Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

著者: Simon I Hay, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J. Abu‐Raddad, Ilana N. Ackerman, Isaac Akinkunmi Adedeji, Olatunji Adetokunboh, Ashkan Afshin, Rakesh Aggarwal, Sutapa Agrawal, Anurag Agrawal, Muktar Beshir Ahmed, Miloud Taki Eddine Aichour, Amani Nidhal Aichour, Ibtihel Aichour, Sneha Aiyar, Tomi Akinyemiju, Nadia Akseer, Faris Lami, Fares Alahdab, Ziyad Al‐Aly, Khurshid Alam, Noore Alam, Shazia Alam, Deena Alasfoor, Kefyalew Addis Alene, Raghib Ali, Reza Alizadeh‐Navaei, Juma Alkaabi, Ala’a Alkerwi, François Alla, Peter Allebeck, Christine A. Allen, Fatma Al‐Maskari, Mohammad AbdulAziz AlMazroa, Rajaa Al‐Raddadi, Ubai Alsharif, Shirina Alsowaidi, Benjamin M. Althouse, Khalid A Altirkawi, Nelson Alvis‐Guzmán, Azmeraw T. Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Palwasha Anwari, Johan Ärnlöv, Megha Arora, Al Artaman, Krishna Kumar Aryal, Solomon Weldegebreal Asgedom, Tesfay Mehari Atey, Niguse Tadele Atnafu, Leticia Ávila‐Burgos, Euripide Avokpaho, Ashish Awasthi, Shally Awasthi, Mahmoud Reza Azarpazhooh, Peter Azzopardi, Tesleem Kayode Babalola, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Marlena S. Bannick, Aleksandra Barać, Suzanne Barker‐Collo, Till Bärnighausen, Sı́món Barquera, Lope H. Barrero, Sanjay Basu, Robert J. Battista, Katherine E. Battle, Bernhard T. Baune, Shahrzad Bazargan‐Hejazi, Justin Beardsley, Neeraj Bedi, Yannick Béjot, Bayu Begashaw Bekele, Michelle L. Bell, Derrick Bennett, James R. Bennett, Isabela M. Benseñor, Jennifer Benson, Adugnaw Berhane, Derbew Fikadu Berhe, Eduardo Bernabé, Balem Demtsu Betsu, Mircea Beuran, Addisu Shunu Beyene, Anil Bhansali, Samir Bhatt, Zulfiqar A Bhutta, Sibhatu Biadgilign, Burcu Küçük Biçer, Kelly Bienhoff, Boris Bikbov, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Fiona Blyth, Dube Jara Boneya, Dipan Bose, Ibrahim R. Bou-Orm, Rupert Bourne, Michael Brainin, Carol Brayne, Alexandra Bražinová, Nicholas J. K. Breitborde, Paul Svitil Briant, Gabrielle B. Britton, Traolach Brugha, Rachelle Buchbinder, Lemma N Bulto, Blair R Bumgarner, Zahid A Butt, Lucero Cahuana-Hurtado, Ewan Cameron, Ismael Campos‐Nonato, Hélène Carabin, Rosario Cárdenas, David O. Carpenter, Juan Jesús Carrero, Austin Carter, Félix Carvalho, Daniel Casey, Carlos A Castañeda-Orjuela, Chris D Castle, Ferrán Catalá-López, Jung‐Chen Chang, Fiona Charlson, Pankaj Chaturvedi, Honglei Chen, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Rajiv Chowdhury, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Círillo, Danny V. Colombara, Leslie T. Cooper, Cyrus Cooper, Paolo Angelo Cortesi, Monica Cortinovis, Michael H Criqui, Elizabeth A. Cromwell, Marita Cross, John A. Crump, Abel Fekadu Dadi, Koustuv Dalal, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, José das Neves, Dragoş Virgil Daviţoiu, Kairat Davletov, Barbora de Courten, Diego De Leo, Hans De Steur, Barthélémy Kuate Defo, Louisa Degenhardt, Selina Deiparine, Robert P Dellavalle, Kebede Deribe, Amare Deribew, Don C. Des Jarlais, Subhojit Dey, Samath Dhamminda Dharmaratne, Preet K. Dhillon, Daniel Dicker, Shirin Djalainia, Huyen Phuc, Клара Докова, David Teye Doku, E. Ray Dorsey, Kadine Priscila Bender dos Santos, Tim Driscoll, Manisha Dubey, Bruce Bartholow Duncan, Beth E. Ebel, Michelle Echko, Ziad El‐Khatib, Ahmadali Enayati, Aman Yesuf Endries, Sergey Petrovich Ermakov, Holly E Erskine, Setegn Eshetie, Babak Eshrati, Alireza Esteghamati, Kara Estep, Fanuel Belayneh Bekele Fanuel, Tamer H. Farag, Carla Sofia e Sá Farinha, André Faro, Farshad Farzadfar, Mir Sohail Fazeli, Valery L. Feigin, Andrea B Feigl, Seyed‐Mohammad Fereshtehnejad, João Carlos Fernandes, Alize J Ferrari, Tesfaye Regassa Feyissa, Irina Filip, Florian Fischer, Christina Fitzmaurice, Abraham D Flaxman, Nataliya A Foigt, Kyle J Foreman, Richard C. Franklin, Joseph Frostad, Nancy Fullman, Thomas Fürst, João M. Furtado, Neal D. Futran, Emmanuela Gakidou, Alberto L. García‐Basteiro, Teshome Gebre, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Johanna M. Geleijnse, Ayele Geleto, Bikila Lencha Gemechu, Hailay Abrha Gesesew, Peter W. Gething, Alireza Ghajar, Katherine B. Gibney, Richard F Gillum, Ibrahim Ginawi, Melkamu Dedefo Gishu, Giorgia Giussani, William Godwin, Kashish Goel, Shifalika Goenka, Ellen M Goldberg, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Richard A. Gosselin, Carolyn