@article{26974,
  keywords = {Sociodemographic development, Methodology, Life Expectancy},
  author = {GBD 2013 DALYs and HALE Collaborators  and Murray C and Barber RM and Foreman K and Ozgoren AA and Abd-Allah F and Abera SF and Aboyans V and Abraham J and Abubakar I and Abu-Raddad LJ and Abu-Rmeileh N and Achoki T and Ackerman I and Ademi Z and Adou AK and Adsuar J and Afshin A and Agardh EE and Alam SS and Alasfoor D and Albittar M and Alegretti M and Alemu ZA and Alfonso-Cristancho R and Alhabib S and Ali R and Alla F and Allebeck P and Almazroa M and Alsharif U and Alvarez E and Alvis-Guzman N and Amare A and Ameh E and Amini H and Ammar W and Anderson R and Anderson B and Antonio CA and Anwari P and Arnlöv J and Arsenijevic VA and Artaman A and Asghar R and Assadi R and Atkins L and Avila M and Awuah B and Bachman V and Badawi A and Bahit MC and Balakrishnan K and Banerjee A and Barker-Collo S and Barquera S and Barregard L and Barrero LH and Basu A and Basu S and Basulaiman MO and Beardsley J and Bedi N and Beghi E and Bekele T and Bell M and Benjet C and Bennett D and Bensenor I and Benzian H and Bernabé E and Bertozzi-Villa A and Beyene TJ and Bhala N and Bhalla A and Bhutta Z and Bienhoff K and Bikbov B and Biryukov S and Blore J and Blosser CD and Blyth FM and Bohensky MA and Bolliger I and Başara BB and Bornstein N and Bose D and Boufous S and Bourne R and Boyers L and Brainin M and Brayne C and Brazinova A and Breitborde NJ K and Brenner H and Briggs AD and Brooks P and Brown J and Brugha TS and Buchbinder R and Buckle G and Budke C and Bulchis A and Bulloch A and Campos-Nonato I and Carabin H and Carapetis J and Cárdenas R and Carpenter D and Caso V and Castañeda-Orjuela C and Castro RE and Catalá-López F and Cavalleri F and Çavlin A and Chadha V and Chang J and Charlson FJ and Chen H and Chen W and Chiang P and Chimed-Ochir O and Chowdhury R and Christensen H and Christophi C and Cirillo M and Coates M and Coffeng L and Coggeshall MS and Colistro V and Colquhoun S and Cooke GS and Cooper C and Cooper LT and Coppola LM and Cortinovis M and Criqui M and Crump J and Cuevas-Nasu L and Danawi H and Dandona L and Dandona R and Dansereau E and Dargan P and Davey G and Davis A and Davitoiu DV and Dayama A and De Leo D and Degenhardt L and Del Pozo-Cruz B and Dellavalle R and Deribe K and Derrett S and Des Jarlais DC and Dessalegn M and Dharmaratne SD and Dherani MK and Diaz-Torné C and Dicker D and Ding E and Dokova K and Dorsey R and Driscoll T and Duan L and Duber HC and Ebel B and Edmond KM and Elshrek YM and Endres M and Ermakov S and Erskine H and Eshrati B and Esteghamati A and Estep K and Faraon EJ and Farzadfar F and Fay D and Feigin VL and Felson DT and Fereshtehnejad S and Fernandes J and Ferrari A and Fitzmaurice C and Flaxman A and Fleming T and Foigt N and Forouzanfar M and Fowkes GF R and Paleo UF and Franklin R and Fürst T and Gabbe BJ and Gaffikin L and Gankpé FG and Geleijnse J and Gessner BD and Gething P and Gibney K and Giroud M and Giussani G and Dantes HG and Gona P and González-Medina D and Gosselin R and Gotay CC and Goto A and Gouda HN and Graetz N and Gugnani HC and Gupta R and Gupta R and Gutiérrez R and Haagsma J and Hafezi-Nejad N and Hagan H and Halasa YA and Hamadeh R and Hamavid H and Hammami M and Hancock J and Hankey G and Hansen GM and Hao Y and Harb H and Haro JM and Havmoeller R and Hay S and Hay R and Heredia-Pi IB and Heuton K and Heydarpour P and Higashi H and Hijar M and Hoek HW and Hoffman H and Hosgood D and Hossain M and Hotez P and Hoy DG and Hsairi M and Hu G and Huang C and Huang J and Husseini A and Huynh C and Iannarone M and Iburg KM and Innos K and Inoue M and Islami F and Jacobsen K and Jarvis D and Jassal S and Jee SH and Jeemon P and Jensen P and Jha V and Jiang G and Jiang Y and Jonas J and Juel K and Kan H and Karch A and Karema CK and Karimkhani C and Karthikeyan G and Kassebaum N and Kaul A and Kawakami N and Kazanjan K and Kemp AH and Kengne AP and Keren A and Khader Y and Khalifa SE and Khan E and Khan G and Khang Y and Kieling C and Kim D and Kim S and Kim YJ and Kinfu Y and Kinge JM and Kivipelto M and Knibbs L and Knudsen AK and Kokubo Y and Kosen S and Krishnaswami S and Defo BK and Kucuk Bicer B and Kuipers EJ and Kulkarni C and Kulkarni V and Kumar A and Kyu H and Lai T and Lalloo R and Lallukka T and Lam H and Lan Q and Lansingh VC and Larsson A and Lawrynowicz A and Leasher JL and Leigh J and Leung R and Levitz CE and Li B and Li Y and Li Y and Lim S and Lind M and Lipshultz S and Liu S and Liu Y and Lloyd B and Lofgren K and Logroscino G and Looker K and Lortet-Tieulent J and Lotufo P and Lozano R and Lucas R and Lunevicius R and Lyons RA and Ma S and Macintyre M and Mackay MT and Majdan M and Malekzadeh R and Marcenes W and