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.
Bibliographical noteFunding Information:
I N Ackerman reports grants from Victorian Government, outside of the submitted work. C A T Antonio reports personal fees from Johnson & Johnson (Philippines), outside of the submitted work. E Beghi reports grants from Italian Ministry of Health and SOBI and personal fees from Arvelle Therapeutics, outside of the submitted work. Y Béjot reports personal fees from AstraZeneca, Bristol Myers Squibb, Pfizer, and Medtronic, Merck Sharpe & Dohme, and Amgen; grants and personal fees from Boehringer-Ingelheim; personal fees and non-financial support from Servier; and non-financial support from Biogen, outside of the submitted work. P S Briant reports personal fees from WHO, outside of the submitted work. H Christensen reports personal fees from Bristol Myers Squibb, Bayer, and Boehringer Ingelheim, outside of the submitted work. L Degenhardt reports grants from Indivior and Seqirus, outside of the submitted work. S J Dunachie reports grants from the Fleming Fund at the UK Department of Health and Social Care, during the conduct of the study. L M Haile reports personal fees from WHO, outside of the submitted work. S M S Islam reports grants from National Heart Foundation of Australia and Deakin University, during the conduct of the study. S L James reports grants from Sanofi Pasteur and employment from Genentech, outside of the submitted work. P Jeemon reports and Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust—Department of Biotechnology, India Alliance (2015–2020). V Jha reports grants from Baxter Healthcare, GlaxoSmithKline, Zydus Cadilla, NephroPlus, and Biocon, outside of the submitted work. J J Jozwiak reports personal fees from Amgen, ALAB Laboratoria, Teva, Synexus, and Boehringer Ingelheim, outside of the submitted work. S V Katikireddi reports grants from NRS Senior Clinical Fellowship, Scottish Government Chief Scientist Office, and the UK Medical Research Council, during the conduct of the study. S Lewington reports grants from the UK Medical Research Council and the CDC Foundation (with support from Amgen), outside of the submitted work. K J Looker reports grants from WHO and GlaxoSmithKline, outside of the submitted work. S Lorkowski reports personal fees from Akcea Therapeutics, Amedes, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo, Merck Sharp & Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield and non-financial support from Preventicus, outside of the submitted work. R A Lyons reports grants from Health Data Research UK, outside of the submitted work. J Massano reports personal fees from Abbvie, Bial, Merck Sharp & Dohme, and Zambon and other support from Boston Scientific, GE Healthcare, Medtronic, and Roche, outside of the submitted work. W Mendoza is a Program Analyst in Population and Development at the UN Population Fund Country Office in Peru, an institution that does not necessarily endorse this study. M Moradi-Lakeh reports personal fees from Novartis, outside of the submitted work. J F Mosser reports grants from the Bill & Melinda Gates Foundation, during the conduct of the study. S Nomura reports grants from the Japanese Ministry of Education, Culture, Sports, Science, and Technology. S B Patten reports funding from the Cuthbertson & Fischer Chair in Pediatric Mental Health, during the conduct of the study. T Pilgrim reports grants and personal fees from Biotronik and Boston Scientific, grants from Edwards Lifesciences, and personal fees from HighLife SAS for his work as a member of clinical event committee for a study sponsored by HighLife SAS, outside of the submitted work. M J Postma reports grants and personal fees from Merck Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, and Seqirus; personal fees from Quintiles, Novartis, and Pharmerit; grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, and Budi; and other support from Ingress Health, PAG, and Asc Academics, outside of the submitted work. E Pupillo reports grants from AIFA, outside of the submitted work. A E Schutte reports personal fees from Omron, Servier, Novartis, Takeda, and Abbott, outside of the submitted work. M G Shrime reports grants from Damon Runyon Cancer Research Foundation and Mercy Ships, outside of the submitted work. J A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, Practice Point Communications, National Institutes of Health, and the American College of Rheumatology; personal fees from Simply Speaking; other support from Amarin Pharmaceuticals and Viking Pharmaceuticals; and non-financial support from the steering committee of OMERACT (an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies), US Food and Drug Administration, Arthritis Advisory Committee, Veterans Affairs Rheumatology Field Advisory Committee, and the editor and director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside of the submitted work. S T S Skou reports personal fees from Journal of Orthopaedic & Sports Physical Therapy and Munksgaard and grants from The Lundbeck Foundation, outside of the submitted work; and being co-founder of GLA:D. GLA:D is a non-profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. J D Stanaway reports grants from Bill & Melinda Gates Foundation, during the conduct of the study. R Uddin reports travel and accommodation reimbursement from Deakin University Institute for Physical Activity and Nutrition, outside of the submitted work. All other authors declare no competing interests.
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