Journal
LANCET
Volume 380, Issue 9859, Pages 2197-2223Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(12)61689-4
Keywords
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Categories
Funding
- Berlin Heart Honoraria
- Lundbeck
- Medtronic
- Prana Biotechnology
- Safework Australia
- Assurance-Maladie (CNAMTS) InVS
- Inserm
- CHU de Nancy
- CHU de Nice
- Conseil Regional de Lorraine
- Societe Francaise de Negma-Lerads
- Pfizer
- Pierre Fabre Medicaments
- Sanofi-Afentis France
- Spanish Health Ministry
- Hospital de Cruces Rheumatology Association
- Novartis
- National Council for Scientific and Technological Development (CNPq, Brazil)
- Takeda
- Savient
- Ardea
- Regeneron
- Allergan
- URL pharmaceuticals
- 36 companies
- National Institutes of Arthritis, Musculoskeletal and Skin Diseases (NIAMS)
- National Institutes of Aging (NIA)
- National Cancer Institute (NCI)
- Agency for Health Quality and Research Center for Education and Research on Therapeutics (CERTs)
- Wellcome Trust [098045, 085308]
- Department of Health London for the National Health Service Information Centre
- University of Leicester
- Australian National Health and Medical Research Council (NHMRC)
- Monash University
- Cabrini Health
- BUPA Foundation
- NIH
- National Institute of Environmental Health Sciences
- Africa Programme for Onchocerciasis Control (WHO/APOC)
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
- NIH [K23 AG034236]
- Parkinson Council
- Australian NHMRC
- US Department of Veterans Affairs
- Health Research Council of New Zealand
- University of Otago
- National Institute for Stroke and Applied Neurosciences
- AUT University
- NHMRC
- Swedish Research Council [2011-1071]
- Bill and Melinda Gates Foundation
- Australian National Health and Medical Research Council
- World Health Organization
- World Mental Health Japan (WMH-J)
- Japan Ministry of Health, Labour, and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- Australian Government
- National Health and Medical Research Council of Australia
- Arthritis Foundation of Australia
- Tasmanian Community Fund
- Masonic Centenary Medical Research Foundation
- Royal Hobart Hospital Research Foundation
- University of Tasmania
- Tehran University of Medical Sciences
- South African Medical Research Council Burden of Disease Research Unit
- University of Cape Town School of Public Health and Family Medicine
- Brien Holden Vision Institute
- National Drug and Alcohol Research Centre (UNSW, Australia)
- Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases
- Biostatistics, Epidemiologic and Bioinformatic Training in Environmental Health Training Grant [ES015459]
- Foundation for Alcohol Research and Education
- Victorian Department of Health
- Burke Global Health Fellowship
- Harold Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation
- Vanderbilt Clinical and Translational Scholars Award
- Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia)
- European Center for Injury Prevention, Universidad de Navarra
- Department of Health and Ageing
- Commonwealth Government of Australia
- Institute of Bone and Joint Research (IBJR)
- University of Sydney (USYD)
- National Institute of Environmental Health Sciences [ES00260]
- Wellcome Trust UK
- Medical Research Council UK
- Anthony Cerami and Ann Dunne Research Trust
- Medical Research Council [G0801056B, G0901214] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10084] Funding Source: researchfish
- Grants-in-Aid for Scientific Research [22390130, 21119003] Funding Source: KAKEN
- MRC [G0901214] Funding Source: UKRI
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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.
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