Abstract
Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 743-800 |
| Number of pages | 58 |
| Journal | The Lancet |
| Volume | 386 |
| Issue number | 9995 |
| DOIs | |
| State | Published - Aug 22 2015 |
ASJC Scopus subject areas
- Medicine(all)
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In: The Lancet, Vol. 386, No. 9995, 22.08.2015, p. 743-800.
Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013
T2 - A systematic analysis for the Global Burden of Disease Study 2013
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AU - Salomon, Joshua A.
AU - Murray, Christopher J.L.
N1 - Funding Information: This study was funded by the Bill & Melinda Gates Foundation . VF and RK were partly supported by the unrestricted educational grant from Lundbeck and Auckland University of Technology University . RM received funding from Ministry of Health, Labour and Welfare of Japan . LD is supported by an Australian National health and Medical Research Council (NHMRC) Principal Research Fellowship (# 1041742 ). Work by NY was supported by funding from the Japan Society of Clinical Pharmacology and Therapeutics . YK would like to thank the National Heart Foundation, Australia , for extending a special grant to the University of Canberra that enabled him to participate in the GBD 2013 study and more broadly engage in research on cardiovascular conditions in Australia. TW would like to acknowledge the Wellcome Trust , through whom he is supported through a Senior Research Fellowship number 091758 . During the study, KJL received funding from Health Protection Scotland , the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions , and Sexual Health 24 . KJL received funding from WHO to conduct the review of HSV.2 seroprevalence data that informed this study. GR's contribution to this paper has been on behalf of the International Society of Nephrology (ISN) , as a follow-up of the activities of the GBD 2010 Genitourinary Diseases Expert Group. KTD would like to acknowledge the following funding source of institutional support: University of Illinois , Lemann Institute for Brazilian Studies Faculty Research Grant . KR is supported by the NIHR Oxford BRC and an NIHR Career Development Fellowship . FC-L would like to thank funding support by CIBERSAM , Instituto de Salud Carlos III , Spanish Ministry of Economy and Competitiveness, Madrid, Spain . LJAR would like to acknowledge the support of Qatar National Research Fund ( NPRP 04-924-3-251 ) who provided the main funding for generating the data provided to the GBD-IHME effort. MBS is a member of the board of directors of the Anxiety and Depression Association of America (a non-profit professional and consumer organization). He has in the past 24 months been a consultant for companies that either market or are conducting research involving antidepressant or antianxiety medications: Janssen, Pfizer, and Tonix Pharmaceuticals. JAC is supported by the joint US National Institutes of Health-National Science Foundation Ecology and Evolution of Infectious Disease program ( R01 TW009237 ) and the UK Biotechnology and Biological Sciences Research Council (BBSRC) ( BB/J010367/1 ), and by UK BBSRC Zoonoses in Emerging Livestock Systems awards BB/L017679 , BB/L018926 , and BB/L018845 . HW, AF, FC, and HE are affiliated with the Queensland Centre for Mental Health Research, which receives funding from the Queensland Department of Health . EB has received money for board membership by VIROPHARMA and EISAI ; funding for travel and speaker honoraria from UCB-Pharma and GlaxoSmithKline and funding for educational presentations from GlaxoSmithKline ; grants for research activities from the Italian Drug Agency , Italian Ministry of Health , Sanofi-Aventis , and the American ALS Association . ML would like to acknowledge the institutional support received from CeRIMP , Centro Regionale Infortuni e Malattie Professionali Regione Toscana (via S. Salvi, 12 - 50135 Firenze – Italy) . AB would like to acknowledge funding from the Wellcome Trust . CW was supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust and King's College London , funded by the NIHR . DS has received research grants or consultancy honoraria from Abbott , ABMRF , Astrazeneca , Biocodex , Eli-Lilly , GlaxoSmithKline , Jazz Pharmaceuticals , Johnson & Johnson , Lundbeck , National Responsible Gambling Foundation , Novartis , Orion , Pfizer , Pharmacia , Roche , Servier , Solvay , Sumitomo , Sun , Takeda , Tikvah , and Wyeth . DS would like to acknowledge support by the Medical Research Council of South Africa . DAQ was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number 5T32HD057822 . The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. PJ is supported by a career development fellowship from the Wellcome Trust , Public Health Foundation of India and a consortium of UK universities . CK receives research grants from Brazilian public funding agencies Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq) , Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) , and