Gotay, Atsushi Goto, Alessandra C. Goulart, Nicholas Graetz, H. C. Gugnani, Prakash Chandra Gupta, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Rahul Gupta, Reyna Alma Gutiérrez, Vladimir Hachinski, Nima Hafezi‐Nejad, Alemayehu Hailu, Gessessew Bugssa Hailu, Randah R Hamadeh, Samer Hamidi, Mouhanad Hammami, Alexis J. Handal, Graeme J. Hankey, Yuantao Hao, Hilda L Harb, Habtamu Abera Hareri, Josep María Haro, Kimani M Harun, James Harvey, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Roderick J. Hay, Mohammad Taghi Hedayati, Delia Hendrie, Nathaniel J Henry, Ileana Heredia-Pi, Pouria Heydarpour, Hans W. Hoek, Howard J. Hoffman, Masako Horino, Nobuyuki Horita, Hung Chak Ho, Sorin Hostiuc, Peter J. Hotez, Damian G Hoy, Aung Soe Htet, Guoqing Hu, John J. Huang, Chantal Huynh, Kim Moesgaard Iburg, Ehimario Igumbor, Chad Ikeda, Caleb Mackay Salpeter Irvine, Sheikh Mohammed Shariful Islam, Kathryn H. Jacobsen, Nader Jahanmehr, Mihajlo Jakovljević, Peter James, Simerjot K Jassal, Mehdi Javanbakht, Sudha Jayaraman, Panniyammakal Jeemon, Paul N. Jensen, Vivekanand Jha, Guohong Jiang, Denny John, Catherine O. Johnson, Sarah Charlotte Johnson, Jost B. Jonas, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Ritul Kamal, Chittaranjan Kar, Nadim E Karam, André Karch, Corine Karema, Seyed M Karimi, Chanté Karimkhani, Amir Kasaeian, Getachew Mullu Kassa, Nigussie Assefa Kassaw, Nicholas J Kassebaum, Anshul Kastor, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Peter Njenga Keiyoro, Laura Kemmer, André Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Khader, Ibrahim A Khalil, Ejaz Ahmad Khan, Young‐Ho Khang, Abdullah T Khoja, Ardeshir Khosravi, Jagdish Khubchandani, Ali Kiadaliri, Christian Kieling, Yun Jin Kim, Daniel Kim, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kısa, Katarzyna Kissimova‐Skarbek, Niranjan Kissoon, Mika Kivimäki, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A Kopec, Soewarta Kosen, Georgios A. Kotsakis, Parvaiz A Koul, Ai Koyanagi, Michael Kravchenko, Kristopher J Krohn, G Anil Kumar, Pushpendra Kumar, Hmwe Hmwe Kyu, Anton Lager, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Nkurunziza Lambert, Qing Lan, Van Charles Lansingh, Anders Larsson, Janet L Leasher, Paul H. Lee, J. Paul Leigh, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miriam Levi, Li Y, Yongmei Li, Xiaofeng Liang, Misgan Legesse Liben, Stephen S Lim, Shai Linn, Patrick Y Liu, Angela Liu, Shiwei Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Katharine J Looker, Alan D Lopez, Stefan Lorkowski, Paulo A. Lotufo, Rafael Lozano, Tim Lucas, Raimundas Lunevičius, Ronan A Lyons, Erlyn Rachelle King Macarayan, Emilie R Maddison, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Carlos Magis‐Rodríguez, Mahdi Mahdavi, Marek Majdán, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Déborah Carvalho Malta, Abdullah Al Mamun, Helena Manguerra, Treh Manhertz, LG Mantovani, Chabila C Mapoma, Lyn March, Laurie B. Marczak, José Martı́nez-Raga, Paulo Henrique Viegas Martins, Francisco Rogerlândio Martins‐Melo, Ira Martopullo, Winfried März, Manu Raj Mathur, Mohsen Mazidi, Colm McAlinden, Madeline McGaughey, John J. McGrath, Martin McKee, Suresh Mehata, Toni Meier, Kidanu Gebremariam Meles, Peter Memiah, Ziad A. Memish, Walter Mendoza, Melkamu Merid Mengesha, Mubarek Abera Mengistie, Desalegn Tadese Mengistu, George A. Mensah, Tuomo J Meretoja, Atte Meretoja, Haftay Berhane Mezgebe, Renata Micha, Anoushka Millear, Ted R. Miller, Shawn Minnig, Mojde Mirarefin, Erkin М Мirrakhimov, Awoke Misganaw, Shiva Raj Mishra, Philip B. Mitchell, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Muktar Sano Kedir, Kedir Endris Mohammed, Shafiu Mohammed, Murali B V Mohan, Ali H. Mokdad, Sarah K Mollenkopf, Lorenzo Monasta, Julio Cesar Montañez Hernandez, Marcella Montico, Maziar Moradi‐Lakeh, Paula Moraga, Lídia Morawska, Rintaro Mori, Shane D. Morrison, Mark Moses, Cliff Mountjoy-Venning, Kalayu Brhane Mruts, Ulrich Müeller, Kate Muller, Michele E Murdoch, Gudlavalleti Venkata Satyanarayana Murthy, Srinivas Murthy, Kamarul Imran Musa, Jean B. Nachega, Gabriele Nagel, Mohsen Naghavi, Aliya Naheed, Kovin Naidoo, Vinay Nangia, Jamal Nasher, Gopalakrishnan Natarajan, Dumessa Edessa Negasa, Ruxandra Irina Negoi, Ionuţ Negoi, Charles R. 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BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation.