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Articles

Global, regional, and national incidence, prevalence, and


years lived with disability for 310 diseases and injuries,
19902015: a systematic analysis for the Global Burden of
Disease Study 2015
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators*

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the worlds population to Lancet 2016; 388: 1545602
live in full health, a trend largely attributable to an epidemiological transition in many countries from causes aecting See Editorial page 1447
children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, See Comment pages 1448
Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with and 1450
disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. *Collaborators listed at the end
of the Article

Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated Correspondence to:
Prof Theo Vos, Institute for
and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, Health Metrics and Evaluation,
updates to literature reviews for 85 causes, and the identication and inclusion of additional studies published up to Seattle, WA 98121, USA
November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. tvos@uw.edu
Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the
DisMod-MR Bayesian meta-regression tool rst developed for GBD 2010 and GBD 2013. For some causes, we used
alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence
and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines
measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to
compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.

Findings We generated 93 billion estimates from the various combinations of prevalence, incidence, and YLDs for
causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess
of 1 billion: upper respiratory infections (172 billion, 95% uncertainty interval [UI] 154192 billion) and diarrhoeal
diseases (239 billion, 230250 billion). Eight causes of chronic disease and injury each aected more than 10% of the
worlds population in 2015: permanent caries, tension-type headache, iron-deciency anaemia, age-related and other
hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that
aected the greatest number of people in 2015 was anaemia, with 236 billion (235237 billion) individuals aected.
The second and third leading impairments by number of individuals aected were hearing loss and vision loss,
respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on
a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates
were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause
included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 2030% of total disability,
largely attributable to nutritional deciencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower
back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense
organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in
Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two
north African and Middle Eastern countries; iron-deciency anaemia in Somalia and Venezuela; depression in Uganda;
onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.

Interpretation Ageing of the worlds population is increasing the number of people living with sequelae of diseases
and injuries. Shifts in the epidemiological prole driven by socioeconomic change also contribute to the continued
increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by
gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach
of the GBD study provides opportunities to examine broad trends, compare those trends between countries or
subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or
weakness of the estimates available.

Funding Bill & Melinda Gates Foundation.

Copyright The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.

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Introduction Along with broad recognition that data from some


Although substantial progress has been made toward regions were sparse and that more and higher quality data
reducing mortality and extending life expectancy in general would probably improve estimation, useful
throughout the world over the past few decades, the debates on the GBD results have been published. These
epidemiological transition is manifest in the growing debates have focused on the analysis or presentation of
importance of non-fatal diseases, outcomes, and injuries individual diseases, such as changes over time in GBD
which pose, partly as a consequence of decreasing death estimates of dementia,5 the accuracy of HIV incidence
rates, a rising challenge to the ability of the worlds estimates,6,7 the absence of sepsis as a disease,8,9 the quality
population to live in full health. Complementing of some cancer registry data,10 and the absence of mental
information on deaths by age, sex, cause, geography, and disorders as sequelae of neglected tropical diseases.11 The
time with equally detailed information on disease GBD empirical approach to measuring the publics view of
incidence, prevalence, and severity is key to a balanced health state severity has generated substantial interest with
debate in health policy. For this reason, the Global questions about the relative importance of dierent
Burden of Disease (GBD) Study uses the disability- dimensions of health,12,13 the quantication of health loss,14,15
adjusted life-year (DALY), combining years of life lost and discussions of the transferability of judgments about
(YLLs) due to mortality and years lived with disability relative health to conventional notions of disability and
(YLDs) in a single metric. One DALY can be thought of dependence.5 In each cycle of the GBD, we seek to improve
as one lost year of healthy life. The sum of DALYs in a the estimates, reecting published and unpublished
population can be thought of as the gap between the critique through the acquisition of new data, expansion of
populations present health status and an ideal situation the network of collaborators, changes in how data are
where the entire population lives to an advanced age, corrected for bias, advances in modelling techniques, and
free of disease. Assessments of how dierent diseases the targeted expansion of the GBD cause list.
lead to multimorbidity and reductions in functional The primary objective of this component of the GBD
health status are important for both health system was to use all available data of sucient quality to
planning1 and a broader range of social policy issues generate reliable and valid assessments of disease and
such as the appropriate age for retirement in some injury sequelae incidence, prevalence, and YLDs for all
countries.2,3 Many challenges in making standardised 310 causes in the GBD cause hierarchy for 591 locations
estimates of non-fatal health outcomes are similar to in the GBD study during 19902015. We describe the
those aecting mortality estimates (including variations change over time and between populations in relation to
in case denitions, data collection methods, variable where countries fall on the development continuum.16
quality of data collection, conicting data, and missing Continuing eorts to improve data and code transparency
data) but are compounded by more sparse and varied are an important part of the GBD cycle. These results
data sources, the need to characterise each disease by its thus supersede any previous publications about the GBD
disabling sequelae or consequence(s), and the need to on disease incidence, prevalence, and YLDs.
quantify the severity of these consequences. The
standardised approach of the annual GBD updates Methods
addresses these measurement problems to enhance Overall approach
comparability between causes by geography and We estimated incidence and prevalence by age, sex, cause,
over time. year, and geography using a wide range of updated and
The estimates from GBD 2013 drew attention to large standardised analytical procedures. The overall logic of
increases in the number of YLDs over the previous our analytical approach is shown for the entire non-fatal
See Online for appendix decade, whereas rates of YLDs for most causes remained estimation process in gure 1. The appendix provides a
stable or showed only small decreases.4 The GBD 2013 single source for detail of inputs, analytical processes,
assessment largely attributed increases in the number and outputs and methods specic to each cause. This
of YLDs to musculoskeletal disorders, mental and study complies with the Guidelines for Accurate and
substance use disorders, neurological disorders, and Transparent Health Estimates Reporting (GATHER)
chronic respiratory diseases, as well as population growth recommendations (methods appendix pp 1, 60810).17
and ageing. GBD 2013 also brought attention to increased
dierences in trends between mortality and morbidity Geographies in GBD 2015
for many causes. YLDs as a proportion of DALYs The geographies included in GBD 2015 have been
increased globally, a manifestation of the continuing arranged into a set of hierarchical categories composed of
epidemiological transition in low-income and middle- seven super-regions and a further nested set of 21 regions
income countries. Decreases in mortality from diseases containing 195 countries and territories. Eight additional
such as pneumonia, diarrhoea, maternal and neonatal subnational assessments were done for Brazil, China,
disorders, and an absence of progress in reducing YLD India, Japan, Kenya, Saudi Arabia, South Africa, Sweden,
rates continued to drive a transition toward a greater and the USA (methods appendix pp 61124). For this
global number of YLDs. study we present data at the national and territory level.

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1 Data sources 2 Data adjustment 3b Alternative disease modelling strategies (details figure 1B)

Case notications Seroprevalence Case fatality Prevalence and


Adjustment for HIV/AIDS and Malaria to incidence proportion and Neonatal Cancer incidence of
TB models cause of death disorders sequelae from
under-reporting rate models alternative models 8 YLDs
Expansion factors for
case notications
YLLs residual
Population-at-risk CSMR from causes without
data 4 Impairment and underlying cause estimation
CoDCorrect primary data
Seroprevalence data Scaled proportion of Apply aetiology or Scale impairment Prevalence and incidence
Proportion of
disease or impairment Scale to disease or impairment severity proportions to prevalence by of sequelae of impairment
Compute excess sequelae or causes 100% sequelae or underlying disease or impairment underlying cause or or diseases (by severity
Disease registries mortality before causes morbidity estimates severity to envelope or underlying cause) YLD to YLL ratio for
from available 12 residual
incidence or causes without
Birth registries primary data
prevalence and
CSMR data
Active screening Non-fatal database: 3a DisMod-MR
Agesex 2.1 estimation 7 Comorbidity
prevalence, incidence, excess
splitting YLDs for each disease
Intervention coverage mortality rate, RR, SMR, Prevalence and Prevalence and Comorbidity
DisMod-MR Proportion by Unadjusted YLD and injury by age, sex,
duration, remission, incidence by disease incidence of correction
2.1 or impairment sequelae sequelae by sequelae year, and country
Add study-level severity proportions, and (COMO)
Vital registration covariaties intermediary modelling
variables Study Country Sequelae mapped
Surveillance Pre DisMod bias covariates covariates to health states
correction
Community surveys 5 Severity distribution
Regression to estimate 6 Disability weights Disability weights for
Surveys with disability weight by Scale to 235 health states
National surveys Adjustment for diagnostic information cause in survey
multiple outpatient 100%
and SF-12 respondents controlling
visits per prevalent or for comorbidity Household surveys Analysis of paired
Outpatient hospital incident case based
data on claims data Opportunistic surveys comparison and
by IHME to ll SF-12 Open access web- population health
Claims data: Map SF-12 to Meta-analysis DisMod analysis
for 60 lay descriptions GBD disability proportion by proportion by based survey equivalence responses
outpatient visits Adjustment from
primary code to all Adjusted weights severity level severity level
Claims data: code based on claims input Map EQ5D Lay descriptions for GBD collaborator
MEPS to SF-12
inpatient visits data for causes data 235 health states advice
with long duration

Adjustment for 3c Injury modelling strategy


Inpatient hospital
data multiple admissions Generate causenature Long-term prevalence
in same individual Apply causenature Probability of Long-term incidence
of injury matrices long-term by causenature DisMod-MR 2.1 by causenature
with negative injury of matrices and inpatient or
disability combination
Cohort follow-up binomial models outpatient
studies
Determine most Short-term incidence SMR data from
Short-term prevalence Meta-analysis cohort studies
severe nature of Incidence by cause by causenature
of injury code and inpatient by causenature and
injury category in inpatient or outpatient
any individual or outpatient

Non-fatal estimation process Colours of non-fatal estimation


Input data Raw data source Post DisMod-MR Cohort study Estimate duration
of short-term
Process Data adjustment DisMod-MR disability
Expert estimates
Database Injury modelling duration untreated
Results injuries
Alternative disease modelling Disability weights
Database Impairment and underlying cause Final burden estimates

Figure 1: Analytical ow chart for the estimation of cause-specic YLDs by location, age, sex, and year for GBD 2015
Ovals represent data inputs, square boxes represent analytical steps, cylinders represent databases, and parallelograms represent intermediate and nal results. The ow chart is colour-coded by major
estimation component: raw data sources, in pink; data adjustments, in yellow; DisMod-MR 2.1 estimation, in purple; alternative modelling strategies, in light green; injury modelling strategy, in dark
green; estimation of impairments and underlying causes, in brown; post-DisMod-MR and comorbidity correction, in blue; disability weights, in orange; and cause of death and demographic inputs, in
grey. GBD=Global Burden of Disease. TB=tuberculosis. SF-12=Short Form 12 questions. MEPS=Medical Expenditure Panel Surveys. CSMR=cause-specic mortality rate. SMR=standardised mortality
ratio. YLDs=years lived with disability. YLLs=years of life lost. IHME=Institute for Health Metrics and Evaluation.

List of causes and sequelae The cause and sequelae list was expanded based upon
The GBD cause and sequelae list is organised feedback after the release of GBD 2013 and input from
hierarchically (methods appendix 62553). At Level 1 GBD 2015 collaborators. Nine causes for which
there are three cause groups: communicable, maternal, non-fatal outcomes are estimated were added: Ebola
neonatal, and nutritional diseases (Group 1 diseases); virus disease, motor-neuron disease, environmental
non-communicable diseases; and injuries. These Level 1 heat and cold exposure, four subtypes of leukaemia,
aggregates are subdivided at Level 2 of the hierarchy into and two subtypes of non-melanoma skin cancer
21 cause groupings. The disaggregation into Levels 3 (methods appendix pp 62553). The incorporation of
and 4 contains the nest level of detail for causes these changes expanded the cause list from the
captured in GBD 2015. Sequelae of diseases and injuries 301 causes with non-fatal estimates examined in
are organised at Levels 5 and 6 of the hierarchy. The GBD 2013, to 310 causes with non-fatal estimates and
nest detail for all sequelae estimated in GBD is at from 2337 to 2619 unique sequelae at Level 6 of the
Level 6 and is aggregated into summary sequelae hierarchy. At the newly created Level 5 of the hierarchy
categories (Level 5) for causes with large numbers of there were 154 summary sequela categories. The
sequelae. Sequelae in GBD are mutually exclusive and methods appendix (pp 65461) provides a list of
collectively exhaustive, and thus our YLD estimates at International Classication of Diseases version 9
each level of the hierarchy sum to the total of the level (ICD-9) and version 10 (ICD-10) codes used in the
above. Prevalence aggregations are estimated at the level extraction of hospital and claims data, mapped to GBD
of individuals who might have more than one sequela or 2015 non-fatal causes, impairments, and nature of
disease and therefore are not additive. injury categories.

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Period of analysis claims data, we generated several correction factors to


A complete set of age-specic, sex-specic, cause- account for bias in health service encounter data from
specic, and geography-specic incidence and prevalence elsewhere, which were largely available to us aggregated
numbers and rates were computed for the years 1990, by ICD code and by primary diagnosis only. First, for
1995, 2000, 2005, 2010, and 2015. In this study we focus chronic disorders, we estimated the ratio between
on trends for main and national results over the past prevalence from primary diagnoses and prevalence from
decade, from 2005 to 2015, together with more detailed all diagnoses associated with a claim. Second, we used
For data visualisations at results for 2015. Online data visualisations at vizhub the claims data to generate the average number of
vizhub see http://vizhub. provide access to results for all GBD metrics. outpatient visits per disorder. Similarly, we generated per
healthdata.org/gbd-compare
Non-fatal modelling strategies vary substantially person discharge rates from hospital inpatient data in the
between causes. Figure 1 outlines the general process of USA and New Zealand, the only sources with unique
non-fatal outcome estimation from data inputs to patient identiers available for GBD 2015.
nalisation of YLD burden results; step 3b of that process In GBD 2013, we calculated a geographical and temporal
identies alternative modelling approaches used for data representativeness index (DRI) of non-fatal data
specic causes (methods appendix pp 603, 604). The sources for each cause or impairment. The DRI represents
starting point for non-fatal estimation is the compilation the fraction of countries for which any incidence,
of data sources identied through systematic analysis prevalence, remission, or mortality risk data were available
and extractions based on predetermined inclusion and for a cause. This metric quanties data availability, not
exclusion criteria (methods appendix p 603). As part of data quality. The overall DRI and period-specic DRI
the inclusion criteria, we dened disease-specic or measures for each cause and impairment are presented in
injury-specic reference case denitions and study the methods appendix (pp 66268). DRI ranged from 90%
methods, as well as alternative allowable case denitions for nine causes, including tuberculosis and measles, to
and study methods which were adjusted for if we detected less than 5% for acute hepatitis C and the category of
a systematic bias. We used 15 types of primary data other exposures to mechanical forces. Required case
sources representing disease prevalence, incidence, reporting resulted in high DRI values for notiable
mortality risk, duration, remission, or severity in the infectious diseases; the network of population-based
estimation process (oval shapes in gure 1). registries for cancers resulted in a DRI of above 50%.
DRI values ranged from 61% in North Korea to 913%
Data sources in the USA. Many high-income countries, as well as
For this iteration of the study, we updated data searches Brazil, India, and China, had DRI values above 63%; data
through systematic data and literature reviews for availability was low in several countries, including
85 causes published up to Oct 31, 2015. For other Equatorial Guinea, Djibouti, and South Sudan.
causes, input from GBD collaborators resulted in
the identication and inclusion of a small number of Non-fatal disease models
additional studies published after January, 2013. Data were In addition to the corrections applied to claims and
systematically screened from household surveys archived hospital data, a number of other adjustments were applied
For Global Health Data Exchange in the Global Health Data Exchange, sources suggested including agesex splitting, bias correction, adjustments
see http://ghdx.healthdata.org to us by in-country experts, and surveys identied in for under-reporting of notication data, and computing
major multinational survey data catalogues and Ministry expected values of excess mortality. In GBD 2013, we
of Health and Central Statistical Oce websites. Case estimated expected values of excess mortality from
notications reported to WHO were updated up to and prevalence or incidence and cause-specic mortality
For data in GBD 2015 see http:// including 2015. Citations for all data sources used for non- rate data for a few causes only, including tuberculosis
ghdx.healthdata.org/global- fatal estimation in GBD 2015 are provided in searchable and chronic obstructive pulmonary disease. In order to
burden-disease-study-2015
form through a new web tool. A description of the achieve greater consistency between our cause of death
search terms used for cause-specic systematic reviews, and non-fatal data, we adopted this strategy systematically
inclusion and exclusion criteria, and the preferred and for GBD 2015. We matched every prevalence data point
alternative case denitions and study methods are detailed (or incidence datapoint for short duration disorders) with
by cause in the methods appendix (pp 26601). the cause-specic mortality rate value corresponding to
Hospital inpatient data were extracted from the age range, sex, year, and location of the datapoint.
284 country-year and 976 subnational-year combinations The ratio of cause-specic mortality rate to prevalence is
from 27 countries in North America, Latin America, conceptually equivalent to an excess mortality rate.
Europe, and New Zealand. Outpatient encounter data To estimate non-fatal health outcomes in previous
were available from the USA, Norway, Sweden, and iterations of GBD, most diseases and impairments were
Canada for 48 country-years. For GBD 2015, we also modelled in DisMod-MR, a Bayesian meta-regression tool
accessed aggregate data derived from claims information originally developed for GBD 2010 (step 3a in gure 1).18
in a database of US private and public insurance schemes DisMod-MR was designed to address statistical challenges
for the years 2000, 2010, and 2012. From the linked in estimation of non-fatal health outcomes, and for

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synthesis of often sparse and heterogeneous epidemio- same as the general cancer health states. For motor-
logical data. For GBD 2015, the computational engine of neuron disease we accessed the Pooled Resource Open-
DisMod-MR 2.1 remained unchanged, but we substantially Access ALS Clinical Trials (PROACT) database containing
rewrote the code that organises the ow of data and detailed information on symptoms and impairments for
settings at each level of the analytical cascade. The more than 8500 patients who took part in the trials.23
sequence of estimation occurs at ve levels: global, super-
region, region, country, and where applicable, subnational Disability weights
locations (appendix pp 61124). At each level of the cascade, We used the same disability weights as in GBD 2013 (see
the DisMod-MR 2.1 computational engine enforces methods appendix pp 66994 for a complete listing of
consistency between all disease parameters. For GBD 2015, the lay descriptions and values for the 235 health states
we generated ts for the years 1990, 1995, 2000, 2005, 2010, used in GBD 2015).
and 2015. We log-linearly interpolated estimates for the
intervening years in each 5-year period. Greater detail on Comorbidity
DisMod-MR 2.1 is available at Global Health Data In step 7, we estimated the co-occurrence of dierent For DisMod-MR 2.1 engine and
Exchange and the methods appendix (pp 711). diseases by simulating 40 000 individuals in each the code see http://ghdx.
healthdata.org/global-burden-
In previous iterations of GBD, custom models were geographyagesexyear combination as exposed to the disease-study-2015
created for a short list of causes for which the compartment independent probability of having any of the sequelae
model underpinning DisMod (susceptible, diseased, and included in GBD 2015 based on disease prevalence. We
dead) was insucient to capture the complexity of the tested the contribution of dependent and independent
disease or for which incidence and prevalence needed to comorbidity in the US Medical Expenditure Panel Surveys
be derived from other data. Step 3b of gure 1 describes (MEPS) data, and found that independent comorbidity
the development of custom models with greater detail was the dominant factor even though there are well
shown in the methods appendix gure 1B (p 604, and known examples of dependent comorbidity. Age was
for associated write-ups pp 26601) for HIV/AIDS, the main predictor of comorbidity such that age-specic
tuberculosis, malaria, cancer, neonatal disorders, microsimulations accommodated most of the required
infectious diseases for which we derived incidence from comorbidity correction. Taking dependent comorbidity
seroprevalence data, and infectious diseases for which we into account changed the overall YLDs estimated in the
derived incidence from cause of death rates and pooled MEPS data by only 25% (and ranging from 06% to
estimates of the case fatality proportion. 34% depending on age) in comparison to assuming
In GBD 2013, we estimated the countryagesexyear independent comorbidity (methods appendix pp 1820).24
prevalence of nine impairments (step 4 of gure 1).
Impairments in GBD are disorders or specic domains of YLD computation
functional health loss that are spread across many GBD We report 95% uncertainty intervals (95% UI) for each
causes as sequelae and for which there are better data to quantity in this analysis using 1000 samples from the
estimate the occurrence of the overall impairment than for posterior distribution of prevalence and 1000 samples of
each sequela based on the underlying cause. Overall the disability weight to generate 1000 samples of the YLD
impairment prevalence was estimated with DisMod-MR 2.1 distribution. The 95% UI is reported as the 25th and 975th
except for anaemia, for which spatiotemporal Gaussian values of the distribution. We report signicant changes
Process regression methods were applied. We constrained in disease estimates between countries or over time if the
cause-specic estimates of impairments, such as in the change was noted in more than 950 of the 1000 samples
19 causes of blindness, to sum to the total prevalence computed for each result. For GBD 2015, we computed
estimated for that impairment. Anaemia, epilepsy, hearing age-standardised prevalence YLD rates from the updated
loss, heart failure, and intellectual disability were estimated world population age standard developed for GBD 2013.25
at dierent levels of severity. Less common diseases and their sequelae were included
in 35 residual categories (methods appendix pp 69597).
Severity distributions For 22 of these residual categories, estimates were made
In step 5, sequelae were further dened in terms from epidemiological data for incidence or prevalence.
of severity for 194 causes at Level 4 of the hierarchy For 13 residual categories, we estimated YLDs by
(gure 1A). We generally followed the same approach for multiplying the residual YLL estimates by the ratio of
estimating the distribution of severity as in GBD 2013. YLDs to YLLs from the estimates for explicitly modelled
For Ebola virus disease, we created a health state for the Level 3 causes in the same disease category.
infectious disease episode with duration derived from
average hospital admission times, and a health state for Socio-demographic Index
ongoing postinfection malaise and joint problems based In GBD 2013, a sociodemographic status variable
on four follow-up studies1922 from which we derived an was computed based on a principal components
average duration. The health states for the subtypes of analysis of income per capita, educational attainment,
leukaemia and non-melanoma skin cancer were the average age of the population, and the total fertility

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rate.26 For GBD 2015, we excluded mean age of the


Incidence (thousands) Percentage change population because it is directly aected by death
(%)
rates. To improve interpretability for GBD 2015, we
2005 2015 computed a Socio-demographic Index (SDI) similar to
Upper respiratory infections 15 624 257 17 230 659 103 the computation of the human development index.27
(13 851 23717 411 199) (15 351 51619 172 439) (90 to 116)* In the SDI, each component was weighted equally and
Diarrhoeal diseases 2 235 739 2 392 517 70 rescaled from zero (for the lowest value observed during
(2 139 0502 348 407) (2 301 1012 503 094) (60 to 80)*
19802015) to one (for the highest value observed) for
Permanent caries 426 963 487 629 142
(371 216484 332) (423 507552 895) (131 to 154)*
income per capita and average years of schooling, and
Otitis media 429 820 471 027 96
the reverse for the total fertility rate. The nal SDI score
(353 915525 059) (386 606577 286) (79 to 112)* was computed as the geometric mean of each of the
Lower respiratory infections 273 131 291 759 68 components. SDI ranged from 0060 in Mozambique in
(257 286288 078) (276 244307 004) (56 to 81)* 1987 to 0978 in District of Columbia, USA, in 2015.
Malaria 339 275 286 859 154
(261 417447 605) (219 712377 332) (230 to 81)* Role of the funding source
Gastritis and duodenitis 185 250 213 729 154 The funder of the study had no role in study design,
(167 471204 974) (192 486236 339) (108 to 172%)*
data collection, data analysis, data interpretation,
Pyoderma 178 382 207 452 163
(172 199184 147) (200 498213 936) (156% to 170)*
or writing of the report. The corresponding author
Gonococcal infection 138 220 172 676 249
had full access to all the data in the study and had
(107 106184 385) (129 731235 737) (179 to 310)* nal responsibility for the decision to submit for
Interstitial nephritis and 127 380 152 295 196 publication.
urinary tract infections (124 308130 683) (148 748156 177) (192 to 199)*
Varicella and herpes zoster 128 678 142 413 107 Results
(124 298133 090) (137 804147 181) (100 to 114)* Global incidence and prevalence
Trichomoniasis 121 948 140 781 154 We generated over 93 billion outcomes of incidence,
(104 825141 284) (121 207163 163) (145 to 165)*
prevalence, and YLDs for 310 diseases, injuries, and
Acute hepatitis A 109 609 114 212 42
(101 813117 648) (103 349124 776) (72 to 170)
aggregate categories; 2619 unique and aggregate
Hepatitis B 98 277 111 212 132
sequelae; nine impairments; 63 agesex groups;
(86 507112 527) (97 410126 251) (43 to 352) 591 geographies; and 26 individual years from 1990
Gallbladder and biliary 88 215 104 322 183 to 2015. Each of these 93 billion estimates was
diseases (79 27696 495) (93 074114 430) (160 to 207)* calculated 1000 times to determine uncertainty
Peptic ulcer disease 83 388 87 410 48 intervals. Here, we present key summary ndings
(77 76089 435) (80 34394 506) (26 to 70)* on global incidence of short duration diseases, global
Dengue 32 749 79 609 1431 prevalence of long-term disorders, global prevalence
(18 87968 335) (53 784169 704) (03 to 5647)
of impairments, global numbers and rates of YLDs
Other sense organ diseases 60 659 69 945 153
(58 72162 579) (67 85672 080) (146 to 160)*
and changes from 2005 to 2015, global YLL and YLD
Chlamydial infection 56 976 61 173 74
rates of change, patterns of comorbidity, the expected
(45 48970 839) (48 87176 698) (55 to 94)* changes in the composition of YLDs with SDI, and
Maternal abortion, 53 942 53 958 00 country ndings of leading causes of YLDs.
miscarriage, and ectopic (43 63067 168) (43 22467 417) (38 to 40) Disorders of less than 3 months duration and injuries
pregnancy with incidence of more than 1 million cases per year in
Syphilis 43 515 45 413 44 2015 are listed in table 1. There were two disorders with
(37 47951 054) (37 78754 921) (03 to 81)
incidence greater than 1 billion per year: upper respiratory
Deciduous caries 41 353 43 688 56
(28 72358 131) (29 63062 543) (21 to 81)* infections (172 billion [95% UI 154192 billion]), and
Genital herpes 29 112 39 791 367
diarrhoeal diseases (239 billion [230250 billion]).
(25 13133 432) (35 56944 572) (324 to 416)* A further 13 diseases and injuries caused between
Urolithiasis 17 875 22 080 235 100 million and 1 billion incident cases a year
(16 32019 728) (20 18324 295) (212 to 256)* and 16 diseases and injuries had incident cases of
Cellulitis 17 312 21 211 225 between 10 million and 100 million per year (table 1).
(15 98818 739) (19 58222 985) (210 to 241)* The disease and injury sequelae with a duration of
Maternal hypertensive 20 416 20 731 15 more than 3 months and a global prevalence of more
disorders (17 59323 417) (17 35524 379) (30 to 63)
than 1% in 2015 are presented in table 2, aggregated to
Acute hepatitis E 18 869 19 525 35
(17 34020 580) (18 01121 273) (22% to 47)* the cause level. Prevalence for impairments is presented
Whooping cough 22 457 16 298 274
at the bottom of table 3. Eight out of 56 high-prevalence
(17 32228 268) (12 59920 445) (295 to 252)* causes aected more than 10% of the worlds population
(Table 1 continues on next page) in 2015. A further 48 causes aected between 1% and
10% of the worlds population (table 2). Although many of

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these causes are not among the dominant causes of YLDs


Incidence (thousands) Percentage change
because of comparatively low average disability weights, (%)
some causes, such as headaches, gynaecological diseases,
2005 2015
oral disorders, and skin diseases, put great demands on
health system resources by their sheer numbers. (Continued from previous page)
Anaemia was the most common of our nine Typhoid fever 15 341 12 538 183
impairments, aecting 236 billion (235237 billion) (13 45417 417) (10 88714 283) (208 to 156)*
people in 2015. The next most common impairments Maternal sepsis and other 11 938 11 817 10
were hearing loss of greater than 20 dB (133 billion maternal infections (945715 125) (930015 009) (46 to 28)

[126140 billion]), vision loss (940 million Appendicitis 10 159 11 619 144
(9549 to 10 840) (10 918 to 12 407) (135 to 152)*
[905974 million]), developmental intellectual disability
Pancreatitis 7160 8 902 243
(153 million [114191 million]), infertility (113 million (6 6607 694) (8 2129 643) (219 to 266)*
[934136 million]), heart failure (400 million Maternal haemorrhage 8438 8740 36
[386414 million]), and epilepsy (392 million (661410 620) (677411 061) (03 to 76)
[343437 million]; table 3; see results appendix Other sexually transmitted 7569 7656 12
(pp 74048) for the prevalence estimates of the underlying diseases (65118741) (65838853) (01 to 24)
causes of these impairments). Iron deciency was the Ischaemic heart disease 6308 7287 155
cause of anaemia in more than half of all cases. Over (59186716) (67987808) (143 to 168)*

90% of hearing loss was classied as age-related or other Maternal obstructed labour 6830 6521 45
and uterine rupture (52028933) (49778588) (91 to 03)*
hearing loss. The largest number of people with vision
Hepatitis C 4609 5394 170
loss had uncorrected refraction error. Idiopathic (4316 to 4918) (5032 to 5778) (157 to 184)*
developmental intellectual disability, idiopathic female Ischaemic stroke 4651 5385 158
infertility, and idiopathic epilepsy were the most common (4397 to 4912) (5017 to 5726) (134 to 184)*
causes of their impairments. Ischaemic heart disease Measles 15 610 4652 702
was the most common cause of heart failure. (669931 357) (20729206) (736 to 660)*
Paratyphoid fever 5580 4587 178
Global causes of disability (44986896) (37385601) (226 to 127)*

Global trends in YLDs 2005 to 2015 Haemorrhagic stroke 3144 3583 140
(29733307) (33363822) (114 to 162)*
GBD 2015 included the assessment of 2619 sequelae at
Paralytic ileus and intestinal 2664 3167 189
Level 6 of the GBD cause hierarchy, including 1316 sequelae obstruction (24942855) (29463406) (169 to 207)*
from injuries that contributed to the global burden of Encephalitis 1489 1603 77
disability. Causes at Level 4 of the hierarchy that resulted in (13801608) (14721750) (59 to 95)*
30 million or more YLDs in 2015 included lower back pain, Acute glomerulonephritis 1528 1534 04
major depressive disorder, age-related and other hearing (13951672) (13941685) (26 to 31)
loss, and neck pain. Figure 2 compares the leading causes Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.
of global YLDs in 2005 and 2015, using the cause
breakdowns at Level 3 of the GBD cause hierarchy. Among Table 1: Global incidence of short duration (less than 3 months) sequelae in 2005 and 2015 for all ages
and both sexes combined, with percentage change between 2005 and 2015 for level 4 causes with
the ten leading causes of YLDs, iron-deciency anaemia
incidence greater than 1 million cases per year
and depressive disorders switched ranks to positions three
and four respectively, diabetes rose from the eighth to the
sixth position, migraine dropped from position six to Age-standardised YLD rates attributable to hepatitis A, B,
seven, and other musculoskeletal disorders dropped from and C increased, and decreased for hepatitis E. The number
rank seven to eight (gure 2). of individuals with chronic hepatitis C infection increased
Estimates of prevalence and YLDs at the global level for from 121 million (108133 million) in 2005 to 142 million
2005 and 2015 for each cause are presented in table 3 (see (127157 million) in 2015.
results appendix pp 71740 for full detail at the sequelae
level). Prevalence and age-standardised YLDs for Changes in age-standardised YLDs and YLLs over time
21 Group 1 diseases decreased signicantly and by more In 2005, non-communicable diseases (NCDs) accounted
than 10%, including measles, African trypanosomiasis, for 23 of the leading 25 causes of age-standardised YLDs
diphtheria, lymphatic lariasis, and rabies. worldwide and 23 of the 25 leading causes in 2015
Age-standardised YLD rates for all maternal causes and (gure 2). Although diabetes rose only two ranks in the
sequelae combined decreased between 2005 and 2015, list of leading cause of YLDs, from position eight to six
whereas overall age-standardised YLDs for neonatal between 2005 and 2015, the increase in age-standardised
disorders increased by 311% (032679%) since 2005 to rate was 54% (3275%). Musculoskeletal disorders
144 YLDs per 100 000 (109185 YLDs per 100 000) in 2015, occupied three of the leading 25 causes of disability in
and age-standardised YLD rates decreased and absolute both 2005 and 2015; lower back and neck pain were the
numbers of cases increased for nutritional deciencies. single largest cause with little change in their rates.