Fundacao de Amparo a Pesquisa do Estado do Rio Grande do Sul (FAPERGS) . He has also received authorship royalties from publishers Artmed and Manole. RAL is partly funded through the Farr Institute at CIPHER . The Farr Institute at CIPHER is supported by a ten-funder consortium: Arthritis Research UK , the British Heart Foundation , Cancer Research UK , the Economic and Social Research Council , the Engineering and Physical Sciences Research Council , the Medical Research Council , the National Institute of Health Research , the National Institute for Social Care and Health Research (Welsh Assembly Government) , the Chief Scientist Office (Scottish Government Health Directorates) , the Wellcome Trust , (MRC Grant No: MR/K006525/1 ). JAS has received research grants from Takeda and Savient and consultant fees from Savient , Takeda , Regeneron and Allergan . JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's Guidelines Subcommittee of the Quality of Care Committee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. SIH is funded by a Wellcome Trust Grant (# 095066 ). JM is funded as a Research Career Development Fellow from the Wellcome Trust (# 089963/Z/09/Z ). RL is supported by a National Health and Medical Research of Australia Fellowship . KK thanks the Director of International Institute for Population Sciences (IIPS) for giving KK the opportunity to do PhD at the IIPS, during which KK got the chance to become a GBD Study 2013 collaborator. HC is supported by the Intramural Research Program of the NIH , the National Institute of Environmental Health Sciences . The GBD Vision Loss Expert Group received additional funding from Brien Holden Vision Institute . NP has an honorary position with the University of Melbourne, through the Centre for Eye Research Australia (CERA), and is employed by the Fred Hollows Foundation (FHF). Access to information on population-based prevalence studies from the countries they support work in was primarily as a result of her work at FHF, and the review of the manuscript and revisions suggested were a part of her position at CERA. CERA receives Operational Infrastructure CERA receives Operational Infrastructure Support funding from the Victorian Articles 56 Government. I-HO and S-JY's work was funded by a grant of the Korean Health Technology research and development project , Ministry of Health and Welfare, North Korea (grant number HI13C0729 ). SS is supported by grants from the NIH and employed by NRF and has honoraria from pharmaceutical companies. KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876 ). LM would like to acknowledge the Commonwealth Government of Australia and the Institute of Bone and Joint Research as funders of this work as all the original data collection for musculoskeletal was funded by these sources. BDG works for Agence de Médecine Préventive which receives grant specific support from Crucell , GlaxoSmithKline , Merck , Novartis , and Sanofi Pasteur . None of these sources contributed to the current work. MGS previously served as a consultant for Ellicon. DCDJ was supported by NIH grant R01 DA 003574 . LJA-R would like to acknowledge the Qatar National Research Fund ( NPRP 04-924-3-251 ) who provided the main funding for generating the data he provided to the GBD-IHME effort. The GBD Genitourinary Diseases Expert Group's activities with the GBD 2013 have been made on behalf of the International Society of Nephrology. AK would like to acknowledge funding support from Oklahoma Center for the Advancement of Science and Technology . KR is supported by the NIHR Oxford BRC and an NIHR Career Development Fellowship . KD is supported by a Wellcome Trust Training Fellowship (grant number 099876 ). KS would like to acknowledge funding from the South African Medical Research Council . IR and WHO staff acknowledge that the authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. Funding Information: FP-R has consulted for Astra-Zeneca, Menarini, and Pfizer, honoraria for developing educational materials from Astra-Zeneca, and Menarini, been a speaker for Astra-Zeneca, Menarini, Sociedad Espanola de Reumatologia, and has received investigational grants from Fundacion Espanola de Reumatologia , Ministerio de Sanidad (Gobierno de Espana) , Asociacion de Reumatologos del Hospital de Cruces . JC reports grants from National Kidney Foundation , is a board member of the Kidney Disease Improving Global Outcomes, and has a patent on glomerular filtration rate estimation using a panel of biomarkers pending. The other authors declare no competing interests. Publisher Copyright: © 2015 Elsevier Ltd.
PY - 2015/8/22
Y1 - 2015/8/22
N2 - Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
AB - Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
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U2 - 10.1016/S0140-6736(15)60692-4
DO - 10.1016/S0140-6736(15)60692-4
M3 - Article
C2 - 26063472
AN - SCOPUS:84940447040
SN - 0140-6736
VL - 386
SP - 743
EP - 800
JO - The Lancet
JF - The Lancet
IS - 9995
ER -