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

Theo Vos, Amanuel Alemu Abajobir, Cristiana Abbafati, Kaja M. Abbas, Kalkidan Hassen Abate, Foad Abd-Allah, Abdishakur M. Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J. Abu-Raddad, Ilana N. Ackerman, Abdu Abdullahi Adamu, Olatunji Adetokunboh, Mohsen Afarideh, Ashkan Afshin, Sanjay Kumar Agarwal, Rakesh Aggarwal, Anurag Agrawal, Sutapa AgrawalAliasghar Ahmad Kiadaliri, Hamid Ahmadieh, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Sneha Aiyar, Rufus Olusola Akinyemi, Nadia Akseer, Faris Hasan Al Lami, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Tahiya Alam, Deena Alasfoor, Kefyalew Addis Alene, Raghib Ali, Reza Alizadeh-Navaei, Ala'a Alkerwi, Francois Alla, Peter Allebeck, Christine Allen, Fatma Al-Maskari, Rajaa Al-Raddadi, Ubai Alsharif, Shirina Alsowaidi, Khalid A. Altirkawi, Azmeraw T. Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Hjalte H. Andersen, Carl Abelardo T. Antonio, Palwasha Anwari, Johan Arnlov, Al Artaman, Krishna Kumar Aryal, Hamid Asayesh, Solomon W. Asgedom, Reza Assadi, Tesfay Mehari Atey, Niguse Tadele Atnafu, Sachin R. Atre, Leticia Avila-Burgos, Euripide Frinel G. Arthur Avokpaho, Ashish Awasthi, Quintanilla Beatriz Paulina Ayala, Huda Omer Ba Saleem, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Amitava Banerjee, Marlena S. Bannick, Aleksandra Barac, Ryan M. Barber, Suzanne L. Barker-Collo Suzanne L., Till Baernighausen, Simon Barquera, Lars Barregard, Lope H. Barrero, Sanjay Basu, Bob Battista, Katherine E. Battle, Bernhard T. Baune, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Yannick Bejot, Bayu Begashaw Bekele, Michelle L. Bell, Derrick A. Bennett, Isabela M. Bensenor, Jennifer Benson, Adugnaw Berhane, Derbew Fikadu Berhe, Eduardo Bernabe, Balem Demtsu Betsu, Mircea Beuran, Addisu Shunu Beyene, Neeraj Bhala, Anil Bhansali, Samir Bhatt, Zulfiqar A. Bhutta, Sibhatu Biadgilign, Kelly Bienhoff, Boris Bikbov, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Dube Jara Boneya, Soufiane Boufous, Rupert R. A. Bourne, Alexandra Brazinova, Traolach S. Brugha, Rachelle Buchbinder, Lemma Negesa Bulto Bulto, Blair R. Bumgarner, Zahid A. Butt, Lucero Cahuana-Hurtado, Ewan Cameron, Mate Car, Helene Carabin, Jonathan R. Carapetis, Rosario Cardenas, David O. Carpenter, Juan Jesus Carrero, Austin Carter, Felix Carvalho, Daniel C. Casey, Valeria Caso, Carlos A. Castaneda-Orjuela, Chris D. Castle, Ferran Catala-Lopez, Hsing-Yi Chang, Jung-Chen Chang, Fiona J. Charlson, Honglei Chen, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal A. Chitheer, Devasahayam Jesudas Christopher, Liliana G. Ciobanu, Massimo Cirillo, Danny Colombara, Cyrus Cooper, Paolo Angelo Cortesi, Michael H. Criqui, John A. Crump, Abel Fekadu Dadi, Koustuv Dalal, Lalit Dandona, Rakhi Dandona, Jose Das Neves, Dragos V. Davitoiu, Barbora De Courten, Diego De Leo, Louisa Degenhardt, Selina Deiparine, Robert P. Dellavalle, Kebede Deribe, Don C. Des Jarlais, Subhojit Dey, Samath D. Dharmaratne, Preet Kaur Dhillon, Daniel Dicker, Eric L. Ding, Shirin Djalalinia, Phuc Do Huyen, E. Ray Dorsey, Kadine Priscila Bender Dos Santos, Dirk Douwes-Schultz, Kerrie E. (Aunty) Doyle, Tim R. Driscoll, Manisha Dubey, Bruce Bartholow Duncan, Ziad Ziad El-Khatib, Jerisha Ellerstrand, Ahmadali Enayati, Aman Yesuf Endries, Sergey Petrovich Ermakov, Holly