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      2015                            d10aSociodemographic development10aMethodology10aLife Expectancy1 aGBD 2013 DALYs and HALE Collaborators 1 aMurray C1 aBarber RM1 aForeman K1 aOzgoren AA1 aAbd-Allah F1 aAbera SF1 aAboyans V1 aAbraham J1 aAbubakar I1 aAbu-Raddad LJ1 aAbu-Rmeileh N1 aAchoki T1 aAckerman I1 aAdemi Z1 aAdou AK1 aAdsuar J1 aAfshin A1 aAgardh EE1 aAlam SS1 aAlasfoor D1 aAlbittar M1 aAlegretti M1 aAlemu ZA1 aAlfonso-Cristancho R1 aAlhabib S1 aAli R1 aAlla F1 aAllebeck P1 aAlmazroa M1 aAlsharif U1 aAlvarez E1 aAlvis-Guzman N1 aAmare A1 aAmeh E1 aAmini H1 aAmmar W1 aAnderson R1 aAnderson B1 aAntonio CA1 aAnwari P1 aArnlöv J1 aArsenijevic VA1 aArtaman A1 aAsghar R1 aAssadi R1 aAtkins L1 aAvila M1 aAwuah B1 aBachman V1 aBadawi A1 aBahit MC1 aBalakrishnan K1 aBanerjee A1 aBarker-Collo S1 aBarquera S1 aBarregard L1 aBarrero LH1 aBasu A1 aBasu S1 aBasulaiman MO1 aBeardsley J1 aBedi N1 aBeghi E1 aBekele T1 aBell M1 aBenjet C1 aBennett D1 aBensenor I1 aBenzian H1 aBernabé E1 aBertozzi-Villa A1 aBeyene TJ1 aBhala N1 aBhalla A1 aBhutta Z1 aBienhoff K1 aBikbov B1 aBiryukov S1 aBlore J1 aBlosser CD1 aBlyth FM1 aBohensky MA1 aBolliger I1 aBaşara BB1 aBornstein N1 aBose D1 aBoufous S1 aBourne R1 aBoyers L1 aBrainin M1 aBrayne C1 aBrazinova A1 aBreitborde NJ K1 aBrenner H1 aBriggs AD1 aBrooks P1 aBrown J1 aBrugha TS1 aBuchbinder R1 aBuckle G1 aBudke C1 aBulchis A1 aBulloch A1 aCampos-Nonato I1 aCarabin H1 aCarapetis J1 aCárdenas R1 aCarpenter D1 aCaso V1 aCastañeda-Orjuela C1 aCastro RE1 aCatalá-López F1 aCavalleri F1 aÇavlin A1 aChadha V1 aChang J1 aCharlson FJ1 aChen H1 aChen W1 aChiang P1 aChimed-Ochir O1 aChowdhury R1 aChristensen H1 aChristophi C1 aCirillo M1 aCoates M1 aCoffeng L1 aCoggeshall MS1 aColistro V1 aColquhoun S1 aCooke GS1 aCooper C1 aCooper LT1 aCoppola LM1 aCortinovis M1 aCriqui M1 aCrump J1 aCuevas-Nasu L1 aDanawi H1 aDandona L1 aDandona R1 aDansereau E1 aDargan P1 aDavey G1 aDavis A1 aDavitoiu DV1 aDayama A1 aDe Leo D1 aDegenhardt L1 aDel Pozo-Cruz B1 aDellavalle R1 aDeribe K1 aDerrett S1 aDes Jarlais DC1 aDessalegn M1 aDharmaratne SD1 aDherani MK1 aDiaz-Torné C1 aDicker D1 aDing E1 aDokova K1 aDorsey R1 aDriscoll T1 aDuan L1 aDuber HC1 aEbel B1 aEdmond KM1 aElshrek YM1 aEndres M1 aErmakov S1 aErskine H1 aEshrati B1 aEsteghamati A1 aEstep K1 aFaraon EJ1 aFarzadfar F1 aFay D1 aFeigin VL1 aFelson DT1 aFereshtehnejad S1 aFernandes J1 aFerrari A1 aFitzmaurice C1 aFlaxman A1 aFleming T1 aFoigt N1 aForouzanfar M1 aFowkes GF R1 aPaleo UF1 aFranklin R1 aFürst T1 