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Prevalence (thousands) Percentage change


(%) However, age-standardised rates of YLDs increased for
osteoarthritis 390% (300483%) by 2015. Depressive
2005 2015
disorders were the fourth leading cause of disability in
Permanent caries 2 045 859 2 344 628 146 2005 and the third leading cause of disability in 2015,
(1 909 8452 170 355) (2 193 7512 488 741) (137 to 155)*
and age-standardised YLD rates associated with the
Tension-type headache 1 306 390 1 505 892 153
(1 160 4231 463 889) (1 337 3101 681 575) (140 to 166)* disorder increased marginally (10% [0515%]).
Iron-deciency anaemia 1 456 387 1 477 531 15
Age-standardised rates of YLDs from alcohol use disorders
(1 449 8461 462 782) (1 470 9021 485 322) (09 to 21)* decreased after 2005 (45% [2364%]) whereas disability
Age-related and other 943 504 1 210 055 283 due to drug use disorders increased by 82% (62102%).
hearing loss (886 325995 403) (1 140 2241 274 665) (274 to 292)* In contrast with global trends for NCDs, both relative
Migraine 831 726 958 789 153 ranks and age-standardised YLD rates decreased for
(755 991918 968) (872 1091 055 631) (140 to 166)* most injuries. Falls, which were the 13th leading cause
Genital herpes 716 115 845 826 181 of disability in 2005, dropped to the 15th rank,
(626 987817 387) (736 724968 066) (164 to 199)*
and age-standardised YLD rates decreased (858%
Refraction and 672 165 819 307 219
accommodation disorders (649 969694 024) (789 917848 059) (205 to 232)* [523122%]). Other unintentional injuries decreased
Ascariasis 854 489 761 894 108
in global rank from 27th in 2005 to 34th in 2015,
(790 000924 895) (682 558861 031) (225 to 25) and age-standardiSed YLD rates decreased by 167%
G6PD trait 663 704 728 549 98 (157179%).
(625 032703 799) (676 735781 534) (79 to 114)* The leading causes of disability varied considerably with
Acne vulgaris 605 008 632 741 46 age (gure 3). The leading cause in children younger than
(568 577642 061) (595 242671 249) (35 to 56)* 5 years was iron-deciency anaemia followed by skin
Other skin and 492 883 605 036 228 diseases, protein-energy malnutrition, and diarrhoea. In
subcutaneous diseases (480 852505 426) (589 500619 676) (221 to 234)*
older children, iron-deciency anaemia, skin diseases,
Deciduous caries 534 122 558 028 45
(449 525635 866) (462 649669 027) (23 to 61)* asthma, and mental health disorders such as conduct,
Low back pain 460 164 539 907 173
autistic spectrum, and anxiety disorders were top ten
(444 680477 119) (521 449559 556) (165 to 182)* causes of disability. In adolescents and young adults (aged
Periodontal diseases 428 784 537 506 254 between 15 and 39 years), iron-deciency anaemia, skin
(372 953498 682) (465 114625 889) (241 to 265)* diseases, depression, lower back and neck pain, and
Fungal skin diseases 434 604 492 373 133 migraine led the rankings. Other mental health disorders
(395 512475 904) (448 951538 232) (125 to 141)* such as anxiety disorders and schizophrenia were in the
Trichuriasis 473 399 463 652 21 top ten causes in this age group. In middle-aged adults,
(443 689505 928) (426 621502 939) (120 to 90)
musculoskeletal disorders dominated the top rankings
Diabetes 333 325 435 328 306
(310 773355 510) (404 736468 562) (280 to 330)* followed by mental health disorders, especially depression.
Premenstrual syndrome 391 207 430 697 101
Diabetes and sense organ disorders were more prominent
(375 009407 896) (410 841450 494) (79 to 118)* causes of disability in middle-age. In older adults (older
Hookworm disease 462 111 428 246 73 than 65 years), sense organ disorders were the top-ranked
(430 885495 596) (394 486468 292) (169 to 35) cause of disability. Musculoskeletal disorders remained a
Sickle-cell trait 338 756 404 566 194 dominant source of disability, and chronic obstructive
(318 736378 582) (381 223448 155) (183 to 203)* pulmonary disease entered the top ten. In the oldest age
Asthma 327 097 358 198 95 groups, ischaemic heart disease and Alzheimers and
(296 406358 060) (323 134393 466) (76 to 116)*
other dementias made their rst appearance in the top ten.
Neck pain 295 532 358 007 211
(258 878338 138) (313 408409 411) (190 to 233)* We examined the trends in YLDs and YLLs in a
Hepatitis B 293 745 343 251 169
scatterplot (gure 4). YLLs decreased for the majority of
(284 478303 036) (330 541357 195) (153 to 184)* causes. For Group 1 causes and injuries, the decrease in
Other musculoskeletal 283 317 342 068 207 YLLs was accompanied by a decrease in YLDs, albeit at a
disorders (254 135315 519) (305 431385 147) (175 to 240)* slower pace. The exceptions were neonatal encephalopathy,
Urolithiasis 259 567 318 763 228 haemolytic disease and other neonatal jaundice,
(238 100281 892) (290 695 349 154) (208 to 249)*
leishmaniasis, meningitis, hepatitis, and sexually trans-
Thalassaemias trait 252 798 279 451 105 mitted diseases with increasing YLD rates between 1990
(247 008259 972) (272 819287 357) (101 to 110)*
and 2015. A few Group 1 disorders and injuries had a
Malaria 207 773 278 961 343
(186 530230 942) (240 158320 921) (268 to 423)* faster decrease in YLDs than in YLLs: intestinal infections,
Edentulism and severe 216 473 275 619 273 obstructed labour, and neonatal sepsis. The only NCDs
tooth loss (207 563226 331) (264 201288 252) (269 to 277)* with a faster decrease in YLDs compared with YLLs were
Anxiety disorders 232 597 267 202 149 epilepsy and cervical cancer. Another small number of
(204 165264 445) (234 064306 318) (130 to 168)* NCDs saw an increase in YLDs and YLLs, including drug
(Table 2 continues on next page) use disorders, diabetes, and Parkinsons disease. NCDs
with decreasing YLLs but increasing YLDs included

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Prevalence (thousands) Percentage change


cancers of the prostate, testis, uterus, kidney, colorectum, (%)
and pancreas, melanoma, and congenital disorders. Some 2005 2015
cancers (stomach and Hodgkins lymphoma), rheumatic
(Continued from previous page)
heart disease, asthma, chronic obstructive pulmonary
disease, acute glomerulonephritis, peptic ulcer disease, Other sense organ diseases 214 761 266 346 240
gastritis, hernia, and gallbladder disease had decreasing (207 401222 622) (257 047276 383) (231 to 249)*

YLLs and YLDs, but with a faster decrease in YLLs than in Schistosomiasis 329 773 252 340 235
(297 093367 878) (211 032321 081) (325 to 44)*
YLDs. The rate of change in YLDs for the main drivers of
G6PD deciency 231 109 247 074 69
non-fatal health loss, musculoskeletal disorders, and (205 067259 769) (209 307286 713) (14 to 119)*
mental and substance use disorders was small. Dermatitis 215 260 245 291 140
(199 590230 536) (227 283262 752) (132 to 148)*
Global distribution of disability weights across individuals Osteoarthritis 178 665 237 369 329
Figure 5 shows the global distribution of individuals from (173 558184 053) (230 336244 648) (319 to 338)*
our comorbidity microsimulation by six categories of Major depressive disorder 183 434 216 047 178
disability, age, and sex for the highest and lowest SDI (163 947206 420) (192 863243 319) (166 to 190)*

quintile. The six categories of disability are no disability, Scabies 191 482 204 152 66
(166 101223 739) (177 534237 466) (40 to 95)*
very mild disability (disability weight less than or equal to
Viral skin diseases 161 167 174 843 85
001), mild disability (from 001 to 005 inclusive), (152 218170 651) (165 156185 072) (80 to 90)*
moderate (from 005 to 01 inclusive), severe (from 01 to Chronic obstructive 149 115 174 483 170
03 inclusive), and profound (greater than 03). In 2015, pulmonary disease (137 380160 739) (160 205188 952) (151 to 190)*
most of the worlds population experienced mild or Genital prolapse 137 383 161 679 177
greater disability. Having no disability at all was most (121 623154 875) (142 335182 566) (152 to 200)*
common in children. After age 25 years, the proportion of Gastritis and duodenitis 135 993 157 060 155
the population having no disability became progressively (134 420137 351) (154 055160 141) (129 to 179)*

smaller, and by age 55 years in low SDI countries and age Peripheral vascular disease 115 109 154 651 344
(101 439131 405) (136 318176 211) (334 to 352)*
75 years in high SDI countries, nearly everyone had some
Uterine broids 126 797 151 115 192
form of disability. Very mild to moderate disability (ie, (120 900133 050) (144 147158 477) (188 to 195)*
individuals with a disability weight of 01 or less) was Hepatitis C 120 457 142 123 180
common in childhood and young adults, but was replaced (108 080133 129) (126 978157 045) (167 to 192)*
by more severe disability with increasing age. The Other mental and 107 895 128 178 188
patterns were similar for both sexes, apart from a much substance use disorders (107 213108 449) (127 512128 877) (179 to 197)*
larger amount of disability in women older than 80 years Iodine deciency 103 701 110 920 70
in the top SDI quintiles, reecting the much higher (93 441116 438) (100 337125 253) (47 to 94)*

average age of women in this age category. For policy Ischaemic heart disease 87 511 110 193 259
(80 13396 170) (100 332121 427) (246 to 272)*
considerations around the age of retirement in ageing
Benign prostatic 80 684 104 625 297
populations, it is noteworthy that from age 60 years hyperplasia (70 33890 853) (90 730118 244) (275 to 320)*
onwards more than half of the population had severe or Dysthymia 86 812 104 106 199
worse disability. The extent to which this loss of health (74 97499 103) (90 398118 969) (184 to 215)*
limits or precludes the ability to work depends on the Chronic kidney disease due 79 184 100 824 273
nature of the impairments and the type of employment in to diabetes (68 48190 737) (86 923115 652) (249 to 299)*
older workers with that level of disability. Chronic kidney disease due 74 917 94 553 262
to other causes (64 01286 576) (81 142109 371) (242 to 283)*

Expected changes in disease prole with higher Idiopathic developmental 82 996 92 074 109
intellectual disability (47 588117 109) (52 280130 411) (95 to 119)*
Socio-demographic Index
Other cardiovascular and 72 772 90 348 242
Figure 6 depicts changes in patterns of disability by level of circulatory diseases (68 09077 763) (84 71196 659) (227 to 255)*
SDI for age-standardised and all-age YLD rates per 100 000. Otitis media 83 022 86 393 41
Age-standardised YLD rates gradually decreased with (73 65793 266) (76 37497 104) (27% to 55)*
increasing SDI in both sexes (gure 6A). The cause Psoriasis 67 753 79 700 176
composition of YLDs somewhat varied across levels of (65 10770 298) (76 69182 804) (170 to 183)*
SDI; these dierences were largely derived from absolute Other 73 045 74 385 18
haemoglobinopathies and (72 60073 470) (73 89874 862) (09 to 27%)
levels of disability due to communicable causes and
haemolytic anaemias
nutritional deciencies, and to a lesser extent, maternal
and neonatal disorders. Age-standardised YLD rates due to Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.
NCDs and injuries were similar at all SDI levels.
Table 2: Global prevalence of longer duration (more than 3 months) sequelae in 2005 and 2015 for all
Across levels of SDI, mental and substance use ages and both sexes combined, with percentage change between 2005 and 2015 for Level 4 causes with
disorders, musculoskeletal disorders, and other NCDs prevalence greater than 1%
were consistently among the leading causes of

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age-standardised YLD rates. Anaemia led to generally African countries; depression in ve eastern sub-Saharan
higher rates of age-standardised YLDs in women than in Africa countries; other neglected tropical diseases in
men across levels of SDI, but the largest imbalance Angola, Democratic Republic of the Congo, and Gabon;
occurred at SDI levels between 010 and 050. Disability sense organ disorders in Comoros and Myanmar;
from injuries exacted a larger burden for men than for diabetes in Fiji and Marshall Islands; war in Lebanon and
women, particularly at lower levels of SDI. Syria; and onchocerciasis in Liberia.
Without adjustments for population age structure
(gure 6B), the eect of ageing populations and causes Regional, country, territory, and selected subnational results
of disability that disproportionately aect older Lower back and neck pain was the leading cause of
individuals become prominent. At all levels of SDI, disability in all high-income countries in 2015. However,
total YLDs per 100 000 did not notably dier by sex; ratios of observed to expected YLDs from lower back and
instead, the cause composition of disability showed neck pain ranged from 060 for Singapore to more than
greater dierences. Below an SDI score of 025, 159 in Norway. Most high-income countries experienced
communicable causes accounted for 3045% of total higher than expected levels of disability due to depressive
disability, primarily due to nutritional deciencies, disorders. The USA and Australia were the only two high-
malaria, and neglected tropical diseases. YLDs income countries where drug use disorders were a top ten
per 100 000 due to musculoskeletal disorders, cause of disability, and observed levels of YLDs were much
particularly lower back and neck pain and other mus- higher than expected. South Koreas ratio of observed-to-
culoskeletal disorders, increased substantially from low expected levels of YLDs due to diabetes exceeded 130,
to high SDI, with a more pronounced increase whereas Japans diabetes-related disability was lower than
beginning at an SDI score of 06. This rise was expected on the basis of SDI. In the UK, observed disability
particularly evident in women. due to asthma was well above expected levels.
In 2015, lower back and neck pain was the leading
Trends in age-standardised YLDs per capita cause of YLDs for all but two countries in Latin America
Globally, age-standardised YLDs per capita (an indicator and the Caribbean; Haiti and Venezuela were the
of overall disability experienced per person in a given exceptions, with iron-deciency anaemia as the leading
place) moderately decreased for both sexes between 1990 causes of disability for both countries. Disability due to
and 2015 (results appendix pp 71416). Age-standardised diabetes surpassed expected levels by at least a factor of
YLDs per capita were consistently higher for women two for six countries and territories: Antigua, Barbados,
than for men at the global level. For both sexes, YLDs Dominica, Puerto Rico, Trinidad and Tobago, and the
per capita were generally higher for lower levels of SDI. Virgin Islands. Peru, however, had a ratio of less than 06
YLDs per capita were noticeably larger for low SDI and for observed and expected YLDs for diabetes.
low-middle SDI groups than for other SDI levels (ie, In 2015, lower back and neck pain was the leading
high SDI, high-middle SDI, and middle SDI), which cause of YLDs for 24 out of 28 countries and territories of
were more similar to each other. southeast Asia, east Asia, and Oceania. Other leading
causes of disability were sensory disorders in Myanmar,
Leading causes of YLDs and deviations from expected levels diabetes in Fiji and the Marshall Islands, and
based on Socio-demographic Index iron-deciency anaemia in Papua New Guinea. Although
Clear, though varied, patterns emerged across and within lower back and neck pain was the primary cause of
GBD regions in comparison of observed levels of YLDs disability, many countries had far lower levels of this
due to leading causes of disability with levels expected on than expected given their SDI, including Thailand (073),
the basis of SDI. Figure 7 displays ratios of observed and Indonesia (076), and Malaysia (075). Observed YLDs
expected YLDs for the leading ten causes at level 3 of the due to depressive disorders were often lower than
GBD hierarchy in 2015, colour coded by the magnitude expected, with 22 countries recording ratios below 080.
of dierences between observed and expected YLDs. Conversely, numerous geographies recorded YLD ratios
Globally, lower back and neck pain was the leading exceeding 200 for diabetes (eg, 229 in Taiwan).
cause of disability in 2015. Two mental disorders, major Beyond lower back and neck pain, which was the leading
depressive and anxiety disorders, were the third and cause of YLDs for three of ve countries in south Asia in
ninth leading causes of global disability, and diabetes was 2015 (with India and Pakistan being the exception), a
the sixth leading driver of disability. Iron-deciency mixture of causes accounted for the regions main causes
anaemia was the only Group 1 cause among the leading of disability; this heterogeneity probably reects the
ten causes for global YLDs (ranked fourth). Sensory diversity of countries in the region and their places along
disorders ranked second and skin diseases ranked fth. the development spectrum. Iron-deciency anaemia was
Lower back and neck pain was the leading global cause of the rst leading cause and lower back and neck pain was
disability in 2015 in most countries. The leading cause of the second leading cause of YLDs in both India and
disability in 2015 was iron-deciency anaemia in Pakistan, whereas sensory disorders, other musculoskeletal
27 countries; HIV/AIDS in all six southern sub-Saharan disorders, and iron-deciency anaemia ranked second for

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
All causes 792 0047 151 21
(588 53871 019 9552) (145 to 156)* (25 to 17)*
Communicable, maternal, 4 133 8223 80 42 112 5019 05 97
neonatal, and nutritional (4 108 1325 to (73 to 87)* (48 to 36)* (80 3474156 2709) (24 to 25) (114 to 70)*
diseases 4 161 2626)
HIV/AIDS and tuberculosis 46 0052 186 29 67023 21 122
(44 9858 to 47 1466) (152 to 221)* (00 to 59) (4798688635) (35 to 72) (170 to 78)*
Tuberculosis 88612 92 72 27124 94 68
(80763 to 97072) (63 to 122)* (95 to 47)* (1829937440) (64 to 125)* (92 to 42)*
HIV/AIDS 37 2775 211 56 39899 24 156
(36 2799 to 38 3391) (169 to 255)* (20 to 96)* (2891251595) (105 to 55) (230 to 85)*
HIV/AIDStuberculosis 12580 179 283 4719 178 281
(11425 to 13869) (207 to 149)* (307 to 257)* (31606456) (207 to 147)* (306 to 255)*
HIV/AIDS resulting in 37 5433 236 79 35180 02 136
other diseases (36 3500 to 39 0284) (205 to 267)* (51 to 106)* (2 55544 5589) (93 to 93) (221 to 52)*
HIV aggregate 21 1490 195 297 15436 204 304
(20 2603 to 22 2923) (225 to 163)* (323 to 269)* (1 10722 0252) (234 to 172)* (331 to 276)*
AIDS aggregate 16 3943 2995 2329 19744 255 61
(15 7470 to 17 1542) (2514 to 3555)* (1935 to 2790)* (1432025599) (09 to 561)* (146 to 324)
Diarrhoea, lower respiratory 402 3204 80 29 14 8650 62 40
infections, and other (393 7465 to (72 to 88)* (37 to 23)* (10 397020 2834) (54 to 71)* (47 to 33)*
common infectious diseases 408 9942)
Diarrhoeal diseases 35 8206 64 33 57317 64 31
(34 3421 to 37 5378) (55 to 73)* (41 to 25)* (3 94337 8905) (54 to 75)* (40 to 22)*
Diarrhoea episodes 35 8163 64 33 57304 64 31
aggregate (34 3375 to 37 5341) (55 to 73)* (41 to 25)* (3 94227 8890) (54 to 75)* (40 to 22)*
Guillain-Barr syndrome 42 169 02 13 169 02
due to diarrhoeal diseases (32 to 55) (147 to 195)* (09 to 04) (0819) (147 to 195)* (09 to 04)
Intestinal infectious diseases 16668 233 282 2203 186 242
(15944 to 1 7328) (256 to 206)* (304 to 258)* (14933065) (228 to 138)* (281 to 198)*
Typhoid fever 14467 183 239 1910 177 232
(12562 to 1 6481) (208 to 156)* (263 to 213)* (12952678) (221 to 126)* (274 to 185)*
Typhoid fever episodes 11979 183 239 1133 181 237
aggregate (10413 to 13666) (217 to 148)* (271 to 205)* (7581625) (226 to 134)* (278 to 192)*
Complications of 2488 182 238 778 170 226
typhoid fever aggregate (2108 to 2922) (286 to 54)* (335 to 121)* (5161108) (285 to 30)* (331 to 99)*
Paratyphoid fever 5293 178 238 275 175 235
(4313 to 6463) (226 to 127)* (282 to 192)* (175407) (247 to 92)* (301 to 161)*
Paratyphoid fever 5022 178 238 244 175 235
episodes aggregate (4096 to 6127) (226 to 124)* (282 to 190)* (155364) (249 to 87)* (307 to 155)*
Intestinal perforation 271 176 237 31 175 236
due to paratyphoid (209 to 345) (330 to 14) (378 to 61)* (1946) (328 to 16) (377 to 59)*
Other intestinal infectious 18 670 693
diseases (0641) (788 to 458)* (802 to 501)*
Lower respiratory infections 89866 51 82 5404 49 81
(85452 to 93937) (40 to 62)* (91 to 73)* (36537603) (35 to 63)* (92 to 70)*
Lower respiratory 89822 51 82 5391 49 81
infection episodes (85398 to 93879) (40 to 62)* (91 to 73)* (36457595) (35 to 63)* (92 to 70)*
aggregate
Guillain-Barr syndrome 44 169 02 13 169 02
due to lower respiratory (25 to 69) (147 to 195)* (09 to 04) (0722) (147 to 195)* (09 to 04)
infections
Upper respiratory infections 233 4703 102 14 27384 101 13
(208 0097 to 259 0768) (89 to 115)* (20 to 08)* (1538646443) (89 to 115)* (19 to 06)*
Upper respiratory infection 233 4582 102 14 27348 101 13
episodes aggregate (207 9979 to 259 0652) (89 to 115)* (20 to 08)* (1 53394 6414) (89 to 115)* (19 to 06)*
Guillain-Barr syndrome 121 169 02 36 170 02
due to upper respiratory (96 to 152) (147 to 195)* (09 to 04) (2254) (147 to 195)* (09 to 04)
infections
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Otitis media 112 0891 52 44 33215 33 56
(100 5046 to 123 6556) (41 to 65)* (55 to 34)* (2 11424 9063) (06 to 60)* (80 to 31)*
Acute otitis media 25 6308 94 13 3349 94 14
(21 0442 to 31 5706) (75 to 112)* (04 to 30) (16946237) (75 to 114)* (03 to 31)
Chronic otitis media 86 4583 41 60 29866 27 63
aggregate (76 4030 to 97 1337) (27 to 55)* (72 to 48)* (190424 3711) (02 to 56) (89 to 36)*
Meningitis 87335 169 25 15169 150 19
(83206 to 91071) (134 to 200)* (06 to 51) (1076119860) (137 to 165)* (07 to 30)*
Pneumococcal meningitis 72972 222 69 7288 176 39
(62285 to 86353) (197 to 251)* (47 to 96)* (51319599) (155 to 197)* (20 to 56)*
Acute pneumococcal 403 253 121 53 251 119
meningitis (335 to 484) (174 to 338)* (52 to 195)* (3478) (151 to 371)* (32 to 223)*
Complications of 72569 222 69 7235 176 38
pneumococcal (61913 to 85917) (197 to 251)* (47 to 96)* (50929524) (154 to 196)* (20 to 56)*
meningitis aggregate
H inuenzae type b 24556 83 180 3021 69 33
meningitis (19667 to 30326) (122 to 39)* (215 to 139)* (20944071) (34 to 106)* (66 to 00)
Acute H inuenzae type 220 192 260 29 187 256
b meningitis (172 to 287) (253 to 119)* (318 to 192)* (1845) (261 to 108)* (324 to 181)*
Complications of H 24335 82 179 2991 73 30
inuenzae type b (19474 to 30108) (121 to 37)* (215 to 137)* (20794027) (37 to 110)* (63 to 03)
meningitis aggregate
Meningococcal meningitis 17208 220 75 1616 197 51
(13277 to 2 1805) (179 to 262)* (38 to 113)* (11172156) (175 to 221)* (32 to 74)*
Acute meningococcal 228 244 127 30 247 129
meningitis (189 to 277) (144 to 349)* (37 to 224)* (1845) (109 to 394)* (05 to 259)*
Complications of 16980 220 74 1586 196 50
meningococcal (13052 to 21552) (179 to 262)* (38 to 112)* (10942119) (174 to 220)* (31 to 73)*
meningitis aggregate
Other meningitis 30152 190 35 3245 153 09
(24385 to 36180) (166 to 216)* (14 to 59)* (22514281) (133 to 174)* (08 to 27)
Other meningitis 1345 163 57 178 166 59
episodes aggregate (1200 to 1517) (102 to 225)* (01 to 114)* (115253) (86 to 240)* (11 to 125)
Complications of other 28804 191 34 3067 152 06
meningitis aggregate (23007 to 34749) (165 to 219)* (12 to 58)* (21334066) (132 to 175)* (11 to 26)
Encephalitis 43158 48 93 4570 67 63
(31458 to 58756) (28 to 74)* (113 to 67)* (32675949) (46 to 90)* (82 to 43)*
Acute encephalitis 818 71 41 108 75 37
(748 to 895) (52 to 90)* (57 to 24)* (71155) (38 to 111)* (69 to 05)*
Complications of 42336 48 94 4462 67 64
encephalitis aggregate (30696 to 57875) (27 to 73)* (114 to 68)* (31885814) (46 to 90)* (83 to 44)*
Diphtheria 06 596 628 00 597 628
(03 to 12) (817 to 127)* (831 to 195)* (0001) (817 to 127)* (831 to 195)*
Whooping cough 22326 274 324 1103 273 323
(17259 to 28007) (295 to 252)* (343 to 303)* (6561670) (296 to 248)* (345 to 300)*
Tetanus 2093 84 27 91 89 181
(2048 to 2147) (61 to 98)* (50 to 14)* (67122) (145 to 37)* (233 to 133)*
Severe tetanus 86 463 521 11 459 518
(65 to 130) (540 to 360)* (591 to 429)* (0719) (538 to 357)* (589 to 426)*
Complications of tetanus 2007 133 18 80 10 88
aggregate (1967 to 2045) (128 to 139)* (14 to 23)* (58106) (37 to 54) (130 to 49)*
Measles 1274 702 723 115 700 720
(568 to 2522) (736 to 660)* (754 to 684)* (43253) (736 to 654)* (754 to 677)*
Varicella and herpes zoster 59077 152 04 2078 185 04
(54894 to 63446) (141 to 165)* (08 to 00)* (12793165) (165 to 208)* (14 to 07)
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Neglected tropical diseases 1 900 0626 04 107 20 7631 47 145
and malaria (1 863 1488 to (25 to 19) (127 to 87)* (13 382432 1745) (132 to 89) (222 to 24)*
1 940 0585)
Malaria 295 7173 299 200 33582 161 85
(257 5684 to 338 4490) (225 to 372)* (129 to 272)* (2356947039) (128 to 193)* (54 to 114)*
Asymptomatic malaria 206 1472 373 264 00 00 00
parasitaemia (168 6707 to 246 8887) (270 to 481)* (166 to 368)* (0000) (00 to 00) (00 to 00)
(PfPR)
Malaria episodes 16 7568 159 211 3466 158 209
aggregate (10 3418 to 25 9655) (236 to 84)* (284 to 141)* (17445984) (236 to 82)* (282 to 137)*
Complications of malaria 8769 284 184 2749 247 150
aggregate (7981 to 9579) (265 to 305)* (165 to 203)* (20973448) (205 to 291)* (112 to 189)*
Anaemia due to malaria 71 9364 263 170 27367 211 131
parasitaemia (70 1375 to 73 5042) (244 to 280)* (153 to 186)* (1848039188) (181 to 243)* (105 to 161)*
(PfPR) aggregate
Chagas disease 66536 71 221 631 18 210
(57505 to 75756) (97 to 41)* (242 to 197)* (421908) (51 to 17) (236 to 183)*
Chagas disease episodes 56347 78 222 00 187 276
aggregate (48505 to 64141) (103 to 49)* (243 to 198)* (0001) (229 to 144)* (311 to 241)*
Complications of Chagas 6660 52 220 448 25 210
disease aggregate (5255 to 8206) (79 to 19)* (243 to 196)* (300628) (60 to 12) (236 to 183)*
Heart failure due to 3530 03 209 182 02 209
Chagas disease aggregate (2215 to 5035) (29 to 40) (234 to 182)* (97294) (36 to 44) (238 to 178)*
Leishmaniasis 38593 273 114 458 255 105
(34384 to 45704) (59 to 550)* (70 to 351) (228867) (219 to 289)* (75 to 135)*
Visceral leishmaniasis 608 106 23 43 108 26
(575 to 647) (97 to 114)* (16 to 30)* (2961) (21 to 207)* (54 to 115)
Cutaneous and 38959 270 110 415 273 114
mucocutaneous (3 3246 to 4 7675) (237 to 301)* (83 to 138)* (194808) (236 to 305)* (83 to 145)*
leishmaniasis
African trypanosomiasis 107 687 723 30 674 710
(60 to 170) (704 to 673)* (738 to 710)* (1453) (726 to 621)* (755 to 666)*
Schistosomiasis 252 3395 235 309 24726 218 291
(211 0325 to 321 0813) (325 to 44)* (390 to 137)* (1275045212) (293 to 40)* (360 to 131)*
Schistosomiasis episodes 130 2857 263 331 7407 273 340
aggregate (114 4339 to 156 9000) (345 to 136)* (405 to 213)* (292315840) (352 to 141)* (410 to 220)*
Complications of 105 6219 196 277 11888 180 263
schistosomiasis aggregate (76 6410 to 160 3394) (326 to 141) (394 to 30) (53592 4633) (305 to 156) (375 to 43)
Anaemia due to 16 3313 196 270 5431 215 278
schistosomiasis aggregate (16 0758 to 16 6551) (211 to 177)* (283 to 253)* (36517815) (240 to 186)* (300 to 251)*
Cysticercosis 19310 62 208 2867 163 292
(15978 to 23120) (102 to 25)* (243 to 176)* (19423928) (213 to 118)* (333 to 253)*
Cystic echinococcosis 13830 247 67 1268 243 66
(12659 to 14986) (226 to 270)* (50 to 85)* (8671746) (211 to 275)* (41 to 92)*
Lymphatic lariasis 38 4641 449 516 20750 162 277
(31 3282 to 46 7830) (499 to 399)* (560 to 472)* (1120633112) (321 to 39)* (415 to 171)*
Prevalence of detectable 19 7079 588 635 00 00 00
microliaria due to (17 1738 to 22 2705) (618 to 553)* (661 to 603)* (0000) (00 to 00) (00 to 00)
lymphatic lariasis
Complications of 18 7563 148 267 20750 162 277
lymphatic lariasis (12 4201 to 26 3971) (299 to 35)* (401 to 167)* (1120633112) (321 to 39)* (415 to 171)*
aggregate
Onchocerciasis 15 5315 291 368 11357 212 312
(11 9635 to 19 9938) (395 to 188)* (460 to 275)* (546220054) (385 to 48)* (467 to 162)*
Asymptomatic 22804 624 662 00 00 00
onchocerciasis (15250 to 31732) (661 to 596)* (695 to 637)* (0000) (00 to 00) (00 to 00)
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Skin disease due to 12 2239 174 265 10556 222 316
onchocerciasis aggregate (8 4747 to 16 5852) (310 to 27)* (386 to 131)* (467418947) (418 to 32)* (490 to 148)*
Vision loss due to 10254 23 223 801 61 254
onchocerciasis aggregate (7248 to 14521) (150 to 118) (323 to 110)* (5131175) (169 to 60) (339 to 159)*
Trachoma 35571 46 193 2792 12 239
(29405 to 43218) (04 to 92)* (229 to 152)* (19283960) (56 to 30) (275 to 203)*
Dengue 47300 1436 1197 7641 1408 1177
(26541 to 10 2542) (03 to 5647) (101 to 4987) (34681 7442) (01 to 5584) (98 to 4943)
Dengue episodes 14092 1341 1108 821 1414 1179
aggregate (9376 to 29438) (38 to 5212) (132 to 4590) (4501839) (04 to 5492)* (94 to 4867)
Post-dengue chronic 33246 1437 1198 6820 1408 1176
fatigue syndrome (16003 to 73479) (03 to 5647) (101 to 4987) (29521 6089) (02 to 5580) (98 to 4941)
Yellow fever 28 257 316 01 257 316
(08 to 77) (316 to 192)* (369 to 258)* (0003) (316 to 192)* (369 to 258)*
Rabies 07 434 508 01 434 508
(06 to 08) (515 to 338)* (576 to 426)* (0101) (515 to 338)* (576 to 426)*
Intestinal nematode 1 447 2093 25 128 31738 228 304
infections (1 414 9950 to (51 to 02) (152 to 104)* (1861350908) (273 to 173)* (345 to 254)*
1 481 3323)
Ascariasis 761 8938 108 203 8710 377 439
(682 5575 to 861 0315) (225 to 25) (307 to 82)* (48251 4643) (453 to 294)* (508 to 364)*
Complications of 47 6264 356 421 8710 377 439
ascariasis aggregate (44 0875 to 51 7119) (419 to 284)* (478 to 356)* (48251 4643) (453 to 294)* (508 to 364)*
Asymptomatic ascariasis 714 2307 85 182 00 00 00
(634 2019 to 814 0095) (209 to 64) (293 to 49)* (0000) (00 to 00) (00 to 00)
Trichuriasis 463 6521 21 122 5441 167 249
(426 6212 to 502 9394) (120 to 90) (211 to 21)* (29079460) (306 to 36) (375 to 68)*
Complications of 27 1296 156 241 5441 167 249
trichuriasis aggregate (24 1887 to 31 8908) (278 to 21) (350 to 82)* (29079460) (306 to 36) (375 to 68)*
Asymptomatic 436 5254 11 113 00 00 00
trichuriasis (400 0133 to 475 9855) (118 to 110) (210 to 03)* (0000) (00 to 00) (00 to 00)
Hookworm disease 428 2459 73 172 17588 146 229
(394 4860 to 468 2924) (169 to 35) (258 to 75)* (1088527549) (199 to 94)* (277 to 182)*
Complications of 51 0129 140 232 10467 155 244
hookworm disease (48 1511 to 54 3462) (210 to 62)* (295 to 163)* (572817321) (240 to 63)* (321 to 163)*
aggregate
Anaemia due to 24 2202 62 155 7121 132 205
hookworm disease (24 0782 to 24 3652) (73 to 51) (165 to 146)* (476310311) (156 to 111)* (226 to 187)*
aggregate
Asymptomatic 352 9486 64 164 00 00 00
hookworm disease (319 1432 to 392 5744) (183 to 75) (272 to 39)* (0000) (00 to 00) (00 to 00)
Food-borne trematodiases 71 0954 40 93 16865 37 100
(67 3655 to 75 2469) (15 to 66)* (114 to 71)* (857130668) (04 to 101)* (134 to 52)*
Asymptomatic food- 56 1317 38 93 00 00 00
borne trematodiases (45 7659 to 63 6203) (12 to 66)* (116 to 69)* (0000) (0000) (0000)
aggregate
Symptomatic food-borne 14 9637 48 93 16865 37 100
trematodiases aggregate (8 6327 to 25 2566) (05 to 114)* (128 to 42)* (857130668) (04 to 101) (134 to 52)*
Leprosy 5142 01 197 310 06 192
(4870 to 5457) (05 to 03) (202 to 193)* (209435) (15 to 29) (208 to 174)*
Ebola 28 54 5213 49 8179 06 51 9088 47 4530
(12 to 52) (46 3862 to (41 8656 to (0211) (42 7390 to 66 8843)* (38 6095 to
68 3469)* 62 7649)* 61 7303)*
Other neglected tropical 61 4526 01 77 52611 74 12
diseases (60 8428 to 62 0549) (10 to 13) (88 to 66)* (2558512 1990) (189 to 506) (255 to 380)
(Table 3 continues on next page)

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Articles

Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Anaemia due to other 61 4526 01 77 21582 60 124
neglected tropical diseases (60 8428 to 62 0549) (10 to 13) (88 to 66)* (1 44633 0731) (82 to 38)* (145 to 104)*
aggregate
Maternal disorders 11 3729 21 79 8988 51 151
(10 6866 to 11 8941) (42 to 92) (136 to 18)* (642812229) (187 to 112) (270 to 03)*
Maternal haemorrhage 23048 16 78 847 01 91
(22316 to 2 3935) (30 to 65) (120 to 34)* (5731195) (135 to 172) (213 to 66)
Maternal hemorrhage 1917 29 64 313 33 60
episodes aggregate (1278 to 2775) (365 to 662) (421 to 499) (181490) (306 to 549) (363 to 411)*
Anaemia due to 21134 15 79 535 18 108
maternal haemorrhage (20828 to 21415) (09 to 39) (101 to 58)* (350786) (59 to 26) (145 to 69)*
aggregate
Maternal sepsis and other 31408 37 78 565 10 97
maternal infections (26580 to 37277) (152 to 278) (242 to 131) (2951024) (423 to 704) (471 to 552)
Maternal sepsis and 9000 24 102 453 27 105
other maternal (4867 to 14623) (503 to 937) (544 to 781) (222827) (490 to 910) (532 to 736)
infections aggregate
Infertility due to 22421 64 68 112 67 66
puerperal sepsis (2 0305 to 24830) (44 to 89)* (86 to 47)* (42243) (40 to 95)* (89 to 41)*
Maternal hypertensive 46244 27 58 2224 26 59
disorders (30308 to 65924) (379 to 698)* (430 to 554)* (11843654) (373 to 685) (424 to 544)
Maternal hypertensive 46292 28 57 2191 27 58
disorders episodes (30315 to 66024) (378 to 700) (429 to 557) (11543633) (370 to 688) (424 to 552)
aggregate
Eclampsia 54 58 129 33 57 128
(22 to 105) (690 to 1822) (716 to 1583) (1263) (690 to 1822) (716 to 1583)
Maternal obstructed 10772 131 239 3520 126 234
labour and uterine rupture (9333 to 12552) (175 to 79)* (277 to 197)* (23464999) (173 to 73)* (274 to 189)*
Obstructed labour, acute 896 36 114 277 31 109
event (530 to 1429) (459 to 747) (497 to 601) (148470) (449 to 721) (490 to 582)
Fistula due to maternal 9876 139 249 3243 133 243
obstructed labour and (8506 to 11560) (163 to 114)* (270 to 228)* (21624574) (166 to 101)* (271 to 217)*
uterine rupture
aggregate
Maternal abortion, 4413 04 94 482 04 93
miscarriage, and ectopic (2855 to 6306) (372 to 581) (424 to 442) (272785) (369 to 605) (424 to 456)
pregnancy
Other maternal disorders 1350 22 122
(9061902) (196 to 175) (277 to 55)
Neonatal disorders 52 9619 147 39 10 7105 133 31
(50 4358 to 54 9784)* (119 to 178)* (13 to 67)* (8113913 7861) (95 to 174)* (03 to 68)
Neonatal preterm birth 41 8554 106 04 50909 44 52
complications (36 8434 to 47 1881)* (62 to 152)* (43 to 38)* (3864565556)* (11 to 101) (101 to 02)
Vision loss due to 42451 111 23 1355 139 08
retinopathy of (33862 to 52653) (72 to 151)* (58 to 13) (8302088) (95 to 184) (45 to 32)
prematurity aggregate
Complications of 37 6090 105 01 49554 41 53
preterm birth (33 0867 to 42 6970) (56 to 157)* (46 to 45) (3756963948) (14 to 100) (104 to 02)
complications
aggregate
Neonatal encephalopathy 13 6815 273 162 37694 251 142
due to birth asphyxia and (9 7973 to 19 7593) (246 to 300)* (137 to 185)* (2451758093) (220 to 283)* (115 to 170)*
trauma
Neonatal sepsis and other 1391 16 67 177 18 69
neonatal infections (799 to 2160) (30 to 00)* (80 to 52)* (92310) (35 to 01) (85 to 51)*
Severe infection due to 1301 22 73 166 21 71
neonatal sepsis and (711 to 2076) (38 to 05)* (88 to 56)* (81300) (37 to 03)* (87 to 54)*
other neonatal
infections
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Complications of 89 80 24 11 26 27
neonatal sepsis and (75 to 104) (43 to 127)* (11 to 69) (0616) (94 to 144) (141 to 85)
other neonatal
infections aggregate
Haemolytic disease and 20428 200 92 6030 170 65
other neonatal jaundice (18250 to 23090) (188 to 214)* (80 to 103)* (45197708) (148 to 194)* (44 to 86)*
Other neonatal disorders 12295 199 85
(83651 6472) (08 to 411)* (85 to 276)
Nutritional deciencies 1 482 6553 27 71 54 6324 35 114
(1 477 0859 to (2232)* (7567)* (36 772877 8943) (4921)* (127103)*
Protein-energy 22 8343 48 121 28233 45 118
malnutrition (21 7640 to 23 9851) (102 to 08) (171 to 69)* (1820339842) (98 to 11) (167 to 66)*
Iodine deciency 110 9195 70 60 23869 77 44
(100 3372 to 125 2528) (47 to 94)* (80 to 38)* (1 50833 5642) (57 to 98)* (64 to 24)*
Visible goiter due to 108 3076 69 62 19275 69 60
iodine deciency (97 7057 to 122 2600) (45 to 94)* (82 to 40)* (1192030401) (44 to 93)* (82 to 39)*
aggregate
Visible goiter with heart 03 396 42 00 396 42
failure due to iodine (03 to 04) (383 to 410)* (33 to 52)* (0001) (383 to 410)* (33 to 52)*
deciency aggregate
Intellectual disability due 26116 104 20 4593 110 28
to iodine deciency (10856 to 36213) (61 to 126)* (20 to 43) (16347528) (64 to 136)* (16 to 52)
aggregate
Vitamin A deciency 49011 93 01 2324 109 02
(39756 to 59217) (62 to 125)* (27 to 27) (14353459) (75 to 146)* (27 to 33)
Iron-deciency anaemia 1 477 5305 15 80 48 5292 38 116
(1 470 9023 to (09 to 21)* (85 to 74)* (32 560869 7252) (51 to 24)* (128 to 105)*
1 485 3222)
Iron-deciency anaemia 1 477 4584 397 61 81 396 60
without heart failure (1 470 8244 to (381413)* (4774)* (55114) (352443)* (2599)*
aggregate
Iron-deciency anaemia 721 397 61 81 396 60
with heart failure aggregate (646 to 807) (381 to 413)* (47 to 74)* (55114) (352 to 443)* (25 to 99)*
Other nutritional 6607 167 229
deciencies (396010269) (368 to 58) (415 to 21)*
Other communicable, 1 604 9199 161 04 39297 65 40
maternal, neonatal, (1 563 7868 to (153 to 170)* (11 to 04) (2566957866) (39 to 92)* (62 to 17)*
and nutritional 1 636 5310)
diseases
Sexually transmitted 1 145 5275 169 10 15737 169 13
diseases excluding (1 100 9712 to (157 to 183)* (21 to 01) (974025018) (145 to 191)* (06 to 34)
HIV 1 176 6851)
Syphilis 43 6049 37 98 2428 153 56
(37 1603 to 50 6583) (04 to 70) (134 to 69)* (16613337) (122 to 185)* (80 to 30)*
Early syphilis aggregate 42 3509 33 99 103 34 99
(35 8984 to 49 4413) (09 to 68) (136 to 69)* (30253) (11 to 74) (137 to 63)*
Adult tertiary syphilis 12540 158 56 2326 159 54
(11271 to 13858) (132 to 183)* (78 to 36)* (15543228) (126 to 191)* (79 to 28)*
Chlamydial infection 82 8224 83 29 3646 101 18
(66 4264 to 104 3285) (61 to 107)* (48 to 09)* (21065895) (69 to 134)* (45 to 08)
Chlamydial infection 81 0725 83 29 3327 107 11
episodes aggregate (64 7358 to 102 6358) (60 to 107)* (48 to 09)* (18525460) (71 to 144)* (41 to 21)
Pelvic inammatory 173 14 115 231 18 111
diseases due to (1478 to 2020) (08 to 34) (132 to 98)* (155 to 325) (22 to 57) (14.5 to 78)*
chlamydial infection
aggregate
(Table 3 continues on next page)

