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      Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

      research-article
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          Summary

          Background

          Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs).

          Methods

          Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis.

          Findings

          Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coeffi cient –0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa.

          Interpretation

          Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantifi cation of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.

          Funding

          Bill & Melinda Gates Foundation.

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          Contributors
          Journal
          2985213R
          5470
          Lancet
          Lancet
          Lancet (London, England)
          0140-6736
          1474-547X
          16 January 2019
          15 December 2012
          29 January 2019
          : 380
          : 9859
          : 2163-2196
          Affiliations
          School of Population Health
          Institute for Health Metrics and Evaluation
          Institute for Health Metrics and Evaluation
          Institute for Health Metrics and Evaluation
          China Medical Board, Boston, MA, USA
          MRC-HPA Centre for Environment and Healthe, Department of Epidemiology and Biostatistics, School of Public Health
          Department of Global Health Policy
          School of Public Health
          Sudanese Public Health Consultancy Group, Sudan
          Department of Cardiology, Dupuytren University Hospital, Limoges, France
          University of Texas, San Antonio, TX, USA
          University of Melbourne, Melbourne, VIC,Australia
          Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,India
          Institute for Health Metrics and Evaluation
          Emory University, Atlanta, GA,USA
          Ministry of Health, Riyadh, Saudi Arabia
          Institute for Health Metrics and Evaluation
          St George’s University of London, London, UK
          Department of Epidemiology, School of Public Health
          Institute for Health Metrics and Evaluation
          Institute for Health Metrics and Evaluation
          Mayo Clinic, Rochester, MN,USA
          Independent Consultant, Geneva, Switzerland
          University of Auckland, Auckland, New Zealand
          Department of Industrial Engineering, School of Engineering, Pontifi cia Universidad Javeriana, Bogota,Colombia
          Harvard Medical School, Harvard University, Boston, MA, USA
          Imperial College London, London, UK
          Queensland Centre for Mental Health Research
          Yale University, New Haven, CT, USA
          Boston University, Boston, MA, USA
          Clinical Trial Service Unit and Epidemiological Studies Unit
          Dental Institute
          Harvard Medical School, Harvard University, Boston, MA, USA
          Queen Mary University of London, London, UK
          Moscow State University of Medicine and Dentistry, Research Institute of Transplantology and Artifi cial Organs, Moscow, Russia
          King Fahad Medical City, Riyadh, Saudi Arabia
          Michigan State University, East Lansing, MI, USA
          MRC Epidemiology Unit, Cambridge,UK
          London School of Hygiene and Tropical Medicine, London, UK
          School of Population Health
          University of Sydney, Sydney, NSW, Australia
          Institute for Health Metrics and Evaluation
          Inserm, Paris,France
          Transport and Road Safety Research
          Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
          Institut de Recherche pour le Développement, Martinique, France
          Moorfi elds Eye Hospital, London, UK
          University of Cambridge, Cambridge, UK
          University of Sydney, Sydney, NSW, Australia
          London School of Hygiene and Tropical Medicine, London, UK
          University of Melbourne, Melbourne, VIC,Australia
          University of Leicester, Leicester, UK
          Flinders University, Adelaide,SA, Australia
          University of New South Wales, Sydney, NSW, Australia
          Institute, Malvern, VIC, Australia
          Bloomberg School of Public Health
          Texas A&M University, College Station, TX, USA
          Great Ormond Street Hospital, London, UK
          Imperial College London, London, UK
          Institute for Health Metrics and Evaluation
          National Drug and Alcohol Research Centre
          Institute for Health Metrics and Evaluation
          Washington University, St Louis, MO, USA
          University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
          Telethon Institute for Child Health Research, Centre for Child, Health Research
          Universidad Camilo Jose Cela, Villanueva de la Cañada, Spain
          Mario Negri, Institute for Pharmacological, Research, Bergamo, Italy
          School of Population Health
          National Institute of Environmental Health Sciences, Research, Triangle Park, NC, USA
          Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
          Institute for Health Metrics and Evaluation
          Cedars-Sinai Medical Center, Los Angeles, CA, USA
          Erasmus MC, University Medical Center, Rotterdam, Rotterdam, Netherlands
          Boston Children’s Hospital
          Menzies School of Health Research, Darwin, NT, Australia
          Institute for Health Metrics and Evaluation
