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

Abstract

SummaryBackgroundHow 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 life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific 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 Socio-demographic 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.FindingsGlobally, 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, a...

Socio‐economic disparity in global burden of near vision loss: an analysis for 2017 with time trends since 1990

“…A detailed description of the methodology of GBD study has been described elsewhere (Kyu et al. ). The DALY numbers of country income groups by World Bank classification (http://www.worldbank.org/) and the national age‐standardized DALY rates per 100,000 population of near vision loss were collected from the Global Health Data Exchange (http://ghdx.healthdata.org/gbd-data-tool).…”

“…; Kyu et al. ). This description also refers to uncorrected presbyopia or functional presbyopia in the past, indicating an isolated near visual impairment (NVI) and most can be optically corrected.…”

“…Near vision loss caused the greatest burden of 9.8 million DALYs among eye diseases in 2017 (Kyu et al. ).…”

“Running the Gauntlet”: Formidable challenges in advancing neglected tropical diseases vaccines from development through licensure, and a “Call to Action”

“…Shown in Table 1 are the nine NTDs that are currently targeted by human vaccines (in different stages of development). [7][8][9][10][11][12][13][14][15] Also, in development, there are two • Chronic and debilitating • Ancient afflictions • Disproportionately affecting populations living in poverty • Illnesses that promote poverty vaccines for cysticercosis and echinococcosis, respectively, which would be used as veterinary vaccines to prevent transmission to humans. 16 In terms of the NTDs targeted by human vaccines, according to the Global Burden of Disease (GBD) Study 2017 together these diseases affect approximately 400 million people at any given time, 7 a population that largely represents most of the world's approximately 700 million people now believed to be living below the World Bank poverty figure of $1.90 per day.…”

“…According to the GBD 2017, together they result in 8.5 million DALYs annually, a value that exceeds the DALYs from global cervical cancers. 8 However, many investigators in the community of NTDs scientists and researchers feel that even 8.5 million DALYs is a "low-ball" estimate. For example, the current disease burden estimates for hookworm infection may not adequately encompass the cases of severe and moderate anemia resulting from this helminthiasis, 9 while current DALYs estimates for schistosomiasis fail to consider all of the chronic morbidities and end-organ pathologies, as well as increased susceptibility to HIV/AIDs among adolescent girls and women.…”