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Articles

Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Infertility due to 15766 111 30 88 111 29
chlamydial infection (14508 to 17039) (100 to 122)* (39 to 20) (36 to 184) (90 to 132)* (48 to 11)*
aggregate
Gonococcal infection 47 4685 253 122 4449 263 126
(35 8481 to 62 0997) (183 to 312)* (59 to 177)* (26086918) (200 to 314)* (67 to 173)*
Gonococcal infection 46 5615 256 125 4303 273 135
episodes aggregate (34 9282 to 61 2274) (185 to 316)* (61 to 181)* (25056715) (207 to 325)* (74 to 183)*
Pelvic inammatory 9070 100 38 146 35 87
diseases due to (8220 to 1 0163) (76 to 118)* (60 to 22)* (96214) (08 to 71) (124 to 57)*
gonococcal infection
aggregate
Trichomoniasis 167 6186 162 09 1943 161 10
(144 7441 to 193 4440) (153 to 172)* (04 to 13)* (7804083) (150 to 172)* (03 to 18)*
Genital herpes 885 1694 181 13 2364 195 07
(772 3038 to (164 to 199)* (27 to 01) (7435542) (174 to 230)* (14 to 50)
1 008 5881)
Moderate infection 3890 381 295 190 376 291
due to initial genital (880 to 9097) (336 to 432)* (254 to 343)* (43458) (309 to 456)* (229 to 367)*
herpes episode
Complications of 884 7803 181 13 2173 181 12
genital herpes (771 9146 to (164 to 199)* (27 to 00) (6225345) (163 to 199)* (27 to 03)
aggregate 1 008 4006)
Other sexually 48218 96 47 907 37 100
transmitted diseases (44528 to 51746) (81 to 110)* (59 to 36)* (6151297) (11 to 62)* (122 to 78)*
Pelvic inammatory 5072 12 122 668 13 120
diseases due to other (4372 to 5919) (01 to 26) (131 to 112)* (454929) (12 to 42) (143 to 98)*
sexually transmitted
diseases aggregate
Infertility due to other 43145 107 38 239 108 36
sexually transmitted (39438 to 46571) (91 to 122)* (51 to 24)* (97488) (90 to 127)* (52 to 20)*
diseases aggregate
Other sexually 3294 195 67
transmitted diseases (20015042) (144 to 246)* (22 to 113)*
Hepatitis 497 9012 167 22 4064 126 12
(490 3972 to 505 8152) (158 to 176)* (14 to 29)* (26765888) (17 to 241)* (83 to 115)
Acute hepatitis A 87855 42 28 1725 95 19
(7 9500 to 9 5982) (72 to 170) (135 to 91) (11152497) (01 to 204) (69 to 120)
Hepatitis B 356 0834 167 28 1902 169 12
(342 9424 to 370 2315) (150 to 184)* (13 to 43)* (12112822) (45 to 402) (169 to 207)
Acute hepatitis B 12 8322 132 10 1902 169 12
aggregate (11 2396 to 14 5674) (43 to 352) (146 to 200) (12112822) (45 to 402) (169 to 207)
Chronic hepatitis B 343 2512 169 28 00 00 00
(330 5413 to 357 1946) (153 to 184)* (15 to 43)* (0000) (00 to 00) (00 to 00)
Hepatitis C 142 7453 180 12 87 170 33
(127 5598 to 157 7041) (167 to 192)* (01 to 22)* (43165) (122 to 217)* (05 to 73)
Acute hepatitis C 6223 170 34 87 170 33
aggregate (5804 to 6666) (157 to 184)* (25 to 43)* (43165) (122 to 217)* (05 to 73)
Chronic hepatitis C 142 1229 180 12 00 00 00
(126 9777 to 157 0449) (167 to 192)* (01 to 22)* (0000) (00 to 00) (00 to 00)
Acute hepatitis E 15019 35 32 349 49 26
(13854 to 16364) (22 to 47)* (41 to 23)* (224517) (44 to 155) (109 to 68)
Other infectious diseases 54 8354 04 80 19496 16 87
(54 3858 to 55 2738) (16 to 23) (98 to 62)* (1307127971) (51 to 20) (120 to 55)*
Non-communicable diseases 6 652 1534 137 00 638 4808 188 01
(6 633 0998 to (136 to 138)* (00 to 01) (478 7166819 4989) (184 to 192)* (04 to 02)
6 668 8052)
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Neoplasms 90 4975 444 124 85693 366 64
(89 2157 to 91 8961) (421 to 467)* (106 to 142)* (6265511 0792) (318 to 412)* (27 to 97)*
Lip and oral cavity cancer 24251 386 79 2091 367 62
(22787 to 25823) (303 to 471)* (15 to 143)* (15022714) (286 to 453)* (01 to 127)
Nasopharynx cancer 7327 180 55 697 168 68
(5805 to 8839) (02 to 398)* (192 to 111) (472958) (08 to 360)* (187 to 77)
Other pharynx cancer 9455 327 22 795 307 06
(8859 to 10150) (238 to 415)* (45 to 90) (5781043) (219 to 392)* (62 to 72)
Oesophageal cancer 7460 196 82 1286 95 161
(6415 to 9257) (25 to 399)* (212 to 71) (9201675) (31 to 241) (254 to 52)*
Stomach cancer 35394 163 99 3965 120 133
(33399 to 37762) (89 to 244)* (155 to 37)* (29245042) (48 to 202)* (188 to 71)*
Colon and rectum cancer 93990 426 87 7628 384 53
(90593 to 97583) (381 to 472)* (54 to 122)* (56429796) (337 to 433)* (19 to 89)*
Colon and rectum 93770 426 87 7598 384 54
cancer aggregate (90373 to 97364) (381 to 473)* (54 to 122)* (56199753) (337 to 433)* (19 to 90)*
Stoma due to colon and 220 261 49 30 260 47
rectum cancer (213 to 228) (250 to 272)* (57 to 41)* (2041)* (207 to 316)* (94 to 00)*
Liver cancer 6187 598 236 1882 252 18
(5507 to 6880) (382 to 822)* (68 to 406)* (13042456) (99 to 450)* (135 to 132)
Liver cancer due to 3059 206 36 599 95 125
hepatitis B (2358 to 4189) (91 to 632) (265 to 291) (402804) (83 to 341) (265 to 61)
Liver cancer due to 2687 801 381 443 477 132
hepatitis C (2284 to 3208) (539 to 1138)* (171 to 651)* (316573) (342 to 659)* (27 to 277)*
Liver cancer due to 2736 588 221 535 393 72
alcohol use (2290 to 3507) (289 to 948)* (03 to 491) (373701) (221 to 616)* (58 to 235)
Liver cancer due to other 1510 249 20 305 121 119
causes (1188 to 2010) (56 to 635) (263 to 295) (207406) (45 to 328) (249 to 48)
Gallbladder and biliary 1494 220 74 395 190 95
tract cancer (1385 to 1589) (144 to 301)* (132 to 13)* (277515) (118 to 268)* (151 to 37)*
Pancreatic cancer 3938 462 109 866 384 51
(3729 to 4171) (407 to 521)* (67 to 154)* (6111122) (331 to 438)* (11 to 93)*
Larynx cancer 14126 262 23 1473 240 39
(13400 to 14999) (201 to 330)* (70 to 29) (10571943) (181 to 300)* (84 to 07)
Larynx cancer aggregate 8209 244 49 936 215 68
(7491 to 9111) (142 to 358)* (125 to 34) (6741215) (127 to 308)* (131 to 02)
Laryngectomy due to 5910 287 18 537 286 19
larynx cancer (5765 to 6054) (280 to 293)* (13 to 24)* (358776) (258 to 314)* (02 to 41)
Tracheal, bronchus, and 32997 377 56 5136 311 06
lung cancer (30951 to 35364) (296 to 471)* (05 to 126) (37796488) (234 to 400)* (52 to 71)
Malignant skin melanoma 30823 590 262 1805 563 237
(24758 to 39017) (507 to 670)* (195 to 326)* (12082576) (479 to 640)* (169 to 299)*
Non-melanoma skin 25582 768 345 1480 829 401
cancer (24948 to 26256) (720 to 816)* (308 to 382)* (10471977) (727 to 939)* (319 to 487)*
Non-melanoma skin 21559 935 496 1420 864 428
cancer (squamous-cell (20195 to 23122) (822 to 1058)* (405 to 592)* (10071871) (756 to 982)* (342 to 521)*
carcinoma)
Non-melanoma skin 5781 270 39 60 269 38
cancer (basal-cell (4977 to 6717) (240 to 297)* (-60 to 18)* (29111) (235 to 301)* (64 to 12)*
carcinoma)
Breast cancer 21 3618 415 99 17965 361 53
(20 2495 to 22 2663) (334 to 496)* (41 to 157)* (1270724116) (292 to 427)* (04 to 101)*
Breast cancer aggregate 10 7185 627 320 9898 466 158
(95817 to 11 6672) (429 to 833)* (162 to 481)* (719812710) (327 to 615)* (53 to 275)*
Mastectomy due to 10 6385 251 47 8068 251 46
breast cancer (10 4048 to 10 8945) (241 to 261)* (54 to 39)* (520311718) (240 to 262)* (55 to 38)*
(Table 3 continues on next page)

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Articles

Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Cervical cancer 34424 16 205 2640 14 205
(31299 to 37650) (114 to 98) (282 to 115)* (18793426) (109 to 98) (280 to 116)*
Uterine cancer 38277 395 82 2502 371 61
(34256 to 42852) (229 to 559)* (40 to 200) (17243410) (211 to 529)* (54 to 176)
Ovarian cancer 11742 283 03 1507 258 17
(11074 to 12501) (208 to 363)* (51 to 63) (11051923) (178 to 339)* (74 to 43)
Prostate cancer 14 4344 706 297 11503 605 215
(11 9322 to 19 7851) (616 to 814)* (225 to 384)* (80491 6433) (517 to 706)* (145 to 296)*
Prostate cancer 13 4923 746 325 10697 635 235
aggregate (10 9847 to 18 8375) (647 to 863)* (246 to 421)* (73951 5437) (537 to 749)* (158 to 326)*
Impotence and 9420 290 09 806 289 10
incontinence due to (9271 to 9573) (286 to 294)* (12 to 05)* (5521118) (271 to 305)* (24 to 02)
prostate cancer
aggregate
Testicular cancer 6858 419 234 421 403 215
(6347 to 7324) (308 to 524)* (139 to 322)* (284583) (293 to 506)* (119 to 304)*
Kidney cancer 28703 579 228 2027 544 198
(27280 to 30315) (500 to 660)* (168 to 291)* (14572705) (469 to 618)* (140 to 256)*
Bladder cancer 34079 357 33 2670 321 07
(32400 to 36033) (286 to 433)* (20 to 90) (19373494) (258 to 388)* (40 to 56)
Bladder cancer episodes 32734 363 37 2441 331 12
aggregate (3 1053 to 3 4707) (289 to 443)* (18 to 96) (17623174) (261 to 404)* (39 to 67)
Urinary incontinence 1343 228 57 229 230 53
due to bladder cancer (1297 to 1394) (220 to 237)* (62 to 51)* (159312) (187 to 271)* (86 to 22)*
Brain and nervous system 12051 253 42 1261 247 28
cancer (11017 to 13229) (149 to 376)* (39 to 138) (9031645) (150 to 363)* (47 to 120)
Thyroid cancer 31665 1011 608 1900 968 565
(29367 to 33406) (864 to 1129)* (489 to 702)* (13252593) (816 to 1092)* (443 to 663)*
Mesothelioma 608 413 95 122 395 79
(581 to 636) (351 to 477)* (46 to 145)* (87158) (321 to 468)* (21 to 139)*
Hodgkins lymphoma 5744 178 00 485 146 36
(5190 to 6729) (105 to 253)* (61 to 64) (337658) (74 to 217)* (96 to 24)*
Non-Hodgkin lymphoma 42923 635 305 3123 579 256
(37410 to 45936) (475 to 743)* (191 to 384)* (22184142) (438 to 678)* (151 to 331)*
Multiple myeloma 4882 546 180 1040 490 136
(4494 to 5277) (448 to 645)* (107 to 254)* (7361348) (400 to 585)* (69 to 210)*
Leukaemia 23036 358 102 3794 286 43
(22161 to 23845) (297 to 418)* (57 to 148)* (27624889) (212 to 369)* (11 to 104)
Acute lymphoid 8755 254 102 973 257 81
leukaemia (7090 to 10723) (73 to 464)* (50 to 278) (6801298) (115 to 408)* (31 to 200)
Chronic lymphoid 9040 317 45 1198 276 05
leukaemia (8332 to 9744) (222 to 429)* (22 to 124) (8721529) (189 to 374)* (60 to 77)
Acute myeloid 9993 384 142 1209 365 104
leukaemia (8825 to 11368) (266 to 507)* (57 to 235)* (8731556) (275 to 456)* (37 to 174)*
Chronic myeloid 2977 222 34 414 177 75
leukaemia (2718 to 3247) (143 to 310)* (93 to 34) (295536) (102 to 260)* (133 to 12)*
Other neoplasms 45775 361 109 3232 344 90
(41455 to 49220) (272 to 445)* (41 to 176)* (22864318) (262 to 426)* (24 to 154)*
Cardiovascular diseases 422 7384 248 18 25 6201 235 22
(415 5345 to (240 to 256)* (25 to 12)* (18 401633 6566) (217 to 245)* (32 to 17)*
427 8708)
Rheumatic heart disease 33 4388 47 163 16547 34 154
(29 7257 to 43 1198) (110 to 01) (225 to 121)* (1041425309) (99 to 14) (215 to 111)*
Rheumatic heart 32 2368 56 169 15186 55 168
disease, without heart (28 5208 to 41 9127) (119 to 08)* (231 to 127)* (941123564) (117 to 06)* (229 to 123)*
failure
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Heart failure due to 12020 298 22 1361 296 24
rheumatic heart disease (11382 to 12690) (285 to 312)* (13 to 32)* (9451876) (272 to 321)* (06 to 42)*
aggregate
Ischaemic heart disease 110 5503 259 34 72747 302 03
(100 6759 to 121 7987) (246 to 272)* (42 to 26)* (4958699403) (291 to 313)* (10 to 03)
Myocardial infarction 15 9301 64 181 330 152 131
episodes aggregate (14 1065 to 17 7640) (19 to 106)* (216 to 148)* (230449) (126 to 179)* (151 to 111)*
Angina due to ischaemic 72 3446 293 03 47945 295 00
heart disease aggregate (62 6998 to 83 4600) (277 to 307)* (12 to 05) (3100766336) (278 to 310)* (10 to 08)
Heart failure due to 22 2757 319 06 24472 319 05
ischaemic heart disease (21 2720 to 23 3204) (311 to 327)* (12 to 01)* (1736833426) (310 to 328)* (11 to 01)
aggregate
Cerebrovascular disease 42 4309 210 44 64552 207 42
(42 0682 to 42 7671) (204 to 215)* (48 to 39)* (4487086096) (198 to 216)* (49 to 35)*
Ischaemic stroke 24 9290 218 52 36600 220 49
(24 3622 to 25 6100) (210 to 226)* (58 to 46)* (2559348749) (210 to 230)* (57 to 42)*
Chronic ischaemic 24 6632 219 51 36051 221 49
stroke aggregate (24 0921 to 25 3458) (211 to 227)* (58 to 45)* (2512648153) (211 to 231)* (56 to 41)*
Ischaemic stroke 2658 168 106 549 175 100
episodes aggregate (2466 to 2851) (142 to 197)* (127 to 85)* (363745) (138 to 209)* (129 to 72)*
Haemorrhagic stroke 18 6696 192 33 27952 191 31
(18 2587 to 19 1245) (185 to 199)* (38 to 27)* (1945837496) (181 to 202)* (39 to 23)*
Chronic haemorrhagic 18 4948 193 32 27573 192 30
stroke aggregate (18 0885 to 18 9595) (186 to 199)* (38 to 26)* (1918237006) (181 to 203)* (38 to 22)*
Acute haemorrhagic 1748 143 91 379 146 88
stroke aggregate (1623 to 1878) (116 to 166)* (111 to 73)* (247512) (118 to 170)* (110 to 69)*
Hypertensive heart disease 60862 371 34 6700 372 36
(57327 to 64341) (362 to 379)* (29 to 39)* (46719171) (359 to 384)* (28 to 44)*
Cardiomyopathy and 25368 267 13 2751 263 13
myocarditis (24048 to 26614) (256 to 277)* (20 to 07)* (19033779) (246 to 281)* (25 to 02)*
Acute myocarditis 1563 214 22 78 211 21
(1371 to 1796) (191 to 237)* (13 to 31)* (48116) (185 to 239)* (03 to 38)*
Heart failure due to 23804 270 15 2673 265 14
cardiomyopathy (22543 to 25022) (259 to 281)* (22 to 09)* (18593679) (247 to 283)* (-26 to -02)*
aggregate
Atrial brillation and 33 2943 282 25 26346 282 24
utter (29 9598 to 37 2020) (272 to 291)* (31 to 19)* (1782636373) (271 to 293)* (31 to 17)*
Peripheral vascular disease 154 6506 344 18 5728 345 20
(136 3180 to 176 2109) (334 to 352)* (13 to 23)* (272110562) (324 to 368)* (12 to 28)*
Endocarditis 1157 227 54 123 229 52
(1081 to 1248) (209 to 245)* (67 to 41)* (85171) (186 to 276)* (88 to 12)*
Endocarditis episodes 169 228 07 10 227 09
aggregate (157 to 182) (203 to 253)* (27 to 12) (0614) (200 to 253)* (31 to 12)
Heart failure due to 988 227 61 114 229 55
endocarditis aggregate (911 to 1076) (207 to 247)* (76 to 46)* (79159) (183 to 280)* (93 to 12)*
Heart failure due to 11265 344 12 1237 344 13
other cardiovascular (10459 to 12061) (333 to 356)* (04 to 20)* (8601733) (325 to 365)* (02 to 27)
diseases aggregate
Other cardiovascular 89 2211 240 04 59470 237 05
diseases episodes (83 6358 to 95 4704) (226 to 254)* (02 to 10)* (4074681059) (222 to 252)* (02 to 11)
aggregate
Chronic respiratory 514 6258 121 33 30 4659 118 46
diseases (503 3223 to 527 6170) (111 to 131)* (41 to 24)* (23 341438 2942) (102 to 136)* (62 to 31)*
Chronic obstructive 174 4831 170 58 12 0470 162 59
pulmonary disease (160 2049 to 188 9517) (151 to 190)* (73 to 44)* (10 206813 7254) (134 to 188)* (80 to 39)*
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Chronic obstructive 168 6946 165 61 96716 123 80
pulmonary disease (154 4431 to 182 9571) (145 to 185)* (76 to 46)* (8183611 0809) (92 to 153)* (105 to 56)*
without heart failure
aggregate
Severe chronic 58764 349 24 23755 351 25
obstructive pulmonary (50737 to 65483) (311 to 378)* (03 to 42) (1890327472) (314 to 382)* (00 to 45)
disease with heart
failure aggregate
Pneumoconiosis 24058 303 82 4740 266 60
(23172 to 24863) (278 to 329)* (62 to 102)* (30566826) (236 to 293)* (36 to 84)*
Silicosis 4029 181 43 657 185 39
(3649 to 4422) (157 to 203)* (61 to 26)* (417954) (145 to 224)* (70 to 09)*
Silicosis without heart 3890 176 46 592 171 47
failure aggregate (3510 to 4268) (152 to 199)* (64 to 28)* (368879) (127 to 213)* (80 to 15)*
Severe silicosis with 139 322 15 64 331 23
heart failure (120 to 156) (291 to 348)* (05 to 33) (4585) (269 to 405)* (27 to 79)
aggregate
Asbestosis 1573 306 27 248 302 25
(1448 to 1709) (288 to 326)* (13 to 41)* (160356) (270 to 336)* (01 to 52)
Asbestosis without 1545 306 27 235 299 25
heart failure (1418 to 1681) (287 to 325)* (13 to 41)* (150340) (264 to 334)* (02 to 54)
aggregate
Severe asbestosis with 28 356 11 13 357 13
heart failure (26 to 30) (342 to 371)* (01 to 21)* (0917)* (313 to 400)* (22 to 47)
aggregate
Coal workers 842 370 76 133 363 70
pneumoconiosis (767 to 936) (341 to 399)* (52 to 100)* (84191)* (294 to 434)* (13 to 129)*
Coal workers 823 369 75 124 360 69
pneumoconiosis (749 to 917) (340 to 398)* (52 to 100)* (78179)* (286 to 435)* (09 to 132)*
without heart failure
aggregate
Severe coal workers 19 416 82 09 416 82
pneumoconiosis with (16 to 21) (378 to 451)* (54 to 109)* (0612)* (377 to 452)* (52 to 109)*
heart failure
aggregate
Other pneumoconiosis 23886 279 83 3702 275 83
(21647 to 26291) (253 to 307)* (60 to 105)* (23925339)* (239 to 310)* (53 to 112)*
Other 23742 278 83 3636 273 84
pneumoconiosis (21503 to 26151) (252 to 307)* (60 to 106)* (23405249)* (236 to 308)* (53 to 114)*
without heart failure
aggregate
Severe other 144 411 45 65 405 43
pneumoconiosis with (131 to 156) (390 to 430)* (34 to 55)* (4685) (351 to 457)* (03 to 84)*
heart failure
aggregate
Asthma 358 1979 95 25 15 8989 94 23
(323 1337 to 393 4656) (76 to 116)* (43 to 05)* (10 371022 3441) (74 to 115)* (43 to 03)*
Asymptomatic asthma 108 4611 95 25 00 00 00
(92 8425 to 126 2505) (76 to 116)* (43 to 05)* (0000) (00 to 00) (00 to 00)
Symptomatic asthma 249 7368 95 25 15 8989 94 23
aggregate (220 4696 to 278 4197) (76 to 116)* (43 to 05)* (10 371022 3441) (74 to 115)* (43 to 03)*
Interstitial lung disease 19160 258 06 2347 257 07
and pulmonary sarcoidosis (17574 to 20755) (238 to 277)* (09 to 21) (14753342) (235 to 281)* (11 to 26)
Interstitial lung disease 17187 252 05 1485 227 02
and pulmonary (15657 to 18810) (231 to 272)* (11 to 21) (8882214) (196 to 259)* (22 to 26)
sarcoidosis without
heart failure aggregate
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Severe interstitial lung 1974 315 13 862 313 13
disease and pulmonary (1441 to 2427) (297 to 332)* (01 to 29) (5481176) (286 to 341)* (10 to 37)
sarcoidosis with heart
failure aggregate
Other chronic respiratory 18113 17 158
diseases (1483721234) (73 to 122) (235 to 69)*
Cirrhosis and other chronic 28283 340 82 5010 313 73
liver diseases (27913 to 28623)* (324 to 358)* (70 to 95)* (35296831) (298 to 329)* (61 to 84)*
Cirrhosis and other 7965 305 47 1306 305 48
chronic liver diseases due (7376 to 8573) (284 to 327)* (32 to 62)* (8871787) (270 to 338)* (22 to 73)*
to hepatitis B
Cirrhosis and other 6808 353 76 1114 352 76
chronic liver diseases due (6283 to 7342) (330 to 375)* (60 to 91)* (7821526) (316 to 386)* (50 to 103)*
to hepatitis C
Cirrhosis and other 8156 373 98 1339 372 99
chronic liver diseases due (7587 to 8772) (354 to 393)* (85 to 112)* (9251851) (339 to 405)* (75 to 124)*
to alcohol use
Cirrhosis and other 7503 238 68 1250 233 68
chronic liver diseases due (7143 to 7859) (225 to 251)* (59 to 76)* (8751722) (201 to 268)* (42 to 95)*
to other causes
Digestive diseases 258 2482 123 94 12 1428 114 93
(255 3864 to (109 to 137)* (104 to 83)* (8 492016 5925) (98 to 132)* (106 to 79)*
260 8439)
Peptic ulcer disease 72 0442 48 170 23417 11 195
(71 3027 to 72 7637) (37 to 60)* (178 to 160)* (1605632936) (02 to 25) (206 to 184)*
Peptic ulcer disease 49777 47 167 5187 45 167
symptomatic episodes (45776 to 53795) (24 to 69)* (184 to 150)* (35797032) (22 to 68)* (185 to 149)*
Anaemia due to peptic 67 0666 48 170 18231 02 203
ulcer disease aggregate (66 4654 to 67 6169) (37 to 61)* (179 to 160)* (1225826212) (14 to 19) (216 to 190)*
Gastritis and duodenitis 161 0011 155 69 49130 112 95
(157 9283 to 164 0711) (130 to 179)* (88 to 50)* (3347369671) (80 to 146)* (119 to 69)*
Gastritis and duodenitis, 39410 154 69 4160 154 67
symptomatic episodes (35470 to 43589) (109 to 173)* (108 to 57)* (27715679) (112 to 175)* (106 to 52)*
Anaemia due to gastritis 157 0601 155 69 44971 108 98
and duodenitis (154 0551 to 160 1410) (129 to 179)* (89 to 50)* (3050663930) (74 to 145)* (124 to 70)*
aggregate
Appendicitis 4421 143 28 1360 144 30
(4146 to 4723) (134 to 152)* (21 to 34)* (9201846) (106 to 180)* (02 to 61)
Paralytic ileus and 1197 189 13 373 186 11
intestinal obstruction (1107 to 1304) (169 to 207)* (28 to 00)* (251511) (159 to 212)* (34 to 12)
Inguinal, femoral, and 18 4767 65 106 1958 65 104
abdominal hernia (16 5772 to 20 3398) (42 to 86)* (124 to 90)* (9703631) (43 to 87)* (122 to 88)*
Inammatory bowel 11 2235 157 37 23871 156 36
disease (10 3968 to 12 0004) (150 to 163)* (41 to 34)* (165323 2635) (147 to 164)* (42 to 30)*
Vascular intestinal 351 233 24 110 234 20
disorders (324 to 381) (210 to 258)* (41 to 06)* (74148) (197 to 272)* (52 to 12)
Gallbladder and biliary 56565 169 41 6010 168 39
diseases (51993 to 61681) (145 to 192)* (59 to 22)* (40948264) (142 to 193)* (59 to 19)*
Pancreatitis 10182 242 19 3000 240 20
(9416 to 1 0974) (217 to 265)* (00 to 37) (20344067) (203 to 274)* (08 to 46)
Other digestive diseases 12199 219 10
(838516775) (144 to 324)* (71 to 74)
Neurological disorders 2 261 3164 155 05 59 3256 156 14
(2 204 3666 to (146 to 164)* (03 to 12) (40 845081 0833) (143 to 169)* (24 to 04)*
2 316 2826)
Alzheimers disease and 45 9563 377 11 68512 388 11
other dementias (40 1785 to 52 6559) (362 to 390)* (03 to 18)* (4883990628) (371 to 405)* (02 to 18)*
(Table 3 continues on next page)