Margolis D and Margono C and Marzan M and Masci JR and Mashal M and Matzopoulos R and Mayosi BM and Mazorodze T and Mcgill NW and McGrath J and Mckee M and Mclain A and Meaney PA and Medina C and Mehndiratta MM and Mekonnen W and Melaku YA and Meltzer M and Memish Z and Mensah G and Meretoja A and Mhimbira FA and Micha R and Miller T and Mills EJ and Mitchell PB and Mock C and Ibrahim NM and Mohammad K and Mokdad A and Mola G and Monasta L and Hernandez JMC and Montico M and Montine T and Mooney M and Moore A and Moradi-Lakeh M and Moran A and Mori R and Moschandreas J and Moturi W and Moyer ML and Mozaffarian D and Msemburi W and Mueller U and Mukaigawara M and Mullany EC and Murdoch M and Murray J and Murthy KS and Naghavi M and Naheed A and Naidoo K and Naldi L and Nand D and Nangia V and Narayan VK M and Nejjari C and Neupane SP and Newton CR and Ng M and Ngalesoni FN and Nguyen G and Nisar M and Nolte S and Norheim O and Norman R and Norrving B and Nyakarahuka L and Oh I and Ohkubo T and Ohno S and Olusanya BO and Opio JN and Ortblad K and Ortiz A and Pain A and Pandian J and Panelo CIA and Papachristou C and Park E and Park J and Patten S and Patton G and Paul VK and Pavlin BI and Pearce N and Pereira DM and Perez-Padilla R and Perez-Ruiz F and Perico N and Pervaiz A and Pesudovs K and Peterson C and Petzold M and Phillips M and Phillips B and Phillips D and Piel FB and Plass D and Poenaru D and Polinder S and Pope D and Popova S and Poulton RG and Pourmalek F and Prabhakaran D and Prasad N and Pullan R and Qato DM and Quistberg AD and Rafay A and Rahimi K and Rahman S and Raju M and Rana SM and Razavi H and Reddy S and Refaat A and Remuzzi G and Resnikoff S and Ribeiro AL and Richardson L and Richardus JH and Roberts A and Rojas-Rueda D and Ronfani L and Roth GA and Rothenbacher D and Rothstein DH and Rowley JT and Roy N and Ruhago G and Saeedi M and Saha S and Sahraian MA and Sampson U and Sanabria JR and Sandar L and Santos IS and Satpathy M and Sawhney M and Scarborough P and Schneider I and Schöttker B and Schumacher A and Schwebel D and Scott JG and Seedat S and Sepanlou SG and Serina P and Servan-Mori EE and Shackelford KA and Shaheen A and Shahraz S and Levy TS and Shangguan S and She J and Sheikhbahaei S and Shi P and Shibuya K and Shinohara Y and Shiri R and Shishani K and Shiue I and Shrime M and Sigfusdottir ID and Silberberg DH and Simard EP and Sindi S and Singh A and Singh JA and Singh L and Skirbekk V and Slepak EL and Sliwa K and Soneji S and Søreide K and Soshnikov S and Sposato LA and Sreeramareddy C and Stanaway J and Stathopoulou V and Stein DJ and Stein MB and Steiner C and Steiner TJ and Stevens A and Stewart A and Stovner LJ and Stroumpoulis K and Sunguya BF and Swaminathan S and Swaroop M and Sykes B and Tabb KM and Takahashi K and Tandon N and Tanne D and Tanner M and Tavakkoli M and Taylor H and Ao BT and Tediosi F and Temesgen A and Templin T and Ten Have M and Tenkorang EY and Terkawi AS and Thomson B and Thorne-Lyman AL and Thrift AG and Thurston GD and Tillmann T and Tonelli M and Topouzis F and Toyoshima H and Traebert J and Tran BX and Trillini M and Truelsen T and Tsilimbaris MK and Tuzcu EM and Uchendu US and Ukwaja KN and Undurraga E and Uzun SB and van Brakel WH and Vijver S and Gool CH and Van Os J and Vasankari T and Venketasubramanian N and Violante F and Vlassov V and Vollset SE and Wagner G and Wagner J and Waller SG and Wan X and Wang H and Wang J and Wang L and Warouw TS and Weichenthal S and Weiderpass E and Weintraub R and Wenzhi W and Werdecker A and Westerman R and Whiteford HA and Wilkinson JD and Williams T and Wolfe CD and Wolock TM and Woolf AD and Wulf SK and Wurtz B and Xu G and Yan L and Yano Y and Ye P and Yentür G and Yip P and Yonemoto N and Yoon S and Younis MZ and Yu C and Zaki ME and Zhao Y and Zheng Y and Zonies D and Zou X and Salomon JA and Lopez AD and Vos T},
  title = {Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013 : Quantifying the epidemiological transition.},
  abstract = {<p><strong>BACKGROUND: </strong>The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.</p>

<p><strong>METHODS: </strong>We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.</p>

<p><strong>FINDINGS: </strong>Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.</p>

<p><strong>INTERPRETATION: </strong>Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.</p>

<p><strong>Direct to the Lancet site: </strong><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61340-X/abstract">http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61340-X/abstract</a></p>
},
  year = {2015},
  journal = {Lancet (London, England)},
  volume = {386},
  pages = {2145 – 2191},
  issn = {1474-547X},
  doi = {10.1016/S0140-6736(15)61340-X},
  language = {eng},
}