Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
journal contributionposted on 08.12.2020, 16:57 by Theo Vos, Stephen S Lim, Cristiana Abbafati, Kaja M Abbas, Mohammad Abbasi, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Mohammad Abdollahi, Ibrahim Abdollahpour, Hassan Abolhassani, Victor Aboyans, Elissa M Abrams, Lucas Guimaraes Abreu, Michael RM Abrigo, Laith Jamal Abu-Raddad, Abdelrahman I Abushouk, Alyssa Acebedo, Ilana N Ackerman, Maryam Adabi, Abdu A Adamu, Oladimeji M Adebayo, Victor Adekanmbi, Jaimie D Adelson, Olatunji O Adetokunboh, Davoud Adham, Mahdi Afshari, Ashkan Afshin, Emilie E Agardh, Gina Agarwal, Kareha M Agesa, Mohammad Aghaali, Seyed Mohammad Kazem Aghamir, Anurag Agrawal, Tauseef Ahmad, Alireza Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Ehsan Ahmadpour, Temesgen Yihunie Akalu, Rufus Olusola Akinyemi, Tomi Akinyemiju, Blessing Akombi, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Samiah Alam, Tahiya Alam, Turki M Alanzi, Samuel B Albertson, Jacqueline Elizabeth Alcalde-Rabanal, Niguse Meles Alema, Muhammad Ali, Saqib Ali, Gianfranco Alicandro, Mehran Alijanzadeh, Cyrus Alinia, Vahid Alipour, Syed Mohamed Aljunid, Francois Alla, Peter Allebeck, Amir Almasi-Hashiani, Jordi Alonso, Rajaa M Al-Raddadi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Saeed Amini, Mostafa Amini-Rarani, Arya Aminorroaya, Fatemeh Amiri, Arianna Maever L Amit, Dickson A Amugsi, Gianna Gayle Herrera Amul, Deanna Anderlini, Catalina Liliana Andrei, Tudorel Andrei, Mina Anjomshoa, Fereshteh Ansari, Iman Ansari, Alireza Ansari-Moghaddam, Carl Abelardo T Antonio, Catherine M Antony, Ernoiz Antriyandarti, Davood Anvari, Razique Anwer, Jalal Arabloo, Morteza Arab-Zozani, Aleksandr Y Aravkin, Filippo Ariani, Johan Arnlov, Krishna K Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Ali A Asadi-Pooya, Babak Asghari, Charlie Ashbaugh, Desta Debalkie Atnafu, Sachin R Atre, Floriane Ausloos, Marcel Ausloos, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Ghasem Azarian, Zelalem Nigussie Azene, Ebrahim Babaee, Alaa Badawi, Mojtaba Bagherzadeh, Mohammad Hossein Bakhshaei, Ahad Bakhtiari, Senthilkumar Balakrishnan, Shivanthi Balalla, Shelly Balassyano, Maciej Banach, Palash Chandra Banik, Marlena S Bannick, Agegnehu Bante Bante, Adhanom Gebreegziabher Baraki, Miguel A Barboza, Suzanne Lyn Barker-Collo, Celine M Barthelemy, Lingkan Barua, Akbar Barzegar, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Gholamreza Bazmandegan, Neeraj Bedi, Ettore Beghi, Yannick Bejot, Aminu K Bello, Rose G Bender, Derrick A Bennett, Fiona B Bennitt, Isabela M Bensenor, Catherine P Benziger, Kidanemaryam Berhe, Eduardo Bernabe, Gregory J Bertolacci, Reshmi Bhageerathy, Neeraj Bhala, Dinesh Bhandari, Pankaj Bhardwaj, Krittika Bhattacharyya, Zulfiqar A Bhutta, Sadia Bibi, Molly H Biehl, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Antonio Biondi, Binyam Minuye Birihane, Donal Bisanzio, Catherine Bisignano, Raaj Kishore Biswas, Somayeh Bohlouli, Mehdi Bohluli, Srinivasa Rao Rao Bolla, Archith Boloor, Alexandra S Boon-Dooley, Guilherme Borges, Antonio Maria Borzi, Rupert Bourne, Oliver J Brady, Michael Brauer, Carol Brayne, Nicholas JK Breitborde, Hermann Brenner, Paul Svitil Briant, Andrew M Briggs, Nikolay Ivanovich Briko, Gabrielle B Britton, Dana Bryazka, Rachelle Buchbinder, Blair R Bumgarner, Reinhard Busse, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis LA Alberto Camera, Ismael R Campos-Nonato, Josip Car, Rosario Cardenas, Giulia Carreras, Juan J Carrero, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A Castaneda-Orjuela, Giulio Castelpietra, Chris D Castle, Franz Castro, Ferran Catala-Lopez, Kate Causey, Christopher R Cederroth, Kelly M Cercy, Ester Cerin, Joht Singh Chandan, Alex R Chang, Fiona J Charlson, Vijay Kumar Chattu, Sarika Chaturvedi, Odgerel Chimed-Ochir, Ken Lee Chin, Daniel Youngwhan Cho, Hanne Christensen, Dinh-Toi Chu, Michael T Chung, Flavia M Cicuttini, Liliana G Ciobanu, Massimo Cirillo, Emma L Collins, Kelly Compton, Sara Conti, Paolo Angelo Cortesi, Vera Marisa Costa, Ewerton Cousin, Richard G Cowden, Benjamin C Cowie, Elizabeth A Cromwell, Di H Cross, Christopher Stephen Crowe, Jessica A Cruz, Matthew Cunningham, Saad MA Dahlawi, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Aso Mohammad Darwesh, Ahmad Daryani, Jai K Das, Rajat Das Gupta, Jose das Neves, Claudio Alberto Davila-Cervantes, Kairat Davletov, Diego De Leo, Frances E Dean, Nicole K DeCleene, Amanda Deen, Louisa Degenhardt, Robert Paul Dellavalle, Feleke Mekonnen Demeke, Desalegn Getnet Demsie, Edgar Denova-Gutierrez, Nebiyu Dereje Dereje, Nikolaos Dervenis, Rupak Desai, Assefa Desalew, Getenet Ayalew Dessie, Samath Dhamminda Dharmaratne, Govinda Prasad Dhungana, Mostafa Dianatinasab, Daniel Diaz, Zahra Sadat Dibaji Forooshani, Zachary V Dingels, M Ashworth Dirac, Shirin Djalalinia, Hoa Thi Do, Klara Dokova, Fariba Dorostkar, Chirag P Doshi, Leila Doshmangir, Abdel Douiri, Matthew C Doxey, Tim Robert Driscoll, Susanna J Dunachie, Bruce B Duncan, Andre Rodrigues Duraes, Arielle Wilder Eagan, Mohammad Ebrahimi Kalan, David Edvardsson, Joshua R Ehrlich, Nevine El Nahas, Iman El Sayed, Maha El Tantawi, Iffat Elbarazi, Islam Y Elgendy, Hala Rashad Elhabashy, Shaimaa I El-Jaafary, Iqbal RF Elyazar, Mohammad Hassan Emamian, Sophia Emmons-Bell, Holly E Erskine, Babak Eshrati, Sharareh Eskandarieh, Saman Esmaeilnejad, Firooz Esmaeilzadeh, Alireza Esteghamati, Kara Estep, Arash Etemadi, Atkilt Esaiyas Etisso, Mohammad Farahmand, Anwar Faraj, Mohammad Fareed, Roghiyeh Faridnia, Carla Sofia E Sa Farinha, Andrea Farioli, Andre Faro, Mithila Faruque, Farshad Farzadfar, Nazir Fattahi, Mehdi Fazlzadeh, Valery L Feigin, Rachel Feldman, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Alize J Ferrari, Manuela L Ferreira, Irina Filip, Florian Fischer, James L Fisher, Ryan Fitzgerald, Carsten Flohr, Luisa Sorio Flor, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Lisa M Force, Carla Fornari, Masoud Foroutan, Jack T Fox, Marisa Freitas, Weijia Fu, Takeshi Fukumoto, Joao M Furtado, Mohamed M Gad, Emmanuela Gakidou, Natalie C Galles, Silvano Gallus, Amiran Gamkrelidze, Alberto L Garcia-Basteiro, William M