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Articles

Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Parkinsons disease 61933 316 06 7378 314 07
(57257 to 67772) (282 to 355)* (19 to 35) (51619901) (278 to 353)* (21 to 37)
Epilepsy 23 4145 113 11 62869 64 163
(21 5496 to 25 4194) (70 to 155)* (50 to 27) (4315882502) (115 to 12)* (209 to 116)*
Multiple sclerosis 20120 191 20 6675 188 20
(18657 to 21669) (170 to 213)* (39 to 03)* (47208556) (162 to 215)* (42 to 01)
Motor neuron disease 2024 223 13 423 221 14
(1897 to 2160) (199 to 248)* (33 to 07) (305551) (195 to 248)* (35 to 08)
Migraine 958 7892 153 06 32 8988 153 08
(872 1090 to (140 to 166)* (03 to 15) (20 303648 8832) (140 to 166)* (01 to 18)
1 055 6306)
Tension-type headache 1 505 8923 153 05 22605 153 06
(1 337 3100 to (140 to 166)* (01 to 11) (1058141697) (140 to 167)* (01 to 13)
1 681 5750)
Medication overuse 58 4545 190 04 91647 189 06
headache (50 8349 to 67 3639) (154 to 227)* (24 to 33) (6094513 0780) (154 to 228)* (23 to 35)
Other neurological 115 170 02 4159 322 21
disorders (91 to 146) (148 to 196)* (09 to 04) (30125475) (275 to 363)* (53 to 09)
Mental and substance use 1 058 9038 143 03 149 9779 161 11
disorders (1 038 5449 to (136 to 149)* (03 to 09) (108 7161193 1308) (155 to 168)* (07 to 14)*
1 080 4138)
Schizophrenia 23 3830 195 01 15 0205 195 03
(20 6080 to 26 4184) (186 to 204)* (04 to 06) (10 816118 6232) (185 to 204)* (04 to 09)
Alcohol use disorders 63 4695 111 46 63213 111 45
(57 5078 to 69 8635) (89 to 135)* (65 to 24)* (4205689858)* (90 to 136)* (64 to 23)*
Alcohol dependence 62 5753 111 46 62762 111 45
aggregate (56 6217 to 68 9443) (89 to 135)* (66 to 25)* (4167789297) (89 to 136)* (65 to 23)*
Fetal alcohol syndrome 8942 111 05 451 107 06
aggregate (8333 to 9519) (103 to 117)* (11 to 02) (292651) (82 to 131)* (27 to 16)
Drug use disorders 46 3886 163 39 98494 236 82
(45 2524 to 47 4466) (150 to 176)* (28 to 50)* (69590127752) (215 to 259)* (62 to 102)*
Opioid use disorders 16 7465 233 64 69696 233 65
(14 6593 to 19 1075) (207 to 260)* (42 to 86)* (4842589998) (206 to 262)* (42 to 90)*
Asymptomatic opioid 27168 233 64 00 00 00
dependence (19799 to 37044) (207 to 260)* (42 to 86)* (0000) (00 to 00) (00 to 00)*
Symptomatic opioid 14 0297 233 64 69696 233 65
dependence (12 0422 to 16 1228) (207 to 260)* (42 to 86)* (4842589998) (206 to 262)* (42 to 90)
aggregate
Cocaine use disorders 38463 311 141 5215 306 140
(34016 to 43098) (280 to 343)* (120 to 164)* (32907339) (272 to 344)* (114 to 170)*
Asymptomatic 19278 311 141 00 00 00
cocaine dependence (15443 to 23578) (280 to 343)* (120 to 164)* (0000) (00 to 00) (00 to 00)
Symptomatic cocaine 19185 311 141 5215 306 140
dependence (15421 to 23419) (280 to 343)* (120 to 164)* (32907339) (272 to 344)* (114 to 170)*
aggregate
Amphetamine use 65998 304 192 8747 303 191
disorders (52957 to 80244) (270 to 342)* (161 to 225)* (513413087) (261 to 348)* (155 to 230)*
Asymptomatic 36137 304 192 00 00 00
amphetamine (27226 to 46307) (270 to 342)* (161 to 225)* (0000) (00 to 00) (00 to 00)
dependence
Symptomatic 29861 304 192 8747 303 191
amphetamine (21865 to 3 8930) (270 to 342)* (161 to 225)* (51341 3087) (261 to 348)* (155 to 230)*
dependence
aggregate
Cannabis use disorders 19 7625 53 38 5772 53 37
(17 9824 to 21 7702) (40 to 65)* (47 to 29)* (37188162) (37 to 71)* (50 to 23)*
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Asymptomatic 11 4309 53 38 00 00 00
cannabis dependence (10 1594 to 12 8929) (40 to 65)* (47 to 29)* (0000) (00 to 00) (00 to 00)
Symptomatic 83316 53 38 5772 53 37
cannabis dependence (72443 to 95931) (40 to 65)* (47 to 29)* (37188162) (37 to 71)* (50 to 23)*
aggregate
Other drug use disorders 9064 305 172
(55011 3121) (257 to 356)* (129 to 217)*
Depressive disorders 311 1476 184 07 54 2554 182 10
(300 0168 to 320 5443) (172 to 195)* (03 to 16) (37 569972 9433) (172 to 192)* (05 to 15)*
Major depressive 216 0470 178 08 44 2244 178 11
disorder (192 8634 to 243 3194) (166 to 190)* (02 to 14)* (29 672560 2970) (166 to 190)* (05 to 17)*
Dysthymia 104 1063 199 06 10 0310 198 07
(90 3981 to 118 9689) (184 to 215)* (03 to 14) (6 605914 2671) (183 to 215)* (02 to 16)
Bipolar disorder 44 0158 149 03 90047 149 05
(38 1504 to 50 9125) (141 to 158)* (01 to 05)* (5501713 3880) (139 to 159)* (00 to 09)
Anxiety disorders 267 2024 149 08 24 6430 148 10
(234 0643 to 306 3180) (130 to 168)* (05 to 21) (16 813733 6478) (128 to 166)* (04 to 23)
Eating disorders 64684 191 99 13861 190 100
(61706 to 67536) (165 to 218)* (75 to 124)* (915919412) (169 to 212)* (81 to 119)*
Anorexia nervosa 29121 120 51 6205 121 52
(23577 to 35962) (93 to 148)* (26 to 76)* (41138977) (90 to 151)* (23 to 80)*
Bulimia nervosa 36294 253 142 7656 253 142
(29375 to 44068) (236 to 271)* (125 to 158)* (490011085) (232 to 276)* (122 to 162)*
Autistic spectrum 62 2124 123 03 10 0515 123 06
disorders (58 9790 to 64 7443) (105 to 141)* (12 to 19) (67401138003) (119 to 128)* (02 to 09)*
Autism 24 7901 126 05 63359 125 07
(20 9576 to 29 3931) (122 to 129)* (03 to 07)* (4112089161) (119 to 131)* (02 to 12)*
Asperger syndrome and 37 2454 121 02 37156 120 03
other autistic spectrum (31 5105 to 44 8831) (118 to 124)* (01 to 03)* (2479654246) (115 to 125)* (01 to 07)
disorders
Attention-decit or 51 0943 03 36 6201 04 35
hyperactivity disorder (46 1624 to 57 2677) (04 to 10) (42 to 30)* (37019477) (06 to 12) (44 to 28)*
Conduct disorder 48 1355 04 13 57705 05 14
(39 3152 to 58 1516) (01 to 11) (09 to 16)* (3485289557) (03 to 14) (07 to 20)*
Idiopathic developmental 92 0740 109 10 34421 103 02
intellectual disability (52 2801 to 130 4112) (95 to 119)* (00 to 18)* (1506459969) (82 to 114)* (15 to 12)
Other mental and 128 1783 188 02 96134 187 03
substance use disorders (127 5125 to 128 8772) (179 to 197)* (06 to 09) (6699712 9519) (177 to 198)* (06 to 11)
Diabetes, urogenital, 2 944 6268 155 03 66 0927 223 12
blood, and endocrine (2 925 0162 to (147 to 161)* (09 to 03) (46 781588 8658) (208 to 240)* (01 to 23)*
diseases 2 968 5113)
Diabetes 435 3284 306 45 33 3608 325 54
(404 7361 to 468 5624) (280 to 330)* (24 to 64)* (23 043545 5308) (297 to 353)* (32 to 75)*
Uncomplicated diabetes 271 7136 278 32 12 5990 277 33
(241 4142 to 302 3817) (249 to 304)* (11 to 53)* (7979918 3942) (248 to 303)* (12 to 54)*
Neuropathy and other 159 0677 356 66 20 4596 356 67
complications of (134 6667 to 187 1740) (322 to 388)* (41 to 90)* (13 572028 7496) (323 to 388)* (42 to 90)*
diabetes aggregate
Vision loss due to 45471 347 50 3023 361 57
diabetes aggregate (38238 to 54160) (324 to 369)* (36 to 63)* (21014155) (336 to 387)* (41 to 74)*
Acute glomerulonephritis 1005 09 145 50 06 141
(921 to 1101) (44 to 19) (173 to 126)* (3275) (46 to 28) (174 to 114)*
Chronic kidney disease 322 5106 269 09 81728 238 01
(312 7182 to 330 3511) (258 to 280)* (00 to 18) (6118610 2293) (229 to 248)* (04 to 06)
Chronic kidney disease 100 8239 273 21 24561 230 06
due to diabetes (86 9227 to 115 6523) (249 to 299)* (05 to 37)* (1780431512) (207 to 254)* (07 to 20)
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Stage 3 chronic kidney 90 9377 279 23 1196 118 63
disease due to (77 9065 to 104 6170) (254 to 305)* (06 to 40)* (7971755) (65 to 167)* (100 to 28)*
diabetes aggregate
Stage 4 chronic 64413 216 09 7877 202 04
kidney disease due to (55213 to 74013) (191 to 242)* (04 to 22) (54181 1061) (176 to 227)* (10 to 18)
diabetes aggregate
Stage 5 chronic kidney 26944 256 13 13593 253 14
disease untreated due (23319 to 30915) (230 to 282)* (00 to 28) (920517914) (224 to 284)* (03 to 32)
to diabetes
End-stage chronic 7505 198 30 1895 266 07
kidney disease due to (6433 to 8642) (164 to 234)* (52 to 07)* (13052520) (223 to 309)* (21 to 37)
diabetes aggregate
Chronic kidney disease 78 9623 260 02 15080 285 12
due to hypertension (67 8467 to 91 0212) (236 to 286)* (14 to 19) (1108719381) (258 to 315)* (06 to 33)
Stage 3 chronic kidney 72 7724 259 02 808 221 44
disease due to (61 6625 to 84 4982) (233 to 286)* (16 to 20) (5421201) (175 to 266)* (80 to 09)*
hypertension
aggregate
Stage 4 chronic 41022 259 07 4898 252 05
kidney disease due to (35035 to 47726) (224 to 295)* (16 to 28) (34146967) (221 to 287)* (15 to 25)
hypertension
aggregate
Stage 5 chronic kidney 16522 307 18 8168 305 20
disease untreated due (14045 to 19137) (275 to 342)* (05 to 41) (565210603) (270 to 345)* (05 to 47)
to hypertension
End-stage chronic 4355 275 06 1206 332 38
kidney disease due to (3633 to 5091) (220 to 336)* (31 to 49) (8311623) (274 to 398)* (03 to 89)
hypertension
aggregate
Chronic kidney disease 67 3487 289 11 19514 222 07
due to (58 1989 to 77 4395) (258 to 323)* (11 to 36) (1432224792) (201 to 244)* (21 to 07)
glomerulonephritis
Stage 3 chronic kidney 59 7908 299 13 1113 171 56
disease due to (50 8446 to 69 6927) (264 to 336)* (11 to 41) (7351652) (131 to 207)* (88 to 27)*
glomerulonephritis
aggregate
Stage 4 chronic 48724 213 05 6025 202 05
kidney disease due to (42972 to 55066) (188 to 239)* (22 to 16) (41848456) (177 to 229)* (23 to 15)
glomerulonephritis
aggregate
Stage 5 chronic kidney 22281 236 06 11226 235 04
disease untreated due (18957 to 25969) (213 to 259)* (20 to 07) (773714613) (205 to 263)* (24 to 15)
to glomerulonephritis
End-stage chronic 4574 205 26 1150 260 04
kidney disease due to (3771 to 5430) (167 to 245)* (51 to 00)* (8021529) (211 to 312)* (32 to 41)
glomerulonephritis
aggregate
Chronic kidney disease 94 5535 262 01 22572 230 05
due to other causes (81 1418 to 109 3713) (242 to 283)* (11 to 15) (1663428922) (211 to 251)* (16 to 06)
Stage 3 chronic kidney 85 4598 266 01 1322 176 62
disease due to other (72 4716 to 99 6054) (246 to 288)* (12 to 16)* (8801945) (140 to 208)* (88 to 38)*
causes aggregate
Stage 4 chronic 60584 213 02 7397 194 10
kidney disease due to (52579 to 69384) (189 to 235)* (11 to 08) (51351 0296) (170 to 216)* (22 to 02)
other causes
aggregate
Stage 5 chronic kidney 24646 257 01 12330 255 03
disease untreated due (21151 to 28359) (238 to 275)* (09 to 11) (855916041) (230 to 280)* (11 to 18)
to other causes
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
End-stage chronic 5706 216 22 1524 263 01
kidney disease due to (4856 to 6681) (180 to 250)* (42 to 02)* (10732008) (218 to 307)* (30 to 32)
other causes
aggregate
Urinary diseases and male 436 0817 242 09 42209 289 07
infertility (425 5777 to 446 4505) (228 to 254)* (01 to 19) (2699960452) (268 to 310)* (21 to 07)
Interstitial nephritis and 29012 193 31 966 192 33
urinary tract infections (28319 to 29804) (190 to 197)* (29 to 33) (5991440) (175 to 209)* (18 to 47)*
Urolithiasis 319 6002 228 09 897 234 28
(291 5192 to 349 9661) (208 to 249)* (07 to 25) (6091225) (200 to 270)* (01 to 55)*
Benign prostatic 104 6253 297 13 37927 298 13
hyperplasia (90 7298 to 118 2440) (275 to 320)* (28 to 02) (2423854373) (276 to 322)* (28 to 03)
Male infertility 29 0332 226 96 1739 227 98
(23 9725 to 34 7668) (193 to 256)* (68 to 121)* (7013653)* (193 to 259)* (69 to 125)*
Other urinary diseases 679 172 06
(455965) (91 to 272)* (73 to 77)*
Gynaecological diseases 794 3032 138 18 10 0012 107 33
(786 4979 to 801 1697) (132 to 145)* (24 to 12)* (6807014 3123) (94 to 119)* (43 to 25)*
Uterine broids 151 1150 192 04 23835 111 58
(144 1469 to 158 4775) (188 to 195)* (06 to 02)* (1450238344) (86 to 132)* (77 to 42)*
Uterine broids cases 108 3350 230 17 6459 261 34
aggregate (101 6184 to 115 2336) (223 to 237)* (12 to 21)* (314911933) (250 to 273)* (27 to 43)*
Mild abdominal pain 42 7800 105 55 17375 64 89
with anaemia due to (41 6345 to 43 8814) (95 to 115)* (63 to 46)* (1125726254) (45 to 81)* (105 to 74)*
uterine broids
aggregate
Polycystic ovarian 60 1064 107 05 5326 108 05
syndrome (46 1393 to 75 9634) (101 to 114)* (09 to 00)* (23891 0446) (99 to 115)* (11 to 00)
Polycystic ovarian 47 1168 104 08 4080 105 07
syndrome cases (35 8801 to 60 9199) (98 to 111)* (12 to 03)* (18117977) (97 to 113)* (12 to 01)*
aggregate
Hirsutism and 12 9896 119 04 1246 115 01
infertility due to (8 6356 to 18 9756) (109 to 127)* (04 to 11) (4722780) (96 to 129)* (15 to 13)
polycystic ovarian
syndrome aggregate
Female infertility 61 3001 246 112 3445 250 117
(45 8899 to 79 6471) (192 to 300)* (65 to 158)* (13437467) (197 to 300)* (72 to 162)*
Endometriosis 10 7582 116 26 9964 117 24
(9 1655 to 12 4859) (109 to 122)* (30 to 22)* (64711 3847) (104 to 129)* (35 to 15)*
Endometriosis cases 10 1675 115 27 9373 116 25
aggregate (8 6524 to 11 8288) (109 to 122)* (31 to 23)* (61071 3126) (103 to 129)* (36 to 16)*
Abdominal pain and 5907 123 10 591 123 09
infertility due to (4152 to 7872) (112 to 133)* (18 to 03)* (342908) (95 to 152)* (34 to 15)
endometriosis
aggregate
Genital prolapse 161 6791 177 66 5030 178 65
(142 3347 to 182 5665) (152 to 200)* (85 to 48)* (24259043) (154 to 203)* (84 to 46)*
Premenstrual syndrome 430 6969 101 21 36216 102 20
(410 8407 to 450 4944) (79 to 118)* (39 to 07)* (2249554285) (80 to 120)* (38 to 04)*
Other gynaecological 45 0188 80 42 16198 62 57
diseases (44 0573 to 46 0312) (73 to 86)* (48 to 37)* (1129822100) (49 to 76)* (68 to 46)*
Other gynaecological 23 9081 138 04 9368 138 02
diseases cases (22 9757 to 24 9180) (135 to 140)* (05 to 02)* (63541 3059) (126 to 151)* (12 to 08)
aggregate
Anaemia due to other 21 1108 21 82 6829 27 123
gynaecological (20 9006 to 21 3282) (09 to 34)* (93 to 71)* (46109780) (46 to 07)* (140 to 106)*
diseases aggregate
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Haemoglobinopathies and 1 571 6100 111 11 82215 43 49
haemolytic anaemias (1 545 2045 to (95 to 126)* (25 to 03) (5528611 7666) (29 to 55)* (60 to 39)*
1 605 0998)
Thalassaemias 4390 14 65 313 10 70
(4057 to 4963) (01 to 34) (78 to 46)* (212444) (38 to 61) (114 to 25)*
-thalassaemia major 2292 44 42 161 41 47
cases aggregate (2227 to 2382) (36 to 52)* (49 to 34)* (110229) (25 to 115) (106 to 19)
Haemoglobin E or 674 54 25 51 18 59
-thalassaemia cases (601 to 752) (29 to 81)* (48 to 01) (3473) (100 to 142) (167 to 49)
aggregate
Haemoglobin H 1390 53 118 97 49 114
disease cases (1075 to 1964) (100 to 08) (162 to 63)* (64141) (123 to 49) (182 to 24)*
aggregate
Heart failure due to 34 263 01 04 264 06
thalassaemias (32 to 36) (243 to 284)* (11 to 14)* (0306) (160 to 383)* (93 to 118)
aggregate
Thalassaemias trait 279 4514 105 21 39222 61 36
(272 8189 to 287 3574) (101 to 110)* (25 to 17)* (2607956536) (48 to 74)* (46 to 26)*
-thalassaemia trait 226 0296 101 25 36617 59 38
cases aggregate (220 1115 to 233 3320) (96 to 105)* (30 to 21)* (2437652708) (47 to 72)* (49 to 28)*
Haemoglobin E trait 53 4218 126 01 2605 84 05
cases aggregate (51 1223 to 55 8825) (115 to 137)* (10 to 08) (17473828) (52 to 113)* (32 to 21)
Sickle-cell disorders 44499 82 28 3714 77 23
(42937 to 46007) (52 to 119)* (02 to 62) (25905180) (33 to 123)* (18 to 66)
Homozygous sickle- 40351 65 12 3394 65 13
cell and severe sickle- (38760 to 41737) (33 to 103)* (18 to 48) (23774721) (20 to 114)* (29 to 59)
cell/-thalassaemia
cases aggregate
Haemoglobin SC 3976 296 215 301 229 152
disease cases (3682 to 4274) (183 to 456)* (110 to 365)* (211421) (96 to 374)* (28 to 289)*
aggregate
Mild 172 161 64 19 132 27
sickle-cell/- (159 to 186) (101 to 218)* (08 to 115)* (1326) (47 to 219)* (49 to 105)
thalassaemia cases
aggregate
Sickle-cell trait 404 5659 194 75 17203 108 14
(381 2234 to 448 1546) (183 to 203)* (65 to 83)* (1156524590) (73 to 134)* (18 to 36)
G6PD deciency 247 0737 69 44 284 18 77
(209 3067 to 286 7127) (14 to 119)* (93 to 01) (193396) (21 to 60) (112 to 40)*
G6PD cases aggregate 247 0685 69 44 277 12 81
(209 3016 to 286 7077) (14 to 119)* (93 to 01) (189387) (28 to 55) (116 to 43)*
Heart failure due to 52 381 79 06 381 78
G6PD deciency (47 to 57) (366 to 398)* (68 to 91)* (0409) (346 to 415)* (50 to 106)*
aggregate
G6PD trait 728 5492 98 27 280 43 53
(676 7348 to 781 5338) (79 to 114)* (43 to 12)* (193389) (01 to 88)* (90 to 12)*
Other 74 3851 18 90 21198 38 123
haemoglobinopathies (73 8976 to 74 8616) (09 to 27)* (97 to 82)* (1423930299) (55 to 22)* (138 to 110)*
and haemolytic
anaemias
Other 74 2733 18 90 20674 41 126
haemoglobinopathies (73 7860 to 74 7511) (09 to 27)* (98 to 82)* (1384329639) (58 to 24)* (141 to 112)*
and haemolytic
anaemias cases
aggregate
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Heart failure due to 1118 349 20 131 349 21
other (1038 to 1196) (339 to 360)* (13 to 27)* (89182) (312 to 387)* (08 to 50)
haemoglobinopathies
and haemolytic
anaemias aggregate
Endocrine, metabolic, 66 1289 40 72 21105 13 83
blood, and immune (65 5971 to 66 6638) (22 to 59)* (87 to 55)* (1431529937) (11 to 38) (104 to 61)*
disorders
Endocrine metabolic 75772 198 06 2924 195 05
blood and immune (73826 to 77666) (190 to 206)* (12 to 00) (20024018) (181 to 210)* (16 to 06)
disorders cases
aggregate
58 4304 22 80 18044 13 95
(57 936058 9467) (0343)* (9762)* (1216025823) (3915) (11970)*
Anaemia due to 58 4304 22 80 18044 13 95
endocrine metabolic (57 9360 to 58 9467) (03 to 43)* (97 to 62)* (1216025823) (39 to 15) (119 to 70)*
blood and immune
disorders aggregate
Heart failure due to 1214 307 19 136 307 17
endocrine metabolic blood (1133 to 1300) (296 to 319)* (26 to 12)* (94191) (274 to 340)* (43 to 08)
and immune disorders
aggregate
Musculoskeletal disorders 1 304 1004 207 07 146 7838 205 07
(1 288 6028 to (202 to 212)* (11 to 03)* (106 7647194 4735) (196 to 215)* (13 to 00)*
1 316 6414)
Rheumatoid arthritis 24 4912 238 06 57778 236 07
(22 5520 to 26 7507) (211 to 267)* (15 to 29) (4016177696) (209 to 267)* (14 to 31)*
Osteoarthritis 237 3686 329 22 12 8862 348 39
(230 3359 to 244 6481) (319 to 338)* (16 to 29)* (8 999717 5400) (336 to 360)* (30 to 48)*
Osteoarthritis of the hip 35 6292 335 18 17762 358 37
cases aggregate (32 4826 to 38 9701) (324 to 346)* (10 to 26)* (1224924770) (344 to 373)* (26 to 50)*
Osteoarthritis of the knee 201 7394 327 23 11 1100 346 39
cases aggregate (195 2053 to 208 2766) (317 to 339)* (15 to 31)* (7742115 1232) (333 to 359)* (30 to 49)*
Low back and neck pain 820 6898 187 20 94 9415 186 21
(803 4674 to 837 8089) (179 to 194)* (26 to 14)* (67 8253128 0350) (176 to 196)* (27 to 14)*
Low back pain 539 9074 173 28 60 0748 172 26
(521 4486 to 559 5560) (165 to 182)* (34 to 22)* (42 721982 3437) (164 to 181)* (32 to 20)*
Neck pain 358 0066 211 11 34 8667 210 11
(313 4084 to 409 4110) (190 to 233)* (24 to 00) (23 362147 6369) (189 to 232)* (23 to 01)
Gout 42 2142 264 05 13428 263 06
(37 6882 to 47 4955) (252 to 277)* (01 to 10)* (910018438) (246 to 279)* (03 to 15)
Asymptomatic gout 37 7129 264 05 00 00 00
(33 5984 to 42 4670) (252 to 277)* (01 to 10)* (0000) (00 to 00) (00 to 00)
Other musculoskeletal 342 0677 207 12 31 8354 205 13
disorders (305 4307 to 385 1467) (175 to 240)* (12 to 37) (21 489144 2684) (172 to 237)* (11 to 38)
Other non-communicable 5 316 3421 146 04 139 0018 204 12
diseases (5 283 7018 to (143 to 148)* (02 to 06)* (95 4590197 7043) (195 to 215)* (06 to 20)*
5 355 9283)
Congenital anomalies 95 7064 225 93 86210 285 147
(88 1334 to 102 4834) (185 to 263)* (58 to 128)* (5389112 9502) (200 to 376)* (71 to 227)*
Neural tube defects 14496 177 72 4991 184 81
(9884 to 20918) (145 to 203)* (43 to 97)* (28538237) (141 to 222)* (41 to 116)*
Congenital heart 48 8691 298 154 16882 297 156
anomalies (34 3257 to 72 8292) (253 to 341)* (114 to 192)* (659431169) (256 to 337)* (117 to 191)*
Less severe heart 44 5995 294 152 14310 293 152
anomalies cases (29 8006 to 68 4985) (245 to 340)* (107 to 191)* (532727477) (242 to 340)* (107 to 192)*
aggregate
(Table 3 continues on next page)

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Articles

Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Severe congenital 40086 337 185 2350 335 185
heart anomalies (26711 to 60112) (274 to 390)* (129 to 233)* (9324678) (274 to 387)* (132 to 232)*
Critical congenital 1558 420 286 92 420 289
heart anomalies (903 to 2524) (275 to 529)* (155 to 385)* (32187) (264 to 542)* (149 to 401)*
Heart failure due to 1052 116 10 129 116 10
congenital heart (992 to 1114) (109 to 124)* (15 to 05)* (88182) (83 to 151)* (39 to 20)
anomalies aggregate
Cleft lip and cleft palate 68826 195 66 796 122 09
(40292 to 11 4835) (77 to 275)* (39 to 139) (3951431) (26 to 199)* (79 to 77)
Down syndrome 53618 179 64 5070 203 65
(34246 to 81921) (137 to 218)* (23 to 100)* (28628372) (158 to 242)* (22 to 102)*
Turner syndrome 3724 119 01 66 114 01
(1746 to 6771) (98 to 139)* (17 to 19) (24144) (87 to 140)* (24 to 22)
Klinefelter syndrome 2205 128 05 13 135 02
(1155 to 3955) (109 to 142)* (12 to 19) (0531) (106 to 156)* (22 to 20)
Other chromosomal 47286 162 43 4541 185 42
abnormalities (26289 to 83032) (118 to 198)* (01 to 77)* (23358521) (136 to 223)* (05 to 79)
Other congenital 32 3630 145 20 53850 313 171
anomalies (17 7881 to 59 3941) (123 to 168)* (01 to 41) (3209485621) (188 to 459)* (61 to 303)*
Skin and subcutaneous 2 239 4934 125 07 44 8960 117 04
diseases (2 222 7163 to (121 to 128)* (04 to 11)* (28 943367 1596) (110 to 123)* (01 to 07)*
2 258 2528)
Dermatitis 245 2906 140 03 87880 136 16
(227 2834 to 262 7522) (132 to 148)* (01 to 07)* (5963412 2735) (129 to 144)* (10 to 22)*
Eczema cases 85 5856 130 33 52392 130 34
aggregate (75 1152 to 97 0317) (124 to 136)* (28 to 38)* (35151 to 73486) (122 139)* (27 to 42)*
Contact dermatitis 98 0151 152 10 26320 150 09
cases aggregate (85 0970 to 110 3967) (133 to 169)* (12 to 09)* (1625838524) (131 to 168)* (14 to 05)*
Seborrhoeic 61 6900 133 13 9168 132 13
dermatitis cases (54 6428 to 68 7888) (120 to 147)* (17 to 10)* (521614541) (118 to 147)* (18 to 08)*
aggregate
Psoriasis 79 6997 176 04 64383 175 06
(76 6909 to 82 8045) (170 to 183)* (01 to 09) (4495687345) (166 to 184)* (00 to 12)
Cellulitis 9599 240 58 690 236 58
(8876 to 10336) (221 to 257)* (43 to 72)* (450978) (207 to 261)* (35 to 81)*
Pyoderma 58127 155 14 327 154 15
(55817 to 60190) (147 to 163)* (07 to 21)* (132684) (140 to 168)* (03 to 27)*
Scabies 204 1517 66 26 52689 66 25
(177 5337 to 237 4662) (40 to 95)* (45 to 06)* (2966986056) (38 to 95)* (45 to 05)*
Fungal skin diseases 492 3726 133 16 27833 133 17
(448 9509 to 538 2325) (125 to 141)* (13 to 19)* (1105659053) (124 to 141)* (14 to 20)*
Viral skin diseases 174 8431 85 11 53969 84 10
(165 1563 to 185 0720) (80 to 90)* (14 to 08)* (3417179599) (79 to 90)* (14 to 06)*
Molluscum 40 4642 52 09 12630 53 08
contagiosum cases (35 6856 to 46 2334) (47 to 58)* (13 to 05)* (783019323) (46 to 61)* (15 to 02)*
aggregate
Viral warts cases 134 3789 95 11 41339 94 10
aggregate (125 6839 to 143 0280) (89 to 101)* (14 to 07)* (2628461534) (88 to 101)* (15 to 06)*
Acne vulgaris 632 7410 46 08 68540 46 08
(595 2419 to 671 2489) (35 to 56)* (01 to 17) (3275112 7139) (35 to 56)* (01 to 18)
Alopecia areata 20 5949 140 11 6956 139 10
(19 6078 to 21 6170) (135 to 144)* (13 to 10)* (428510356) (131 to 147)* (17 to 04)*
Pruritus 69 5825 176 04 7416 175 05
(62 0632 to 78 1526) (157 to 195)* (07 to 16) (360013486) (156 to 194)* (07 to 17)
Urticaria 67 7498 107 01 41157 107 00
(58 7432 to 77 0864) (96 to 120)* (03 to 00) (2567258336) (96 to 120)* (05 to 04)
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Decubitus ulcer 10875 354 47 1613 345 47
(9912 to 11897) (334 to 374)* (33 to 60)* (11202187) (319 to 373)* (26 to 69)*
Other skin and 605 0363 228 24 35505 226 25
subcutaneous diseases (589 5000 to 619 6756) (221 to 234)* (19 to 29)* (1706265144) (220 to 233)* (20 to 29)*
Sense organ diseases 1 788 1256 237 06 68 5152 252 06
(1 771 3670 to (233 to 241)* (03 to 09)* (47 798293 8948) (242 to 264)* (00 to 13)
1 808 4388)
Glaucoma 59545 391 42 5413 394 43
(50775 to 69058) (369 to 414)* (28 to 55)* (37007479) (370 to 419)* (26 to 58)*
Cataract 59 7270 269 32 38797 255 42
(53 6332 to 66 8792) (252 to 285)* (45 to 20)* (2766952292) (241 to 269)* (52 to 32)*
Macular degeneration 61884 485 82 4624 477 69
(52503 to 72732) (461 to 508)* (69 to 98)* (32746330) (452 to 499)* (53 to 86)*
Refraction and 819 3074 219 04 14 5938 211 03
accommodation (789 9174 to 848 0592) (205 to 232)* (13 to 06) (9392922 9011) (202 to 221)* (09 to 04)
disorders
Age-related and other 1 210 0552 283 14 40 5968 264 11
hearing loss (1 140 2242 to (274 to 292)* (10 to 18)* (27 898456 0750) (246 to 283)* (00 to 21)*
1 274 6648)
Other vision loss 25 7974 271 55 1 7564 299 56
(22 6756 to 28 5046) (246 to 295)* (42 to 67)* (1248923927) (278 to 320)* (43 to 67)*
Other sense organ 267 6897 240 08 66847 238 09
diseases (258 3798 to 277 7114) (231 to 249)* (01 to 14)* (4185097147) (229 to 248)* (02 to 15)*
Acute other sense 13438 149 09 354 148 09
organ diseases (13035 to 13859) (142 to 157)* (04 to 14)* (216516) (127 to 169)* (09 to 27)
Chronic other sense 266 3459 240 08 66493 239 09
organ diseases (257 0474 to 276 3830) (231 to 249)* (01 to 14)* (4162396624) (230 to 249)* (02 to 15)*
Oral disorders 3 521 9011 145 04 16 9696 224 02
(3 468 0882 to 3 575 (138 to 150)* (01 to 09) (10 296526 0445) (216 to 232)* (05 to 01)
8544)
Deciduous caries 572 6941 45 23 1472 41 27
(475 0898 to 686 9912) (23 to 61)* (42 to 07)* (6302921) (16 to 59)* (49 to 08)*
Permanent caries 2 521 1978 145 08 17434 135 04
(2 361 4183 to (137 to 154)* (03 to 14)* (776733209) (126 to 144)* (12 to 04)
2 679 6687)
Periodontal diseases 537 5060 254 11 35207 254 12
(465 1139 to 625 8888) (241 to 265)* (05 to 17)* (1359372537) (241 to 265)* (06 to 18)*
Edentulism and severe 275 6191 273 09 76403 273 08
tooth loss (264 2008 to 288 2523) (269 to 277)* (11 to 07)* (5096610 5623) (269 to 277)* (11 to 06)*
Other oral disorders 133 7190 159 01 39181 158 00
(127 4997 to 139 7762) (154 to 164)* (02 to 01) (2432758794) (153 to 164)* (02 to 03)
Injuries 1 019 1574 164 34 41 0220 80 99
(977 4057 to (155 to 174)* (41 to 26)* (29 290455 2884) (46 to 111)* (125 to 75)*
1 064 7042)
Transport injuries 115 9810 231 00 64448 122 80
(110 5759 to 123 0471) (225 to 237)* (04 to 04) (4500687330) (87 to 158)* (107 to 53)*
Road injuries 107 7224 234 03 59561 133 71
(102 2145 to 114 8500) (228 to 241)* (01 to 07) (4130880763) (99 to 167)* (97 to 46)*
Pedestrian road injuries 14 1578 229 07 7708 96 106
(12 6645 to 16 0959) (217 to 241)* (14 to 00) (532910608) (55 to 136)* (137 to 76)*
Cyclist road injuries 18 7006 214 04 9682 99 90
(16 5454 to 20 9511) (199 to 227)* (12 to 04) (655213485) (55 to 142)* (125 to 59)*
Motorcyclist road 26 4172 317 73 13979 176 33
injuries (23 4967 to 29 7220) (303 to 330)* (65 to 81)* (962019198) (130 to 221)* (70 to 02)
Motor vehicle road 44 3114 187 41 25854 122 84
injuries (40 2126 to 49 4963) (177 to 198)* (47 to 34)* (1811235568) (96 to 148)* (104 to 66)*
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Other road injuries 41353 402 152 2337 321 95
(36037 to 46927) (386 to 421)* (144 to 161)* (15833209) (283 to 355)* (68 to 119)*
Other transport injuries 82585 188 32 4887 03 171
(74690 to 91416) (179 to 197)* (36 to 27)* (34866605) (40 to 52) (205 to 133)*
Unintentional injuries 790 1018 143 52 30 6795 62 114
(759 5874 to (138 to 148)* (55 to 49)* (21 602941 9537) (31 to 90)* (136 to 92)*
824 9950)
Falls 225 7369 251 17 11 7702 113 86
(207 9143 to 245 7872) (244 to 258)* (13 to 21)* (8257616 1664) (67 to 157)* (121 to 52)*
Drowning 44555 70 131 2473 67 234
(40412 to 49194) (58 to 81)* (135 to 127)* (17343358) (103 to 24)* (262 to 202)*
Fire, heat, and hot 69 6666 108 83 22694 19 135
substances (60 9881 to 78 5501) (101 to 117)* (88 to 79)* (1571431318) (18 to 55) (161 to 112)*
Poisonings 57224 138 20 5494 88 45
(48293 to 68541) (127 to 149)* (32 to 06)* (36787911) (67 to 108)* (66 to 26)*
Exposure to mechanical 183 5824 139 35 35808 59 99
forces (169 6586 to 197 8596) (130 to 147)* (40 to 29)* (2485749229) (29 to 89)* (121 to 76)*
Unintentional rearm 23330 134 63 932 41 126
injuries (20745 to 26251) (124 to 144)* (71 to 56)* (6541262) (06 to 74)* (150 to 101)*
Unintentional 97593 97 77 3537 114 68
suocation (81425 to 11 9169) (55 to 139)* (103 to 51)* (24584803) (86 to 140)* (86 to 51)*
Other exposure to 171 4901 141 32 31339 54 101
mechanical forces (157 8210 to 185 3644) (132 to 149)* (37 to 26)* (2172143566) (22 to 85)* (126 to 77)*
Adverse eects of medical 11 1586 31 139 14874 31 139
treatment (87735 to 13 6102) (13 to 49)* (154 to 124)* (926922230) (13 to 49)* (154 to 124)*
Animal contact 34 0497 94 66 11009 46 88
(30 7742 to 37 5690) (80 to 106)* (75 to 59)* (763814869) (30 to 62)* (100 to 75)*
Venomous animal 14 6807 132 36 8207 53 78
contact (13 1734 to 16 3751) (122 to 142)* (44 to 28)* (558111175) (37 to 71)* (92 to 62)*
Non-venomous animal 19 3691 67 88 2803 25 114
contact (16 7945 to 22 3065) (48 to 82)* (101 to 77)* (18724105) (02 to 47)* (131 to 98)*
Foreign body 32 3459 157 19 12633 37 109
(28 8773 to 36 0264) (141 to 171)* (29 to 11)* (899417225) (02 to 75)* (136 to 81)*
Pulmonary aspiration 13 3512 155 16 6902 02 140
and foreign body in (11 0690 to 16 7987) (125 to 184)* (36 to 02) (47799731) (41 to 45) (172 to 104)*
airway
Foreign body in eyes 10072 163 14 562 152 05
(4440 to 1 5934) (150 to 182)* (08 to 19)* (2401006) (138 to 167)* (09 to 13)
Foreign body in other 17 9874 159 23 5170 80 77
body part (15 8741 to 20 2379) (149 to 170)* (30 to 16)* (36447133) (55 to 106)* (96 to 58)*
Environmental heat and 61 9423 159 42 26571 64 110
cold exposure (56 2119 to 68 7618) (154 to 165)* (46 to 38)* (1861736362) (37 to 94)* (130 to 89)*
Other unintentional 161 4416 47 137 57536 04 167
injuries (147 9713 to 176 2043) (40 to 53)* (141 to 133)* (3913180241) (14 to 21) (178 to 157)*
Self-harm and 24 0830 152 55 10775 19 151
interpersonal violence (22 2797 to 25 7444) (146 to 157)* (59 to 52)* (76271 4482) (16 to 58) (178 to 121)*
Self-harm 63586 152 62 3327 09 159
(56821 to 71545) (145 to 158)* (67 to 58)* (23244469) (21 to 45) (184 to 132)*
Interpersonal violence 17 7244 152 53 7448 24 146
(16 1866 to 19 2684) (145 to 159)* (57 to 48)* (521910073) (14 to 64) (175 to 116)*
Assault by rearm 10436 161 49 465 46 132
(9008 to 12132) (149 to 173)* (58 to 42)* (324649) (07 to 81)* (161 to 105)*
Assault by sharp object 40195 125 70 1234 64 211
(33304 to 46681) (115 to 136)* (77 to 63)* (8481687) (114 to 09)* (248 to 168)*
Assault by other means 12 6613 160 47 5748 43 133
(11 4255 to 14 0189) (152 to 168)* (53 to 43)* (40407822) (08 to 80)* (159 to 104)*
(Table 3 continues on next page)

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Prevalence (thousands) YLDs (thousands)


2015 Percentage change in Percentage change in 2015 Percentage change in Percentage change in
counts between 2005 ASR between 2005 and counts between 2005 ASR between 2005
and 2015 2015 and 2015 and 2015
(Continued from previous page)
Forces of nature, war, and 88 9917 288 117 28202 234 72
legal intervention (65 1310 to 116 7861) (184 to 405)* (29 to 217)* (19213 to 38501) (17 to 478)* (114 to 283)
Exposure to forces of 25 2937 135 13 7969 274 359
nature (16 1936 to 37 6587) (21 to 322) (145 to 141) (5414 to 10914) (432 to 62)* (496 to 178)*
Collective violence and 63 6979 361 181 20233 705 471
legal intervention (45 248783 1864) (209549)* (51344)* (1303829030) (3301183)* (153888)*
Impairments
Anaemia 2 359 1079 40 71 77 8767 07 102
(2 349 9383 to (35 to 45)* (76 to 67)* (52 4369 to 111 3600) (20 to 04) (112 to 92)*
2 369 0658)
Developmental 152 6640 126 20 16 8751 150 38
intellectual disability (113 5115 to 190 7641) (122 to 130)* (16 to 24)* (12 0726 to 22 3731) (134 to 170)* (22 to 57)*
Epilepsy 39 1605 158 35 11 7700 58 49
(34 2708 to 43 6858) (126 to 189)* (05 to 64)* (8 5788 to 15 2763) (05 to 110)* (98 to 01)*
Guillain-Barr syndrome 350 170 02 104 170 02
(286 to 421) (147 to 195)* (09 to 04) (66 to 150) (147 to 195) (09 to 04)
Hearing loss 1 330 9029 260 09 46 1831 236 06
(1 261 4010 to (252 to 267)* (05 to 13)* (31 5667 to 63 2099) (221 to 251)* (04 to 15)
1 397 1006)
Heart failure 40 0486 323 03 61994 332 11
(38 6132 to 41 4182) (316 to 331)* (02 to 08) (47007 to 77855) (317 to 346)* (01 to 20)*
Infertility 113 1138 211 80 7524 199 70
(93 4294136 4975) (176245)* (49109)* (327715438) (168227)* (4394)*
Pelvic inammatory 7541 11 120 999 13 117
disease (6528 to 8787) (01 to 21)* (127 to 112)* (678 to 1386) (07 to 34) (134 to 100)*
Vision loss 939 5802 224 04 24 4627 224 02
(905 0095 to 974 1123) (212 to 236)* (13 to 04) (16 9549 to 34 4551) (216 to 233)* (08 to 03)

Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.

