Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

How long one lives, how many years of life are spent in good and poor health, and how the population’s
state of health and leading causes of disability change over time all have implications for policy, planning, and provision
of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifes the
number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity
of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.
Methods We used data for age-specifc mortality rates, years of life lost (YLLs) due to premature mortality, and years
lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to
calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specifc mortality rates and YLDs per
capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We
assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good
health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.
Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8),
from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years
(5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected
at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7%
(8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1)
in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to
10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries,
ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years
[60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1]
in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating
more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males
in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the
extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional
years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were
spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years
[72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years
[43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the fve leading causes of DALYs were
neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary
disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable
diseases and by 49·8% (47·9–51·6) for neo