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Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010


Murray, CJL and Vos, T and Lozano, R and Naghavi, M and Flaxman, AD and Michaud, C and Ezzati, M and Shibuya, K and Salomon, JA and Abdalla, S and Aboyans, V and Abraham, J and Ackerman, I and Aggarwal, R and Ahn, SY and Ali, MK and Alvarado, M and Anderson, HR and Anderson, LM and Andrews, KG and Atkinson, C and Baddour, LM and Bahalim, AN and Barker-Collo, S and Barrero, LH and Bartels, DH and Basanez, M and Baxter, A and Bell, ML and Benjamin, EJ and Bennett, D and Bernabe, E and Bhalla, K and Bhandari, B and Bikbov, B and Bin Abdulhak, A and Birbeck, G and Black, JA and Blencowe, H and Blore, JD and Blyth, F and Bolliger, I and Bonaventure, A and Boufous, S and Bourne, R and Boussinesq, M and Braithwaite, T and Brayne, C and Bridgett, L and Brooker, S and Brooks, P and Brugha, TS and Bryan-Hancock, C and Bucello, C and Buchbinder, R and Buckle, G and Budke, CM and Burch, M and Burney, P and Burstein, R and Calabria, B and Campbell, B and Canter, CE and Carabin, H and Carapetis, J and Carmona, L and Cella, C and Charlson, F and Chen, H and Cheng, AT-A and Chou, D and Chugh, SS and Coffeng, LE and Colan, SD and Colquhoun, S and Colson, KE and Condon, J and Connor, MD and Cooper, LT and Corriere, M and Cortinovis, M and De Vaccaro, KC and Couser, W and Cowie, BC and Criqui, MH and Cross, M and Dabhadkar, KC and Dahiya, M and Dahodwala, N and Damsere-Derry, J and Danaei, G and Davis, A and De Leo, D and Degenhardt, L and Dellavalle, R and Delossantos, A and Denenberg, J and Derrett, S and Des Jarlais, DC and Dharmaratne, SD and Dherani, M and Diaz-Torne, C and Dolk, H and Dorsey, ER and Driscoll, T and Duber, H and Ebel, B and Edmond, K and Elbaz, A and Ali, SE and Erskine, H and Erwin, PJ and Espindola, P and Ewoigbokhan, SE and Farzadfar, F and Feigin, V and Felson, DT and Ferrari, A and Ferri, CP and Fevre, EM and Finucane, MM and Flaxman, S and Flood, L and Foreman, K and Forouzanfar, MH and Fowkes, FGR and Fransen, M and Freeman, MK and Gabbe, BJ and Gabriel, SE and Gakidou, E and Ganatra, HA and Garcia, B and Gaspari, F and Gillum, RF and Gmel, G and Gonzalez-Medina, D and Gosselin, R and Grainger, R and Grant, B and Groeger, J and Guillemin, F and Gunnell, D and Gupta, R and Haagsma, J and Hagan, H and Halasa, YA and Hall, W and Haring, D and Maria Haro, J and Harrison, JE and Havmoeller, R and Hay, RJ and Higashi, H and Hill, C and Hoen, B and Hoffman, H and Hotez, PJ and Hoy, D and Huang, JJ and Ibeanusi, SE and Jacobsen, KH and James, SL and Jarvis, D and Jasrasaria, R and Jayaraman, S and Johns, N and Jonas, JB and Karthikeyan, G and Kassebaum, N and Kawakami, N and Keren, A and Khoo, J-P and King, CH and Knowlton, LM and Kobusingye, O and Koranteng, A and Krishnamurthi, R and Laden, F and Lalloo, R and Laslett, LL and Lathlean, T and Leasher, JL and Lee, YY and Leigh, J and Levinson, Daphna and Lim, SS and Limb, E and Lin, JK and Lipnick, M and Lipshultz, SE and Liu, W and Loane, M and Ohno, SL and Lyons, R and Mabweijano, J and MacIntyre, MF and Malekzadeh, R and Mallinger, L and Manivannan, S and Marcenes, W and March, L and Margolis, DJ and Marks, GB