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, 388 (10053), 1545-1602

Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 310 Diseases and Injuries, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015

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Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 310 Diseases and Injuries, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Lancet.

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Abstract

Background: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.

Methods: We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.

Findings: We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4-19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30-2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35-2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.

Interpretation: Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.

Funding: Bill & Melinda Gates Foundation.

Figures

Figure 1
Figure 1
Analytical flow chart for the estimation of cause-specific YLDs by location, age, sex, and year for GBD 2015 Ovals represent data inputs, square boxes represent analytical steps, cylinders represent databases, and parallelograms represent intermediate and final results. The flow chart is colour-coded by major estimation component: raw data sources, in pink; data adjustments, in yellow; DisMod-MR 2.1 estimation, in purple; alternative modelling strategies, in light green; injury modelling strategy, in dark green; estimation of impairments and underlying causes, in brown; post-DisMod-MR and comorbidity correction, in blue; disability weights, in orange; and cause of death and demographic inputs, in grey. GBD=Global Burden of Disease. TB=tuberculosis. SF-12=Short Form 12 questions. MEPS=Medical Expenditure Panel Surveys. CSMR=cause-specific mortality rate. SMR=standardised mortality ratio. YLDs=years lived with disability. YLLs=years of life lost. IHME=Institute for Health Metrics and Evaluation.
Figure 2
Figure 2
Leading 30 Level 3 causes of global YLDs for both sexes combined, 1990, 2005, and 2015, with percentage change in number of YLDs, and all-age and age-standardised rates Causes are connected by lines between time periods. For the time period of 1990 to 2005 and for 2005 to 2015, three measures of change are shown: percent change in the number of YLDs, percent change in the all-age YLD rate, and percent change in the age-standardised YLD rate. YLD=years lived with disability. COPD=chronic obstructive pulmonary disease.
Figure 3
Figure 3
Leading ten Level 3 causes of global age-specific years lived with disability in 2015 Each cause is coloured by the percentage change in age-specific years lived with disability from 2005 to 2015. Alzheimer's=Alzheimer disease and other dementias. ASD=autism. Back & neck=low back and neck pain. Conduct=conduct disorders. Congenital=congenital anomalies. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Endocrine=endocrine, metabolic, blood, and immune disorders. Gyne=gynaecological disorders. Haemog=haemoglobinopathies and haemolytic anaemias. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN preterm=neonatal preterm birth complications. NN sepsis=neonatal sepsis and other neonatal infections. Other NTD=other neglected tropical diseases. Oral=oral disorders. Osteoarth=osteoarthritis. Other inf=other infectious diseases. Other mental=other mental and substance use disorders. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. PEM=protein-energy malnutrition. Schiz=schizophrenia. Sense=sense organ disease. Skin=skin and subcutaneous diseases.
Figure 4
Figure 4
Global annualised rate of change in age-standardised years of life lost (YLLs) and years lived with disability (YLDs) for Level 3 causes between 1990 and 2015 TB=tuberculosis. HIV=HIV/AIDS. Diarrhoea=diarrhoeal diseases. Intest Inf=intestinal infectious diseases. LRI=lower respiratory infections. URI=upper respiratory infections. Otitis=otitis media. Whooping=whooping cough. Varicella=varicella and herpes zoster. Chagas=chagas disease. Cysticer=cysticercosis. LF=lymphatic filariasis. Oncho=onchocerciasis. Trachoma=trachoma. Dengue=dengue. Yellow Fev=yellow fever.Nematode=intestinal nematode infections. Mat hem=maternal haemorrhage. Mat sepsis=maternal sepsis and other maternal infections. Mat HTN=maternal hypertensive disorders. Obst labour=maternal obstructed labour and uterine rupture. Comp abort=maternal abortion, miscarriage, and ectopic pregnancy. Oth mat=other maternal disorders. NN preterm=neonatal preterm birth complications. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN sepsis=neonatal sepsis and other neonatal infections. NN haemol=haemolytic disease and other neonatal jaundice. Oth NN=other neonatal disorders. PEM=protein-energy malnutrition. Iodine=iodine deficiency. Oth nutr=other nutritional deficiencies. STD=sexually transmitted diseases excluding HIV. Hep=hepatitis. Stomach C=stomach cancer. Melanoma=malignant skin melanoma. Skin C=non-melanoma skin cancer. Cervix C=cervical cancer. Uterus C=uterine cancer. Prostate C=prostate cancer. Testis C=testicular cancer. Kidney C=kidney cancer. Thyroid C=thyroid cancer. Hodgkin=Hodgkin lymphoma. Lymphoma=non-Hodgkin lymphoma. Myeloma=multiple myeloma. Oth neopla=Other neoplasms. RHD=rheumatic heart disease. Stroke=cerebrovascular disease. HTN HD=hypertensive heart disease. PVD=peripheral vascular disease. COPD=chronic obstructive pulmonary disease. Asthma=asthma. ILD=interstitial lung disease and pulmonary sarcoidosis. Oth resp=other chronic respiratory diseases. PUD=peptic ulcer disease. Gastritis=gastritis and duodenitis. Hernia=inguinal, femoral, and abdominal hernia. Oth digest=other digestive diseases. Parkinson=Parkinson's disease. Schiz=schizophrenia. Drugs=drug use disorders. AGN=acute glomerulonephritis. Congenital=congenital anomalies. Skin=skin and subcutaneous diseases. Road inj=road injuries. Oth trans=other transport injuries. Drown=drowning. Fire=fire, heat, and hot substances. Poison=poisonings. Mech=exposure to mechanical forces. Med treat=adverse effects of medical treatment. Animal=animal contact. F body=foreign body. Heat & cold=environmental heat and cold exposure. Oth unint=other unintentional injuries. Violence=interpersonal violence. War=collective violence and legal intervention.
Figure 5
Figure 5
Population pyramids with the number of individuals, by age and sex, grouped by severity of their disability weight (DW) for all comorbid conditions combined into no disability, very mild disability (DW 0–0·01), mild disability (DW 0·01–0·05), moderate disability (DW 0·05–0·1), severe disability (DW 0·1–0·3), and very severe disability (DW >0·3) for geographies of high (A) and low (B) quintiles of Socio-demographic Index in 2015 Disability weights are combined multiplicatively as 1−(1−DW1)(1− DW2)…(1−DWn) for n comorbid sequelae. Socio-demographic Index (SDI) is calculated for each geography as a function of lag-dependent income per capita, average educational attainment in the population aged over 15 years, and the total fertility rate. SDI units are interpretable; a zero represents the lowest level of income per capita, educational attainment, and highest total fertility rate (TFR) observed from 1980 to 2015 and a one represents the highest income per capita, educational attainment, and lowest TFR observed in the same period. Cutoffs on the SDI scale for the quintiles have been selected based on examination of the entire distribution of geographies between 1980 and 2015.
Figure 6
Figure 6
Expected relationship between age-standardised years lived with disability (YLD) rates per 100 000 people for the 21 GBD Level 2 causes and SDI (A) and the expected relationship between all-age years lived with disability (YLD) rates per 100 000 people for the 21 GBD Level 2 causes and SDI (B) by sex These stacked curves represent the average relationship between SDI and each cause of YLDs observed across all geographies over the time period 1990 to 2015. In each figure, the y-axis spans from lowest SDI up to highest SDI. To the left of the midline are male rates, and the female rates are to the right; higher rates are further from the midline. SDI=Socio-demographic Index.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
Figure 7
Figure 7
Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI in 2015, by location Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimer's=Alzheimer's disease and other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias. Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deficiency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders. Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deficiencies. Other unint=other unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.

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