Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Cristiana Abbafati, Kaja M. Abbas, Mohsen Abbasi-Kangevari, Foad Abd-Allah, Ahmed Abdelalim, Mohammad Abdollahi, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Hassan Abolhassani, Victor Aboyans, Lucas Guimarães Abreu, Michael R.M. Abrigo, Ahmed Abualhasan, Laith Jamal Abu-Raddad, Abdelrahman I. Abushouk, Maryam Adabi, Victor Adekanmbi, Abiodun Moshood Adeoye, Olatunji O. Adetokunboh, Davoud AdhamShailesh M. Advani, Ashkan Afshin, Gina Agarwal, Seyed Mohammad Kazem Aghamir, Anurag Agrawal, Tauseef Ahmad, Keivan Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Temesgen Yihunie Akalu, Rufus Olusola Akinyemi, Tomi Akinyemiju, Blessing Akombi, Chisom Joyqueenet Akunna, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Samiah Alam, Tahiya Alam, Fahad Mashhour Alanezi, Turki M. Alanzi, Biresaw Wassihun Alemu, Khalid F. Alhabib, Muhammad Ali, Saqib Ali, Gianfranco Alicandro, Cyrus Alinia, Vahid Alipour, Hesam Alizade, Syed Mohamed Aljunid, François Alla, Peter Allebeck, Amir Almasi-Hashiani, Hesham M. Al-Mekhlafi, Jordi Alonso, Khalid A. Altirkawi, Mostafa Amini-Rarani, Fatemeh Amiri, Dickson A. Amugsi, Robert Ancuceanu, Deanna Anderlini, Jason A. Anderson, Catalina Liliana Andrei, Tudorel Andrei, Colin Angus, Mina Anjomshoa, Fereshteh Ansari, Alireza Ansari-Moghaddam, Ippazio Cosimo Antonazzo, Carl Abelardo T. Antonio, Catherine M. Antony, Ernoiz Antriyandarti, Davood Anvari, Razique Anwer, Seth Christopher Yaw Appiah, Jalal Arabloo, Morteza Arab-Zozani, Aleksandr Y. Aravkin, Filippo Ariani, Bahram Armoon, Johan Ärnlöv, Afsaneh Arzani, Mehran Asadi-Aliabadi, Ali A. Asadi-Pooya, Charlie Ashbaugh, Michael Assmus, Zahra Atafar, Desta Debalkie Atnafu, Maha Moh d.Wahbi Atout, Floriane Ausloos, Marcel Ausloos, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Samad Azari, Ghasem Azarian, Zelalem Nigussie Azene, Alaa Badawi, Ashish D. Badiye, Mohammad Amin Bahrami, Mohammad Hossein Bakhshaei, Ahad Bakhtiari, Shankar M. Bakkannavar, Alberto Baldasseroni, Kylie Ball, Shoshana H. Ballew, Daniela Balzi, Maciej Banach, Srikanta K. Banerjee, Agegnehu Bante Bante, Adhanom Gebreegziabher Baraki, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Lope H. Barrero, Celine M. Barthelemy, Lingkan Barua, Sanjay Basu, Bernhard T. Baune, Mohsen Bayati, Jacob S. Becker, Neeraj Bedi, Ettore Beghi, Yannick Béjot, Michelle L. Bell, Fiona B. Bennitt, Isabela M. Bensenor, Kidanemaryam Berhe, Adam E. Berman, Akshaya Srikanth Bhagavathula, Reshmi Bhageerathy, Neeraj Bhala, Dinesh Bhandari, Krittika Bhattacharyya, Zulfiqar A. Bhutta, Ali Bijani, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Antonio Biondi, Binyam Minuye Birihane, Catherine Bisignano, Raaj Kishore Biswas, Helen Bitew, Somayeh Bohlouli, Mehdi Bohluli, Alexandra S. Boon-Dooley, Guilherme Borges, Antonio Maria Borzì, Shiva Borzouei, Cristina Bosetti, Soufiane Boufous, Dejana Braithwaite, Michael Brauer, Nicholas J.K. Breitborde, Susanne Breitner, Hermann Brenner, Paul Svitil Briant, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Gabrielle B. Britton, Dana Bryazka, Blair R. Bumgarner, Katrin Burkart, Richard Thomas Burnett, Sharath Burugina Nagaraja, Zahid A. Butt, Florentino Luciano Caetano Dos Santos, Leah E. Cahill, Luis Alberto Cámera, Ismael