Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.

Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting.

Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]).

Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Non-fatal data availability in terms of site-years by GBD region and year for Level 1 causes of burden, 1990–2017 This figure represents non-fatal data from 1990 to 2017, showing the number of site-years for each location-year combination for each Level 1 cause of burden by GBD region.

Figure 2

Leading Level 3 causes of age-standardised YLD rates by location for both sexes combined, 2017 ATG=Antigua and Barbuda. COPD=chronic obstructive pulmonary disease. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines. YLD=years lived with disability.

Figure 3

Trends of age-standardised YLD rates per 100 000 for the top eight Level 3 causes of non-fatal burden in 2017 for each sex by SDI quintile, 1990–2017 Mean estimates are shown. SDI=Socio-demographic Index. YLDs=years lived with disability. *One legend is shown for females and males. Anxiety disorders are a top cause of non-fatal burden for females and other musculoskeletal disorders are a top cause of non-fatal burden for males.

Figure 4

Co-evolution of all-age and age-standardised YLD rates with SDI globally and for GBD regions for Level 1 causes for both sexes combined, 1990–2017 Coloured lines are global and region values for YLDs. Each point in a line represents 1 year, starting from 1990 and ending in 2017. In all regions, SDI has increased over time so progress in SDI is associated with points further to the right and later years for a given region, with a downwards gradient indicating a reduction in YLD rate. The black lines indicate the trajectories for each geography expected on the basis of SDI alone. SDI=Socio-demographic Index. YLDs=years lived with disability.

Figure 5

Sex differences in global prevalence and YLD rates per 100 000 for 22 Level 2 causes by age, 2017 The figure represents the difference in prevalence (A) and YLD rates (B) between males and females as well as the cause composition of those differences for each GBD age group for the Level 2 causes of non-fatal burden. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. YLDs=years lived with disability.

Figure 6

Absolute difference in non-fatal trend equality for males and females in terms of age-standardised YLD rates, 1990–2017 This figure shows whether females or males experienced more favourable trends between 1990 and 2017 in terms of age-standardised YLDs by GBD region and Level 2 cause. Circles indicate females experienced more favourable trends and triangles indicate males experienced more favourable trends, where more favourable refers to either decreasing more or increasing less. Green indicates that the overall trend is improving (ie, decreasing age-standardised YLDs) and red indicates that the overall trend is worsening (ie, increasing age-standardised YLDs). Yellow indicates cause-regions where one sex is increasing and the other sex is decreasing. For example, in Andean Latin America for substance use, the large yellow triangle means that males have experienced decreasing age-standardised YLDs whereas the trend for females is the opposite (ie, increasing age-standardised YLDs). Different sizes refer to greater deviations from equal trends between 1990 and 2017. For example, for chronic respiratory conditions, males have experienced more favourable trends in both Andean Latin America and the Caribbean, with both regions having decreasing trends over time for both sexes, but the Caribbean is closer to having equal trends for males and females between 1990 and 2017. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. STIs=sexually transmitted infections. NCDs=non-communicable diseases. NTDs=neglected tropical diseases. YLDs=years lived with disability. *Round brackets indicate excluded endpoints whereas square brackets indicate included endpoints.

Figure 7

Leading 20 Level 3 causes of global prevalence for 1990, 2007, and 2017, with percentage change in number of cases and all-age and age-standardised rates for each sex Causes are connected by lines between time periods; solid lines are increases and dashed lines are decreases. For the time periods 1990–2007 and 2007–17, three measures of change are shown: percentage change in the number of cases, percentage change in the all-age prevalence rate, and percentage change in the age-standardised prevalence rate. Communicable, maternal, neonatal, and nutritional diseases are shown in red; non-communicable causes in blue; and injuries in green. Statistically significant changes are shown in bold. COPD=chronic obstructive pulmonary disease. STIs=sexually transmitted infections.

Figure 8

Leading 20 Level 3 causes of global YLDs for 1990, 2007, and 2017, with percentage change in number of YLDs and all age and age-standardised rates for each sex Causes are connected by lines between time periods; solid lines are increases and dashed lines are decreases. For the time periods 1990–2007 and 2007–17, three measures of change are shown: percentage change in the number of YLDs, percentage change in the all-age YLD rate, and percentage change in the age-standardised YLD rate. Communicable, maternal, neonatal, and nutritional diseases are shown in red; non-communicable causes in blue; and injuries in green. Statistically significant changes are shown in bold. COPD=chronic obstructive pulmonary disease. YLDs=years lived with disability.