Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010

a systematic analysis for the Global Burden of Disease Study 2010

Christopher Murray, Theo Vos, Rafael Lozano, Mahsen Naghavi, Abraham Flaxman, Catherine Michaud, Majid Ezzati, Kenji Shibuya, Joshua Salomon, Safa Abdalla, Victor Aboyans, Jerry Abraham, Ilana Ackerman, Rakesh Aggarwal, Stephanie Ahn, Mohammad Ali, Miriam Alvarado, H Ross Anderson, Laurie Anderson, Kathryn Andrews & 339 others Charles Atkinson, Larry Baddour, Adil Bahalim, Suzanne Barker-Collo, Lope Barrero, David Bartels, Maria-Gloria Basanez, Amanda Baxter, Michelle Bell, Emelia Benjamin, D Bennett, Eduardo Bernabe, Kavi Bhalla, Bishal Bhandari, Boris Bikbov, Aref Bin Abdulhak, Gretchen Birbeck, James Black, Hannah Blencowe, Jed Blore, Fiona Blyth, Ian Bolliger, Audrey Bonaventure, Soufiane Boufous, Rupert Bourne, Michel Boussinseq, Tasanee Braithwaite, Carol Brayne, Lisa Bridgett, Simon Brooker, Peter Brooks, Traolach Brugha, Claire Bryan-Hancock, Chiara Bucello, Rachelle Buchbinder, Geoffrey Buckle, Christine Budke, Michael Burch, Peter Burney, Roy Burstein, Bianca Calabria, Benjamin Campbell, Charles Canter, Helene Carabin, Jonathan Carapetis, Loreto Carmona, Claudia Cella, Fiona Charlson, Honglei Chen, Andrew Tai-Ann Cheng, David Chou, Sumeet Chugh, Luc Coffeng, Steven Colan, Samantha Colquhoun, K Ellicott Colson, John Condon, Myles Connor, Leslie Cooper, Matthew Corriere, Monica Cortinovis, Karen Courville de Vaccaro, William Couser, Benjamin Cowie, Michael Criqui, Marita Cross, Kaustubh Dabhadkar, Manu Dahiya, Nabila Dahodwala, James Damsere-Derry, Goodarz Danaei, Adrian Davis, Diego De Leo, Louisa Degenhardt, Robert Dellavalle, Allyne Delossantos, Julie Denenberg, Sarah Derrett, Don Des Jarlais, Samath Dharmarante, Mukesh dhernai, Cesar Diaz-Torne, Helen Dolk, E Ray Dorsey, Tim Driscoll, Herbert Duber, Beth Ebel, Karen Edmond, Alexis Elbaz, Suad Eltahir Ali, Holly Erskine, Patricia Erwin, Patricia Espindola, Stalin Ewoigbokhan, Farshad Farzadfar, Valery Feigin, David Felson, Alize Ferrari, Cleusa Ferri, Eric Fevre, Mariel M Finucane, Seth Flaxman, Louise Flood, Kyle Foreman, Mohammad Forouzanfar, Francis Fowkes, Marlene Fransen, Michael Freeman, Belinda Gabbe, S Gabriel, Emmanuela Gakidou, Hammad Ganatra, Bianca Garcia, Flavio Gaspari, Richard Gillum, Gerhard Gmel, Diego Gonzalez-Medina, Richard Gosselin, Rebecca Grainger, Bridget Grant, Justina Groeger, Francis Guillemin, David Gunnell, Ramyani Gupta, Juanita Haagsma, Holly Hagan, Yara Halasa, W Hall, Diana Haring, Josep Maria Haro, James Harrison, Rasmus Havmoeller, Rodrick Hay, Hideki Higashi, Catherine Hill, Bruno Hoen, Howard Hoffman, Peter Hotez, Damian Hoy, John Huang, Sydney Ibeanusi, Kathryn Jacobsen, Spencer James, Deborah Jarvis, Rashmi Jasrasaria, Sudha Jayaraman, Nicole Johns, Jost Jonas, Ganesan Karthikeyan, Nicholas Kassebaum, Norito Kawakami, Andre Keren, Jon-Paul Khoo, Charles King, Lisa Marie Knowlton, Olive Kobusingye, Adofo Koranteng, Rita Krisnamurthi, Francine Laden, Ratilal Lalloo, Laura Laslett, Tim Lathlean, Janet Leasher, Yong Yi Lee, James Leigh, Daphna Levinson, Stephen Lim, Elizabeth Limb, John Kent Lin, Michael Lipnick, Steven Lipshultz, W Liu, Maria Loane, Summer Ohno, Ronan Lyons, Jacqueline Mabweijano, Michael MacIntyre, Reza Malekzadeh, Leslie Mallinger, Sivabalan Manivannan, Wagner Marcenes, Lyn March, David Margolis, G MARKS, Robin Marks, Akira Matsumori, Richard Matzopoulos, Bongani Mayosi, John McAnulty, Mary McDermott, Neil McGill, John McGrath, Maria Elena Medina-Mora, Michele Meltzer, George Menash, Tony Merriman, Ana-Claire Meyer, Valeria Miglioli, Matthew Miller, Ted Miller, Philip Mitchell, Charles Mock, Ana Olga Mocumbi, Terrie Moffitt, Ali A Mokdad, Lorenzo Monasta, Marcella Montico, Maziar Moradi-Lakeh, Andrew Moran, Lidia Morawska, Rintaro Mori, Michele Murdoch, Michael Mwaniki, Kovin Naidoo, M Nathan Nair, Luigi Naldi, KM Venkat Narayan, Paul Nelson, Robert Nelson, Michael Nevitt, Charles Newton, Sandra Nolte, Paul Norman, Rosana Norman, Martin O'Donnell, Simon O'Hanlon, Casey Olives, Saad Omer, Katrina Ortblad, Richard Osborne, Doruk Ozgediz, Andrew Page, Bishnu Pahari, Jeyaraj Durai Pandian, Andrea Panozo Rivero, Scott Patten, Neil Pearce, Rogelio Perez Padilla, Fernando Perez-Ruiz, Norberto Perico, Konrad Pesudovs, David Phillips, Michael Phillips, Kelsey Pierce, Sebastien Pion, Guilherme Polanczyk, Suzanne Polinder, C Arden Pope III, Svetlana Popova, Esteban Porrini, Farshad Pourmalek, Martin Prince, Rachel Pullan, Kapa Ramaiah, Dharani Ranganathan, Homie Razavi, Mathilda Regan, Jurgen Rehm, David B Rein, Guiseppe Remuzzi, Kathryn Richardson, Fredrick Rivara, Thomas Roberts, C ROBINSON, Felipe Rodriguez De Leon, Luca Ronfani, Robin Room, Lisa Rosenfeld, Lesley Rushton, Ralph Sacco, Sukanta Saha, Uchechukwu Sampson, Lidia Sanchez-Riera, Ella Sanman, David Schwebel, James graham Scott, Maria Segui-Gomez, Saeid Shahraz, Donald Shepard, Hwashin Shin, Rupak Shivakoti, David Singh, Gitanjali Singh, Jasvinder Singh, Jessica Singleton, David Sleet, Karen Sliwa, Emma Smith, J L Smith, Nicolas Stapelberg, Andrew Steer, Timothy Steiner, Wilma Stolk, Lars Jacob Stovner, Christopher Sudfeld, Sana Syed, Giorgio Tamburlini, Mohammad Tavakkoli, H Taylor, Jennifer Taylor, William Taylor, Bernadette Thomas, W Murray Thomson, George Thurston, Imad Tleyjeh, Marcello Tonelli, Jeffrey Towbin, Thomas Truelsen, Miltiadis Tsilimbaris, Clotilde Ubeda, Eduardo Undurraga, Marieke van der Werf, Jim van Os, Monica Vavilala, N Venketasubramanian, Mengru Wang, Wenzhi Wang, Kerrianne Watt, David Weatherall, Martin Weinstock, Robert Weintraub, Marc Weisskopf, Myrna Weissman, Richard White, Harvey Whiteford, Natasha Wiebe, Steven Wiersma, J Wilkinson, Hywel Williams, Sean Williams, Emma Witt, Frederick Wolfe, Anthony Woolf, Sarah Wulf, Pon-Hsiu Yeh, Anita Zaidi, Zhi-Jie Zheng, David Zonies, Alan Lopez

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.

    Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.

    Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.

    Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.

    Original languageEnglish
    Pages (from-to)2197-2223
    Number of pages27
    JournalLancet
    Volume380
    Issue number9859
    DOIs
    Publication statusPublished - 2012

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    Quality-Adjusted Life Years
    Wounds and Injuries
    Africa South of the Sahara
    Uncertainty
    Mortality
    Global Burden of Disease
    Mothers
    Australasia
    Nutrition Disorders
    Weights and Measures
    Premature Mortality
    Health
    Major Depressive Disorder
    Life Expectancy
    Mental Disorders
    Myocardial Ischemia
    Acquired Immunodeficiency Syndrome
    Age Groups
    Stroke
    HIV

    Cite this

    Murray, Christopher ; Vos, Theo ; Lozano, Rafael ; Naghavi, Mahsen ; Flaxman, Abraham ; Michaud, Catherine ; Ezzati, Majid ; Shibuya, Kenji ; Salomon, Joshua ; Abdalla, Safa ; Aboyans, Victor ; Abraham, Jerry ; Ackerman, Ilana ; Aggarwal, Rakesh ; Ahn, Stephanie ; Ali, Mohammad ; Alvarado, Miriam ; Anderson, H Ross ; Anderson, Laurie ; Andrews, Kathryn ; Atkinson, Charles ; Baddour, Larry ; Bahalim, Adil ; Barker-Collo, Suzanne ; Barrero, Lope ; Bartels, David ; Basanez, Maria-Gloria ; Baxter, Amanda ; Bell, Michelle ; Benjamin, Emelia ; Bennett, D ; Bernabe, Eduardo ; Bhalla, Kavi ; Bhandari, Bishal ; Bikbov, Boris ; Abdulhak, Aref Bin ; Birbeck, Gretchen ; Black, James ; Blencowe, Hannah ; Blore, Jed ; Blyth, Fiona ; Bolliger, Ian ; Bonaventure, Audrey ; Boufous, Soufiane ; Bourne, Rupert ; Boussinseq, Michel ; Braithwaite, Tasanee ; Brayne, Carol ; Bridgett, Lisa ; Brooker, Simon ; Brooks, Peter ; Brugha, Traolach ; Bryan-Hancock, Claire ; Bucello, Chiara ; Buchbinder, Rachelle ; Buckle, Geoffrey ; Budke, Christine ; Burch, Michael ; Burney, Peter ; Burstein, Roy ; Calabria, Bianca ; Campbell, Benjamin ; Canter, Charles ; Carabin, Helene ; Carapetis, Jonathan ; Carmona, Loreto ; Cella, Claudia ; Charlson, Fiona ; Chen, Honglei ; Tai-Ann Cheng, Andrew ; Chou, David ; Chugh, Sumeet ; Coffeng, Luc ; Colan, Steven ; Colquhoun, Samantha ; Colson, K Ellicott ; Condon, John ; Connor, Myles ; Cooper, Leslie ; Corriere, Matthew ; Cortinovis, Monica ; Courville de Vaccaro, Karen ; Couser, William ; Cowie, Benjamin ; Criqui, Michael ; Cross, Marita ; Dabhadkar, Kaustubh ; Dahiya, Manu ; Dahodwala, Nabila ; Damsere-Derry, James ; Danaei, Goodarz ; Davis, Adrian ; De Leo, Diego ; Degenhardt, Louisa ; Dellavalle, Robert ; Delossantos, Allyne ; Denenberg, Julie ; Derrett, Sarah ; Des Jarlais, Don ; Dharmarante, Samath ; dhernai, Mukesh ; Diaz-Torne, Cesar ; Dolk, Helen ; Dorsey, E Ray ; Driscoll, Tim ; Duber, Herbert ; Ebel, Beth ; Edmond, Karen ; Elbaz, Alexis ; Eltahir Ali, Suad ; Erskine, Holly ; Erwin, Patricia ; Espindola, Patricia ; Ewoigbokhan, Stalin ; Farzadfar, Farshad ; Feigin, Valery ; Felson, David ; Ferrari, Alize ; Ferri, Cleusa ; Fevre, Eric ; Finucane, Mariel M ; Flaxman, Seth ; Flood, Louise ; Foreman, Kyle ; Forouzanfar, Mohammad ; Fowkes, Francis ; Fransen, Marlene ; Freeman, Michael ; Gabbe, Belinda ; Gabriel, S ; Gakidou, Emmanuela ; Ganatra, Hammad ; Garcia, Bianca ; Gaspari, Flavio ; Gillum, Richard ; Gmel, Gerhard ; Gonzalez-Medina, Diego ; Gosselin, Richard ; Grainger, Rebecca ; Grant, Bridget ; Groeger, Justina ; Guillemin, Francis ; Gunnell, David ; Gupta, Ramyani ; Haagsma, Juanita ; Hagan, Holly ; Halasa, Yara ; Hall, W ; Haring, Diana ; Maria Haro, Josep ; Harrison, James ; Havmoeller, Rasmus ; Hay, Rodrick ; Higashi, Hideki ; Hill, Catherine ; Hoen, Bruno ; Hoffman, Howard ; Hotez, Peter ; Hoy, Damian ; Huang, John ; Ibeanusi, Sydney ; Jacobsen, Kathryn ; James, Spencer ; Jarvis, Deborah ; Jasrasaria, Rashmi ; Jayaraman, Sudha ; Johns, Nicole ; Jonas, Jost ; Karthikeyan, Ganesan ; Kassebaum, Nicholas ; Kawakami, Norito ; Keren, Andre ; Khoo, Jon-Paul ; King, Charles ; Knowlton, Lisa Marie ; Kobusingye, Olive ; Koranteng, Adofo ; Krisnamurthi, Rita ; Laden, Francine ; Lalloo, Ratilal ; Laslett, Laura ; Lathlean, Tim ; Leasher, Janet ; Yi Lee, Yong ; Leigh, James ; Levinson, Daphna ; Lim, Stephen ; Limb, Elizabeth ; Lin, John Kent ; Lipnick, Michael ; Lipshultz, Steven ; Liu, W ; Loane, Maria ; Ohno, Summer ; Lyons, Ronan ; Mabweijano, Jacqueline ; MacIntyre, Michael ; Malekzadeh, Reza ; Mallinger, Leslie ; Manivannan, Sivabalan ; Marcenes, Wagner ; March, Lyn ; Margolis, David ; MARKS, G ; Marks, Robin ; Matsumori, Akira ; Matzopoulos, Richard ; Mayosi, Bongani ; McAnulty, John ; McDermott, Mary ; McGill, Neil ; McGrath, John ; Medina-Mora, Maria Elena ; Meltzer, Michele ; Menash, George ; Merriman, Tony ; Meyer, Ana-Claire ; Miglioli, Valeria ; Miller, Matthew ; Miller, Ted ; Mitchell, Philip ; Mock, Charles ; Mocumbi, Ana Olga ; Moffitt, Terrie ; Mokdad, Ali A ; Monasta, Lorenzo ; Montico, Marcella ; Moradi-Lakeh, Maziar ; Moran, Andrew ; Morawska, Lidia ; Mori, Rintaro ; Murdoch, Michele ; Mwaniki, Michael ; Naidoo, Kovin ; Nair, M Nathan ; Naldi, Luigi ; Narayan, KM Venkat ; Nelson, Paul ; Nelson, Robert ; Nevitt, Michael ; Newton, Charles ; Nolte, Sandra ; Norman, Paul ; Norman, Rosana ; O'Donnell, Martin ; O'Hanlon, Simon ; Olives, Casey ; Omer, Saad ; Ortblad, Katrina ; Osborne, Richard ; Ozgediz, Doruk ; Page, Andrew ; Pahari, Bishnu ; Pandian, Jeyaraj Durai ; Rivero, Andrea Panozo ; Patten, Scott ; Pearce, Neil ; Perez Padilla, Rogelio ; Perez-Ruiz, Fernando ; Perico, Norberto ; Pesudovs, Konrad ; Phillips, David ; Phillips, Michael ; Pierce, Kelsey ; Pion, Sebastien ; Polanczyk, Guilherme ; Polinder, Suzanne ; Pope III, C Arden ; Popova, Svetlana ; Porrini, Esteban ; Pourmalek, Farshad ; Prince, Martin ; Pullan, Rachel ; Ramaiah, Kapa ; Ranganathan, Dharani ; Razavi, Homie ; Regan, Mathilda ; Rehm, Jurgen ; Rein, David B ; Remuzzi, Guiseppe ; Richardson, Kathryn ; Rivara, Fredrick ; Roberts, Thomas ; ROBINSON, C ; Rodriguez De Leon, Felipe ; Ronfani, Luca ; Room, Robin ; Rosenfeld, Lisa ; Rushton, Lesley ; Sacco, Ralph ; Saha, Sukanta ; Sampson, Uchechukwu ; Sanchez-Riera, Lidia ; Sanman, Ella ; Schwebel, David ; Scott, James graham ; Segui-Gomez, Maria ; Shahraz, Saeid ; Shepard, Donald ; Shin, Hwashin ; Shivakoti, Rupak ; Singh, David ; Singh, Gitanjali ; Singh, Jasvinder ; Singleton, Jessica ; Sleet, David ; Sliwa, Karen ; Smith, Emma ; Smith, J L ; Stapelberg, Nicolas ; Steer, Andrew ; Steiner, Timothy ; Stolk, Wilma ; Stovner, Lars Jacob ; Sudfeld, Christopher ; Syed, Sana ; Tamburlini, Giorgio ; Tavakkoli, Mohammad ; Taylor, H ; Taylor, Jennifer ; Taylor, William ; Thomas, Bernadette ; Thomson, W Murray ; Thurston, George ; Tleyjeh, Imad ; Tonelli, Marcello ; Towbin, Jeffrey ; Truelsen, Thomas ; Tsilimbaris, Miltiadis ; Ubeda, Clotilde ; Undurraga, Eduardo ; van der Werf, Marieke ; van Os, Jim ; Vavilala, Monica ; Venketasubramanian, N ; Wang, Mengru ; Wang, Wenzhi ; Watt, Kerrianne ; Weatherall, David ; Weinstock, Martin ; Weintraub, Robert ; Weisskopf, Marc ; Weissman, Myrna ; White, Richard ; Whiteford, Harvey ; Wiebe, Natasha ; Wiersma, Steven ; Wilkinson, J ; Williams, Hywel ; Williams, Sean ; Witt, Emma ; Wolfe, Frederick ; Woolf, Anthony ; Wulf, Sarah ; Yeh, Pon-Hsiu ; Zaidi, Anita ; Zheng, Zhi-Jie ; Zonies, David ; Lopez, Alan. / Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010 : a systematic analysis for the Global Burden of Disease Study 2010. In: Lancet. 2012 ; Vol. 380, No. 9859. pp. 2197-2223.
    @article{4833b4a9a4354cf68cfe452c5257d2d6,
    title = "Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010",
    abstract = "Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23{\%} (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41{\%} of global DALYs in 1990 to 25{\%} in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80{\%} of DALYs in sub-Saharan Africa. In 1990, 47{\%} of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43{\%} from non-communicable diseases, and 10{\%} from injuries. By 2010, this had shifted to 35{\%}, 54{\%}, and 11{\%}, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29{\%}), followed by lower respiratory infections (top rank in 1990; 44{\%} decline in DALYs), stroke (fifth in 1990; 19{\%} increase), diarrhoeal diseases (second in 1990; 51{\%} decrease), and HIV/AIDS (33rd in 1990; 351{\%} increase). Major depressive disorder increased from 15th to 11th rank (37{\%} increase) and road injury from 12th to 10th rank (34{\%} increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.",
    keywords = "acquired immune deficiency syndrome, adolescent, adult, aged, article, cerebrovascular accident, child, communicable disease, death, diarrhea, disability, diseases, female, health status, human, Human immunodeficiency virus infection, injury, ischemic heart disease, life expectancy, major clinical study, major depression, male, maternal disease, mortality, newborn disease, nutritional disorder, priority journal, quality adjusted life year, respiratory tract infection, school child, age, health, infant, middle aged, newborn, preschool child, prevalence, sex difference, statistics, very elderly, young adult, consultation, disability adjusted life year, non communicable disease, quality of life, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Health Status, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prevalence, Quality-Adjusted Life Years, Sex Factors, World Health, Wounds and Injuries, Young Adult",
    author = "Christopher Murray and Theo Vos and Rafael Lozano and Mahsen Naghavi and Abraham Flaxman and Catherine Michaud and Majid Ezzati and Kenji Shibuya and Joshua Salomon and Safa Abdalla and Victor Aboyans and Jerry Abraham and Ilana Ackerman and Rakesh Aggarwal and Stephanie Ahn and Mohammad Ali and Miriam Alvarado and Anderson, {H Ross} and Laurie Anderson and Kathryn Andrews and Charles Atkinson and Larry Baddour and Adil Bahalim and Suzanne Barker-Collo and Lope Barrero and David Bartels and Maria-Gloria Basanez and Amanda Baxter and Michelle Bell and Emelia Benjamin and D Bennett and Eduardo Bernabe and Kavi Bhalla and Bishal Bhandari and Boris Bikbov and Abdulhak, {Aref Bin} and Gretchen Birbeck and James Black and Hannah Blencowe and Jed Blore and Fiona Blyth and Ian Bolliger and Audrey Bonaventure and Soufiane Boufous and Rupert Bourne and Michel Boussinseq and Tasanee Braithwaite and Carol Brayne and Lisa Bridgett and Simon Brooker and Peter Brooks and Traolach Brugha and Claire Bryan-Hancock and Chiara Bucello and Rachelle Buchbinder and Geoffrey Buckle and Christine Budke and Michael Burch and Peter Burney and Roy Burstein and Bianca Calabria and Benjamin Campbell and Charles Canter and Helene Carabin and Jonathan Carapetis and Loreto Carmona and Claudia Cella and Fiona Charlson and Honglei Chen and {Tai-Ann Cheng}, Andrew and David Chou and Sumeet Chugh and Luc Coffeng and Steven Colan and Samantha Colquhoun and Colson, {K Ellicott} and John Condon and Myles Connor and Leslie Cooper and Matthew Corriere and Monica Cortinovis and {Courville de Vaccaro}, Karen and William Couser and