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

GBD 2013 DALYs and HALE Collaborators

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2145-2191
Number of pages47
JournalThe Lancet
Issue number10009
StatePublished - 28 Nov 2015


FundersFunder number
Consortium of UK Universities
Cruces Hospital Rheumatology Association
Health Protection Scotland
National Health and Medical Research Council Public Health
National Institutes of Health
Science Foundation for Young Scholars in Zhongshan Hospital2012ZSQN04
Spanish Foundation for Rheumatology
Spanish Health Ministry
National Institutes of HealthP30DK056338, 5T32HD057822
National Institutes of Health
National Institute of Environmental Health SciencesZIAES101986
National Institute of Environmental Health Sciences
Takeda Pharmaceutical Company
Oklahoma Center for the Advancement of Science and Technology
National Institute for Social Care and Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Queensland Health
Wellcome Trust099876
Wellcome Trust
Scottish Government Health and Social Care Directorate
Brien Holden Vision Institute
Savient Pharmaceuticals
Medical Research Council
Engineering and Physical Sciences Research Council
Economic and Social Research Council
National Institute for Health and Care Research
British Heart Foundation
Cancer Research UK
Arthritis Research UK
Chief Scientist Office
National Health and Medical Research Council
Public Health Foundation of India
Ministry of Education, Culture, Sports, Science and Technology
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen ForschungPBBSP3-146869, P300P3-154634
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
National Natural Science Foundation of China81200051
National Natural Science Foundation of China
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Fudan University20520133474
Fudan University
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Ministry of Health and WelfareHI13C0729
Ministry of Health and Welfare
National Research Foundation of Korea
Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
Specialized Research Fund for the Doctoral Program of Higher Education of China20110071120060
Specialized Research Fund for the Doctoral Program of Higher Education of China
Consortium of International Agricultural Research Centers


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