@article{21600,
  author = {Yan L. and Wang J. and Feigin V. and Reddy K. and Wang H. and Kengne A. and Wolfe C. and Jee S. and Jiang Y. and Karthikeyan G. and Ohkubo T. and Tandon N. and Gupta R. and Gupta R. and Shi P. and Kumar G. and McKee M. and Salomon J. and Chen H. and Patton G. and Mayosi B. and Vos T. and Thrift A. and Barquera S. and Christensen H. and Swaminathan S. and Remuzzi G. and Sliwa K. and Norrving B. and Cirillo M. and Yu C. and Barker-Collo S. and Kieling C. and Gabbe B. and Jassal S. and Prabhakaran D. and van de Vijver S. and Ali R. and Fowkes F. and Hijar M. and Blyth F. and Murray J. and Ma S. and Phillips M. and Wang L. and Dandona R. and Shiue I. and Dandona L. and Tonelli M. and Bennett D. and Yip P. and Li Y. and Li Y. and Stewart A. and Micha R. and Lim S. and Mozaffarian D. and Buchbinder R. and Zhao Y. and Boufous S. and Pesudovs K. and Bhalla A. and Derrett S. and Murray C. and Lozano R. and Flaxman A. and Ohno S. and Hankey G. and Pandian J. and Liu Y. and Bornstein N. and Ukwaja K. and Jha V. and Farzadfar F. and Khang Y. and Lopez A. and Mills E. and Karimkhani C. and Boyers L. and Dellavalle R. and Collaborators; GBD and Barber R. and Foreman K. and Ozgoren A. and Abd-Allah F. and Abera S. and Aboyans V. and Abraham J. and Abubakar I. and Abu-Raddad L. and Abu-Rmeileh N. and Achoki T. and Ackerman I. and Ademi Z. and Adou A. and Adsuar J. and Afshin A. and Agardh E. and Alam S. and Alasfoor D. and Albittar M. and Alegretti M. and Alemu Z. and Alfonso-Cristancho R. and Alhabib S. and Alla F. and Allebeck P. and Almazroa M. and Alsharif U. and Alvarez E. and Alvis-Guzman N. and Amare A. and Ameh E. and Amini H. and Ammar W. and Anderson H. and Anderson B. and Antonio C. and Anwari P. and Arnlov J. and Arsenijevic V. and Artaman A. and Asghar R. and Assadi R. and Atkins L. and Avila M. and Awuah B. and Bachman V. and Badawi A. and Bahit M. and Balakrishnan K. and Banerjee A. and Barregard L. and Barrero L. and Basu A. and Basu S. and Basulaiman M. and Beardsley J. and Bedi N. and Beghi E. and Bekele T. and Bell M. and Benjet C. and Bensenor I. and Benzian H. and Bernabe E. and Bertozzi-Villa A. and Beyene T. and Bhala N. and Bhutta Z. and Bienhoff K. and Bikbov B. and Biryukov S. and Blore J. and Blosser C. and Bohensky M. and Bolliger I. and Basara B. and Bose D. and Bourne R. and Brainin M. and Brayne C. and Brazinova A. and Breitborde N. and Brenner H. and Briggs A. and Brooks P. and Brown J. and Brugha T. and Buckle G. and Budke C. and Bulchis A. and Bulloch A. and Campos-Nonato I. and Carabin H. and Carapetis J. and Cardenas R. and Carpenter D. and Caso V. and Castaneda-Orjuela C. and Castro R. and Catala-Lopez F. and Cavalleri F. and Cavlin A. and Chadha V. and Chang J. and Charlson F. and Chen W. and Chiang P. and Chimed-Ochir O. and Chowdhury R. and Christophi C. and Coates M. and Coffeng L. and Coggeshall M. and Colistro V. and Colquhoun S. and Cooke G. and Cooper C. and Cooper L. and Coppola L. and Cortinovis M. and Criqui M. and Crump J. and Cuevas-Nasu L. and Danawi H. and Dansereau E. and Dargan P. and Davey G. and Davis A. and Davitoiu D. and Dayama A. and De Leo D. and Degenhardt L. and Del Pozo-Cruz B. and Deribe K. and Jarlais D. and Dessalegn M. and Dharmaratne