Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Theo VosStephen S LimCristiana AbbafatiKaja AbbasMohammad AbbasiMitra AbbasifardMohsen Abbasi‐KangevariHedayat AbbastabarFoad Abd-AllahAhmed AbdelalimMohammad AbdollahiIbrahim AbdollahpourHassan AbolhassaniVictor AboyansElissa M. AbramsLucas Guimarães AbreuMichael R.M. AbrigoLaith J. Abu‐RaddadAbdelrahman Ibrahim AbushoukAlyssa AcebedoIlana N. AckermanMaryam AdabiAbdu A. AdamuOladimeji AdebayoVictor AdekanmbiJaimie D. AdelsonOlatunji AdetokunbohDavoud AdhamMahdi AfshariAshkan AfshinEmilie AgardhGina AgarwalKareha M AgesaMohammad AghaaliSeyed Mohammad Kazem AghamirAnurag AgrawalTauseef AhmadAlireza AhmadiMehdi AhmadiHamid AhmadiehEhsan AhmadpourTemesgen Yihunie AkaluRufus AkinyemiTomi AkinyemijuBlessing Akombi-InyangZiyad Al‐AlyKhurshid AlamNoore AlamShazia AlamShazia AlamTurki AlanziSamuel B AlbertsonJacqueline Elizabeth Alcalde‐RabanalNiguse Meles AlemaMuhammad AliSaqib AliGianfranco AlicandroMehran AlijanzadehCyrus AliniaVahid AlipourSyed Mohamed AljunidFrançois AllaPeter AllebeckAmir Almasi‐HashianiJordi AlonsoRajaa Al‐RaddadiKhalid A AltirkawiNelson Alvis‐GuzmánNelson J. Alvis-ZakzukGK MiniMostafa Amini‐RaraniArya AminorroayaFatemeh AmiriArianna Maever L. AmitDickson A AmugsiGianna Gayle Herrera AmulDeanna AnderliniCătălina Liliana AndreiTudorel AndreiMina AnjomshoaFereshteh AnsariIman AnsariAlireza Ansari-MoghaddamCarl Abelardo T AntonioCatherine M AntonyErnoiz AntriyandartiDavood AnvariRazique AnwerJalal ArablooMorteza Arab‐ZozaniAleksandr Y. AravkinFilippo ArianiJohan ÄrnlövKavumpurathu Raman ThankappanAfsaneh ArzaniMehran Asadi-AliabadiAli A. Asadi‐PooyaBabak AsghariCharlie AshbaughDesta Debalkie AtnafuSachin AtreFloriane AusloosMarcel AusloosBeatriz Paulina Ayala QuintanillaGetinet AyanoMartin Amogre AyanoreYared Asmare AynalemSamad AzariGhasem AzarianZelalem Nigussie AzeneEbrahim BabaeeAlaa BadawiMojtaba BagherzadehMohammad Hossein BakhshaeiAhad BakhtiariSenthilkumar BalakrishnanShivanthi BalallaShelly BalassyanoMaciej BanachPalash Chandra BanikMarlena S. BannickAgegnehu BanteAdhanom Gebreegziabher BarakiMiguel A. BarbozaSuzanne Barker‐ColloCeline M BarthelemyLingkan BaruaAkbar BarzegarSanjay BasuBernhard T. BauneMohsen BayatiGholamreza BazmandeganNeeraj BediEttore BeghiYannick BéjotAminu K. BelloRose G BenderDerrick BennettFiona B BennittIsabela M. BenseñorCatherine P. BenzigerKidanemaryam BerheEduardo BernabéGregory J BertolacciBhageerathy ReshmiNeeraj BhalaDinesh BhandariPankaj BhardwajKrittika BhattacharyyaZulfiqar A BhuttaSadia BibiMolly H BiehlBoris BikbovMuhammad Shahdaat Bin SayeedAntonio BiondiBinyam Minuye BirhaneDonal BisanzioCatherine BisignanoRaaj Kishore BiswasSomayeh BohlouliMehdi BohluliSrinivasa Rao BollaArchith BoloorAlexandra S Boon-DooleyGuilherme BorgesAntonio Maria BorzìRupert BourneOliver J. BradyMichael BräuerCarol BrayneNicholas J. K. BreitbordeHermann BrennerPaul Svitil BriantAndrew M. BriggsН. И. БрикоGabrielle B. BrittonDana BryazkaRachelle BuchbinderBlair R BumgarnerReinhard BusseZahid A ButtFlorentino Luciano Caetano dos SantosLuis LA Alberto CámeraIsmael Campos‐NonatoJosip CarRosario CárdenasGiulia CarrerasJuan Jesús CarreroFélix CarvalhoJoão Maurício Castaldelli-MaiaCarlos A Castañeda-OrjuelaGiulio