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Review
. 2020 Oct 17;396(10258):1135-1159.
doi: 10.1016/S0140-6736(20)31404-5.

Five insights from the Global Burden of Disease Study 2019

Collaborators
Review

Five insights from the Global Burden of Disease Study 2019

GBD 2019 Viewpoint Collaborators. Lancet. .

Abstract

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

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Conflict of interest statement

Declaration of interests

R Ancuceanu reports receiving consultancy and speakers’ fees from various pharmaceutical companies. E Beghi reports grants from Italian Ministry of Health and Swedish Orphan Biovitrum; and personal fees from Arvelle Therapeutics, outside the submitted work. M Bell reports grants from US Environmental Protection Agency, National Institutes of Health (NIH), and Wellcome Trust Foundation, during the conduct of this work; and Honorarium and travel reimbursement from the NIH (for review of grant proposals), American Journal of Public Health (participation as editor), Global Research Laboratory and Seoul National University, Royal Society, London UK, Ohio University, Atmospheric Chemistry Gordon Research Conference, Johns Hopkins Bloomberg School of Public Health, Arizona State University, Ministry of the Environment Japan, Hong Kong Polytechnic University, University of Illinois–Champaign, and the University of Tennessee–Knoxville, outside the submitted work. PS Briant and L Haile report personal fees from WHO, outside of the submitted work. V Jha reports grants from Baxter Healthcare, GlaxoSmithKline, Zydus Cadilla, Biocon, and NephroPlus, outside the submitted work. S Lorkowski reports personal fees from Akcea Therapeutics, Amedes, Amgen, Berlin-Chemie, Boehringer Ingelheim, Daiichi Sankyo, Merck Sharp and Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield; and non-financial support from Preventicus, outside the submitted work. J Mosser reports grants from Bill and Melinda Gates Foundation, during the conduct of this work. S Nomura reports grants from the Ministry of Education, Culture, Sports, Science, and Technology. C Pond reports personal fees from Nutricia, during the conduct of this work; grants from the National Medical Research council in relation to dementia; and travel grants and remuneration related to education of primary care professionals in relation to dementia, outside of this work. M Postma reports grants from BioMerieux, WHO, EU, Foundation for Innovative New Diagnostics, Antilope, Pangkalan Data Pendidikan Tinggi, Indonesia Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan), Bayer, and Budi, personal fees from Quintiles, Novartis, and Pharmerit; grants and personal fees from IMSQuintiles, Bristol-Myers Squibb, AstraZeneca, Seqirus, Sanofi, Merck Sharp and Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, and Novavax; stocks from Ingress Health, and Pharmacoeconomics Advice Groningen; and acting as advisor to Asc Academics, all outside the submitted work. E Pupillo reports grants from Agenzia Italiana del Farmaco (Italian Medicines Agency), outside the submitted work. A Schutte reports personal fees from Omron Healthcare, Takeda, Servier, Novartis, and Abbott, outside the submitted work. M Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation, outside the submitted work. J Singh reports personal fees from Crealta–Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology; personal fees from Simply Speaking; stock options in Amarin pharmaceuticals and Viking pharmaceuticals; membership in the steering committee of Outcome Measures in Rheumatology, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, membership in the Food and Drug Administration’s Arthritis Advisory Committee, membership in the Veterans Affairs Rheumatology Field Advisory Committee; and non-financial support from University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. J Stanaway reports grants from Bill and Melinda Gates Foundation, during the conduct of this work. D Stein reports personal fees from Lundbeck and Sun, outside the submitted work. C Swope reports working for a private sector organization, Delos Living. R Uddin reports travel and accommodation reimbursement from Deakin University Institute for Physical Activity and Nutrition, outside the submitted work. R Vaicekonyte reports working for a private sector organisation, Delos Living. All other authors declare no competing interests.

Figures

Figure 1
Figure 1. Change in HALE disaggregated by SDI quintiles, 2000–19
SDI quintiles as assessed in 2019. Expected change in HALE related to change in SDI is based on fitting spline functions to the relationship between age-specific mortality and SDI, and age-specific years lived with disability per capita and SDI. HALE=healthy life expectancy. SDI=Socio-demographic Index.
Figure 2
Figure 2. Global ARC for age-standardised DALY rates and DALY counts, 1990–2010 and 2010–19
Results are shown for three broad cause groups: CMNN diseases, NCDs, and injuries. ARC=annualised rate of change. CMNN=communicable, maternal, neonatal, and nutritional. DALY=disability-adjusted life-year. NCDs=non-communicable diseases.
Figure 3
Figure 3. Relationships of UHC effective coverage in 204 countries and territories for health services targeting CMNN diseases and NCDs versus SDI, 2019
CMNN=communicable, maternal, neonatal, and nutritional. NCDs=non-communicable diseases. SDI=Socio-demographic Index. UHC=universal health coverage.
Figure 4
Figure 4. Global ARC in exposure for select risks, 2010–19
Risk factors are ordered by global attributable DALYs. Values are shaded by change in exposure, from dark blue (largest decrease) to dark red (largest increase). Exposure is measured as the age-standardised summary exposure value. Summary exposure value is an integrated measure of risk exposure that allows comparison across continuous, polytomous, and dichotomous risk factors. ARC=annualised rate of change. DALYs=disability-adjusted life-years. SBP=systolic blood pressure.
Figure 5
Figure 5. Number of countries and territories with negative natural rate of population increase, 1950–2019, and in the reference forecast scenario, 2020–2100
The natural rate of increase is negative when the crude death rate exceeds the crude birth rate.

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