R. Campos-Nonato, Rosario Cárdenas, Giulia Carreras, Juan J. Carrero, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A. Castañeda-Orjuela, Giulio Castelpietra, Franz Castro, Kate Causey, Christopher R. Cederroth, Kelly M. Cercy, Ester Cerin, Joht Singh Chandan, Kai Lan Chang, Fiona J. Charlson, Vijay Kumar Chattu, Sarika Chaturvedi, Nicolas Cherbuin, Odgerel Chimed-Ochir, Daniel Youngwhan Cho, Jee Young Jasmine Choi, Hanne Christensen, Dinh Toi Chu, Michael T. Chung, Sheng Chia Chung, Flavia M. Cicuttini, Liliana G. Ciobanu, Massimo Cirillo, Thomas Khaled Dwayne Classen, Aaron J. Cohen, Kelly Compton, Owen R. Cooper, Vera Marisa Costa, Ewerton Cousin, Richard G. Cowden, Di H. Cross, Jessica A. Cruz, Saad M.A. Dahlawi, Albertino Antonio Moura Damasceno, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, William James Dangel, Anna Karin Danielsson, Paul I. Dargan, Aso Mohammad Darwesh, Ahmad Daryani, Jai K. Das, Rajat Das Gupta, José das Neves, Claudio Alberto Dávila-Cervantes, Dragos Virgil Davitoiu, Diego De Leo, Louisa Degenhardt, Marissa DeLang, Robert Paul Dellavalle, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Desalegn Getnet Demsie, Edgar Denova-Gutiérrez, Nikolaos Dervenis, Govinda Prasad Dhungana, Mostafa Dianatinasab, Diana Dias da Silva, Daniel Diaz, Zahra Sadat Dibaji Forooshani, Shirin Djalalinia, Hoa Thi Do, Klara Dokova, Fariba Dorostkar, Leila Doshmangir, Tim Robert Driscoll, Bruce B. Duncan, Andre Rodrigues Duraes, Arielle Wilder Eagan, David Edvardsson, Nevine El Nahas, Iman El Sayed, Maha El Tantawi, Iffat Elbarazi, Islam Y. Elgendy, Shaimaa I. El-Jaafary, Iqbal R.F. Elyazar, Sophia Emmons-Bell, Holly E. Erskine, Sharareh Eskandarieh, Saman Esmaeilnejad, Alireza Esteghamati, Kara Estep, Arash Etemadi, Atkilt Esaiyas Etisso, Jessica Fanzo, Mohammad Farahmand, Mohammad Fareed, Roghiyeh Faridnia, Andrea Farioli, Andre Faro, Mithila Faruque, Farshad Farzadfar, Nazir Fattahi, Mehdi Fazlzadeh, Valery L. Feigin, Rachel Feldman, Seyed Mohammad Fereshtehnejad, Eduarda Fernandes, Giannina Ferrara, Alize J. Ferrari, Manuela L. Ferreira, Irina Filip, Florian Fischer, James L. Fisher, Luisa Sorio Flor, Nataliya A. Foigt, Morenike Oluwatoyin Folayan, Artem Alekseevich Fomenkov, Lisa M. Force, Masoud Foroutan, Richard Charles Franklin, Marisa Freitas, Weijia Fu, Takeshi Fukumoto, João M. Furtado, Mohamed M. Gad, Emmanuela Gakidou, Silvano Gallus, Alberto L. Garcia-Basteiro, William M. Gardner, Biniyam Sahiledengle Geberemariyam, Assefa Ayalew Ayalew Ayalew Gebreslassie, Abraham Geremew, Anna Gershberg Hayoon, Peter W. Gething, Maryam Ghadimi, Keyghobad Ghadiri, Fatemeh Ghaffarifar, Mansour Ghafourifard, Farhad Ghamari, Ahmad Ghashghaee, Hesam Ghiasvand, Nermin Ghith, Asadollah Gholamian, Rakesh Ghosh, Paramjit Singh Gill, Themba G. Ginindza, Giorgia Giussani, Elena V. Gnedovskaya, Salime Goharinezhad, Sameer Vali Gopalani, Giuseppe Gorini, Houman Goudarzi, Alessandra C. Goulart, Felix Greaves, Michal Grivna, Giuseppe Grosso, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Rafael Alves Guimarães, Rashid Abdi Guled, Gaorui Guo, Yuming Guo, Rajeev Gupta, Tarun Gupta, Beatrix Haddock, Nima Hafezi-Nejad, Abdul Hafiz, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Brian J. Hall, Iman Halvaei, Randah R. Hamadeh, Samer