Disability Adjusted Life Years (DALYs)

According to World Health Organization’s report upon household air pollution and health (2018), it has been estimated that globally around 3 billion of population uses kerosene and solid fuels (i.e. cow dung, charcoal, wood, coal and crop waste) for cooking food in ineffectual stoves and in open fires. However, the majority of the population lives in rural areas and has low income. As the process of such type of cooking is inefficient which results in producing high level of toxic compounds and gases within the surroundings of household, these gases then directly penetrates into the lungs causing health diseases. Such gases and compound fall into household air pollution or indoor air pollution categories.
This report examined the impact of household air pollution upon the health of household members and the minimizing this impact through usage of efficient cookstoves (i.e. Jaan Pakistan Supreme Stove). The survey was conducted upon the respondents residing in some of the off-grid districts of Pakistan by asking questions regarding their own understandings of danger of household air pollution and feasibility of using efficient biomass fuel combustion technology and its impact upon their lives.

This introduction to MANDERSON, L., ed. Rethinking Wellbeing. Essays on Health, Disability and Disadvantage, Perth: API Network/Curtin University, 1-25, explores the different ways in which health and wellbeing intersect, and the challenges to understanding wellbeing

Summary
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 lifeyears
(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 Sociodemographic
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.

Background Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss
(premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and
resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location
using data from the Global Burden of Diseases, Injuries, and Risk Factors Study.
Methods We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured
as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum
of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and
Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations
and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely
came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs).
Findings In 2016, there were 45·9 million (95% UI 39·9–54·6) patients with all-active epilepsy (both idiopathic and
secondary epilepsy globally; age-standardised prevalence 621·5 per 100000 population; 540·1–737·0). Of these patients,
24·0 million (20·4–27·7) had active idiopathic epilepsy (prevalence 326·7 per 100000 population; 278·4–378·1).
Prevalence of active epilepsy increased with age, with peaks at 5–9 years (374·8 [280·1–490·0]) and at older than 80 years
of age (545·1 [444·2–652·0]). Age-standardised prevalence of active idiopathic epilepsy was 329·3 per 100000 population
(280·3–381·2) in men and 318·9 per 100000 population (271·1–369·4) in women, and was similar among SDI quintiles.
Global age-standardised mortality rates of idiopathic epilepsy were 1·74 per 100000 population (1·64–1·87;
1·40 per 100000 population [1·23–1·54] for women and 2·09 per 100000 population [1·96–2·25] for men).
Age-standardised DALYs were 182·6 per 100000 population (149·0–223·5; 163·6 per 100000 population [130·6–204·3]
for women and 201·2 per 100000 population [166·9–241·4] for men). The higher DALY rates in men were due to higher
YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6·0% (–4·0 to 16·7) change in
the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates
(24·5% [10·8 to 31·8]) and age-standardised DALY rates (19·4% [9·0 to 27·6]). A third of the difference in age-standardised
DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income
settings, and two-thirds were due to a higher YLL rate in low SDI countries.
Interpretation Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of
disability and mortality. Standardised collection of data on epilepsy in population representative surveys will
strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data
is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected
from improved access to existing treatments in low-income countries and from the development of new effective
drugs worldwide.

Background: The measurement of health benefits is a key issue in health economic evaluations. There is very scarce empirical literature exploring the differences of using quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as benefit metrics and their potential impact in decision-making. Methods: Two previously published models delivering outputs in QALYs, were adapted to estimate DALYs: a Markov model for human papilloma virus (HPV) vaccination, and a pneumococcal vaccination deterministic model (PNEUMO). Argentina, Chile, and the United Kingdom studies were used, where local EQ-5D social value weights were available to provide local QALY weights. A primary study with descriptive vignettes was done (n = 73) to obtain EQ-5D data for all health states included in both models. Several scenario analyses were carried-out to evaluate the relative importance of using different metrics (DALYS or QALYs) to estimate health benefits on these economic evaluations. Results: QALY gains were larger than DALYs avoided in all countries for HPV, leading to more favorable decisions using the former. With discounting and age-weighting – scenario with greatest differences in all countries – incremental DALYs avoided represented the 75%, 68%, and 43% of the QALYs gained in Argentina, Chile, and United Kingdom respectively. Differences using QALYs or DALYs were less consistent and sometimes in the opposite direction for PNEUMO. These differences, similar to other widely used assumptions, could directly influence decision-making using usual gross domestic products (GDPs) per capita per DALY or QALY thresholds. Conclusion: We did not find evidence that contradicts current practice of many researchers and decision-makers of using QALYs or DALYs interchangeably. Differences attributed to the choice of metric could influence final decisions, but similarly to other frequently used assumptions. Implications for policy makers • Quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs) are usually used interchangeably in economic evaluations of health technologies. • This paper shows that the magnitude of health benefit estimated through QALYs or DALYs could be significantly different and potentially alter the study conclusions. • The magnitude of the uncertainty associated to the choice of metric was not greater to other common sources of uncertainty in economic evaluations (ie, discounting, parameter or structural uncertainty). Implications for the public In this paper we show that the choice of the measure of health benefit (Quality-adjusted life years [QALYs] or disability-adjusted life years [DALYs]) can potentially alter the results and conclusions of an economic evaluation to determine the cost-effectiveness of a health technology. This finding, together with other sources of uncertainty should be taken into account when designing, performing or reporting this type of studies.

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.

