• Theo Vos, Abraham D Flaxman, Mohsen Naghavi, Rafael Lozano, Catherine Michaud, Majid Ezzati, Kenji Shibuya, Joshua A Salomon, Safa Abdalla, Victor Aboyans, Jerry Abraham, Ilana Ackerman, Rakesh Aggarwal, Stephanie Y Ahn, Mohammed K Ali, Miriam Alvarado, H Ross Anderson, Laurie M Anderson, Kathryn G Andrews, Charles Atkinson, Larry M Baddour, Adil N Bahalim, Suzanne Barker-Collo, Lope H Barrero, David H Bartels, Maria-Gloria Basáñez, Amanda Baxter, Michelle L Bell, Emelia J Benjamin, Derrick Bennett, Eduardo Bernabé, Kavi Bhalla, Bishal Bhandari, Boris Bikbov, Bin AbdulhakArefA, Gretchen Birbeck, James A Black, Hannah Blencowe, Jed D Blore, Fiona Blyth, Ian Bolliger, Audrey Bonaventure, Soufiane Boufous, Rupert Bourne, Michel Boussinesq, Tasanee Braithwaite, Carol Brayne, Lisa Bridgett, Simon Brooker, Peter Brooks, Traolach S Brugha, Claire Bryan-Hancock, Chiara Bucello, Rachelle Buchbinder, Geoffrey Buckle, Christine M Budke, Michael Burch, Peter Burney, Roy Burstein, Bianca Calabria, Benjamin Campbell, Charles E Canter, Hélène Carabin, Jonathan Carapetis, Loreto Carmona, Claudia Cella, Fiona Charlson, Honglei Chen, Andrew Tai-Ann Cheng, David Chou, Sumeet S Chugh, Luc E Coffeng, Steven D Colan, Samantha Colquhoun, K Ellicott Colson, John Condon, Myles D Connor, Leslie T Cooper, Matthew Corriere, Monica Cortinovis, Karen Courville de Vaccaro, William Couser, Benjamin C Cowie, Michael H Criqui, Marita Cross, Kaustubh C Dabhadkar, Manu Dahiya, Nabila Dahodwala, James Damsere-Derry, Goodarz Danaei, Adrian Davis, Diego De Leo, Louisa Degenhardt, Robert Dellavalle, Allyne Delossantos, Julie Denenberg, Sarah Derrett, Don C Des Jarlais, Samath D Dharmaratne, Mukesh Dherani, Cesar Diaz-Torne, Helen Dolk, E Ray Dorsey, Tim Driscoll, Herbert Duber, Beth Ebel, Karen Edmond, Alexis Elbaz, Suad Eltahir Ali, Holly Erskine, Patricia J Erwin, Patricia Espindola, Stalin E Ewoigbokhan, Farshad Farzadfar, Valery Feigin, David T Felson, Alize Ferrari, Cleusa P Ferri, Eric M Fèvre, Mariel M Finucane, Seth Flaxman, Louise Flood, Kyle Foreman, Mohammad H Forouzanfar, Francis Gerry R Fowkes, Richard Franklin, Marlene Fransen, Michael K Freeman, Belinda J Gabbe, Sherine E Gabriel, Emmanuela Gakidou, Hammad A Ganatra, Bianca Garcia, Flavio Gaspari, Richard F Gillum, Gerhard Gmel, Richard Gosselin, Rebecca Grainger, Justina Groeger, Francis Guillemin, David Gunnell, Ramyani Gupta, Juanita Haagsma, Holly Hagan, Yara A Halasa, Wayne Hall, Diana Haring, Josep Maria Haro, James E Harrison, Rasmus Havmoeller, Roderick J Hay, Hideki Higashi, Catherine Hill, Bruno Hoen, Howard Hoffman, Peter J Hotez, Damian Hoy, John J Huang, Sydney E Ibeanusi, Kathryn H Jacobsen, Spencer L James, Deborah Jarvis, Rashmi Jasrasaria, Sudha Jayaraman, Nicole Johns, Jost B Jonas, Ganesan Karthikeyan, Nicholas Kassebaum, Norito Kawakami, Andre Keren, Jon-Paul Khoo, Charles H King, Lisa Marie Knowlton, Olive Kobusingye, Adofo Koranteng, Rita Krishnamurthi, Ratilal Lalloo, Laura L Laslett, Tim Lathlean, Janet L Leasher, Yong Yi Lee, James Leigh, Stephen S Lim, Elizabeth Limb, John Kent Lin, Michael Lipnick, Steven E Lipshultz, Wei Liu, Maria Loane, Summer Lockett Ohno, Ronan Lyons, Jixiang Ma, Jacqueline Mabweijano, Michael F MacIntyre, Reza Malekzadeh, Leslie Mallinger, Sivabalan Manivannan, Wagner Marcenes, Lyn March, David J Margolis, Guy B Marks, Robin Marks, Akira Matsumori, Richard Matzopoulos, Bongani M Mayosi, John H McAnulty, Mary M McDermott, Neil McGill, John McGrath, Maria Elena Medina-Mora, Michele Meltzer, George A Mensah, Tony R Merriman, Ana-Claire Meyer, Valeria Miglioli, Matthew Miller, Ted R Miller, Philip B Mitchell, Ana Olga Mocumbi, Terrie E Moffitt, Ali A Mokdad, Lorenzo Monasta, Marcella Montico, Maziar Moradi-Lakeh, Andrew Moran, Lidia Morawska, Rintaro Mori, Michele E Murdoch, Michael K Mwaniki, Kovin Naidoo, M Nathan Nair, Luigi Naldi, K M Venkat Narayan, Paul K Nelson, Robert G Nelson, Michael C Nevitt, Charles R Newton, Sandra Nolte, Paul Norman, Rosana Norman, Martin O'Donnell, Simon O'Hanlon, Casey Olives, Saad B Omer, Katrina Ortblad, Richard Osborne, Doruk Ozgediz, Andrew Page, Bishnu Pahari, Jeyaraj Durai Pandian, Andrea Panozo Rivero, Scott B Patten, Neil Pearce, Rogelio Perez Padilla, Fernando Perez-Ruiz, Norberto Perico, Konrad Pesudovs, David Phillips, Michael R Phillips, Kelsey Pierce, Sébastien Pion, Guilherme V Polanczyk, Suzanne Polinder, C Arden Pope, Svetlana Popova, Esteban Porrini, Farshad Pourmalek, Martin Prince, Rachel L Pullan, Kapa D Ramaiah, Dharani Ranganathan, Homie Razavi, Mathilda Regan, Jürgen T Rehm, David B Rein, Guiseppe Remuzzi, Kathryn Richardson, Frederick P Rivara, Thomas Roberts, Carolyn Robinson, Felipe Rodriguez De Leòn, Luca Ronfani, Robin Room, Lisa C Rosenfeld, Lesley Rushton, Ralph L Sacco, Sukanta Saha, Uchechukwu Sampson, Lidia Sanchez-Riera, Ella Sanman, David C Schwebel, James Graham Scott, Maria Segui-Gomez, Saeid Shahraz, Donald S Shepard, Hwashin Shin, Rupak Shivakoti, David Singh, Gitanjali M Singh, Jasvinder A Singh, Jessica Singleton, David A Sleet, Karen Sliwa, Emma Smith, Jennifer L Smith, Nicolas J C Stapelberg, Andrew Steer, Timothy Steiner, Wilma A Stolk, Lars Jacob Stovner, Christopher Sudfeld, Sana Syed, Giorgio Tamburlini, Mohammad Tavakkoli, Hugh R Taylor, Jennifer A Taylor, William J Taylor, Bernadette Thomas, W Murray Thomson, George D Thurston, Imad M Tleyjeh, Marcello Tonelli, Jeffrey A Towbin, Thomas Truelsen, Miltiadis K Tsilimbaris, Clotilde Ubeda, Eduardo A Undurraga, Marieke J van der Werf, Jim van Os, Monica S Vavilala, N Venketasubramanian, Mengru Wang, Wenzhi Wang, Kerrianne Watt, David J Weatherall, Martin A Weinstock, Robert Weintraub, Marc G Weisskopf, Myrna M Weissman, Richard A White, Harvey Whiteford, Steven T Wiersma, James D Wilkinson, Hywel C Williams, Sean R M Williams, Emma Witt, Frederick Wolfe, Anthony D Woolf, Sarah Wulf, Pon-Hsiu Yeh, Anita K M Zaidi, Zhi-Jie Zheng, David Zonies, Alan D Lopez, Christopher J L Murray, Mohammad A AlMazroa, and Ziad A Memish.
• School of Population Health, Brisbane, QLD, Australia.
• Lancet. 2012 Dec 15; 380 (9859): 216321962163-96.

BackgroundNon-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs).MethodsOf the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis.FindingsGlobal prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa.InterpretationRates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.FundingBill & Melinda Gates Foundation.Copyright © 2012 Elsevier Ltd. All rights reserved.

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