Table 3: Global prevalence and YLDs for 2015, percentage change of counts, and percentage change of age-standardised rates between 2005 and 2015 for all causes, Level 5 sequelae, and
nine impairments

disability in Nepal, Bangladesh, and Bhutan, respectively. region. Observed YLDs due to diabetes consistently
YLDs due to anxiety were lower than expected in all exceeded expected levels, with two countries posting
countries in the region except for Bangladesh. ratios higher than 300 (ie, Qatar [312], and the United
In the GBD super-region of central Europe, eastern Arab Emirates [352]). Iran and Morocco recorded much
Europe, and central Asia, lower back and neck pain was the higher disability due to drug use disorders than expected
leading cause of disability in every geographical region in based on SDI.
2015; Although all countries in eastern and central Europe In comparison with the rest of the world, ranks of cause-
recorded higher than expected YLD ratios for most of their specic disability, and their ratios of observed to expected
top ten causes, central Asia mostly had lower than expected values, were vastly dierent in sub-Saharan Africa. Of the
or as expected YLD ratios. Sense organ diseases were the 46 countries within the super-regions, nine had lower back
second leading causes of disability and depressive disorders and neck pain as the leading cause of YLDs in 2015. In
were the third leading causes in this super-region. southern Sub-Saharan Africa, HIV/AIDS was the leading
Sizeable discrepancies occurred for observed and cause of disability for all countries. Iron-deciency anaemia
expected YLDs based on SDI throughout north Africa ranked as the leading cause of YLDs for 11 countries in
and the Middle East, probably reecting the uneven western sub-Saharan Africa. For the remaining countries,
achievements in development found in this region. lower back and neck pain were primarily the leading cause
Lower back and neck pain was the primary driver of of YLDs; Liberia, the exception, had onchocerciasis as its
YLDs in the region. Exceptions to this were Lebanon and leading cause of disability. Malaria and various neglected
Syria, for which war caused the most disability in 2015, tropical diseases caused more YLDs than expected in most
and Afghanistan for which iron-deciency was the west African countries. For eastern sub-Saharan Africa,
leading cause. Depression, sense organ diseases, diabetes sense organ diseases, iron deciency, depressive disorders,
ranked second, third, and fourth, respectively, for the and lower back and neck pain were leading causes of YLDs

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Articles

in 2015. In central sub-Saharan Africa, skin diseases were much faster for YLLs; this pattern is to be expected if access
consistently among the leading three-to-four causes of to eective treatment is decreasing the number of deaths
disability in this region. HIV/AIDS resulted in far more but not reducing prevalence or incidence. The last category
YLDs than expected based on SDI, with Equatorial Guinea, includes disorders where decreases are equal, if not slightly
and Central African Republic recording ratios of observed higher, for YLDs including ischaemic heart disease, falls,
versus expected YLDs higher than 200. cervical cancer, and other injuries. Examination of
dierential trends by region or country might provide
Discussion insights into the role of access to treatment in reducing
We used 60 900 data sources to estimate the incidence YLLs and, conversely, the role of increasing or decreasing
and prevalence of 2619 sequelae of 310 causes for risks and social determinants in driving changes in disease
591 geographical regions for the years 1990, 1995, 2000, incidence and prevalence. More detailed exploration of
2005, 2010, and 2015. After accounting for variation over these dierential trends is warranted in future work.
time and across regions in case denitions, disease assays,
survey instruments, and coding practice, and using Disability and retirement age
standardised modelling approaches to deal with missing As life expectancy has steadily increased in most countries,
data, conicting data, and a range of sampling and non- there have been calls in some high SDI countries to extend
sampling errors, we characterised the global and national retirement ages to reect these changes in survival.2830
patterns in non-fatal health outcomes. We found that global A crucial factor in these debates is whether individuals are
age-standardised YLDs per capita decreased slightly in the living for longer and have higher average levels of
last 25 years from 0114 (00850147) in 1990 to 0110 functional health at each age or not. In this study, we
(00820141) per capita in 2015, a total decrease of 369% found that age-standardised YLDs per capita decreased,
(312425%) over a generation (appendix pp 71416). The but rather slowly, over the period 2005 to 2015. Comparison
ageing of the worlds population and the general increase of trends in age-standardised YLDs and YLLs by cause
in YLDs per capita with age resulted in an increase in shows that the main causes of YLDs are not decreasing
global YLDs per capita. Within this overall pattern, 133 out and in some settings might be increasing. Other than a
of 310 causes had statistically signicant decreases in YLDs somewhat slower rate of improvement for YLDs at oldest
per capita between 2005 and 2015 compared with 82 causes age (80 years), age discontinuities are not observable in
with statistically signicant increases in YLDs per capita these patterns. Ultimately, the debate on retirement age
over the same time period. The most important will hinge on the skill sets required for dierent types
contributors to global YLDs were musculoskeletal disorders of work, whether work contributes to diminished
(185% [164209%] of all YLDs in 2015), mental and or improved functional health status, and societal
substance use disorders (184% [156212%]), and the expectations for retirement. Our ndings suggest that the
category of other NCDs (179% [150217%]), dominated burden from mental and substance use disorders, and
by hearing loss, vision loss, and skin diseases. musculoskeletal disorders, which are frequent causes of
early retirement31,32 in terms of age-specic prevalence, has
Typology of diseases based on YLDs and YLLs not declined much over time; the continued prevalence of
The comparison of trends in age-standardised YLDs and these and other disorders associated with increasing age
YLLs provides insight into the drivers of dierences in might limit the capacities of an older workforce.
rates of increases and decreases for diseases and injuries.
Diseases and injuries can be parsed into four groups. The Epidemiological transition
rst of these are a small set of disorders including causes The analysis of YLD rates by Level 2 causes as a function of
such as drug use disorders and skin cancer for which age- SDI shows a very dierent picture than that reported for
standardised rates of both YLDs and YLLs increased at a YLLs. At the lower end of the SDI spectrum, incremental
rate of more than 04% per year from 2005 to 2015. increases in SDI are associated with reductions in both
A second category of diseases includes those in which age-standardised YLDs and all-age YLD rates spurred by
YLDs are increasing but YLLs are decreasing, including decreases in disability from neglected tropical diseases and
disorders such as thyroid cancer, cirrhosis, and neonatal anaemia as well as decreases in tuberculosis, diarrhoea,
encephalopathy. One explanation for this pattern is that pneumonia, meningitis, and other infectious diseases.
risk factors, broadly dened, are causing an increase in At SDI levels above 08 (see methods appendix pp 698711
incidence, whereas access to eective treatment has for SDI values for each country), age-standardised rates of
improved enough to continue reducing mortality. For a health loss increase slightly, attributable to higher rates of
third category of disorders, YLDs are essentially constant, mental and substance use disorders, musculoskeletal
but YLLs are decreasing. This grouping is quite large and disorders, and neurological disorders. In this phase of the
includes many of the major causes of disability such as epidemiological transition, this increase in rates, although
musculoskeletal disorders, various neurological disorders, small, combined with population ageing, results in
and a number of cancers. For many infectious causes, increases in YLDs per 100 000. The rising average YLD per
decreased are occurring for both YLLs and YLDs but are capita rates have implications for health systems; a larger

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Leading causes 1990 Leading causes 2005 % change % change % change age- Leading causes 2015 % change % change % change age-
number all-age standardised number all-age standardised
of YLDs YLD rate YLD rate of YLDs YLD rate YLD rate
19902005 19902005 19902005 200515 200515 200515
1 Lower back and neck pain 1 Lower back and neck pain 345 94 18 1 Lower back and neck pain 186 49 21
2 Iron-deciency anaemia 2 Sense organ diseases 394 134 21 2 Sense organ diseases 252 108 06
3 Sense organ diseases 3 Iron-deciency anaemia 148 66 06 3 Depressive disorders 182 45 10
4 Depressive disorders 4 Depressive disorders 329 80 06 4 Iron-deciency anaemia 38 149 116
5 Skin diseases 5 Skin diseases 219 08 05 5 Skin diseases 117 12 04
6 Migraine 6 Migraine 297 55 03 6 Diabetes 325 172 54
7 Other musculoskeletal disorders 7 Other musculoskeletal disorders 518 234 135 7 Migraine 153 20 08
8 Anxiety disorders 8 Diabetes 692 376 207 8 Other musculoskeletal disorders 205 66 13
9 Diabetes 9 Anxiety disorders 261 26 15 9 Anxiety disorders 148 15 10
10 Asthma 10 Asthma 26 165 155 10 Oral disorders 224 82 02
11 Oral disorders 11 Oral disorders 339 89 16 11 Asthma 94 33 23
12 Falls 12 Schizophrenia 361 107 07 12 Schizophrenia 195 57 03
13 Schizophrenia 13 Falls 134 78 139 13 Osteoarthritis 348 192 39
14 COPD 14 COPD 222 06 98 14 COPD 162 28 59
15 Autistic spectrum 15 Osteoarthritis 530 244 63 15 Falls 113 15 86
16 Haemoglobinopathies 16 Gynaecological diseases 291 50 34 16 Autistic spectrum 123 07 06
17 Gynaecological diseases 17 Autistic spectrum 232 02 05 17 Gynaecological diseases 107 21 33
18 Intestinal nematode 18 Other mental and substance 325 78 02 18 Drug use disorders 236 94 82
19 Osteoarthritis 19 Drug use disorders 421 156 116 19 Other mental and substance 187 50 03
20 Other mental and substance 20 Haemoglobinopathies 108 99 53 20 Medication overuse headache 189 52 06
21 Bipolar disorder 21 Bipolar disorder 294 52 01 21 Bipolar disorder 149 16 05
22 Epilepsy 22 Medication overuse headache 326 79 15 22 Congenital anomalies 285 137 147
23 Medication overuse headache 23 Epilepsy 109 98 79 23 Haemoglobinopathies 43 77 49
24 Other unintentional 24 Congenital anomalies 489 211 224 24 Chronic kidney disease 238 95 01
25 Drug use disorders 25 Chronic kidney disease 353 101 24 25 Ischaemic heart disease 302 152 03
26 Diarrhoeal diseases 26 Conduct disorder 158 58 07 26 Alzheimers disease 388 228 11
27 Conduct disorder 27 Other unintentional 07 181 236 27 Cerebrovascular disease 207 68 42
28 Chronic kidney disease 28 Alcohol use disorders 282 42 25 28 Alcohol use disorders 111 17 45
29 Congenital anomalies 29 Ischaemic heart disease 407 144 27 29 Epilepsy 64 172 163
30 Alcohol use disorders 30 Diarrhoeal diseases 22 205 99 30 Other cardiovascular 239 96 05
33 Cerebrovascular disease 31 Cerebrovascular disease 33 Conduct disorder Communicable, maternal,
34 Ischaemic heart disease 33 Alzheimers disease 34 Other unintentional neonatal, and nutritional
36 Other cardiovascular 34 Other cardiovascular 35 Diarrhoeal diseases Non-communicable
40 Alzheimers disease 39 Intestinal nematode 46 Intestinal nematode Injuries

Figure 2: Leading 30 Level 3 causes of global YLDs for both sexes combined, 1990, 2005, and 2015, with percentage change in number of YLDs, and all-age and age-standardised rates
Causes are connected by lines between time periods. For the time period of 1990 to 2005 and for 2005 to 2015, three measures of change are shown: percent change in the number of YLDs, percent
change in the all-age YLD rate, and percent change in the age-standardised YLD rate. YLD=years lived with disability. COPD=chronic obstructive pulmonary disease.

fraction of the population is likely to need care for many Mental and substance use disorders
disorders. Some of these disorders are currently costly to Consistent with the ndings of earlier GBD studies,
manage.33 The increase in health-care costs per individual GBD 2015 conrms the large contribution of mental and
in the population that occurs once an SDI of 08 is exceeded substance use disorders to global disability. For the rst
is a predictable component of the epidemiological time, in GBD 2015 we found a positive association
transition; these costs should be anticipated during the between conict and depression and anxiety, albeit with
health planning processes of countries in that stage of the wide uncertainty. This uncertainty is due to sparse and
transition. low-quality data for these disorders in post-conict
countries. Going forward, we plan to make separate
Disease-specic issues estimates for post-traumatic stress disorder in GBD,
Musculoskeletal disorders which might add considerably more data from conict
Musculoskeletal disorders continue to be a leading cause settings and show a stronger association. GBD results
of disability worldwide and more so when taking into have provided an evidence base to support global action
account that additional musculoskeletal burden from such as a stated commitment by the World Bank and
long-term sequelae of fractures and dislocations is WHO to make mental health a global development
classied under injuries in GBD. A key component of priority39 and the consideration of mental health and
healthy ageing is to maintain mobility, and a key public substance use disorders in shaping the Sustainable
health intervention recommended for improving health Development Goals.40 Cost-eective interventions are
outcomes for all chronic diseases is physical activity. able to reduce the burden imposed by mental and
Painful musculoskeletal disorders increase with age and substance use disorders, including in low-income and
are a great threat to mobility, compromising health more middle-income countries.41
broadly.3436 Even if cures for musculoskeletal disorders Increases in deaths attributable to drug use in the
are not yet available, the clinical goal of preventing USA have resulted in considerable policy and media
disability is attainable.37,38 attention. In our assessment, the ten countries with the

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1 2 3 4 5 6 7 8 9 10
Early neonatal Iron NN sepsis PEM Haemog Other inf Diarrhoea NN preterm Congenital Endocrine NN enceph
Late neonatal Iron PEM Diarrhoea Congenital Haemog NN preterm Other nutr NN enceph Other inf Epilepsy
Post neonatal Iron Diarrhoea PEM Haemog Skin Other NTD Congenital Other inf NN preterm Endocrine
14 years Iron Skin PEM Diarrhoea Sense Asthma Haemog Other NTD Congenital Otitis
59 years Iron Skin Asthma Sense Haemog Other NTD Conduct Malaria ASD Anxiety
1014 years Iron Skin Conduct Anxiety Asthma Migraine Sense Depression Back & neck Haemog
1519 years Skin Depression Iron Back & neck Migraine Anxiety Sense Conduct Other MSK Asthma
2024 years Depression Back & neck Skin Migraine Iron Other MSK Anxiety Sense Other mental Drugs
2529 years Back & neck Depression Migraine Skin Iron Other MSK Anxiety Sense Drugs Schiz
3034 years Back & neck Depression Migraine Skin Iron Sense Other MSK Anxiety Schiz Gynae
3539 years Back & neck Depression Migraine Sense Other MSK Skin Iron Anxiety Diabetes Schiz
4044 years Back & neck Depression Sense Migraine Other MSK Diabetes Skin Iron Anxiety Schiz
4549 years Back & neck Depression Sense Diabetes Other MSK Migraine Skin Iron Anxiety Schiz
5054 years Back & neck Sense Depression Diabetes Other MSK Migraine Skin Osteoarth Anxiety Schiz
5559 years Back & neck Sense Diabetes Depression Other MSK Migraine Osteoarth Skin Oral Anxiety
6064 years Back & neck Sense Diabetes Depression Other MSK Osteoarth Oral Skin Migraine COPD
6569 years Sense Back & neck Diabetes Depression Other MSK Osteoarth Oral COPD Skin IHD
7074 years Sense Back & neck Diabetes Depression Oral Other MSK Osteoarth COPD IHD Skin
7579 years Sense Back & neck Diabetes Alzheimer's Depression Oral Osteoarth Other MSK COPD IHD
80 years Sense Alzheimers Back & neck Diabetes Falls IHD Osteoarth Depression COPD Oral
Rate of change 200515
019 to 003 003 to 001 001 to 006 006 to 009 009 to 015
015 to 019 019 to 024 024 to 029 029 to 042 042 to 063

Figure 3: Leading ten Level 3 causes of global age-specic years lived with disability in 2015
Each cause is coloured by the percentage change in age-specic years lived with disability from 2005 to 2015. Alzheimers=Alzheimer disease and other dementias.
ASD=autism. Back & neck=low back and neck pain. Conduct=conduct disorders. Congenital=congenital anomalies. COPD=chronic obstructive pulmonary disease.
Drugs=drug use disorders. Endocrine=endocrine, metabolic, blood, and immune disorders. Gyne=gynaecological disorders. Haemog=haemoglobinopathies and haemolytic
anaemias. IHD=ischaemic heart disease. Iron=iron-deciency anaemia. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN preterm=neonatal
preterm birth complications. NN sepsis=neonatal sepsis and other neonatal infections. Other NTD=other neglected tropical diseases. Oral=oral disorders.
Osteoarth=osteoarthritis. Other inf=other infectious diseases. Other mental=other mental and substance use disorders. Other MSK=other musculoskeletal disorders.
Other nutr=other nutritional deciencies. PEM=protein-energy malnutrition. Schiz=schizophrenia. Sense=sense organ disease. Skin=skin and subcutaneous diseases.

highest prevalence of opioid dependence in decreasing for diabetes. We also included, wherever possible, studies
order in 2015 were Iran, United Arab Emirates, Russia, reporting on mean FPG but not diabetes prevalence, using
Morocco, the USA, Australia, Ukraine, Tunisia, Belarus, a regression between mean FPG and diabetes prevalence
Canada, and Iraq. Among these countries, we estimated from studies reporting on both. We have also made the
the highest excess mortality from opioid dependence in assessment of diabetes prevalence more consistent with
the eastern European countries at about twice the level cause of death data for diabetes. Our improved eorts at
of that in the USA, Canada, and the north African and measuring the prevalence of diabetes conrms the
Middle Eastern countries; the lowest rate among these increase in global age-standardised incidence, prevalence,
highly prevalent countries was in Australia. Within the and YLDs. Of note, the increase in YLDs at the global scale
USA, prescription opioids have been estimated to is greater than the increase in YLLs, which reects
account for 37% of drug overdose deaths in 2013.42,43 improved access to treatments that lower case fatality. The
The availability of overdose response treatments in rise of diabetes prevalence, related to the global increase in
the form of naloxone kits to laypersons has also body-mass index,46 given the costs of treating the disease47
accelerated.44 An alternative approach is opioid and the related increases in cardiovascular risks, poses one
substitution treatment to reduce the risk of overdose. of the more important challenges to health systems in the
The intensity at which countries use harm-reduction coming years. This is particularly the case in regions with
strategies such as needle exchange and opioid high prevalence of diabetes such as central America,
substitution programmes follows an inverse pattern,45 north Africa and the Middle East, and Oceania.
with the most intense programmes in Australia, but Ezzati and colleagues48 and the International Diabetes
very rare use of such strategies in eastern Europe, Federation (IDF)49 have estimated diabetes prevalence for
suggesting that embracing harm reduction is an many countries; the intra-class correlation coecient for
eective means of reducing drug deaths. the estimates from Ezzati and colleagues and the GBD
for 2015 is 074, and for the IDF estimates is 065. These
Diabetes large dierences appear to stem from the inclusion of
To obtain standard estimates for health loss due to diabetes cause of death data in the modelling for GBD and also
for GBD 2015 using both fasting plasma glucose (FPG) from the inclusion of self-reported diabetes prevalence in
means and standard deviations as well as diabetes the study by Ezzati and colleagues.48 In GBD, these
prevalence, we re-extracted all available data from 1990 to sources were excluded from our analyses because of
2015. Across studies, we found 20 dierent case denitions changing patterns in the prevalence of known and

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5 Key
Dengue
Non-communicable diseases
Injuries HIV
Communicable, maternal, neonatal, and nutritional diseases

Thyroid C

Prostate C Kidney C
2 Lymphoma
Testis C Melanoma skin C

Congenital
Myeloma
NN enceph
Other neopla
1 NN hemol Uterus C Diabetes War
Other NN Drugs
HTN HD Parkinsons
YLDs (%)

Schiz ILD
Varicella Hep
0 STD Skin PVD
URI NN preterm
Stroke
Otitis Diarrhoea COPD Med treat
PEM Road injuries
Asthma Hodgkin NN sepsis
Hernia
1 TB LRI Gastritis Mech Epilepsy
Chagas RHD Mat HTN Violence
Animal
Stomach C F body Other trans
Mat sepsis Other digest Self-harm
AGN LF
Poison Fire Heat Other unint
and cold
Iodine Cervix C
2
Comp abort Trachoma
Cysticer Mat hem Obst labour
PUD
Intest inf
Drowning
Whooping Oncho
3 Other mat
Other resp

4
Nematode

Yellow fev

5
5 4 3 2 1 0 1 2 3 4 5
YLLs (%)

Figure 4: Global annualised rate of change in age-standardised years of life lost (YLLs) and years lived with disability (YLDs) for Level 3 causes between
1990 and 2015
TB=tuberculosis. HIV=HIV/AIDS. Diarrhoea=diarrhoeal diseases. Intest Inf=intestinal infectious diseases. LRI=lower respiratory infections. URI=upper respiratory
infections. Otitis=otitis media. Whooping=whooping cough. Varicella=varicella and herpes zoster. Chagas=chagas disease. Cysticer=cysticercosis. LF=lymphatic
lariasis. Oncho=onchocerciasis. Trachoma=trachoma. Dengue=dengue. Yellow Fev=yellow fever.Nematode=intestinal nematode infections. Mat hem=maternal
haemorrhage. Mat sepsis=maternal sepsis and other maternal infections. Mat HTN=maternal hypertensive disorders. Obst labour=maternal obstructed labour and
uterine rupture. Comp abort=maternal abortion, miscarriage, and ectopic pregnancy. Oth mat=other maternal disorders. NN preterm=neonatal preterm birth
complications. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN sepsis=neonatal sepsis and other neonatal infections.
NN haemol=haemolytic disease and other neonatal jaundice. Oth NN=other neonatal disorders. PEM=protein-energy malnutrition. Iodine=iodine deciency.
Oth nutr=other nutritional deciencies. STD=sexually transmitted diseases excluding HIV. Hep=hepatitis. Stomach C=stomach cancer. Melanoma=malignant skin
melanoma. Skin C=non-melanoma skin cancer. Cervix C=cervical cancer. Uterus C=uterine cancer. Prostate C=prostate cancer. Testis C=testicular cancer. Kidney
C=kidney cancer. Thyroid C=thyroid cancer. Hodgkin=Hodgkin lymphoma. Lymphoma=non-Hodgkin lymphoma. Myeloma=multiple myeloma. Oth neopla=Other
neoplasms. RHD=rheumatic heart disease. Stroke=cerebrovascular disease. HTN HD=hypertensive heart disease. PVD=peripheral vascular disease. COPD=chronic
obstructive pulmonary disease. Asthma=asthma. ILD=interstitial lung disease and pulmonary sarcoidosis. Oth resp=other chronic respiratory diseases. PUD=peptic
ulcer disease. Gastritis=gastritis and duodenitis. Hernia=inguinal, femoral, and abdominal hernia. Oth digest=other digestive diseases. Parkinson=Parkinsons disease.
Schiz=schizophrenia. Drugs=drug use disorders. AGN=acute glomerulonephritis. Congenital=congenital anomalies. Skin=skin and subcutaneous diseases.
Road inj=road injuries. Oth trans=other transport injuries. Drown=drowning. Fire=re, heat, and hot substances. Poison=poisonings. Mech=exposure to mechanical
forces. Med treat=adverse eects of medical treatment. Animal=animal contact. F body=foreign body. Heat & cold=environmental heat and cold exposure.
Oth unint=other unintentional injuries. Violence=interpersonal violence. War=collective violence and legal intervention.

1580 www.thelancet.com Vol 388 October 8, 2016


Articles

unknown diabetes in surveys that vary with geography,


making it dicult to crosswalk these studies.

Dementia A
Brayne and colleagues50,51 reported that age-specic Female Male
prevalence of Alzheimers was decreasing in the UK. Of 80
the four studies in the USA with similar measurements 7579
over time that were reviewed, one showed a decrease,
7074
whereas no change in prevalence was seen
in the remaining studies.52,53 Our assessment of 6569
age-standardised prevalence showed that Alzheimers 6064
and other dementias decreased slowly in the UK, by
5559
369% (253485%) from 2005 to 2015, but remained
constant in the rest of the world. The decrease might be 5054
due to reductions in vascular dementias rather than 4549
Age (years)

reductions in Alzheimers and other dementias. Our


4044
assessment also suggests that the number of individuals
with Alzheimers disease increased from 217 million 3539

(189248 million) worldwide in 1990 to 460 million 3034


(402527 million) in 2015. Although it is useful to
2529
know that age-standardised rates might be starting to
decrease, if only slightly, the rapid increase in the 2024

absolute number of cases points to the major challenge 1519


that dementia presents to societies with increasing life 1014
expectancy. This number is similar to the most recent
59
estimates from the World Alzheimer Report 2015 that
estimated 468 million people living with dementia in 04
2015. However, there is less agreement about new cases 50 39 28 17 6 0 6 17 28 39 50
per year: The World Alzheimer Report estimated
99 million new cases of dementia per year in 2015 B
compared with 644 million (552745 million) new
80
cases in 2015 estimated in GBD 2015. The World
Alzheimer Report separately analysed prevalence and 7579
incidence whereas we use DisMod-MR 2.1 to produce 7074
internally consistent prevalence and incidence estimates.
6569
We observed a fundamental disagreement in the
underlying incidence and prevalence data in many 6064

countries and decided to exclude incidence data from 5559


our modelling approach, putting greater trust in 5054
prevalence studies than incidence studies, arguing that
4549
the point of incidence in dementia is more dicult to
Age (years)

establish than prevalence when the diagnosis over time 4044


becomes more established. 3539

3034
Figure 5: Population pyramids with the number of individuals, by age and
sex, grouped by severity of their disability weight (DW) for all comorbid 2529
conditions combined into no disability, very mild disability (DW 0001),
mild disability (DW 001005), moderate disability (DW 00501), severe 2024
disability (DW 0103), and very severe disability (DW >03) for geographies 1519
of high (A) and low (B) quintiles of Socio-demographic Index in 2015
Disability weights are combined multiplicatively as 1(1DW1)(1 DW2)... 1014
(1DWn) for n comorbid sequelae. Socio-demographic Index (SDI) is calculated
for each geography as a function of lag-dependent income per capita, average 59
educational attainment in the population aged over 15 years, and the total 04
fertility rate. SDI units are interpretable; a zero represents the lowest level of
income per capita, educational attainment, and highest total fertility rate (TFR) 46 36 26 15 5 0 5 15 26 36 46
observed from 1980 to 2015 and a one represents the highest income per Population (millions)
capita, educational attainment, and lowest TFR observed in the same period. Disability No disability Mild Severe
Cutos on the SDI scale for the quintiles have been selected based on level Very mild Moderate Very severe
examination of the entire distribution of geographies between 1980 and 2015.

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Hepatitis C highly eective but costly.54 Some programmes have been


The availability of new medical treatments for chronic launched in Egypt and other lower-SDI countries that
hepatitis C has driven considerable interest in the oer treatment at lower cost. Good data on the number
prevalence data for this disease. Available treatments are of courses of treatment that have been delivered are not
widely available. Given the number of individuals with
A chronic infection and the potential to be cured, tracking
Males Females
the fraction of people treated each year should be
undertaken. Even in high-income countries such as the
USA, the fraction of those treated among those who
would benet from treatment is not yet available.

075
Malaria
Our assessment of malaria prevalence and incidence in
high burden sub-Saharan Africa was based on the Malaria
Socio-demographic Index

Atlas Project spatial analysis of prevalence surveys done


across Africa between 2000 and 2015.55,56 The dynamic
050 map of malaria prevalence was updated for GBD 2015 and
extended back to 1980. Children younger than 5 years
in sub-Saharan Africa showed a remarkable 335%
(248460%) decrease in incidence from the 2005 peak
of 078 (056096) cases per person per year to 052
025 (033071) in 2015. Yet there were 817 million
(5201117 million) incident cases in this age group in
2015. The decrease in children was more rapid than that
recorded for older age groups. In adolescents and adults,
incidence dropped by 300% (172392%) and
15 000 13 000 11 000 9000 7000 5000 3000 1000 1000 3000 5000 7000 9000 11 000 13 000 15 000
Age-standardised YLD rate per 100 000 people
211% (153269%), respectively, and resulted in
587 million (377915 million) and 533 million
B (407675 million) incident cases, respectively, in 2015.
The observed decreases in malaria incidence underscore
the remarkable eect of the scale-up of antimalarial
interventions57 across Africa in the past decade.55
Sustaining the levels of these interventions is crucial to
075
continue to reduce malaria morbidity on the continent,
avoid resurgence, and improve on these levels that are
vital to global aspirations for malaria eradication.58 Overall,
we estimate there were 2869 million (21973773 million)
Socio-demographic Index

cases of malaria worldwide in 2015, whereas the World


Malaria Report (WMR) 2015 reports 214 million
050
(149303 million) cases in 2015.59 Of these cases, the WMR
estimates that 88% of cases occurred in the WHO African
region (188 million) whereas we estimate 1894 million
(15172394 million; 661%) cases for GBD 2015. Outside
of Africa, the WMR reports 26 million cases versus our
025
estimate of 973 million (5021818 million), but both
sets of estimates feature identical regional rankings
among the six WHO regions with malaria. Increasing
convergence in estimates is expected as dynamic maps of
15 000 13 000 11 000 9000 7000 5000 3000 1000 1000 3000 5000 7000 9000 11 000 13 000 15 000
All-age YLD rate per 100 000 people
Figure 6: Expected relationship between age-standardised years lived with
Forces of nature, war, and legal intervention Mental and substance use Other communicable, maternal, disability (YLD) rates per 100 000 people for the 21 GBD Level 2 causes and SDI
Self-harm and interpersonal violence disorders neonatal, and nutritional diseases
Nutritional deciences
(A) and the expected relationship between all-age years lived with disability
Unintentional injuries Neurological disorders
Transport injuries Digestive diseases Neonatal disorders (YLD) rates per 100 000 people for the 21 GBD Level 2 causes and SDI (B) by sex
Other non-communicable diseases Cirrhosis and other chronic Maternal disorders These stacked curves represent the average relationship between SDI and each
Musculoskeletal disorders liver diseases Neglected tropical diseases and malaria cause of YLDs observed across all geographies over the time period 1990 to 2015.
Diabetes, urogenital, blood, Chronic respiratory diseases Diarrhoea, lower respiratory, and
other common infectious diseases
In each gure, the y-axis spans from lowest SDI up to highest SDI. To the left of the
and endocrine diseases Cardiovascular diseases
Neoplasms HIV/AIDS and tuberculosis midline are male rates, and the female rates are to the right; higher rates are
further from the midline. SDI=Socio-demographic Index.

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Back & neck Sense Depression Iron Skin Diabetes Migraine Other MSK Anxiety Oral
Global (10) (093) (101) (093) (098) (093) (129) (093) (086)
(096)
Back & neck Sense Depression Skin Diabetes Migraine Other MSK Anxiety Oral Iron
High income (094) (111) (092) (129) (104) (127) (132) (095) (092)
(111)
Back & neck Depression Diabetes Sense Other MSK Skin Anxiety Migraine Drugs Iron
High-income North America (131) (23) (089) (183) (094) (154) (097) (294) (09)
(108)
Back & neck Sense Depression Skin Other MSK Diabetes Migraine Iron Anxiety Oral
Canada (091) (098) (102) (162) (157) (113) (117) (123) (095)
(131)
Back & neck Depression Other MSK Skin Sense Migraine Anxiety Iron Diabetes Falls
Greenland (094) (218) (103) (068) (103) (128) (099) (072) (117)
(11)
Back & neck Depression Diabetes Sense Other MSK Skin Anxiety Migraine Drugs Iron
USA (134) (239) (089) (186) (093) (157) (095) (302) (087)
(105)
Back & neck Depression Sense Other MSK Skin Anxiety Migraine Diabetes Asthma Drugs
Australasia (13) (084) (193) (093) (172) (117) (127) (159) (291)
(112)
Back & neck Depression Other MSK Sense Skin Migraine Anxiety Diabetes Drugs Asthma
Australia (133) (20) (084) (093) (121) (172) (122) (305) (158)
(112)
Back & neck Depression Sense Anxiety Skin Diabetes Other MSK Migraine Asthma Oral
New Zealand (114) (085) (177) (092) (151) (153) (10) (163) (109)
(115)
Back & neck Sense Depression Skin Diabetes Migraine Oral Other MSK Iron Falls
High-income Asia Pacific (104) (086) (098) (096) (089) (096) (092) (112) (089)
(084)
Back & neck Depression Skin Sense Diabetes Iron Migraine Falls Anxiety Asthma
Brunei (09) (093) (105) (239) (106) (084) (135) (085) (113)
(082)
Back & neck Sense Depression Skin Oral Diabetes Migraine Other MSK Alzheimer's Iron
Japan (105) (087) (10) (097) (083) (091) (105) (106)
(082) (093)
Back & neck Sense Depression Skin Migraine Iron Oral Other MSK Anxiety Falls
Singapore (101) (095) (093) (075) (105) (095) (085) (092)
(06) (083)
Back & neck Sense Depression Diabetes Skin Migraine Iron Other MSK Oral Falls
South Korea (102) (083) (137) (092) (083) (128) (094) (106)
(09) (09)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Other MSK Falls
Western Europe (094) (105) (117) (087) (128) (088) (099) (094) (104)
(127)
Back & neck Sense Depression Skin Migraine Oral Falls Anxiety Diabetes Iron
Andorra (091) (112) (088) (115) (113) (123) (124) (094) (082)
(141)
Back & neck Sense Depression Migraine Skin Oral Anxiety Diabetes Falls Other MSK
Austria (093) (107) (129) (088) (123) (122) (09) (119) (086)
(122)
Back & neck Sense Depression Skin Migraine Diabetes Oral Falls Anxiety Other MSK
Belgium (106) (101) (087) (114) (11) (117) (125) (117) (083)
(139)
Back & neck Sense Depression Migraine Skin Diabetes Anxiety Oral Asthma Other MSK
Cyprus (096) (107) (114) (088) (127) (122) (109) (124) (079)
(14)
Back & neck Sense Depression Skin Migraine Other MSK Diabetes Oral Anxiety Iron
Denmark (079) (11) (094) (109) (123) (112) (107) (125) (079)
(145)
Back & neck Sense Depression Skin Falls Migraine Diabetes Oral Asthma Iron
Finland (085) (123) (092) (158) (114) (106) (112) (135) (10)
(138)
Back & neck Sense Depression Skin Anxiety Migraine Falls Oral Other MSK Diabetes
France (092) (103) (086) (154) (104) (123) (10) (102) (069)
(115)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Falls Other MSK
Germany (098) (108) (123) (086) (147) (102) (105) (102) (082)
(148)
Back & neck Sense Depression Migraine Skin Oral Anxiety Diabetes Falls Alzheimer's
Greece (095) (121) (111) (083) (113) (119) (071) (086) (101)
(128)
Back & neck Sense Depression Migraine Skin Anxiety Oral Iron Diabetes Falls
Iceland (093) (089) (115) (079) (123) (118) (083) (081) (096)
(138)
Back & neck Sense Depression Skin Migraine Anxiety Iron Other MSK Oral Asthma
Ireland (092) (107) (091) (114) (158) (10) (109) (117) (136)
(125)
Back & neck Sense Depression Skin Migraine Iron Diabetes Oral Other MSK War
Israel (094) (11) (086) (114) (111) (12) (115) (095) (697772)
(12)
Back & neck Sense Depression Migraine Diabetes Skin Anxiety Other MSK Alzheimer's Falls
Italy (109) (106) (139) (101) (086) (124) (10) (122) (094)
(131)
Back & neck Sense Depression Migraine Skin Diabetes Oral Anxiety Falls Asthma
Luxembourg (092) (111) (128) (087) (13) (121) (123) (115) (142)
(142)
Back & neck Sense Depression Diabetes Migraine Skin Oral Anxiety Falls Asthma
Malta (089) (102) (102) (113) (09) (115) (118) (113) (112)
(131)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Other MSK Falls
Netherlands (09) (099) (121) (087) (159) (123) (132) (113) (094)
(15)
Back & neck Sense Depression Anxiety Skin Migraine Diabetes Oral Other MSK Falls
Norway (081) (103) (187) (085) (107) (122) (115) (087) (107)
(159)
Back & neck Sense Depression Migraine Skin Diabetes Oral Anxiety Other MSK Asthma
Portugal (083) (109) (113) (088) (078) (109) (113) (094) (118)
(134)
Back & neck Sense Depression Migraine Skin Diabetes Iron Falls Anxiety Oral
Spain (099) (109) (115) (086) (078) (125) (102) (101) (091)
(097)
Back & neck Sense Depression Diabetes Skin Migraine Anxiety Other MSK Oral Iron
Sweden (078) (105) (136) (09) (091) (122) (102) (09) (089)
(125)

