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      2012                            d10aYoung Adult10aWounds and Injuries10aSex Factors10aQuality-Adjusted Life Years10aPrevalence10aMiddle Aged10aMale10aInfant, Newborn10aInfant10aHumans10aHealth Status10aGlobal health10aFemale10aChild, Preschool10aChild10aAged, 80 and over10aAged10aAge Factors10aAdult10aAdolescent1 aMurray C1 aVos T1 aLozano R1 aNaghavi M1 aFlaxman A1 aMichaud C1 aEzzati M1 aShibuya K1 aSalomon JA1 aAbdalla S1 aAboyans V1 aAbraham J1 aAckerman I1 aAggarwal R1 aAhn SY1 aAli M1 aAlvarado M1 aAnderson R1 aAnderson L1 aAndrews K1 aAtkinson C1 aBaddour LM1 aBahalim AN1 aBarker-Collo S1 aBarrero LH1 aBartels D1 aBasáñez M1 aBaxter A1 aBell M1 aBenjamin E1 aBennett D1 aBernabé E1 aBhalla K1 aBhandari B1 aBikbov B1 aBin Abdulhak A1 aBirbeck G1 aBlack J1 aBlencowe H1 aBlore J1 aBlyth FM1 aBolliger I1 aBonaventure A1 aBoufous S1 aBourne R1 aBoussinesq M1 aBraithwaite T1 aBrayne C1 aBridgett L1 aBrooker S1 aBrooks P1 aBrugha TS1 aBryan-Hancock C1 aBucello C1 aBuchbinder R1 aBuckle G1 aBudke C1 aBurch M1 aBurney P1 aBurstein R1 aCalabria B1 aCampbell B1 aCanter CE1 aCarabin H1 aCarapetis J1 aCarmona L1 aCella C1 aCharlson FJ1 aChen H1 aCheng AT1 aChou D1 aChugh S1 aCoffeng L1 aColan SD1 aColquhoun S1 aColson E1 aCondon J1 aConnor MD1 aCooper LT1 aCorriere M1 aCortinovis M1 aVaccaro KC1 aCouser W1 aCowie BC1 aCriqui M1 aCross M1 aDabhadkar K1 aDahiya M1 aDahodwala N1 aDamsere-Derry J1 aDanaei G1 aDavis A1 aDe Leo D1 aDegenhardt L1 aDellavalle R1 aDelossantos A1 aDenenberg J1 aDerrett S1 aDes Jarlais DC1 aDharmaratne SD1 aDherani MK1 aDiaz-Torné C1 aDolk H1 aDorsey R1 aDriscoll T1 aDuber HC1 aEbel B1 aEdmond KM1 aElbaz A1 aAli SE1 aErskine H1 aErwin PJ1 aEspindola P1 aEwoigbokhan SE1 aFarzadfar F1 aFeigin VL1 aFelson DT1 aFerrari A1 aFerri CP1 aFèvre EM1 aFinucane MM1 aFlaxman S1 aFlood L1 aForeman K1 aForouzanfar M1 aFowkes FG1 aFransen M1 aFreeman M1 aGabbe BJ1 aGabriel SE1 aGakidou E1 aGanatra HA1 aGarcia B1 aGaspari F1 aGillum RF1 aGmel G1 aGonzález-Medina D1 aGosselin R1 aGrainger R1 aGrant B1 aGroeger J1 aGuillemin F1 aGunnell D1 aGupta R1 aHaagsma J1 aHagan H1 aHalasa YA1 aHall W1 aHaring D1 aHaro JM1 aHarrison J1 aHavmoeller R1 aHay R1 aHigashi H1 aHill C1 aHoen B1 aHoffman H1 aHotez P1 aHoy DG1 aHuang J1 aIbeanusi S1 aJacobsen K1 aJames S1 aJarvis D1 aJasrasaria R1 aJayaraman S1 aJohns N1 aJonas J1 aKarthikeyan G1 aKassebaum N1 aKawakami N1 aKeren A1 aKhoo J1 aKing C1 aKnowlton LM1 aKobusingye O1 aKoranteng A1 aKrishnamurthi R1 aLaden F1 aLalloo R1 aLaslett L1 aLathlean T1 aLeasher JL1 aLee YY1 aLeigh J1 aLevinson D1 aLim S1 aLimb E1 aLin JK1 aLipnick M1 aLipshultz S1 aLiu W1 