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 (original) (raw)

Health is improving globally, but this means more populations are spending more time with functional health loss-an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI-a relative compression of morbidity-which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs, HALE, and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation Research in context Evidence before this study Disability-adjusted life years (DALYs), a summary measure of population health based on estimates of premature mortality and nonfatal health loss, originated from the initial Global Burden of Disease (GBD) study in 1993. DALYs, in combination with other summary measures such as healthy life expectancy (HALE), offer relatively simple yet powerful metrics against which progress and challenges in improving disease burden and extending healthy lifespans can be effectively monitored over time. Published in 2012, GBD 2010 provided updated estimates of DALYs due to 291 causes and HALE in 187 countries from 1990 to 2010. GBD 2013 extended this time series to 2013, 188 countries, and 306 causes. Novel analyses for quantifying epidemiologic transitions were introduced as part of GBD 2013, enabling a comparison of shifts in years of life lost (YLLs) and years lived with disability (YLDs) with increasing levels of development. The World Health Organization (WHO) has produced estimates of DALYs and HALE largely based off GBD 2010 and GBD 2013; however, modifications were implemented for a subset of causes, disability weights, and countries, and a normative life table of 91.9 years at birth was used for calculating YLLs.