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Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Kyu, Hmwe Hmwe; Abate, Degu; Abate, Kalkidan Hassen; Abay, Solomon M; Abbafati, Cristiana; Abbasi, Nooshin; Abbastabar, Hedayat; Abd-Allah, Foad; Abdela, Jemal; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abebe, Molla; Abebe, Zegeye; Abil, Olifan Zewdie; Aboyans, Victor; Abrham, Aklilu Roba; Abu-Raddad, Laith Jamal; Abu-Rmeileh, Niveen M E; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Acharya, Pawan; Ackerman, Ilana N; Adamu, Abdu A; Adebayo, Oladimeji M; Adekanmbi, Victor; Ademi, Zanfina; Adetokunboh, Olatunji O; Adib, Mina G; Adsuar, Jose C; Afanvi, Kossivi Agbelenko; Afarideh, Mohsen; Afshin, Ashkan; Agarwal, Gina; Agesa, Kareha M; Aggarwal, Rakesh; Aghayan, Sargis Aghasi; Agrawal, Anurag; Ahmadi, Alireza; Ahmadi, Mehdi; Ahmadieh, Hamid; Ahmed, Muktar Beshir; Ahmed, Sayem; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Akinyemiju, Tomi; Akseer, Nadia; Al-Aly, Ziyad; Al-Eyadhy, Ayman; Al-Mekhlafi, Hesham M; Al-Raddadi, Rajaa...

Authors

Hmwe Hmwe Kyu

Degu Abate

Kalkidan Hassen Abate

Solomon M Abay

Cristiana Abbafati

Nooshin Abbasi

Hedayat Abbastabar

Foad Abd-Allah

Jemal Abdela

Ahmed Abdelalim

Ibrahim Abdollahpour

Rizwan Suliankatchi Abdulkader

Molla Abebe

Zegeye Abebe

Olifan Zewdie Abil

Victor Aboyans

Aklilu Roba Abrham

Laith Jamal Abu-Raddad

Niveen M E Abu-Rmeileh

Manfred Mario Kokou Accrombessi

Dilaram Acharya

Pawan Acharya

Ilana N Ackerman

Abdu A Adamu

Oladimeji M Adebayo

Victor Adekanmbi

Zanfina Ademi

Olatunji O Adetokunboh

Mina G Adib

Jose C Adsuar

Kossivi Agbelenko Afanvi

Mohsen Afarideh

Ashkan Afshin

Gina Agarwal

Kareha M Agesa

Rakesh Aggarwal

Sargis Aghasi Aghayan

Anurag Agrawal

Alireza Ahmadi

Mehdi Ahmadi

Hamid Ahmadieh

Muktar Beshir Ahmed

Sayem Ahmed

Amani Nidhal Aichour

Ibtihel Aichour

Miloud Taki Eddine Aichour

Tomi Akinyemiju

Nadia Akseer

Ziyad Al-Aly

Ayman Al-Eyadhy

Hesham M Al-Mekhlafi

Rajaa M Al-Raddadi

Fares Alahdab

Khurshid Alam

Tahiya Alam

Alaa Alashi

Seyed Moayed Alavian

Kefyalew Addis Alene

Mehran Alijanzadeh

Reza Alizadeh-Navaei

Syed Mohamed Aljunid

Ala'a Alkerwi

François Alla

Peter Allebeck

Jordi Alonso

Ubai Alsharif

Khalid Altirkawi

Nelson Alvis-Guzman

Leopold N Aminde

Erfan Amini

Mohammadreza Amiresmaili

Walid Ammar

Yaw Ampem Amoako

Nahla Hamed Anber

Catalina Liliana Andrei

Sofia Androudi

Megbaru Debalkie Animut

Mina Anjomshoa

Mustafa Geleto Ansha

Carl Abelardo T Antonio

Palwasha Anwari

Jalal Arabloo

Olatunde Aremu

Johan Ärnlöv

Amit Arora

Megha Arora

Al Artaman

Krishna K Aryal

Hamid Asayesh

Zerihun Ataro

Marcel Ausloos

Leticia Avila-Burgos

Euripide F G A Avokpaho

Ashish Awasthi

Beatriz Paulina Ayala Quintanilla

Rakesh Ayer

Peter S Azzopardi

Arefeh Babazadeh

Hamid Badali

Kalpana Balakrishnan

Ayele Geleto Bali

Maciej Banach

Joseph Adel Mattar Banoub

Aleksandra Barac

Miguel A Barboza

Suzanne Lyn Barker-Collo

Till Winfried Bärnighausen

Simon Barquera

Lope H Barrero

Shahrzad Bazargan-Hejazi

Neeraj Bedi

Ettore Beghi

Masoud Behzadifar

Meysam Behzadifar

Bayu Begashaw Bekele

Eyasu Tamru Bekru

Abate Bekele Belachew

Yihalem Abebe Belay

Michelle L Bell

Aminu K Bello

Derrick A Bennett

Isabela M Bensenor

Adugnaw Berhane

Eduardo Bernabe

Robert S Bernstein

Mircea Beuran

Tina Beyranvand

Neeraj Bhala

Samir Bhatt

Soumyadeep Bhaumik

Zulfiqar A Bhutta

Belete Biadgo

Molly H Biehl

Ali Bijani

Boris Bikbov

Ver Bilano

Nigus Bililign

Muhammad Shahdaat Bin Sayeed

Donal Bisanzio

Tone Bjørge

Archie Bleyer

Eshetu Mulisa Bobasa

Ibrahim R Bou-Orm

Soufiane Boufous

Rupert Bourne

Oliver J Brady

Luisa C Brant

Carol Brayne

Alexandra Brazinova

Nicholas J K Breitborde

Hermann Brenner

Paul Svitil Briant

Andrey Nikolaevich Briko

Gabrielle Britton

Traolach Brugha

Rachelle Buchbinder

Reinhard Busse

Zahid A Butt

Lucero Cahuana-Hurtado

Julio Cesar Campuzano Rincon

Jorge Cano

Rosario Cárdenas

Juan J Carrero

Austin Carter

Félix Carvalho

Carlos A Castañeda-Orjuela

Jacqueline Castillo Rivas

Franz Castro

Ferrán Catalá-López

Kelly M Cercy

Ester Cerin

Yazan Chaiah

Jung-Chen Chang

Fiona J Charlson

Vijay Kumar Chattu

