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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
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Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi JYJ, Choudhari SG, Chowdhury EK, Chu DT, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve JW, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang BF, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam MS, Islam SMS, Islam RM, Ismail NE, Isola G, Itumalla R, Iwagami M, Iyamu IO, Jahani MA, Jakovljevic M, Jayawardena R, Jha RP, John O, Jonas JB, Joo T, Kabir A, Kalhor R, Kamath A, Kanchan T, Kandel H, Kapoor N, Kayode GA, Kebede SA, Keshavarz P, Keykhaei M, Khader YS, Khajuria H, Khan MAB, Khan MN, Khan M, Khater AM, Khoja TAM, Khubchandani J, Kim MS, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kivimäki M, Korshunov VA, Korzh O, Koyanagi A, Krishan K, Kuate Defo B, Kumar GA, Kumar N, Kusuma D, La Vecchia C, Lacey B, Larsson AO, Lasrado S, Lee WC, Lee CB, Lee PH, Lee SWH, Li MC, Lim SS, Lim LL, Lucchetti G, Majeed A, Malik AA, Mansouri B, Mantovani LG, Martini S, Mathur P, McAlinden C, Mehedi N, Mekonnen T, Menezes RG, Mersha AG, Miao Jonasson J, Miazgowski T, Michalek IM, Mirica A, Mirrakhimov EM, Mirza AZ, Mithra P, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed A, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradpour F, Moradzadeh R, Mostafavi E, Mueller UO, Murray CJL, Mustafa A, Nagel G, Nangia V, Naqvi AA, Nayak BP, Nazari J, Ndejjo R, Negoi RI, Neupane Kandel S, Nguyen CT, Nguyen HLT, Noubiap JJ, Nowak C, Oancea B, Odukoya OO, Oguntade AS, Ojo TT, Olagunju AT, Onwujekwe OE, Ortiz A, Owolabi MO, Palladino R, Panda-Jonas S, Pandi-Perumal SR, Pardhan S, Parekh T, Parvizi M, Pepito VCF, Perianayagam A, Petcu IR, Pilania M, Podder V, Polibin RV, Postma MJ, Prashant A, Rabiee N, Rabiee M, Rahimi-Movaghar V, Rahman MA, Rahman MM, Rahman M, Rahmawaty S, Rajai N, Ram P, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao S, Rawaf S, Rawaf DL, Rawal L, Renzaho AMN, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rodriguez JAB, Roever L, Rohloff P, Rwegerera GM, Ryan PM, Saber-Ayad MM, Sabour S, Saddik B, Saeedi Moghaddam S, Sahebkar A, Sahoo H, Saif-Ur-Rahman KM, Salimzadeh H, Samaei M, Sanabria J, Santric-Milicevic MM, Sathian B, Sathish T, Schlaich MP, Seidu AA, Šekerija M, Senthil Kumar N, Seylani A, Shaikh MA, Shamshad H, Shawon MSR, Sheikhbahaei S, Shetty JK, Shiri R, Shivakumar KM, Shuval K, Singh JA, Singh A, Skryabin VY, Skryabina AA, Sofi-Mahmudi A, Soheili A, Sun J, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tadbiri H, Tadesse EG, Tariqujjaman M, Thankappan KR, Thapar R, Thomas N, Timalsina B, Tobe-Gai R, Tonelli M, Tovani-Palone MR, Tran BX, Tripathy JP, Tudor Car L, Tusa BS, Uddin R, Upadhyay E, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Verma M, Villalobos-Daniel VE, Vladimirov SK, Vo B, Vu GT, Vukovic R, Waheed Y, Wamai RG, Werdecker A, Wickramasinghe ND, Winkler AS, Wubishet BL, Xu X, Xu S, Yahyazadeh Jabbari SH, Yatsuya H, Yaya S, Yazie TSY, Yi S, Yonemoto N, Yunusa I, Zadey S, Zaman SB, Zamanian M, Zamora N, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zumla A, Naghavi M, Schmidt MI. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019. Lancet Diabetes Endocrinol 2022; 10:177-192. [PMID: 35143780 PMCID: PMC8860753 DOI: 10.1016/s2213-8587(21)00349-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. FINDINGS In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (-28·4 to -2·9) for all diabetes, and by 21·0% (-33·0 to -5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13·6% [-28·4 to 3·4]) and for type 1 diabetes (-13·6% [-29·3 to 8·9]). INTERPRETATION Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. FUNDING Bill & Melinda Gates Foundation.
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Ward JL, Azzopardi PS, Francis KL, Santelli JS, Skirbekk V, Sawyer SM, Kassebaum NJ, Mokdad AH, Hay SI, Abd-Allah F, Abdoli A, Abdollahi M, Abedi A, Abolhassani H, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abushouk AI, Adebayo OM, Adekanmbi V, Adham D, Advani SM, Afshari K, Agrawal A, Ahmad T, Ahmadi K, Ahmed AE, Aji B, Akombi-Inyang B, Alahdab F, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Alemu BW, Al-Hajj S, Alhassan RK, Ali S, Alicandro G, Alijanzadeh M, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini S, Aminorroaya A, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari I, Antonio CAT, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Atout MMW, Ausloos M, Avenyo EK, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Aynalem YA, Azari S, Azene ZN, Bakhshaei MH, Bakkannavar SM, Banach M, Banik PC, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Bekuma TT, Bell AW, Bell ML, Benjet C, Bensenor IM, Berhe AK, Berhe K, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Birhanu TTM, Biswas RK, Bohlouli S, Bolla SR, Boloor A, Borschmann R, Boufous S, Bragazzi NL, Braithwaite D, Breitborde NJK, Brenner H, Britton GB, Burns RA, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chang HY, Chang JC, Charan J, Chattu VK, Chaturvedi S, Choi JYJ, Chowdhury MAK, Christopher DJ, Chu DT, Chung MT, Chung SC, Cicuttini FM, Constantin TV, Costa VM, Dahlawi SMA, Dai H, Dai X, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dávila-Cervantes CA, Davletov K, De la Hoz FP, De Leo D, Dervenis N, Desai R, Desalew A, Deuba K, Dharmaratne SD, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Didarloo A, Djalalinia S, Dorostkar F, Doshi CP, Doshmangir L, Doyle KE, Duraes AR, Ebrahimi Kalan M, Ebtehaj S, Edvardsson D, El Tantawi M, Elgendy IY, El-Jaafary SI, Elsharkawy A, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati S, Faro A, Farzadfar F, Fattahi N, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Fomenkov AA, Foroutan M, Fukumoto T, Gad MM, Gaidhane AM, Gallus S, Gebre T, Gebremedhin KB, Gebremeskel GG, Gebremeskel L, Gebreslassie AA, Gesesew HA, Ghadiri K, Ghafourifard M, Ghamari F, Ghashghaee A, Gilani SA, Gnedovskaya EV, Godinho MA, Golechha M, Goli S, Gona PN, Gopalani SV, Gorini G, Grivna M, Gubari MIM, Gugnani HC, Guimarães RA, Guo Y, Gupta R, Haagsma JA, Hafezi-Nejad N, Haile TG, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamadeh RR, Hamagharib Abdullah K, Hamidi S, Handiso DW, Hanif A, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hashi A, Hassan A, Hassanipour S, Hassankhani H, Hayat K, Heidari-Soureshjani R, Herteliu C, Heydarpour F, Ho HC, Hole MK, Holla R, Hoogar P, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Huda TM, Humayun A, Hussain R, Hwang BF, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Intarut N, Iqbal U, Irvani SSN, Islam MM, Islam SMS, Iso H, Ivers RQ, Jahani MA, Jakovljevic M, Jalali A, Janodia MD, Javaheri T, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Jones KM, Joukar F, Jozwiak JJ, Juliusson PB, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kalhor R, Kamyari N, Kanchan T, Karch A, Karimi SE, Kaur S, Kayode GA, Keiyoro PN, Khalid N, Khammarnia M, Khan M, Khan MN, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khazaie H, Khoja AT, Kieling C, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Koolivand A, Kosen S, Koyanagi A, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lan Q, Landires I, Lansingh VC, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Leigh J, Leonardi M, Leung J, Levi M, Lewycka S, Li B, Li MC, Li S, Lim LL, Lim SS, Liu X, Lorkowski S, Lotufo PA, Lunevicius R, Maddison R, Mahasha PW, Mahdavi MM, Mahmoudi M, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martinez-Raga J, Martins-Melo FR, Mason-Jones AJ, Masoumi SZ, Mathur MR, Maulik PK, McGrath JJ, Mehndiratta MM, Mehri F, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Mohammad DK, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed S, Monasta L, Moradi G, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morrison SD, Mosapour A, Mousavi Khaneghah A, Mueller