aGabbe BJ1 aGaffikin L1 aGankpé FG1 aGeleijnse J1 aGessner BD1 aGething P1 aGibney K1 aGiroud M1 aGiussani G1 aDantes HG1 aGona P1 aGonzález-Medina D1 aGosselin R1 aGotay CC1 aGoto A1 aGouda HN1 aGraetz N1 aGugnani HC1 aGupta R1 aGupta R1 aGutiérrez R1 aHaagsma J1 aHafezi-Nejad N1 aHagan H1 aHalasa YA1 aHamadeh R1 aHamavid H1 aHammami M1 aHancock J1 aHankey G1 aHansen GM1 aHao Y1 aHarb H1 aHaro JM1 aHavmoeller R1 aHay S1 aHay R1 aHeredia-Pi IB1 aHeuton K1 aHeydarpour P1 aHigashi H1 aHijar M1 aHoek HW1 aHoffman H1 aHosgood D1 aHossain M1 aHotez P1 aHoy DG1 aHsairi M1 aHu G1 aHuang C1 aHuang J1 aHusseini A1 aHuynh C1 aIannarone M1 aIburg KM1 aInnos K1 aInoue M1 aIslami F1 aJacobsen K1 aJarvis D1 aJassal S1 aJee SH1 aJeemon P1 aJensen P1 aJha V1 aJiang G1 aJiang Y1 aJonas J1 aJuel K1 aKan H1 aKarch A1 aKarema CK1 aKarimkhani C1 aKarthikeyan G1 aKassebaum N1 aKaul A1 aKawakami N1 aKazanjan K1 aKemp AH1 aKengne AP1 aKeren A1 aKhader Y1 aKhalifa SE1 aKhan E1 aKhan G1 aKhang Y1 aKieling C1 aKim D1 aKim S1 aKim YJ1 aKinfu Y1 aKinge JM1 aKivipelto M1 aKnibbs L1 aKnudsen AK1 aKokubo Y1 aKosen S1 aKrishnaswami S1 aDefo BK1 aKucuk Bicer B1 aKuipers EJ1 aKulkarni C1 aKulkarni V1 aKumar A1 aKyu H1 aLai T1 aLalloo R1 aLallukka T1 aLam H1 aLan Q1 aLansingh VC1 aLarsson A1 aLawrynowicz A1 aLeasher JL1 aLeigh J1 aLeung R1 aLevitz CE1 aLi B1 aLi Y1 aLi Y1 aLim S1 aLind M1 aLipshultz S1 aLiu S1 aLiu Y1 aLloyd B1 aLofgren K1 aLogroscino G1 aLooker K1 aLortet-Tieulent J1 aLotufo P1 aLozano R1 aLucas R1 aLunevicius R1 aLyons RA1 aMa S1 aMacintyre M1 aMackay MT1 aMajdan M1 aMalekzadeh R1 aMarcenes W1 aMargolis D1 aMargono C1 aMarzan M1 aMasci JR1 aMashal M1 aMatzopoulos R1 aMayosi BM1 aMazorodze T1 aMcgill NW1 aMcGrath J1 aMckee M1 aMclain A1 aMeaney PA1 aMedina C1 aMehndiratta MM1 aMekonnen W1 aMelaku YA1 aMeltzer M1 aMemish Z1 aMensah G1 aMeretoja A1 aMhimbira FA1 aMicha R1 aMiller T1 aMills EJ1 aMitchell PB1 aMock C1 aIbrahim NM1 aMohammad K1 aMokdad A1 aMola G1 aMonasta L1 aHernandez JMC1 aMontico M1 aMontine T1 aMooney M1 aMoore A1 aMoradi-Lakeh M1 aMoran A1 aMori R1 aMoschandreas J1 aMoturi W1 aMoyer ML1 aMozaffarian D1 aMsemburi W1 aMueller U1 aMukaigawara M1 aMullany EC1 aMurdoch M1 aMurray J1 aMurthy KS1 aNaghavi M1 aNaheed A1 aNaidoo K1 aNaldi L1 aNand D1 aNangia V1 aNarayan VK M1 aNejjari C1 aNeupane SP1 aNewton CR1 aNg M1 aNgalesoni FN1 aNguyen G1 aNisar M1 aNolte S1 aNorheim O1 aNorman R1 aNorrving B1 aNyakarahuka L1 aOh I1 aOhkubo T1 aOhno S1 aOlusanya BO1 aOpio JN1 aOrtblad K1 aOrtiz A1 aPain A1 aPandian J1 aPanelo CIA1 aPapachristou C1 