Peggy Pei-Chia Chiang

Abdulaal Chitheer

Jee-Young J Choi

Hanne Christensen

Devasahayam J Christopher

Sheng-Chia Chung

Flavia M Cicuttini

Massimo Cirillo

Daniel Collado-Mateo

Cyrus Cooper

Paolo Angelo Cortesi

Monica Cortinovis

Ewerton Cousin

Michael H Criqui

Elizabeth A Cromwell

Marita Cross

John A Crump

Alemneh Kabeta Daba

Berihun Assefa Dachew

Abel Fekadu Dadi

Lalit Dandona

Rakhi Dandona

Paul I Dargan

Ahmad Daryani

Rajat Das Gupta

José Das Neves

Tamirat Tesfaye Dasa

Dragos Virgil Davitoiu

Fernando Pio De La Hoz

Diego De Leo

Jan-Walter De Neve

Hans De Steur

Meaza Girma Degefa

Louisa Degenhardt

Selina Deiparine

Gebre Teklemariam Demoz

Edgar Denova-Gutiérrez

Kebede Deribe

Nikolaos Dervenis

Don C Des Jarlais

Subhojit Dey

Samath D Dharmaratne

Meghnath Dhimal

Mesfin Tadese Dinberu

M Ashworth Dirac

Shirin Djalalinia

Linh Doan

Klara Dokova

David Teye Doku

E Ray Dorsey

Kerrie E Doyle

Tim Robert Driscoll

Manisha Dubey

Eleonora Dubljanin

Eyasu Ejeta Duken

Bruce B Duncan

Andre R Duraes

Hedyeh Ebrahimi

Soheil Ebrahimpour

Michelle M Echko

Dumessa Edessa

David Edvardsson

Andem Effiong

Anne Elise Eggen

Joshua R Ehrlich

Charbel El Bcheraoui

Ziad El-Khatib

Iqbal R F Elyazar

Ahmadali Enayati

Melese Linger Endalifer

Aman Yesuf Endries

Benjamin Er

Holly E Erskine

Sharareh Eskandarieh

Alireza Esteghamati

Sadaf Esteghamati

Hamed Fakhim

Mahbobeh Faramarzi

Mohammad Fareed

Farzaneh Farhadi

Talha A Farid

Carla Sofia E sá Farinha

Andrea Farioli

Andre Faro

Farshad Farzadfar

Ali Akbar Fazaeli

Valery L Feigin

Netsanet Fentahun

Seyed-Mohammad Fereshtehnejad

Eduarda Fernandes

Joao C Fernandes

Alize J Ferrari

Manuela L Ferreira

Irina Filip

Florian Fischer

Christina Fitzmaurice

Nataliya A Foigt

Kyle J Foreman

Tahvi D Frank

Takeshi Fukumoto

Nancy Fullman

Thomas Fürst

João M Furtado

Emmanuela Gakidou

Seana Gall

Silvano Gallus

Morsaleh Ganji

Alberto L Garcia-Basteiro

William M Gardner

Abadi Kahsu Gebre

Amanuel Tesfay Gebremedhin

Teklu Gebrehiwo Gebremichael

Tilayie Feto Gelano

Johanna M Geleijnse

Ricard Genova-Maleras

Yilma Chisha Dea Geramo

Peter W Gething

Kebede Embaye Gezae

Mohammad Rasoul Ghadami

Keyghobad Ghadiri

Maryam Ghasemi-Kasman

Mamata Ghimire

Aloke Gopal Ghoshal

Paramjit Singh Gill

Tiffany K Gill

Ibrahim Abdelmageed Ginawi

Giorgia Giussani

Elena V Gnedovskaya

Ellen M Goldberg

Srinivas Goli

Hector Gómez-Dantés

Philimon N Gona

Sameer Vali Gopalani

Taren M Gorman

Alessandra C Goulart

Bárbara Niegia Garcia Goulart

Ayman Grada

Giuseppe Grosso

Harish Chander Gugnani

Francis Guillemin

Yuming Guo

Prakash C Gupta

Rahul Gupta

Rajeev Gupta

Tanush Gupta

Reyna Alma Gutiérrez

Bishal Gyawali

Juanita A Haagsma

Vladimir Hachinski

Nima Hafezi-Nejad

Hassan Haghparast Bidgoli

Tekleberhan B Hagos

Tewodros Tesfa Hailegiyorgis

Arvin Haj-Mirzaian

Arya Haj-Mirzaian

Randah R Hamadeh

Samer Hamidi

Alexis J Handal

Graeme J Hankey

Yuantao Hao

Hilda L Harb

Sivadasanpillai Harikrishnan

Hamidreza Haririan

Josep Maria Haro

Hadi Hassankhani

Hamid Yimam Hassen

Rasmus Havmoeller

Roderick J Hay

Simon I Hay

Akbar Hedayatizadeh-Omran

Behzad Heibati