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Back & neck Sense Depression Skin Migraine Oral Falls Anxiety Diabetes Other MSK
Switzerland
(148) (09) (108) (088) (108) (122) (141) (125) (089) (074)
Back & neck Sense Depression Skin Migraine Asthma Other MSK Anxiety Oral Iron
UK
(117) (079) (096) (088) (11) (186) (118) (107) (091) (092)
Back & neck Sense Depression Skin Migraine Other MSK Asthma Anxiety Oral Iron
England
(117) (079) (095) (087) (104) (122) (179) (108) (091) (095)
Back & neck Sense Depression Skin Migraine Asthma Falls Oral Anxiety Diabetes
Northern Ireland
(111) (073) (097) (088) (103) (141) (121) (091) (089) (063)
Back & neck Migraine Sense Depression Asthma Skin Diabetes Other MSK Falls Anxiety
Scotland
(123) (175) (079) (097) (235) (089) (107) (102) (121) (112)
Back & neck Sense Depression Asthma Skin Migraine Diabetes Other MSK Falls Anxiety
Wales
(115) (079) (107) (259) (09) (103) (095) (108) (107) (109)
Back & neck Depression Sense Skin Anxiety Migraine Iron Diabetes Other MSK Asthma
Southern Latin America
(088) (107) (084) (093) (153) (093) (102) (083) (107) (103)
Back & neck Depression Sense Skin Anxiety Iron Migraine Diabetes Other MSK Asthma
Argentina
(087) (107) (084) (092) (152) (112) (091) (082) (109) (101)
Back & neck Depression Sense Skin Anxiety Migraine Diabetes Other MSK Oral Asthma
Chile
(088) (11) (086) (096) (157) (095) (09) (105) (098) (108)
Back & neck Sense Depression Skin Anxiety Iron Migraine Diabetes Asthma Other MSK
Uruguay
(089) (08) (103) (093) (149) (109) (094) (06) (111) (092)
Central Europe, eastern Europe, Back & neck Sense Depression Skin Iron Migraine Diabetes Oral Anxiety Osteoarth
and central Asia (12) (116) (11) (089) (145) (099) (10) (099) (081) (129)
Back & neck Sense Depression Iron Skin Migraine Diabetes Oral Drugs Osteoarth
Eastern Europe (121) (125) (093) (096) (326) (133)
(117) (181) (089) (101)
Back & neck Sense Depression Skin Migraine Diabetes Iron Falls Oral Drugs
Belarus (119) (122) (113) (089) (284)
(118) (115) (102) (102) (097)
Back & neck Sense Depression Skin Migraine Diabetes Iron Oral Osteoarth Alcohol
Estonia (116) (116) (093) (528)
(108) (125) (088) (103) (105) (138)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Osteoarth Anxiety
Latvia (089)
(124) (122) (097) (132) (085) (103) (118) (135) (077)
Back & neck Sense Depression Skin Diabetes Migraine Iron Oral Osteoarth IHD
Lithuania
(123) (117) (116) (086) (108) (104) (118) (095) (132) (194)
Back & neck Sense Depression Skin Migraine Iron Diabetes Oral Anxiety Alcohol
Moldova
(12) (096) (10) (095) (102) (124) (067) (094) (07) (329)
Back & neck Sense Depression Iron Skin Migraine Diabetes Drugs Oral Alcohol
Russia
(12) (13) (114) (222) (088) (10) (095) (339) (098) (605)
Back & neck Sense Depression Skin Migraine Diabetes Oral Osteoarth Drugs IHD
Ukraine
(126) (117) (129) (089) (103) (086) (092) (124) (326) (176)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Central Europe
(129) (11) (106) (114) (09) (098) (101) (093) (129) (091)
Back & neck Sense Depression Skin Iron Migraine Anxiety Oral Diabetes Osteoarth
Albania
(137) (094) (098) (083) (125) (098) (088) (098) (051) (091)
Back & neck Sense Depression Diabetes Skin Migraine War Oral Iron Anxiety
Bosnia
(116) (098) (098) (101) (09) (098) (188724) (106) (101) (088)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Bulgaria
(128) (104) (106) (118) (09) (098) (101) (096) (121) (112)
Back & neck Sense Depression Skin Diabetes Migraine Oral Iron Osteoarth Anxiety
Croatia
(137) (097) (104) (09) (083) (097) (107) (11) (12) (092)
Back & neck Sense Depression Diabetes Skin Migraine Oral Iron Anxiety Osteoarth
Czech Republic
(138) (109) (113) (146) (088) (098) (104) (105) (096) (143)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Hungary
(138) (105) (107) (162) (096) (098) (094) (095) (135) (085)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Macedonia
(126) (099) (101) (114) (089) (098) (097) (089) (121) (058)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Osteoarth
Montenegro
(127) (104) (104) (115) (091) (098) (112) (098) (091) (126)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth IHD
Poland
(121) (127) (107) (125) (088) (097) (103) (095) (134) (209)
Back & neck Sense Depression Skin Migraine Diabetes Oral Iron Osteoarth Anxiety
Romania
(133) (103) (104) (09) (098) (075) (104) (118) (128) (089)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Serbia
(131) (10) (102) (122) (092) (098) (098) (091) (123) (08)
Back & neck Sense Depression Skin Diabetes Migraine Iron Anxiety Oral Osteoarth
Slovakia
(134) (106) (108) (089) (125) (097) (109) (094) (085) (135)
Back & neck Sense Depression Skin Diabetes Migraine Oral Iron Osteoarth Anxiety
Slovenia
(135) (099) (109) (09) (107) (098) (116) (118) (135) (095)
Back & neck Sense Depression Iron Skin Migraine Diabetes Anxiety Oral Asthma
Central Asia
(101) (098) (097) (136) (087) (098) (098) (08) (106) (069)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Disaster
Armenia
(10) (103) (101) (14) (087) (097) (111) (106) (081) (13888)
Back & neck Sense Depression Iron Skin Diabetes Migraine Anxiety Oral Osteoarth
Azerbaijan
(098) (108) (102) (155) (088) (136) (096) (082) (103) (126)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Osteoarth
Georgia
(093) (105) (101) (119) (085) (098) (125) (102) (082) (121)

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Kazakhstan
(104) (24) (11) (103) (09) (096) (117) (114) (082) (131)
Back & neck Iron Depression Sense Skin Migraine Anxiety Diabetes Oral Asthma
Kyrgyzstan
(104) (13) (091) (085) (086) (10) (076) (052) (105) (069)
Back & neck Depression Sense Skin Iron Migraine Diabetes Anxiety Oral Falls
Mongolia
(098) (094) (094) (087) (097) (098) (079) (078) (102) (137)
Back & neck Iron Depression Sense Skin Migraine Anxiety Diabetes Oral Epilepsy
Tajikistan
(106) (103) (087) (08) (085) (10) (078) (066) (106) (154)
Back & neck Depression Sense Iron Skin Migraine Diabetes Anxiety Oral Asthma
Turkmenistan
(094) (10) (106) (131) (088) (096) (133) (082) (102) (065)
Back & neck Depression Sense Iron Skin Migraine Diabetes Anxiety Oral Asthma
Uzbekistan
(10) (094) (093) (108) (087) (098) (084) (078) (103) (079)
Back & neck Sense Depression Skin Anxiety Iron Diabetes Migraine Asthma Other MSK
Latin America and Caribbean
(087) (106) (108) (099) (152) (102) (112) (10) (118) (101)
Back & neck Sense Depression Diabetes Skin Iron Migraine Anxiety Other MSK Oral
Central Latin America
(086) (112) (094) (144) (095) (093) (09) (101) (089) (108)
Back & neck Sense Depression Skin Anxiety Migraine Diabetes Asthma Other MSK Oral
Colombia
(094) (114) (102) (102) (135) (089) (081) (123) (093) (107)
Back & neck Sense Depression Skin Iron Migraine Anxiety Diabetes Asthma Other MSK
Costa Rica
(089) (116) (101) (091) (101) (088) (108) (072) (118) (098)
Back & neck Sense Iron Depression Skin Diabetes Migraine Anxiety Asthma Oral
El Salvador
(094) (096) (159) (09) (094) (094) (091) (103) (124) (107)
Back & neck Iron Sense Skin Depression Diabetes Migraine Anxiety Asthma Oral
Guatemala
(096) (106) (094) (096) (085) (167) (09) (105) (102) (118)
Honduras Back & neck Sense Skin Depression Iron Asthma Migraine Anxiety Diabetes Oral
(098) (095) (106) (088) (079) (154) (091) (105) (089) (107)
Mexico Back & neck Sense Diabetes Depression Skin Migraine Anxiety Other MSK Oral Iron
(079) (117) (19) (091) (091) (091) (085) (094) (108) (05)
Nicaragua Back & neck Sense Depression Skin Iron Migraine Anxiety Diabetes Asthma Oral
(096) (095) (087) (096) (082) (091) (105) (085) (096) (108)
Panama Back & neck Sense Depression Skin Diabetes Iron Migraine Asthma Anxiety Oral
(091) (119) (099) (095) (135) (12) (088) (137) (109) (103)
Venezuela Iron Back & neck Sense Depression Skin Diabetes Migraine Anxiety Asthma Other MSK
(306) (09) (112) (096) (098) (117) (086) (106) (101) (09)
Andean Latin America Back & neck Sense Depression Iron Skin Anxiety Migraine Diabetes Asthma Oral
(093) (107) (109) (134) (102) (137) (10) (076) (11) (109)
Bolivia Back & neck Iron Sense Depression Skin Anxiety Migraine Diabetes Asthma Oral
(10) (152) (097) (103) (102) (133) (099) (073) (111) (112)
Ecuador Back & neck Sense Depression Iron Skin Diabetes Anxiety Migraine Oral Asthma
(091) (102) (108) (133) (099) (115) (137) (087) (109) (086)
Peru Back & neck Sense Depression Skin Iron Migraine Anxiety Asthma Oral Diabetes
(092) (114) (111) (103) (129) (107) (138) (122) (109) (057)
Caribbean Back & neck Sense Depression Iron Skin Diabetes Anxiety Migraine Asthma Other MSK
(089) (106) (111) (12) (109) (124) (149) (10) (162) (105)
Antigua Back & neck Depression Sense Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(082) (12) (121) (22) (105) (143) (149) (094) (137) (131)
Bahamas Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(082) (119) (118) (194) (105) (154) (149) (094) (147) (138)
Barbados Back & neck Sense Diabetes Depression Skin Other MSK Iron Anxiety Migraine Asthma
(081) (107) (205) (115) (096) (157) (149) (146) (094) (126)
Belize Back & neck Depression Iron Skin Sense Anxiety Diabetes Migraine Asthma Other MSK
(084) (104) (119) (105) (092) (135) (114) (097) (158) (113)
Bermuda Back & neck Depression Sense Skin Iron Anxiety Diabetes Migraine Other MSK Asthma
(089) (125) (119) (102) (132) (153) (187) (096) (141) (146)
Cuba Back & neck Sense Depression Skin Diabetes Anxiety Iron Migraine Other MSK Asthma
(082) (111) (114) (108) (091) (146) (136) (095) (111) (131)
Dominica Back & neck Diabetes Sense Depression Skin Iron Anxiety Migraine Asthma Other MSK
(083) (212) (107) (112) (105) (129) (141) (095) (152) (125)
Dominican Republic Back & neck Sense Depression Skin Iron Anxiety Migraine Asthma Diabetes Other MSK
(082) (098) (107) (105) (119) (137) (097) (15) (071) (091)
Grenada Back & neck Depression Sense Iron Skin Diabetes Other MSK Anxiety Migraine Asthma
(08) (111) (106) (152) (105) (178) (173) (141) (094) (143)
Guyana Back & neck Iron Depression Sense Diabetes Skin Anxiety Migraine Asthma Other MSK
(084) (141) (102) (091) (136) (104) (133) (097) (158) (085)
Haiti Iron Back & neck Depression Disaster Skin Sense Asthma Anxiety Migraine Diabetes
(101) (096) (089) (122789) (102) (08) (197) (145) (10) (138)
Jamaica Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(083) (10) (11) (143) (105) (125) (138) (095) (139) (148)
Puerto Rico Back & neck Sense Diabetes Depression Skin Anxiety Iron Other MSK Migraine Asthma
(088) (12) (237) (123) (102) (153) (138) (13) (095) (141)
Saint Lucia Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Asthma Other MSK
(083) (105) (111) (148) (105) (126) (141) (095) (152) (125)
Saint Vincent and the Grenadines Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Asthma Other MSK
(082) (105) (11) (184) (105) (123) (141) (095) (145) (121)

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Back & neck Sense Depression Skin Iron Diabetes Anxiety Migraine Asthma Other MSK
Suriname (082) (098) (105) (125) (121) (138) (096) (153) (119)
(107)
Back & neck Diabetes Sense Depression Skin Iron Anxiety Other MSK Migraine Asthma
Trinidad and Tobago (081) (311) (111) (15) (149) (158)
(117) (118) (144) (094)
Back & neck Sense Diabetes Depression Skin Other MSK Iron Anxiety Migraine Asthma
Virgin Islands, USA (089) (138) (146)
(119) (214) (124) (102) (144) (154) (096)
Back & neck Depression Sense Anxiety Skin Migraine Iron Diabetes Other MSK Asthma
Tropical Latin America
(087) (123) (099) (214) (10) (112) (10) (086) (121) (141)
Back & neck Depression Sense Anxiety Skin Migraine Iron Diabetes Other MSK Asthma
Brazil
(086) (123) (099) (215) (10) (112) (10) (086) (122) (143)
Back & neck Depression Sense Skin Anxiety Iron Migraine Diabetes Other MSK Asthma
Paraguay
(097) (124) (097) (114) (181) (106) (106) (092) (09) (101)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Migraine Schiz Anxiety
Southeast Asia, east Asia, and Oceania
(086) (094) (074) (10) (076) (122) (08) (065) (131) (072)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Schiz Migraine Anxiety
East Asia
(089) (091) (073) (096) (064) (11) (079) (138) (057) (071)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Schiz Migraine Anxiety
China
(088) (091) (074) (096) (062) (109) (079) (139) (057) (07)
Back & neck Sense Skin Iron Depression Other MSK Diabetes COPD Anxiety Migraine
North Korea
(105) (077) (093) (092) (061) (115) (059) (21) (083) (059)
Back & neck Sense Diabetes Other MSK Depression Skin Anxiety Iron Migraine Osteoarth
Taiwan (province of China)
(099) (108) (229) (159) (073) (089) (103) (105) (063) (144)
Back & neck Sense Skin Depression Diabetes Other MSK Iron Migraine Anxiety Asthma
Southeast Asia
(081) (101) (106) (076) (11) (153) (081) (083) (075) (102)
Back & neck Iron Sense Skin Depression Migraine Other MSK Asthma Anxiety Diabetes
Cambodia
(094) (094) (095) (105) (067) (082) (111) (114) (081) (082)
Back & neck Sense Skin Diabetes Depression Other MSK Iron Migraine Anxiety Asthma
Indonesia
(076) (099) (105) (117) (077) (167) (094) (083) (077) (093)
Back & neck Skin Iron Sense Depression Diabetes Other MSK Migraine Asthma Anxiety
Laos
(09) (105) (07) (084) (068) (136) (127) (082) (128) (08)
Back & neck Sense Skin Depression Diabetes Other MSK Nematode Anxiety Migraine Schiz
Malaysia
(075) (10) (105) (084) (151) (182) (440593) (12) (079) (118)
Back & neck Sense Iron Skin Depression Migraine Other MSK Anxiety Haemog Diabetes
Maldives
(082) (098) (135) (108) (075) (084) (117) (076) (361) (056)
Back & neck Diabetes Sense Depression Skin Other MSK Migraine Anxiety Asthma Oral
Mauritius
(082) (204) (115) (084) (107) (177) (082) (08) (103) (084)
Sense Back & neck Skin Depression Diabetes Iron Other MSK Migraine Asthma Anxiety
Myanmar
(113) (079) (104) (069) (123) (069) (138) (082) (108) (079)
Philippines Back & neck Sense Skin Diabetes Iron Depression Other MSK Migraine Asthma Anxiety
(095) (105) (107) (149) (092) (075) (169) (082) (129) (077)
Sri Lanka Back & neck Sense Diabetes Skin Depression Iron Migraine Asthma Anxiety Other MSK
(081) (114) (144) (106) (081) (104) (082) (114) (079) (086)
Seychelles Back & neck Sense Skin Depression Diabetes Migraine Other MSK Anxiety Asthma Schiz
(079) (118) (107) (084) (134) (082) (115) (081) (091) (115)
Thailand Back & neck Sense Depression Skin Other MSK Diabetes Migraine Iron Anxiety Asthma
(073) (104) (082) (106) (163) (083) (084) (082) (079) (108)
Timor-Leste Back & neck Sense Iron Skin Depression Migraine Asthma Other MSK Diabetes Anxiety
(087) (097) (066) (107) (07) (082) (115) (103) (105) (084)
Vietnam Back & neck Sense Skin Depression Migraine Other MSK Diabetes Schiz Other nutr Asthma
(085) (092) (107) (077) (085) (118) (06) (12) (7236) (086)
Oceania Back & neck Iron Skin Diabetes Sense Depression Asthma Other MSK Nematode Migraine
(101) (098) (136) (269) (096) (07) (176) (158) (375) (077)
American Samoa Back & neck Diabetes Skin Sense Iron Depression Other MSK Asthma Migraine Anxiety
(09) (278) (134) (103) (091) (077) (187) (131) (072) (083)
Micronesia Back & neck Skin Diabetes Sense Depression Other MSK Asthma Iron Migraine Anxiety
(091) (131) (168) (091) (072) (165) (145) (066) (073) (082)
Fiji Diabetes Back & neck Skin Sense Iron Depression Asthma Other MSK Nematode Migraine
(307) (084) (127) (103) (11) (075) (164) (145) (5808) (072)
Guam Back & neck Diabetes Sense Skin Other MSK Depression Iron Asthma Other NTD Migraine
(094) (317) (127) (124) (196) (089) (097) (147) (234 96429) (072)
Kiribati Back & neck Diabetes Nematode Skin Sense Iron Depression Asthma Migraine Other MSK
(093) (307) (702) (127) (081) (054) (065) (168) (072) (103)
Marshall Diabetes Back & neck Skin Iron Sense Nematode Depression Other MSK Asthma Migraine
(331) (088) (129) (123) (087) (721) (069) (17) (141) (072)
Northern Mariana Islands Back & neck Skin Diabetes Depression Sense Other MSK Iron Migraine Anxiety Asthma
(086) (125) (33) (082) (128) (161) (108) (071) (085) (116)
Papua New Guinea Iron Back & neck Skin Sense Diabetes Depression Asthma Nematode Other MSK LF
(097) (095) (129) (084) (235) (063) (17) (334) (143) (10035)
Samoa Back & neck Skin Sense Diabetes Iron Depression Other MSK Asthma Migraine Anxiety
(09) (133) (092) (15) (084) (074) (16) (116) (073) (082)
Solomon Islands Back & neck Skin Diabetes Sense Iron Depression Other MSK Asthma Migraine Anxiety
(095) (125) (269) (081) (053) (065) (156) (145) (073) (088)
Tonga Back & neck Skin Diabetes Sense Iron Depression Other MSK Asthma Migraine Osteoarth
(092) (134) (149) (083) (097) (073) (169) (168) (073) (201)

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Back & neck Skin Diabetes Sense Depression Other MSK Asthma Migraine Nematode Anxiety
Vanuatu (091) (131) (179) (082) (067) (155) (145) (073) (291) (083)
Back & neck Depression Sense Diabetes Iron Skin Migraine Other MSK Anxiety Asthma
North Africa and Middle East (107) (093) (086) (162) (082) (084) (134) (106) (094)
(107)
Back & neck Depression Sense Diabetes Iron Skin Migraine Other MSK Anxiety Asthma
North Africa and Middle East (107) (093) (086) (162) (082) (084) (134) (106) (094)
(107)
Iron Back & neck War Skin Depression Sense Diabetes Other unint Migraine Anxiety
Afghanistan (08) (115) (16345) (084) (08) (528) (118) (123)
(073) (272)
Back & neck Diabetes Depression Sense Skin Migraine Other MSK Iron Anxiety Asthma
Algeria (104) (095) (104) (10)
(147) (082) (083) (108) (152) (07)
Back & neck Diabetes Depression Sense Other MSK Skin Migraine Iron Anxiety Drugs
Bahrain
(095) (29) (111) (102) (196) (09) (107) (143) (107) (178)
Back & neck Iron Diabetes Sense Depression Skin Migraine Other MSK Anxiety Asthma
Egypt
(108) (153) (15) (093) (077) (084) (107) (119) (10) (096)
Back & neck Depression Sense Diabetes Migraine Skin Other MSK Anxiety Drugs Other cardio
Iran
(103) (105) (094) (148) (098) (08) (144) (107) (341) (621)
Back & neck Diabetes Depression War Sense Skin Iron Migraine Anxiety Other MSK
Iraq
(108) (219) (093) (39543) (079) (075) (065) (106) (114) (092)
Back & neck Depression Diabetes Skin Iron Sense Migraine Other MSK Anxiety Asthma
Jordan
(10) (101) (199) (092) (097) (092) (105) (169) (107) (103)
Back & neck Depression Migraine Skin Diabetes Sense Iron Anxiety Other MSK Asthma
Kuwait
(088) (118) (106) (089) (246) (109) (118) (112) (132) (101)
War Back & neck Diabetes Depression Sense Skin Iron Migraine Anxiety Asthma
Lebanon
(10 68982) (083) (20) (102) (09) (093) (135) (103) (127) (114)
Back & neck Depression Diabetes Sense Skin Migraine War Iron Anxiety Other MSK
Libya
(104) (10) (13) (081) (087) (107) (46477) (072) (104) (119)
Back & neck Diabetes Sense Depression Skin Migraine Iron Other MSK Anxiety Drugs
Morocco
(114) (221) (079) (088) (092) (105) (056) (136) (109) (401)
Back & neck Depression Skin Sense Iron Migraine Anxiety Diabetes War Other MSK
Palestine
(106) (129) (083) (072) (059) (107) (107) (114) (19872) (108)
Back & neck Depression Diabetes Other Cardio Sense Migraine Skin Iron Other MSK Anxiety
Oman
(095) (107) (242) (192) (101) (11) (085) (115) (143) (105)
Back & neck Depression Diabetes Migraine Skin Sense Anxiety Other MSK Iron Heat & cold
Qatar
(094) (115) (312) (112) (094) (096) (105) (126) (114) (1726)
Back & neck Depression Migraine Skin Sense Diabetes Anxiety Other MSK Iron Asthma
Saudi Arabia
(099) (111) (127) (093) (101) (151) (108) (133) (052) (08)
Back & neck Iron Depression Skin Sense Migraine Diabetes Anxiety Asthma Other MSK
Sudan
(107) (081) (084) (084) (075) (108) (19) (115) (118) (116)
War Back & neck Depression Sense Skin Iron Migraine Diabetes Anxiety Asthma
Syria
(161215) (105) (094) (078) (08) (073) (107) (107) (106) (099)
Back & neck Diabetes Depression Sense Skin Other MSK Migraine Anxiety Iron Asthma
Tunisia
(102) (135) (10) (082) (089) (158) (102) (104) (066) (105)
Back & neck Sense Depression Diabetes Other MSK Skin Migraine Iron Anxiety Oral
Turkey
(113) (085) (092) (13) (167) (083) (101) (093) (092) (118)
Back & neck Depression Diabetes Other MSK Migraine Sense Skin Drugs Anxiety Iron
United Arab Emirates
(099) (118) (352) (192) (114) (115) (091) (216) (104) (121)
Back & neck War Depression Skin Sense Iron Migraine Diabetes Anxiety Other MSK
Yemen
(111) (24822) (084) (084) (077) (044) (111) (176) (117) (134)
Iron Back & neck Sense Depression Other MSK Skin Migraine Diabetes Anxiety COPD
South Asia
(137) (091) (111) (092) (196) (089) (119) (09) (08) (177)
Iron Back & neck Sense Depression Other MSK Skin Migraine Diabetes Anxiety COPD
South Asia
(137) (091) (111) (092) (196) (089) (119) (09) (08) (177)
Back & neck Other MSK Sense Depression Iron Skin Migraine Anxiety Diabetes Epilepsy
Bangladesh
(106) (27) (095) (082) (067) (094) (12) (111) (10) (297)
Back & neck Iron Sense Depression Skin Other MSK Migraine Diabetes Diarrhoea Anxiety
Bhutan
(105) (148) (098) (083) (095) (184) (119) (117) (333) (088)
Iron Back & neck Sense Depression Other MSK Migraine Skin Diabetes Anxiety COPD
India
(158) (089) (116) (094) (193) (12) (086) (083) (074) (201)
Back & neck Sense Skin Migraine Other MSK Iron Depression Disaster Anxiety Asthma
Nepal
(113) (089) (097) (133) (193) (048) (063) (66196) (094) (107)
Iron Back & neck Sense Depression Skin Migraine Other MSK Diabetes Anxiety Asthma
Pakistan
(102) (087) (093) (09) (10) (113) (156) (147) (092) (091)
Iron Back & neck Depression Sense Skin Other NTD Migraine HIV Asthma Malaria
Sub-Saharan Africa
(079) (098) (104) (102) (093) (124) (08) (474) (098) (225)
HIV Back & neck Depression Sense Skin Iron Diabetes Migraine Asthma Anxiety
Southern sub-Saharan Africa
(11159) (103) (105) (106) (095) (096) (154) (078) (129) (079)
HIV Back & neck Iron Depression Sense Skin Diabetes Asthma Migraine TB
Botswana
(14061) (098) (151) (109) (098) (095) (133) (149) (077) (1589)
HIV Back & neck Depression Sense Skin Iron Diabetes Asthma Migraine Anxiety
Lesotho
(7348) (108) (114) (091) (093) (064) (163) (168) (077) (078)
HIV Back & neck Iron Depression Sense Skin Diabetes Asthma Migraine Anxiety
Namibia
(7797) (099) (128) (109) (095) (096) (107) (142) (078) (076)
HIV Back & neck Sense Depression Diabetes Skin Iron Migraine Asthma Anxiety
South Africa
(16551) (104) (112) (104) (165) (095) (101) (078) (127) (081)

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HIV Back & neck Depression Skin Sense Iron Diabetes Asthma Nematode Migraine
Swaziland
(17235) (094) (109) (095) (097) (092) (151) (195) (573) (077)
HIV Back & neck Iron Depression Skin Sense Asthma Migraine Diabetes Anxiety
Zimbabwe
(4619) (104) (082) (104) (094) (088) (118) (078) (112) (075)
Iron Back & neck Depression Sense Skin Malaria Migraine Schisto Anxiety Asthma
Western sub-Saharan Africa
(099) (111) (099) (098) (085) (339) (079) (1095) (082) (082)
Iron Back & neck Depression Sense Skin Malaria Migraine Anxiety Asthma Schisto
Benin
(076) (108) (094) (091) (091) (586) (085) (083) (081) (4381)
Iron Back & neck Depression Skin Sense Malaria Migraine Haemog Anxiety Diarrhoea
Burkina Faso
(073) (108) (091) (092) (087) (156) (09) (172) (09) (081)
Back & neck Depression Iron Skin Sense Oncho HIV Malaria Migraine Anxiety
Cameroon
(105) (099) (057) (092) (093) (654 33273) (944) (4565) (077) (078)
Back & neck Depression Iron Sense Skin Migraine Diabetes Other cardio Anxiety Asthma
Cape Verde
(101) (105) (108) (098) (093) (076) (083) (952) (073) (076)
Iron Back & neck Skin Depression Sense Migraine Diarrhoea Asthma Anxiety Heat & cold
Chad
(131) (118) (091) (092) (092) (086) (10) (085) (087) (425)
Iron Back & neck Skin Sense Depression Malaria Migraine HIV Asthma Anxiety
Cte dIvoire
(075) (106) (108) (097) (094) (1532) (08) (45) (091) (081)
Iron Back & neck Depression Skin Sense Malaria Migraine Anxiety Diarrhoea Asthma
The Gambia
(073) (108) (101) (091) (084) (343) (084) (085) (094) (074)
Back & neck Iron Depression Sense Skin Malaria Migraine Schisto Anxiety Diabetes
Ghana
(092) (087) (10) (099) (069) (15078) (076) (662712) (075) (066)
Back & neck Iron Skin Sense Depression Malaria Schisto Migraine Asthma Anxiety
Guinea
(11) (068) (106) (093) (092) (214) (1379) (087) (095) (086)
Iron Back & neck Depression Sense Skin Migraine Malaria HIV Schisto Asthma
Guinea-Bissau
(077) (111) (092) (092) (091) (085) (177) (278) (1556) (09)
Oncho Back & neck Iron Sense Skin Depression Schisto Malaria Migraine Anxiety
Liberia
(92 16185) (11) (073) (091) (091) (082) (1867) (185) (085) (085)
Iron Back & neck Sense Depression Skin Malaria Migraine Anxiety Heat & cold Diarrhoea
Mali
(111) (093) (094) (092) (083) (111) (09) (09) (329) (066)
Iron Back & neck Sense Depression Skin Migraine Asthma Anxiety Heat & cold Schisto
Mauritania
(124) (107) (106) (096) (091) (079) (094) (08) (599) (23773)
Iron Back & neck Sense Skin Depression Migraine Heat & cold Malaria Diarrhoea Anxiety
Niger
(078) (116) (094) (094) (092) (098) (39) (032) (077) (097)
Iron Back & neck Depression Sense Skin Schisto Malaria Migraine Anxiety Asthma
Nigeria
(118) (118) (105) (103) (078) (292668) (5871) (073) (08) (086)
Back & neck Iron Depression Sense Skin Other NTD Migraine Malaria Asthma Anxiety
So Tom and Prncipe
(104) (065) (099) (097) (092) (254) (078) (243) (088) (079)
Iron Back & neck Depression Sense Skin Migraine Anxiety Diarrhoea Asthma Diabetes
Senegal
(104) (098) (095) (093) (091) (083) (084) (096) (072) (101)
Back & neck Iron Depression Skin Sense Malaria Migraine Oncho Asthma Anxiety
Sierra Leone
(108) (059) (093) (091) (087) (516) (084) (46 36269) (086) (084)
Back & neck Iron Depression Skin Sense Malaria Migraine Asthma Anxiety Diarrhoea
Togo
(11) (071) (095) (097) (094) (885) (082) (093) (082) (104)
Depression Iron Sense Skin Back & neck Migraine Other NTD Anxiety HIV Asthma
Eastern sub-Saharan Africa
(111) (062) (099) (095) (078) (079) (088) (094) (382) (094)
Depression Back & neck Skin Sense Iron Migraine Asthma Diarrhoea Anxiety Malaria
Burundi
(105) (085) (092) (09) (026) (088) (10) (099) (10) (079)
Sense Depression Back & neck Iron Skin Malaria Migraine Asthma Anxiety Diabetes
Comoros
(109) (106) (086) (06) (091) (76) (08) (106) (092) (111)
Iron Depression Sense Back & neck Skin Other NTD Heat & cold Migraine Diabetes Anxiety
Djibouti
(088) (112) (102) (073) (091) (276) (943) (075) (116) (087)
Eritrea Iron Depression Sense Skin Back & neck War Schisto Migraine Asthma Anxiety
(089) (106) (10) (091) (07) (10299) (4257) (081) (097) (094)
Ethiopia Depression Sense Skin Back & neck Iron Schisto Anxiety Migraine Other NTD Asthma
(113) (10) (102) (08) (032) (2664) (10) (076) (066) (079)
Kenya Iron Other NTD Depression Sense Skin Back & neck HIV Migraine Anxiety Schisto
(105) (438) (113) (109) (101) (081) (968) (08) (087) (1762)
Madagascar Iron Sense Depression Back & neck Skin Asthma Schisto Migraine Anxiety Diarrhoea
(07) (114) (109) (083) (09) (128) (14577) (079) (092) (107)
Malawi Depression Iron Back & neck Sense Skin HIV Malaria Migraine Anxiety Asthma
(105) (053) (085) (093) (091) (757) (262) (083) (096) (09)
Mozambique Iron Depression Sense HIV Back & neck Skin Malaria Migraine Asthma Anxiety
(071) (104) (099) (743) (083) (089) (188) (084) (096) (097)
Rwanda Back & neck Sense Depression Iron War Skin Asthma Migraine Anxiety Other NTD
(08) (094) (088) (05) (19809) (077) (125) (079) (092) (082)
Somalia Iron Depression Sense Skin Back & neck Schisto Iodine Asthma Migraine Other NTD
(123) (103) (099) (093) (081) (165) (35) (103) (093) (084)
South Sudan Iron Depression Sense Oncho Back & neck Skin Schisto Heat & cold Asthma Migraine
(081) (105) (102) (45 41575) (081) (091) (1122) (589) (11) (084)
Tanzania Iron Depression Skin Sense Back & neck Migraine Asthma Anxiety HIV Malaria
(085) (108) (093) (086) (065) (072) (097) (09) (538) (1232)
Uganda Depression Skin Sense Iron Back & neck Malaria HIV Asthma Migraine Anxiety
(131) (091) (096) (045) (079) (975) (686) (101) (079) (089)

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Depression HIV Skin Sense Iron Back & neck Migraine Schisto Asthma Anxiety
Zambia
(111) (2066) (091) (096) (052) (077) (088) (198448) (093) (088)
Other NTD Iron Back & neck Sense Skin Depression Oncho Asthma Malaria Migraine
Central sub-Saharan Africa
(436) (07) (11) (122) (111) (097) (31 76728) (144) (143) (087)
Other NTD Skin Sense Back & neck Depression Iron Asthma Schisto Malaria Migraine
Angola
(405) (113) (125) (10) (10) (038) (159) (56716) (1561) (08)
Iron Back & neck Sense Skin Depression Oncho Asthma Other NTD HIV Migraine
Central African Republic
(084) (112) (117) (11) (095) (37 52786) (146) (095) (34) (087)
Iron Sense Back & neck Skin Other NTD Depression Asthma Diabetes Schisto Migraine
Congo (Brazzaville)
(103) (127) (10) (116) (585) (104) (125) (12) (10 90969) (077)
Other NTD Iron Back & neck Sense Skin Oncho Depression Asthma Malaria Migraine
DR Congo
(456) (076) (115) (121) (11) (31 56222) (096) (14) (111) (09)
Back & neck Sense Skin Depression Diabetes Iron Asthma Malaria Migraine HIV
Equatorial Guinea
(095) (123) (114) (111) (122) (075) (172) (668341) (078) (2187)
Other NTD Iron Sense Back & neck Depression Skin Schisto Diabetes Asthma Migraine
Gabon
(2482) (158) (131) (094) (113) (11) (55 30855) (114) (162) (077)

Colour key
00081 081088 088094 094099 099105
105113 113126 126158 158

Figure 7: Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI
in 2015, by location
Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimers=Alzheimers disease and
other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias.
Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deciency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders.
Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deciencies. Other unint=other
unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.

malaria prevalence and incidence become available for all than WHO (120%). Our list of countries with high burden
malaria-endemic countries outside of Africa. of tuberculosis is consistent with that of WHO, with a few
exceptions. Afghanistan and Cambodia are lower in our
Tuberculosis estimates, and surpassed by Ukraine and Angola.
We added new data from tuberculosis prevalence surveys
done in Indonesia, Ghana, and several subnational Cardiovascular diseases
locations in India. Our analysis of tuberculosis relied on Ageing and population growth have led to a growing
prevalence surveys, case notications and cause-specic number of people living with atherosclerotic vascular
mortality estimates. We used the expert judgment values disease worldwide, despite the decrease in incident
for the case-detection rates (CDRs) from WHO as an initial myocardial infarction and ischaemic stroke in high-
guide of how much notications need to be increased to income regions. Rising levels of obesity and diabetes in
reect incidence of all tuberculosis, but relied on many countries makes this an area of major concern for
DisMod-MR 2.1 to nd an estimate that is consistent with global health. Increased attention will need to be directed
available prevalence and cause-specic mortality rates. We toward this highly treatable set of disorders. Health
found that, particularly in older age groups, our estimated systems will need to improve the delivery of cost-eective
CDR often falls below the all-age CDR of WHO. In treatments such as blood pressure and cholesterol-
GBD 2013, we used a relative risk approach to predict the lowering drugs while eorts continue to focus on
proportion of HIV-infected individuals with tuberculosis. decreasing tobacco smoking, improving diet, and
In GBD 2015, we improved our modelling strategy by increasing physical activity. Investments in universal
making use of more abundantly available data on the primary care and public health campaigns need to be
proportions of HIV infected cases among all tuberculosis balanced against the need to improve access to emergency
cases from the WHO case notications to separate out care, including the strengthening of pre-hospital systems
combined HIV and tuberculosis from all forms of and expanded access to revascularisation treatments.
tuberculosis. In our modelling of tuberculosis, we have not
separately estimated the incidence and prevalence related Cancer
to multidrug-resistant tuberculosis. Given the policy The International Agency for Research on Cancer last
interest in multidrug-resistant tuberculosis, we plan to produced cancer estimates by country, age, sex, and
include estimates for multidrug-resistant tuberculosis in cancer site for 2012 for the GLOBOCAN project.60 The
future rounds of the GBD. Our global tuberculosis (all- total estimated cancer incidence from GLOBOCAN for
forms) incidence estimate (102 million [92115 million] 2012 was 141 million individuals. By comparison, GBD
cases in 2015) is slightly higher than that of WHO 2015 estimated 186 million (180194 million) new
(96 million cases in 2014), and we estimate a slightly cases of cancer in 2015, which includes cases of non-
larger fraction of combined HIV and tuberculosis (130%) melanoma skin cancer. GLOBOCAN used nine dierent

