Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010.

China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5-1·8 million), ischaemic heart disease (948,700 deaths, 774,500-1,024,600), and chronic obstructive pulmonary disease (934,000 deaths, 846,600-1,032,300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2-32·5) in 1990 to 39·4% (34·9-43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Bill & Melinda Gates Foundation.

Yang G ，Wang Y ，Zeng Y ，Gao GF ，Liang X ，Zhou M ，Wan X ，Yu S ，Jiang Y ，Naghavi M ，Vos T ，Wang H ，Lopez AD ，Murray CJ ... -  《-》

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Bill & Melinda Gates Foundation.

GBD 2013 DALYs and HALE Collaborators ，Murray CJ ，Barber RM ，Foreman KJ ，Abbasoglu Ozgoren A ，Abd-Allah F ，Abera SF ，Aboyans V ，Abraham JP ，Abubakar I ，Abu-Raddad LJ ，Abu-Rmeileh NM ，Achoki T ，Ackerman IN ，Ademi Z ，Adou AK ，Adsuar JC ，Afshin A ，Agardh EE ，Alam SS ，Alasfoor D ，Albittar MI ，Alegretti MA ，Alemu ZA ，Alfonso-Cristancho R ，Alhabib S ，Ali R ，Alla F ，Allebeck P ，Almazroa MA ，Alsharif U ，Alvarez E ，Alvis-Guzman N ，Amare AT ，Ameh EA ，Amini H ，Ammar W ，Anderson HR ，Anderson BO ，Antonio CA ，Anwari P ，Arnlöv J ，Arsic Arsenijevic VS ，Artaman A ，Asghar RJ ，Assadi R ，Atkins LS ，Avila MA ，Awuah B ，Bachman VF ，Badawi A ，Bahit MC ，Balakrishnan K ，Banerjee A ，Barker-Collo SL ，Barquera S ，Barregard L ，Barrero LH ，Basu A ，Basu S ，Basulaiman MO ，Beardsley J ，Bedi N ，Beghi E ，Bekele T ，Bell ML ，Benjet C ，Bennett DA ，Bensenor IM ，Benzian H ，Bernabé E ，Bertozzi-Villa A ，Beyene TJ ，Bhala N ，Bhalla A ，Bhutta ZA ，Bienhoff K ，Bikbov B ，Biryukov S ，Blore JD ，Blosser CD ，Blyth FM ，Bohensky MA ，Bolliger IW ，Bora Başara B ，Bornstein NM ，Bose D ，Boufous S ，Bourne RR ，Boyers LN ，Brainin M ，Brayne CE ，Brazinova A ，Breitborde NJ ，Brenner H ，Briggs AD ，Brooks PM ，Brown JC ，Brugha TS ，Buchbinder R ，Buckle GC ，Budke CM ，Bulchis A ，Bulloch AG ，Campos-Nonato IR ，Carabin H ，Carapetis JR ，Cárdenas R ，Carpenter DO ，Caso V ，Castañeda-Orjuela CA ，Castro RE ，Catalá-López F ，Cavalleri F ，Çavlin A ，Chadha VK ，Chang JC ，Charlson FJ ，Chen H ，Chen W ，Chiang PP ，Chimed-Ochir O ，Chowdhury R ，Christensen H ，Christophi CA ，Cirillo M ，Coates MM ，Coffeng LE ，Coggeshall MS ，Colistro V ，Colquhoun SM ，Cooke GS ，Cooper C ，Cooper LT ，Coppola LM ，Cortinovis M ，Criqui MH ，Crump JA ，Cuevas-Nasu L ，Danawi H ，Dandona L ，Dandona R ，Dansereau E ，Dargan