UO, Muriithi MK, Murray CJL, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Naimzada MD, Nangia V, Nayak VC, Nazari J, Ndejjo R, Negoi I, Negoi RI, Netsere HB, Nguefack-Tsague G, Nguyen DN, Nguyen HLT, Nie J, Ningrum DNA, Nnaji CA, Nomura S, Noubiap JJ, Nowak C, Nuñez-Samudio V, Ogbo FA, Oghenetega OB, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Omer MO, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Pandey A, Panelo CIA, Park EK, Patten SB, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pesudovs K, Pham HQ, Phillips MR, Piradov MA, Pirsaheb M, Postma MJ, Pottoo FH, Pourjafar H, Pourshams A, Prada SI, Pupillo E, Quazi Syed Z, Rabiee MH, Rabiee N, Radfar A, Rafiee A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Ramezanzadeh K, Ranabhat CL, Rao SJ, Rashedi V, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Renzaho AMN, Rezaei N, Rezaei N, Rezai MS, Riahi SM, Rickard J, Roever L, Ronfani L, Roth GA, Rubagotti E, Rumisha SF, Rwegerera GM, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salem MR, Salimzadeh H, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarrafzadegan N, Sarveazad A, Sathish T, Sattin D, Saxena D, Saxena S, Schiavolin S, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Sha F, Shafaat O, Shahabi S, Shaheen AA, Shaikh MA, Shakiba S, Shamsi M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shetty BSK, Shi P, Shigematsu M, Shin JI, Shiri R, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Simonetti B, Singh JA, Singh V, Sinke AH, Skryabin VY, Slater H, Smith EUR, Sobhiyeh MR, Sobngwi E, Soheili A, Somefun OD, Sorrie MB, Soyiri IN, Sreeramareddy CT, Stein DJ, Stokes MA, Sudaryanto A, Sultan I, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Taherkhani A, Tamiru AT, Tareque MI, Thankappan KR, Thapar R, Thomas N, Titova MV, Tonelli M, Tovani-Palone MR, Tran BX, Travillian RS, Tsai AC, Tsatsakis A, Tudor Car L, Uddin R, Unim B, Unnikrishnan B, Upadhyay E, Vacante M, Valadan Tahbaz S, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villeneuve PJ, Violante FS, Vlassov V, Vos T, Vu GT, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Westerman R, Wickramasinghe ND, Wu AM, Wu C, Yahyazadeh Jabbari SH, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefinezhadi T, Yu C, Yu Y, Yuce D, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zarafshan H, Zarei A, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao XJG, Zhu C, Patton GC, Viner RM. Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 398:1593-1618. [PMID: 34755628 PMCID: PMC8576274 DOI: 10.1016/s0140-6736(21)01546-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/07/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING Bill & Melinda Gates Foundation.
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Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V, Abualhasan A, Abu-Rmeileh NME, Abushouk AI, Adebayo OM, Agarwal G, Agasthi P, Ahinkorah BO, Ahmad S, Ahmadi S, Ahmed Salih Y, Aji B, Akbarpour S, Akinyemi RO, Al Hamad H, Alahdab F, Alif SM, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Shahi Salman R, Alvis-Guzman N, Ancuceanu R, Anderlini D, Anderson JA, Ansar A, Antonazzo IC, Arabloo J, Ärnlöv J, Artanti KD, Aryan Z, Asgari S, Ashraf T, Athar M, Atreya A, Ausloos M, Baig AA, Baltatu OC, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barone MTU, Basu S, Bazmandegan G, Beghi E, Beheshti M, Béjot Y, Bell AW, Bennett DA, Bensenor IM, Bezabhe WM, Bezabih YM, Bhagavathula AS, Bhardwaj P, Bhattacharyya K, Bijani A, Bikbov B, Birhanu MM, Boloor A, Bonny A, Brauer M, Brenner H, Bryazka D, Butt ZA, Caetano dos Santos FL, Campos-Nonato IR, Cantu-Brito C, Carrero JJ, Castañeda-Orjuela CA, Catapano AL, Chakraborty PA, Charan J, Choudhari SG, Chowdhury EK, Chu DT, Chung SC, Colozza D, Costa VM, Costanzo S, Criqui MH, Dadras O, Dagnew B, Dai X, Dalal K, Damasceno AAM, D'Amico E, Dandona L, Dandona R, Darega Gela J, Davletov K, De la Cruz-Góngora V, Desai R, Dhamnetiya D, Dharmaratne SD, Dhimal ML, Dhimal M, Diaz D, Dichgans M, Dokova K, Doshi R, Douiri A, Duncan BB, Eftekharzadeh S, Ekholuenetale M, El Nahas N, Elgendy IY, Elhadi M, El-Jaafary SI, Endres M, Endries AY, Erku DA, Faraon EJA, Farooque U, Farzadfar F, Feroze AH, Filip I, Fischer F, Flood D, Gad MM, Gaidhane S, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Ghozy S, Gialluisi A, Giampaoli S, Gilani SA, Gill PS, Gnedovskaya EV, Golechha M, Goulart AC, Guo Y, Gupta R, Gupta VB, Gupta VK, Gyanwali P, Hafezi-Nejad N, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hashi A, Hassan TS, Hassen HY, Havmoeller RJ, Hay SI, Hayat K, Hegazy MI, Herteliu C, Holla R, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iacoviello L, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Iqbal U, Irvani SSN, Islam SMS, Ismail NE, Iso H, Isola G, Iwagami M, Jacob L, Jain V, Jang SI, Jayapal SK, Jayaram S, Jayawardena R, Jeemon P, Jha RP, Johnson WD, Jonas JB, Joseph N, Jozwiak JJ, Jürisson M, Kalani R, Kalhor R, Kalkonde Y, Kamath A, Kamiab Z, Kanchan T, Kandel H, Karch A, Katoto PDMC, Kayode GA, Keshavarz P, Khader YS, Khan EA, Khan IA, Khan M, Khan MAB, Khatib MN, Khubchandani J, Kim GR, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Kolte D, Koolivand A, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Krishnamurthi RV, Kumar GA, Kusuma D, La Vecchia C, Lacey B, Lak HM, Lallukka T, Lasrado S, Lavados PM, Leonardi M, Li B, Li S, Lin H, Lin RT, Liu X, Lo WD, Lorkowski S, Lucchetti G, Lutzky Saute R, Magdy Abd El Razek H, Magnani FG, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Manafi N, Mansournia MA, Mantovani LG, Martini S, Mazzaglia G, Mehndiratta MM, Menezes RG, Meretoja A, Mersha AG, Miao Jonasson J, Miazgowski B, Miazgowski T, Michalek IM, Mirrakhimov EM, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Mokhayeri Y, Molokhia M, Moni MA, Montasir AA, Moradzadeh R, Morawska L, Morze J, Muruet W, Musa KI, Nagarajan AJ, Naghavi M, Narasimha Swamy S, Nascimento BR, Negoi RI, Neupane Kandel S, Nguyen TH, Norrving B, Noubiap JJ, Nwatah VE, Oancea B, Odukoya OO, Olagunju AT, Orru H, Owolabi MO, Padubidri JR, Pana A, Parekh T, Park EC, Pashazadeh Kan F, Pathak M, Peres MFP, Perianayagam A, Pham TM, Piradov MA, Podder V, Polinder S, Postma MJ, Pourshams A, Radfar A, Rafiei A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmani AM, Rajai N, Ranasinghe P, Rao CR, Rao SJ, Rathi P, Rawaf DL, Rawaf S, Reitsma MB, Renjith V, Renzaho AMN, Rezapour A, Rodriguez JAB, Roever L, Romoli M, Rynkiewicz A, Sacco S, Sadeghi M, Saeedi Moghaddam S, Sahebkar A, Saif-Ur-Rahman KM, Salah R, Samaei M, Samy AM, Santos IS, Santric-Milicevic MM, Sarrafzadegan N, Sathian B, Sattin D, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Sepanlou SG, Seylani A, Sha F, Shahabi S, Shaikh MA, Shannawaz M, Shawon MSR, Sheikh A, Sheikhbahaei S, Shibuya K, Siabani S, Silva DAS, Singh JA, Singh JK, Skryabin VY, Skryabina AA, Sobaih BH, Stortecky S, Stranges S, Tadesse EG, Tarigan IU, Temsah MH, Teuschl Y, Thrift AG, Tonelli M, Tovani-Palone MR, Tran BX, Tripathi M, Tsegaye GW, Ullah A, Unim B, Unnikrishnan B, Vakilian A, Valadan Tahbaz S, Vasankari TJ, Venketasubramanian N, Vervoort D, Vo B, Volovici V, Vosoughi K, Vu GT, Vu LG, Wafa HA, Waheed Y, Wang Y, Wijeratne T, Winkler AS, Wolfe CDA, Woodward M, Wu JH, Wulf Hanson S, Xu X, Yadav L, Yadollahpour A, Yahyazadeh Jabbari SH, Yamagishi K, Yatsuya H, Yonemoto N, Yu C, Yunusa I, Zaman MS, Zaman SB, Zamanian M, Zand R, Zandifar A, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhong C, Zuniga YMH, Murray CJL. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20:795-820. [PMID: 34487721 PMCID: PMC8443449 DOI: 10.1016/s1474-4422(21)00252-0] [Citation(s) in RCA: 1651] [Impact Index Per Article: 550.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. METHODS We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. FINDINGS In 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING Bill & Melinda Gates Foundation.