Delia Hendrie

Andualem Henok

Ileana Heredia-Pi

Claudiu Herteliu

Fatemeh Heydarpour

Pouria Heydarpour

Desalegn Tsegaw Hibstu

Hans W Hoek

Howard J Hoffman

Michael K Hole

Enayatollah Homaie Rad

Praveen Hoogar

H Dean Hosgood

Seyed Mostafa Hosseini

Mehdi Hosseinzadeh

Mihaela Hostiuc

Sorin Hostiuc

Peter J Hotez

Damian G Hoy

Mohamed Hsairi

Aung Soe Htet

John J Huang

Kim Moesgaard Iburg

Chad Thomas Ikeda

Olayinka Stephen Ilesanmi

Seyed Sina Naghibi Irvani

Caleb Mackay Salpeter Irvine

Sheikh Mohammed Shariful Islam

Farhad Islami

Kathryn H Jacobsen

Leila Jahangiry

Nader Jahanmehr

Sudhir Kumar Jain

Mihajlo Jakovljevic

Spencer L James

Achala Upendra Jayatilleke

Panniyammakal Jeemon

Ravi Prakash Jha

Vivekanand Jha

John S Ji

Catherine O Johnson

Jost B Jonas

Jitendra Jonnagaddala

Zahra Jorjoran Shushtari

Ankur Joshi

Jacek Jerzy Jozwiak

Suresh Banayya Jungari

Mikk Jürisson

Zubair Kabir

Rajendra Kadel

Amaha Kahsay

Rizwan Kalani

Tanuj Kanchan

Chittaranjan Kar

Manoochehr Karami

Behzad Karami Matin

André Karch

Corine Karema

Narges Karimi

Seyed M Karimi

Amir Kasaeian

Dessalegn H Kassa

Getachew Mullu Kassa

Tesfaye Dessale Kassa

Nicholas J Kassebaum

Srinivasa Vittal Katikireddi

Anil Kaul

Norito Kawakami

Zhila Kazemi

Ali Kazemi Karyani

Masoud Masoud Keighobadi

Peter Njenga Keiyoro

Laura Kemmer

Grant Rodgers Kemp

Andre Pascal Kengne

Andre Keren

Yousef Saleh Khader

Behzad Khafaei

Morteza Abdullatif Khafaie

Alireza Khajavi

Nauman Khalid

Ibrahim A Khalil

Ejaz Ahmad Khan

Muhammad Shahzeb Khan

Muhammad Ali Khan

Young-Ho Khang

Mona M Khater

Mohammad Khazaei

Abdullah T Khoja

Ardeshir Khosravi

Mohammad Hossein Khosravi

Aliasghar A Kiadaliri

Zelalem Teklemariam Kidanemariam

Daniel N Kiirithio

Cho-Il Kim

Daniel Kim

Young-Eun Kim

Yun Jin Kim

Ruth W Kimokoti

Yohannes Kinfu

Adnan Kisa

Katarzyna Kissimova-Skarbek

Ann Kristin Skrindo Knudsen

Jonathan M Kocarnik

Sonali Kochhar

Yoshihiro Kokubo

Tufa Kolola

Jacek A Kopec

Soewarta Kosen

Georgios A Kotsakis

Parvaiz A Koul

Ai Koyanagi

Kewal Krishan

Sanjay Krishnaswami

Kristopher J Krohn

Barthelemy Kuate Defo

Burcu Kucuk Bicer

G Anil Kumar

Manasi Kumar

Igor Kuzin

Deepesh P Lad

Sheetal D Lad

Alessandra Lafranconi

Ratilal Lalloo

Tea Lallukka

Faris Hasan Lami

Justin J Lang

Sinéad M Langan

Van C Lansingh

Arman Latifi

Kathryn Mei-Ming Lau

Jeffrey V Lazarus

Janet L Leasher

Jorge R Ledesma

Paul H Lee

James Leigh

Mostafa Leili

Cheru Tesema Leshargie

Janni Leung

Miriam Levi

Sonia Lewycka

Shanshan Li

Yichong Li

Xiaofeng Liang

Yu Liao

Misgan Legesse Liben

Lee-Ling Lim

Stephen S Lim

Miteku Andualem Limenih

Shai Linn

Shiwei Liu

Katharine J Looker

Alan D Lopez

Stefan Lorkowski

Paulo A Lotufo

Rafael Lozano

Tim C D Lucas

Raimundas Lunevicius

Ronan A Lyons

Stefan Ma

Erlyn Rachelle King Macarayan

Mark T Mackay

Emilie R Maddison

Fabiana Madotto

Dhaval P Maghavani

Hue Thi Mai

Marek Majdan

Reza Majdzadeh

Azeem Majeed

Reza Malekzadeh

Deborah Carvalho Malta

Abdullah A Mamun

Ana-Laura Manda

Helena Manguerra

Mohammad Ali Mansournia

Ana Maria Mantilla Herrera

Lorenzo Giovanni Mantovani

