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
