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, 380 (9859), 2197-223

Disability-adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 Regions, 1990-2010: A Systematic Analysis for the Global Burden of Disease Study 2010

Christopher J L Murray  1 Theo VosRafael LozanoMohsen NaghaviAbraham D FlaxmanCatherine MichaudMajid EzzatiKenji ShibuyaJoshua A SalomonSafa AbdallaVictor AboyansJerry AbrahamIlana AckermanRakesh AggarwalStephanie Y AhnMohammed K AliMiriam AlvaradoH Ross AndersonLaurie M AndersonKathryn G AndrewsCharles AtkinsonLarry M BaddourAdil N BahalimSuzanne Barker-ColloLope H BarreroDavid H BartelsMaria-Gloria BasáñezAmanda BaxterMichelle L BellEmelia J BenjaminDerrick BennettEduardo BernabéKavi BhallaBishal BhandariBoris BikbovAref Bin AbdulhakGretchen BirbeckJames A BlackHannah BlencoweJed D BloreFiona BlythIan BolligerAudrey BonaventureSoufiane BoufousRupert BourneMichel BoussinesqTasanee BraithwaiteCarol BrayneLisa BridgettSimon BrookerPeter BrooksTraolach S BrughaClaire Bryan-HancockChiara BucelloRachelle BuchbinderGeoffrey BuckleChristine M BudkeMichael BurchPeter BurneyRoy BursteinBianca CalabriaBenjamin CampbellCharles E CanterHélène CarabinJonathan CarapetisLoreto CarmonaClaudia CellaFiona CharlsonHonglei ChenAndrew Tai-Ann ChengDavid ChouSumeet S ChughLuc E CoffengSteven D ColanSamantha ColquhounK Ellicott ColsonJohn CondonMyles D ConnorLeslie T CooperMatthew CorriereMonica CortinovisKaren Courville de VaccaroWilliam CouserBenjamin C CowieMichael H CriquiMarita CrossKaustubh C DabhadkarManu DahiyaNabila DahodwalaJames Damsere-DerryGoodarz DanaeiAdrian DavisDiego De LeoLouisa DegenhardtRobert DellavalleAllyne DelossantosJulie DenenbergSarah DerrettDon C Des JarlaisSamath D DharmaratneMukesh DheraniCesar Diaz-TorneHelen DolkE Ray DorseyTim DriscollHerbert DuberBeth EbelKaren EdmondAlexis ElbazSuad Eltahir AliHolly ErskinePatricia J ErwinPatricia EspindolaStalin E EwoigbokhanFarshad FarzadfarValery FeiginDavid T FelsonAlize FerrariCleusa P FerriEric M FèvreMariel M FinucaneSeth FlaxmanLouise FloodKyle ForemanMohammad H ForouzanfarFrancis Gerry R FowkesMarlene FransenMichael K FreemanBelinda J GabbeSherine E GabrielEmmanuela GakidouHammad A GanatraBianca GarciaFlavio GaspariRichard F GillumGerhard GmelDiego Gonzalez-MedinaRichard GosselinRebecca GraingerBridget GrantJustina GroegerFrancis GuilleminDavid GunnellRamyani GuptaJuanita HaagsmaHolly HaganYara A HalasaWayne HallDiana HaringJosep Maria HaroJames E HarrisonRasmus HavmoellerRoderick J HayHideki HigashiCatherine HillBruno HoenHoward HoffmanPeter J HotezDamian HoyJohn J HuangSydney E IbeanusiKathryn H JacobsenSpencer L JamesDeborah JarvisRashmi JasrasariaSudha JayaramanNicole JohnsJost B JonasGanesan KarthikeyanNicholas KassebaumNorito KawakamiAndre KerenJon-Paul KhooCharles H KingLisa Marie KnowltonOlive KobusingyeAdofo KorantengRita KrishnamurthiFrancine LadenRatilal LallooLaura L LaslettTim LathleanJanet L LeasherYong Yi LeeJames LeighDaphna LevinsonStephen S LimElizabeth LimbJohn Kent LinMichael LipnickSteven E LipshultzWei LiuMaria LoaneSummer Lockett OhnoRonan LyonsJacqueline MabweijanoMichael F MacIntyreReza