Joemer C Maravilla

Wagner Marcenes

Ashley Marks

Francisco Rogerlândio Martins-Melo

Ira Martopullo

Winfried März

Melvin B Marzan

João Massano

Benjamin Ballard Massenburg

Manu Raj Mathur

Pallab K Maulik

Mohsen Mazidi

Colm McAlinden

John J McGrath

Martin McKee

Brian J McMahon

Suresh Mehata

Ravi Mehrotra

Kala M Mehta

Varshil Mehta

Fabiola Mejia-Rodriguez

Tesfa Mekonen

Addisu Melese

Mulugeta Melku

Peter T N Memiah

Ziad A Memish

Walter Mendoza

Getnet Mengistu

George A Mensah

Seid Tiku Mereta

Atte Meretoja

Tuomo J Meretoja

Tomislav Mestrovic

Bartosz Miazgowski

Tomasz Miazgowski

Anoushka I Millear

Ted R Miller

G K Mini

Mojde Mirarefin

Andreea Mirica

Erkin M Mirrakhimov

Awoke Temesgen Misganaw

Philip B Mitchell

Habtamu Mitiku

Babak Moazen

Bahram Mohajer

Karzan Abdulmuhsin Mohammad

Moslem Mohammadi

Noushin Mohammadifard

Mousa Mohammadnia-Afrouzi

Mohammed A Mohammed

Shafiu Mohammed

Farnam Mohebi

Ali H Mokdad

Mariam Molokhia

Lorenzo Monasta

Julio Cesar Montañez

Mahmood Moosazadeh

Ghobad Moradi

Mahmoudreza Moradi

Maziar Moradi-Lakeh

Mehdi Moradinazar

Paula Moraga

Lidia Morawska

Ilais Moreno Velásquez

Joana Morgado-Da-Costa

Shane Douglas Morrison

Marilita M Moschos

Seyyed Meysam Mousavi

Kalayu Brhane Mruts

Achenef Asmamaw Muche

Kindie Fentahun Muchie

Ulrich Otto Mueller

Oumer Sada Muhammed

Satinath Mukhopadhyay

Kate Muller

John Everett Mumford

G V S Murthy

Kamarul Imran Musa

Ghulam Mustafa

Ashraf F Nabhan

Chie Nagata

Gabriele Nagel

Mohsen Naghavi

Aliya Naheed

Azin Nahvijou

Gurudatta Naik

Farid Najafi

Hae Sung Nam

Vinay Nangia

Jobert Richie Nansseu

Nahid Neamati

Ionut Negoi

Ruxandra Irina Negoi

Subas Neupane

Charles Richard James Newton

Josephine W Ngunjiri

Anh Quynh Nguyen

Grant Nguyen

Ha Thu Nguyen

Huong Lan Thi Nguyen

Huong Thanh Nguyen

Long Hoang Nguyen

Minh Nguyen

Nam Ba Nguyen

Son Hoang Nguyen

Emma Nichols

Dina Nur Anggraini Ningrum

Molly R Nixon

Shuhei Nomura

Mehdi Noroozi

Bo Norrving

Jean Jacques Noubiap

Hamid Reza Nouri

Malihe Nourollahpour Shiadeh

Mohammad Reza Nowroozi

Elaine O Nsoesie

Peter S Nyasulu

Christopher M Odell

Richard Ofori-Asenso

Felix Akpojene Ogbo

In-Hwan Oh

Olanrewaju Oladimeji

Andrew T Olagunju

Tinuke O Olagunju

Pedro R Olivares

Helen Elizabeth Olsen

Bolajoko Olubukunola Olusanya

Jacob Olusegun Olusanya

Kanyin L Ong

Sok King Ong

Eyal Oren

Alberto Ortiz

Erika Ota

Stanislav S Otstavnov

Simon Øverland

Mayowa Ojo Owolabi

Mahesh P A

Rosana Pacella

Abhijit P Pakhare

Amir H Pakpour

Adrian Pana

Songhomitra Panda-Jonas

Eun-Kee Park

James Park

Charles D H Parry

Hadi Parsian

Yahya Pasdar

Shanti Patel

Snehal T Patil

Ajay Patle

George C Patton

Vishnupriya Rao Paturi

Deepak Paudel

Katherine R Paulson

Neil Pearce

Alexandre Pereira

David M Pereira

Norberto Perico

Konrad Pesudovs

Max Petzold

Hai Quang Pham

Michael R Phillips

David M Pigott

Julian David Pillay

Michael A Piradov

Meghdad Pirsaheb

Farhad Pishgar

Oleguer Plana-Ripoll

Suzanne Polinder

Svetlana Popova

Maarten J Postma

Akram Pourshams

Hossein Poustchi

Dorairaj Prabhakaran

Swayam Prakash

V Prakash

Narayan Prasad

Caroline A Purcell