Hamidi, Melanie S. Hammer, Graeme J. Hankey, Hamidreza Haririan, Josep Maria Haro, Ahmed I. Hasaballah, Md Mehedi Hasan, Edris Hasanpoor, Abdiwahab Hashi, Soheil Hassanipour, Hadi Hassankhani, Rasmus J. Havmoeller, Simon I. Hay, Khezar Hayat, Golnaz Heidari, Reza Heidari-Soureshjani, Hannah J. Henrikson, Molly E. Herbert, Claudiu Herteliu, Fatemeh Heydarpour, Thomas R. Hird, Hans W. Hoek, Ramesh Holla, Praveen Hoogar, H. Dean Hosgood, Naznin Hossain, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Mohamed Hsairi, Vivian Chia Rong Hsieh, Guoqing Hu, Kejia Hu, Tanvir M. Huda, Ayesha Humayun, Chantal K. Huynh, Bing Fang Hwang, Vincent C. Iannucci, Segun Emmanuel Ibitoye, Nayu Ikeda, Kevin S. Ikuta, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Leeberk Raja Inbaraj, Helen Ippolito, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine, M. Mofizul Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Rebecca Q. Ivers, Chidozie C.D. Iwu, Chinwe Juliana Iwu, Ihoghosa Osamuyi Iyamu, Jalil Jaafari, Kathryn H. Jacobsen, Hussain Jafari, Morteza Jafarinia, Mohammad Ali Jahani, Mihajlo Jakovljevic, Farzad Jalilian, Spencer L. James, Hosna Janjani, Tahereh Javaheri, Javad Javidnia, Panniyammakal Jeemon, Ensiyeh Jenabi, Ravi Prakash Jha, Vivekanand Jha, John S. Ji, Lars Johansson, Oommen John, Yetunde O. John-Akinola, Catherine Owens Johnson, Jost B. Jonas, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Zubair Kabir, Hamed Kalani, Rizwan Kalani, Leila R. Kalankesh, Rohollah Kalhor, Tanuj Kanchan, Neeti Kapoor, Behzad Karami Matin, André Karch, Mohd Anisul Karim, Getachew Mullu Kassa, Srinivasa Vittal Katikireddi, Gbenga A. Kayode, Ali Kazemi Karyani, Peter Njenga Keiyoro, Cathleen Keller, Laura Kemmer, Parkes J. Kendrick, Nauman Khalid, Mohammad Khammarnia, Ejaz Ahmad Khan, Maseer Khan, Khaled Khatab, Mona M. Khater, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Salman Khazaei, Christian Kieling, Yun Jin Kim, Ruth W. Kimokoti, Adnan Kisa, Sezer Kisa, Mika Kivimäki, Luke D. Knibbs, Ann Kristin Skrindo Knudsen, Jonathan M. Kocarnik, Sonali Kochhar, Jacek A. Kopec, Vladimir Andreevich Korshunov, Parvaiz A. Koul, Ai Koyanagi, Moritz U.G. Kraemer, Kewal Krishan, Kris J. Krohn, Hans Kromhout, Barthelemy Kuate Defo, G. Anil Kumar, Vivek Kumar, Om P. Kurmi, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Faris Hasan Lami, Iván Landires, Justin J. Lang, Sinéad M. Langan, Anders O. Larsson, Savita Lasrado, Paolo Lauriola, Jeffrey V. Lazarus, Paul H. Lee, Shaun Wen Huey Lee, Kate E. Legrand, James Leigh, Matilde Leonardi, Haley Lescinsky, Janni Leung, Miriam Levi, Shanshan Li, Lee Ling Lim, Shai Linn, Shiwei Liu, Simin Liu, Yang Liu, Justin Lo, Alan D. Lopez, Jaifred Christian F. Lopez, Platon D. Lopukhov, Stefan Lorkowski, Paulo A. Lotufo, Alton Lu, Alessandra Lugo, Emilie R. Maddison, Phetole Walter Mahasha, Mokhtar Mahdavi Mahdavi, Morteza Mahmoudi, Azeem Majeed, Afshin Maleki, Shokofeh Maleki, Reza Malekzadeh, Deborah Carvalho Malta, Abdullah A. Mamun, Ana Laura Manda, Helena Manguerra, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Ana M. Mantilla Herrera, Joemer C. Maravilla, Ashley Marks, Randall V. Martin, Santi Martini, Francisco Rogerlândio Martins-Melo, Anthony Masaka, Seyedeh Zahra Masoumi, Manu Raj Mathur, Kunihiro