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Overall global health improving, years lived with disability rising

Around the world, the average life expectancy increased by more than 6 years between 1990 and 2013; however, individuals are spending more years than ever living with illnesses or disabilities, according to recently published data in The Lancet.

“The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability,” Theo Vos, MD, MSc, PhD, professor of global health at the Institute for Health Metrics and Evaluation (IHME) at University of Washington, said in a press release.

Theo and colleagues analyzed data on age-specific mortality, years of life lost to premature mortality and years lived with a disability from the Global Burden of Disease Study 2013 to assess changes in disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) across 188 countries for the years 1990, 1995, 2000, 2005, 2010 and 2013.

Results demonstrated that average life expectancy increased from 65.3 years in 1990 to 71.5 years in 2013. Additionally, HALE at birth increased by 5.4 years: from 56.9 years in 1990 to 62.3 years in 2013.

In most countries, the increases in life expectancy were greater than increases in HALE, according to the study. 

DALYs — estimated for 306 causes for each country — decreased by 3.6% since 1990, with a 26.7% decrease in age-standardized DALY rates per 100,000 people.

While the researchers noted that DALYs varied greatly by country, overall, the top ten leading causes of increases in DALYs included:

1. Ischemic heart disease;
2. Lower respiratory infection;
3. Stroke;
4. Low back and neck pain;
5. Road injuries;
6. Diarrheal diseases;
7. Chronic obstructive pulmonary disease;
8. Neonatal preterm birth complications;
9. HIV/AIDS; and
10. Malaria. 

Sociodemographic status accounted for more than half of the discrepancies between countries in rates of diarrhea; lower respiratory infections,;other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal and nutritional diseases; musculoskeletal disorders; and other noncommunicable diseases, according to the researchers.

Conversely, this factor was associated with less than10% of variability in DALYs due to cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes; urogenital, blood and endocrine diseases; unintentional injuries; self-harm; and interpersonal violence, they wrote. 

Due to the increase in life expectancy, premature mortality has decreased while years lived with disability have increased, creating an increased burden on health care systems, according to the study.

The researchers stressed the importance of country-specific evaluations of DALYs and HALEs to determine the most effective health policies to ensure that disease burdens are thwarted whenever possible. 

“Factors including income and education have an important impact on health but don’t tell the full story. Looking at healthy life expectancy and health loss at the country level can help guide policies to ensure that people everywhere can have long and healthy lives no matter where they live,” Murray said in a press release. – by Casey Hower

Disclosures: Vos and Murray report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.