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GBD 2017: Global Results

GBD 2017: Global Results. November 2018. Outline. Main findings Definitions: GBD and DALYs Population/fertility Mortality Life expectancy Healthy life expectancy (HALE) Years lost due to death and disability (DALYs) Causes of death (YLLs) Morbidity (YLDs) Risk factors SDGs.

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GBD 2017: Global Results

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  1. GBD 2017: Global Results November 2018

  2. Outline • Main findings • Definitions: GBD and DALYs • Population/fertility • Mortality • Life expectancy • Healthy life expectancy (HALE) • Years lost due to death and disability (DALYs) • Causes of death (YLLs) • Morbidity (YLDs) • Risk factors • SDGs

  3. Main findings • 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.

  4. Main findings (continued) • 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.

  5. What’s new in GBD 2017 Improved statistical methods, new and more data sources • For the first time, a comprehensive series of population and fertility estimates were produced • Nineteen new causes of death and disability were added, for a total of 359 causes • Mortality • New population estimates led to substantial changes in mortality estimates in many countries • The analysis was extended to start in 1950

  6. What’s new in GBD 2017 (continued) • SDGs: 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 indicators • Risk factors: • Bullying victimization added as new risk factor • Examines how risks change according to level of development • More accurate method of estimating smoking risk

  7. What is the Global Burden of Disease? A systematic,scientificeffort to quantify the comparative magnitude of health lossdue to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time.

  8. What is a disability-adjusted life year (DALY)?

  9. Population/fertility Important new feature of GBD: comprehensivepopulation 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.

  10. Recent population growth has been highest in Africa, Asia, and South America Population growth rate, 2010–2017 • 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.

  11. Countries plotted by total fertility rate and population growth rate, 2017 • 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%.

  12. Fertility in females under 25 varies widely by country Fertility rates for females under 25, by number of countries, 2017 • 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.

  13. Mortality Highlights • 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 • 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. • While females tend to live longer than males, the gap in life expectancy between them varies substantially by level of socioeconomic development.

  14. 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.

  15. 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)* *SDI captures three different aspects of development: income, education, and fertility

  16. Life expectancy and healthy life expectancy 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.

  17. Life expectancy Life expectancy at birth, both sexes, 2017 • 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

  18. 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.

  19. Healthy life expectancy (HALE) Healthy life expectancy at birth, both sexes, 2017 • 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.

  20. Performance in healthy life expectancy across regions Healthy life expectancy above or below expected amount based on level of development, GBD super-regions, 2017

  21. 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.

  22. Disability-adjusted life years (DALYs) 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

  23. Leading causes of early death and disability‡ at lowest and highest levels of development, 2017 ‡Ranking based on number of all-ages DALYs §SDI captures three different aspects of development: income, education, and fertility COPD = chronic obstructive pulmonary disease

  24. Causes of death 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.

  25. Leading causes of early death, 1990–2017 **Ranking based on number of years lived with disability (YLLs) at all ages

  26. Change in mortality* due to extensively drug-resistant tuberculosis, 2007–2017 *Reflects annual rate of change in all-ages deaths per 100,000 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.

  27. 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. **Death rate at all ages and for both sexes

  28. Morbidity 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.

  29. 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.

  30. Leading causes of global all-age disability, 1990 and 2017 **Headache disorders mainly include migraine. †Chronic obstructive pulmonary disease 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.

  31. Risk factors: changes in early death and disability attributable to risk factors Annual change in rate of disability-adjusted life years (DALYs) attributable to risk factors, both sexes, age-adjusted, 1990–2017

  32. Risk factors Leading risk factors causing early death and disability, by sex, 2017 *Rank based on number of all-ages DALYs Smoking and high systolic blood pressure are global leading risk factors

  33. Regional** trends in high blood pressure and smoking High blood pressure Smoking **GBD super-regions 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.

  34. Sustainable Development Goals 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.

  35. Sustainable Development Goals Index* score, 2017 Global average SDG index score, 2017: 59.4

  36. SDGs: Differences by sex in 2017 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

  37. Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt Global under-5 mortality rate SDG target: Reduce under-5 mortality to 25 per 100,000 live births or below by 2030

  38. Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt Global maternal mortality ratio SDG target: Reduce maternal mortality ratio to 70 per 100,000 live births or below by 2030

  39. Looking ahead to 2030: despite progress, achievement of SDGs by 2030 is in doubt Global prevalence of overweight in children aged 2 to 4 SDG target: Eliminate child overweight by 2030

  40. Questions? 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

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