Matsushita, Pallab K. Maulik, Colm McAlinden, John J. McGrath, Martin McKee, Man Mohan Mehndiratta, Fereshteh Mehri, Kala M. Mehta, Ziad A. Memish, Walter Mendoza, Ritesh G. Menezes, Endalkachew Worku Mengesha, Alibek Mereke, Seid Tiku Mereta, Atte Meretoja, Tuomo J. Meretoja, Tomislav Mestrovic, Bartosz Miazgowski, Tomasz Miazgowski, Irmina Maria Michalek, Ted R. Miller, Edward J. Mills, G. K. Mini, Mohammad Miri, Andreea Mirica, Erkin M. Mirrakhimov, Hamed Mirzaei, Maryam Mirzaei, Roya Mirzaei, Mehdi Mirzaei-Alavijeh, Awoke Temesgen Misganaw, Prasanna Mithra, Babak Moazen, Dara K. Mohammad, Yousef Mohammad, Naser Mohammad Gholi Mezerji, Abdollah Mohammadian-Hafshejani, Noushin Mohammadifard, Reza Mohammadpourhodki, Ammas Siraj Mohammed, Hussen Mohammed, Jemal Abdu Mohammed, Shafiu Mohammed, Ali H. Mokdad, Mariam Molokhia, Lorenzo Monasta, Meghan D. Mooney, Ghobad Moradi, Masoud Moradi, Maziar Moradi-Lakeh, Rahmatollah Moradzadeh, Paula Moraga, Lidia Morawska, Joana Morgado-Da-Costa, Shane Douglas Morrison, Abbas Mosapour, Jonathan F. Mosser, Simin Mouodi, Seyyed Meysam Mousavi, Amin Mousavi Khaneghah, Ulrich Otto Mueller, Satinath Mukhopadhyay, Erin C. Mullany, Kamarul Imran Musa, Saravanan Muthupandian, Ashraf F. Nabhan, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Gabriele Nagel, Mohsen Naghavi, Behshad Naghshtabrizi, Mukhammad David Naimzada, Farid Najafi, Vinay Nangia, Jobert Richie Nansseu, Morteza Naserbakht, Vinod C. Nayak, Ionut Negoi, Josephine W. Ngunjiri, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Ming Nguyen, Yeshambel T. 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Valdez, Aaron van Donkelaar, Tommi Juhani Vasankari, Yasser Vasseghian, Yousef Veisani, Narayanaswamy Venketasubramanian, Francesco S. Violante, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Rade Vukovic, Yasir Waheed, Mitchell Taylor Wallin, Yafeng Wang, Yuan Pang Wang, Alexandrea Watson, Jingkai Wei, Melissa Y.Wei Wei, Robert G. Weintraub, Jordan Weiss, Andrea Werdecker, J. Jason West, Ronny Westerman, Joanna L. Whisnant, Harvey A. Whiteford, Kirsten E. Wiens, Charles D.A. Wolfe, Sarah S. Wozniak, Ai Min Wu, Junjie Wu, Sarah Wulf Hanson, Gelin Xu, Rixing Xu, Simon Yadgir, Seyed Hossein Yahyazadeh Jabbari, Kazumasa Yamagishi, Mousa Yaminfirooz, Yuichiro Yano, Sanni Yaya, Vahid Yazdi-Feyzabadi, Tomas Y. Yeheyis, Christopher Sabo Yilgwan, Mekdes Tigistu Yilma, Paul Yip, Naohiro Yonemoto, Mustafa Z. Younis, Theodore Patrick Younker, Bahman Yousefi, Zabihollah Yousefi, Taraneh Yousefinezhadi, Abdilahi Yousuf Yousuf, Chuanhua Yu, Hasan Yusefzadeh, Telma Zahirian Moghadam, Mohammad Zamani, Maryam Zamanian, Hamed Zandian, Mikhail Sergeevich Zastrozhin, Yunquan Zhang, Zhi Jiang Zhang, Jeff T. Zhao, Xiu Ju George Zhao, Yingxi Zhao, Peng Zheng, Maigeng Zhou, Kairat Davletov, Arash Ziapour, Stefania Mondello, Stephen S. Lim, Christopher J.L. Murray, Taweewat Wiangkham, Saeed Amini

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Abstract

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.

Original languageEnglish
Pages (from-to)1204-1222
Number of pages19
JournalThe Lancet
Volume396
Issue number10258
DOIs
Publication statusPublished - 2020 Oct 17

ASJC Scopus subject areas

  • Medicine(all)

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