Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
Date
2017
Type:
Artículo
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55
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Publisher
Elsevier
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Abstract
BACKGROUND:
Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures
of health across geographies and time that can inform assessments of epidemiological patterns and
health system performance, help to prioritise investments in research and development, and
monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated
HALE and DALYs for geographies worldwide and evaluate how disease burden changes with
development.
METHODS:
We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD
2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE
and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by
summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age
group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific
death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed
from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator
constructed from measures of income per capita, average years of schooling, and total fertility rate.
FINDINGS:
Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in
communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased
DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was
caused by changes in population growth and ageing, but it was accelerated by widespread
improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both
total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by
2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due
to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs
(including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin,
oral, and sense organ diseases) either increased or remained unchanged, leading to increases in
their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an
average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women,
while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively.
Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life
spent with functional health loss; however, rising SDI was related to increases in total disability.
Many countries and territories in central America and eastern sub-Saharan Africa had increasingly
lower rates of disease burden than expected given their SDI. At the same time, a subset of
geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven
mainly by rising burden due to war, interpersonal violence, and various NCDs.
INTERPRETATION:
Health is improving globally, but this means more populations are spending more time with
functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health
decreases somewhat with increasing SDI, a relative compression of morbidity, which supports
continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of
DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark
geography-specific health performance and SDG progress. Country-specific drivers of disease
burden, particularly for causes with higher-than-expected DALYs, should inform financial and
research investments, prevention efforts, health policies, and health system improvement
initiatives for all countries along the development continuum.
Description
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Citation
GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1603-1658. doi: 10.1016/S0140-6736(16)31460-X. Erratum in: Lancet. 2017 Jan 7;389(10064):e1.
Keywords
Global Health, Life Expectancy/trends