%0 Journal Article %J JAMA Oncol %D 2015 %T The Global Burden of Cancer 2013. %A Fitzmaurice, Christina %A Dicker, Daniel %A Pain, Amanda %A Hamavid, Hannah %A Moradi-Lakeh, Maziar %A MacIntyre, Michael F %A Allen, Christine %A Hansen, Gillian %A Woodbrook, Rachel %A Wolfe, Charles %A Hamadeh, Randah R %A Moore, Ami %A Werdecker, Andrea %A Gessner, Bradford D %A Te Ao, Braden %A McMahon, Brian %A Karimkhani, Chante %A Yu, Chuanhua %A Cooke, Graham S %A Schwebel, David C %A Carpenter, David O %A Pereira, David M %A Nash, Denis %A Kazi, Dhruv S %A De Leo, Diego %A Plass, Dietrich %A Ukwaja, Kingsley N %A Thurston, George D %A Yun Jin, Kim %A Simard, Edgar P %A Mills, Edward %A Park, Eun-Kee %A Catalá-López, Ferrán %A deVeber, Gabrielle %A Gotay, Carolyn %A Khan, Gulfaraz %A Hosgood, H Dean %A Santos, Itamar S %A Leasher, Janet L %A Singh, Jasvinder %A Leigh, James %A Jonas, Jost %A Sanabria, Juan %A Beardsley, Justin %A Jacobsen, Kathryn H %A Takahashi, Ken %A Franklin, Richard C %A Ronfani, Luca %A Montico, Marcella %A Naldi, Luigi %A Tonelli, Marcello %A Geleijnse, Johanna %A Petzold, Max %A Shrime, Mark G %A Younis, Mustafa %A Yonemoto, Naohiro %A Breitborde, Nicholas %A Yip, Paul %A Pourmalek, Farshad %A Lotufo, Paulo A %A Esteghamati, Alireza %A Hankey, Graeme J %A Ali, Raghib %A Lunevicius, Raimundas %A Malekzadeh, Reza %A Dellavalle, Robert %A Weintraub, Robert %A Lucas, Robyn %A Hay, Roderick %A Rojas-Rueda, David %A Westerman, Ronny %A Sepanlou, Sadaf G %A Nolte, Sandra %A Patten, Scott %A Weichenthal, Scott %A Abera, Semaw Ferede %A Fereshtehnejad, Seyed-Mohammad %A Shiue, Ivy %A Driscoll, Tim %A Vasankari, Tommi %A Alsharif, Ubai %A Rahimi-Movaghar, Vafa %A Vlassov, Vasiliy V %A Marcenes, W S %A Mekonnen, Wubegzier %A Melaku, Yohannes Adama %A Yano, Yuichiro %A Artaman, Al %A Campos, Ismael %A MacLachlan, Jennifer %A Mueller, Ulrich %A Kim, Daniel %A Trillini, Matias %A Eshrati, Babak %A Williams, Hywel C %A Shibuya, Kenji %A Dandona, Rakhi %A Murthy, Kinnari %A Cowie, Benjamin %A Amare, Azmeraw T %A Antonio, Carl Abelardo %A Castañeda-Orjuela, Carlos %A van Gool, Coen H %A Violante, Francesco %A Oh, In-Hwan %A Deribe, Kedede %A Soreide, Kjetil %A Knibbs, Luke %A Kereselidze, Maia %A Green, Mark %A Cárdenas, Rosario %A Roy, Nobhojit %A Tillman, Taavi %A Li, Yongmei %A Krueger, Hans %A Monasta, Lorenzo %A Dey, Subhojit %A Sheikhbahaei, Sara %A Hafezi-Nejad, Nima %A Kumar, G Anil %A Sreeramareddy, Chandrashekhar T %A Dandona, Lalit %A Wang, Haidong %A Vollset, Stein Emil %A Mokdad, Ali %A Salomon, Joshua A %A Lozano, Rafael %A Vos, Theo %A Forouzanfar, Mohammad %A Lopez, Alan %A Murray, Christopher %A Naghavi, Mohsen %X

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.

OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.

EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.

FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.

CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

%B JAMA Oncol %V 1 %P 505-27 %8 2015 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26181261?dopt=Abstract %R 10.1001/jamaoncol.2015.0735 %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