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. 2024 May 18;403(10440):2133-2161.
doi: 10.1016/S0140-6736(24)00757-8. Epub 2024 Apr 17.

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Collaborators

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Diseases and Injuries Collaborators. Lancet. .

Abstract

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

Findings: Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from King Edward Medical University including study material, research articles, valid data sources and authentic real time information for this manuscript; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, University of Massachusetts, KEMCAANA, KEMCA-UK Scientific Conferences and Webinars; support for attending meetings and/or travel from King Edward Medical University to attend meetings; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Ethical Review Board, as well as Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Pakistan Association of Medical Editors, Fellow of Faculty of Public Health Royal Colleges UK (FFPH), and Society of Prevention, Advocacy And Research, King Edward Medical University (SPARK); and other support as Dean of Public Health and Preventive Medicine at King Edward Medical University, as the Chief Editor Annals of King Edward Medical University, as the Director of Quality Enhancement Cell King Edward Medical University, as an international-level Fellow of Faculty of Public Health UK, as an Advisory Board Member and Chair Scientific Session KEMCA-UK, as a Chairperson of KEMCAANA (the International Scientific Conference), as a national-level member on the Research and Publications Higher Education Commission (HEC Pakistan), as a member of the Research and Journals Committee (Pakistan) the Medical and Dental Council (Pakistan), the National Bioethics Committee (Pakistan), the Corona Experts Advisory Group (Punjab), the Chair of the Dengue Experts Advisory Group, and a member of the Punjab Residency Program Research Committee; all outside the submitted work. R Ancuceanu reports consulting fees from AbbVie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Sandoz, and B. Braun; all outside the submitted work. D B Anderson reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with PM&R journal as Senior Editor, which includes an annual stipend, outside the submitted work. P Atorkey reports infrastructure support for the present manuscript from the Australian College of Applied Professions, Discipline of Psychological Sciences, Sydney, Australia and the School of Medicine and Public Health, The University of Newcastle, Australia. J L Baker reports grants paid to their institution from Novo Nordisk Foundation, World Cancer Research Fund, Independent Research Council Denmark, and EU Horizon; consulting fees from Novo Nordisk Denmark A/S; unpaid leadership or fiduciary role in other board, society, committee or advocacy group with European Association for the Study of Obesity; all outside the submitted work. S Barteit reports research grants from the Carl-Zeiss Foundation and the German Research Foundation (DFG); stock or stock options from CHEERS company, a for-profit company focusing on climate change and health evaluation and response systems; all outside the submitted work. M L Bell reports grants or contracts paid to their institution from US Environmental Protection Agency (EPA), US National Institutes of Health (NIH), High Tide Foundation, Health Effects Institute, Yale Women Faculty Forum, Environmental Defense Fund, Wellcome Trust Foundation, Yale Climate Change and Health Center, Robert Wood Johnson Foundation, and Hutchinson Postdoctoral Fellowship; consulting fees from Clinique and SciQuest; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, Organization of Teratology Information Specialists, University of Pennsylvania, and Boston University for speaking events, IOP Publishing for editorial duties, NIH, Health Canada, PAC-10, UK Research and Innovation, and AXA Research Fund Fellowship for grant review, Korea University for adjunct teaching/research, Harvard University and University of Montana for external advisory committee membership; support for travel from Colorado School of Public Health, University of Texas, Duke University, Boston University, University of Pennsylvania, Harvard University, American Journal of Public Health, and Columbia University; paid leadership or fiduciary roles in board, society, committee or advocacy groups, with US EPA Clean Air Scientific Advisory Committee (CASAC), and unpaid roles with Johns Hopkins EHE Advisory Board, Harvard external advisory committee for training grant, WHO Global Air Pollution and Health Technical Advisory Group, National Academies Panels and Committees; all outside the submitted work. P J G Bettencourt reports patents planned, issued or pending WO2020229805A1, BR112021022592A2, EP3965809A1, OA1202100511, US2023173050A1, EP4265271A2 and EP4275700A2; other interests as project reviewer at Botnar Foundation; all outside the submitted work. 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B Bikbov reports grants or contracts from European Commission and University of Rome; support for attending meetings and/or travel from European Renal Association via reimbursement of hotel stay for congress lecturers; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with Advocacy Group, International Society of Nephrology and Western Europe Regional Board, International Society of Nephrology; other non-financial support from Scientific-Tools.Org for a public health consultancy; all outside the submitted work. M Carvalho reports other support from The Laboratório Associado para a Química Verde (LAQV/REQUIMTE), University of Porto, Porto, Portugal, and Foundation for Science and Technology (FCT) and the Portuguese Ministry of Science, Technology, and Higher Education (MCTES) under the scope of the project UIDP/50006/2020 (DOI 10.54499/UIDP/50006/2020), outside the submitted work. 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S Das reports unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with Association for Diagnostics & Laboratory Medicine (ADLM) India Section as Program Chair, Clinical & Laboratory Standards Institute (CLSI) nominating committee as a member, Women in Global Health India as a member; all outside the submitted work. L Degenhardt reports untied educational grants to examine new opioid medications in Australia from Indivior and Seqirus, outside the submitted work. A K Demetriades reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid, with AO Knowledge Forum Degen as Steering Committee Member, Global Neuro Foundation as Board Member, and European Association of Neurosurgical Societies (EANS) as Board Member/Officer; all outside the submitted work. A Faro reports support for the present manuscript from the National Council for Scientific and Technological Development, CNPq, Brazil. 