Benjamin Cowie and Michael Criqui and Marita Cross and Kaustubh Dabhadkar and Manu Dahiya and Nabila Dahodwala and James Damsere-Derry and Goodarz Danaei and Adrian Davis and {De Leo}, Diego and Louisa Degenhardt and Robert Dellavalle and Allyne Delossantos and Julie Denenberg and Sarah Derrett and {Des Jarlais}, Don and Samath Dharmarante and Mukesh dhernai and Cesar Diaz-Torne and Helen Dolk and Dorsey, {E Ray} and Tim Driscoll and Herbert Duber and Beth Ebel and Karen Edmond and Alexis Elbaz and {Eltahir Ali}, Suad and Holly Erskine and Patricia Erwin and Patricia Espindola and Stalin Ewoigbokhan and Farshad Farzadfar and Valery Feigin and David Felson and Alize Ferrari and Cleusa Ferri and Eric Fevre and Finucane, {Mariel M} and Seth Flaxman and Louise Flood and Kyle Foreman and Mohammad Forouzanfar and Francis Fowkes and Marlene Fransen and Michael Freeman and Belinda Gabbe and S Gabriel and Emmanuela Gakidou and Hammad Ganatra and Bianca Garcia and Flavio Gaspari and Richard Gillum and Gerhard Gmel and Diego Gonzalez-Medina and Richard Gosselin and Rebecca Grainger and Bridget Grant and Justina Groeger and Francis Guillemin and David Gunnell and Ramyani Gupta and Juanita Haagsma and Holly Hagan and Yara Halasa and W Hall and Diana Haring and {Maria Haro}, Josep and James Harrison and Rasmus Havmoeller and Rodrick Hay and Hideki Higashi and Catherine Hill and Bruno Hoen and Howard Hoffman and Peter Hotez and Damian Hoy and John Huang and Sydney Ibeanusi and Kathryn Jacobsen and Spencer James and Deborah Jarvis and Rashmi Jasrasaria and Sudha Jayaraman and Nicole Johns and Jost Jonas and Ganesan Karthikeyan and Nicholas Kassebaum and Norito Kawakami and Andre Keren and Jon-Paul Khoo and Charles King and Knowlton, {Lisa Marie} and Olive Kobusingye and Adofo Koranteng and Rita Krisnamurthi and Francine Laden and Ratilal Lalloo and Laura Laslett and Tim Lathlean and Janet Leasher and {Yi Lee}, Yong and James Leigh and Daphna Levinson and Stephen Lim and Elizabeth Limb and Lin, {John Kent} and Michael Lipnick and Steven Lipshultz and W Liu and Maria Loane and Summer Ohno and Ronan Lyons and Jacqueline Mabweijano and Michael MacIntyre and Reza Malekzadeh and Leslie Mallinger and Sivabalan Manivannan and Wagner Marcenes and Lyn March and David Margolis and G MARKS and Robin Marks and Akira Matsumori and Richard Matzopoulos and Bongani Mayosi and John McAnulty and Mary McDermott and Neil McGill and John McGrath and Medina-Mora, {Maria Elena} and Michele Meltzer and George Menash and Tony Merriman and Ana-Claire Meyer and Valeria Miglioli and Matthew Miller and Ted Miller and Philip Mitchell and Charles Mock and Mocumbi, {Ana Olga} and Terrie Moffitt and Mokdad, {Ali A} and Lorenzo Monasta and Marcella Montico and Maziar Moradi-Lakeh and Andrew Moran and Lidia Morawska and Rintaro Mori and Michele Murdoch and Michael Mwaniki and Kovin Naidoo and Nair, {M Nathan} and Luigi Naldi and Narayan, {KM Venkat} and Paul Nelson and Robert Nelson and Michael Nevitt and Charles Newton and Sandra Nolte and Paul Norman and Rosana Norman and Martin O'Donnell and Simon O'Hanlon and Casey Olives and Saad Omer and Katrina Ortblad and Richard Osborne and Doruk Ozgediz and Andrew Page and Bishnu Pahari and Pandian, {Jeyaraj Durai} and Rivero, {Andrea Panozo} and Scott Patten and Neil Pearce and {Perez Padilla}, Rogelio and Fernando Perez-Ruiz and Norberto Perico and Konrad Pesudovs and David Phillips and Michael Phillips and Kelsey Pierce and Sebastien Pion and Guilherme Polanczyk and Suzanne Polinder and {Pope III}, {C Arden} and Svetlana Popova and Esteban Porrini and Farshad Pourmalek and Martin Prince and Rachel Pullan and Kapa Ramaiah and Dharani Ranganathan and Homie Razavi and Mathilda Regan and Jurgen Rehm and Rein, {David B} and Guiseppe Remuzzi and Kathryn Richardson and Fredrick Rivara and Thomas Roberts and C ROBINSON and {Rodriguez De Leon}, Felipe and Luca Ronfani and Robin Room and Lisa Rosenfeld and Lesley Rushton and Ralph Sacco and Sukanta Saha and Uchechukwu Sampson and Lidia Sanchez-Riera and Ella Sanman and David Schwebel and Scott, {James graham} and Maria Segui-Gomez and Saeid Shahraz and Donald Shepard and Hwashin Shin and Rupak Shivakoti and David Singh and Gitanjali Singh and Jasvinder Singh and Jessica Singleton and David Sleet and Karen Sliwa and Emma Smith and Smith, {J L} and Nicolas Stapelberg and Andrew Steer and Timothy Steiner and Wilma Stolk and Stovner, {Lars Jacob} and Christopher Sudfeld and Sana Syed and Giorgio Tamburlini and Mohammad Tavakkoli and H Taylor and Jennifer Taylor and William Taylor and Bernadette Thomas and Thomson, {W Murray} and George Thurston and Imad Tleyjeh and Marcello Tonelli and Jeffrey Towbin and Thomas Truelsen and Miltiadis Tsilimbaris and Clotilde Ubeda and Eduardo Undurraga and {van der Werf}, Marieke and {van Os}, Jim and Monica Vavilala and N Venketasubramanian and Mengru Wang and Wenzhi Wang and Kerrianne Watt and David Weatherall and Martin Weinstock and Robert Weintraub and Marc Weisskopf and Myrna Weissman and Richard White and Harvey Whiteford and Natasha Wiebe and Steven Wiersma and J Wilkinson and Hywel Williams and Sean Williams and Emma Witt and Frederick Wolfe and Anthony Woolf and Sarah Wulf and Pon-Hsiu Yeh and Anita Zaidi and Zhi-Jie Zheng and David Zonies and Alan Lopez",
    year = "2012",
    doi = "10.1016/S0140-6736(12)61689-4",
    language = "English",
    volume = "380",
    pages = "2197--2223",
    journal = "Lancet",
    issn = "0140-6736",
    publisher = "The Lancet Publishing Group",
    number = "9859",

    }

    Murray, C, Vos, T, Lozano, R, Naghavi, M, Flaxman, A, Michaud, C, Ezzati, M, Shibuya, K, Salomon, J, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, S, Ali, M, Alvarado, M, Anderson, HR, Anderson, L, Andrews, K, Atkinson, C, Baddour, L, Bahalim, A, Barker-Collo, S, Barrero, L, Bartels, D, Basanez, M-G, Baxter, A, Bell, M, Benjamin, E, Bennett, D, Bernabe, E, Bhalla, K, Bhandari, B, Bikbov, B, Abdulhak, AB, Birbeck, G, Black, J, Blencowe, H, Blore, J, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinseq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, T, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, C, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, C, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Tai-Ann Cheng, A, Chou, D, Chugh, S, Coffeng, L, Colan, S, Colquhoun, S, Colson, KE, Condon, J, Connor, M, Cooper, L, Corriere, M, Cortinovis, M, Courville de Vaccaro, K, Couser, W, Cowie, B, Criqui, M, Cross, M, Dabhadkar, K, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, D, Dharmarante, S, dhernai, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Eltahir Ali, S, Erskine, H, Erwin, P, Espindola, P, Ewoigbokhan, S, Farzadfar, F, Feigin, V, Felson, D, Ferrari, A, Ferri, C, Fevre, E, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, M, Fowkes, F, Fransen, M, Freeman, M, Gabbe, B, Gabriel, S, Gakidou, E, Ganatra, H, Garcia, B, Gaspari, F, Gillum, R, Gmel, G, Gonzalez-Medina, D, Gosselin, R, Grainger, R, Grant, B, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, Y, Hall, W, Haring, D, Maria Haro, J, Harrison, J, Havmoeller, R, Hay, R, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, P, Hoy, D, Huang, J, Ibeanusi, S, Jacobsen, K, James, S, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, J, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, J-P, King, C, Knowlton, LM, Kobusingye, O, Koranteng, A, Krisnamurthi, R, Laden, F, Lalloo, R, Laslett, L, Lathlean, T, Leasher, J, Yi Lee, Y, Leigh, J, Levinson, D, Lim, S, Limb, E, Lin, JK, Lipnick, M, Lipshultz, S, Liu, W, Loane, M, Ohno, S, Lyons, R, Mabweijano, J, MacIntyre, M, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, D, MARKS, G, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, B, McAnulty, J, McDermott, M, McGill, N, McGrath, J, Medina-Mora, ME, Meltzer, M, Menash, G, Merriman, T, Meyer, A-C, Miglioli, V, Miller, M, Miller, T, Mitchell, P, Mock, C, Mocumbi, AO, Moffitt, T, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, M, Mwaniki, M, Naidoo, K, Nair, MN, Naldi, L, Narayan, KMV, Nelson, P, Nelson, R, Nevitt, M, Newton, C, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, S, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, S, Pearce, N, Perez Padilla, R, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, M, Pierce, K, Pion, S, Polanczyk, G, Polinder, S, Pope III, CA, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, R, Ramaiah, K, Ranganathan, D, Razavi, H, Regan, M, Rehm, J, Rein, DB, Remuzzi, G, Richardson, K, Rivara, F, Roberts, T, ROBINSON, C, Rodriguez De Leon, F, Ronfani, L, Room, R, Rosenfeld, L, Rushton, L, Sacco, R, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, D, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, D, Shin, H, Shivakoti, R, Singh, D, Singh, G, Singh, J, Singleton, J, Sleet, D, Sliwa, K, Smith, E, Smith, JL, Stapelberg, N, Steer, A, Steiner, T, Stolk, W, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, H, Taylor, J, Taylor, W, Thomas, B, Thomson, WM, Thurston, G, Tleyjeh, I, Tonelli, M, Towbin, J, Truelsen, T, Tsilimbaris, M, Ubeda, C, Undurraga, E, van der Werf, M, van Os, J, Vavilala, M, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, D, Weinstock, M, Weintraub, R, Weisskopf, M, Weissman, M, White, R, Whiteford, H, Wiebe, N, Wiersma, S, Wilkinson, J, Williams, H, Williams, S, Witt, E, Wolfe, F, Woolf, A, Wulf, S, Yeh, P-H, Zaidi, A, Zheng, Z-J, Zonies, D & Lopez, A 2012, 'Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010', Lancet, vol. 380, no. 9859, pp. 2197-2223. https://doi.org/10.1016/S0140-6736(12)61689-4

    Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010 : a systematic analysis for the Global Burden of Disease Study 2010. / Murray, Christopher; Vos, Theo; Lozano, Rafael; Naghavi, Mahsen; Flaxman, Abraham; Michaud, Catherine; Ezzati, Majid; Shibuya, Kenji; Salomon, Joshua; Abdalla, Safa; Aboyans, Victor; Abraham, Jerry; Ackerman, Ilana; Aggarwal, Rakesh; Ahn, Stephanie; Ali, Mohammad; Alvarado, Miriam; Anderson, H Ross; Anderson, Laurie; Andrews, Kathryn; Atkinson, Charles; Baddour, Larry; Bahalim, Adil; Barker-Collo, Suzanne; Barrero, Lope; Bartels, David; Basanez, Maria-Gloria; Baxter, Amanda; Bell, Michelle; Benjamin, Emelia; Bennett, D; Bernabe, Eduardo; Bhalla, Kavi; Bhandari, Bishal; Bikbov, Boris; Abdulhak, Aref Bin; Birbeck, Gretchen; Black, James; Blencowe, Hannah; Blore, Jed; Blyth, Fiona; Bolliger, Ian; Bonaventure, Audrey; Boufous, Soufiane; Bourne, Rupert; Boussinseq, Michel; Braithwaite, Tasanee; Brayne, Carol; Bridgett, Lisa; Brooker, Simon; Brooks, Peter; Brugha, Traolach; Bryan-Hancock, Claire; Bucello, Chiara; Buchbinder, Rachelle; Buckle, Geoffrey; Budke, Christine; Burch, Michael; Burney, Peter; Burstein, Roy; Calabria, Bianca; Campbell, Benjamin; Canter, Charles; Carabin, Helene; Carapetis, Jonathan; Carmona, Loreto; Cella, Claudia; Charlson, Fiona; Chen, Honglei; Tai-Ann Cheng, Andrew; Chou, David; Chugh, Sumeet; Coffeng, Luc; Colan, Steven; Colquhoun, Samantha; Colson, K Ellicott; Condon, John; Connor, Myles; Cooper, Leslie; Corriere, Matthew; Cortinovis, Monica; Courville de Vaccaro, Karen; Couser, William; Cowie, Benjamin; Criqui, Michael; Cross, Marita; Dabhadkar, Kaustubh; Dahiya, Manu; Dahodwala, Nabila; Damsere-Derry, James; Danaei, Goodarz; Davis, Adrian; De Leo, Diego; Degenhardt, Louisa; Dellavalle, Robert; Delossantos, Allyne; Denenberg, Julie; Derrett, Sarah; Des Jarlais, Don; Dharmarante, Samath; dhernai, Mukesh; Diaz-Torne, Cesar; Dolk, Helen; Dorsey, E Ray; Driscoll, Tim; Duber, Herbert; Ebel, Beth; Edmond, Karen; Elbaz, Alexis; Eltahir Ali, Suad; Erskine, Holly; Erwin, Patricia; Espindola, Patricia; Ewoigbokhan, Stalin; Farzadfar, Farshad; Feigin, Valery; Felson, David; Ferrari, Alize; Ferri, Cleusa; Fevre, Eric; Finucane, Mariel M; Flaxman, Seth; Flood, Louise; Foreman, Kyle; Forouzanfar, Mohammad; Fowkes, Francis; Fransen, Marlene; Freeman, Michael; Gabbe, Belinda; Gabriel, S; Gakidou, Emmanuela; Ganatra, Hammad; Garcia, Bianca; Gaspari, Flavio; Gillum, Richard; Gmel, Gerhard; Gonzalez-Medina, Diego; Gosselin, Richard; Grainger, Rebecca; Grant, Bridget; Groeger, Justina; Guillemin, Francis; Gunnell, David; Gupta, Ramyani; Haagsma, Juanita; Hagan, Holly; Halasa, Yara; Hall, W; Haring, Diana; Maria Haro, Josep; Harrison, James; Havmoeller, Rasmus; Hay, Rodrick; Higashi, Hideki; Hill, Catherine; Hoen, Bruno; Hoffman, Howard; Hotez, Peter; Hoy, Damian; Huang, John; Ibeanusi, Sydney; Jacobsen, Kathryn; James, Spencer; Jarvis, Deborah; Jasrasaria, Rashmi; Jayaraman, Sudha; Johns, Nicole; Jonas, Jost; Karthikeyan, Ganesan; Kassebaum, Nicholas; Kawakami, Norito; Keren, Andre; Khoo, Jon-Paul; King, Charles; Knowlton, Lisa Marie; Kobusingye, Olive; Koranteng, Adofo; Krisnamurthi, Rita; Laden, Francine; Lalloo, Ratilal; Laslett, Laura; Lathlean, Tim; Leasher, Janet; Yi Lee, Yong; Leigh, James; Levinson, Daphna; Lim, Stephen; Limb, Elizabeth; Lin, John Kent; Lipnick, Michael; Lipshultz, Steven; Liu, W; Loane, Maria; Ohno, Summer; Lyons, Ronan; Mabweijano, Jacqueline; MacIntyre, Michael; Malekzadeh, Reza; Mallinger, Leslie; Manivannan, Sivabalan; Marcenes, Wagner; March, Lyn; Margolis, David; MARKS, G; Marks, Robin; Matsumori, Akira; Matzopoulos, Richard; Mayosi, Bongani; McAnulty, John; McDermott, Mary; McGill, Neil; McGrath, John; Medina-Mora, Maria Elena; Meltzer, Michele; Menash, George; Merriman, Tony; Meyer, Ana-Claire; Miglioli, Valeria; Miller, Matthew; Miller, Ted; Mitchell, Philip; Mock, Charles; Mocumbi, Ana Olga; Moffitt, Terrie; Mokdad, Ali A; Monasta, Lorenzo; Montico, Marcella; Moradi-Lakeh, Maziar; Moran, Andrew; Morawska, Lidia; Mori, Rintaro; Murdoch, Michele; Mwaniki, Michael; Naidoo, Kovin; Nair, M Nathan; Naldi, Luigi; Narayan, KM Venkat; Nelson, Paul; Nelson, Robert; Nevitt, Michael; Newton, Charles; Nolte, Sandra; Norman, Paul; Norman, Rosana; O'Donnell, Martin; O'Hanlon, Simon; Olives, Casey; Omer, Saad; Ortblad, Katrina; Osborne, Richard; Ozgediz, Doruk; Page, Andrew; Pahari, Bishnu; Pandian, Jeyaraj Durai; Rivero, Andrea Panozo; Patten, Scott; Pearce, Neil; Perez Padilla, Rogelio; Perez-Ruiz, Fernando; Perico, Norberto; Pesudovs, Konrad; Phillips, David; Phillips, Michael; Pierce, Kelsey; Pion, Sebastien; Polanczyk, Guilherme; Polinder, Suzanne; Pope III, C Arden; Popova, Svetlana; Porrini, Esteban; Pourmalek, Farshad; Prince, Martin; Pullan, Rachel; Ramaiah, Kapa; Ranganathan, Dharani; Razavi, Homie; Regan, Mathilda; Rehm, Jurgen; Rein, David B; Remuzzi, Guiseppe; Richardson, Kathryn; Rivara, Fredrick; Roberts, Thomas; ROBINSON, C; Rodriguez De Leon, Felipe; Ronfani, Luca; Room, Robin; Rosenfeld, Lisa; Rushton, Lesley; Sacco, Ralph; Saha, Sukanta; Sampson, Uchechukwu; Sanchez-Riera, Lidia; Sanman, Ella; Schwebel, David; Scott, James graham; Segui-Gomez, Maria; Shahraz, Saeid; Shepard, Donald; Shin, Hwashin; Shivakoti, Rupak; Singh, David; Singh, Gitanjali; Singh, Jasvinder; Singleton, Jessica; Sleet, David; Sliwa, Karen; Smith, Emma; Smith, J L; Stapelberg, Nicolas; Steer, Andrew; Steiner, Timothy; Stolk, Wilma; Stovner, Lars Jacob; Sudfeld, Christopher; Syed, Sana; Tamburlini, Giorgio; Tavakkoli, Mohammad; Taylor, H; Taylor, Jennifer; Taylor, William; Thomas, Bernadette; Thomson, W Murray; Thurston, George; Tleyjeh, Imad; Tonelli, Marcello; Towbin, Jeffrey; Truelsen, Thomas; Tsilimbaris, Miltiadis; Ubeda, Clotilde; Undurraga, Eduardo; van der Werf, Marieke; van Os, Jim; Vavilala, Monica; Venketasubramanian, N; Wang, Mengru; Wang, Wenzhi; Watt, Kerrianne; Weatherall, David; Weinstock, Martin; Weintraub, Robert; Weisskopf, Marc; Weissman, Myrna; White, Richard; Whiteford, Harvey; Wiebe, Natasha; Wiersma, Steven; Wilkinson, J; Williams, Hywel; Williams, Sean; Witt, Emma; Wolfe, Frederick; Woolf, Anthony; Wulf, Sarah; Yeh, Pon-Hsiu; Zaidi, Anita; Zheng, Zhi-Jie; Zonies, David; Lopez, Alan.

    In: Lancet, Vol. 380, No. 9859, 2012, p. 2197-2223.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010

    T2 - a systematic analysis for the Global Burden of Disease Study 2010

    AU - Murray, Christopher

    AU - Vos, Theo

    AU - Lozano, Rafael

    AU - Naghavi, Mahsen

    AU - Flaxman, Abraham

    AU - Michaud, Catherine

    AU - Ezzati, Majid

    AU - Shibuya, Kenji

    AU - Salomon, Joshua

    AU - Abdalla, Safa

    AU - Aboyans, Victor

    AU - Abraham, Jerry

    AU - Ackerman, Ilana

    AU - Aggarwal, Rakesh

    AU - Ahn, Stephanie

    AU - Ali, Mohammad

    AU - Alvarado, Miriam

    AU - Anderson, H Ross

    AU - Anderson, Laurie

    AU - Andrews, Kathryn

    AU - Atkinson, Charles

    AU - Baddour, Larry

    AU - Bahalim, Adil

    AU - Barker-Collo, Suzanne

    AU - Barrero, Lope

    AU - Bartels, David

    AU - Basanez, Maria-Gloria

    AU - Baxter, Amanda

    AU - Bell, Michelle

    AU - Benjamin, Emelia

    AU - Bennett, D

    AU - Bernabe, Eduardo

    AU - Bhalla, Kavi

    AU - Bhandari, Bishal

    AU - Bikbov, Boris

    AU - Abdulhak, Aref Bin

    AU - Birbeck, Gretchen

    AU - Black, James

    AU - Blencowe, Hannah

    AU - Blore, Jed

    AU - Blyth, Fiona

    AU - Bolliger, Ian

    AU - Bonaventure, Audrey

    AU - Boufous, Soufiane

    AU - Bourne, Rupert

    AU - Boussinseq, Michel

    AU - Braithwaite, Tasanee

    AU - Brayne, Carol

    AU - Bridgett, Lisa

    AU - Brooker, Simon

    AU - Brooks, Peter

    AU - Brugha, Traolach

    AU - Bryan-Hancock, Claire

    AU - Bucello, Chiara

    AU - Buchbinder, Rachelle

    AU - Buckle, Geoffrey

    AU - Budke, Christine

    AU - Burch, Michael

    AU - Burney, Peter

    AU - Burstein, Roy

    AU - Calabria, Bianca

    AU - Campbell, Benjamin

    AU - Canter, Charles

    AU - Carabin, Helene

    AU - Carapetis, Jonathan

    AU - Carmona, Loreto

    AU - Cella, Claudia

    AU - Charlson, Fiona

    AU - Chen, Honglei

    AU - Tai-Ann Cheng, Andrew

    AU - Chou, David

    AU - Chugh, Sumeet

    AU - Coffeng, Luc

    AU - Colan, Steven

    AU - Colquhoun, Samantha

    AU - Colson, K Ellicott

    AU - Condon, John

    AU - Connor, Myles

    AU - Cooper, Leslie

    AU - Corriere, Matthew

    AU - Cortinovis, Monica

    AU - Courville de Vaccaro, Karen

    AU - Couser, William

    AU - Cowie, Benjamin

    AU - Criqui, Michael

    AU - Cross, Marita

    AU - Dabhadkar, Kaustubh

    AU - Dahiya, Manu

    AU - Dahodwala, Nabila

    AU - Damsere-Derry, James

    AU - Danaei, Goodarz

    AU - Davis, Adrian

    AU - De Leo, Diego

    AU - Degenhardt, Louisa

    AU - Dellavalle, Robert

    AU - Delossantos, Allyne

    AU - Denenberg, Julie

    AU - Derrett, Sarah

    AU - Des Jarlais, Don

    AU - Dharmarante, Samath

    AU - dhernai, Mukesh

    AU - Diaz-Torne, Cesar

    AU - Dolk, Helen

    AU - Dorsey, E Ray

    AU - Driscoll, Tim

    AU - Duber, Herbert

    AU - Ebel, Beth

    AU - Edmond, Karen

    AU - Elbaz, Alexis

    AU - Eltahir Ali, Suad

    AU - Erskine, Holly

    AU - Erwin, Patricia

    AU - Espindola, Patricia

    AU - Ewoigbokhan, Stalin

    AU - Farzadfar, Farshad

    AU - Feigin, Valery

    AU - Felson, David

    AU - Ferrari, Alize

    AU - Ferri, Cleusa

    AU - Fevre, Eric

    AU - Finucane, Mariel M

    AU - Flaxman, Seth

    AU - Flood, Louise

    AU - Foreman, Kyle

    AU - Forouzanfar, Mohammad

    AU - Fowkes, Francis

    AU - Fransen, Marlene

    AU - Freeman, Michael

    AU - Gabbe, Belinda

    AU - Gabriel, S

    AU - Gakidou, Emmanuela

    AU - Ganatra, Hammad

    AU - Garcia, Bianca

    AU - Gaspari, Flavio

    AU - Gillum, Richard

    AU - Gmel, Gerhard

    AU - Gonzalez-Medina, Diego

    AU - Gosselin, Richard

    AU - Grainger, Rebecca

    AU - Grant, Bridget

    AU - Groeger, Justina

    AU - Guillemin, Francis

    AU - Gunnell, David

    AU - Gupta, Ramyani

    AU - Haagsma, Juanita

    AU - Hagan, Holly

    AU - Halasa, Yara

    AU - Hall, W

    AU - Haring, Diana

    AU - Maria Haro, Josep

    AU - Harrison, James

    AU - Havmoeller, Rasmus

    AU - Hay, Rodrick

    AU - Higashi, Hideki

    AU - Hill, Catherine

    AU - Hoen, Bruno

    AU - Hoffman, Howard

    AU - Hotez, Peter

    AU - Hoy, Damian

    AU - Huang, John

    AU - Ibeanusi, Sydney

    AU - Jacobsen, Kathryn

    AU - James, Spencer

    AU - Jarvis, Deborah

    AU - Jasrasaria, Rashmi

    AU - Jayaraman, Sudha

    AU - Johns, Nicole

    AU - Jonas, Jost

    AU - Karthikeyan, Ganesan

    AU - Kassebaum, Nicholas

    AU - Kawakami, Norito

    AU - Keren, Andre

    AU - Khoo, Jon-Paul

    AU - King, Charles

    AU - Knowlton, Lisa Marie

    AU - Kobusingye, Olive

    AU - Koranteng, Adofo

    AU - Krisnamurthi, Rita

    AU - Laden, Francine

    AU - Lalloo, Ratilal

    AU - Laslett, Laura

    AU - Lathlean, Tim

    AU - Leasher, Janet

    AU - Yi Lee, Yong

    AU - Leigh, James

    AU - Levinson, Daphna

    AU - Lim, Stephen

    AU - Limb, Elizabeth

    AU - Lin, John Kent

    AU - Lipnick, Michael

    AU - Lipshultz, Steven

    AU - Liu, W

    AU - Loane, Maria

    AU - Ohno, Summer

    AU - Lyons, Ronan

    AU - Mabweijano, Jacqueline

    AU - MacIntyre, Michael

    AU - Malekzadeh, Reza

    AU - Mallinger, Leslie

    AU - Manivannan, Sivabalan

    AU - Marcenes, Wagner

    AU - March, Lyn

    AU - Margolis, David

    AU - MARKS, G

    AU - Marks, Robin

    AU - Matsumori, Akira

    AU - Matzopoulos, Richard

    AU - Mayosi, Bongani

    AU - McAnulty, John

    AU - McDermott, Mary

    AU - McGill, Neil

    AU - McGrath, John

    AU - Medina-Mora, Maria Elena

    AU - Meltzer, Michele

    AU - Menash, George

    AU - Merriman, Tony

    AU - Meyer, Ana-Claire

    AU - Miglioli, Valeria

    AU - Miller, Matthew

    AU - Miller, Ted

    AU - Mitchell, Philip

    AU - Mock, Charles

    AU - Mocumbi, Ana Olga

    AU - Moffitt, Terrie

    AU - Mokdad, Ali A

    AU - Monasta, Lorenzo

    AU - Montico, Marcella

    AU - Moradi-Lakeh, Maziar

    AU - Moran, Andrew

    AU - Morawska, Lidia

    AU - Mori, Rintaro

    AU - Murdoch, Michele

    AU - Mwaniki, Michael

    AU - Naidoo, Kovin

    AU - Nair, M Nathan

    AU - Naldi, Luigi

    AU - Narayan, KM Venkat

    AU - Nelson, Paul

    AU - Nelson, Robert

    AU - Nevitt, Michael

    AU - Newton, Charles

    AU - Nolte, Sandra

    AU - Norman, Paul

    AU - Norman, Rosana

    AU - O'Donnell, Martin

    AU - O'Hanlon, Simon

    AU - Olives, Casey

    AU - Omer, Saad

    AU - Ortblad, Katrina

    AU - Osborne, Richard

    AU - Ozgediz, Doruk

    AU - Page, Andrew

    AU - Pahari, Bishnu

    AU - Pandian, Jeyaraj Durai

    AU - Rivero, Andrea Panozo

    AU - Patten, Scott

    AU - Pearce, Neil

    AU - Perez Padilla, Rogelio

    AU - Perez-Ruiz, Fernando

    AU - Perico, Norberto

    AU - Pesudovs, Konrad

    AU - Phillips, David

    AU - Phillips, Michael

    AU - Pierce, Kelsey

    AU - Pion, Sebastien

    AU - Polanczyk, Guilherme

    AU - Polinder, Suzanne

    AU - Pope III, C Arden

    AU - Popova, Svetlana

    AU - Porrini, Esteban

    AU - Pourmalek, Farshad

    AU - Prince, Martin

    AU - Pullan, Rachel

    AU - Ramaiah, Kapa

    AU - Ranganathan, Dharani

    AU - Razavi, Homie

    AU - Regan, Mathilda

    AU - Rehm, Jurgen

    AU - Rein, David B

    AU - Remuzzi, Guiseppe

    AU - Richardson, Kathryn

    AU - Rivara, Fredrick

    AU - Roberts, Thomas

    AU - ROBINSON, C

    AU - Rodriguez De Leon, Felipe

    AU - Ronfani, Luca

    AU - Room, Robin

    AU - Rosenfeld, Lisa

    AU - Rushton, Lesley

    AU - Sacco, Ralph

    AU - Saha, Sukanta

    AU - Sampson, Uchechukwu

    AU - Sanchez-Riera, Lidia

    AU - Sanman, Ella

    AU - Schwebel, David

    AU - Scott, James graham

    AU - Segui-Gomez, Maria

    AU - Shahraz, Saeid

    AU - Shepard, Donald

    AU - Shin, Hwashin

    AU - Shivakoti, Rupak

    AU - Singh, David

    AU - Singh, Gitanjali

    AU - Singh, Jasvinder

    AU - Singleton, Jessica

    AU - Sleet, David

    AU - Sliwa, Karen

    AU - Smith, Emma

    AU - Smith, J L

    AU - Stapelberg, Nicolas

    AU - Steer, Andrew

    AU - Steiner, Timothy

    AU - Stolk, Wilma

    AU - Stovner, Lars Jacob

    AU - Sudfeld, Christopher

    AU - Syed, Sana

    AU - Tamburlini, Giorgio

    AU - Tavakkoli, Mohammad

    AU - Taylor, H

    AU - Taylor, Jennifer

    AU - Taylor, William

    AU - Thomas, Bernadette

    AU - Thomson, W Murray

    AU - Thurston, George

    AU - Tleyjeh, Imad

    AU - Tonelli, Marcello

    AU - Towbin, Jeffrey

    AU - Truelsen, Thomas

    AU - Tsilimbaris, Miltiadis

    AU - Ubeda, Clotilde

    AU - Undurraga, Eduardo

    AU - van der Werf, Marieke

    AU - van Os, Jim

    AU - Vavilala, Monica

    AU - Venketasubramanian, N

    AU - Wang, Mengru

    AU - Wang, Wenzhi

    AU - Watt, Kerrianne

    AU - Weatherall, David

    AU - Weinstock, Martin

    AU - Weintraub, Robert

    AU - Weisskopf, Marc

    AU - Weissman, Myrna

    AU - White, Richard

    AU - Whiteford, Harvey

    AU - Wiebe, Natasha

    AU - Wiersma, Steven

    AU - Wilkinson, J

    AU - Williams, Hywel

    AU - Williams, Sean

    AU - Witt, Emma

    AU - Wolfe, Frederick

    AU - Woolf, Anthony

    AU - Wulf, Sarah

    AU - Yeh, Pon-Hsiu

    AU - Zaidi, Anita

    AU - Zheng, Zhi-Jie

    AU - Zonies, David

    AU - Lopez, Alan

    PY - 2012

    Y1 - 2012

    N2 - Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.

    AB - Background: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. Methods: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Findings: Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Interpretation: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.

    KW - acquired immune deficiency syndrome

    KW - adolescent

    KW - adult

    KW - aged

    KW - article

    KW - cerebrovascular accident

    KW - child

    KW - communicable disease

    KW - death

    KW - diarrhea

    KW - disability

    KW - diseases

    KW - female

    KW - health status

    KW - human

    KW - Human immunodeficiency virus infection

    KW - injury

    KW - ischemic heart disease

    KW - life expectancy

    KW - major clinical study

    KW - major depression

    KW - male

    KW - maternal disease

    KW - mortality

    KW - newborn disease

    KW - nutritional disorder

    KW - priority journal

    KW - quality adjusted life year

    KW - respiratory tract infection

    KW - school child

    KW - age

    KW - health

    KW - infant

    KW - middle aged

    KW - newborn

    KW - preschool child

    KW - prevalence

    KW - sex difference

    KW - statistics

    KW - very elderly

    KW - young adult

    KW - consultation

    KW - disability adjusted life year

    KW - non communicable disease

    KW - quality of life

    KW - Adolescent

    KW - Adult

    KW - Age Factors

    KW - Aged

    KW - Aged, 80 and over

    KW - Child

    KW - Child, Preschool

    KW - Female

    KW - Health Status

    KW - Humans

    KW - Infant

    KW - Infant, Newborn

    KW - Male

    KW - Middle Aged

    KW - Prevalence

    KW - Quality-Adjusted Life Years

    KW - Sex Factors

    KW - World Health

    KW - Wounds and Injuries

    KW - Young Adult

    U2 - 10.1016/S0140-6736(12)61689-4

    DO - 10.1016/S0140-6736(12)61689-4

    M3 - Article

    VL - 380

    SP - 2197

    EP - 2223

    JO - Lancet

    JF - Lancet

    SN - 0140-6736

    IS - 9859

    ER -