CastelpietraChris D CastleFranz CastroFerrán Catalá-LópezKate CauseyChristopher R. CederrothKelly CercyEster CerinJoht Singh ChandanAlex R. ChangFiona J CharlsonVijay Kumar ChattuSarika ChaturvediOdgerel Chimed‐OchirKen Lee ChinDaniel ChoHanne ChristensenDinh‐Toi ChuMichael T. ChungFlavia CicuttiniLiliana G CiobanuMassimo CírilloEmma L. CollinsKelly ComptonSara ContiPaolo Angelo CortesiVera Marisa CostaEwerton CousinRichard G. CowdenBenjamin C CowieElizabeth A. CromwellDi H. CrossChristopher S. CroweJessica A CruzMatthew CunninghamSaad M A DahlawiGiovanni DamianiLalit DandonaRakhi DandonaAso Mohammad DarweshAhmad DaryaniJai K DasRajat Das GuptaJosé das NevesClaudio Alberto Dávila-CervantesKairat DavletovDiego De LeoFrances DeanNicole K. DeCleeneAmanda DeenLouisa DegenhardtRobert P DellavalleFeleke Mekonnen DemekeDesalegn Getnet DemsieEdgar Denova‐GutiérrezNebiyu DerejeNikolaos DervenisRupak DesaiAssefa DesalewGetenet DessieSamath D DharmaratneGovinda Prasad DhunganaMostafa DianatinasabDaniel DíazBudi AjiZachary V DingelsM. Ashworth DiracShirin DjalaliniaHoa DoКлара ДоковаFariba DorostkarChirag DoshiLeila DoshmangirAbdel DouiriMatthew C DoxeyTim DriscollSusanna DunachieBruce Bartholow DuncanAndré Rodrigues DurãesArielle Wilder EaganMohammad Ebrahimi KalanDavid EdvardssonJoshua R. EhrlichNevine El NahasIman El SayedMaha El TantawiIffat ElbaraziIslam Y. ElgendyHala Rashad ElhabashyShaimaa I El-JaafaryIqbal ElyazarMohammad Hassan EmamianSophia Emmons‐BellHolly E ErskineBabak EshratiSharareh EskandariehSaman EsmaeilnejadFirooz EsmaeilzadehAlireza EsteghamatiKara EstepArash EtemadiAtkilt Esaiyas EtissoMohammad FarahmandAnwar FarajMohammad FareedRoghiyeh FaridniaCarla Sofia e Sá FarinhaAndrea FarioliAndré FaroMithila FaruqueFarshad FarzadfarNazir FattahiMehdi FazlzadehValery L. FeiginRachel FeldmanSeyed‐Mohammad FereshtehnejadEduarda FernandesAlize J FerrariManuela L. FerreiraIrina FilipFlorian FischerJames L. FisherRyan FitzgeraldCarsten FlohrLuísa Sório FlorNataliya A FoigtMorẹ́nikẹ́ Oluwátóyìn FoláyanLisa M. ForceCarla FornariMasoud ForoutanJack T FoxMarisa FreitasWeijia FuTakeshi FukumotoJoão M. FurtadoMohamed M. GadEmmanuela GakidouNatalie C GallesSilvano GallusAmiran GamkrelidzeAlberto L. García‐BasteiroWilliam M. 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Abstract:
Summary
Background
In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.Methods
GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution.Findings
Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI.Interpretation
As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve.Funding
Bill & Melinda Gates Foundation.This report is the first of a series of publications about the Victorian Burden of
Disease Study. The study uses the methods developed for the Global Burden of
Disease Study adapted to the Victorian context. It provides a comprehensive
assessment of the amount of ill health, the ’burden of disease’, in Victoria in 1996
and projected to the year 2016. Mortality, disability and illness arising from over
130 diseases, injuries and risk factors are measured in Disability-Adjusted Life Years
(DALYs). The mortality component of the burden of disease, the Years of Life Lost
(YLLs), is the topic of this first report.