E. Erskine, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Fanuel Belayneh Bekele Fanuel, Carla Sofia e Sa Farinha, Andre Faro, Farshad Farzadfar, Mir Sohail Fazeli, Valery L. Feigin, Seyed-Mohammad Fereshtehnejad, Joao C. Fernandes, Alize J. Ferrari, Tesfaye Regassa Feyissa, Irina Filip, Florian Fischer, Christina Fitzmaurice, Abraham D. Flaxman, Luisa Sorio Flor, Nataliya Foigt, Kyle J. Foreman, Richard C. Franklin, Nancy Fullman, Thomas Furst, Joao M. Furtado, Neal D. Futran, Emmanuela Gakidou, Morsaleh Ganji, Alberto L. Garcia-Basteiro, Teshome Gebre, Tsegaye Tewelde Gebrehiwot, Ayele Geleto, Bikila Lencha Gemechu, Hailay Abrha Gesesew, Peter W. Gething, Alireza Ghajar, Katherine B. Gibney, Paramjit Singh Gill, Richard F. Gillum, Ibrahim Abdelmageem Mohamed Ginawi, Ababi Zergay Giref, Melkamu Dedefo Gishu, Giorgia Giussani, William W. Godwin, Audra L. Gold, Ellen M. Goldberg, Philimon N. Gona, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Alessandra Carvalho Goulart, Max Griswold, Harish Chander Gugnani, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Nima Hafezi-Nejad, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Randah Ribhi Hamadeh, Samer Hamidi, Alexis J. Handal, Graeme J. Hankey, Yuantao Hao, Hilda L. Harb, Habtamu Abera Hareri, Haro Josep Maria, James Harvey, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Caitlin Hawley, Roderick J. Hay, Simon I. Hay, Nathaniel J. Henry, Heredia-Pi Ileana Beatriz, Pouria Heydarpour, Hans W. Hoek, Howard J. Hoffman, Nobuyuki Horita, H. Dean Hosgood, Sorin Hostiuc, Peter J. Hotez, Damian G. Hoy, Aung Soe Htet, Guoqing Hu, Hsiang Huang, Chantal Huynh, Kim Moesgaard Iburg, Ehimario Uche Igumbor, Chad Ikeda, Caleb Mackay Salpeter Irvine, Kathryn H. Jacobsen, Nader Jahanmehr, Mihajlo B. Jakovljevic, Simerjot K. Jassal, Mehdi Javanbakht, Sudha P. Jayaraman, Panniyammakal Jeemon, Paul N. Jensen, Vivekanand Jha, Guohong Jiang, Denny John, Catherine O. Johnson, Sarah Charlotte Johnson, Jost B. Jonas, Mikk Jurisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Ritul Kamal, Haidong Kan, Nadim E. Karam, Andre Karch, Corine Kakizi Karema, Amir Kasaeian, Getachew Mullu Kassa, Nigussie Assefa Kassaw, Nicholas J. Kassebaum, Anshul Kastor, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Peter Njenga Keiyoro, Andre Pascal Kengne, Andre Keren, Yousef Saleh Khader, Ibrahim A. Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Ardeshir Khosravi, Jagdish Khubchandani, Christian Kieling, Daniel Kim, Pauline Kim, Yun Jin Kim, Ruth W. Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna A. Kissimova-Skarbek, Mika Kivimaki, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A. Kopec, Soewarta Kosen, Parvaiz A. Koul, Ai Koyanagi, Michael Kravchenko, Sanjay Krishnaswami, Kristopher J. Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G. Anil Kumar, Pushpendra Kumar, Sanjiv Kumar, Hmwe H. Kyu, Dharmesh Kumar Lal, Ratilal Lalloo, Nkurunziza Lambert, Qing Lan, Anders Larsson, Pablo M. Lavados, Janet L. Leasher, Jong-Tae Lee, Paul H. Lee, James Leigh, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miriam Levi, Yichong Li, Yongmei Li, Kappe Darya Li, Xiaofeng Liang, Misgan Legesse Liben, Stephen S. Lim, Shai Linn, Angela Liu, Patrick Y. Liu, Shiwei Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Stephanie J. London, Katharine J. Looker, Alan