Mostafa Qorbani

D Alex Quistberg

Amir Radfar

Anwar Rafay

Alireza Rafiei

Fakher Rahim

Kazem Rahimi

Zohreh Rahimi

Afarin Rahimi-Movaghar

Vafa Rahimi-Movaghar

Mahfuzar Rahman

Mohammad Hifz Ur Rahman

Muhammad Aziz Rahman

Sajjad Ur Rahman

Rajesh Kumar Rai

Fatemeh Rajati

Prabhat Ranjan

Puja C Rao

Davide Rasella

David Laith Rawaf

Salman Rawaf

K Srinath Reddy

Robert C Reiner

Marissa Bettay Reitsma

Giuseppe Remuzzi

Andre M N Renzaho

Serge Resnikoff

Satar Rezaei

Mohammad Sadegh Rezai

Antonio Luiz P Ribeiro

Nicholas L S Roberts

Stephen R Robinson

Leonardo Roever

Luca Ronfani

Gholamreza Roshandel

Ali Rostami

Gregory A Roth

Dietrich Rothenbacher

Enrico Rubagotti

Perminder S Sachdev

Nafis Sadat

Ehsan Sadeghi

Sahar Saeedi Moghaddam

Hosein Safari

Yahya Safari

Roya Safari-Faramani

Mahdi Safdarian

Sare Safi

Saeid Safiri

Rajesh Sagar

Amirhossein Sahebkar

Mohammad Ali Sahraian

Haniye Sadat Sajadi

Nasir Salam

Joseph S Salama

Payman Salamati

Zikria Saleem

Yahya Salimi

Hamideh Salimzadeh

Joshua A Salomon

Sundeep Santosh Salvi

Inbal Salz

Abdallah M Samy

Juan Sanabria

Maria Dolores Sanchez-Niño

Damian Francesco Santomauro

Itamar S Santos

João Vasco Santos

Milena M Santric Milicevic

Bruno Piassi Sao Jose

Mayank Sardana

Abdur Razzaque Sarker

Rodrigo Sarmiento-Suárez

Nizal Sarrafzadegan

Benn Sartorius

Shahabeddin Sarvi

Brijesh Sathian

Maheswar Satpathy

Arundhati R Sawant

Monika Sawhney

Sonia Saxena

Elke Schaeffner

Maria Inês Schmidt

Ione J C Schneider

Aletta Elisabeth Schutte

David C Schwebel

Falk Schwendicke

James G Scott

Mario Sekerija

Sadaf G Sepanlou

Edson Serván-Mori

Seyedmojtaba Seyedmousavi

Hosein Shabaninejad

Azadeh Shafieesabet

Mehdi Shahbazi

Amira A Shaheen

Masood Ali Shaikh

Mehran Shams-Beyranvand

Mohammadbagher Shamsi

Heidar Sharafi

Kiomars Sharafi

Mehdi Sharif

Mahdi Sharif-Alhoseini

Jayendra Sharma

Rajesh Sharma

Jun She

Aziz Sheikh

Peilin Shi

Kenji Shibuya

Mekonnen Sisay Shiferaw

Mika Shigematsu

Rahman Shiri

Reza Shirkoohi

Ivy Shiue

Yalda Shokoohinia

Farhad Shokraneh

Haitham Shoman

Mark G Shrime

Si Si

Soraya Siabani

Abla Mehio Sibai

Tariq J Siddiqi

Inga Dora Sigfusdottir

Rannveig Sigurvinsdottir

Diego Augusto Santos Silva

João Pedro Silva

Dayane Gabriele Alves Silveira

Narayana Sarma Venkata Singam

Jasvinder A Singh

Narinder Pal Singh

Virendra Singh

Dhirendra Narain Sinha

Eirini Skiadaresi

Vegard Skirbekk

Karen Sliwa

David L Smith

Mari Smith

Adauto Martins Soares Filho

Badr Hasan Sobaih

Soheila Sobhani

Moslem Soofi

Reed J D Sorensen

Luciano A Sposato

Chandrashekhar T Sreeramareddy

Vinay Srinivasan

Jeffrey D Stanaway

Vladimir I Starodubov

Dan J Stein

Caitlyn Steiner

Timothy J Steiner

Mark A Stokes

Lars Jacob Stovner

Michelle L Subart

Agus Sudaryanto

Mu'awiyyah Babale Sufiyan

Gerhard Sulo

Bruno F Sunguya

Patrick John Sur

Bryan L Sykes

P N Sylaja

Dillon O Sylte

Cassandra E I Szoeke

Rafael Tabarés-Seisdedos

Takahiro Tabuchi

Santosh Kumar Tadakamadla

Nikhil Tandon

Segen Gebremeskel Tassew

Mohammad Tavakkoli

Nuno Taveira

Hugh R Taylor

Arash Tehrani-Banihashemi

Tigist Gashaw Tekalign

