November 2018 2 Main findings Definitions GBD and DALYs Populationfertility Mortality Life expectancy Healthy life expectancy HALE Years lost due to death and disability DALYs Causes of death YLLs ID: 935983
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Slide1
GBD 2017: Global Results
November 2018
Slide22
Main findings
Definitions: GBD and DALYs
Population/fertilityMortalityLife expectancyHealthy life expectancy (HALE)Years lost due to death and disability (DALYs)Causes of death (YLLs)Morbidity (YLDs)Risk factorsSDGs
Outline
Slide3Main findings
3
In 2017, the
top three countries in life expectancy were Singapore (84.8 years), Japan (84.2 years), and Switzerland (84.0 years); lowest were Central African Republic (51.9 years), Lesotho (54.7 years), and Mozambique (58.4 years). However, the question is whether additional years are spent in good health or poor health – global trends in non-communicable diseases (NCDs) indicate that more effort is needed to increase healthy life expectancy.Fertility: In 2017, 91 countries have total fertility rates below the replacement rate of 2.05, while the opposite is true in 104 countries where higher total fertility rates which may drive population increases.While females tend to live longer than males, many of these additional years are spent in poor health.An unintended consequence of greater access to health care globally is increases in mortality from diseases and disorders linked to antibiotic resistance.
Slide4Main findings (continued)
4
Among age groups, the
under-5 age group experienced huge reductions in mortality between 1950 and 2017, while adults have made much less progress, particularly adult males. HIV remains a massive public health threat, particularly because global financing has plateaued, domestic health spending has stayed low among high-burden countries, and its incidence has not declined as quickly in younger as in older populations.Risk factors: high blood pressure and smoking are leading global risk factors linked to early death and disability at all ages.SDGs: Despite progress, achievement of SDGs by 2030 is in doubt. To meet SDGs, there is a need to increase progress on health-related indicators between 2017 and 2030.
Slide5What’s new in GBD 2017
5
Improved statistical methods, new and more data sources
For the first time, a comprehensive series of population and fertility estimates were producedNineteen new causes of death and disability were added, for a total of 359 causesMortalityNew population estimates led to substantial changes in mortality estimates in many countriesThe analysis was extended to start in 1950
Slide6SDGs: added four new indicators, producing estimates for
41 of 52 health-related SDG indicators
Subnational analyses of SDGs for subset of countries
and analysis of trends by sex for select indicatorsRisk factors: Bullying victimization added as new risk factorExamines how risks change according to level of developmentMore accurate method of estimating smoking riskWhat’s new in GBD 2017 (continued)
6
Slide77
What is the Global Burden of Disease?
A
systematic,
scientific
effort to quantify the
comparative
magnitude of
health loss
due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time.
Slide8What is a disability-adjusted life year (DALY)?
8
Slide9Important new feature of GBD:
comprehensive
population and fertility estimates produced for the first time. The GBD study’s new estimates improve upon previously available estimates in three key ways:Precision. Current standard for population estimates is five-year age groupings, but GBD estimates are for single years.Standardization. GBD uses the same methodology to estimate populations across locations, ensuring valid comparisons.Transparency. All data sources/methods are published, publicly accessible, and free.Population/fertility
9
Slide10Population growth rate, 2010–2017
Recent population growth has been highest in Africa, Asia, and South America
10
Global population increased from 2.6 billion in 1950 to 7.6 billion in 2017.
Despite growth, approximately half of 195 countries recorded total fertility rates
below
the replacement rate of approximately 2.05 in 2017.
Slide1111
Immigration can also drive increases in population despite total fertility rates below replacement level. This is the case in several countries in the Middle East (see top-left quadrant of figure).
Of the 60 countries with a total fertility rate of 3.0 or greater in 2017, most are in sub-Saharan Africa, where the proportion of women whose contraceptive needs are being met is 46.5%.