Summary
Background Past research in population health trends has shown
that injuries form a substantial burden of population health loss.
Regular updates to injury burden assessments are critical. We report
Global Burden of Disease (GBD) 2017 Study estimates on morbidity
and mortality for all injuries.
Methods We reviewed results for injuries from the GBD 2017 study.
GBD 2017 measured injury-specific mortality and years of life lost
(YLLs) using the Cause of Death Ensemble model. To measure non-fatal
injuries, GBD 2017 modelled injury-specific incidence and converted
this to prevalence and years lived with disability (YLDs). YLLs and YLDs
were summed to calculate disability-adjusted life years (DALYs).
Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138)
injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554)
deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802)new cases of injury globally, which increased to 520 710 288 (493430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017.
Future research in injury burden should focus on prevention in high-urden populations, improving data collection and ensuring access to medical care.

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specifi c mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

In recent years, it has become commonplace among the Global Burden of Disease (GBD) study authors to regard the disability-adjusted life year (DALY) primarily as a descriptive health metric. During the first phase of the GBD (1990–1996), it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning (1990–1996) to the most recent releases (2010–2017). We identify numerous assumptions underlying the DALY and group ...

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.

Summary Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95...

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specifi c mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

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.

Certain methodological characteristics appear common to all priority-setting exercises in public health, namely (a) some form of quantification of disease burden; (b) feasibility and cost-effectiveness of the interventions; and (c) reliance on consensus among experts. The role of disease burden estimates in priority-setting needs elaboration. Evidently a disease burden estimate is only one component of a priority-setting exercise. Faced with disease burden estimates, people quickly recognize the main causes of illness and develop a motivation to reduce them. This motivation to apprehend the main causes of disease burden inevitably leads one to search for appropriate technologies and their cost-effectiveness. Considerations of technical and practical feasibility and the cost-effectiveness of interventions play a crucial role in the minds of policy-makers (along with social, political and ethical considerations) in determining which causes of the disease burden are targeted by the health care delivery system and which are the subjects of further research. Thus, the primary role of a disease burden estimate is to set the agenda by creating an environment of concern and by motivating policy-makers. In addition, disease burden estimates provide benchmarks for future evaluation of the effect of health care interventions. Specific disease burden estimates are useful for analysing the cost-effectiveness of interventions and health resource allocation modelling. Summary measures of population health are a generalization of the concept of disease burden measurement. Summary measures include measures of the health gap and measures of health expectancy. The health gap measures are nothing but measures of disease burden. Health expectancy measures, like the disability-adjusted life expectancy (DALE), can be derived from measures of disease burden, like the disability-adjusted life years and the local life table. The health expectancy measures are useful for summarizing average health attainment of a population and for communicating this to a general audience. The health gap measures, like the DALY, allow additive disaggregation and further analysis of the causes and factors that contribute to the overall disease burden, and also help to identify the potential for enhancement of healthy life expectancy.
Limitations of disease burden information for priority-setting should also be recognized. It is sometimes believed that understanding the composition of disease burden and identifying the main causes of illness are all that is required for priority-setting. People tend to uncritically assume that priorities are set by merely attacking the main causes of illness. This is partly true in so far as some form of "attack" on the main causes of illness is imperative. For this reason, the main causes of illness are important subjects for research. In the case of health services, disease burden information may help draw attention to the problem. However, feasibility and cost-effectiveness are additional considerations to set priorities for the organization and delivery of health care services. Health care priority-setting is distinct from research priority-setting. Health priority-setting includes both but may be used, in context, to mean priorities in service provision. Mooney and Creese (1993) discussed the role of disease burden estimates in priority-setting, while Prost and Jancloes (1993) discussed the role of epidemiology in public health priority-setting. It should be noted that disease burden estimates mostly consist of descriptive epidemiological information. Descriptive epidemiology provided traditional disease burden profiles consisting of cause specific mortality and disease prevalence. The family of summary measures of health status do incorporate some value judgements by way of disability severity or health state preference weights, etc. (Shiell 1997). However, these measures are more sensitive to descriptive epidemiological estimates (Murray and Lopez 1996). Discussions about the role of epidemiological estimates in priority-setting would therefore apply to summary measures of disease burden estimates as well.

In recent years, it has become commonplace among the Global Burden of Disease (GBD) study authors to regard the disability-adjusted life year (DALY) primarily as a descriptive health metric. During the first phase of the GBD (1990–1996), it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning (1990–1996) to the most recent releases (2010–2017). We identify numerous assumptions underlying the DALY and group ...

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.

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.

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.

Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017....

Introduction: Advances in human immunodeficiency virus (HIV)
treatment have led to greater survival rates and have brought about
a shift in the burden of disease from mortality to morbidity. The main
purpose of this study is to estimate the Disability Adjusted Life Years
(DALYs) of HIV infected patients associated with different modes of
transmission.
Methods: Non-parametric Kaplan-Meier estimate has been utilised to
develop survival function, and the mean residual life model has been
utilised to estimate the life expectancy of patients alive at the end of
the study. The impact of factors such as age, sex, hepatitis B and syphilis
on life expectancy has also been assessed by fitting a proportional
mean residual life model. DALYs have been calculated based on the
results of both models.
Results: Retrospective time to event data of HIV patients undergoing
Antiretroviral Therapy (ART) in Dr Ram Manohar Lohia Hospital, New
Delhi, India has been utilised to illustrate the modelling technique.
The study suggests that in total, 42300.15 DALYs were lost which
includes 39765.10 years of life lost due to premature death and 2535.05
years of life lived with disability. When the covariates were taken into
consideration, 47592.14 DALYs were found to have been lost with an
average of 17.64 DALYs lost per patient.
Conclusion: Our results suggest that the high-risk groups such as
homosexuals and parent to child transmission are a major cause of
concern, which are in accordance with the existing national policies.
Also, we would suggest that gender-based and age-based policies
should be incorporated to reduce the burden of disease.

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individual, loss of life itself (YLL) occurs when that individual's life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life.

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.

Summary Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95...

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.

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.

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.

Summary 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. Caus...

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

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.

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.

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.

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specifi c mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.