Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Published September 14, 2017, in The Lancet (opens in a new window)
Background
As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
Methods
We estimated prevalence and incidence for 328 diseases and injuries and 2,982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modeling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Findings
Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57.6 million (95% uncertainty interval [UI] 40.8–75.9 million [7.2%, 6.0–8.3]), 45.1 million (29.0–62.8 million [5.6%, 4.0–7.2]), 36.3 million (25.3–50.9 million [4.5%, 3.8–5.3]), 34.7 million (23.0–49.6 million [4.3%, 3.5–5.2]), and 34.1 million (23.5–46.0 million [4.2%, 3.2–5.3]) of total YLDs, respectively. Age-standardized rates of YLDs for all causes combined decreased between 1990 and 2016 by 2.7% (95% UI 2.3–3.1). Despite mostly stagnant age-standardized rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the aging of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardized YLD rates for all conditions combined were 10.4% (95% UI 9.0–11.8) higher in women than in men. Iron-deficiency anemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardized rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardized YLD rates for all causes between the location with the lowest rate (China, 9,201 YLDs per 100,000, 95% UI 6,862–11,943) and highest rate (Yemen, 14,774 YLDs per 100,000, 11,018–19,228).
Interpretation
The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardized YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are aging, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
Citation
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 14 Sept 2017: 390; 1211–59.
Authors
- Theo Vos,
- Christopher J.L. Murray,
- Ashkan Afshin,
- Tahiya Alam,
- Christine Allen,
- Marlena Bannick,
- Ryan Barber,
- Jennifer Benson,
- Kelly Bienhoff,
- Stan Biryukov,
- Blair Bumgarner,
- Austin Carter,
- Daniel Casey,
- Chris Castle,
- Fiona Charlson,
- Danny Colombara,
- Lalit Dandona,
- Rakhi Dandona,
- Louisa Degenhardt,
- Daniel Dicker,
- Dirk Douwes-Schultz,
- Holly Erskine,
- Kara Estep,
- Alize Ferrari,
- Christina Fitzmaurice,
- Abraham Flaxman,
- Kyle Foreman,
- Nancy Fullman,
- Emmanuela Gakidou,
- Will Godwin,
- Ellen Goldberg,
- Max Griswold,
- James Harvey,
- Caitlin Hawley,
- Simon Hay,
- Nathaniel Henry,
- Chantal Huynh,
- Chad Ikeda,
- Caleb Irvine,
- Catherine Johnson,
- Sarah Johnson,
- Nicholas Kassebaum,
- Ibrahim Khalil,
- Pauline Kim,
- Kris Krohn,
- Hmwe Hmwe Kyu,
- Stephen Lim,
- Angela Liu,
- Patrick Liu,
- Rafael Lozano,
- Helena Manguerra,
- Treh Manhertz,
- Laurie Marczak,
- Ira Martopullo,
- Madeline McGaughey,
- Claire McNellan,
- Anoushka Millear,
- Awoke Misganaw Temesgen,
- Ali Mokdad,
- Mark Moses,
- Cliff Mountjoy-Venning,
- Kate Muller,
- Mohsen Naghavi,
- Grant Nguyen,
- Minh Nguyen,
- Emma Nichols,
- Helen Olsen,
- Liane Ong,
- Aaron Osgood-Zimmerman,
- Katherine Paulson,
- David Pigott,
- Christine Pinho,
- Martin Pletcher,
- Caroline Purcell,
- Zane Rankin,
- Puja Rao,
- Sarah Ray,
- Bobby Reiner,
- Nikolas Reinig,
- Marissa Reitsma,
- Gregory Roth,
- Nafis Sadat,
- Joseph Salama,
- Damian Santomauro,
- Katya Shackelford,
- Chloe Shields,
- Shreya Shirude,
- Erica Leigh Slepak,
- Amber Sligar,
- David Smith,
- Mari Smith,
- Reed Sorensen,
- Vinay Srinivasan,
- Jeff Stanaway,
- Caitlyn Steiner,
- Bryan Strub,
- Michelle Subart,
- Patrick Sur,
- Dillon Sylte,
- Ornwipa Thamsuwan,
- Katie Ballesteros,
- Chris Troeger,
- Derrick Tsoi,
- Rachel Updike,
- Stein Emil Vollset,
- Marcia Weaver,
- Harvey Whiteford,
- Rachel Woodbrook,
- Sarah Wulf Hanson,
- Simon Yadgir,
- Maigeng Zhou,
- Ben Zipkin,
- Luisa Sorio Flor
Datasets
All our datasets are housed in our data catalog, the Global Health Data Exchange (GHDx). Visit the GHDx to download data from this article.