Countries plotted by total fertility rate and population growth rate, 2017
Slide1212
Fertility rates for females under 25, by number of countries, 2017
Fertility in females under 25 varies widely by country
Among countries, total fertility under age 25 ranged from a low of 0.08 births to a high of 2.4 births.
Since 1990, countries have achieved nearly universal declines in fertility under age 25, which is a key indicator for Sustainable Development Goal 3.
Still, in 50 countries, total fertility was higher in females younger than 25 than in those 30 or older.
Slide13Highlights
Rapid progress in life expectancy from 1950 to 2017:
Males, up from 48 years in 1950 to 71 years in 2017
Females, up from 53 years in 1950 to 76 years in 2017Among age groups, the under-5 age group experienced huge reductions in mortality between 1950 and 2017, while adults have made much less progress, particularly adult males.While females tend to live longer than males, the gap in life expectancy between them varies substantially by level of socioeconomic development.
13
Mortality
Slide1414
Total number of global deaths, 1950–2017
The proportion of deaths in those over age 75 increased from 12% of total deaths in 1950 to 39% in 2017.
There have been dramatic declines in under-5 mortality, but there were still 5.4 million deaths among children under 5 worldwide in 2017.
Slide1515
*
SDI captures three different aspects of development: income, education, and fertility
Under-5 mortality by level of socioeconomic development, 1990–2017
Declines in under-5 mortality were fastest among countries in the lowest quintile of
Socio-demographic Index (SDI)
*
Slide1616
Life expectancy:
Number of years a person is expected to live based on their present age.
Healthy life expectancy (HALE):
the number of years that a person at a given age can expect to live in full health, taking into account mortality and disability.
Highlights:
In 2017 globally, life expectancy at birth was 73 years,
but healthy life expectancy at birth was only 63 years.
This means on average, 10 years of life were
spent in poor health in 2017.
While females tend to live longer than males, the gap in life
expectancy between them varies substantially by level
of socioeconomic development.
Life expectancy and healthy life expectancy
Slide1717
Life expectancy at birth, both sexes, 2017
Life expectancy
There was rapid progress in life expectancy from 1950 to 2017:
Males,
up from 48 years in 1950 to 71 years in 2017
Females,
up from 53 years in 1950 to 76 years in 2017
Slide1818
Life expectancy at birth by sex and level of socioeconomic development, 2017
Disparities in life expectancy between males and females were greatest in countries at the high-middle and middle levels of development.
Slide1919
Healthy life expectancy at birth, both sexes, 2017
Healthy life expectancy (HALE)
Globally, in 2017, life expectancy was 73 years, but HALE was only
63 years – on average, 10 years of life were spent in poor health in 2017.
Slide2020
Performance in healthy life expectancy across regions
Healthy life expectancy above or below expected amount based on level of development, GBD super-regions, 2017
Slide2121
Extra years lived by females compared to males in good health versus poor health, 2017
While females tend to live longer than males, many of these extra years are spent in poor health.
Slide2222
Early death and disability is measured in terms of
disability-adjusted life years (DALYs).
Highlights
From 1990 to 2017, 41% decrease in communicable diseases and neonatal disorders
From 1990 to 2017, 40% increase in
non-communicable diseases
Large disparities persist in health and disease burden by sex and level of development
Disability-adjusted life years (DALYs)
Slide2323
‡
Ranking based on number of all-ages DALYs
§
SDI captures three different aspects of development: income, education, and fertility
COPD = chronic obstructive pulmonary disease
Leading causes of early death and disability
‡
at lowest and highest levels of development, 2017
Slide2424
Highlights
Between 1990 and 2017, early death from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders dropped, with the greatest declines in the least developed countries.
Progress in reducing mortality from some common diseases has stalled or reversed, primarily for non-communicable diseases such as cardiovascular diseases and cancers.
An unintended consequence of increased access
to health care globally is increases in mortality from diseases and disorders linked to antibiotic resistance.