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B M Schaarschmidt reports research grants from Else Kröner-Fresenius Foundatuin, DFG, and PharmaCept; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca; support for attending meetings and/or travel from Bayer AG; all outside the submitted work. S Setoguchi reports grants or contracts paid to their institution from NIH, Cystic Fibrosis Foundation, Pfizer Inc, Daiichi Sankyo, and Bristol Myers Squibb; consulting fees from Pfizer Japan, Merck Inc, Bristol Myers Squibb, and Regeneron for providing scientific advise on study design and analytic approaches for validation studies, post-market safety studies and pre-market studies for medications and medical conditions; all outside the submitted work. A Sharifan reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid with Cochrane as a steering member of the Cochrane Early Career Professionals Network; and receipt of 30 days of complimentary access to ScienceDirect, Scopus, Reaxys, and Geofacets after reviewing manuscripts for two journals published by Elsevier; outside the submitted work. S Sharma reports support for the present manuscript from the John J Bonica Postdoctoral Fellowship from the International Association for the Study of Pain (IASP; 2021-2023); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events and a travel grant for delivering a talk on “Technologies for pain education in developing countries” conducted by the Pain Education SIG of the IASP at the World Pain Congress in Toronto (2022); outside the submitted work. V Sharma reports other financial or non-financial support from DFSS (MHA)'s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, outside the submitted work. V Shivarov reports one patent and one utility model with the Bulgarian Patent Office; stock or stock options from ICONplc (RSUs); and other financial interests from an ICONplc salary; all outside the submitted work. S Shrestha reports other financial interests from the Graduate Research Merit Scholarship from the School of Pharmacy at Monash University Malaysia, outside the submitted work. J P Silva reports support for the present manuscript from the Portuguese Foundation for Science and Technology through payment of their salary (contract with reference 2021.01789.CEECIND/CP1662/CT0014). C R Simpson reports grants or contracts from MBIE (New Zealand), HRC (New Zealand), Ministry of Health (New Zealand), Medical Research Council (UK), and Chief Scientist Office (UK); leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid with the New Zealand Government Data Ethics Advisory Group as the Chair; outside the submitted work. J A Singh reports consulting fees from AstraZeneca, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications; and the NIH and the American College of Rheumatology; payment for lectures, presentations, speakers bureaus, manuscript writing, or educational events as a member of the speaker's bureau of Simply Speaking; support for attending meetings and/or travel as a past steering committee member of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board with the US Food and Drug Administration Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committees or advocacy group, paid or unpaid, as a past steering committee member of the OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, Co-Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, and Charlotte's Web Holdings Inc, and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; outside the submitted work. S T Skou reports grants or contracts from European Research Council paid to their university from the EU's Horizon 2020 research innovation program (grant agreement No 801790), EU's Horizon 2020 research innovation program paid to their hospital (grant agreement No 945377), and Region Zealand paid to their hospital; royalties or licenses from Munksgaard for book chapters and TrustMe-Ed for online lectures; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Nestlé Health Science for a presentation at a webinar on osteoarthritis; participation on a Data Safety Monitoring Board or Advisory Board, paid or unpaid, with UK-based National Institute for Health and Care Research (NIHR)-funded trial PERFORM: Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity, NIHR 202020); other support as co-founder of GLA:D, a not-for profit initiative hosted at University of Southern Denmark; all outside the submitted work. D J Stein reports consulting fees from Discovery Vitality, Johnson & Johnson, Kanna, L'Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda, and Vistagen, outside the submitted work. A P Stoian reports consulting fees paid to their institution from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Novartis, Sandoz, Sanofi, and Servier; payment or honoraria paid to their institution for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Novartis, Medochemie, Sandoz, Sanofi, and Servier; support for attending meetings and/or travel, paid to their institution, from Novo Nordisk, Medochemie, and Sanofi; participation on a Data Safety Monitoring Board or Advisory Board, paid to their institution, with AstraZeneca, Eli Lilly, Novo Nordisk, and Sanofi; leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid, with Central European Diabetes Association (CEDA) and Association for Renal-Metabolic & Nutritional Studies (ASRMN); receipt of medical writing (unpaid) from Novo Nordisk and Sanofi; all outside the submitted work. C K Suemoto reports grants or contracts Alzheimer's Association and São Paulo Research Foundation (FAPESP), paid to their institution, and CNPq, paid to them; support for attending meetings and/or travel from Alzheimer's Association; leadership or fiduciary roles in other board, society, committee, or advocacy group, unpaid, with Brazilian Society of Geriatrics and Gerontology; all outside the submitted work. J H V Ticoalu reports a leadership or fiduciary role in other board, society, committee or advocacy group with Benang Merah Research Center as Co-founder, outside the submitted work. S J Tromans reports grants or contracts from the 2023 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England. This is a contracted study from NHS Digital, via the Department of Health and Social Care; outside the submitted work. P Willeit reports consulting fees from Novartis; outside the submitted work. A Wimo reports grants or contracts from VINNOVA program: PREDEM, EU-project JPND: ADDITION, EU-project JPND: EURO-FINGER, EU-project IHI: PROMINENT, EU-project JPND: PMI-AD, and EU-project H2020: PRODEMOS; royalties or licenses as license holder of RUD-instrument (part); leadership or fiduciary roles in other board, society, committee, or advocacy group, unpaid, with ADI: MSAP; all outside the submitted work. M Zielińska reports other financial interest as an AstraZeneca employee, outside the submitted work. A Zumla reports grants or contracts from The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme, UK NIHR Senior Investigator, and Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate; participation on a Data Safety Monitoring Board or Advisory Board member of the WHO Mass Gatherings Expert Group and WHO Health Emergencies Programme in Geneva, a member of the EU-EDCTP3-Global Health (Brussells) Scientific Committee; all outside the submitted work.

