GBD 2010: design, definitions, and metrics

The Global Burden of Diseases, Injuries, and Risk Factors (GBD) enterprise is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geography for specific points in time. The GBD construct of the burden of disease is health loss, not income or productivity loss. 1 Murray CJL Lopez AD The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press on behalf of the World Health Organization and The World Bank, Boston, MA1996 Google Scholar For decision makers, health-sector leaders, researchers, and informed citizens, the GBD approach provides an opportunity to see the big picture, to compare diseases, injuries, and risk factors, and to understand in a given place, time, and age-sex group what are the most important contributors to health loss. GBD 2010: understanding disease, injury, and riskPublication of the Global Burden of Disease Study 2010 (GBD 2010) is a landmark event for this journal and, we hope, for health. The collaboration of 486 scientists from 302 institutions in 50 countries has produced an important contribution to our understanding of present and future health priorities for countries and the global community. Full-Text PDF From new estimates to better dataThe Global Burden of Disease Study 2010 (GBD 2010) in The Lancet represents an unprecedented effort to improve global and regional estimates of levels and trends in the burden of disease. Accurate assessment of the global, regional, and country health situation and trends is critical for evidence-based decision making for public health. WHO therefore warmly welcomes GBD 2010, which was undertaken by the Institute for Health Metrics and Evaluation (IHME) with its partners and draws on the contributions of many scientists, including those who work in WHO programmes. Full-Text PDF Data for better health—and to help end povertyThe World Bank Group welcomes the publication of the new Global Burden of Disease Study (GBD). The Bank commissioned the first GBD in 1990, and continues to make extensive use of this signal contribution to global health. Like its predecessors, the new, methodologically updated GBD 2010 marks a milestone in global health knowledge and our capacity for evidence-based action. It will once again set the terms of health policy, planning, and funding discussions for years to come. Full-Text PDF AIDS is not overOptimism and momentum has been building around the real possibility that an AIDS-free generation is imminent. Public enthusiasm is fuelled by news about the rapid scale-up of antiretroviral therapy, evidence that HIV treatment can prevent new infections, and expanded coverage of programmes to prevent mother-to-child transmission of HIV. Yet, the most recent estimates of HIV prevalence and incidence and of AIDS-related mortality released by UNAIDS1, together with data from the Global Burden of Disease Study 2010 in The Lancet,2,3 make it clear that AIDS is not over. Full-Text PDF Should the GBD risk factor rankings be used to guide policy?The Global Burden of Disease Study 2010 (GBD 2010) estimates provide important new insights. Alongside estimates of health burden attributable to 291 diseases and injuries,1 Stephen Lim and colleagues2 estimate the health burden associated with 67 risk factors, organised into a hierarchy of clusters. So as to distinguish real changes in global burden and risk factors from changes in methods, they not only estimated the burden and risk factor ranking for 2010, but also recalculated estimates for 1990. Full-Text PDF A promise to save 100 000 trauma patientsIn The Lancet, Christopher Murray and colleagues present the findings of their 2010 Global Burden of Disease Study, in which they show that injuries cost the global population some 300 million years of healthy life every year, causing 11% of disability-adjusted life years (DALYs) worldwide.1 Road-traffic crashes were the number one killer of young people and accounted for nearly a third of the world injury burden—a total of 76 million DALYs in 2010, up from 57 million in 1990. Most of the victims were young, and many had families that depended on them. Full-Text PDF The story of GBD 2010: a “super-human” effortWhat has working on the international, multi-investigator Global Burden of Disease 2010 been like? Pamela Das and Udani Samarasekera asked the researchers involved. Full-Text PDF Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010Despite global and regional health crises, global life expectancy has increased continuously and substantially in the past 40 years. Yet substantial heterogeneity exists across age groups, among countries, and over different decades. 179 of 187 countries have had increases in life expectancy after the slowdown in progress in the 1990s. Efforts should be directed to reduce mortality in low-income and middle-income countries. Potential underestimation of achievement of the Millennium Development Goal 4 might result from limitations of demographic data on child mortality for the most recent time period. Full-Text PDF Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Full-Text PDF Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results. Full-Text PDF Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. Full-Text PDF Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010Rates 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. Full-Text PDF Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Full-Text PDF A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. Full-Text PDF GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiologyThe data, methods, and findings of the Global Burden of Disease Study 2010 (GBD 2010) are described in detail in The Lancet. This large collaboration is an evolution of a body of work that began with GBD 1990.1 The number of diseases, injuries, and risk factors evaluated and the geographical units of analysis have greatly expanded in the past 20 years, and change over time has been assessed. Nevertheless, GBD 2010 follows the basic principles of GBD 1990: trying to use all the relevant published and unpublished evidence; capturing fatal and non-fatal health outcomes with comparable metrics; and separating epidemiological assessment from advocacy concerns or entanglement of agendas. Full-Text PDF