammar, W. and Amoako, Y. A. and Anber, N. H. and Andrei, C. L. and Androudi, S. and Animut, M. D. and Anjomshoa, M. and Ansha, M. G. and Antonio, C. A. T. and Anwari, P. and Arabloo, J. and Aremu, O. and Ärnlöv, J. and Arora, A. and Arora, M. and Artaman, A. and Aryal, K. K. and Asayesh, H. and Ataro, Z. and Ausloos, M. and Avila-Burgos, L. and Avokpaho, E. F. G. A. and Awasthi, A. and Ayala Quintanilla, B. P. and Ayer, R. and Azzopardi, P. S. and Babazadeh, A. and Badali, H. and Balakrishnan, K. (2018) 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. The Lancet, 392 (10159). pp. 1859-1922.

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Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countri.pdf

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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 y ars 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. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Item Type: Article
Additional Information: Cited By :207 Export Date: 16 February 2020 CODEN: LANCA Correspondence Address: Murray, C.J.L.; Institute for Health Metrics and EvaluationUnited States; email:
Uncontrolled Keywords: age Algeria Article Bahrain Burundi Central African Republic cerebrovascular accident chronic obstructive lung disease communicable disease disability-adjusted life year disease severity Federation of Bosnia and Herzegovina female health status human international cooperation ischemic heart disease life expectancy lower respiratory tract infection major clinical study male mortality rate newborn disease non communicable disease prevalence priority journal sex factor Singapore Slovakia trend study Ukraine
Subjects: WA Public Health
WB Practice of Medicine
W General medicine- Health professions
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 11 May 2020 06:22
Last Modified: 11 May 2020 06:22

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