Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a
comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in
195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates
from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the
non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world’s
population experiences non-fatal health loss with considerable heterogeneity among different causes, locations,
ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving
analytical strategies, and increasing the amount of high-quality data.
Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated
and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit
records, and health insurance claims, and additionally used results from cause of death models to inform estimates
using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil,
Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan
(province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of
estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each
condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of
each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI),
a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we
calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies
with the Guidelines for Accurate and Transparent Health Estimates Reporting.
Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache
disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the
greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent
tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron
deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and
depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates
decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased
by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100).
The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and
6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised
prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017
included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs 1400 [1279–1524] per
100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal
violence (3265 [2943–3630] vs 5643 [5057–6302]).
Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly
three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing
numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive
since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies
across the globe experiencing varying burdens and trends of health loss. This study emphasises how global
improvements in premature mortality for select conditions have led to older populations with complex and potentially
expensive diseases, yet also highlights global achievements