Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

Abstract

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.

Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.

Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.

Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Keywords: burden of disease; descriptive epidemiology; epidemiology.

Figure 1

Age-standardised YLL and YLD rates for 17 cause-of-injury categories by level of Socio-demographic Index. YLL, years of life lost.

Figure 2

Co-evolution of all injury age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.

Figure 3

Co-evolution of road injury age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.

Figure 4

Co-evolution of interpersonal violence age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.

Figure 5

Co-evolution of self-harm age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.

Figure 6

Co-evolution of drowning age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.

Figure 7

Co-evolution of falls age-standardised DALY rates with SDI for the world and 21 GBD regions for 1990–2017 with comparison with the values expected on the basis of SDI alone. DALY, disability-adjusted life year; GBD, Global Burden of Disease; SDI, Socio-demographic Index.