Gardner, Biniyam Sahiledengle Geberemariyam, Abiyu Mekonnen Gebrehiwot, Ketema Bizuwork Gebremedhin, Assefa Ayalew Ayalew Ayalew Gebreslassie, Anna Gershberg Hayoon, Peter W Gething, Maryam Ghadimi, Keyghobad Ghadiri, Mansour Ghafourifard, Alireza Ghajar, Farhad Ghamari, Ahmad Ghashghaee, Hesam Ghiasvand, Nermin Ghith, Asadollah Gholamian, Syed Amir Gilani, Paramjit Singh Gill, Mojgan Gitimoghaddam, Giorgia Giussani, Srinivas Goli, Ricardo Santiago Gomez, Sameer Vali Gopalani, Giuseppe Gorini, Taren M Gorman, Harrison Chase Gottlich, Houman Goudarzi, Alessandra C Goulart, Barbara Niegia Garcia Goulart, Ayman Grada, Michal Grivna, Giuseppe Grosso, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Andre Luiz Sena Guimaraes, Rafael Alves Guimaraes, Rashid Abdi Guled, Gaorui Guo, Yuming Guo, Rajeev Gupta, Juanita A Haagsma, Beatrix Haddock, Nima Hafezi-Nejad, Abdul Hafiz, Hailey Hagins, Lydia M Haile, Brian J Hall, Iman Halvaei, Randah R Hamadeh, Kanaan Hamagharib Abdullah, Erin B Hamilton, Chieh Han, Hannah Han, Graeme J Hankey, Josep Maria Haro, James D Harvey, Ahmed I Hasaballah, Amir Hasanzadeh, Maryam Hashemian, Soheil Hassanipour, Hadi Hassankhani, Rasmus J Havmoeller, Roderick J Hay, Simon I Hay, Khezar Hayat, Behnam Heidari, Golnaz Heidari, Reza Heidari-Soureshjani, Delia Hendrie, Hannah J Henrikson, Nathaniel J Henry, Claudiu Herteliu, Fatemeh Heydarpour, Thomas R Hird, Hans W Hoek, Michael K Hole, Ramesh Holla, Praveen Hoogar, H Dean Hosgood, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Damian G Hoy, Mohamed Hsairi, Vivian Chia-rong Hsieh, Guoqing Hu, Tanvir M Huda, Fernando N Hugo, Chantal K Huynh, Bing-Fang Hwang, Vincent C Iannucci, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Leeberk Raja Inbaraj, Helen Ippolito, Seyed Sina Naghibi Irvani, M Mofizul Islam, MdMohaimenul Islam, Sheikh Mohammed Shariful Islam, Farhad Islami, Hiroyasu Iso, Rebecca Q Ivers, Chidozie CD Iwu, Ihoghosa Osamuyi Iyamu, Jalil Jaafari, Kathryn H Jacobsen, Farhad Jadidi-Niaragh, Hussain Jafari, Morteza Jafarinia, Deepa Jahagirdar, Mohammad Ali Jahani, Nader Jahanmehr, Mihajlo Jakovljevic, Amir Jalali, Farzad Jalilian, Spencer L James, Hosna Janjani, Manthan Dilipkumar Janodia, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Ensiyeh Jenabi, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Peng Jia, Oommen John, Yetunde O John-Akinola, Catherine Owens Johnson, Sarah Charlotte Johnson, Jost B Jonas, Tamas Joo, Ankur Joshi, Jacek Jerzy Jozwiak, Mikk Jurisson, Ali Kabir, Zubair Kabir, Hamed Kalani, Rizwan Kalani, Leila R Kalankesh, Rohollah Kalhor, Zahra Kamiab, Tanuj Kanchan, Behzad Karami Matin, Andre Karch, Mohd Anisul Karim, Salah Eddin Karimi, Getachew Mullu Kassa, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Norito Kawakami, Gbenga A Kayode, Suzanne H Keddie, Cathleen Keller, Maia Kereselidze, Morteza Abdullatif Khafaie, Nauman Khalid, Maseer Khan, Khaled Khatab, Mona M Khater, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Mohammad Taghi Khodayari, Roba Khundkar, Neda Kianipour
Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation.