%0 Journal Article %J Lancet %D 2015 %T Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. %A Murray, Christopher J L %A Barber, Ryan M %A Foreman, Kyle J %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Jerry P %A Abubakar, Ibrahim %A Abu-Raddad, Laith J %A Abu-Rmeileh, Niveen M %A Achoki, Tom %A Ackerman, Ilana N %A Ademi, Zanfina %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Alla, François %A Allebeck, Peter %A AlMazroa, Mohammad A %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amare, Azmeraw T %A Ameh, Emmanuel A %A Amini, Heresh %A Ammar, Walid %A Anderson, H Ross %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsic Arsenijevic, Valentina S %A Artaman, Al %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Avila, Marco A %A Awuah, Baffour %A Bachman, Victoria F %A Badawi, Alaa %A Bahit, Maria C %A Balakrishnan, Kalpana %A Banerjee, Amitava %A Barker-Collo, Suzanne L %A Barquera, Simon %A Barregard, Lars %A Barrero, Lope H %A Basu, Arindam %A Basu, Sanjay %A Basulaiman, Mohammed O %A Beardsley, Justin %A Bedi, Neeraj %A Beghi, Ettore %A Bekele, Tolesa %A Bell, Michelle L %A Benjet, Corina %A Bennett, Derrick A %A Bensenor, Isabela M %A Benzian, Habib %A Bernabe, Eduardo %A Bertozzi-Villa, Amelia %A Beyene, Tariku J %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Bienhoff, Kelly %A Bikbov, Boris %A Biryukov, Stan %A Blore, Jed D %A Blosser, Christopher D %A Blyth, Fiona M %A Bohensky, Megan A %A Bolliger, Ian W %A Bora Başara, Berrak %A Bornstein, Natan M %A Bose, Dipan %A Boufous, Soufiane %A Bourne, Rupert R A %A Boyers, Lindsay N %A Brainin, Michael %A Brayne, Carol E %A Brazinova, Alexandra %A Breitborde, Nicholas J K %A Brenner, Hermann %A Briggs, Adam D %A Brooks, Peter M %A Brown, Jonathan C %A Brugha, Traolach S %A Buchbinder, Rachelle %A Buckle, Geoffrey C %A Budke, Christine M %A Bulchis, Anne %A Bulloch, Andrew G %A Campos-Nonato, Ismael R %A Carabin, Hélène %A Carapetis, Jonathan R %A Cárdenas, Rosario %A Carpenter, David O %A Caso, Valeria %A Castañeda-Orjuela, Carlos A %A Castro, Ruben E %A Catalá-López, Ferrán %A Cavalleri, Fiorella %A Cavlin, Alanur %A Chadha, Vineet K %A Chang, Jung-Chen %A Charlson, Fiona J %A Chen, Honglei %A Chen, Wanqing %A Chiang, Peggy P %A Chimed-Ochir, Odgerel %A Chowdhury, Rajiv %A Christensen, Hanne %A Christophi, Costas A %A Cirillo, Massimo %A Coates, Matthew M %A Coffeng, Luc E %A Coggeshall, Megan S %A Colistro, Valentina %A Colquhoun, Samantha M %A Cooke, Graham S %A Cooper, Cyrus %A Cooper, Leslie T %A Coppola, Luis M %A Cortinovis, Monica %A Criqui, Michael H %A Crump, John A %A Cuevas-Nasu, Lucia %A Danawi, Hadi %A Dandona, Lalit %A Dandona, Rakhi %A Dansereau, Emily %A Dargan, Paul I %A Davey, Gail %A Davis, Adrian %A Davitoiu, Dragos V %A Dayama, Anand %A De Leo, Diego %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Dellavalle, Robert P %A Deribe, Kebede %A Derrett, Sarah %A Des Jarlais, Don C %A Dessalegn, Muluken %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Diaz-Torné, Cesar %A Dicker, Daniel %A Ding, Eric L %A Dokova, Klara %A Dorsey, E Ray %A Driscoll, Tim R %A Duan, Leilei %A Duber, Herbert C %A Ebel, Beth E %A Edmond, Karen M %A Elshrek, Yousef M %A Endres, Matthias %A Ermakov, Sergey P %A Erskine, Holly E %A Eshrati, Babak %A Esteghamati, Alireza %A Estep, Kara %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fay, Derek F %A Feigin, Valery L %A Felson, David T %A Fereshtehnejad, Seyed-Mohammad %A Fernandes, Jefferson G %A Ferrari, Alize J %A Fitzmaurice, Christina %A Flaxman, Abraham D %A Fleming, Thomas D %A Foigt, Nataliya %A Forouzanfar, Mohammad H %A Fowkes, F Gerry R %A Paleo, Urbano Fra %A Franklin, Richard C %A Fürst, Thomas %A Gabbe, Belinda %A Gaffikin, Lynne %A Gankpé, Fortuné G %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gething, Peter %A Gibney, Katherine B %A Giroud, Maurice %A Giussani, Giorgia %A Gomez Dantes, Hector %A Gona, Philimon %A Gonzalez-Medina, Diego %A Gosselin, Richard A %A Gotay, Carolyn C %A Goto, Atsushi %A Gouda, Hebe N %A Graetz, Nicholas %A Gugnani, Harish C %A Gupta, Rahul %A Gupta, Rajeev %A Gutiérrez, Reyna A %A Haagsma, Juanita %A Hafezi-Nejad, Nima %A Hagan, Holly %A Halasa, Yara A %A Hamadeh, Randah R %A Hamavid, Hannah %A Hammami, Mouhanad %A Hancock, Jamie %A Hankey, Graeme J %A Hansen, Gillian M %A Hao, Yuantao %A Harb, Hilda L %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hay, Roderick J %A Heredia-Pi, Ileana B %A Heuton, Kyle R %A Heydarpour, Pouria %A Higashi, Hideki %A Hijar, Martha %A Hoek, Hans W %A Hoffman, Howard J %A Hosgood, H Dean %A Hossain, Mazeda %A Hotez, Peter J %A Hoy, Damian G %A Hsairi, Mohamed %A Hu, Guoqing %A Huang, Cheng %A Huang, John J %A Husseini, Abdullatif %A Huynh, Chantal %A Iannarone, Marissa L %A Iburg, Kim M %A Innos, Kaire %A Inoue, Manami %A Islami, Farhad %A Jacobsen, Kathryn H %A Jarvis, Deborah L %A Jassal, Simerjot K %A Jee, Sun Ha %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jiang, Ying %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Karch, André %A Karema, Corine K %A Karimkhani, Chante %A Karthikeyan, Ganesan %A Kassebaum, Nicholas J %A Kaul, Anil %A Kawakami, Norito %A Kazanjan, Konstantin %A Kemp, Andrew H %A Kengne, Andre P %A Keren, Andre %A Khader, Yousef S %A Khalifa, Shams Eldin A %A Khan, Ejaz A %A Khan, Gulfaraz %A Khang, Young-Ho %A Kieling, Christian %A Kim, Daniel %A Kim, Sungroul %A Kim, Yunjin %A Kinfu, Yohannes %A Kinge, Jonas M %A Kivipelto, Miia %A Knibbs, Luke D %A Knudsen, Ann Kristin %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Krishnaswami, Sanjay %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kuipers, Ernst J %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kyu, Hmwe H %A Lai, Taavi %A Lalloo, Ratilal %A Lallukka, Tea %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larsson, Anders %A Lawrynowicz, Alicia E B %A Leasher, Janet L %A Leigh, James %A Leung, Ricky %A Levitz, Carly E %A Li, Bin %A Li, Yichong %A Li, Yongmei %A Lim, Stephen S %A Lind, Maggie %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Lofgren, Katherine T %A Logroscino, Giancarlo %A Looker, Katharine J %A Lortet-Tieulent, Joannie %A Lotufo, Paulo A %A Lozano, Rafael %A Lucas, Robyn M %A Lunevicius, Raimundas %A Lyons, Ronan A %A Ma, Stefan %A MacIntyre, Michael F %A Mackay, Mark T %A Majdan, Marek %A Malekzadeh, Reza %A Marcenes, Wagner %A Margolis, David J %A Margono, Christopher %A Marzan, Melvin B %A Masci, Joseph R %A Mashal, Mohammad T %A Matzopoulos, Richard %A Mayosi, Bongani M %A Mazorodze, Tasara T %A Mcgill, Neil W %A McGrath, John J %A McKee, Martin %A McLain, Abigail %A Meaney, Peter A %A Medina, Catalina %A Mehndiratta, Man Mohan %A Mekonnen, Wubegzier %A Melaku, Yohannes A %A Meltzer, Michele %A Memish, Ziad A %A Mensah, George A %A Meretoja, Atte %A Mhimbira, Francis A %A Micha, Renata %A Miller, Ted R %A Mills, Edward J %A Mitchell, Philip B %A Mock, Charles N %A Mohamed Ibrahim, Norlinah %A Mohammad, Karzan A %A Mokdad, Ali H %A Mola, Glen L D %A Monasta, Lorenzo %A Montañez Hernandez, Julio C %A Montico, Marcella %A Montine, Thomas J %A Mooney, Meghan D %A Moore, Ami R %A Moradi-Lakeh, Maziar %A Moran, Andrew E %A Mori, Rintaro %A Moschandreas, Joanna %A Moturi, Wilkister N %A Moyer, Madeline L %A Mozaffarian, Dariush %A Msemburi, William T %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Mullany, Erin C %A Murdoch, Michele E %A Murray, Joseph %A Murthy, Kinnari S %A Naghavi, Mohsen %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nand, Devina %A Nangia, Vinay %A Narayan, K M Venkat %A Nejjari, Chakib %A Neupane, Sudan P %A Newton, Charles R %A Ng, Marie %A Ngalesoni, Frida N %A Nguyen, Grant %A Nisar, Muhammad I %A Nolte, Sandra %A Norheim, Ole F %A Norman, Rosana E %A Norrving, Bo %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Ohno, Summer L %A Olusanya, Bolajoko O %A Opio, John Nelson %A Ortblad, Katrina %A Ortiz, Alberto %A Pain, Amanda W %A Pandian, Jeyaraj D %A Panelo, Carlo Irwin A %A Papachristou, Christina %A Park, Eun-Kee %A Park, Jae-Hyun %A Patten, Scott B %A Patton, George C %A Paul, Vinod K %A Pavlin, Boris I %A Pearce, Neil %A Pereira, David M %A Perez-Padilla, Rogelio %A Perez-Ruiz, Fernando %A Perico, Norberto %A Pervaiz, Aslam %A Pesudovs, Konrad %A Peterson, Carrie B %A Petzold, Max %A Phillips, Michael R %A Phillips, Bryan K %A Phillips, David E %A Piel, Frédéric B %A Plass, Dietrich %A Poenaru, Dan %A Polinder, Suzanne %A Pope, Daniel %A Popova, Svetlana %A Poulton, Richie G %A Pourmalek, Farshad %A Prabhakaran, Dorairaj %A Prasad, Noela M %A Pullan, Rachel L %A Qato, Dima M %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahman, Sajjad U %A Raju, Murugesan %A Rana, Saleem M %A Razavi, Homie %A Reddy, K Srinath %A Refaat, Amany %A Remuzzi, Giuseppe %A Resnikoff, Serge %A Ribeiro, Antonio L %A Richardson, Lee %A Richardus, Jan Hendrik %A Roberts, D Allen %A Rojas-Rueda, David %A Ronfani, Luca %A Roth, Gregory A %A Rothenbacher, Dietrich %A Rothstein, David H %A Rowley, Jane T %A Roy, Nobhojit %A Ruhago, George M %A Saeedi, Mohammad Y %A Saha, Sukanta %A Sahraian, Mohammad Ali %A Sampson, Uchechukwu K A %A Sanabria, Juan R %A Sandar, Logan %A Santos, Itamar S %A Satpathy, Maheswar %A Sawhney, Monika %A Scarborough, Peter %A Schneider, Ione J %A Schöttker, Ben %A Schumacher, Austin E %A Schwebel, David C %A Scott, James G %A Seedat, Soraya %A Sepanlou, Sadaf G %A Serina, Peter T %A Servan-Mori, Edson E %A Shackelford, Katya A %A Shaheen, Amira %A Shahraz, Saeid %A Shamah Levy, Teresa %A Shangguan, Siyi %A She, Jun %A Sheikhbahaei, Sara %A Shi, Peilin %A Shibuya, Kenji %A Shinohara, Yukito %A Shiri, Rahman %A Shishani, Kawkab %A Shiue, Ivy %A Shrime, Mark G %A Sigfusdottir, Inga D %A Silberberg, Donald H %A Simard, Edgar P %A Sindi, Shireen %A Singh, Abhishek %A Singh, Jasvinder A %A Singh, Lavanya %A Skirbekk, Vegard %A Slepak, Erica Leigh %A Sliwa, Karen %A Soneji, Samir %A Søreide, Kjetil %A Soshnikov, Sergey %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stanaway, Jeffrey D %A Stathopoulou, Vasiliki %A Stein, Dan J %A Stein, Murray B %A Steiner, Caitlyn %A Steiner, Timothy J %A Stevens, Antony %A Stewart, Andrea %A Stovner, Lars J %A Stroumpoulis, Konstantinos %A Sunguya, Bruno F %A Swaminathan, Soumya %A Swaroop, Mamta %A Sykes, Bryan L %A Tabb, Karen M %A Takahashi, Ken %A Tandon, Nikhil %A Tanne, David %A Tanner, Marcel %A Tavakkoli, Mohammad %A Taylor, Hugh R %A Te Ao, Braden J %A Tediosi, Fabrizio %A Temesgen, Awoke M %A Templin, Tara %A Ten Have, Margreet %A Tenkorang, Eric Y %A Terkawi, Abdullah S %A Thomson, Blake %A Thorne-Lyman, Andrew L %A Thrift, Amanda G %A Thurston, George D %A Tillmann, Taavi %A Tonelli, Marcello %A Topouzis, Fotis %A Toyoshima, Hideaki %A Traebert, Jefferson %A Tran, Bach X %A Trillini, Matias %A Truelsen, Thomas %A Tsilimbaris, Miltiadis %A Tuzcu, Emin M %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Undurraga, Eduardo A %A Uzun, Selen B %A Van Brakel, Wim H %A van de Vijver, Steven %A van Gool, Coen H %A van Os, Jim %A Vasankari, Tommi J %A Venketasubramanian, N %A Violante, Francesco S %A Vlassov, Vasiliy V %A Vollset, Stein Emil %A Wagner, Gregory R %A Wagner, Joseph %A Waller, Stephen G %A Wan, Xia %A Wang, Haidong %A Wang, JianLi %A Wang, Linhong %A Warouw, Tati S %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Wenzhi, Wang %A Werdecker, Andrea %A Westerman, Ronny %A Whiteford, Harvey A %A Wilkinson, James D %A Williams, Thomas N %A Wolfe, Charles D %A Wolock, Timothy M %A Woolf, Anthony D %A Wulf, Sarah %A Wurtz, Brittany %A Xu, Gelin %A Yan, Lijing L %A Yano, Yuichiro %A Ye, Pengpeng %A Yentür, Gökalp K %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Zaki, Maysaa E %A Zhao, Yong %A Zheng, Yingfeng %A Zonies, David %A Zou, Xiaonong %A Salomon, Joshua A %A Lopez, Alan D %A Vos, Theo %K Aged %K Chronic Disease %K Communicable Diseases %K Female %K Global Health %K Health Transition %K Humans %K Life Expectancy %K Male %K Middle Aged %K Mortality, Premature %K Quality-Adjusted Life Years %K Socioeconomic Factors %K Wounds and Injuries %X

BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 386 %P 2145-91 %8 2015 Nov 28 %G eng %N 10009 %1 http://www.ncbi.nlm.nih.gov/pubmed/26321261?dopt=Abstract %R 10.1016/S0140-6736(15)61340-X %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Murray, Christopher J L %A Ortblad, Katrina F %A Guinovart, Caterina %A Lim, Stephen S %A Wolock, Timothy M %A Roberts, D Allen %A Dansereau, Emily A %A Graetz, Nicholas %A Barber, Ryan M %A Brown, Jonathan C %A Wang, Haidong %A Duber, Herbert C %A Naghavi, Mohsen %A Dicker, Daniel %A Dandona, Lalit %A Salomon, Joshua A %A Heuton, Kyle R %A Foreman, Kyle %A Phillips, David E %A Fleming, Thomas D %A Flaxman, Abraham D %A Phillips, Bryan K %A Johnson, Elizabeth K %A Coggeshall, Megan S %A Abd-Allah, Foad %A Abera, Semaw Ferede %A Abraham, Jerry P %A Abubakar, Ibrahim %A Abu-Raddad, Laith J %A Abu-Rmeileh, Niveen Me %A Achoki, Tom %A Adeyemo, Austine Olufemi %A Adou, Arsène Kouablan %A Adsuar, José C %A Agardh, Emilie Elisabet %A Akena, Dickens %A Al Kahbouri, Mazin J %A Alasfoor, Deena %A Albittar, Mohammed I %A Alcalá-Cerra, Gabriel %A Alegretti, Miguel Angel %A Alemu, Zewdie Aderaw %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Alla, François %A Allen, Peter J %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Amini, Hassan %A Ammar, Walid %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Ali %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Badawi, Alaa %A Balakrishnan, Kalpana %A Banerjee, Amitava %A Basu, Sanjay %A Beardsley, Justin %A Bekele, Tolesa %A Bell, Michelle L %A Bernabe, Eduardo %A Beyene, Tariku Jibat %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Abdulhak, Aref Bin %A Binagwaho, Agnes %A Blore, Jed D %A Basara, Berrak Bora %A Bose, Dipan %A Brainin, Michael %A Breitborde, Nicholas %A Castañeda-Orjuela, Carlos A %A Catalá-López, Ferrán %A Chadha, Vineet K %A Chang, Jung-Chen %A Chiang, Peggy Pei-Chia %A Chuang, Ting-Wu %A Colomar, Mercedes %A Cooper, Leslie Trumbull %A Cooper, Cyrus %A Courville, Karen J %A Cowie, Benjamin C %A Criqui, Michael H %A Dandona, Rakhi %A Dayama, Anand %A De Leo, Diego %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Deribe, Kebede %A Des Jarlais, Don C %A Dessalegn, Muluken %A Dharmaratne, Samath D %A Dilmen, Uğur %A Ding, Eric L %A Driscoll, Tim R %A Durrani, Adnan M %A Ellenbogen, Richard G %A Ermakov, Sergey Petrovich %A Esteghamati, Alireza %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fereshtehnejad, Seyed-Mohammad %A Fijabi, Daniel Obadare %A Forouzanfar, Mohammad H %A Fra Paleo, Urbano %A Gaffikin, Lynne %A Gamkrelidze, Amiran %A Gankpé, Fortuné Gbètoho %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gibney, Katherine B %A Ginawi, Ibrahim Abdelmageem Mohamed %A Glaser, Elizabeth L %A Gona, Philimon %A Goto, Atsushi %A Gouda, Hebe N %A Gugnani, Harish Chander %A Gupta, Rajeev %A Gupta, Rahul %A Hafezi-Nejad, Nima %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Hankey, Graeme J %A Harb, Hilda L %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hedayati, Mohammad T %A Pi, Ileana B Heredia %A Hoek, Hans W %A Hornberger, John C %A Hosgood, H Dean %A Hotez, Peter J %A Hoy, Damian G %A Huang, John J %A Iburg, Kim M %A Idrisov, Bulat T %A Innos, Kaire %A Jacobsen, Kathryn H %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Kankindi, Ida %A Karam, Nadim E %A Karch, André %A Karema, Corine Kakizi %A Kaul, Anil %A Kawakami, Norito %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre Pascal %A Keren, Andre %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz Ahmed %A Khang, Young-Ho %A Khonelidze, Irma %A Kinfu, Yohannes %A Kinge, Jonas M %A Knibbs, Luke %A Kokubo, Yoshihiro %A Kosen, S %A Defo, Barthelemy Kuate %A Kulkarni, Veena S %A Kulkarni, Chanda %A Kumar, Kaushalendra %A Kumar, Ravi B %A Kumar, G Anil %A Kwan, Gene F %A Lai, Taavi %A Balaji, Arjun Lakshmana %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larson, Heidi J %A Larsson, Anders %A Lee, Jong-Tae %A Leigh, James %A Leinsalu, Mall %A Leung, Ricky %A Li, Yichong %A Li, Yongmei %A de Lima, Graça Maria Ferreira %A Lin, Hsien-Ho %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Lotufo, Paulo A %A Machado, Vasco Manuel Pedro %A Maclachlan, Jennifer H %A Magis-Rodriguez, Carlos %A Majdan, Marek %A Mapoma, Christopher Chabila %A Marcenes, Wagner %A Marzan, Melvin Barrientos %A Masci, Joseph R %A Mashal, Mohammad Taufiq %A Mason-Jones, Amanda J %A Mayosi, Bongani M %A Mazorodze, Tasara T %A Mckay, Abigail Cecilia %A Meaney, Peter A %A Mehndiratta, Man Mohan %A Mejia-Rodriguez, Fabiola %A Melaku, Yohannes Adama %A Memish, Ziad A %A Mendoza, Walter %A Miller, Ted R %A Mills, Edward J %A Mohammad, Karzan Abdulmuhsin %A Mokdad, Ali H %A Mola, Glen Liddell %A Monasta, Lorenzo %A Montico, Marcella %A Moore, Ami R %A Mori, Rintaro %A Moturi, Wilkister Nyaora %A Mukaigawara, Mitsuru %A Murthy, Kinnari S %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nangia, Vinay %A Narayan, K M Venkat %A Nash, Denis %A Nejjari, Chakib %A Nelson, Robert G %A Neupane, Sudan Prasad %A Newton, Charles R %A Ng, Marie %A Nisar, Muhammad Imran %A Nolte, Sandra %A Norheim, Ole F %A Nowaseb, Vincent %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Olusanya, Bolajoko O %A Omer, Saad B %A Opio, John Nelson %A Orisakwe, Orish Ebere %A Pandian, Jeyaraj D %A Papachristou, Christina %A Caicedo, Angel J Paternina %A Patten, Scott B %A Paul, Vinod K %A Pavlin, Boris Igor %A Pearce, Neil %A Pereira, David M %A Pervaiz, Aslam %A Pesudovs, Konrad %A Petzold, Max %A Pourmalek, Farshad %A Qato, Dima %A Quezada, Amado D %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahimi-Movaghar, Vafa %A ur Rahman, Sajjad %A Raju, Murugesan %A Rana, Saleem M %A Razavi, Homie %A Reilly, Robert Quentin %A Remuzzi, Giuseppe %A Richardus, Jan Hendrik %A Ronfani, Luca %A Roy, Nobhojit %A Sabin, Nsanzimana %A Saeedi, Mohammad Yahya %A Sahraian, Mohammad Ali %A Samonte, Genesis May J %A Sawhney, Monika %A Schneider, Ione J C %A Schwebel, David C %A Seedat, Soraya %A Sepanlou, Sadaf G %A Servan-Mori, Edson E %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shiue, Ivy %A Shivakoti, Rupak %A Sigfusdottir, Inga Dora %A Silberberg, Donald H %A Silva, Andrea P %A Simard, Edgar P %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soneji, Samir %A Soshnikov, Sergey S %A Sreeramareddy, Chandrashekhar T %A Stathopoulou, Vasiliki Kalliopi %A Stroumpoulis, Konstantinos %A Swaminathan, Soumya %A Sykes, Bryan L %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Tenkorang, Eric Yeboah %A Terkawi, Abdullah Sulieman %A Thomson, Alan J %A Thorne-Lyman, Andrew L %A Towbin, Jeffrey A %A Traebert, Jefferson %A Tran, Bach X %A Dimbuene, Zacharie Tsala %A Tsilimbaris, Miltiadis %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Uzun, Selen Begüm %A Vallely, Andrew J %A Vasankari, Tommi J %A Venketasubramanian, N %A Violante, Francesco S %A Vlassov, Vasiliy Victorovich %A Vollset, Stein Emil %A Waller, Stephen %A Wallin, Mitchell T %A Wang, Linhong %A Wang, XiaoRong %A Wang, Yanping %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A White, Richard A %A Wilkinson, James D %A Williams, Thomas Neil %A Woldeyohannes, Solomon Meseret %A Wong, John Q %A Xu, Gelin %A Yang, Yang C %A Yano, Yuichiro %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhao, Yong %A Zheng, Yingfeng %A Zhou, Maigeng %A Zhu, Jun %A Zou, Xiao Nong %A Lopez, Alan D %A Vos, Theo %K Age Distribution %K Epidemics %K Female %K Global Health %K HIV Infections %K Humans %K Incidence %K Malaria %K Male %K Mortality %K Organizational Objectives %K Sex Distribution %K Tuberculosis %X

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.

METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.

FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.

INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 384 %P 1005-70 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/25059949?dopt=Abstract %R 10.1016/S0140-6736(14)60844-8