TY - JOUR
T1 - Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
AU - GBD 2021 Diseases and Injuries Collaborators
AU - Ferrari, Alize J.
AU - Santomauro, Damian Francesco
AU - Aali, Amirali
AU - Abate, Yohannes Habtegiorgis
AU - Abbafati, Cristiana
AU - Abbastabar, Hedayat
AU - Abd ElHafeez, Samar
AU - Abdelmasseh, Michael
AU - Abd-Elsalam, Sherief
AU - Abdollahi, Arash
AU - Abdullahi, Auwal
AU - Abegaz, Kedir Hussein
AU - Zuñiga, Roberto Ariel Abeldaño
AU - Aboagye, Richard Gyan
AU - Abolhassani, Hassan
AU - Abreu, Lucas Guimarães
AU - Abualruz, Hasan
AU - Abu-Gharbieh, Eman
AU - Abu-Rmeileh, Niveen M.E.
AU - Ackerman, Ilana N.
AU - Addo, Isaac Yeboah
AU - Addolorato, Giovanni
AU - Adebiyi, Akindele Olupelumi
AU - Adepoju, Abiola Victor
AU - Adewuyi, Habeeb Omoponle
AU - Afyouni, Shadi
AU - Afzal, Saira
AU - Afzal, Sina
AU - Agodi, Antonella
AU - Ahmad, Aqeel
AU - Ahmad, Danish
AU - Ahmad, Firdos
AU - Ahmad, Shahzaib
AU - Ahmed, Ali
AU - Ahmed, Luai A.
AU - Ahmed, Muktar Beshir
AU - Ajami, Marjan
AU - Akinosoglou, Karolina
AU - Akkaif, Mohammed Ahmed
AU - Al Hasan, Syed Mahfuz
AU - Alalalmeh, Samer O.
AU - Al-Aly, Ziyad
AU - Albashtawy, Mohammed
AU - Aldridge, Robert W.
AU - Alemu, Meseret Desalegn
AU - Alemu, Yihun Mulugeta
AU - Alene, Kefyalew Addis
AU - Ali Saeed, Adel
AU - Al-Gheethi,
AU - Alharrasi, Maryam
AU - Alhassan, Robert Kaba
AU - Ali, Mohammed Usman
AU - Ali, Rafat
AU - Ali, Syed Shujait Shujait
AU - Alif, Sheikh Mohammad
AU - Aljunid, Syed Mohamed
AU - Al-Marwani, Sabah
AU - Almazan, Joseph Uy
AU - Alomari, Mahmoud A.
AU - Al-Omari, Basem
AU - Altaany, Zaid
AU - Alvis-Guzman, Nelson
AU - Alvis-Zakzuk, Nelson J.
AU - Alwafi, Hassan
AU - Al-Wardat, Mohammad Sami
AU - Al-Worafi, Yaser Mohammed
AU - Aly, Safwat
AU - Alzoubi, Karem H.
AU - Amare, Azmeraw T.
AU - Amegbor, Prince M.
AU - Ameyaw, Edward Kwabena
AU - Amin, Tarek Tawfik
AU - Amindarolzarbi, Alireza
AU - Amiri, Sohrab
AU - Amugsi, Dickson A.
AU - Ancuceanu, Robert
AU - Anderlini, Deanna
AU - Anderson, David B.
AU - Andrade, Pedro Prata
AU - Andrei, Catalina Liliana
AU - Ansari, Hossein
AU - Antony, Catherine M.
AU - Anwar, Saleha
AU - Anwar, Sumadi Lukman
AU - Anwer, Razique
AU - Anyanwu, Philip Emeka
AU - Arab, Juan Pablo
AU - Arabloo, Jalal
AU - Arafat, Mosab
AU - Araki, Daniel T.
AU - Aravkin, Aleksandr Y.
AU - Arkew, Mesay
AU - Armocida, Benedetta
AU - Arndt, Michael Benjamin
AU - Arooj, Mahwish
AU - Artamonov, Anton A.
AU - Aruleba, Raphael Taiwo
AU - Arumugam, Ashokan
AU - Ashbaugh, Charlie
AU - Ashemo, Mubarek Yesse
AU - Ashraf, Muhammad
AU - Asika, Marvellous O.
AU - Askari, Elaheh
AU - Astell-Burt, Thomas
AU - Athari, Seyyed Shamsadin
AU - Atorkey, Prince
AU - Atout, Maha Moh d.Wahbi
AU - Atreya, Alok
AU - Aujayeb, Avinash
AU - Ausloos, Marcel
AU - Avan, Abolfazl
AU - Awotidebe, Adedapo Wasiu
AU - Awuviry-Newton, Kofi
AU - Quintanilla, Beatriz Paulina Ayala
AU - Ayuso-Mateos, Jose L.
AU - Azadnajafabad, Sina
AU - Azevedo, Rui M.S.
AU - Babu, Abraham Samuel
AU - Badar, Muhammad
AU - Badiye, Ashish D.
AU - Baghdadi, Soroush
AU - Bagheri, Nasser
AU - Bah, Sulaiman
AU - Bai, Ruhai
AU - Baker, Jennifer L.
AU - Bakkannavar, Shankar M.
AU - Bako, Abdulaziz T.
