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Journal ArticleDOI

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Theo Vos1, Ryan M Barber1, Brad Bell1, Amelia Bertozzi-Villa1  +686 moreInstitutions (287)
22 Aug 2015-The Lancet (Elsevier Limited)-Vol. 386, Iss: 9995, pp 743-800
TL;DR: In the Global Burden of Disease Study 2013 (GBD 2013) as mentioned in this paper, the authors estimated the quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.
About: This article is published in The Lancet.The article was published on 2015-08-22 and is currently open access. It has received 4510 citations till now. The article focuses on the topics: Mortality rate & Population.

Summary (4 min read)

Introduction

  • The Global Burden of Disease Study 2013 (GBD 2013) is the first of a series of yearly updates for the GBD studies that began with estimates for 1990 and were most recently updated to 2010.
  • In view of the ambitious goal of the GBD 2010, to synthesise the global evidence for the country-age-sex-year prevalence of all major disorders, several specific estimates were critiqued.
  • The validity of disability weights was questioned for selected states including hearing loss, vision loss, drug use, spinal cord lesion, intellectual disability, and musculoskeletal disorders.
  • The GBD 2013 provides an opportunity to incorporate constructive criticism about GBD 2010 data sources, model development, methods, and interpretation.

Overview

  • The authors general approach was similar to that for GBD 2010.
  • The analysis of incidence and prevalence for HIV/AIDS, tuberculosis, and malaria for GBD 2013 have already been reported in detail.

Cause and sequelae list changes

  • Based on feedback about GBD 2010, and input from the GBD 2013 collaborators, the authors expanded the cause and sequelae list .
  • First, the authors included asymptomatic states as explicit sequelae so that overall disease prevalence estimates were available, which might be useful for disease targeting, health service planning, or mass treatment strategies.
  • Asymptomatic sequelae, by definition, were not associated with ill health and therefore were not assigned disability weights.
  • Third, the authors added several new causes and sequelae.
  • All these additions to the cause list were done to either reduce the size of the large residual categories, such as other injuries, or recognition of substantial epidemiological heterogeneity within a disease category .

Data sources

  • GBD 2010 collaborators undertook systematic reviews for most of the causes and sequelae.
  • For some sequelae, the majority of the data came from household survey microdata reanalysis and administrative data such as hospital discharges.
  • Documentation of the GBD 2010 systematic reviews, however, was not centralised and only some of these reviews have been published.
  • The overall DRI simply counts the fraction of countries that have any incidence, prevalence, remission, or excess mortality data available for causes that are prevalent in that country.
  • Figure 1 shows a map of the percentages of causes for which there were data available in each of the 188 countries between 1990 and 2013.

Sequelae incidence and prevalence

  • At the global level, a mixed-effects non-linear regression with all available country data was used to generate initial global estimates that are passed to the next level of the DisMod cascade to inform the model for each super region.
  • External validity was also evaluated through cross-validation on a small number of sequelae due to the computational time and complexity for this analysis.
  • The authors selected ten DisMod-MR 2.0 models representing a range of data densities to evaluate.
  • 68 Based on evidence that individuals with most cancers continue to have higher mortality beyond 5 years than do the general population, the authors estimated the burden of cancer for up to 10 years after incidence.

Injuries

  • The authors followed a similar strategy to GBD 2010 for estimating the burden of injuries, except for an expanded list of 26 external cause-of-injury categories (from 15) and 47 nature-of-injury categories (from 23) for both short-term outcomes and lasting disability .
  • First, for each external cause, DisMod-MR 2.0 was used to analyse incidence based on hospital, emergency department, and survey data.
  • Second, the authors estimated the distribution of nature of injury for each external cause using data that had both types of code available.
  • 76 Short-term disability was estimated for all natures of injury by cause-of-injury categories as the product of prevalence (estimated by multiplying incidence by mean duration) and the appropriate disability weight.

YLDs from 29 residual causes

  • Many diseases remain for which the authors do not explicitly model disease prevalence and YLDs.
  • The GBD cause list is collectively exhaustive such that all sequelae with an ICD code are mapped to a cause group .
  • The authors then computed the ratio of YLLs to YLDs for these specific causes (on a country-sex-year basis) and applied them to the residual category's YLLs to estimate its YLDs.
  • For the last two, the authors used US outpatient data or prevalence data from the Medical Expenditure Panel Survey (MEPS), National Epidemiologic Survey on Alcohol and Related Conditions , or the 1997 Australian mental health survey 77 and applied a severity distribution from these surveys in all countries and periods.

Impairments

  • As in GBD 2010, the authors estimated the country-age-sex-year prevalence of nine impairments: anaemia, epilepsy, hearing loss, heart failure, intellectual disability, infertility, vision loss, Guillain-Barré, and pelvic inflammatory disease.
  • The severity distribution of cause-specific prevalence of each impairment was estimated as explained above or, in the absence of severity-specific data, assumed to be proportionate across all levels of severity.
  • The severity of heart failure is derived from their MEPS analysis and therefore is not specific for country, year, age, or sex.
  • 43, 79 To disaggregate marginal estimates of anaemia severity and cause into a complete set of prevalence estimates for cause and severity pairs, the authors developed a new method for GBD 2013 that used techniques from Bayesian contingency table modelling.
  • Hearing loss due to otitis media and age-related hearing loss were estimated by DisMod-MR 2.0 using prevalence data.

Severity distributions

  • Important changes to the sequelae list with regards to severity include low back pain, alcohol and drug dependence categories, uterine prolapse, and epilepsy.
  • Stress incontinence was added as a sequela of uterine prolapse with a new disability weight that is distinct from full incontinence.
  • For the remaining causes, the authors used the same approach for estimating the distribution of severity as in the GBD 2010; empirical analysis of this model was updated through the addition of 2 years from the US MEPS.
  • The introduction of a mild health state for four drug dependence categories required identification of epidemiological data to estimate the proportion of cases with mild versus more severe disability.