aPark E1 aPark J1 aPatten S1 aPatton G1 aPaul VK1 aPavlin BI1 aPearce N1 aPereira DM1 aPerez-Padilla R1 aPerez-Ruiz F1 aPerico N1 aPervaiz A1 aPesudovs K1 aPeterson C1 aPetzold M1 aPhillips M1 aPhillips B1 aPhillips D1 aPiel FB1 aPlass D1 aPoenaru D1 aPolinder S1 aPope D1 aPopova S1 aPoulton RG1 aPourmalek F1 aPrabhakaran D1 aPrasad N1 aPullan R1 aQato DM1 aQuistberg AD1 aRafay A1 aRahimi K1 aRahman S1 aRaju M1 aRana SM1 aRazavi H1 aReddy S1 aRefaat A1 aRemuzzi G1 aResnikoff S1 aRibeiro AL1 aRichardson L1 aRichardus JH1 aRoberts A1 aRojas-Rueda D1 aRonfani L1 aRoth GA1 aRothenbacher D1 aRothstein DH1 aRowley JT1 aRoy N1 aRuhago G1 aSaeedi M1 aSaha S1 aSahraian MA1 aSampson U1 aSanabria JR1 aSandar L1 aSantos IS1 aSatpathy M1 aSawhney M1 aScarborough P1 aSchneider I1 aSchöttker B1 aSchumacher A1 aSchwebel D1 aScott JG1 aSeedat S1 aSepanlou SG1 aSerina P1 aServan-Mori EE1 aShackelford KA1 aShaheen A1 aShahraz S1 aLevy TS1 aShangguan S1 aShe J1 aSheikhbahaei S1 aShi P1 aShibuya K1 aShinohara Y1 aShiri R1 aShishani K1 aShiue I1 aShrime M1 aSigfusdottir ID1 aSilberberg DH1 aSimard EP1 aSindi S1 aSingh A1 aSingh JA1 aSingh L1 aSkirbekk V1 aSlepak EL1 aSliwa K1 aSoneji S1 aSøreide K1 aSoshnikov S1 aSposato LA1 aSreeramareddy C1 aStanaway J1 aStathopoulou V1 aStein DJ1 aStein MB1 aSteiner C1 aSteiner TJ1 aStevens A1 aStewart A1 aStovner LJ1 aStroumpoulis K1 aSunguya BF1 aSwaminathan S1 aSwaroop M1 aSykes B1 aTabb KM1 aTakahashi K1 aTandon N1 aTanne D1 aTanner M1 aTavakkoli M1 aTaylor H1 aAo BT1 aTediosi F1 aTemesgen A1 aTemplin T1 aTen Have M1 aTenkorang EY1 aTerkawi AS1 aThomson B1 aThorne-Lyman AL1 aThrift AG1 aThurston GD1 aTillmann T1 aTonelli M1 aTopouzis F1 aToyoshima H1 aTraebert J1 aTran BX1 aTrillini M1 aTruelsen T1 aTsilimbaris MK1 aTuzcu EM1 aUchendu US1 aUkwaja KN1 aUndurraga E1 aUzun SB1 avan Brakel WH1 aVijver S1 aGool CH1 aVan Os J1 aVasankari T1 aVenketasubramanian N1 aViolante F1 aVlassov V1 aVollset SE1 aWagner G1 aWagner J1 aWaller SG1 aWan X1 aWang H1 aWang J1 aWang L1 aWarouw TS1 aWeichenthal S1 aWeiderpass E1 aWeintraub R1 aWenzhi W1 aWerdecker A1 aWesterman R1 aWhiteford HA1 aWilkinson JD1 aWilliams T1 aWolfe CD1 aWolock TM1 aWoolf AD1 aWulf SK1 aWurtz B1 aXu G1 aYan L1 aYano Y1 aYe P1 aYentür G1 aYip P1 aYonemoto N1 aYoon S1 aYounis MZ1 aYu C1 aZaki ME1 aZhao Y1 aZheng Y1 aZonies D1 aZou X1 aSalomon JA1 aLopez AD1 aVos T00aGlobal, 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.  a2145 – 21910 v3863 a<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>
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