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Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimi-Movaghar A, Rahman MA, Rajabpour-Sanati A, Rajati F, Ramezanzadeh K, Ranabhat CL, Rao PC, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawal L, Razo C, Redford SB, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro ALP, Ribeiro DC, Ribeiro D, Rickard J, Roberts NLS, Roberts S, Robinson SR, Roever L, Rolfe S, Ronfani L, Roshandel G, Roth GA, Rubagotti E, Rumisha SF, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Sadeghi M, Saeidi S, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salamati P, Salehi Zahabi S, Salem H, Salem MRR, Salimzadeh H, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santomauro DF, Santos IS, Santos JV, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Sbarra AN, Schaeffer LE, Schiavolin S, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Senbeta AM, Senthilkumaran S, Sepanlou SG, Shackelford KA, Shadid J, Shahabi S, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharara F, Sheena BS, Sheikhtaheri A, Shetty RS, Shibuya K, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Simpson KE, Singh A, Singh JA, Skiadaresi E, Skou ST, Skryabin VY, Sobngwi E, Sokhan A, Soltani S, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Stanaway JD, Stark BA, Ştefan SC, Stein C, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Stubbs JL, Sudaryanto A, Sufiyan MB, Sulo G, Sultan I, Sykes BL, Sylte DO, Szócska M, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tajdini M, Takahashi K, Taveira N, Teagle WL, Teame H, Tehrani-Banihashemi A, Teklehaimanot BF, Terrason S, Tessema ZT, Thankappan KR, Thomson AM, Tohidinik HR, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Troeger CE, Truelsen TC, Tsai AC, Tsatsakis A, Tudor Car L, Tyrovolas S, Uddin R, Ullah S, Undurraga EA, Unnikrishnan B, Vacante M, Vakilian A, Valdez PR, Varughese S, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vukovic A, Vukovic R, Waheed Y, Walters MK, Wang J, Wang Y, Wang YP, Ward JL, Watson A, Wei J, Weintraub RG, Weiss DJ, Weiss J, Westerman R, Whisnant JL, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wilner LB, Wilson S, Wojtyniak B, Wolfe CDA, Wool EE, Wu AM, Wulf Hanson S, Wunrow HY, Xu G, Xu R, Yadgir S, Yahyazadeh Jabbari SH, Yamagishi K, Yaminfirooz M, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, Younis MZ, Younker TP, Yousefi Z, Yousefifard M, Yousefinezhadi T, Yousuf AY, Yu C, Yusefzadeh H, Zahirian Moghadam T, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zangeneh A, Zastrozhin MS, Zewdie KA, Zhang Y, Zhang ZJ, Zhao JT, Zhao Y, Zheng P, Zhou M, Ziapour A, Zimsen SRM, Naghavi M, Murray CJL. 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. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6299] [Impact Index Per Article: 1574.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
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.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi 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Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang KL, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chimed-Ochir O, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Classen TKD, Cohen AJ, Compton K, Cooper OR, Costa VM, Cousin E, Cowden RG, Cross DH, Cruz JA, Dahlawi SMA, Damasceno AAM, Damiani G, Dandona L, Dandona R, Dangel WJ, Danielsson AK, Dargan PI, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davitoiu DV, De Leo D, Degenhardt L, DeLang M, Dellavalle RP, Demeke FM, Demoz GT, Demsie DG, Denova-Gutiérrez E, Dervenis N, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dibaji Forooshani ZS, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshmangir L, Driscoll TR, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Nahas N, El Sayed I, El 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Zandian H, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao JT, Zhao XJG, Zhao Y, Zhou M, Ziapour A, Zimsen SRM, Brauer M, Afshin A, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3234] [Impact Index Per Article: 808.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abolhassani H, Abreu LG, Abrigo MRM, Abushouk AI, Adabi M, Adair T, Adebayo OM, Adedeji IA, Adekanmbi V, Adeoye AM, Adetokunboh OO, Advani SM, Afshin A, Aghaali M, Agrawal A, Ahmadi K, Ahmadieh H, Ahmed MB, Al-Aly Z, Alam K, Alam T, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Ali M, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Alizade H, Aljunid SM, Allebeck P, Almadi MAH, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Amini-Rarani M, Aminorroaya A, Amit AML, Ancuceanu R, Andrei CL, Androudi S, Angus C, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Anvari D, Appiah SCY, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Aryal KK, Asadi-Pooya AA, Asgari S, Asghari Jafarabadi M, Atteraya MS, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azarian G, Babaee E, Badiye AD, Bagli E, Bahrami MA, Bakhtiari A, Balassyano S, Banach M, Banik PC, Barker-Collo SL, Bärnighausen TW, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Bell ML, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bertolacci GJ, Bhageerathy R, Bhala N, Bhattacharyya K, Bhutta ZA, Bijani A, Biondi A, Bisanzio D, Bisignano C, Biswas RK, Bjørge T, Bohlouli S, Bohluli M, Bolla SRR, Borzì AM, Borzouei S, Brady OJ, Braithwaite D, Brauer M, Briko AN, Briko NI, Bumgarner BR, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cai T, Callender CSKH, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castelpietra G, Castro F, Catalá-López F, Cederroth CR, Cerin E, Chattu VK, Chin KL, Chu DT, Ciobanu LG, Cirillo M, Comfort H, Costa VM, Cowden RG, Cromwell EA, Croneberger AJ, Cunningham M, Dahlawi SMA, Damiani G, D'Amico E, Dandona L, Dandona R, Dargan PI, Darwesh AM, Daryani A, Das Gupta R, das Neves J, Davletov K, De Leo D, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Dhungana GP, Dias da Silva D, Diaz D, Dippenaar IN, Djalalinia S, Do HT, Dokova K, Doku DT, Dorostkar F, Doshi CP, Doshmangir L, Doyle KE, Dubljanin E, Duraes AR, Edvardsson D, Effiong A, El Sayed I, El Tantawi M, Elbarazi I, El-Jaafary SI, Emamian MH, Eskandarieh S, Esmaeilzadeh F, Estep K, Farahmand M, Faraj A, Fareed M, Faridnia R, Faro A, Farzadfar F, Fattahi N, Fazaeli AA, Fazlzadeh M, Feigin VL, Fereshtehnejad SM, Fernandes E, Ferreira ML, Filip I, Fischer F, Flohr C, Foigt NA, Folayan MO, Fomenkov AA, Freitas M, Fukumoto T, Fuller JE, Furtado JM, Gad MM, Gakidou E, Gallus S, Gebrehiwot AM, Gebremedhin KB, Gething PW, Ghamari F, Ghashghaee A, Gholamian A, Gilani SA, Gitimoghaddam M, Glushkova EV, Gnedovskaya EV, Gopalani SV, Goulart AC, Gugnani HC, Guo Y, Gupta R, Gupta SS, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Han C, Handiso DW, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hassanipour S, Hassankhani H, Hay SI, Heibati B, Heidari-Soureshjani R, Henny K, Henry NJ, Herteliu C, Heydarpour F, Hole MK, Hoogar P, Hosgood HD, Hossain N, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hu G, Huda TM, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imani-Nasab MH, Islam M, Iso H, Iwu CJ, Jaafari J, Jacobsen KH, Jahagirdar D, Jahanmehr N, Jalali A, Jalilian F, James SL, Janjani H, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir Z, Kalani H, Kalankesh LR, Kamiab Z, Kanchan T, Kapoor N, Karch A, Karimi SE, Karimi SA, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keiyoro PN, Keller C, Khader YS, Khalid N, Khan EA, Khan M, Khang YH, Khater AM, Khater MM, Khazaei S, Khazaie H, Khodayari MT, Khubchandani J, Kianipour N, Kim CI, Kim YE, Kim YJ, Kinfu Y, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Komaki H, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar M, Kumar P, Kumar V, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lami FH, Lansky S, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lazarus JV, Lee PH, Lee SWH, Leever AT, LeGrand KE, Leonardi M, Li S, Lim LL, Lim SS, Linn S, Lodha R, Logroscino G, Lopez AD, Lopukhov PD, Lotufo PA, Lozano R, Lu A, Lunevicius R, Madadin M, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahasha PW, Mahdavi MM, Malekzadeh R, Mamun AA, Manafi N, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mapoma CC, Martini S, Martins-Melo FR, Masaka A, Mastrogiacomo CI, Mathur MR, May EA, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Meitei WB, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mestrovic T, Michalek IM, Mihretie KM, Miller TR, Mills EJ, Milne GJ, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadbeigi A, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed H, Mohammed S, Mohebi F, Mohseni Bandpei MA, Mokari A, Mokdad AH, Momen NC, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Joo M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Musa KI, Muthupandian S, Nabavizadeh B, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naik G, Najafi F, Nangia V, Nansseu JR, Ndwandwe DE, Negoi I, Negoi RI, Ngunjiri JW, Nguyen HLT, Nguyen TH, Nigatu YT, Nikbakhsh R, Nikpoor AR, Nixon MR, Nnaji CA, Nomura S, Noubiap JJ, Nouraei Motlagh S, Nowak C, Oţoiu A, Odell CM, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Ong KL, Onwujekwe OE, Ortiz A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Park J, Pasupula DK, Patel JR, Patel SK, Patton GC, Paulson KR, Pazoki Toroudi H, Pease SA, Peden AE, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico N, Pigott DM, Pilgrim T, Pilz TM, Piradov MA, Pirsaheb M, Pokhrel KN, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poznańska A, Prada SI, Prakash S, Preotescu L, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiei A, Raggi A, Rahman MA, Rajabpour-Sanati A, Ram P, Ranabhat CL, Rao SJ, Rasella D, Rashedi V, Rastogi P, Rathi P, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rickard J, Roever L, Ronfani L, Roshandel G, Rostamian M, Rubagotti E, Rwegerera GM, Sabour S, Saddik B, Sadeghi E, Sadeghi M, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salama JS, Salamati P, Salem MRR, Salimi Y, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saylan M, Schaeffer LE, Schiavolin S, Schwebel DC, Schwendicke F, Sekerija M, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shabani M, Shahabi S, Shahbaz M, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharafi Z, Sharara F, Sharma R, Shaw DH, Sheikh A, Shin JI, Shiri R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Simonetti B, Simpson KE, Singh JA, Skiadaresi E, Skryabin VY, Soheili A, Sokhan A, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stockfelt L, Stokes MA, Stubbs JL, Sudaryanto A, Sufiyan MB, Suliankatchi Abdulkader R, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tang M, Taveira N, Taylor HJ, Teagle WL, Tehrani-Banihashemi A, Teklehaimanot BF, Tessema ZT, Thankappan KR, Thomas N, Thrift AG, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Traini E, Tran BX, Travillian R, Trias-Llimós S, Truelsen TC, Tudor Car L, Unnikrishnan B, Upadhyay E, Vacante M, Vakilian A, Valdez PR, Valli A, Vardavas C, Vasankari TJ, Vasconcelos AMN, Vasseghian Y, Veisani Y, Venketasubramanian N, Vidale S, Violante FS, Vlassov V, Vollset SE, Vos T, Vujcic IS, Vukovic A, Vukovic R, Waheed Y, Wallin MT, Walters MK, Wang H, Wang YP, Watson S, Wei J, Weiss J, Weldesamuel GT, Werdecker A, Westerman R, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wojtyniak B, Wolfe CDA, Wondmieneh AB, Wool EE, Wu AM, Wu J, Xu G, Yamada T, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yilgwan CS, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, York HW, Younis MZ, Younker TP, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yusefzadeh H, Zahirian Moghadam T, Zakzuk J, Zaman SB, Zamani M, Zamanian M, Zandian H, Zhang ZJ, Zheng P, Zhou M, Ziapour A, Murray CJL. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1160-1203. [PMID: 33069325 PMCID: PMC7566045 DOI: 10.1016/s0140-6736(20)30977-6] [Citation(s) in RCA: 701] [Impact Index Per Article: 175.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. METHODS 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. FINDINGS The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. INTERPRETATION Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. FUNDING Bill & Melinda Gates Foundation.
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Deshpande A, Miller-Petrie MK, Lindstedt PA, Baumann MM, Johnson KB, Blacker BF, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abegaz KH, Abejie AN, Abreu LG, Abrigo MR, Abualhasan A, Accrombessi MMK, Adamu AA, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhikari TB, Afarideh M, Agudelo-Botero M, Ahmadi M, Ahmadi K, Ahmed MB, Ahmed AE, Akalu TY, Akanda AS, Alahdab F, Al-Aly Z, Alam S, Alam N, Alamene GM, Alanzi TM, Albright J, Albujeer A, Alcalde-Rabanal JE, Alebel A, Alemu ZA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amit AML, Amul GGH, Andrei CL, Anjomshoa M, Ansariadi A, Antonio CAT, Antony B, Antriyandarti E, Arabloo J, Aref HMA, Aremu O, Armoon B, Arora A, Aryal KK, Arzani A, Asadi-Aliabadi M, Asmelash D, Atalay HT, Athari SM, Athari SS, Atre SR, Ausloos M, Awasthi S, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azman AS, Babaee E, Badawi A, Bagherzadeh M, Bakkannavar SM, Balakrishnan S, Banach M, Banoub JAM, Barac A, Barboza MA, Bärnighausen TW, Basu S, Bay VD, Bayati M, Bedi N, Beheshti M, Behzadifar M, Behzadifar M, Bejarano Ramirez DF, Bell ML, Bennett DA, Benzian H, Berbada DA, Bernstein RS, Bhat AG, Bhattacharyya K, Bhaumik S, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biswas RK, Bohlouli S, Boufous S, Brady OJ, Briko AN, Briko NI, Britton GB, Brown A, Burugina Nagaraja S, Butt ZA, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car J, Cárdenas R, Carvalho F, Castañeda-Orjuela CA, Castro F, Cerin E, Chalise B, Chattu VK, Chin KL, Christopher DJ, Chu DT, Cormier NM, Costa VM, Cromwell EA, Dadi AFF, Dahiru T, Dahlawi SMA, Dandona R, Dandona L, Dang AK, Daoud F, Darwesh AM, Darwish AH, Daryani A, Das JK, Das Gupta R, Dash AP, Dávila-Cervantes CA, Davis Weaver N, De la Hoz FP, De Neve JW, Demissie DB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Dipeolu IO, Do HT, Dolecek C, Doyle KE, Dubljanin E, Duraes AR, Edinur HA, Effiong A, Eftekhari A, El Nahas N, El Sayed Zaki M, El Tantawi M, Elhabashy HR, El-Jaafary SI, El-Khatib Z, Elkout H, Elsharkawy A, Enany S, Endalew DA, Eshrati B, Eskandarieh S, Etemadi A, Ezekannagha O, Faraon EJA, Fareed M, Faro A, Farzadfar F, Fasil AF, Fazlzadeh M, Feigin VL, Fekadu W, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Flohr C, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Frostad JJ, Fukumoto T, Gad MM, Garcia GM, Gatotoh AM, Gayesa RT, Gebremedhin KB, Geramo YCD, Gesesew HA, Gezae KE, Ghashghaee A, Ghazi Sherbaf F, Gill TK, Gill PS, Ginindza TG, Girmay A, Gizaw Z, Goodridge A, Gopalani SV, Goulart BNG, Goulart AC, Grada A, Green MS, Gubari MIM, Gugnani HC, Guido D, Guimarães RA, Guo Y, Gupta R, Gupta R, Ha GH, Haagsma JA, Hafezi-Nejad N, Haile DH, Haile MT, Hall BJ, Hamidi S, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassen HY, Hayelom DH, Hegazy MI, Heibati B, Heidari B, Hendrie D, Henok A, Herteliu C, Heydarpour F, Hidru HDD, Hird TR, Hoang CL, Hollerich GI, Hoogar P, Hossain N, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Hussen MAA, Ibitoye SE, Ilesanmi OS, Ilic MD, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam SMS, Ivers RQ, Iwu CJ, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kanchan T, Karch A, Karki S, Kasaeian A, Kasahun GG, Kasaye HK, Kassa GG, Kassa GM, Kayode GA, Kebede MM, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalilov R, Khan EA, Khan J, Khan MN, Khatab K, Khater MM, Khater AM, Khayamzadeh M, Khazaei M, Khosravi MH, Khubchandani J, Kiadaliri A, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kochhar S, Kolola T, Komaki H, Kosen S, Koul PA, Koyanagi A, Krishan K, Kuate Defo B, Kugbey N, Kumar P, Kumar GA, Kumar M, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lam H, Lami FH, Lansingh VC, Lasrado S, Lebedev G, Lee PH, LeGrand KE, Leili M, Lenjebo TL, Leshargie CT, Levine AJ, Lewycka S, Li S, Linn S, Liu S, Lopez JCF, Lopukhov PD, Magdy Abd El Razek M, Mahadeshwara Prasad D, Mahasha PW, Mahotra