Figures

Figure 1
Figure 1
Leading 25 Level 3 causes of global DALYs in 2010, 2020, and 2021, for both sexes combined, and all ages Causes are connected by lines between time periods, where solid lines represent an increase or no change in rank and dashed lines represent a decrease in rank. Faded colours indicate that the cause is not within the top 25 causes of DALYs for that year. Data in parentheses are 95% uncertainty intervals. COPD=chronic obstructive pulmonary disease. DALY=disability-adjusted life-year.
Figure 2
Figure 2
The distribution of global DALYs by age and sex for Level 2 causes, COVID-19, and other COVID-19 pandemic-related outcomes in 2021 DALY=disability-adjusted life-year.
Figure 3
Figure 3
Age-specific DALY rates for Level 1 causes of communicable, maternal, neonatal, and nutritional diseases (A), non-communicable diseases (B), and injuries (C), by age, sex, year, and SDI quintile The y-axis shows DALYs per 100 000 population on a logarithmic scale. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
Figure 4
Figure 4
Leading ten Level 3 causes of DALYs in 2021 by SDI quintile, region, super-region, and annualised rate of change between 2010 and 2021 Level 3 causes are ranked by attributable DALYs from left (first) to right (tenth) for each GBD region and SDI quintile, with GBD super-regions in bold. Leading ten Level 3 causes of DALYs are ranked according to 2021 DALYs counts. COPD=chronic obstructive pulmonary disease. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
Figure 5
Figure 5
Leading Level 3 causes of age-standardised DALY rates by location, all ages, both sexes, in 2021 Dotted lines indicate disputed territories. DALY=disability-adjusted life-year.

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