AU - Balakrishnan, Senthilkumar
AU - Bam, Kiran
AU - Banik, Palash Chandra
AU - Barchitta, Martina
AU - Bardhan, Mainak
AU - Bardideh, Erfan
AU - Barker-Collo, Suzanne Lyn
AU - Barqawi, Hiba Jawdat
AU - Barrow, Amadou
AU - Barteit, Sandra
AU - Barua, Lingkan
AU - Aliabadi, Somaye Bashiri
AU - Basiru, Afisu
AU - Basu, Sanjay
AU - Basu, Saurav
AU - Bathini, Prapthi Persis
AU - Batra, Kavita
AU - Baune, Bernhard T.
AU - Bayileyegn, Nebiyou Simegnew
AU - Behnam, Babak
AU - Behnoush, Amir Hossein
AU - Beiranvand, Maryam
AU - Ramirez, Diana Fernanda Bejarano
AU - Bell, Michelle L.
AU - Bello, Olorunjuwon Omolaja
AU - Beloukas, Apostolos
AU - Bensenor, Isabela M.
AU - Berezvai, Zombor
AU - Bernabe, Eduardo
AU - Bernstein, Robert S.
AU - Bettencourt, Paulo J.G.
AU - Bhagavathula, Akshaya Srikanth
AU - Bhala, Neeraj
AU - Bhandari, Dinesh
AU - Bhargava, Ashish
AU - Bhaskar, Sonu
AU - Bhat, Vivek
AU - Bhatti, Gurjit Kaur
AU - Bhatti, Jasvinder Singh
AU - Bhatti, Manpreet S.
AU - Bhatti, Rajbir
AU - Bhutta, Zulfiqar A.
AU - Bikbov, Boris
AU - Bishai, Jessica Devin
AU - Bisignano, Catherine
AU - Bitra, Veera R.
AU - Bjørge, Tone
AU - Bodolica, Virginia
AU - Bodunrin, Aadam Olalekan
AU - Bogale, Eyob Ketema
AU - Hashemi, Milad Bonakdar
AU - Bonny, Aime
AU - Basara, Berrak Bora
AU - Borhany, Hamed
AU - Boxe, Christopher
AU - Brady, Oliver J.
AU - Bragazzi, Nicola Luigi
AU - Braithwaite, Dejana
AU - Brant, Luisa C.
AU - Brauer, Michael
AU - Breitner, Susanne
AU - Brenner, Hermann
AU - Brown, Julie
AU - Brugha, Traolach
AU - Bulamu, Norma B.
AU - Buonsenso, Danilo
AU - Burkart, Katrin
AU - Burns, Richard A.
AU - Busse, Reinhard
AU - Bustanji, Yasser
AU - Butt, Zahid A.
AU - Byun, Justin
AU - dos Santos, Florentino Luciano Caetano
AU - Calina, Daniela
AU - Cámera, Luis Alberto
AU - Campos-Nonato, Ismael R.
AU - Cao, Chao
AU - Capodici, Angelo
AU - Carr, Sinclair
AU - Carreras, Giulia
AU - Carugno, Andrea
AU - Carvalho, Márcia
AU - Castaldelli-Maia, Joao Mauricio
AU - Castañeda-Orjuela, Carlos A.
AU - Castelpietra, Giulio
AU - Catapano, Alberico L.
AU - Cattaruzza, Maria Sofia
AU - Caye, Arthur
AU - Cegolon, Luca
AU - Cembranel, Francieli
AU - Cenderadewi, Muthia
AU - Cerin, Ester
AU - Chakraborty, Promit Ananyo
AU - Chan, Jeffrey Shi Kai
AU - Chan, Raymond N.C.
AU - Chandika, Rama Mohan
AU - Chandrasekar, Eeshwar K.
AU - Charalampous, Periklis
AU - Chattu, Vijay Kumar
AU - Chatzimavridou-Grigoriadou, Victoria
AU - Chen, Angela W.
AU - Chen, An Tian
AU - Chen, Catherine S.
AU - Chen, Haowei
AU - Chen, Nathalie M.
AU - Cheng, Esther T.W.
AU - Chimed-Ochir, Odgerel
AU - Chimoriya, Ritesh
AU - Ching, Patrick R.
AU - Cho, William C.S.
AU - Choi, Sungchul
AU - Chong, Bryan
AU - Chong, Yuen Yu
AU - Choudhari, Sonali Gajanan
AU - Chowdhury, Rajiv
AU - Christensen, Steffan Wittrup Mc Phee
AU - Chu, Dinh Toi
AU - Chukwu, Isaac Sunday
AU - Kerr, Jessica A.
AU - Lee, Wei Chen
AU - Marx, Wolfgang
AU - Wang, Cong
AU - Hanson, Sarah Wulf
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/5/18
Y1 - 2024/5/18
N2 - Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.
AB - Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.
UR - http://www.scopus.com/inward/record.url?scp=85191888198&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(24)00757-8
DO - 10.1016/S0140-6736(24)00757-8
M3 - Article
C2 - 38642570
AN - SCOPUS:85191888198
SN - 0140-6736
VL - 403
SP - 2133
EP - 2161
JO - The Lancet
JF - The Lancet
IS - 10440
ER -