Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990'2016: a systematic analysis for the Global Burden of Disease Study 2016
Hay, Simon I; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; et al
Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).
We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 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 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.
The highest globally observed HALE at birth for both women and men was in Singapore, at 75ˇ2 years (95% uncertainty interval 71ˇ9'78ˇ6) for females and 72ˇ0 years (68ˇ8'75ˇ1) for males. The lowest for females was in the Central African Republic (45ˇ6 years [42ˇ0'49ˇ5]) and for males was in Lesotho (41ˇ5 years [39ˇ0'44ˇ0]). From 1990 to 2016, global HALE increased by an average of 6ˇ24 years (5ˇ97'6ˇ48) for both sexes combined. Global HALE increased by 6ˇ04 years (5ˇ74'6ˇ27) for males and 6ˇ49 years (6ˇ08'6ˇ77) for females, whereas HALE at age 65 years increased by 1ˇ78 years (1ˇ61'1ˇ93) for males and 1ˇ96 years (1ˇ69'2ˇ13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 ('2ˇ3% ['5ˇ9 to 0ˇ9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16ˇ1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.
At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.
Type of publication|
Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F.,. . Murray, Christopher J. L. (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the global burden of disease study 2016. Lancet, 390(10100), 1260-1344; 0140-6736; 10.1016/S0140-6736(17)32130-X
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