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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2197-2223 |
| Number of pages | 27 |
| Journal | The Lancet |
| Volume | 380 |
| Issue number | 9859 |
| DOIs | |
| State | Published - Dec 1 2012 |
Funding
We would like to thank the countless individuals who have contributed to the Global Burden of Disease 2010 study in various capacities. We would like to specifically acknowledge the important contribution to this work from multiple staff members of the World Health Organization. We also wish to express our gratitude to the following organisations that hosted consultations during the final stages of the analytic process, providing valuable feedback about the results and the data to improve the study's findings overall: Pan American Health Organization; Eastern Mediterranean Regional Office of WHO; UNAIDS; Ministry of Health, Brazil; China Centers for Disease Control; and the University of Zambia. We would like to thank Lori M Newman, Jördis Ott, Poul Erik Petersen, Shekhar Saxena, and Gretchen A Stevens for their collaboration and input into the analyses and estimates. Finally, we would like to acknowledge the extensive support from all staff members at the Institute for Health Metrics and Evaluation and specifically thank: James Bullard, Andrew Ernst, and Serkan Yalcin for their tireless support of the computational infrastructure required to produce the results; Linda A Ettinger for her expert administrative support in order to facilitate communication and coordination amongst the authors; Peter Speyer, Abigail McLain, Katherine Leach-Kemon, and Eden Stork for their persistent and valuable work to gain access to and catalog as much data as possible to inform the estimates; and Erin C Mullany for her systematic efforts in organising drafts of papers, formatting correspondence with expert groups, and preparing the final manuscript. The following individuals would like to acknowledge various forms of institutional support. J P Abraham, B Bartels, and P Yeh recognise the support of the World Bank Global Road Safety Facility and Department of Global Health & Population, Harvard School of Public Health, and the World Health Organization Violence and Injury Prevention. B Bikbov acknowledges support from the Moscow State University of Medicine and Dentistry, Moscow, Russia; Academician V I Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia; International Society of Nephrology. R Bourne acknowledges the Vision & Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK. S Brooker is supported by a Wellcome Trust Senior Fellowship in Basic Biomedical Science (098045) . T S Brugha received funding from the Department of Health London, for the National Health Service Information Centre, by the University of Leicester. R Buchbinder is partially funded by an Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship, Monash University, and Cabrini Health. P Burney and D Jarvis acknowledge the Chronic Respiratory Disease group received funding from the BUPA Foundation. They had no role in study design, data collection and analysis, interpretation of data, decision to publish, or preparation of the manuscript. C Cella, M Cortinovis, F Gaspari, V Miglioli, and N Perico, on behalf of the entire Genitourinary Expert Group, acknowledge the International Society of Nephrology (ISN). H Chen acknowledges that his participation in this study was in part supported by the intramural research program of the NIH, the National Institute of Environmental Health Sciences. L E Coffeng, and W A Stolk received financial support from the Africa Programme for Onchocerciasis Control (WHO/APOC) for their work on onchocerciasis. B C Cowie received institutional support from the Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia. M Cross and L March acknowledge the University of Sydney (USYD); Institute of Bone and Joint Research, University of Sydney, Department of Rheumatology, Royal North Shore Hospital, St Leonards NSW 2065 Australia. N Dahodwala was supported by NIH grant K23 AG034236 and the Parkinson Council while working on this project. L Degenhardt is supported by an Australian NHMRC Senior Research Fellowship and funding to support her work for illicit drug dependence was provided by the Australian National Drug and Alcohol Research Centre of the University of New South Wales, Australia. R Dellavalle was supported by the US Department of Veterans Affairs while contributing to this study. S Derrett acknowledges the Health Research Council of New Zealand and the University of Otago for their support. V Feigin and R Krishnamurthi were supported by the National Institute for Stroke and Applied Neurosciences, AUT University. E Fevre acknowledges the Wellcome Trust for grant 085308 . W Hall was supported by an NHMRC Australia Fellowship. R Havmoeller was supported by a grant from the Swedish Research Council (#2011-1071) . D Hoy was supported by the Bill and Melinda Gates Foundation and the Australian National Health and Medical Research Council. K H Jacobsen was supported by the World Health Organization for her work on hepatitis A. N Kawakami notes that the collection of data ultimately used in this study was supported by the following grants: The World Mental Health Japan (WMH-J) is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour, and Welfare. He would like to thank staff members, field coordinators, and interviewers of the WMH Japan 2002–2004 Survey. L L Laslett is supported by an Australian Government Australian Postgraduate Award. She also notes that the TasOAC study, the results of which were used in this research, was supported by the 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, and University of Tasmania Institutional Research Grants Scheme. R Malekzadeh received funding from a research grant of Tehran University of Medical Sciences to do the related studies. R Matzopoulos acknowledges the two institutions that support his research work: South African Medical Research Council Burden of Disease Research Unit; and the University of Cape Town School of Public Health and Family Medicine. T Merriman acknowledges the Health Research Council of New Zealand. K Naidoo was supported by the Brien Holden Vision Institute. P Nelson was supported by the National Drug and Alcohol Research Centre (UNSW, Australia). R G Nelson acknowledges his research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. C Olives was funded in part by the Biostatistics, Epidemiologic and Bioinformatic Training in Environmental Health Training Grant (ES015459) . D Ozgediz acknowledges the staff and collaborators at the Mulago Hospital and Makerere University in Kampala, Uganda. K Pesudovs received institutional support from Flinders University. R Room's position at the University of Melbourne and Turning Point Alcohol and Drug Centre is funded by the Foundation for Alcohol Research and Education and the Victorian Department of Health. J A Salomon received support from the Burke Global Health Fellowship while working on this study. U Sampson received funding support from the Harold Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation and the Vanderbilt Clinical and Translational Scholars Award. L Sanchez-Riera acknowledges the Spanish Society of Rheumatology (Sociedad Española de Reumatología). M Segui-Gomez's participation was partly supported by funds from the European Center for Injury Prevention, Universidad de Navarra. E Smith acknowledges the Department of Health and Ageing, Commonwealth Government of Australia, Institute of Bone and Joint Research (IBJR), University of Sydney (USYD). G D Thurston was supported in part by Center grant ES00260 from the National Institute of Environmental Health Sciences . D J Weatherall was supported by the Wellcome Trust UK, the Medical Research Council UK and the Anthony Cerami and Ann Dunne Research Trust.
ASJC Scopus subject areas
- General Medicine