S. and Dherani M. and Diaz-Torne C. and Dicker D. and Ding E. and Dokova K. and Dorsey E. and Driscoll T. and Duan L. and Duber H. and Ebel B. and Edmond K. and Elshrek Y. and Endres M. and Ermakov S. and Erskine H. and Eshrati B. and Esteghamati A. and Estep K. and Faraon E. and Fay D. and Felson D. and Fereshtehnejad S. and Fernandes J. and Ferrari A. and Fitzmaurice C. and Fleming T. and Foigt N. and Forouzanfar M. and Paleo U. and Franklin R. and Furst T. and Gaffikin L. and Gankpe F. and Geleijnse J. and Gessner B. and Gething P. and Gibney K. and Giroud M. and Giussani G. and Dantes H. and Gona P. and Gonzalez-Medina D. and Gosselin R. and Gotay C. and Goto A. and Gouda H. and Graetz N. and Gugnani H. and Gutierrez R. and Haagsma J. and Hafezi-Nejad N. and Hagan H. and Halasa Y. and Hamadeh R. and Hamavid H. and Hammami M. and Hancock J. and Hansen G. and Hao Y. and Harb H. and Haro J. and Havmoeller R. and Hay S. and Hay R. and Heredia-Pi I. and Heuton K. and Heydarpour P. and Higashi H. and Hoek H. and Hoffman H. and Hosgood H. and Hossain M. and Hotez P. and Hoy D. and Hsairi M. and Hu G. and Huang C. and Huang J. and Husseini A. and Huynh C. and Iannarone M. and Iburg K. and Innos K. and Inoue M. and Islami F. and Jacobsen K. and Jarvis D. and Jeemon P. and Jensen P. and Jiang G. and Jonas J. and Juel K. and Kan H. and Karch A. and Karema C. and Kassebaum N. and Kaul A. and Kawakami N. and Kazanjan K. and Kemp A. and Keren A. and Khader Y. and Khalifa S. and Khan E. and Khan G. and Kim D. and Kim S. and Kim Y. and Kinfu Y. and Kinge J. and Kivipelto M. and Knibbs L. and Knudsen A. and Kokubo Y. and Kosen S. and Krishnaswami S. and Defo B. and Bicer B. and Kuipers E. and Kulkarni C. and Kulkarni V. and Kyu H. and Lai T. and Lalloo R. and Lallukka T. and Lam H. and Lan Q. and Lansingh V. and Larsson A. and Lawrynowicz A. and Leasher J. and Leigh J. and Leung R. and Levitz C. and Li B. and Lind M. and Lipshultz S. and Liu S. and Lloyd B. and Lofgren K. and Logroscino G. and Looker K. and Lortet-Tieulent J. and Lotufo P. and Lucas R. and Lunevicius R. and Lyons R. and Macintyre M. and Mackay M. and Majdan M. and Malekzadeh R. and Marcenes W. and Margolis D. and Margono C. and Marzan M. and Masci J. and Mashal M. and Matzopoulos R. and Mazorodze T. and McGill N. and McGrath J. and McLain A. and Meaney P. and Medina C. and Mehndiratta M. and Mekonnen W. and Melaku Y. and Meltzer M. and Memish Z. and Mensah G. and Meretoja A. and Mhimbira F. and Miller T. and Mitchell P. and Mock C. and Ibrahim N. and Mohammad K. and Mokdad A. and Mola G. and Monasta L. and Hernandez J. and Montico M. and Montine T. and Mooney M. and Moore A. and Moradi-Lakeh M. and Moran A. and Mori R. and Moschandreas J. and Moturi W. and Moyer M. and Msemburi W. and Mueller U. and Mukaigawara M. and Mullany E. and Murdoch M. and Murthy K. and Naghavi M. and Naheed A. and Naidoo K. and Naldi L. and Nand D. and Nangia V. and Narayan K. and Nejjari C. and Neupane S. and Newton C. and Ng M. and Ngalesoni F. and Nguyen G. and Nisar M. and Nolte S. and Norheim O. and Norman R. and Nyakarahuka L. and Oh I. and Olusanya B. and Opio J. and Ortblad K. and Ortiz A. and Pain A. and Panelo C. and Papachristou C. and Park E. and Park J. and