and Marks, R and Matsumori, A and Matzopoulos, R and Mayosi, BM and McAnulty, JH and McDermott, MM and McGill, N and McGrath, J and Elena Medina-Mora, M and Meltzer, M and Mensah, GA and Merriman, TR and Meyer, A-C and Miglioli, V and Miller, M and Miller, TR and Mitchell, PB and Mock, C and Mocumbi, AO and Moffitt, TE and Mokdad, AA and Monasta, L and Montico, M and Moradi-Lakeh, M and Moran, A and Morawska, L and Mori, R and Murdoch, ME and Mwaniki, MK and Naidoo, K and Nair, MN and Naldi, L and Narayan, KMV and Nelson, PK and Nelson, RG and Nevitt, MC and Newton, CR and Nolte, S and Norman, P and Norman, R and O'Donnell, M and O'Hanlon, S and Olives, C and Omer, SB and Ortblad, K and Osborne, R and Ozgediz, D and Page, A and Pahari, B and Pandian, JD and Panozo Rivero, A and Patten, SB and Pearce, N and Perez Padilla, R and Perez-Ruiz, F and Perico, N and Pesudovs, K and Phillips, D and Phillips, MR and Pierce, K and Pion, S and Polanczyk, GV and Polinder, S and Pope, CA and Popova, S and Porrini, E and Pourmalek, F and Prince, M and Pullan, RL and Ramaiah, KD and Ranganathan, D and Razavi, H and Regan, M and Rehm, JT and Rein, DB and Remuzzi, G and Richardson, K and Rivara, FP and Roberts, T and Robinson, C and Rodriguez De Leon, F and Ronfani, L and Room, R and Rosenfeld, LC and Rushton, L and Sacco, RL and Saha, S and Sampson, U and Sanchez-Riera, L and Sanman, E and Schwebel, DC and Scott, JG and Segui-Gomez, M and Shahraz, S and Shepard, DS and Shin, H and Shivakoti, R and Singh, D and Singh, GM and Singh, JA and Singleton, J and Sleet, DA and Sliwa, K and Smith, E and Smith, JL and Stapelberg, NJC and Steer, A and Steiner, T and Stolk, WA and Stovner, LJ and Sudfeld, C and Syed, S and Tamburlini, G and Tavakkoli, M and Taylor, HR and Taylor, JA and Taylor, WJ and Thomas, B and Thomson, WM and Thurston, GD and Tleyjeh, IM and Tonelli, M and Towbin, JRA and Truelsen, T and Tsilimbaris, MK and Ubeda, C and Undurraga, EA and van der Werf, MJ and van Os, J and Vavilala, MS and Venketasubramanian, N and Wang, M and Wang, W and Watt, K and Weatherall, DJ and Weinstock, MA and Weintraub, R and Weisskopf, MG and Weissman, MM and White, RA and Whiteford, H and Wiebe, N and Wiersma, ST and Wilkinson, JD and Williams, HC and Williams, SRM and Witt, E and Wolfe, F and Woolf, AD and Wulf, S and Yeh, P-H and Zaidi, AKM and Zheng, Z-J and Zonies, D and Lopez, AD, Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet, 380, (9859) pp. 2197-2223. ISSN 0140-6736 (2012) [Refereed Article]

Copyright Statement

Copyright 2012 Elsevier

DOI: doi:10.1016/S0140-6736(12)61689-4


Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.

Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.

Findings: Global DALYs remained stable from 1990 (2503 billion) to 2010 (2490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.

Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Rheumatology and arthritis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Laslett, LL (Dr Laura Laslett)
ID Code:81788
Year Published:2012
Web of Science® Times Cited:5612
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-01-08
Last Modified:2018-04-09

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