aLoane M1 aOhno SL1 aLyons RA1 aMabweijano J1 aMacintyre M1 aMalekzadeh R1 aMallinger L1 aManivannan S1 aMarcenes W1 aMarch L1 aMargolis D1 aMarks GB1 aMarks R1 aMatsumori A1 aMatzopoulos R1 aMayosi BM1 aMcAnulty JH1 aMcDermott M1 aMcgill NW1 aMcGrath J1 aMedina-Mora ME1 aMeltzer M1 aMensah G1 aMerriman T1 aMeyer A1 aMiglioli V1 aMiller M1 aMiller T1 aMitchell PB1 aMock C1 aMocumbi AO1 aMoffitt T1 aMokdad A1 aMonasta L1 aMontico M1 aMoradi-Lakeh M1 aMoran A1 aMorawska L1 aMori R1 aMurdoch M1 aMwaniki MK1 aNaidoo K1 aNair N1 aNaldi L1 aNarayan VK M1 aNelson P1 aNelson R1 aNevitt M1 aNewton CR1 aNolte S1 aNorman P1 aNorman R1 aO'Donnell M1 aO'Hanlon S1 aOlives C1 aOmer SB1 aOrtblad K1 aOsborne R1 aOzgediz D1 aPage A1 aPahari B1 aPandian JD1 aRivero AP1 aPatten S1 aPearce N1 aPadilla RP1 aPerez-Ruiz F1 aPerico N1 aPesudovs K1 aPhillips D1 aPhillips M1 aPierce K1 aPion S1 aPolanczyk GV1 aPolinder S1 aPope AC1 aPopova S1 aPorrini E1 aPourmalek F1 aPrince M1 aPullan R1 aRamaiah K1 aRanganathan D1 aRazavi H1 aRegan M1 aRehm JT1 aRein DB1 aRemuzzi G1 aRichardson K1 aRivara F1 aRoberts T1 aRobinson C1 aDe Leòn FR1 aRonfani L1 aRoom R1 aRosenfeld LC1 aRushton L1 aSacco RL1 aSaha S1 aSampson U1 aSanchez-Riera L1 aSanman E1 aSchwebel D1 aScott JG1 aSegui-Gomez M1 aShahraz S1 aShepard DS1 aShin H1 aShivakoti R1 aSingh D1 aSingh GM1 aSingh JA1 aSingleton J1 aSleet DA1 aSliwa K1 aSmith E1 aSmith JL1 aStapelberg N1 aSteer AC1 aSteiner TJ1 aStolk W1 aStovner LJ1 aSudfeld C1 aSyed S1 aTamburlini G1 aTavakkoli M1 aTaylor H1 aTaylor JA1 aTaylor W1 aThomas B1 aThomson M1 aThurston GD1 aTleyjeh IM1 aTonelli M1 aTowbin J1 aTruelsen T1 aTsilimbaris MK1 aUbeda C1 aUndurraga E1 aWerf MJ1 aVan Os J1 aVavilala M1 aVenketasubramanian N1 aWang M1 aWang W1 aWatt K1 aWeatherall D1 aWeinstock MA1 aWeintraub R1 aWeisskopf MG1 aWeissman MM1 aWhite R1 aWhiteford HA1 aWiebe N1 aWiersma S1 aWilkinson JD1 aWilliams HC1 aWilliams S1 aWitt E1 aWolfe F1 aWoolf AD1 aWulf SK1 aYeh P1 aZaidi A1 aZheng Z1 aZonies D1 aLopez AD1 aAlmazroa M1 aMemish Z00aDisability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.  uhttp://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61689-4.pdf  a2197-2230 v3803 a<p><strong>BACKGROUND: </strong>Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.</p>

<p><strong>METHODS: </strong>We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.</p>

<p><strong>FINDINGS: </strong>Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.</p>

<p><strong>INTERPRETATION: </strong>Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.</p>

<p><strong>FUNDING: </strong>Bill &amp; Melinda Gates Foundation.</p>
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