Patten S. and Paul V. and Pavlin B. and Pearce N. and Pereira D. and Perez-Padilla R. and Perez-Ruiz F. and Perico N. and Pervaiz A. and Peterson C. and Petzold M. and Phillips B. and Phillips D. and Piel F. and Plass D. and Poenaru D. and Polinder S. and Pope D. and Popova S. and Poulton R. and Pourmalek F. and Prasad N. and Pullan R. and Qato D. and Quistberg D. and Rafay A. and Rahman S. and Raju M. and Rana S. and Razavi H. and Refaat A. and Resnikoff S. and Ribeiro A. and Richardson L. and Richardus J. and Roberts D. and Rojas-Rueda D. and Ronfani L. and Roth G. and Rothenbacher D. and Rothstein D. and Rowley J. and Roy N. and Ruhago G. and Saeedi M. and Saha S. and Sahraian M. and Sampson U. and Sanabria J. and Sandar L. and Santos I. and Satpathy M. and Sawhney M. and Scarborough P. and Schneider I. and Schottker B. and Schumacher A. and Schwebel D. and Scott J. and Seedat S. and Sepanlou S. and Serina P. and Servan-Mori E. and Shackelford K. and Shaheen A. and Shahraz S. and Levy T. and Shangguan S. and She J. and Sheikhbahaei S. and Shibuya K. and Shinohara Y. and Shiri R. and Shishani K. and Shrime M. and Sigfusdottir I. and Silberberg D. and Simard E. and Sindi S. and Singh A. and Singh J. and Singh L. and Skirbekk V. and Slepak E. and Soneji S. and Soreide K. and Soshnikov S. and Sposato L. and Sreeramareddy C. and Stanaway J. and Stathopoulou V. and Stein D. and Stein M. and Steiner C. and Steiner T. and Stevens A. and Stovner L. and Stroumpoulis K. and Sunguya B. and Swaroop M. and Sykes B. and Tabb K. and Takahashi K. and Tanne D. and Tanner M. and Tavakkoli M. and Taylor H. and Ao B. and Tediosi F. and Temesgen A. and Templin T. and M. Have Ten and Tenkorang E. and Terkawi A. and Thomson B. and Thorne-Lyman A. and Thurston G. and Tillmann T. and Topouzis F. and Toyoshima H. and Traebert J. and Tran B. and Trillini M. and Truelsen T. and Tsilimbaris M. and Tuzcu E. and Uchendu U. and Undurraga E. and Uzun S. and Van Brakel W. and van Gool C. and Van Os J. and Vasankari T. and Venketasubramanian N. and Violante F. and Vlassov V. and Vollset S. and Wagner G. and Wagner J. and Waller S. and Wan X. and Warouw T. and Weichenthal S. and Weiderpass E. and Weintraub R. and Wenzhi W. and Werdecker A. and Westerman R. and Whiteford H. and Wilkinson J. and Williams T. and Wolock T. and Woolf A. and Wulf S. and Wurtz B. and Xu G. and Yano Y. and Ye P. and Yentur G. and Yonemoto N. and Yoon S. and Younis M. and Zaki M. and Zheng Y. and Zonies D. and Zou X. and Rahimi K},
  title = {Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition},
  abstract = {BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6-6.6), from 65.3 years (65.0-65.6) in 1990 to 71.5 years (71.0-71.9) in 2013, HALE at birth rose by 5.4 years (4.9-5.8), from 56.9 years (54.5-59.1) to 62.3 years (59.7-64.8), total DALYs fell by 3.6% (0.3-7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6-29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.},
  year = {2015},
  journal = {LancetLancet},
  edition = {2015/09/01},
  isbn = {1474-547X (Electronic)<br/>0140-6736 (Linking)},
  note = {GBD 2013 DALYs and HALE Collaborators<br/>Lancet. 2015 Aug 27. pii: S0140-6736(15)61340-X. doi: 10.1016/S0140-6736(15)61340-X.},
  language = {Eng},
}