Shishay Wahdey Tekelemedhin

Merhawi Gebremedhin Tekle

Mohamad-Hani Temsah

Omar Temsah

Abdullah Sulieman Terkawi

Belay Tessema

Mebrahtu Teweldemedhin

Kavumpurathu Raman Thankappan

Andrew Theis

Sathish Thirunavukkarasu

Nihal Thomas

Binyam Tilahun

Quyen G To

Marcello Tonelli

Roman Topor-Madry

Anna E Torre

Miguel Tortajada-Girbés

Mathilde Touvier

Marcos Roberto Tovani-Palone

Jeffrey A Towbin

Bach Xuan Tran

Khanh Bao Tran

Christopher E Troeger

Afewerki Gebremeskel Tsadik

Derrick Tsoi

Lorainne Tudor Car

Stefanos Tyrovolas

Kingsley Nnanna Ukwaja

Irfan Ullah

Eduardo A Undurraga

Rachel L Updike

Muhammad Shariq Usman

Olalekan A Uthman

Muthiah Vaduganathan

Afsane Vaezi

Pascual R Valdez

Elena Varavikova

Santosh Varughese

Tommi Juhani Vasankari

Narayanaswamy Venketasubramanian

Santos Villafaina

Francesco S Violante

Sergey Konstantinovitch Vladimirov

Vasily Vlassov

Stein Emil Vollset

Theo Vos

Kia Vosoughi

Isidora S Vujcic

Fasil Shiferaw Wagnew

Yasir Waheed

Yafeng Wang

Yuan-Pang Wang

Elisabete Weiderpass

Robert G Weintraub

Daniel J Weiss

Fitsum Weldegebreal

Kidu Gidey Weldegwergs

Andrea Werdecker

T Eoin West

Ronny Westerman

Harvey A Whiteford

Justyna Widecka

Tissa Wijeratne

Hywel C Williams

Lauren B Wilner

Shadrach Wilson

Andrea Sylvia Winkler

Alison B Wiyeh

Charles Shey Wiysonge

Charles D A Wolfe

Anthony D Woolf

Grant M A Wyper

Denis Xavier

Gelin Xu

Simon Yadgir

Seyed Hossein Yahyazadeh Jabbari

Tomohide Yamada

Lijing L Yan

Yuichiro Yano

Mehdi Yaseri

Yasin Jemal Yasin

Alex Yeshaneh

Ebrahim M Yimer

Paul Yip

Engida Yisma

Naohiro Yonemoto

Seok-Jun Yoon

Marcel Yotebieng

Mustafa Z Younis

Mahmoud Yousefifard

Chuanhua Yu

Vesna Zadnik

Zoubida Zaidi

Sojib Bin Zaman

Mohammad Zamani

Hamed Zandian

Heather J Zar

Zerihun Menlkalew Zenebe

Maigeng Zhou

Ben Zipkin

Sanjay Zodpey

Inbar Zucker

Liesl Joanna Zuhlke

Christopher J L Murray



Contributors

Abstract

Background
How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.
Methods
We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.
Findings
Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2).
Interpretation
With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.

Citation

Kyu, H. H., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., …Murray, C. J. L. (2018). Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159), 1859-1922. https://doi.org/10.1016/S0140-6736%2818%2932335-3

Journal Article Type Article
Online Publication Date Nov 8, 2018
Publication Date Nov 10, 2018
Deposit Date May 15, 2019
Publicly Available Date Mar 28, 2024
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 392
Issue 10159
Pages 1859-1922
DOI https://doi.org/10.1016/S0140-6736%2818%2932335-3
Keywords General Medicine
Public URL https://hull-repository.worktribe.com/output/1756426
Publisher URL https://www.sciencedirect.com/science/article/pii/S0140673618323353?via%3Dihub
Additional Information © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

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Copyright Statement
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.





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