NB, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Mansournia MA, Mapoma CC, Martinez G, Martini S, Martins-Melo FR, Mathur MR, Mayala BK, Mazidi M, McAlinden C, Meharie BG, Mehndiratta MM, Mehrabi Nasab E, Mehta KM, Mekonnen T, Mekonnen TC, Meles GG, Meles HG, Memiah PTN, Memish ZA, Mendoza W, Menezes RG, Mereta ST, Meretoja TJ, Mestrovic T, Metekiya WM, Metekiya WM, Miazgowski B, Miller TR, Mini GK, Mirrakhimov EM, Moazen B, Mohajer B, Mohammad Y, Mohammad DK, Mohammad Gholi Mezerji N, Mohammadibakhsh R, Mohammed S, Mohammed JA, Mohammed H, Mohebi F, Mokdad AH, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moraga P, Morales L, Mosapour A, Mosser JF, Mouodi S, Mousavi SM, Mozaffor M, Munro SB, Muriithi MK, Murray CJL, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Naik G, Nangia V, Nascimento BR, Nazari J, Ndwandwe DE, Negoi I, Netsere HB, Ngunjiri JW, Nguyen CT, Nguyen HLT, Nguyen QP, Nigatu SG, Ningrum DNA, Nnaji CA, Nojomi M, Norheim OF, Noubiap JJ, Oancea B, Ogbo FA, Oh IH, Olagunju AT, Olusanya JO, Olusanya BO, Onwujekwe OE, Ortega-Altamirano DV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pana A, Park EK, Patel SK, Pathak A, Patle A, Paulos K, Pepito VCF, Perico N, Pervaiz A, Pescarini JM, Pesudovs K, Pham HQ, Pigott DM, Pilgrim T, Pirsaheb M, Poljak M, Pollock I, Postma MJ, Pourmalek F, Pourshams A, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi S, Rahimi-Movaghar V, Rahman MA, Rahman MHU, Rajati F, Ranabhat CL, Rao PC, Rasella D, Rath GK, Rawaf S, Rawal L, Rawasia WF, Remuzzi G, Renjith V, Renzaho AM, Resnikoff S, Riahi SM, Ribeiro AI, Rickard J, Roever L, Ronfani L, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Saeedi Moghaddam S, Safari Y, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Saleem A, Salem H, Salem MR, Salimi Y, Salimzadeh H, Samy AM, Sanabria J, Santos IS, Santric-Milicevic MM, Sao Jose BP, Saraswathy SYI, Sarrafzadegan N, Sartorius B, Sathian B, Sathish T, Satpathy M, Sawhney M, Sayyah M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shafieesabet A, Shaheen AA, Shahid I, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharma R, Sheikh A, Shetty BSK, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shivakumar KM, Si S, Siabani S, Siddiqi TJ, Silva DAS, Singh V, Singh NP, Singh BBS, Singh JA, Singh A, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Soares Filho AM, Sobhiyeh MR, Sokhan A, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tabarés-Seisdedos R, Tabuchi T, Tadesse DB, Tarigan IU, Taye B, Tefera YM, Tehrani-Banihashemi A, Tekelemedhin SW, Tekle MG, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, ThekkePurakkal AS, Thomas N, Thompson RL, Thomson AJ, Topor-Madry R, Tovani-Palone MR, Traini E, Tran BX, Tran KB, Ullah I, Unnikrishnan B, Usman MS, Uthman OA, Uzochukwu BSC, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, W/hawariat FG, Waheed Y, Wallin MT, Wang YP, Wang Y, Wangdi K, Weiss DJ, Weldesamuel GT, Werkneh AA, Westerman R, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wolde HF, Wondafrash DZ, Wonde TE, Worku GT, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yatsuya H, Yeshaneh A, Yilma MT, Yip P, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi Z, Zaman SB, Zamani M, Zandian H, Zar HJ, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Zuniga YMH, Hay SI, Reiner RC. Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17. Lancet Glob Health 2020; 8:e1162-e1185. [PMID: 32827479 PMCID: PMC7443708 DOI: 10.1016/s2214-109x(20)30278-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. METHODS We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. FINDINGS Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. INTERPRETATION Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. FUNDING Bill & Melinda Gates Foundation.
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Reiner RC, Wiens KE, Deshpande A, Baumann MM, Lindstedt PA, Blacker BF, Troeger CE, Earl L, Munro SB, Abate D, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe G, Abegaz KH, Abreu LG, Abrigo MRM, Accrombessi MMK, Acharya D, Adabi M, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Afarideh M, Ahmadi K, Ahmadi M, Ahmed AE, Ahmed MB, Ahmed R, Ajumobi O, Akal CG, Akalu TY, Akanda AS, Alamene GM, Alanzi TM, Albright JR, Alcalde Rabanal JE, Alemnew BT, Alemu ZA, Ali BA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Alvis-Zakzuk NJ, Amare AT, Amini S, Amit AML, Andrei CL, Anegago MT, Anjomshoa M, Ansari F, Antonio CAT, Antriyandarti E, Appiah SCY, Arabloo J, Aremu O, Armoon B, Aryal KK, Arzani A, Asadi-Lari M, Ashagre AF, Atalay HT, Atique S, Atre SR, Ausloos M, Avila-Burgos L, Awasthi A, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Ayele AA, Aynalem YAA, Azari S, Babaee E, Badawi A, Bakkannavar SM, Balakrishnan S, Bali AG, Banach M, Barac A, Bärnighausen TW, Basaleem H, Bassat Q, Bayati M, Bedi N, Behzadifar M, Behzadifar M, Bekele YA, Bell ML, Bennett DA, Berbada DA, Beyranvand T, Bhat AG, Bhattacharyya K, Bhattarai S, Bhaumik S, Bijani A, Bikbov B, Biswas RK, Bogale KA, Bohlouli S, Brady OJ, Bragazzi NL, Briko NI, Briko AN, Burugina Nagaraja S, Butt ZA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carvalho F, Castro F, Chansa C, Chatterjee P, Chattu VK, Chauhan BG, Chin KL, Christopher DJ, Chu DT, Claro RM, Cormier NM, Costa VM, Damiani G, Daoud F, Dandona L, Dandona R, Darwish AH, Daryani A, Das JK, Das Gupta R, Dasa TT, Davila CA, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demis AB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dessie GA, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Ding EL, Diro HD, Djalalinia S, Do HP, Doku DT, Dolecek C, Dubey M, Dubljanin E, Duko Adema B, Dunachie SJ, Durães AR, Duraisamy S, Effiong A, Eftekhari A, El Sayed I, El Sayed Zaki M, El Tantawi M, Elemineh DA, El-Jaafary SI, Elkout H, Elsharkawy A, Enany S, Endalamfaw A, Endalew DA, Eskandarieh S, Esteghamati A, Etemadi A, Farag TH, Faraon EJA, Fareed M, Faridnia R, Farioli A, Faro A, Farzam H, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Foroutan M, Francis JM, Franklin RC, Frostad JJ, Fukumoto T, Gayesa RT, Gebremariam KT, Gebremedhin KBB, Gebremeskel GG, Gedefaw GA, Geramo YCD, Geta B, Gezae KE, Ghashghaee A, Ghassemi F, Gill PS, Ginawi IA, Goli S, Gomes NGM, Gopalani SV, Goulart BNG, Grada A, Gugnani HC, Guido D, Guimares RA, Guo Y, Gupta R, Gupta R, Hafezi-Nejad N, Haile MT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassankhani H, Hassen HY, Hayelom DH, Heidari B, Henry NJ, Herteliu C, Heydarpour F, Hidru HDD, Hoang CL, Hoogar P, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Ibitoye SE, Ilesanmi OS, Ilic MD, Inbaraj LR, Irvani SSN, Islam SMS, Iwu CJ, Jaca A, Jafari Balalami N, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, Johnson KB, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kahsay A, Kalani H, Kanchan T, Karami Matin B, Karch A, Karki S, Kasaeian A, Kasahun GG, Kayode GA, Kazemi Karyani A, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalil AT, Khalil I, Khalilov R, Khan MN, Khan EA, Khan G, Khan J, Khatab K, Khater A, Khater MM, Khatony A, Khayamzadeh M, Khazaei M, Khazaei S, Khodamoradi E, Khosravi MH, Khubchandani J, Kiadaliri AA, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kissoon N, Kondlahalli SKMKMM, Kosek MN, Koyanagi A, Kraemer MUG, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar P, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lami FH, Lansingh VC, Lasrado S, Lee PH, Leili M, Lenjebo TTLL, Levine AJ, Lewycka S, Li S, Linn S, Lodha R, Longbottom J, Lopukhov PD, Magdeldin S, Mahasha PW, Mahotra NB, Malta DC, Mamun AA, Manafi N, Manafi F, Manda AL, Mansournia MA, Mapoma CC, Marami D, Marczak LB, Martins-Melo FR, März W, Masaka A, Mathur MR, Maulik PK, Mayala BK, McAlinden C, Mehndiratta MM, Mehrotra R, Mehta KM, Meles GG, Melese A, Memish ZA, Mena AT, Menezes RG, Mengesha MM, Mengistu DT, Mengistu G, Meretoja TJ, Miazgowski B, Mihretie KMM, Miller-Petrie MK, Mills EJ, Mir SM, Mirabi P, Mirrakhimov EM, Mohamadi-Bolbanabad A, Mohammad KA, Mohammad Y, Mohammad DK, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadifard N, Mohammed AS, Mohammed S, Mohammed JA, Mohebi F, Mokdad AH, Monasta L, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moradi-Lakeh M, Moraga P, Mosapour A, Mouodi S, Mousavi SM, Mozaffor MMM, Muluneh AG, Muriithi MK, Murray CJL, Murthy GVS, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Najafi F, Nangia V, Nazari J, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen QP, Nguyen TH, Nguyen CT, Nigatu D, Ningrum DNA, Nnaji CA, Nojomi M, Noubiap JJ, Oh IH, Okpala O, Olagunju AT, Omar Bali A, Onwujekwe OE, Ortega-Altamirano DDV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pana A, Pashaei T, Pati S, Patle A, Patton GC, Paulos K, Pepito VCF, Pereira A, Perico N, Pesudovs K, Pigott DM, Piroozi B, Platts-Mills JA, Poljak M, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poustchi H, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman MA, Rajati F, Ramezanzadeh K, Rana SM, Ranabhat CL, Rasella D, Rawaf S, Rawaf DL, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Reta MA, Rezaei S, Ribeiro AI, Rickard J, Rios González CM, Rios-Blancas MJ, Roever L, Ronfani L, Roro EM, Rostami A, Rothenbacher D, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Safari S, Safdarian M, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Salehi F, Salehi Zahabi S, Salem MRR, Salem H, Salimi Y, Salimzadeh H, Sambala EZ, Samy AM, Sanabria J, Santos IS, Saraswathy SYI, Sarker AR, Sartorius B, Sathian B, Satpathy M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Shabaninejad H, Shaheen AA, Shaikh MA, Shalash AS, Shallo SA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharif M, Shey MS, Shibuya K, Shiferaw WSS, Shigematsu M, Shil A, Shin JI, Shiri R, Shirkoohi R, Si S, Siabani S, Singh JA, Singh NP, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Sobhiyeh MR, Sokhan A, Soofi M, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tamirat KS, Tassew AA, Taveira N, Taye B, Tehrani-Banihashemi A, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, Thirunavukkarasu S, Thomas N, Tlaye KG, Tlou B, Tovani-Palone MR, Traini E, Tran KB, Trihandini I, Ullah I, Unnikrishnan B, Valadan Tahbaz S, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, Vos T, Wada FW, Waheed Y, Wang Y, Wang YP, Weldesamuel GT, Welgan CA, Westerman R, Wiangkham T, Wijeratne T, Wiysonge CSS, Wolde HF, Wondafrash DZ, Wonde TE, Wu AM, Xu G, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yenesew MA, Yeshaneh A, Yilma MT, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zamani M, Zambrana-Torrelio C, Zandian H, Zeleke AJ, Zepro NB, Zewale TA, Zhang D, Zhang Y, Zhao XJ, Ziapour A, Zodpey S, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395:1779-1801. [PMID: 32513411 PMCID: PMC7314599 DOI: 10.1016/s0140-6736(20)30114-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING Bill & Melinda Gates Foundation.
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Híjar M, Pérez-Núñez R, Hidalgo-Solórzano E, Hernández Prado B, Valdez-Santiago R, Hamilton EB, James SL, Bertolacci GJ, Cunningham M, Dingels ZV, Fox JT, Liu Z, Roberts NLS, Sylte DO, Agudelo-Botero M, Borges G, Cahuana-Hurtado L, Campos-Nonato IR, Cárdenas R, Dávila-Cervantes CA, Denova-Gutiérrez E, Diaz D, Lansingh VC, Martinez G, Montero-Zamora PA, Serván-Mori E, Lozano R. Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017. Inj Prev 2020; 26:i154-i161. [PMID: 32238437 PMCID: PMC7571365 DOI: 10.1136/injuryprev-2019-043532] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017). METHODS We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics. RESULTS Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas. CONCLUSIONS In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.
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Affiliation(s)
- Martha Híjar
- Research Coordination, AC Environments Foundation, Cuernavaca, Mexico.,CISS, National Institute of Public Health, Cuernavaca, Mexico
| | - Ricardo Pérez-Núñez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Bernardo Hernández Prado
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory J Bertolacci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew Cunningham
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marcela Agudelo-Botero
- School of Medicine, Center for Politics, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Guilherme Borges
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Lucero Cahuana-Hurtado
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | | | - Edgar Denova-Gutiérrez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Daniel Diaz
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico.,Facultad de Medicina Veterinaria y Zootecnia, Autonomous University of Sinaloa, Culiacan Rosales, Mexico
| | - Van C Lansingh
- HelpMeSee, New York, NY, USA.,International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
| | - Gabriel Martinez
- Department of Economics, Autonomous Technology Institute of Mexico, Mexico City, Mexico
| | - Pablo A Montero-Zamora
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.,Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H, Tsoi D, Colombara DV, Abdoli A, Adedoyin RA, Afarideh M, Agrawal S, Ahmad S, Ahmadian E, Ahmadpour E, Akinyemiju T, Akunna CJ, Alipour V, Almasi-Hashiani A, Almulhim AM, Al-Raddadi RM, Alvis-Guzman N, Anber NH, Angus C, Anoushiravani A, Arabloo J, Araya EM, Asmelash D, Ataeinia B, Ataro Z, Atout MMW, Ausloos F, Awasthi A, Badawi A, Banach M, Bejarano Ramirez DF, Bhagavathula AS, Bhala N, Bhattacharyya K, Biondi A, Bolla SR, Boloor A, Borzì AM, Butt ZA, Cámera LLAA, Campos-Nonato IR, Carvalho F, Chu DT, Chung SC, Cortesi PA, Costa VM, Cowie BC, Daryani A, de Courten B, Demoz GT, Desai R, Dharmaratne SD, Djalalinia S, Do HT, Dorostkar F, Drake TM, Dubey M, Duncan BB, Effiong A, Eftekhari A, Elsharkawy A, Etemadi A, Farahmand M, Farzadfar F, Fernandes E, Filip I, Fischer F, Gebremedhin KBB, Geta B, Gilani SA, Gill PS, Gutirrez RA, Haile MT, Haj-Mirzaian A, Hamid SS, Hasankhani M, Hasanzadeh A, Hashemian M, Hassen HY, Hay SI, Hayat K, Heidari B, Henok A, Hoang CL, Hostiuc M, Hostiuc S, Hsieh VCR, Igumbor EU, Ilesanmi OS, Irvani SSN, Jafari Balalami N, James SL, Jeemon P, Jha RP, Jonas JB, Jozwiak JJ, Kabir A, Kasaeian A, Kassaye HG, Kefale AT, Khalilov R, Khan MA, Khan EA, Khater A, Kim YJ, Koyanagi A, La Vecchia C, Lim LL, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Magdy Abd El Razek M, Mai HT, Manafi N, Manafi A, Mansournia MA, Mantovani LG, Mazzaglia G, Mehta D, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Mestrovic T, Miazgowski B, Miller TR, Mirrakhimov EM, Mithra P, Moazen B, Moghadaszadeh M, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Montero-Zamora PA, Moradi G, Naimzada MD, Nayak V, Negoi I, Nguyen TH, Ofori-Asenso R, Oh IH, Olagunju TO, Padubidri JR, Pakshir K, Pana A, Pathak M, Pourshams A, Rabiee N, Radfar A, Rafiei A, Ramezanzadeh K, Rana SMM, Rawaf S, Rawaf DL, Reiner RC, Roever L, Room R, Roshandel G, Safari S, Samy AM, Sanabria J, Sartorius B, Schmidt MI, Senthilkumaran S, Shaikh MA, Sharif M, Sharifi A, Shigematsu M, Singh JA, Soheili A, Suleria HAR, Teklehaimanot BF, Tesfay BE, Vacante M, Vahedian-Azimi A, Valdez PR, Vasankari TJ, Vu GT, Waheed Y, Weldegwergs KG, Werdecker A, Westerman R, Wondafrash DZ, Wondmieneh AB, Yeshitila YG, Yonemoto N, Yu C, Zaidi Z, Zarghi A, Zelber-Sagi S, Zewdie KA, Zhang ZJ, Zhao XJ, Naghavi M, Malekzadeh R. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5:245-266. [PMID: 31981519 PMCID: PMC7026710 DOI: 10.1016/s2468-1253(19)30349-8] [Citation(s) in RCA: 711] [Impact Index Per Article: 177.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. METHODS We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. FINDINGS In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8-38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8-10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3-4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4-133·4] per 100 000 in 2017). There were 10·6 million (10·3-10·9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. INTERPRETATION Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. FUNDING Bill & Melinda Gates Foundation.
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Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Béjot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jóźwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang YH, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Nguyen M, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Anggraini Ningrum DN, Norrving B, Noubiap JJ, O’Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AMN, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin MJ, Shiue I, Silva DAS, Sobngwi E, Soljak M, Sorensen RJD, Sposato LA, Stranges S, Suliankatchi RA, Tabarés-Seisdedos R, Tanne D, Nguyen CT, Thakur JS, Thrift AG, Tirschwell DL, Topor-Madry R, Tran BX, Nguyen LT, Truelsen T, Tsilimparis N, Tyrovolas S, Ukwaja KN, Uthman OA, Varakin Y, Vasankari T, Venketasubramanian N, Vlassov VV, Wang W, Werdecker A, Wolfe CDA, Xu G, Yano Y, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Zhou M, Ziaeian B, Zipkin B, Vos T, Naghavi M, Murray CJL, Roth GA. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379:2429-2437. [PMID: 30575491 PMCID: PMC6247346 DOI: 10.1056/nejmoa1804492] [Citation(s) in RCA: 810] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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Dicker D, Nguyen G, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abdurahman AA, Abebe HT, Abebe M, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Aggarwal R, Aghayan SA, Agrawal S, Agrawal A, Ahmadi M, Ahmadi A, Ahmadieh H, Ahmed MLCB, Ahmed S, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Anlay DZ, Ansari H, Ansariadi A, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asadi-Lari M, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Ataro Z, Atey TMM, Athari SS, Atique S, Atre SR, Atteraya MS, Attia EF, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awuah B, Ayala Quintanilla BP, Ayele HT, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Azzopardi-Muscat N, Badali H, Badawi A, Balakrishnan K, Bali AG, Banach M, Banstola A, Barac A, Barboza MA, Barquera S, Barrero LH, Basaleem H, Bassat Q, Basu A, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhala N, Bhatia E, Bhatt S, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Bisanzio D, Biswas T, Bjørge T, Bleyer A, Basara BB, Bose D, Bosetti C, Boufous S, Bourne R, Brady OJ, Bragazzi NL, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha T, Burke KE, Busse R, Butt ZA, Cahuana-Hurtado L, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Çavlin A, Cerin E, Chaiah Y, Champs AP, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chen W, Chiang PPC, Chimed-Ochir O, Chin KL, Chisumpa VH, Chitheer A, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Cohen AJ, Collado-Mateo D, Constantin MM, Conti S, Cooper C, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cucu A, Cunningham M, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Das Gupta R, das Neves J, Dasa TT, Dash AP, Weaver ND, Davitoiu DV, Davletov K, Dayama A, Courten BD, De la Hoz FP, De leo D, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Dellavalle RP, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dhimal M, Ding EL, Djalalinia S, Doku DT, Dolan KA, Donnelly CA, Dorsey ER, Douwes-Schultz D, Doyle KE, Drake TM, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, Elfaramawi M, El-Khatib Z, Ellingsen CL, Elyazar IRF, Enayati A, Endries AYY, Er B, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Fakhar M, Fakhim H, Farag T, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Feyissa GT, Fijabi DO, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Ford JA, Foreman KJ, Fornari C, Frank TD, Franklin RC, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Galan A, Gallus S, Gambashidze K, Gamkrelidze A, Gankpe FG, Garcia-Basteiro AL, Garcia-Gordillo MA, Gebre T, Gebre AK, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gessner BD, Getachew S, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Giussani G, Goenka S, Goli S, Gomez RS, Gomez-Cabrera MC, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Goulart BNG, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haririan H, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Heredia-Pi I, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Horino M, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc S, Hostiuc M, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Iburg KM, Igumbor EU, Ikeda CT, Ilesanmi OS, Iqbal U, Irvani SSN, Isehunwa OO, Islam SMS, Islami F, Jahangiry L, Jahanmehr N, Jain R, Jain SK, Jakovljevic M, James SL, Javanbakht M, Jayaraman S, Jayatilleke AU, Jee SH, Jeemon P, Jha RP, Jha V, Ji JS, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, K M, Kabir Z, Kadel R, Kahsay A, Kahssay M, Kalani R, Kapil U, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Karimi-Sari H, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kassebaum NJ, Katibeh M, Katikireddi SV, Kaul A, Kawakami N, Kazemeini H, Kazemi Z, Karyani AK, K C P, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kereselidze M, Khader YS, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan G, Khan MS, Khan MA, Khang YH, Khanna T, Khater MM, Khatony A, Khazaie H, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GDD, Kim CI, Kim D, Kim JY, Kim YE, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissimova-Skarbek K, Kissoon N, Kivimäki M, Kleber ME, Knibbs LD, Knudsen AKS, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosek MN, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kudom AA, Kuipers EJ, Kulikoff XR, Kumar GA, Kumar M, Kumar P, Kumsa FA, Kutz MJ, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lam H, Lami FH, Lan Q, Langan SM, Lansingh VC, Lansky S, Larson HJ, Laryea DO, Lassi ZS, Latifi A, Lavados PM, Laxmaiah A, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leshargie CT, Leta S, Levi M, Li S, Li Y, Li X, Liang J, Liang X, Liben ML, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Logroscino G, Lonsdale C, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Lyons RA, Ma S, Mabika C, Macarayan ERK, Mackay MT, Maddison ER, Maddison R, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malik MA, Malta DC, Mamun AA, Manamo WA, Manda AL, Mansournia MA, Mantovani LG, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marina S, Martinez-Raga J, Martins SCO, Martins-Melo FR, März W, Marzan MB, Mashamba-Thompson TP, Masiye F, Massenburg BB, Maulik PK, Mazidi M, McGrath JJ, McKee M, Mehata S, Mehendale SM, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonen T, Mekonnen TC, Meles HG, Meles KG, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miangotar Y, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Misganaw AT, 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Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Ye P, Yearwood JA, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, York HW, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zachariah G, Zadnik V, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeeb H, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang K, Zhang X, Zhou M, Zhu J, Zodpey S, Zucker I, Zuhlke LJJ, Lopez AD, Gakidou E, Murray CJL. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1684-1735. [PMID: 30496102 PMCID: PMC6227504 DOI: 10.1016/s0140-6736(18)31891-9] [Citation(s) in RCA: 575] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING Bill & Melinda Gates Foundation.
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Olusanya JO, Ong KL, Ong SKS, Oren E, Orpana HM, Ortiz A, Ortiz JR, Otstavnov SS, Øverland S, Owolabi MO, Özdemir R, P A M, Pacella R, Pakhale S, Pakhare AP, Pakpour AH, Pana A, Panda-Jonas S, Pandian JD, Parisi A, Park EK, Parry CDH, Parsian H, Patel S, Pati S, Patton GC, Paturi VR, Paulson KR, Pereira A, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pigott DM, Pillay JD, Pirsaheb M, Pishgar F, Polinder S, Postma MJ, Pourshams A, Poustchi H, Pujar A, Prakash S, Prasad N, Purcell CA, Qorbani M, Quintana H, Quistberg DA, Rade KW, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahman M, Rahman MHU, Rahman MA, Rai RK, Rajsic S, Ram U, Ranabhat CL, Ranjan P, Rao PC, Rawaf DL, Rawaf S, Razo-García C, Reddy KS, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Rezai MS, Riahi SM, Ribeiro ALP, Rios-Blancas MJ, Roba KT, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Rothenbacher D, Roy A, Rubagotti E, Sachdev PS, Saddik B, Sadeghi E, Safari H, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Salam N, Salama JS, Salamati P, Saldanha RDF, Saleem Z, Salimi Y, Salvi SS, Salz I, Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santomauro DF, Santos IS, Santos JV, Milicevic MMS, Sao Jose BP, Sarker AR, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Sayyah M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shackelford KA, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma R, She J, Sheikh A, Shi P, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silberberg DH, Silva DAS, Silva JP, Silva 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Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736(18)32203-7] [Citation(s) in RCA: 4178] [Impact Index Per Article: 696.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736%2818%2932203-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 01/19/2024]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Zucker I, Zuhlke LJJ, Lim SS, Murray CJL. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:2091-2138. [PMID: 30496107 PMCID: PMC6227911 DOI: 10.1016/s0140-6736(18)32281-5] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. FINDINGS The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. INTERPRETATION The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. FUNDING Bill & Melinda Gates Foundation.
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Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shoman H, Shrime MG, Shupler MS, Si S, Siabani S, Sibai AM, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Skirbekk V, Smith DL, Smith M, Sobaih BH, Sobhani S, Somayaji R, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Spinelli A, Sposato LA, Sreeramareddy CT, Srinivasan V, Starodubov VI, Steckling N, Stein DJ, Stein MB, Stevanovic G, Stockfelt L, Stokes MA, Sturua L, Subart ML, Sudaryanto A, Sufiyan MB, Sulo G, Sunguya BF, Sur PJ, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Tessema B, Teweldemedhin M, Thankappan KR, Theis A, Thirunavukkarasu S, Thomas HJ, Thomas ML, Thomas N, Thurston GD, Tilahun B, Tillmann T, To QG, Tobollik M, Tonelli M, Topor-Madry R, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Truelsen TC, Truong NT, Tsadik AG, Tudor Car L, Tuzcu EM, Tymeson HD, Tyrovolas S, Ukwaja KN, Ullah I, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Van Donkelaar A, Varavikova E, Varughese S, Vasankari TJ, Venkateswaran V, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vu GT, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Walson JL, Wang Y, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weldegebreal F, Werdecker A, Werkneh AA, West JJ, Westerman R, Whiteford HA, Widecka J, Wijeratne T, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Wong TY, Wu S, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zaidi Z, Zaman SB, Zamani M, Zavala-Arciniega L, Zhang AL, Zhang H, Zhang K, Zhou M, Zimsen SRM, Zodpey S, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1923-1994. [PMID: 30496105 PMCID: PMC6227755 DOI: 10.1016/s0140-6736(18)32225-6] [Citation(s) in RCA: 2618] [Impact Index Per Article: 436.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING Bill & Melinda Gates Foundation.
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Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santos IS, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarmiento-Suárez R, Saroshe S, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Schaeffner E, Schelonka K, Schneider IJC, Schwebel DC, Schwendicke F, Seedat S, Sekerija M, Sepanlou SG, Serván-Mori E, Shabaninejad H, Shackelford KA, Shafieesabet A, Shaheen AA, Shaikh MA, Shakir RA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma J, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shukla SR, Si S, Siabani S, Sibai AM, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Sliwa K, Soares Filho AM, Sobaih BH, Sobhani S, Soofi M, Soriano JB, Soyiri IN, Sreeramareddy CT, Starodubov VI, Steiner C, Stewart LG, Stokes MA, Strong M, Subart ML, Sufiyan MB, Sulo G, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylaja PN, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Tandon N, Tassew AA, Tassew SG, Taveira N, Tawye NY, Tehrani-Banihashemi A, Tekalign TG, Tekle MG, Temsah MH, Terkawi AS, Teshale MY, Tessema B, Teweldemedhin M, Thakur JS, Thankappan KR, Thirunavukkarasu S, Thomas N, Thomson AJ, Tilahun B, To QG, Tonelli M, Topor-Madry R, Torre AE, Tortajada-Girbés M, Tovani-Palone MR, Toyoshima H, Tran BX, Tran KB, Tripathy SP, Truelsen TC, Truong NT, Tsadik AG, Tsegay A, Tsilimparis N, Tudor Car L, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Uzun SB, Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Varughese S, Vasankari TJ, Vasconcelos AMN, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Walson JL, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weldegwergs KG, Werdecker A, Westerman R, Whiteford H, Widecka J, Widecka K, Wijeratne T, Winkler AS, Wiysonge CS, Wolfe CDA, Wu S, Wyper GMA, Xu G, Yamada T, Yano Y, Yaseri M, Yasin YJ, Ye P, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang X, Zhao XJ, Zhou M, Zhu J, Zimsen SRM, Zodpey S, Zoeckler L, Lopez AD, Lim SS. Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1995-2051. [PMID: 30496106 PMCID: PMC6227915 DOI: 10.1016/s0140-6736(18)32278-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. METHODS We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. FINDINGS From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4-52·0). The TFR decreased from 4·7 livebirths (4·5-4·9) to 2·4 livebirths (2·2-2·5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3-200·8) since 1950, from 2·6 billion (2·5-2·6) to 7·6 billion (7·4-7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9-1·2) in Cyprus to a high of 7·1 livebirths (6·8-7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07-0·09) in South Korea to 2·4 livebirths (2·2-2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3-0·4) in Puerto Rico to a high of 3·1 livebirths (3·0-3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. INTERPRETATION Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. FUNDING Bill & Melinda Gates Foundation.
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Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NME, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs ADM, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PGJ, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TKD, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farzadfar F, Fay DFJ, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IAM, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VMP, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega JDD, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS, Pain AW, Pandian JD, Panelo CIA, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SAL, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DAA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJC, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJC, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AMN, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CDA, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, Murray CJ. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:2287-323. [PMID: 26364544 PMCID: PMC4685753 DOI: 10.1016/s0140-6736(15)00128-2] [Citation(s) in RCA: 1719] [Impact Index Per Article: 191.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Ackerman IN, Ademi Z, Adou AK, Adsuar JC, Afshin A, Agardh EE, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allebeck P, Almazroa MA, Alsharif U, Alvarez E, Alvis-Guzman N, Amare AT, Ameh EA, Amini H, Ammar W, Anderson HR, Anderson BO, Antonio CAT, Anwari P, Arnlöv J, Arsic Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Avila MA, Awuah B, Bachman VF, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Basu A, Basu S, Basulaiman MO, Beardsley J, Bedi N, Beghi E, Bekele T, Bell ML, Benjet C, Bennett DA, Bensenor IM, Benzian H, Bernabé E, Bertozzi-Villa A, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bienhoff K, Bikbov B, Biryukov S, Blore JD, Blosser CD, Blyth FM, Bohensky MA, Bolliger IW, Bora Başara B, Bornstein NM, Bose D, Boufous S, Bourne RRA, Boyers LN, Brainin M, Brayne CE, Brazinova A, Breitborde NJK, Brenner H, Briggs AD, Brooks PM, Brown JC, Brugha TS, Buchbinder R, Buckle GC, Budke CM, Bulchis A, Bulloch AG, Campos-Nonato IR, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chiang PP, Chimed-Ochir O, Chowdhury R, Christensen H, Christophi CA, Cirillo M, Coates MM, Coffeng LE, Coggeshall MS, Colistro V, Colquhoun SM, Cooke GS, Cooper C, Cooper LT, Coppola LM, Cortinovis M, Criqui MH, Crump JA, Cuevas-Nasu L, Danawi H, Dandona L, Dandona R, Dansereau E, Dargan PI, Davey G, Davis A, Davitoiu DV, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dherani MK, Diaz-Torné C, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Duber HC, Ebel BE, Edmond KM, Elshrek YM, Endres M, 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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. Lancet 2015; 386:2145-91. [PMID: 26321261 PMCID: PMC4673910 DOI: 10.1016/s0140-6736(15)61340-x] [Citation(s) in RCA: 1284] [Impact Index Per Article: 142.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
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