MalekzadehLeslie MallingerSivabalan ManivannanWagner MarcenesLyn MarchDavid J MargolisGuy B MarksRobin MarksAkira MatsumoriRichard MatzopoulosBongani M MayosiJohn H McAnultyMary M McDermottNeil McGillJohn McGrathMaria Elena Medina-MoraMichele MeltzerGeorge A MensahTony R MerrimanAna-Claire MeyerValeria MiglioliMatthew MillerTed R MillerPhilip B MitchellCharles MockAna Olga MocumbiTerrie E MoffittAli A MokdadLorenzo MonastaMarcella MonticoMaziar Moradi-LakehAndrew MoranLidia MorawskaRintaro MoriMichele E MurdochMichael K MwanikiKovin NaidooM Nathan NairLuigi NaldiK M Venkat NarayanPaul K NelsonRobert G NelsonMichael C NevittCharles R NewtonSandra NoltePaul NormanRosana NormanMartin O'DonnellSimon O'HanlonCasey OlivesSaad B OmerKatrina OrtbladRichard OsborneDoruk OzgedizAndrew PageBishnu PahariJeyaraj Durai PandianAndrea Panozo RiveroScott B PattenNeil PearceRogelio Perez PadillaFernando Perez-RuizNorberto PericoKonrad PesudovsDavid PhillipsMichael R PhillipsKelsey PierceSébastien PionGuilherme V PolanczykSuzanne PolinderC Arden Pope 3rdSvetlana PopovaEsteban PorriniFarshad PourmalekMartin PrinceRachel L PullanKapa D RamaiahDharani RanganathanHomie RazaviMathilda ReganJürgen T RehmDavid B ReinGuiseppe RemuzziKathryn RichardsonFrederick P RivaraThomas RobertsCarolyn RobinsonFelipe Rodriguez De LeònLuca RonfaniRobin RoomLisa C RosenfeldLesley RushtonRalph L SaccoSukanta SahaUchechukwu SampsonLidia Sanchez-RieraElla SanmanDavid C SchwebelJames Graham ScottMaria Segui-GomezSaeid ShahrazDonald S ShepardHwashin ShinRupak ShivakotiDavid SinghGitanjali M SinghJasvinder A SinghJessica SingletonDavid A SleetKaren SliwaEmma SmithJennifer L SmithNicolas J C StapelbergAndrew SteerTimothy SteinerWilma A StolkLars Jacob StovnerChristopher SudfeldSana SyedGiorgio TamburliniMohammad TavakkoliHugh R TaylorJennifer A TaylorWilliam J TaylorBernadette ThomasW Murray ThomsonGeorge D ThurstonImad M TleyjehMarcello TonelliJeffrey A TowbinThomas TruelsenMiltiadis K TsilimbarisClotilde UbedaEduardo A UndurragaMarieke J van der WerfJim van OsMonica S VavilalaN VenketasubramanianMengru WangWenzhi WangKerrianne WattDavid J WeatherallMartin A WeinstockRobert WeintraubMarc G WeisskopfMyrna M WeissmanRichard A WhiteHarvey WhitefordNatasha WiebeSteven T WiersmaJames D WilkinsonHywel C WilliamsSean R M WilliamsEmma WittFrederick WolfeAnthony D WoolfSarah WulfPon-Hsiu YehAnita K M ZaidiZhi-Jie ZhengDavid ZoniesAlan D LopezMohammad A AlMazroaZiad A Memish
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Disability-adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 Regions, 1990-2010: A Systematic Analysis for the Global Burden of Disease Study 2010

Christopher J L Murray et al. Lancet.

Erratum in

  • Lancet. 2013 Feb 23;381(9867):628. AlMazroa, Mohammad A [added]; Memish, Ziad A [added]

Abstract

Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.

Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.

Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.

Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.

Funding: Bill & Melinda Gates Foundation.

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