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Mokdad AH, Forouzanfar MH, Daoud F, Mokdad AA, El Bcheraoui C, Moradi-Lakeh M, Kyu HH, Barber RM, Wagner J, Cercy K, Kravitz H, Coggeshall M, Chew A, O'Rourke KF, Steiner C, Tuffaha M, Charara R, Al-Ghamdi EA, Adi Y, Afifi RA, Alahmadi H, AlBuhairan F, Allen N, AlMazroa M, Al-Nehmi AA, AlRayess Z, Arora M, Azzopardi P, Barroso C, Basulaiman M, Bhutta ZA, Bonell C, Breinbauer C, Degenhardt L, Denno D, Fang J, Fatusi A, Feigl AB, Kakuma R, Karam N, Kennedy E, Khoja TAM, Maalouf F, Obermeyer CM, Mattoo A, McGovern T, Memish ZA, Mensah GA, Patel V, Petroni S, Reavley N, Zertuche DR, Saeedi M, Santelli J, Sawyer SM, Ssewamala F, Taiwo K, Tantawy M, Viner RM, Waldfogel J, Zuñiga MP, Naghavi M, Wang H, Vos T, Lopez AD, Al Rabeeah AA, Patton GC, Murray CJL. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 387:2383-401. [PMID: 27174305 DOI: 10.1016/s0140-6736(16)00648-6] [Citation(s) in RCA: 590] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10-24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors. METHODS The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories. FINDINGS The leading causes of death in 2013 for young people aged 10-14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15-19 years (14·2%) and 20-24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20-24 years (17·1%) and the fourth highest for girls aged 15-19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15-19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20-24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20-24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20-24 years. Alcohol and drug use in those aged 10-24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs. INTERPRETATION Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | | | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Arwa A Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hmwe Hmwe Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ryan M Barber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Wagner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hannah Kravitz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Megan Coggeshall
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Adrienne Chew
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kevin F O'Rourke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caitlyn Steiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marwa Tuffaha
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Yaser Adi
- Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Rima A Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Hanan Alahmadi
- Institute of Public Administration, Riyadh, Saudi Arabia
| | - Fadia AlBuhairan
- King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nicholas Allen
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | | | | | | | | | - Peter Azzopardi
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Carmen Barroso
- International Planned Parenthood Federation, New York, NY, USA
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chris Bonell
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Cecilia Breinbauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Donna Denno
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jing Fang
- Institute for Health Sciences, Kunming Medical University, Kunming City, China
| | - Adesegun Fatusi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Andrea B Feigl
- Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ritsuko Kakuma
- Global and Cultural Mental Health Unit, University of Melbourne, Melbourne, VIC, Australia
| | | | - Elissa Kennedy
- Centre for International Health, Burnet Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tawfik A M Khoja
- Executive Board, Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Fadi Maalouf
- Faculty of Health Sciences, Department of Psychiatry; Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health; Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Amitabh Mattoo
- Melbourne School of Government, University of Melbourne, Melbourne, VIC, Australia; Australia India Institute, Carlton, VIC, Australia; School of International Studies, Jawaharlal Nehru University, New Delhi, Delhi, India
| | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ziad A Memish
- Saudi Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Vikram Patel
- Public Health Foundation of India, Delhi, India; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Petroni
- International Center for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - John Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Fred Ssewamala
- International Center for Child Health and Asset Development, Columbia University, New York, NY, USA
| | - Kikelomo Taiwo
- The Lancet Youth, Lancet Commission on Adolescent Health and Wellbeing, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
| | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - George C Patton
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Murray CJL, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, Dellavalle R, Danaei G, Ezzati M, Fahimi A, Flaxman D, Foreman, Gabriel S, Gakidou E, Kassebaum N, Khatibzadeh S, Lim S, Lipshultz SE, London S, Lopez, MacIntyre MF, Mokdad AH, Moran A, Moran AE, Mozaffarian D, Murphy T, Naghavi M, Pope C, Roberts T, Salomon J, Schwebel DC, Shahraz S, Sleet DA, Murray, Abraham J, Ali MK, Atkinson C, Bartels DH, Bhalla K, Birbeck G, Burstein R, Chen H, Criqui MH, Dahodwala, Jarlais, Ding EL, Dorsey ER, Ebel BE, Ezzati M, Fahami, Flaxman S, Flaxman AD, Gonzalez-Medina D, Grant B, Hagan H, Hoffman H, Kassebaum N, Khatibzadeh S, Leasher JL, Lin J, Lipshultz SE, Lozano R, Lu Y, Mallinger L, McDermott MM, Micha R, Miller TR, Mokdad AA, Mokdad AH, Mozaffarian D, Naghavi M, Narayan KMV, Omer SB, Pelizzari PM, Phillips D, Ranganathan D, Rivara FP, Roberts T, Sampson U, Sanman E, Sapkota A, Schwebel DC, Sharaz S, Shivakoti R, Singh GM, Singh D, Tavakkoli M, Towbin JA, Wilkinson JD, Zabetian A, Murray, Abraham J, Ali MK, Alvardo M, Atkinson C, Baddour LM, Benjamin EJ, Bhalla K, Birbeck G, Bolliger I, Burstein R, Carnahan E, Chou D, Chugh SS, Cohen A, Colson KE, Cooper LT, Couser W, Criqui MH, Dabhadkar KC, Dellavalle RP, Jarlais, Dicker D, Dorsey ER, Duber H, Ebel BE, Engell RE, Ezzati M, Felson DT, Finucane MM, Flaxman S, Flaxman AD, Fleming T, Foreman, Forouzanfar MH, Freedman G, Freeman MK, Gakidou E, Gillum RF, Gonzalez-Medina D, Gosselin R, Gutierrez HR, Hagan H, Havmoeller R, Hoffman H, Jacobsen KH, James SL, Jasrasaria R, Jayarman S, Johns N, Kassebaum N, Khatibzadeh S, Lan Q, Leasher JL, Lim S, Lipshultz SE, London S, Lopez, Lozano R, Lu Y, Mallinger L, Meltzer M, Mensah GA, Michaud C, Miller TR, Mock C, Moffitt TE, Mokdad AA, Mokdad AH, Moran A, Naghavi M, Narayan KMV, Nelson RG, Olives C, Omer SB, Ortblad K, Ostro B, Pelizzari PM, Phillips D, Raju M, Razavi H, Ritz B, Roberts T, Sacco RL, Salomon J, Sampson U, Schwebel DC, Shahraz S, Shibuya K, Silberberg D, Singh JA, Steenland K, Taylor JA, Thurston GD, Vavilala MS, Vos T, Wagner GR, Weinstock MA, Weisskopf MG, Wulf S, Murray. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310:591-608. [PMID: 23842577 PMCID: PMC5436627 DOI: 10.1001/jama.2013.13805] [Citation(s) in RCA: 1731] [Impact Index Per Article: 157.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
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Affiliation(s)
- Christopher J L Murray
- Institute for Health Metrics and Evaluation, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
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