          Menzies School of Health, Research, Darwin, NT, Australia
          National Health Services, Fife, Edinburgh, Scotland, UK
          Loyola University Medical School, Chicago, IL, USA
          School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA
          Mario Negri Institute for Pharmacological, Research, Bergamo, Italy
          Hospital Dr Gustavo N Collado, Puerto Chitre, Panama
          University of Washington, Seattle, WA, USA
          Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
          University of California, San Diego, San Diego, CA, USA
          University of Sydney, Sydney, NSW, Australia
          Emory University, Atlanta, GA,USA
          Institute of Dentistry
          University of Pennsylvania, Philadelphia, PA, USA
          Building and Road Research Institute, Kumasi, Ghana
          School of Public Health
          MRC Hearing and Communication Group, Manchester, UK
          Griffi th University, Brisbane, QLD, Australia
          National Drug and Alcohol Research Centre
          Centre for Health Policy, Programs and Economics
          Denver VA Medical Center, Denver, CO, USA
          Institute for Health Metrics and Evaluation
          University of California, San Diego, San Diego, CA, USA
          University of Otago, Dunedin, New Zealand
          Beth Israel Medical Center, New York, City, NY, USA
          Institute for Health Metrics and Evaluation
          The University of Liverpool, Liverpool, UK
          Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
          University of Ulster, Ulster, UK
          Johns Hopkins University, Baltimore, MD, USA
          Sydney School of Public Health
          University of Washington, Seattle, WA, USA
          University of Washington, Seattle, WA, USA
          London School of Hygiene and Tropical Medicine, London, UK
          Inserm, Paris,France
          Federal Ministry of Health, Khartoum, Sudan
          Queensland Centre for Mental Health Research
          Mayo Clinic, Rochester, MN,USA
          Hospital Maciel, Montevideo, Uruguay
          Emerald Public Health Consulting Services Ltd, Abuja, Nigeria
          Tehran University of Medical Sciences, Tehran, Iran
          National Institute for Stroke and Applied Neurosciences
          School of Medicine
          Queensland Centre for Mental Health Research
          Federal University of São Paulo, São Paulo, Brazil
          University of Edinburgh, Edinburgh, Scotland, UK
          Department of Biostatistics
          Carnegie Mellon University, Pittsburgh, PA, USA
          Flinders University, Adelaide,SA, Australia
          Imperial College London, London, UK
          Institute for Health Metrics and Evaluation
          University of Edinburgh, Edinburgh, Scotland, UK
          Royal Life Saving Society, Sydney, NSW, Australia
          Faculty of Health Sciences
          Institute for Health Metrics and Evaluation
          Department of Epidemiology and Preventive Medicine
          Mayo Clinic, Rochester, MN,USA
          Institute for Health Metrics and Evaluation
          Emory University, Atlanta, GA,USA
          University of Queensland, Brisbane, QLD, Australia
          Mario Negri Institute for Pharmacological, Research, Bergamo, Italy
          Howard University College of Medicine, Washington, DC, USA
          Addiction Info Switzerland, Lausanne, Switzerland
          University of California, San Francisco, San Francisco, CA, USA
          University of Otago, Dunedin, New Zealand
          College of Medicine, SUNY Downstate Medicle Center, Brooklyn, NY, USA
          Université de Lorraine, Nancy, France
          University of Bristol, Bristol, UK
          St George’s University of London, London, UK
          Erasmus MC, University Medical Center, Rotterdam, Rotterdam, Netherlands
          New York University, New York City, NY
          Brandeis University, Waltham, MA, USA
          University of Queensland, Brisbane, QLD, Australia
          Institute for Health Metrics and Evaluation
          Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant, Boi de Llobregat, Spain
          Flinders University, Adelaide,SA, Australia
          Heart Institute
          Karolinska University Hospital, Stockholm, Sweden
          Hospital NHS Trust
          School of Population Health
          The Queen Elizabeth Hospital, Adelaide, SA, Australia
          Université de Franche-Comté, Besançon, France
          National Institute on Deafness and Other Communication Disorders
          National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
          Monash University, Melbourne, VIC, Australia
          Yale University, New Haven, CT, USA
          University of Port Harcourt, Port Harcourt, Nigeria
          George Mason University, Fairfax, VA, USA
          Institute for Health Metrics and Evaluation
          Imperial College London, London, UK
          Institute for Health Metrics and Evaluation
          Brigham and Women’s Hospital
          Institute for Health Metrics and Evaluation
          Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
          All India Institute of Medical Sciences, New Delhi, India
          Department of Anesthesiology and Pain Medicine
          University of Tokyo, Tokyo,Japan
          Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
          Queensland Centre for Mental Health Research
          Case Western Reserve University, Cleveland, OH, USA
          Harvard Humanitarian Initiative
          School of Public Health, Makerere University, Kampala, Uganda
          Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
          Auckland Technical University, Auckland, New Zealand
          School of Dentistry and Oral Health
          University of Tasmania, Tasmania, Australia
          FlindersUniversity, Adelaide,SA, Australia
          Nova Southeastern University, Fort, Lauderdale, FL, USA
          School of Population Health
          Sydney School of Public Health
          Institute for Health Metrics and Evaluation
          St George’s University of London, London, UK
          School of Public Health
          University of California, San Francisco, San Francisco, CA, USA
          Miller School of Medicine, University of Miami, Miami, FL, USA
          Department of Epidemiology
          University of Ulster, Ulster, UK
          Institute for Health Metrics and Evaluation
          Swansea University, Swansea, UK
          National Center for Non-Communicable, Disease Control and Prevention, China Centers for Disease Control, Beijing, China
          Mulago Hospital, Kampala, Uganda
          Institute for Health Metrics and Evaluation
          Digestive Disease Research Center
          Institute for Health Metrics and Evaluation
          Bloomberg School of Public Health
          Queen Mary University of London, London, UK
          Institute of Bone and Joint Research
          University of Pennsylvania, Philadelphia, PA, USA
          University of Sydney, Sydney, NSW, Australia
          University of Melbourne, Melbourne, VIC,Australia
          Asian Pacific Society of Cardiology, Kyoto, Japan
          Medical Research Council, Tygerberg, South Africa
          University of Cape Town, Cape Town, South Africa
          Legacy Health System, Portland, Oregon
          Northwestern University Feinberg School of Medicine, Evanston, IL, USA
          University of Sydney, Sydney, NSW, Australia
          Queensland Brain Institute
          National Institute on Psychiatry Ramón de la Fuente, Mexico City, Mexico
          Thomas Jefferson University, Philadelphia, PA, USA
          Ministry of Health, Riyadh, Saudi Arabia
          Department of Medicine
          University of Otago, Dunedin, New Zealand
          University of California, San Francisco, San Francisco, CA, USA
          Mario Negri Institute for Pharmacological Research, Bergamo, Italy
          School of Public Health
          Pacific Institute for Research and Evaluation, Calverton, MD, USA
          University of New South Wales, Sydney, NSW, Australia
          National Institute of Health, Maputo, Mozambique
          Duke University, Durham, NC, USA
          Institute for Health Metrics and Evaluation
          Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
          Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
          Tehran University of Medical Sciences, Tehran, Iran
          Columbia University, New York City, NY, USA
          Queensland University of Technology, Brisbane, QLD, Australia
          National Center for Child Health and Development, Tokyo, Japan
          Watford General Hospital, Watford, UK
          Kemri-Wellcome Trust, Kilifi, Kenya
          AVRI, University of KwaZulu-Natal, Durban, South Africa
          Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA
          Centro Studi GISED, Bergamo, Italy
          Emory University, Atlanta, GA,USA
          National Drug and Alcohol Research Centre
          National Institute of Diabetes, and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
          Department of Epidemiology and Biostatistics
          University of Oxford, Oxford, UK
          Charité-Universitätsmedizin Berlin, Berlin, Germany
          University of Western Australia, Perth, WA, Australia
          School of Population Health
          HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK
          Imperial College London, London, UK
          University of Washington, Seattle, WA, USA
          Schools of Public Health and Medicine
          Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA
          Deakin University, Melbourne, VIC, Australia
          Global Partners in Anesthesia and Surgery
          School of Population Health
          B P Koirala Institute of Health Sciences, Dharan, Nepal
          Betty Cowan Research and Innovation Center, Ludhiana, India
          Hospital Juan XXIII, La Paz, Bolivia
          University of Calgary, Calgary, AB, Canada
          London School of Hygiene and Tropical Medicine, London, UK
          Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
          Hospital Universitario Cruces, Barakaldo, Spain
          Mario Negri Institute for Pharmacological Research, Bergamo, Italy
          Flinders University, Adelaide, SA, Australia
          Institute for Health Metrics and Evaluation
          Shanghai Mental Health Center, School of Medicine
          Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA
          Institut de Recherche pour le Développement, Martinique, France
          Medical School,Chicago, IL, USA
          Department of Public Health
          Brigham Young University, Provo, UT, USA
          Centre for Addiction and Mental Health, Toronto, ON, Canada
          Hospital Universitario de Canarias, Tenerif, Spain
          Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
          Psychiatry, King’s College London, London, UK
          London School of Hygiene and Tropical Medicine, London, UK
          Vector Control Research Centre, Pondicherry, India
          Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA
          Center for Disease Analysis, Louisville, CO, USA
          University of California, Berkeley, Berkeley, CA, USA
          Centre for Addiction and Mental Health, Toronto, ON, Canada
          NORC, University of Chicago, Chicago, IL, USA
          Mario Negri Institute for Pharmacological Research, Bergamo, Italy
          University of Cambridge, Cambridge, UK
          University of Washington, Seattle, WA, USA
          Institute for Health Metrics and Evaluation
          University of California, San Francisco, San Francisco, CA, USA
          Complejo Hospitalario Caja De Seguro Social, Panama City, Panama
          Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
          School of Population Health
          Institute for Health Metrics and Evaluation
          Imperial College London, London, UK
          Miller School of Medicine, University of Miami, Miami, FL, USA
          Queensland Centre for Mental Health Research
          Vanderbilt University, Nashville, TN, USA
          Institute of Bone and Joint Research
          Institute for Health Metrics and Evaluation
          University of Alabama at Birmingham, Birmingham, AL, USA
          Centre for Clinical Research
          Ministry of Interior, Madrid, Spain
          Brandeis University, Waltham, MA, USA
          Brandeis University, Waltham, MA, USA
          Health Canada, Ottawa, ON, Canada
          Johns Hopkins University, Baltimore, MD, USA
          Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
          Queens Medical Center, Honolulu, HI, USA
          School of Public Health
          University of Alabama at Birmingham, Birmingham, AL, USA
          National Drug and Alcohol Research Centre
          National Center for Injury Prevention and Control
          Hatter Institute
          Department of Rheumatology, Northern Clinical School
          London School of Hygiene and Tropical Medicine, London, UK
          Griffith University, Brisbane, QLD, Australia
          Centre for International Child Health
          Norwegian University of Science and Technology, Trondheim, Norway
          Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
          Department of Neuroscience
          School of Public Health
          Agwa Khan University, Karachi, Pakistan
          Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
          School of Public Health
          University of Melbourne, Melbourne, VIC,Australia
          Drexel University School of Public Health, Philadelphia, PA, USA
          University of Otago, Dunedin, NewZealand
          University of Washington, Seattle, WA, USA
          University of Otago, Dunedin, NewZealand
          NewYork University, NewYork City, NY
          King Fahad Medical City, Riyadh, Saudi Arabia
          Alberta Kidney Disease Network, University of Alberta, Edmonton, AB, Canada
          Cincinnati Children’s Hospital, Cincinnati, OH, USA
          Department of Neurology, Copenhagen University Hospital, Herlev, Denmark
          University of Crete Medical School, Crete, Greece
          Instituto Nacional de Epidemiología, ANLIS, Malbran, Argentina
          Brandeis University, Waltham, MA, USA
          KNCV Tuberculosis Foundation, The Hague, Netherlands
          Maastricht University Medical Centre, Maastricht, Netherlands
          University of Washington, Seattle, WA, USA
          National University of Singapore, Singapore
          Institute for Health Metrics and Evaluation
          Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
          James Cook University, Townsville, QLD, Australia
          University of Oxford, Oxford, UK
          Brown University, Providence, RI, USA
          Department of Paediatrics
          School of Public Health
          Mailman School of Public Health
          School of Public Health
          Queensland Centre for Mental Health Research
          Centers for Disease Control and Prevention, Atlanta, GA, USA
          Miller School of Medicine, University of Miami, Miami, FL, USA
          University of Nottingham, Nottingham, UK
          University of Western Sydney, Campbelltown, NSW, Australia
          Auckland Technical University, Auckland, New Zealand
          Arthritis Research, Wichita, KS, USA
          Royal Cornwall Hospital, Truro, UK
          Institute for Health Metrics and Evaluation
          London School of Economics, London,UK
          Agwa Khan University, Karachi, Pakistan
          School of Public Health, Shanghai Jiao Tong University, Shanghai, China
          Landstuhl Regional Medical Center, Landstuhl, Germany
          School of Population Health
          Institute for Health Metrics and Evaluation
          Author notes

          Contributors

          CJLM, ADL, and TV prepared the first draft. TV, AF, MN, RL, CM, ME, KS, JS, ADL, and CJLM finalised the draft on the basis of comments from all other authors and reviewer feedback. CJLM and ADL had the idea for the study and provided overall guidance. All other authors developed cause-specific models, reviewed results, provided guidance on the selection of key covariates, and reviewed the paper.

          []Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA cjlm@ 123456uw.edu
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          PMC6350784 PMC6350784 6350784 nihpa1005038
          10.1016/S0140-6736(12)61729-2
          6350784
          23245607
          b05e96a1-150e-4d23-993d-5547e33ae574
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