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methods to estimate incidence, which precludes the Emerging infectious diseases


calculation of uncertainty for those estimates. The GBD Emerging and re-emerging infectious diseases pose a
relies on the strength of the mortality estimates and persistent yet dynamic challenge to global health63 and to
transformation of the mortality estimates to incidence, the GBD study. GBD 2015 has included Ebola virus
taking into account uncertainty associated with both the disease in response to the devastating outbreak in west
mortality estimates and with the mortality to incidence Africa starting in 2013,64 whereas we have not captured the
ratios. Until high-quality cancer incidence is available in recent expansions of chikungunya65 and Zika virus across
all countries, the GBD approach, which maximises the the Americas,66 for instance. Quantifying the eect of
amount of data used to determine incidence estimates, is newly emerging epidemic diseases is dicult because the
highly benecial. formal reporting of the disease events might considerably
lag the rst presentation of cases. As a result, contemporary
Vision loss events such as the substantial deviation from baseline
Globally, 343 million (307380 million) people are levels in reported congenital abnormalities in Brazil in
blind, an additional 243 million (216276 million) 2015,67 now established to be associated with Zika virus,68
have severe vision impairment, 214 million will need to be incorporated into GBD 2016.
(193237 million) have moderate vision impairment, and
663 million (638690 million) have near vision Advances in data and analysis
impairment in 2015. Combined, vision loss accounts for DisMod-MR
245 million (170345 million) YLDs and is the third For GBD 2015, we improved the estimation for subnational
largest impairment after anaemia (779 million units in DisMod-MR 2.1 compared to GBD 2013 and made
[5241114 million] YLDs) and hearing loss (462 million substantive eorts to standardise the modelling approach
[316632 million] YLDs). YLDs from vision loss are across diseases. Three changes had an important eect on
slightly lower than those for anxiety disorders, our estimates. First, the cascade was implemented such
which rank ninth worldwide. Largely due to ageing, that national estimates were used to inform subnational
substantial increases occurred from 2005 to 2015 in the estimation (in GBD 2013, each subnational unit was
number of people with blindness (increasing by treated as a country within a GBD region). Second,
233% [219246%]), severe visual impairment wherever possible, we improved the linkage in the
(243% [224260%]), moderate visual impairment estimation between cause-specic mortality and disease
(220% [201237%]), and near vision impairment incidence and prevalence by the systematic inclusion of
(225% [209240%]). Most causes of vision loss can be estimated excess mortality data to provide more
prevented or cured using cost-eective interventions.61,62 informative priors for each location in the geographical
hierarchy. Third, in GBD 2010, and to a lesser degree in
Chronic kidney disease GBD 2013, many DisMod-MR models did not include
Compared with our GBD 2013 estimates, we estimated xed eects of country covariates for incidence or
global prevalence of chronic kidney disease to be lower prevalence. Spatial heterogeneity was largely estimated
by a third. Data for chronic kidney disease at younger from the random eects. For GBD 2015, we systematically
ages are sparse. We increased the number of datapoints tested the inclusion of more xed eects in DisMod-MR 2.1
below the age of 30 years from 20 to 51, and that led to models including, where appropriate, variables related to
considerably lower prevalence estimates for these ages. the risk factor exposures we estimate for each disease.
We have used dierent strategies for estimating deaths
versus YLDs secondary to chronic kidney disease due to Disability weights
other causes. In our cause of death analysis, deaths For GBD 2015, we have not incorporated any new
secondary to many of the causes typically categorised population-based data on disability weights; we have used
within the chronic kidney disease other category, such as the same disability weights as for GBD 2013. The present
cystic disease and other congenital renal diseases, were set of disability weights were based on population surveys
already counted under the primary disease following the in nine countries and an open internet survey. So far,
principles of the ICD, and thus could not be recounted these studies have not found systematic variation in
within the chronic kidney disease other category. In disability weights across populations or within populations
comparison, for the YLD analysis we counted chronic as a function of education, income per capita, or other
kidney disease from these causes in the chronic kidney variables. In future, we hope that more population surveys
disease other category. This dierence in the classication on disability weights will continue to be done to enrich the
of morbidity and mortality from chronic kidney disease database for disability weight estimation. Given that we
other is driven by the underlying nature of the data on have not been able to collect disability weights in every
causes of death and prevalence. In future GBD versions, location included in the GBD, it is possible that disability
we plan to make explicit estimates of death and YLDs for weights might vary systematically across communities.
polycystic kidney disease, an important component of Even if this were to be conrmed empirically, for global
the other category. standardised comparisons we would still use the global

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average disability weights; however, country analyses Self-reported functional health status
might use local disability weights. Until there is evidence We found only modest progress in high-SDI countries
of systematic variation across communities, this remains in reducing age-standardised YLDs per capita over the
a theoretical and not a practical consideration. Given the last 25 years. There are, however, reports in the literature
close correlation between the internet survey and the of substantial improvements based on self-rated
population-based surveys, we are considering the health.71,72 In the USA, these improvements seem to be
implementation of an open rolling internet survey to survey programme-specic and have not been reported
collect more data for disability weights including new or in all data systems.71 Nevertheless, more work is needed
revised health-state descriptions. to understand the dierent trends between our
assessment of YLDs per capita and self-rated health.
GATHER compliance Item response theory has been used in some elds to
Providing all documentation for data sources, establishing identify changing response patterns for single items
access to the datasets used in modelling, and posting the compared with the pool of all items.73 Item response
code has been a labour-intensive activity; GBD 2015 is theory cannot capture systematic changes that aect a
compliant with the new GATHER guidelines as a result.17 set of items, and anchoring vignettes have been
Posting code, we believe, will stimulate other researchers proposed as a strategy to deal with these challenges.72,74
to explore the methods used in GBD estimation of non- In the era of increased interest in measuring functional
fatal outcomes and hopefully lead to suggestions for health status, more exploration of the reasons for
improved estimation. With a steadily growing set of co- the divergence from a sequelae-based approach to
investigators and a widening community interested in measuring functional health status used in GBD versus
global health estimation, the enhanced transparency of an overall self-rating will be an important avenue of
GBD will improve the ecacy of the overall eort. future research.

Using claims data Crosswalks


For the USA we used claims data for selected disorders. Because of the diversity of data sources available,
These data were particularly useful in the estimation of we estimated the statistical association between
state-by-state prevalence for some disorders. Claims data, measurements taken using dierent case denitions,
however, have important potential biases. Because of dierent assays, dierent survey items, or dierent
exclusion of some disadvantaged groups from health ascertainment methods to a reference category. We used
insurance, disease rates might be dierent for individuals these statistical associations to crosswalk each type of data
that are covered compared with those from the general to the reference category. Crosswalks are a crucial
population.69,70 As the claims dataset included information dimension in the GBD analysis; in most cases we estimate
from Medicaid and Medicare, the coverage schemes for these crosswalks from within DisMod-MR 2.1. If
low-income citizens and older adults (older than 65 years) crosswalks were believed to vary substantially by age, sex,
in the USA, the bias toward underestimation might not or location, these crosswalks were estimated outside of
be so great. Indeed, we found that for many diseases, DisMod-MR 2.1 and adjusted data were used as inputs.
such as asthma, diabetes, or rheumatoid arthritis, the Where data are sparse, the estimated crosswalks can shift
claims data were consistent with high-quality survey substantially when new studies are identied that inform
estimates. A potential problem of overestimation exists the crosswalk. With each iteration of the GBD, we have
because visits to rule out a diagnosis can be coded to the recognised the crucial nature of the crosswalk analysis for
diagnosis. Others working with claims have counted data processing. We believe that more research is needed
diagnoses only if they had appeared at least twice during in future iterations of GBD to standardise the approaches
a year. Applying such a restriction would have led to used for estimating crosswalks across disorders and risk
rejection of 4468% of skin disorders, such as acne, factors, and for propagating uncertainty in crosswalks into
psoriasis, or scabies, where one would expect that even the nal results.
after a single visit a diagnosis can be reliably made. As we
tend to adjust the claims data used in DisMod-MR 2.1 if a Data gaps
systematic bias is detected from population-based We have described the availability of data by cause and
sources, such as the National Health and Nutrition geography over dierent time periods, highlighting very
Examination Survey or other quality surveys, we believe large gaps in information availability. The data availability
our estimates have not been inuenced much by this by country ranged from 61% in North Korea to 913% in
problem. The potential for greater inclusion of claims the USA (methods appendix p 606). Among the top ve
data in the GBD analysis is large; in countries with causes of YLDs, data availability was rather poor. Lower
universal health access, claims data might overcome the back pain, iron-deciency anaemia, major depressive
problems of non-responder bias in survey data, which disorder, other hearing loss, and neck pain all have data
tend to lead to underestimates of the true population representativeness indices below 50%. Because of the
prevalence or incidence. broad overview provided of major data sources for disease

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incidence and prevalence, GBD provides a framework to Third, for some disorders the data available to estimate
assist countries in prioritising the collection of new data excess mortality by age and sex and to capture how excess
to inform better monitoring of functional health status. mortality changes with development status are very
By setting clear reference case denitions and data limited. There are probably many unpublished sources
collection methods (methods appendix pp 47), GBD can of information in some countries that could be usefully
also provide guidance on how to collect information most brought to bear on the challenge of estimating the
relevant to population health measurement. agesexyearlocation levels of excess mortality.
Fourth, the microsimulation step of this study assumes
Future directions for GBD that prevalence within an agesexlocationyear group of
With each cycle of the GBD we expect, given the present dierent sequelae is independent. Although this is clearly
interest in subnational assessments, to report increasingly known not to be the case for some pairs of disorders, the
granular results. These subnational ndings will be of independence assumption provides reasonable overall
important national policy interest, but the discipline of adjustments for comorbidity. Progress in incorporating
examining the evidence for each community and modelling dependent comorbidity has been dicult because
at the more granular level will, we believe, improve the information on the correlation structure of prevalence is
quality of the national estimation as well. Additions to the extremely limited and only available for a minor fraction
cause list will continue to be driven by policy interest, such of all possible pairs of conditions in the GBD study.
as the need to incorporate Zika virus, to split diabetes into Fifth, we estimated separate DisMod-MR 2.1 models for
separate estimates for type 1 and type 2, and by adding 1990, 1995, 2000, 2005, 2010, and 2015. Independent
diseases to our cause list that are main contributors to large estimation of each time period implies that the uncertainty
residual categories, such as other cardiovascular disease, intervals for each period are also independent. Furthermore,
other musculoskeletal disorders, and other neurological compositional bias in the data available in dierent time
disorders. We plan to continue to expand our networks of periods might lead to spurious time trends. A more
topic-specic and country collaborators to enhance the appealing strategy would be to simultaneously estimate the
quality of our estimates through their feedback and by trends in incidence, excess mortality, and remission by age
enhancing the amount of data we can bring to bear on and sex consistent with all the available data for a geography
GBD estimation. Our country collaborations to generate on prevalence, incidence, remission, excess mortality, and
subnational estimates have shown us that these eorts cause-specic mortality by age and sex. DisMod-MR 2.1
greatly enhance access to valuable data sources, particularly does not allow for time-varying trends in incidence, excess
administrative datasets on inpatient and outpatient mortality, and remission, but a prototype DisMod-MR AT
episodes and unpublished surveys. (age and time) has been developed and is being tested.
Allowing for all rates to change at dierent paces over age
Limitations and time increases the number of parameters that need to
The GBD 2015 study has some key limitations. First, be estimated by orders of magnitude.
although we have sought to capture and include in our Sixth, we have emphasised in the reporting of results
estimations many sources of uncertainty, we have not the changes from calendar year 2005 to calendar
captured all sources. We have not been able to routinely year 2015, although we have estimated results for 1990,
capture uncertainty due to dierent model specications 1995, 2000, 2005, 2010, and 2015 and interpolated for the
in our results. We do not have the ability to reect the years in between. For some disorders, reporting the
uncertainty of data sources that exist but of which we are change from 2005 to 2015 (such as for Ebola virus
not aware. Subnational collaborations in China and disease) does not capture the major epidemic in west
Mexico revealed many data sources not captured in Africa in 2014. Likewise, disasters and wars are often
previous iterations of the GBD study. Inclusion of these concentrated in a single year; comparisons of any two
data sources can lead to shifts in estimates that are years can provide misleading inferences about trends.
outside the previously estimated 95% UIs. Seventh, for a few disorders (eg, tetanus, neonatal sepsis,
Second, within DisMod-MR 2.1 we estimate the average rabies, and diphtheria) we estimate disease incidence from
association between dierent types of studies for reporting estimates of mortality and the inverse of the case-fatality
on a specic outcome such as the dierence between rate estimated from available studies. When the case-
12-month recall and point prevalence in a survey. These fatality rate is very low, these estimates of incidence are
estimated associations from within the DisMod-MR 2.1 highly sensitive to very small changes in the estimated
likelihood estimation are used to adjust the data to a case-fatality rate and have large uncertainty intervals.
reference case denition or study design. These estimated Finally, although extraordinary eorts have gone into
adjustment factors are themselves uncertain, which vetting the results by GBD researchers and the
increases the overall uncertainty in our estimation. More collaborator network, there are probably some ndings
standardisation in data collection would be highly desirable that have not been scrutinised carefully enough. Making
and would reduce our dependence on the relatively all results and underlying data available and having an
challenging estimation process involved in crosswalks. increasing number of visualisation tools are eective

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strategies that we will keep expanding to meet our goal of Euripide Frinel G Arthur Avokpaho*, Ashish Awasthi*,
producing the highest quality global health data to our Beatriz Paulina Ayala Quintanilla*, Peter Azzopardi*, Umar Bacha*,
Alaa Badawi*, Kalpana Balakrishnan*, Amitava Banerjee*,
growing audience of policy makers, researchers, the Aleksandra Barac*, Suzanne L Barker-Collo*, Till Brnighausen*,
media, and the general population. Lars Barregard*, Lope H Barrero*, Arindam Basu*,
Shahrzad Bazargan-Hejazi*, Brent Bell*, Michelle L Bell*,
Conclusion Derrick A Bennett*, Isabela M Bensenor*, Habib Benzian*,
Adugnaw Berhane*, Eduardo Bernab*, Balem Demtsu Betsu*,
The GBD studies seek to quantify the prevalence and Addisu Shunu Beyene*, Neeraj Bhala*, Samir Bhatt*,
incidence of the major sequelae for a comprehensive list Sibhatu Biadgilign*, Kelly Bienho*, Boris Bikbov*, Stan Biryukov*,
of diseases and injuries; given the diversity of data Donal Bisanzio*, Espen Bjertness*, Jed Blore*, Rohan Borschmann*,
sources, the range of biases in these sources, and the Souane Boufous*, Michael Brainin*, Alexandra Brazinova*,
Nicholas J K Breitborde*, Jonathan Brown*, Rachelle Buchbinder*,
gaps in availability, this is a challenging task. Despite Georey Colin Buckle*, Zahid A Butt*, Bianca Calabria*,
the limitations, the standardised and comprehensive Ismael Ricardo Campos-Nonato*, Julio Cesar Campuzano*,
approach of the GBD studies study provides useful Hlne Carabin*, Rosario Crdenas*, David O Carpenter*,
insights. We believe users of the ndings, including the Juan Jesus Carrero*, Carlos A Castaeda-Orjuela*,
Jacqueline Castillo Rivas*, Ferrn Catal-Lpez*, Jung-Chen Chang*,
wealth of country-specic and cause-specic detail Peggy Pei-Chia Chiang*, Chioma Ezinne Chibueze*,
available in the appendix, can usefully examine the broad Vesper Hichilombwe Chisumpa*, Jee-Young Jasmine Choi*,
trends for their country or subnational geography, Rajiv Chowdhury*, Hanne Christensen*,
benchmark against geographies at a similar level of Devasahayam Jesudas Christopher*, Liliana G Ciobanu*,
Massimo Cirillo*, Matthew M Coates*, Samantha M Colquhoun*,
development, and understand the strength or weakness Cyrus Cooper*, Monica Cortinovis*, John A Crump*,
of these estimates. Regular quantication of health is Solomon Abrha Damtew*, Rakhi Dandona*, Farah Daoud*,
particularly important as the new health-related targets Paul I Dargan*, Jos das Neves*, Gail Davey*, Adrian C Davis*,
of the Sustainable Development Goals have broadened Diego De Leo*, Louisa Degenhardt*, Liana C Del Gobbo*,
Robert P Dellavalle*, Kebede Deribe*, Amare Deribew*, Sarah Derrett*,
the health agenda throughout the world. At the same Don C Des Jarlais*, Samath D Dharmaratne*, Preet K Dhillon*,
time, development and transformations in the risks to Cesar Diaz-Torn*, Eric L Ding*, Tim R Driscoll*, Leilei Duan*,
health experienced by dierent groups in the world are Manisha Dubey*, Bruce Bartholow Duncan*, Hedyeh Ebrahimi*,
Richard G Ellenbogen*, Iqbal Elyazar*, Matthias Endres*,
leading to some broad transformations in health.
Aman Yesuf Endries*, Sergey Petrovich Ermakov*, Babak Eshrati*,
Everyone needs to have access to the timeliest, valid, Kara Estep*, Talha A Farid*, Carla Soa e Sa Farinha*, Andr Faro*,
reliable, and local information possible to enrich debates Maryam S Farvid*, Farshad Farzadfar*, Valery L Feigin*,
on how to accelerate health progress in all communities. David T Felson*, Seyed-Mohammad Fereshtehnejad*,
Jeerson G Fernandes*, Joao C Fernandes*, Florian Fischer*,
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Joseph R A Fitchett*, Kyle Foreman*, F Gerry R Fowkes*,
Theo Vos, Christine Allen, Megha Arora, Ryan M Barber, Jordan Fox*, Richard C Franklin*, Joseph Friedman*,
Zulqar A Bhutta, Alexandria Brown, Austin Carter, Daniel C Casey, Joseph Frostad*, Thomas Frst*, Neal D Futran*, Belinda Gabbe*,
Fiona J Charlson, Alan Z Chen, Megan Coggeshall, Leslie Cornaby, Parthasarathi Ganguly*, Fortun Gbtoho Gankp*, Teshome Gebre*,
Lalit Dandona, Daniel J Dicker, Tina Dilegge, Holly E Erskine, Tsegaye Tewelde Gebrehiwot*, Amanuel Tesfay Gebremedhin*,
Alize J Ferrari, Christina Fitzmaurice, Tom Fleming, Johanna M Geleijnse*, Bradford D Gessner*, Katherine B Gibney*,
Mohammad H Forouzanfar, Nancy Fullman, Peter W Gething, Ibrahim Abdelmageem Mohamed Ginawi*, Ababi Zergaw Giref*,
Ellen M Goldberg, Nicholas Graetz, Juanita A Haagsma, Maurice Giroud*, Melkamu Dedefo Gishu*, Elizabeth Glaser*,
Catherine O Johnson, Nicholas J Kassebaum, Toana Kawashima, William W Godwin*, Hector Gomez-Dantes*, Philimon Gona*,
Laura Kemmer, Ibrahim A Khalil, Yohannes Kinfu, Hmwe H Kyu, Amador Goodridge*, Sameer Vali Gopalani*, Carolyn C Gotay*,
Janni Leung, Xiaofeng Liang, Stephen S Lim, Alan D Lopez, Atsushi Goto*, Hebe N Gouda*, Rebecca Grainger*, Felix Greaves*,
Rafael Lozano, Laurie Marczak, George A Mensah, Ali H Mokdad, Francis Guillemin*, Yuming Guo*, Rahul Gupta*, Rajeev Gupta*,
Mohsen Naghavi, Grant Nguyen, Elaine Nsoesie, Helen Olsen, Vipin Gupta*, Reyna A Gutirrez*, Demewoz Haile*,
David M Pigott, Christine Pinho, Zane Rankin, Nikolas Reinig, Alemayehu Desalegne Hailu*, Gessessew Bugssa Hailu*,
Joshua A Salomon, Logan Sandar, Alison Smith, Jerey Stanaway, Yara A Halasa*, Randah Ribhi Hamadeh*, Samer Hamidi*,
Caitlyn Steiner, Stephanie Teeple, Bernadette A Thomas, Mouhanad Hammami*, Jamie Hancock*, Alexis J Handal*,
Christopher Troeger, Joseph A Wagner, Haidong Wang, Graeme J Hankey*, Yuantao Hao*, Hilda L Harb*,
Valentine Wanga, Harvey A Whiteford, Leo Zoeckler, Sivadasanpillai Harikrishnan*, Josep Maria Haro*,
Amanuel Alemu Abajobir*, Kalkidan Hassen Abate*, Rasmus Havmoeller*, Roderick J Hay*, Ileana Beatriz Heredia-Pi*,
Cristiana Abbafati*, Kaja M Abbas*, Foad Abd-Allah*, Biju Abraham*, Pouria Heydarpour*, Hans W Hoek*, Masako Horino*,
Ibrahim Abubakar*, Laith J Abu-Raddad*, Niveen M E Abu-Rmeileh*, Nobuyuki Horita*, H Dean Hosgood*, Damian G Hoy*,
Ilana N Ackerman*, Akindele Olupelumi Adebiyi*, Zanna Ademi*, Aung Soe Htet*, Hsiang Huang*, John J Huang*,
Arsne Kouablan Adou*, Kossivi Agbelenko Afanvi*, Chantal Huynh*, Marissa Iannarone*, Kim Moesgaard Iburg*,
Emilie Elisabet Agardh*, Arnav Agarwal*, Aliasghar Ahmad Kiadaliri*, Kaire Innos*, Manami Inoue*, Veena J Iyer*, Kathryn H Jacobsen*,
Hamid Ahmadieh*, Oluremi N Ajala*, Rufus Olusola Akinyemi*, Nader Jahanmehr*, Mihajlo B Jakovljevic*, Mehdi Javanbakht*,
Nadia Akseer*, Ziyad Al-Aly*, Khurshid Alam*, Noore K M Alam*, Achala Upendra Jayatilleke*, Sun Ha Jee*, Panniyammakal Jeemon*,
Saleh Fahed Aldhahri*, Miguel Angel Alegretti*, Paul N Jensen*, Ying Jiang*, Tariku Jibat*, Aida Jimenez-Corona*,
Zewdie Aderaw Alemu*, Lily T Alexander*, Samia Alhabib*, Ye Jin*, Jost B Jonas*, Zubair Kabir*, Yogeshwar Kalkonde*,
Raghib Ali*, Alaa Alkerwi*, Franois Alla*, Peter Allebeck*, Ritul Kamal*, Haidong Kan*, Andr Karch*, Corine Kakizi Karema*,
Rajaa Al-Raddadi*, Ubai Alsharif*, Khalid A Altirkawi*, Chante Karimkhani*, Amir Kasaeian*, Anil Kaul*, Norito Kawakami*,
Nelson Alvis-Guzman*, Azmeraw T Amare*, Alemayehu Amberbir*, Peter Njenga Keiyoro*, Andrew Haddon Kemp*, Andre Keren*,
Heresh Amini*, Walid Ammar*, Stephen Marc Amrock*, Chandrasekharan Nair Kesavachandran*, Yousef Saleh Khader*,
Hjalte H Andersen*, Gregory M Anderson*, Benjamin O Anderson*, Abdur Rahman Khan*, Ejaz Ahmad Khan*, Young-Ho Khang*,
Carl Abelardo T Antonio*, Atsede Fantahun Aregay*, Johan rnlv*, Sahil Khera*, Tawk Ahmed Muthafer Khoja*, Jagdish Khubchandani*,
Al Artaman*, Hamid Asayesh*, Reza Assadi*, Suleman Atique*,

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Christian Kieling*, Pauline Kim*, Cho-il Kim*, Daniel Kim*, Cassandra E I Szoeke*, Rafael Tabars-Seisdedos*, Jukka S Takala*,
Yun Jin Kim*, Niranjan Kissoon*, Luke D Knibbs*, Nikhil Tandon*, David Tanne*, Mohammad Tavakkoli*, Bineyam Taye*,
Ann Kristin Knudsen*, Yoshihiro Kokubo*, Dhaval Kolte*, Hugh R Taylor*, Braden J Te Ao*, Bemnet Amare Tedla*,
Jacek A Kopec*, Soewarta Kosen*, Georgios A Kotsakis*, Abdullah Sulieman Terkawi*, Alan J Thomson*,
Parvaiz A Koul*, Ai Koyanagi*, Michael Kravchenko*, Andrew L Thorne-Lyman*, Amanda G Thrift*, George D Thurston*,
Barthelemy Kuate Defo*, Burcu Kucuk Bicer*, Andreas A Kudom*, Ruoyan Tobe-Gai*, Marcello Tonelli*, Roman Topor-Madry*,
Ernst J Kuipers*, G Anil Kumar*, Michael Kutz*, Gene F Kwan*, Fotis Topouzis*, Bach Xuan Tran*, Zacharie Tsala Dimbuene*,
Aparna Lal*, Ratilal Lalloo*, Tea Lallukka*, Hilton Lam*, Miltiadis Tsilimbaris*, Abera Kenay Tura*, Emin Murat Tuzcu*,
Jennifer O Lam*, Sinead M Langan*, Anders Larsson*, Stefanos Tyrovolas*, Kingsley N Ukwaja*, Eduardo A Undurraga*,
Pablo M Lavados*, Janet L Leasher*, James Leigh*, Ricky Leung*, Chigozie Jesse Uneke*, Olalekan A Uthman*,
Miriam Levi*, Yichong Li*, Yongmei Li*, Juan Liang*, Shiwei Liu*, Coen H van Gool*, Yuri Y Varakin*, Tommi Vasankari*,
Yang Liu*, Belinda K Lloyd*, Warren D Lo*, Giancarlo Logroscino*, Narayanaswamy Venketasubramanian*, Raj Kumar Verma*,
Katharine J Looker*, Paulo A Lotufo*, Raimundas Lunevicius*, Francesco S Violante*, Sergey K Vladimirov*,
Ronan A Lyons*, Mark T Mackay*, Mohammed Magdy Abd El Razek*, Vasiliy Victorovich Vlassov*, Stein Emil Vollset*, Gregory R Wagner*,
Mahdi Mahdavi*, Marek Majdan*, Azeem Majeed*, Reza Malekzadeh*, Stephen G Waller*, Linhong Wang*, David A Watkins*,
Wagner Marcenes*, David Joel Margolis*, Jose Martinez-Raga*, Scott Weichenthal*, Elisabete Weiderpass*, Robert G Weintraub*,
Felix Masiye*, Joo Massano*, Stephen Theodore McGarvey*, Andrea Werdecker*, Ronny Westerman*, Richard A White*,
John J McGrath*, Martin McKee*, Brian J McMahon*, Peter A Meaney*, Hywel C Williams*, Charles Shey Wiysonge*, Charles D A Wolfe*,
Alem Mehari*, Fabiola Mejia-Rodriguez*, Alemayehu B Mekonnen*, Sungho Won*, Rachel Woodbrook*, Mamo Wubshet*, Denis Xavier*,
Yohannes Adama Melaku*, Peter Memiah*, Ziad A Memish*, Gelin Xu*, Ajit Kumar Yadav*, Lijing L Yan*, Yuichiro Yano*,
Walter Mendoza*, Atte Meretoja*, Tuomo J Meretoja*, Mehdi Yaseri*, Pengpeng Ye*, Henock Gebremedhin Yebyo*, Paul Yip*,
Francis Apolinary Mhimbira*, Ted R Miller*, Edward J Mills*, Naohiro Yonemoto*, Seok-Jun Yoon*, Mustafa Z Younis*,
Mojde Miraren*, Philip B Mitchell*, Charles N Mock*, Chuanhua Yu*, Zoubida Zaidi*, Maysaa El Sayed Zaki*, Hajo Zeeb*,
Alireza Mohammadi*, Shau Mohammed*, Lorenzo Monasta*, Maigeng Zhou*, Sanjay Zodpey*, Liesl Joanna Zuhlke*,
Julio Cesar Montaez Hernandez*, Marcella Montico*, Christopher J L Murray.
Meghan D Mooney*, Maziar Moradi-Lakeh*, Lidia Morawska*, *Authors listed alphabetically. Corresponding author.
Ulrich O Mueller*, Erin Mullany*, John Everett Mumford*,
Alliations
Michele E Murdoch*, Jean B Nachega*, Gabriele Nagel*,
Institute for Health Metrics and Evaluation (Prof T Vos PhD,
Aliya Naheed*, Luigi Naldi*, Vinay Nangia*, John N Newton*,
C Allen BA, M Arora BSA, R M Barber BS, A Brown MA, A Carter BS,
Marie Ng*, Frida Namnyak Ngalesoni*, Quyen Le Nguyen*,
D C Casey BA, F J Charlson PhD, A Z Chen BS, M Coggeshall BA,
Muhammad Imran Nisar*, Patrick Martial Nkamedjie Pete*,
L Cornaby BS, Prof L Dandona MD, D J Dicker BS, T Dilegge BS,
Joan M Nolla*, Ole F Norheim*, Rosana E Norman*,
H E Erskine PhD, A J Ferrari PhD, C Fitzmaurice MD, T Fleming BS,
Bo Norrving*, Bruno P Nunes*, Felix Akpojene Ogbo*,
M H Forouzanfar MD, N Fullman MPH, E M Goldberg BS,
In-Hwan Oh*, Takayoshi Ohkubo*, Pedro R Olivares*,
N Graetz MPH, J A Haagsma PhD, C O Johnson PhD,
Bolajoko Olubukunola Olusanya*, Jacob Olusegun Olusanya*,
N J Kassebaum MD, T Kawashima MS, L Kemmer PhD, I A Khalil MD,
Alberto Ortiz*, Majdi Osman*, Erika Ota*, Mahesh PA*, Eun-Kee Park*,
H H Kyu PhD, J Leung PhD, Prof S S Lim PhD, Prof A D Lopez PhD,
Mahboubeh Parsaeian*, Valria Maria de Azeredo Passos*,
L Marczak PhD, Prof A H Mokdad PhD, Prof M Naghavi PhD,
Angel J Paternina Caicedo*, Scott B Patten*, George C Patton*,
G Nguyen MPH, E Nsoesie PhD, H Olsen MAIS, D M Pigott DPhil,
David M Pereira*, Rogelio Perez-Padilla*, Norberto Perico*,
C Pinho BA, Z Rankin BS, N Reinig BS, L Sandar BS,
Konrad Pesudovs*, Max Petzold*, Michael Robert Phillips*,
A Smith BA, J Stanaway PhD, C Steiner MPH, S Teeple BA,
Frdric B Piel*, Julian David Pillay*, Farhad Pishgar*, Dietrich Plass*,
B A Thomas MD, C Troeger MPH, J A Wagner BS, H Wang PhD,
James A Platts-Mills*, Suzanne Polinder*, Constance D Pond*,
V Wanga MS, Prof H A Whiteford PhD, L Zoeckler BA,
Svetlana Popova*, Richie G Poulton*, Farshad Pourmalek*,
L T Alexander BA, G M Anderson MSEE, B Bell MLIS, K Bienho MA,
Dorairaj Prabhakaran*, Noela M Prasad*, Mostafa Qorbani*,
S Biryukov BS, J Blore PhD, J Brown MAIS, M M Coates MPH,
Rynaz H S Rabiee*, Amir Radfar*, Anwar Rafay*,
F Daoud BS, K Estep MPA, K Foreman PhD, J Fox BS, J Friedman BA,
Kazem Rahimi*, Vafa Rahimi-Movaghar*, Mahfuzar Rahman*,
J Frostad MPH, W W Godwin BS, J Hancock MLS, C Huynh BA,
Mohammad Hifz Ur Rahman*, Sajjad Ur Rahman*, Rajesh Kumar Rai*,
M Iannarone MSc, P Kim BA, M Kutz BS, F Masiye PhD,
Sasa Rajsic*, Usha Ram*, Puja Rao*, Amany H Refaat*,
M Miraren MPH, M D Mooney BS, M Moradi-Lakeh MD,
Marissa B Reitsma*, Giuseppe Remuzzi*, Serge Resniko*,
E Mullany BA, J E Mumford BA, M Ng PhD, P Rao MPH,
Alex Reynolds*, Antonio L Ribeiro*, Maria Jesus Rios Blancas*,
M B Reitsma BS, A Reynolds BA, G A Roth MD, K A Shackelford BA,
Hirbo Shore Roba*, David Rojas-Rueda*, Luca Ronfani*,
A Sivonda MHA, A Sligar MPH, P Sur BA, Prof S E Vollset DrPH,
Gholamreza Roshandel*, Gregory A Roth*, Dietrich Rothenbacher*,
R Woodbrook MLIS/MA, Prof M Zhou PhD, Prof C J L Murray DPhil),
Ambuj Roy*, Rajesh Sagar*, Ramesh Sahathevan*, Juan R Sanabria*,
Harborview/UW Medicine (R G Ellenbogen MD), School of Dentistry
Maria Dolores Sanchez-Nio*, Itamar S Santos*, Joo Vasco Santos*,
(G A Kotsakis DDS), Harborview Injury Prevention and Research Center
Rodrigo Sarmiento-Suarez*, Benn Sartorius*, Maheswar Satpathy*,
(C N Mock PhD), University of Washington, Seattle, WA, USA
Miloje Savic*, Monika Sawhney*, Michael P Schaub*,
(Prof B O Anderson MD, N D Futran MD, P N Jensen PhD,
Maria Ins Schmidt*, Ione J C Schneider*, Ben Schttker*,
D A Watkins MD); Centre of Excellence in Women and Child Health
David C Schwebel*, James G Scott*, Soraya Seedat*, Sadaf G Sepanlou*,
(Prof Z A Bhutta PhD), Aga Khan University, Karachi, Pakistan
Edson E Servan-Mori*, Katya A Shackelford*, Amira Shaheen*,
(M I Nisar MSc); Centre for Global Child Health, The Hospital for Sick
Masood Ali Shaikh*, Rajesh Sharma*, Upasana Sharma*, Jiabin Shen*,
Children, Toronto, ON, Canada (Prof Z A Bhutta PhD, N Akseer MSc);
Donald S Shepard*, Kevin N Sheth*, Kenji Shibuya*, Min-Jeong Shin*,
School of Public Health (F J Charlson PhD, H E Erskine PhD,
Rahman Shiri*, Ivy Shiue*, Mark G Shrime*, Inga Dora Sigfusdottir*,
A J Ferrari PhD, J Leung PhD, Prof H A Whiteford PhD,
Diego Augusto Santos Silva*, Dayane Gabriele Alves Silveira*,
A A Abajobir MPH, L D Knibbs PhD), School of Dentistry
Abhishek Singh*, Jasvinder A Singh*, Om Prakash Singh*,
(Prof R Lalloo PhD), Centre for Clinical Research (J G Scott PhD),
Prashant Kumar Singh*, Anna Sivonda*, Vegard Skirbekk*,
The University of Queensland, Brisbane, QLD, Australia
Jens Christoer Skogen*, Amber Sligar*, Karen Sliwa*, Michael Soljak*,
(N K M Alam MPH, H N Gouda PhD, Y Guo PhD, Prof J J McGrath
Kjetil Sreide*, Joan B Soriano*, Luciano A Sposato*,
MD); Queensland Centre for Mental Health Research, Brisbane, QLD,
Chandrashekhar T Sreeramareddy*, Vasiliki Stathopoulou*,
Australia (F J Charlson PhD, H E Erskine PhD, A J Ferrari PhD,
Nicholas Steel*, Dan J Stein*, Timothy J Steiner*, Sabine Steinke*,
J Leung PhD, Prof H A Whiteford PhD); Centre for Control of Chronic
Lars Stovner*, Konstantinos Stroumpoulis*, Bruno F Sunguya*,
Conditions (P Jeemon PhD), Public Health Foundation of India, New
Patrick Sur*, Soumya Swaminathan*, Bryan L Sykes*,
Delhi, India (Prof L Dandona MD, R Dandona PhD, G A Kumar PhD);