Disability-adjusted life year
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Objective To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017. Design Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017. Participants Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved. Methods We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017. Results From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population. Conclusions Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.
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Objectives: Timely and accurate assessments of disease burden are essential for developing effective national health policies. We used the Global Burden of Disease Study 2015 to examine burden due to mental and substance use disorders in Australia. Methods: For each of the 20 mental and substance use disorders included in Global Burden of Disease Study 2015, systematic reviews of epidemiological data were conducted, and data modelled using a Bayesian meta-regression tool to produce prevalence estimates by age, sex, geography and year. Prevalence for each disorder was then combined with a disorder-specific disability weight to give years lived with disability, as a measure of non-fatal burden. Fatal burden was measured as years of life lost due to premature mortality which were calculated by combining the number of deaths due to a disorder with the life expectancy remaining at the time of death. Disability-adjusted life years were calculated by summing years lived with disability and years of life lost to give a measure of total burden. Uncertainty was calculated around all burden estimates. Results: Mental and substance use disorders were the leading cause of non-fatal burden in Australia in 2015, explaining 24.3% of total years lived with disability, and were the second leading cause of total burden, accounting for 14.6% of total disability-adjusted life years. There was no significant change in the age-standardised disability-adjusted life year rates for mental and substance use disorders from 1990 to 2015. Conclusion: Global Burden of Disease Study 2015 found that mental and substance use disorders were leading contributors to disease burden in Australia. Despite several decades of national reform, the burden of mental and substance use disorders remained largely unchanged between 1990 and 2015. To reduce this burden, effective population-level preventions strategies are required in addition to effective interventions of sufficient duration and coverage.
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Objective To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017.
Design Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017.
Participants Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved.
Methods We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017.
Results From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population.
Conclusions Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.
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Abstract Background Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2018 estimated the health impact of 219 diseases and injuries on the Australian population. Methods Burden of disease measures years of healthy life lost from living with (non-fatal) and dying prematurely from (fatal) disease and injury. Fatal and non-fatal burden combined provides the total burden, measured in disability-adjusted life years (DALY). One DALY equals 1 year of healthy life lost. Disease burden was estimated for the years 2018, 2015, 2011 and 2003 for Australia. Results In 2018, 5.0 million years of healthy life were lost from disease and injury. Living with illness or injury caused more total disease burden than dying prematurely (52% vs 48%). Between 2003 and 2018, total burden decreased by 13%, driven by less premature deaths. Disease groups with the biggest absolute reductions in burden (DALY rate) were cardiovascular diseases and cancers. The five leading causes of burden were coronary heart disease, back pain, dementia, chronic obstructive pulmonary disease and lung cancer. Males experienced more burden than females for most age groups. Conclusions Overall burden of disease declined between 2003 and 2018, due to a large reduction in burden from dying prematurely. Living with the impact of chronic diseases contributed substantial burden in Australia in 2018. Key messages Living with illness or injury accounts for most of the disease burden in Australia. There have been improvements in fatal burden since 2003.