Causes of death
Slide2525
Leading causes of early death, 1990–2017
**
Ranking based on number of years lived with disability (YLLs) at all ages
Slide2626
Change in mortality
*
due to extensively drug-resistant tuberculosis, 2007–2017 Since 2007, there have been rapid increases in emerging diseases and disorders due to antibiotic use or resistance, including extensively drug-resistant tuberculosis, cellulitis, and Clostridium difficile diarrhea.
*
Reflects annual rate of change in all-ages deaths per 100,000
Slide2727
**
Death rate at all ages and for both sexes
Global mortality
**
from cardiovascular diseases, 2007–2017
Medications that prevent deaths from cardiovascular diseases, such as those that lower blood pressure and cholesterol, are among the most cost-effective interventions available to health systems.
Despite this, mortality
from cardiovascular
diseases has increased
since 2007 worldwide.
Slide2828
Years lived with disability (YLDs):
Years of life lived with any short-term or long-term health loss
Highlights
Globally, the total burden of YLDs increased by 52% between 1990 and 2017.
The burden of disability was driven mainly by non-communicable diseases (NCDs), which caused 80% of YLDs in 2017.
Disability from metabolic conditions, such as type 2 diabetes and fatty liver disease, increased around the world and across levels of development.
Morbidity
Slide2929
Number of total YLDs, global, both sexes, by age group and cause, 2017
The burden of disability is most concentrated in working-age people.
Years lived with disability (YLDs) represent time lived in less-than-ideal health.
Slide3030
**
Headache disorders mainly include migraine.
†
Chronic obstructive pulmonary disease
Leading causes of global all-age disability, 1990 and 2017
While diabetes emerged as the fourth-leading cause of disability globally in 2017, many of the leading causes of disability in 1990 remain so in 2017, namely low back pain, headaches, and depression.
Slide3131
Annual change in rate of disability-adjusted life years (DALYs) attributable to risk factors, both sexes, age-adjusted, 1990–2017
Risk factors: changes in early death and disability attributable to risk factors
Slide3232
Leading risk factors causing early death and disability, by sex, 2017
Risk factors
Smoking and high systolic blood pressure are global leading risk factors
*
Rank based on number of all-ages DALYs
Slide3333
Regional
**
trends in high blood pressure and smoking
The disease burden caused by these two risk factors, compared to the burden expected based on the level of socioeconomic development, varied considerably by super-region.
**
GBD super-regions
High blood pressure
Smoking
Slide3434
About the SDG Index:
The SDG index is a composite measure, ranging from 0 to 100, of overall progress toward meeting the SDGs. It takes into account 40 performance indicators for the health-related SDGs.
This analysis of the health-related SDGs is based on
GBD 2017 estimates.
Highlights
Based on past trends, most countries’ SDG index scores are projected to rise between 2017 and 2030.
By 2030, the under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries likely to attain their targets.
Sustainable Development Goals
Slide3535
Sustainable Development Goals Index
*
score, 2017Global average SDG index score, 2017: 59.4
Slide3636
Global rate of new cases of HIV, 2017
**
Global deaths due to road injuries, 2017
Global prevalence of alcohol use, 2017
**
Median Estimates
†
Heavier drinking was weighted more than light drinking
SDGs: Differences by sex in 2017
Slide3737
Global under-5 mortality rate
Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt
SDG target:
Reduce under-5 mortality to 25 per 100,000 live births or below by 2030
Slide3838
Global maternal mortality ratio
Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt
SDG target:
Reduce maternal mortality ratio to 70 per 100,000 live births or below by 2030
Slide3939
Global prevalence of overweight in children aged 2 to 4
Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt
SDG target:
Eliminate child
overweight by 2030
Slide40Questions?
Media contacts
Kelly Bienhoff
+1-206-897-2884 (office)
+1-913-302-3817 (mobile)
kbien@uw.edu
Dean Owen
+1-206-897-2858 (office)
+1-206-434-5630 (mobile)
dean1227@uw.edu