1594 www.thelancet.com Vol 388 October 8, 2016


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Department of Zoology (P W Gething PhD), Nueld Department of (H Ahmadieh MD, M Yaseri PhD), School of Public Health
Medicine (D Bisanzio PhD, A Deribew PhD), NIHR Musculoskeletal (N Jahanmehr PhD), Shahid Beheshti University of Medical Sciences,
Biomedical Research Centre (Prof C Cooper FMedSci), University of Tehran, Iran; Department of Ophthalmology, Labbanejad Medical
Oxford, Oxford, UK (R Ali FRCP, D A Bennett PhD, K Rahimi DM); Center, Tehran, Iran (H Ahmadieh MD); University of Pittsburgh
Centre for Research & Action in Public Health, Faculty of Health, Medical Center, McKeesport, PA, USA (O N Ajala MD); Newcastle
University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD); University, Newcastle upon Tyne, UK (R O Akinyemi PhD); Washington
National Center for Chronic and Noncommunicable Disease Control University in Saint Louis, St Louis, MO, USA (Z Al-Aly MD); Sydney
and Prevention (L Duan MD, Y Li MPH, S Liu PhD, Y Jin MS, School of Public Health (Prof T R Driscoll PhD), The University of
Prof L Wang MD, P Ye MPH, Prof M Zhou PhD), Chinese Center for Sydney, Sydney, NSW, Australia (K Alam PhD, Prof A H Kemp PhD,
Disease Control and Prevention (Prof X Liang MD), Beijing, China; J Leigh PhD, A B Mekonnen MS); Queensland Health, Brisbane, QLD,
Melbourne School of Population and Global Health Australia (N K M Alam MPH); King Saud University, Riyadh, Saudi
(Prof A D Lopez PhD), Department of Paediatrics (P Azzopardi MEpi), Arabia (S F Aldhahri MD, K A Altirkawi MD); King Fahad Medical City,
The Peter Doherty Institute for Infection and Immunity Riyadh, Saudi Arabia (S F Aldhahri MD); Department of Preventive and
(K B Gibney FRACP), Department of Medicine (A Meretoja PhD), Social Medicine, Faculty of Medicine, University of the Republic,
Murdoch Childrens Research Institute (K Alam PhD, P Azzopardi Montevideo, Uruguay (M A Alegretti MD); Debre Markos University,
MEpi, R Borschmann PhD, S M Colquhoun PhD, Prof G C Patton MD, Debre Markos, Ethiopia (Z A Alemu MPH); King Abdullah Bin
R G Weintraub MBBS), Institute of Health and Ageing Abdulaziz University Hospital, Riyadh, Saudi Arabia (S Alhabib PhD);
(Prof C E I Szoeke PhD), The University of Melbourne, Melbourne, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
VIC, Australia (Z Ademi PhD, K Alam PhD, R Borschmann PhD, (A Alkerwi PhD); School of Public Health, University of Lorraine, Nancy,
S M Colquhoun PhD, Prof H R Taylor AC, R G Weintraub MBBS); France (Prof F Alla PhD, F Guillemin PhD); Department of Public
National Institute of Public Health, Cuernavaca, Mexico (R Lozano MD, Health Sciences (P Allebeck PhD, R H S Rabiee MPH), Department of
I R Campos-Nonato PhD, J C Campuzano PhD, H Gomez-Dantes MSc, Clinical Science, Intervention and Technology (Prof J J Carrero PhD),
I B Heredia-Pi PhD, F Mejia-Rodriguez MD, Department of Neurobiology, Care Sciences and Society (NVS)
J C Montaez Hernandez MSc, M J Rios Blancas MPH, (S M Fereshtehnejad PhD), Department of Medical Epidemiology and
Prof E E Servan-Mori MSc); Center for Translation Research and Biostatistics (E Weiderpass PhD), Karolinska Institutet, Stockholm,
Implementation Science, National Heart, Lung, and Blood Institute, Sweden (R Havmoeller PhD); Ministry of Health, Jeddah, Saudi Arabia
National Institutes of Health, Bethesda, MD, USA (G A Mensah MD); (R Al-Raddadi PhD); Charit Universittsmedizin, Berlin, Germany
Department of Global Health and Population (Prof J A Salomon PhD), (U Alsharif MPH); Universidad de Cartagena, Cartagena de Indias,
Department of Nutrition (A L Thorne-Lyman ScD), Harvard T H Chan Colombia (Prof N Alvis-Guzman PhD); School of Medicine
School of Public Health (O N Ajala MD, Prof T Brnighausen MD, (A T Amare MPH, Y A Melaku MPH), University of Adelaide, Adelaide,
I R Campos-Nonato PhD, E L Ding ScD, M S Farvid PhD, SA, Australia (L G Ciobanu MS); College of Medicine and Health
G R Wagner MD), Harvard Medical School (M Osman MD, Sciences, Bahir Dar University, Bahir Dar, Ethiopia (A T Amare MPH);
M G Shrime MD), Harvard University, Boston, MA, USA Dignitas International, Zomba, Malawi (A Amberbir PhD);
(J R A Fitchett MD); Jimma University, Jimma, Ethiopia Environmental Health Research Center, Kurdistan University of Medical
(K H Abate MS, T T Gebrehiwot MPH, A T Gebremedhin MPH); Sciences, Sanandaj, Iran (H Amini MSPH); Department of
La Sapienza, University of Rome, Rome, Italy (C Abbafati PhD); Epidemiology and Public Health (H Amini MSPH, T Frst PhD), Swiss
Virginia Tech, Blacksburg, VA, USA (Prof K M Abbas PhD); Tropical and Public Health Institute, Basel, Switzerland
Department of Neurology, Cairo University, Cairo, Egypt (C K Karema MSc); Ministry of Public Health, Beirut, Lebanon
(Prof F Abd-Allah MD); NMSM Government College Kalpetta, Kerala, (W Ammar PhD, H L Harb MPH); Oregon Health & Science University,
India (Prof B Abraham MPhil); Institute for Global Health Portland, OR, USA (S M Amrock MD); Center for Sensory-Motor
(Prof I Abubakar PhD), Farr Institute of Health Informatics Research Interaction, Department of Health Science and Technology, Faculty of
(A Banerjee DPhil), Department of Epidemiology and Public Health Medicine, Aalborg University, Aalborg, Denmark (H H Andersen MSc);
(H Benzian PhD), University College London, London, UK; Infectious Department of Health Policy and Administration, College of Public
Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Health, University of the Philippines Manila, Manila, Philippines
Doha, Qatar (L J Abu-Raddad PhD); Institute of Community and (C A T Antonio MD); School of Public Health (Y A Melaku MPH),
Public Health, Birzeit University, Ramallah, Palestine Mekelle University, Mekelle, Ethiopia (A F Aregay MS, B D Betsu MS,
(N M Abu-Rmeileh PhD); Department of Epidemiology and Preventive G B Hailu MSc, H G Yebyo MS); Department of Medical Sciences,
Medicine, School of Public Health and Preventive Medicine Uppsala University, Uppsala, Sweden (Prof J rnlv PhD,
(I N Ackerman PhD, Prof R Buchbinder PhD), School of Public Health Prof A Larsson PhD); Dalarna University, Falun, Sweden
and Preventive Medicine (Prof B Gabbe PhD), Department of Medicine, (Prof J rnlv PhD); Consultant, Windsor, ON, Canada
School of Clinical Sciences at Monash Health (Prof A G Thrift PhD), (A Artaman PhD); Department of Medical Emergency, School of
Monash University, Melbourne, VIC, Australia; College of Medicine Paramedic, Qom University of Medical Sciences, Qom, Iran
(A O Adebiyi MD), University of Ibadan, Ibadan, Nigeria (H Asayesh PhD); Mashhad University of Medical Sciences, Mashhad,
(R O Akinyemi PhD); University College Hospital, Ibadan, Nigeria Iran (R Assadi PhD); Graduate Institute of Biomedical Informatics,
(A O Adebiyi MD); University of Basel, Basel, Switzerland Taipei Medical University, Taipei, Taiwan (S Atique MS); Institut de
(Z Ademi PhD, T Frst PhD); Association Ivoirienne pour le Bien-tre Recherche Clinique du Bnin, Cotonou, Benin Republic
Familial, Abidjan, Cte dIvoire (A K Adou MD); Direction du District (E F G A Avokpaho MPH); Laboratoire dEtudes et de Recherche-Action
Sanitaire de Haho, Notse, Togo (K A Afanvi MD); Faculte des Sciences en Sant (LERAS Afrique), Parakou, Benin Republic
de Sante, Universite de Lome, Lome, Togo (K A Afanvi MD); Institution (E F G A Avokpaho MPH); Sanjay Gandhi Postgraduate Institute of
of Public Health Sciences, Stockholm, Sweden (E E Agardh PhD); Dalla Medical Sciences, Lucknow, India (A Awasthi MSc); The Judith Lumley
Lana School of Public Health (N Akseer MSc), Department of Centre for Mother, Infant and Family Health Research, La Trobe
Nutritional Sciences, Faculty of Medicine (A Badawi PhD), Centre for University, Melbourne, VIC, Australia (B P Ayala Quintanilla PhD);
Addiction and Mental Health (S Popova PhD), University of Toronto, Peruvian National Institute of Health, Lima, Peru
Toronto, ON, Canada (A Agarwal BHSc); McMaster University, (B P Ayala Quintanilla PhD); Wardliparingga Aboriginal Research Unit,
Hamilton, ON, Canada (A Agarwal BHSc); Department of Clinical South Australian Health and Medical Research Institute, Adelaide, SA,
Sciences Lund, Orthopedics, Clinical Epidemiology Unit Australia (P Azzopardi MEpi); School of Health Sciences, University of
(A Ahmad Kiadaliri PhD), Skane University Hospital, Department of Management and Technology, Lahore, Pakistan (U Bacha PhD); Public
Clinical Sciences Lund (Prof B Norrving PhD), Lund University, Lund, Health Agency of Canada, Toronto, ON, Canada (A Badawi PhD);
Sweden; Health Services Management Research Center, Institute for Department of Environmental Health Engineering, Sri Ramachandra
Futures Studies in Health, Kerman University of Medical Sciences, University, Chennai, India (K Balakrishnan PhD); Faculty of Medicine,
Kerman, Iran (A Ahmad Kiadaliri PhD); Ophthalmic Research Center University of Belgrade, Belgrade, Serbia (A Barac PhD); School of

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Psychology, University of Auckland, Auckland, New Zealand Nursing, College of Medicine, National Taiwan University, Taipei,
(S L Barker-Collo PhD); Africa Health Research Institute, Mtubatuba, Taiwan (Prof J Chang PhD); Clinical Governance Unit, Gold Coast
South Africa (Prof T Brnighausen MD); Institute of Public Health, Health, Southport, QLD, Australia (P P Chiang PhD); National Center
Heidelberg University, Heidelberg, Germany (Prof T Brnighausen MD, for Child Health and Development, Setagaya, Japan (C E Chibueze PhD);
S Mohammed PhD); Department of Occupational and Environmental University of Zambia, Lusaka, Zambia (V H Chisumpa MPhil,
Health (Prof L Barregard MD), Health Metrics Unit F Masiye PhD); University of Witwatersrand, Johannesburg, South
(Prof M Petzold PhD), University of Gothenburg, Gothenburg, Sweden; Africa (V H Chisumpa MPhil); Seoul National University Medical
Department of Industrial Engineering, School of Engineering, Ponticia Library, Seoul, South Korea (J J Choi PhD); Department of Public Health
Universidad Javeriana, Bogot, Colombia (L H Barrero ScD); School of and Primary Care, University of Cambridge, Cambridge, UK
Health Sciences, University of Canterbury, Christchurch, New Zealand (R Chowdhury PhD); Bispebjerg University Hospital, Copenhagen,
(A Basu PhD); College of Medicine, Charles R Drew University of Denmark (Prof H Christensen DMSCi); Christian Medical College,
Medicine and Science, Los Angeles, CA, USA Vellore, India (Prof D J Christopher MD); University of Salerno,
(Prof S Bazargan-Hejazi PhD); David Geen School of Medicine, Baronissi, Italy (Prof M Cirillo MD); MRC Lifecourse Epidemiology
University of California, Los Angeles, Los Angeles, CA, USA Unit, University of Southampton, Southampton, UK
(Prof S Bazargan-Hejazi PhD); Kermanshah University of Medical (Prof C Cooper FMedSci); NIHR Biomedical Research Centre,
Science, Kermanshah, Iran (Prof S Bazargan-Hejazi PhD); School of University of Southampton and University Hospital Southampton
Medicine (K N Sheth MD), Yale University, New Haven, CT, USA NHS Foundation Trust, Southampton, UK (Prof C Cooper FMedSci);
(Prof M L Bell PhD, J J Huang MD); Internal Medicine Department IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
(Prof I S Santos PhD), University of So Paulo, So Paulo, Brazil (M Cortinovis Biotech D, N Perico MD, Prof G Remuzzi MD);
(I M Bensenor PhD, Prof P A Lotufo DrPH); Department of Centre for International Health, Dunedin School of Medicine
Epidemiology and Health Promotion, College of Dentistry (Prof J A Crump MD), Injury Prevention Research Unit, Department of
(H Benzian PhD), New York University, New York, NY, USA; Debre Preventive and Social Medicine, Dunedin School of Medicine
Berhane University, Debre Berhan, Ethiopia (A Berhane PhD); Division (Prof S Derrett PhD), University of Otago, Dunedin, New Zealand
of Health and Social Care Research (Prof C D Wolfe MD), Kings College (Prof R G Poulton PhD); Wolaita Sodo University, Wolaita Sodo, Ethiopia
London, London, UK (E Bernab PhD, Prof R J Hay DM); College of (S A Damtew MPH); School of Public Health (K Deribe MPH,
Health and Medical Sciences (H S Roba MPH), Haramaya University, A D Hailu MPH), Addis Ababa University, Addis Ababa, Ethiopia
Harar, Ethiopia (A S Beyene MPH); Queen Elizabeth Hospital (S A Damtew MPH, A Z Giref PhD, D Haile MPH, T Jibat MS,
Birmingham, Birmingham, UK (N Bhala DPhil); University of Otago B Taye PhD); Guys and St Thomas NHS Foundation Trust, London, UK
Medical School, Wellington, New Zealand (N Bhala DPhil); Department (Prof P I Dargan FRCP); i3S - Instituto de Investigao e Inovao em
of Infectious Disease Epidemiology (T Frst PhD), Department of Sade and INEB - Instituto de Engenharia Biomdica (J das Neves PhD),
Epidemiology and Biostatistics (F B Piel PhD), Division of Brain Faculty of Medicine (J Massano MD, J V Santos BHlthSc); University of
Sciences (Prof T J Steiner PhD), Imperial College London, London, UK Porto, Porto, Portugal; Wellcome Trust Brighton & Sussex Centre for
(S Bhatt DPhil, F Greaves PhD, Prof A Majeed MD, M Soljak PhD); Global Health Research, Brighton, UK (Prof G Davey MD); Public
Independent Public Health Consultants, Addis Ababa, Ethiopia Health England, London, UK (Prof A C Davis PhD, F Greaves PhD,
(S Biadgilign MPH); Department of Nephrology Issues of Transplanted Prof J N Newton FRCP, Prof N Steel PhD); Grith University, Brisbane,
Kidney, Academician V I Shumakov Federal Research Center of QLD, Australia (Prof D De Leo DSc); Stanford University, Stanford, CA,
Transplantology and Articial Organs, Moscow, Russia (B Bikbov MD); USA (L C Del Gobbo PhD); University of Colorado School of Medicine
Department of Community Medicine (Prof E Bjertness PhD), University and the Colorado School of Public Health, Aurora, CO, USA
of Oslo, Oslo, Norway (A S Htet MPhil); Transport and Road Safety (R P Dellavalle MD); Brighton and Sussex Medical School, Brighton, UK
(TARS) Research (S Boufous PhD), National Drug and Alcohol Research (K Deribe MPH); KEMRI-Wellcome Trust Research Programme, Kili,
Centre (Prof L Degenhardt PhD), Brien Holden Vision Institute Kenya (A Deribew PhD); Mount Sinai Beth Israel, New York, NY, USA
(Prof S Resniko MD), University of New South Wales, Kensington, (Prof D C Des Jarlais PhD); Icahn School of Medicine at Mount Sinai,
NSW, Australia (B Calabria PhD, Prof P B Mitchell MD); Danube- New York, NY, USA (Prof D C Des Jarlais PhD); Department of
University Krems, Krems, Austria (Prof M Brainin PhD); Faculty of Community Medicine, Faculty of Medicine, University of Peradeniya,
Health Sciences and Social Work, Department of Public Health, Trnava Peradeniya, Sri Lanka (S D Dharmaratne MD); Centre for Control of
University, Trnava, Slovakia (A Brazinova PhD, M Majdan PhD); Chronic Conditions (P Jeemon PhD), Public Health Foundation of India,
International Neurotrauma Research Organization, Vienna, Austria Gurgaon, India (P K Dhillon PhD, P Ganguly MD, Prof S Zodpey PhD);
(A Brazinova PhD); Departments of Pediatrics and Neurology Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(W D Lo MD), College of Medicine (J Shen PhD), The Ohio State (C Diaz-Torn MD); International Institute for Population Sciences,
University, Columbus, OH, USA (Prof N J K Breitborde PhD); Monash Mumbai, India (M Dubey MPhil, M H U Rahman MPhil,
Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Prof U Ram PhD, A Singh PhD, R K Verma MPhil, A K Yadav MPhil);
VIC, Australia (Prof R Buchbinder PhD); University of California, San Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Francisco, San Francisco, CA, USA (G C Buckle MD); Al Shifa Trust Eye (B B Duncan PhD, C Kieling MD, Prof M I Schmidt MD); University of
Hospital, Rawalpindi, Pakistan (Z A Butt PhD); National Centre for North Carolina, Chapel Hill, NC, USA (B B Duncan PhD);
Epidemiology and Population Health, Australian National University, Non-communicable Diseases Research Center, Endocrinology and
Canberra, ACT, Australia (B Calabria PhD, A Lal PhD); Department of Metabolism Population Sciences Institute (H Ebrahimi MD,
Biostatistics and Epidemiology, University of Oklahoma Health Sciences F Pishgar MD, F Farzadfar MD, A Kasaeian PhD, M Parsaeian PhD),
Center, Oklahoma City, OK, USA (H Carabin PhD); Metropolitan Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease
Autonomous University, Mexico City, Mexico (R Crdenas ScD); Research Institute, Shariati Hospital (H Ebrahimi MD), Multiple
University at Albany, Rensselaer, NY, USA (Prof D O Carpenter MD); Sclerosis Research Center, Neuroscience Institute (P Heydarpour MD),
Colombian National Health Observatory, Instituto Nacional de Salud, Hematology-Oncology and Stem Cell Transplantation Research Center
Bogot, Colombia (C A Castaeda-Orjuela MSc); Epidemiology and (A Kasaeian PhD), Digestive Diseases Research Institute
Public Health Evaluation Group, Public Health Department, (Prof R Malekzadeh MD, G Roshandel PhD, S G Sepanlou PhD),
Universidad Nacional de Colombia, Bogot, Colombia Department of Epidemiology and Biostatistics, School of Public Health
(C A Castaeda-Orjuela MSc); Caja Costarricense de Seguro Social, San (M Parsaeian PhD), Uro-Oncology Research Center (F Pishgar MD),
Jose, Costa Rica (Prof J Castillo Rivas MPH); Universidad de Costa Rica, Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD),
San Pedro, Montes de Oca, Costa Rica (Prof J Castillo Rivas MPH); Tehran University of Medical Sciences, Tehran, Iran (M Yaseri PhD);
Department of Medicine, University of Valencia/INCLIVA Health Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
Research Institute and CIBERSAM, Valencia, Spain (I Elyazar PhD); Charit University Medicine Berlin, Berlin, Germany
(F Catal-Lpez PhD); Clinical Epidemiology Program, Ottawa Hospital (Prof M Endres MD); Arba Minch University, Arba Minch, Ethiopia
Research Institute, Ottawa, ON, Canada (F Catal-Lpez PhD); School of (A Y Endries MPH); The Institute of Social and Economic Studies of

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Population, Russian Academy of Sciences, Moscow, Russia (Prof S P Dubai, United Arab Emirates (S Hamidi PhD); Wayne County
Ermakov DSc); Federal Research Institute for Health Organization and Department of Health and Human Services, Detroit, MI, USA
Informatics, Ministry of Health of the Russian Federation, Moscow, (M Hammami MD); University of New Mexico, Albuquerque, NM, USA
Russia (Prof S P Ermakov DSc); Ministry of Health and Medical (A J Handal PhD); School of Medicine and Pharmacology, University
Education, Tehran, Iran (B Eshrati PhD); Arak University of Medical of Western Australia, Perth, WA, Australia (Prof G J Hankey MD);
Sciences, Arak, Iran (B Eshrati PhD); University of Louisville, Louisville, Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
KY, USA (T A Farid MD, A R Khan MD); DGS Directorate General of (Prof G J Hankey MD); Western Australian Neuroscience Research
Health, Lisboa, Portugal (C S E S Farinha MSc); Universidade Aberta, Institute, Nedlands, WA, Australia (Prof G J Hankey MD); School
Lisboa, Portugal (C S E S Farinha MSc); Federal University of Sergipe, of Public Health, Sun Yat-sen University, Guangzhou, China
Aracaju, Brazil (Prof A Faro PhD); Harvard/MGH Center on Genomics, (Prof Y Hao PhD); Sree Chitra Tirunal Institute for Medical Sciences
Vulnerable Populations, and Health Disparities, Mongan Institute for and Technology, Trivandrum, India (S Harikrishnan DM); Parc Sanitari
Health Policy, Massachusetts General Hospital, Boston, MA, USA Sant Joan de Du - CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain
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& Dentistry, Queen Mary University of London, London, UK Carson City, NV, USA (M Horino MPH); Department of Pulmonology,
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of Human Nutrition (J M Geleijnse PhD), Wageningen University, (M Javanbakht PhD); Postgraduate Institute of Medicine, Colombo,
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Paris, France (B D Gessner MD); The Royal Melbourne Hospital, Prevention, Colombo, Sri Lanka (A U Jayatilleke PhD); Graduate School
Melbourne, VIC, Australia (K B Gibney FRACP); College of Medicine, of Public Health, Yonsei University, Seoul, South Korea (Prof S H Jee PhD);
University of Hail, Hail, Saudi Arabia (I A Ginawi MD); University Centre for Chronic Disease Control, New Delhi, India (P Jeemon PhD,
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Charleston, WV, USA (R Gupta MD); Eternal Heart Care Centre and School of Continuing and Distance Education, Nairobi, Kenya
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of Montreal, Montreal, QC, Canada; Institute of Public Health, Tehran, Iran (M Moradi-Lakeh MD); International Laboratory for Air
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Surveillance, West China Second University Hospital, Sichuan Hospital Universitari de Bellvitge, LHospitalet, Spain (J M Nolla PhD);
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Management, Erasmus University Rotterdam, Rotterdam, Netherlands Universidad de Cartagena, Cartagena, Colombia
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Perelman School of Medicine (P A Meaney MD), University of Canada (Prof M Tonelli MD); REQUIMTE/LAQV, Laboratrio de
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School of Medicine, Shanghai, China (Prof M R Phillips MD); Durban (V Stathopoulou PhD); University of East Anglia, Norwich, UK
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Exposure Assessment and Environmental Health Indicators, German Anxiety & Stress Disorders, Cape Town, South Africa
Environment Agency, Berlin, Germany (D Plass DrPH); Department of (Prof D J Stein PhD); Department of Neuroscience, Norwegian
Anesthesiology (A S Terkawi MD), University of Virginia, Charlottesville, University of Science and Technology, Trondheim, Norway
VA, USA (J A Platts-Mills MD); University of Newcastle, Callaghan, (Prof T J Steiner PhD, Prof L J Stovner PhD); Department of
NSW, Australia (Prof C D Pond PhD); The Fred Hollows Foundation, Dermatology, University Hospital Muenster, Muenster, NRW, Germany
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Cancer Research Center, Heidelberg, Germany (B Schttker MPH); Research Center, Nairobi, Kenya (Z Tsala Dimbuene PhD);
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based Dermatology, University of Nottingham, Nottingham, UK grants from the Bill & Melinda Gates Foundation. Matthias Endres
(Prof H C Williams DSc); South African Medical Research Council, Cape reports that The Center for Stroke Research Berlin has received
Town, South Africa (Prof C S Wiysonge PhD); National Institute for institutional funding from the German Ministry for Research and
Health Research Comprehensive Biomedical Research Centre, Guys & Education (BMBF). Katharine J Looker has received funding from the
St Thomas NHS Foundation Trust and Kings College London, London, World Health Organization for the HSV-2 seroprevalence review which
UK (Prof C D Wolfe MD); St Pauls Hospital, Millennium Medical informs this work; during the study, KJL also received separate funding
College, Addis Ababa, Ethiopia (M Wubshet PhD); St Johns Medical from the World Health Organization, USAID/PATH, Sexual Health 24
College and Research Institute, Bangalore, India (Prof D Xavier MD); and the National Institute for Health Research (NIHR) Health Protection
Department of Neurology, Jinling Hospital, Nanjing University School of Research Unit (HPRU) in Evaluation of Interventions at the University
Medicine, Nanjing, China (Prof G Xu PhD); Global Health Research of Bristol; these funders had no role in the writing of the manuscript nor
Center, Duke Kunshan University, Kunshan, China (Prof L L Yan PhD); the decision to submit it for publication, and the views expressed in this
Department of Preventive Medicine, Northwestern University, Chicago, Article do not necessarily represent the views, decisions or policies of the
IL, USA (Y Yano MD); Social Work and Social Administration World Health Organization, the NHS, the NIHR, the Department of
Department and The Hong Kong Jockey Club Centre for Suicide Health or Public Health England. Donal Bisanzio is supported by
Research and Prevention, University of Hong Kong, Hong Kong, China Bill and Melinda Gates Foundation (#OPP1068048). Thomas Frst has
(Prof P Yip PhD); Department of Biostatistics, School of Public Health, received nancial support from the Swiss National Science Foundation
Kyoto University, Kyoto, Japan (N Yonemoto MPH); Jackson State (SNSF; project no P300P3-154634). Rodrigo Sarmiento-Suarez receives
University, Jackson, MS, USA (Prof M Z Younis DrPH); Department of institutional support from Universidad de Ciencias Aplicadas y
Epidemiology and Biostatistics, School of Public Health (Prof C Yu PhD), Ambientales, UDCA, Bogot Colombia. Ronan A Lyons is supported by
Global Health Institute (Prof C Yu PhD), Wuhan University, Wuhan, two grants: The Farr Institute of Health Informatics Research: Arthritis
China; University Hospital, Setif, Algeria (Prof Z Zaidi PhD); Faculty of Research UK, the British Heart Foundation, Cancer Research UK, the
Medicine, Mansoura University, Mansoura, Egypt (Prof M E Zaki PhD); Economic and Social Research Council, the Engineering and Physical
Leibniz Institute for Prevention Research and Epidemiology, Bremen, Sciences Research Council, the Medical Research Council, the National
Germany (Prof H Zeeb PhD); Red Cross War Memorial Childrens Institute of Health Research, the National Institute for Social Care and
Hospital, Cape Town, South Africa (L J Zuhlke PhD). Health Research (Welsh Assembly Government), the Chief Scientist
Oce (Scottish Government Health Directorates), and The Wellcome
Contributors
Trust. Grant No MR/K006525/1, and the National Centre for Population
Christopher J L Murray and Theo Vos prepared the rst draft.
Health and Wellbeing Research. Health and Care Research Wales.
Alan D Lopez and Christopher J L Murray conceived the study and
Stefanos Tyrovolass work is supported by the Foundation for Education
provided overall guidance. All other authors provided data, developed
and European Culture (IPEP), the Sara Borrell postdoctoral programme
models, reviewed results, initiated modelling infrastructure, and/or
(reference no CD15/00019 from the Instituto de Salud Carlos III
reviewed and contributed to the report.
(ISCIII - Spain) and the Fondos Europeo de Desarrollo Regional
Declaration of interests (FEDER). Manami Inoue is the beneciary of a nancial contribution
Bruce Bartholow Duncan and Maria Ins Schmidt have received from the AXA Research fund as chair holder of the AXA Department of
additional funding from the Brazilian Ministry of Health Health and Human Security, Graduate School of Medicine, The
(Process No 25000192049/2014-14). Itamar S Santos reports grants from University of Tokyo from Nov 1, 2012; the AXA Research Fund has no
FAPESP (Brazilian public agency), outside the submitted work. role in this work. Sinead M Langan holds an NIHR Clinician Scientist
Carl Abelardo T Antonio reports grants, personal fees and non-nancial Fellowship (NIHR/CS/010/014); the views expressed in this publication
support from Johnson & Johnson (Philippines), Inc, outside the are those of the authors and not necessarily those of the NHS, the
submitted work. Cyrus Cooper reports other from Alliance for Better NIHR, or the UK Department of Health. Scott Weichenthal
Bone Health, other from Amgen, other from Eli Lilly, other from GSK, acknowledges nancial support from the Cancer Research Society of
other from Medtronic, other from Merck, other from Novartis, other Canada. Yogeshwar Kalkonde is a Wellcome Trust/ DBT India Alliance
from Pzer, other from Roche, other from Servier, outside the submitted Intermediate Fellow in Public Health. John J McGrath received a
work. Walter Mendoza is currently employed by the Peru Country Oce NHMRC John Cade Fellowship (APP1056929). Sarah Derrett reports
of the United Nations Population Fund, an institution which does grants, personal fees, non-nancial support and other from EuroQol
not necessarily endorse this study. Donald S Shepard would Research Foundation, outside the submitted work. Dan J Stein reports
like to acknowledge grant support from Sano Pasteur. personal fees from Lundbeck, personal fees from Novartis, personal fees
Rafael Tabars-Seisdedos and Ferrn Catal-Lpez are supported in part from AMBRF, grants from NRGF, personal fees from Biocodex,
by grant PROMETEOII/2015/021 from Generalitat Valenciana, and personal fees from Sevier, grants from MRC, personal fees from SUN,
Rafael Tabars-Seisdedos is supported by the national grant PI14/00894 and personal fees from CIPLA, outside the submitted work. Tea Lallukka
from ISCIII-FEDER. Walter Mendoza is currently employed by the Peru reports funding from The Academy of Finland, grant #287488.
Country Oce of the United Nations Population Fund, an institution Charles D A Wolfes research was funded and supported by the National
which does not necessarily endorse this study. Veena J Iyer has received Institute for Health Research (NIHR) Biomedical Research Centre based
a Public Health Research Initiative Fellowship (2014-17) from the at Guys and St Thomas NHS Foundation Trust and Kings College
Department of Science and Technology (DST) for a project titled London. The views expressed are those of the author(s) and not
Relationship between Enteric Fever incidence and Climate in the city of necessarily those of the NHS, the NIHR, or the Department of Health.
Ahmedabad, 19902014. Pablo M Lavados reports grants, personal fees The other authors declare no competing interests.
and non-nancial support from BAYER, non-nancial support from
Acknowledgments
Boehringer Ingelheim, grants and personal fees from AstraZeneca,
We would like to thank the countless individuals who have contributed to
grants from CONICYT, and grants from The George Institute for Global
the Global Burden of Disease Study 2015 in various capacities. This paper
Health, outside the submitted work. Noela M Prasad reports and is an
uses data from SHARE Waves 1, 2, 3 (SHARELIFE), 4, and 5 (DOIs:
employee of an international NGO that raises funds from the Australian
10.6103/SHARE.w1.500, 10.6103/SHARE.w2.500, 10.6103/SHARE.w3.500,
Public, and holds a honorary position at CERA, which receives
10.6103/SHARE.w4.500, 10.6103/SHARE.w5.500), see Brsch-Supan et al
Operational Infrastructure Support from the Victorian Government.
(2013) for methodological details. The SHARE data collection has been
Bradford D Gessner reports grants from Crucell, GSK, Hilleman Labs,
primarily funded by the European Commission through FP5
Novartis, Pzer, Merck, and Sano Pasteur, outside the submitted work.
(QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE:
Ai Koyanagis work is supported by the Miguel Servet contract nanced
CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), and FP7
by the CP13/00150 and PI15/00862 projects, integrated into the National
(SHARE-PREP: N211909, SHARE-LEAP: N227822, SHARE M4:
R + D + I and funded by the ISCIII - General Branch Evaluation and
N261982). Additional funding from the German Ministry of Education
Promotion of Health Research - and the European Regional
and Research, the US National Institute on Aging (U01_AG09740-13S2,
Development Fund (ERDF-FEDER). Dorairaj Prabhakaran reports
P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169,

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Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064) and from various national 14 Hausman DM. Health, well-being, and measuring the burden of
funding sources is gratefully acknowledged (see www.share-project.org). disease. Popul Health Metr 2012; 10: 13.
The data reported here have been supplied by the United States Renal 15 Nord E. Uncertainties about disability weights for the Global
Data System (USRDS). The interpretation and reporting of these data are Burden of Disease study. Lancet Glob Health 2015; 3: e66162.
the responsibility of the author(s) and in no way should be seen as an 16 GBD Mortality and Causes of Death Collaborators. Global,
ocial policy or interpretation of the US Government. The Palestinian regional, and national life expectancy, all-cause and cause-specic
Central Bureau of Statistics granted the researchers access to relevant data mortality for 249 causes of death, 19802015: a systematic analysis
in accordance with license no. SLN2014-3-170, after subjecting data to for the Global Burden of Disease Study 2015. Lancet
processing aiming to preserve the condentiality of individual data in 388: 1459544.
accordance with the General Statistics Law2000. The researchers are 17 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and
solely responsible for the conclusions and inferences drawn upon Transparent Health Estimates Reporting: The GATHER statement.
Lancet 2016; published online June 28. http://dx.doi.org/10.1016/
available data. This study has been realised using the data collectved by
S0140-6736(16)30388-9.
the Swiss Household Panel (SHP), which is based at the Swiss Centre of
18 Kiyono P. An integrative metaregression framework for descriptive
Expertise in the Social Sciences FORS. The project is nanced by the
epidemiology, 1 edn. Seattle: University of Washington Press, 2015.
Swiss National Science Foundation. The following individuals would like
19 Clark DV, Kibuuka H, Millard M, et al. Long-term sequelae after
to acknowledge various forms of institutional support: Amanda G Thrift
Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort
is supported by a fellowship from the National Health and Medical study. Lancet Infect Dis 2015; 15: 90512.
Research Council (GNT1042600). Panniyammakal Jeemon is supported
20 Qureshi AI, Chughtai M, Loua TO, et al. Study of Ebola virus
by the Wellcome Trust-DBT India Alliance, Clinical and Public Health, disease survivors in Guinea. Clin Infect Dis 2015; 61: 103542.
Intermediate Fellowship (201520). Amador Goodridge would like to
21 Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and
acknowledge funding for me from Sistema Nacional de Investigadores de immunologic follow-up of convalescent Ebola hemorrhagic fever
Panam-SNI. Jos das Neves was supported in his contribution to this patients and their household contacts, Kikwit, Democratic Republic
work by a Fellowship from Fundao para a Cincia e a Tecnologia, of the Congo. J Infect Dis 1999; 179: S2835.
Portugal (SFRH/BPD/92934/2013). Boris Bikbov, Monica Cortinovis, 22 Bwaka MA, Bonnet M-J, Calain P, et al. Ebola Hemorrhagic Fever
Giuseppe Remuzzi, and Norberto Perico would like to acknowledge that in Kikwit, Democratic Republic of the Congo: clinical observations
their contribution to this paper has been on behalf of the International in 103 patients. J Infect Dis 1999; 179: S1S7.
Society of Nephrology (ISN) as a follow-up of the activities of the GBD 23 PRO-ACT. https://nctu.partners.org/ProACT/Data/Index?Length=0
2010 Genitourinary Diseases Expert Group. Lijing L Yan is supported by &LongLength=0&Rank=1&SyncRoot=System.Type%5B%5D&IsRea
the National Natural Sciences Foundation of China grants (71233001 and dOnly=False&IsFixedSize=True&IsSynchronized=False (accessed
71490732). Miriam Levi would like to acknowledge the institutional May 26, 2016).
support received from CeRIMP, Regional Centre for Occupational 24 Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability
Diseases and Injuries, Tuscany Region, Florence, Italy. No individuals (YLDs) for 1160 sequelae of 289 diseases and injuries
acknowledged received additional compensation for their eorts. 19902010: a systematic analysis for the Global Burden of Disease
Study 2010. Lancet 2012; 380: 216396.
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