Articles
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
- Refers To
Transitioning health systems for multimorbidity
- The Lancet, Available online 7 June 2015,
- Referred to by
Transitioning health systems for multimorbidity
- The Lancet, Available online 7 June 2015,
Summary
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.
Funding
Bill & Melinda Gates Foundation.
Copyright © 2015 Elsevier Ltd. All rights reserved.