Revisions to disability weights

  • The GBD 2010 disability weights measurement study introduced a new method of pairwise comparisons as a means of eliciting weightings for health states in population surveys.
  • In total, responses were gathered from 30 230 people in 167 countries.
  • The revised lay descriptions were based on identifying inconsistency in the way progression across levels of severity had been handled for some outcomes and the addition of social isolation to the descriptions for complete, profound, and severe hearing loss.
  • 85, 87 Because of funding and questionnaire length, the surveys included 140 of 220 GBD 2010 health states for which the lay descriptions had not been revised, 32 health states with revised lay descriptions, and 42 new health states, 16 of which were included in GBD 2013.
  • Most disability weights changed slightly, but some differ more widely .

Comorbidity

  • Many individuals have more than one disease or injury sequela at the same time.
  • For less common sequelae the microsimulation tends to increase the estimated uncertainty in the number of YLDs substantially because, for example, a sequela that is estimated to have a prevalence of less than one in 10 000 will not appear randomly in many microsimulations of 20 000.
  • The numbers of simulants with different comorbidities in a country-age-sex-year was adjusted from 40 000 to equal the estimated population in each country-age-sex-year to produce the estimated distribution of individuals in each country with comorbidities.
  • The authors have reported 95% uncertainty intervals for each quantity in this analysis.
  • For YLDs, the authors incorporated uncertainty in prevalence and uncertainty in the disability weight into the posterior distribution of YLDs.

Results

  • Figure 2A -C shows the population pyramid for developed countries, developing countries excluding sub-Saharan Africa, and sub-Saharan Africa in 1990 and 2013 broken down by the number of sequelae, ranging from none to more than ten sequelae.
  • Declines due to neglected tropical diseases and malaria, as well as diarrhoea and lower respiratory infections also pushed YLD per person lower in some countries.
  • From 1990 to 2013, YLDs per person rose in most countries and YLLs per person declined.

Discussion

  • The authors analysed more than 35 620 epidemiological sources from 188 countries spanning the past three decades to provide the most up-to-date empirical assessment of the leading causes of acute disease incidence, chronic disease prevalence, and YLDs for 6 years (1990, 1995, 2000, 2005, 2010, and 2013) for 188 countries using consistent and comparable methods.
  • For 72 causes, including epidemic disorders like HIV and dengue but also cancers, diabetes, and COPD, age-standardised rates increased significantly.
  • Eleventh, in a study with more than half a million YLD estimates generated from sometimes sparse and always disparate data sources there remain areas where additional evidence or a change in the modelling strategy could lead to better estimates.
  • Yearly updates of GBD allowed for a continued effort to search for new data and improve methods, particularly for disorders with sparse data or inconsistencies between data sources.
  • By extending the GBD analysis to report the commonly understood measures of morbidity and disability in populations, by age, by sex, by country, and over time, this study represents an enormous resource for national, regional, and global policy debates about health priorities, not just to keep people alive well into old age, but to also keep them healthy.

Systematic review

  • The GBD 2013 assessment of morbidity is a major improvement in the evidence base compared with GBD 2010 through the inclusion of new data from surveys, disease registries, and hospital inpatient and outpatient registrations.
  • GBD 2013 also benefits from improvements in the Bayesian meta-regression tool DisMod-MR.
  • The fifty-fold increase in computational speed allowed consistent estimation of prevalence and incidence for each country and time period.

Interpretation

  • This study provides a comprehensive description of morbidity levels and patterns worldwide.
  • Because the study provides a complete re-analysis of trends for each cause from 1990 to 2013, it supersedes the results of the GBD 2010 study.
  • This is the first time that country-specific results for all 188 countries with populations of more than 50 000 people have been comprehensively published.

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Citations
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Abstract: WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

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References
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Journal ArticleDOI
Rafael Lozano1, Mohsen Naghavi1, Kyle J Foreman2, Stephen S Lim1  +192 moreInstitutions (95)
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex, using the Cause of Death Ensemble model.

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25 Apr 2013-Nature
TL;DR: These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.
Abstract: Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. For some patients, dengue is a life-threatening illness. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread. The contemporary worldwide distribution of the risk of dengue virus infection and its public health burden are poorly known. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of disease severity). This infection total is more than three times the dengue burden estimate of the World Health Organization. Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.

7,238 citations

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Theo Vos, Abraham D. Flaxman1, Mohsen Naghavi1, Rafael Lozano1  +360 moreInstitutions (143)
TL;DR: Prevalence and severity of health loss were weakly correlated and age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010, but population growth and ageing have increased YLD numbers and crude rates over the past two decades.

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Mohsen Naghavi1, Haidong Wang1, Rafael Lozano1, Adrian Davis2  +728 moreInstitutions (294)
TL;DR: In the Global Burden of Disease Study 2013 (GBD 2013) as discussed by the authors, the authors used the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data.

5,792 citations

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01 Jan 1975
TL;DR: Discrete Multivariate Analysis is a comprehensive text and general reference on the analysis of discrete multivariate data, particularly in the form of multidimensional tables, and contains a wealth of material on important topics.
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5,309 citations

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Frequently Asked Questions (4)
Q1. What contributions have the authors mentioned in the paper "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013" ?

In this paper, the authors used GBD 2010 methods with some important refinements, such as expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method ( DisMod-MR ), and use of severity splits for various causes. 

In all countries, the share of disability in total burden is increasing because of ageing populations and a slower decline in disability rates compared to the decline in mortality. 

The fifty-fold increase in computational speed allowed consistent estimation of prevalence and incidence for each country and time period. 

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