Disability-adjusted life year
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.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates.DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers.In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region.The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.
Disability-adjusted life year
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This paper uses the Disability Adjusted Life Year (DALY) to estimate disease burden at a local level and relates this to programme budget (PB) data.We estimated DALY using the global burden of disease (GBD) template. For years of life lost, local mortality data were used and for years of life with disability, the GBD estimates from World Health Organization EURO A region (including the UK) were used. We used PB data to analyse how healthcare expenditure matched disease burden.In 2005 the burden of disease in Lambeth was estimated at 36,368 DALYs (13,515 DALYs lost per 100,000) and in Southwark was 34,196 DALYs (13,244 DALYs lost per 100,000). There were gender and area differences. The ranking is different when mortality and morbidity are combined compared with mortality alone. We estimated that the average spend per DALY lost in 2005 was 11,066 pounds in Lambeth and 9390 pounds in Southwark.We used a pragmatic approach to estimate overall disease burden providing a local, more comprehensive picture with important differences in spend by disease and health authority area. However, a more detailed approach to support decisions about prioritization based on modelling interventions that impact on avoidable burden of disease is recommended.
Disability-adjusted life year
Prioritization
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National mental health policies must be grounded in accurate assessments of diseases. In the current article we used the Global Burden of Disease Study 2016 to examine burden due to mental and substance use disorders in Romania.For each mental and substance use disorder included in the GBD 2016 we reported the yearly estimates for YLL (as a measure for non-fatal burden), YLD (fatal burden) and DALY (summing years lived with disability and years of life lost to give a measure of total burden).Mental and substance use disorders were the third leading cause of non-fatal burden in Romania in 2016, explaining 13.53% of total years lived with disability, the ninth leading cause for fatal burden explaining 0.84% of total years of life lost, and were the fifth leading cause of total burden, accounting for 5.52% of total disability-adjusted life years. Among MSDs, depression, anxiety and alcohol use disorders have the highest rate. Starting 1997 there has been a slow decrease of age-standardized disability-adjusted life year rates, with no significant change in the last 5 years.Global Burden of Disease Study 2016 found that mental and substance use disorders were the fifth leading contributors to disease burden in Romania, with anxiety and depressive being the most prevalent. Despite national programs and strategies in the area of mental health initiated especially after 1990, the mental health system does not fully meet the needs of the patients. Effective population-level strategic measures are still required in order to reduce the burden of disease.
Mental disease
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Brazil is an important consumer market for cocaine. However, the consequences of this consumption and the pattern of distribution of the estimates are still poorly studied in the Brazilian states. The Global Burden of Disease study - 2019 (GBD-2019) has enabled us to describe and analyze indicators of mental disorders (MD) attributable by cocaine use in Brazil and its states, in 1990 and 2019.A descriptive study of the burden of cocaine use disorders, using prevalence, age-standardized mortality rate (ASMR), years of life lost (YLL) due to premature death, years lived with disabilities (YLD), and disability adjusted life years (DALY), which accounts for YLL+YLD.Brazil ranks 8th as DALYs due to cocaine use disorder in the world (42.83/100.000; 95% uncertainty intervals [95% UI]: 35.28 to 61.43). Significant increases have occurred in the age-standardized rate prevalence (ASRP), ASMR, DALY, YLD, and YLL, in Brazil and its states, between 1990 and 2019. The ASRP in 2019 was 2.7-fold higher for men (278.60/100.000; 95% UI: 208.20 to 374.39) in comparison to women (104.01/100.000; 95% UI: 76.70 to 143.02). There is a predominance of YLD in the composition of DALYs; however, the YLL had the biggest increases between 1990 and 2019.The high rate of DALYs and the increase in mortality rates show the need to scale up effective interventions to prevent and reduce the burden of disease attributable to cocaine use disorder, which is a preventable cause of death and disability.
Prevalence
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