D. Lopez, Stefan Lorkowski, Paulo A. Lotufo, Nicola Low, Rafael Lozano, Timothy C. D. Lucas, Erlyn Rachelle King Macarayan, Razek Hassan Magdy Abd El, Razek Mohammed Magdy Abd El, Mahdi Mahdavi, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Deborah Carvalho Malta, Abdullah A. Mamun, Helena Manguerra, Treh Manhertz, Ana Mantilla, Lorenzo G. Mantovani, Chabila C. Mapoma, Laurie B. Marczak, Jose Martinez-Raga, Francisco Rogerlandio Martins-Melo, Ira Martopullo, Winfried Maerz, Manu Raj Mathur, Mohsen Mazidi, Colm McAlinden, Madeline McGaughey, John J. McGrath, Martin Mckee, Claire McNellan, Suresh Mehata, Man Mohan Mehndiratta, Tefera Chane Mekonnen, Peter Memiah, Ziad A. Memish, Walter Mendoza, Mubarek Abera Mengistie, Desalegn Tadese Mengistu, George A. Mensah, Atte Meretoja, Tuomo J. Meretoja, Haftay Berhane Mezgebe, Renata Micha, Anoushka Millear, Ted R. Miller, Edward J. Mills, Mojde Mirarefin, Erkin M. Mirrakhimov, Awoke Misganaw, Shiva Raj Mishra, Philip B. Mitchell, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Kedir Endris Mohammed, Shafiu Mohammed, Sanjay K. Mohanty, Ali H. Mokdad, Sarah K. Mollenkopf, Lorenzo Monasta, Hernandez Julio Montanez, Marcella Montico, Maziar Moradi-Lakeh, Paula Moraga, Rintaro Mori, Chloe Morozoff, Shane D. Morrison, Mark Moses, Cliff Mountjoy-Venning, Kalayu Birhane Mruts, Ulrich O. Mueller, Kate Muller, Michele E. Murdoch, Gudlavalleti Venkata Satyanarayana Murthy, Kamarul Imran Musa, Jean B. Nachega, Gabriele Nagel, Mohsen Naghavi, Aliya Naheed, Kovin S. Naidoo, Luigi Naldi, Vinay Nangia, Gopalakrishnan Natarajan, Dumessa Edessa Negasa, Ionut Negoi, Ruxandra Irina Negoi, Charles R. Newton, Josephine Wanjiku Ngunjiri, Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Emma Nichols, Dina Nur Anggraini Ningrum, Sandra Nolte, Minh Nong Vuong, Bo Norrving, Jean Jacques N. Noubiap, Martin J. 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Research output: Contribution to journalArticlepeer-review

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Abstract

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 2982 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 modelling 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 anaemia, 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-standardised 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-standardised 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 ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10.4% (95% UI 9.0-11.8) higher in women than in men. Iron-deficiency anaemia, 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-standardised 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-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) 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-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, 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-todate information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Original languageEnglish
Pages (from-to)1211-1259
Number of pages49
JournalThe Lancet
Volume390
Issue number10100
DOIs
Publication statusPublished - 2017

Open Access - Access Right Statement

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

Keywords

  • diseases
  • health status indicators
  • people with disabilities
  • world health

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