PI ，Davey G ，Davis A ，Davitoiu DV ，Dayama A ，De Leo D ，Degenhardt L ，Del Pozo-Cruz B ，Dellavalle RP ，Deribe K ，Derrett S ，Des Jarlais DC ，Dessalegn M ，Dharmaratne SD ，Dherani MK ，Diaz-Torné C ，Dicker D ，Ding EL ，Dokova K ，Dorsey ER ，Driscoll TR ，Duan L ，Duber HC ，Ebel BE ，Edmond KM ，Elshrek YM ，Endres M ，Ermakov SP ，Erskine HE ，Eshrati B ，Esteghamati A ，Estep K ，Faraon EJ ，Farzadfar F ，Fay DF ，Feigin VL ，Felson DT ，Fereshtehnejad SM ，Fernandes JG ，Ferrari AJ ，Fitzmaurice C ，Flaxman AD ，Fleming TD ，Foigt N ，Forouzanfar MH ，Fowkes FG ，Paleo UF ，Franklin RC ，Fürst T ，Gabbe B ，Gaffikin L ，Gankpé FG ，Geleijnse JM ，Gessner BD ，Gething P ，Gibney KB ，Giroud M ，Giussani G ，Gomez Dantes H ，Gona P ，González-Medina D ，Gosselin RA ，Gotay CC ，Goto A ，Gouda HN ，Graetz N ，Gugnani HC ，Gupta R ，Gupta R ，Gutiérrez RA ，Haagsma J ，Hafezi-Nejad N ，Hagan H ，Halasa YA ，Hamadeh RR ，Hamavid H ，Hammami M ，Hancock J ，Hankey GJ ，Hansen GM ，Hao Y ，Harb HL ，Haro JM ，Havmoeller R ，Hay SI ，Hay RJ ，Heredia-Pi IB ，Heuton KR ，Heydarpour P ，Higashi H ，Hijar M ，Hoek HW ，Hoffman HJ ，Hosgood HD ，Hossain M ，Hotez PJ ，Hoy DG ，Hsairi M ，Hu G ，Huang C ，Huang JJ ，Husseini A ，Huynh C ，Iannarone ML ，Iburg KM ，Innos K ，Inoue M ，Islami F ，Jacobsen KH ，Jarvis DL ，Jassal SK ，Jee SH ，Jeemon P ，Jensen PN ，Jha V ，Jiang G ，Jiang Y ，Jonas JB ，Juel K ，Kan H ，Karch A ，Karema CK ，Karimkhani C ，Karthikeyan G ，Kassebaum NJ ，Kaul A ，Kawakami N ，Kazanjan K ，Kemp AH ，Kengne AP ，Keren A ，Khader YS ，Khalifa SE ，Khan EA ，Khan G ，Khang YH ，Kieling C ，Kim D ，Kim S ，Kim Y ，Kinfu Y ，Kinge JM ，Kivipelto M ，Knibbs LD ，Knudsen AK ，Kokubo Y ，Kosen S ，Krishnaswami S ，Kuate Defo B ，Kucuk Bicer B ，Kuipers EJ ，Kulkarni C ，Kulkarni VS ，Kumar GA ，Kyu HH ，Lai T ，Lalloo R ，Lallukka T ，Lam H ，Lan Q ，Lansingh VC ，Larsson A ，Lawrynowicz AE ，Leasher JL ，Leigh J ，Leung R ，Levitz CE ，Li B ，Li Y ，Li Y ，Lim SS ，Lind M ，Lipshultz SE ，Liu S ，Liu Y ，Lloyd BK ，Lofgren KT ，Logroscino G ，Looker KJ ，Lortet-Tieulent J ，Lotufo PA ，Lozano R ，Lucas RM ，Lunevicius R ，Lyons RA ，Ma S ，Macintyre MF ，Mackay MT ，Majdan M ，Malekzadeh R ，Marcenes W ，Margolis DJ ，Margono C ，Marzan MB ，Masci JR ，Mashal MT ，Matzopoulos R ，Mayosi BM ，Mazorodze TT ，Mcgill NW ，Mcgrath JJ ，Mckee M ，Mclain A ，Meaney PA ，Medina C ，Mehndiratta MM ，Mekonnen W ，Melaku YA ，Meltzer M ，Memish ZA ，Mensah GA ，Meretoja A ，Mhimbira FA ，Micha R ，Miller TR ，Mills EJ ，Mitchell PB ，Mock CN ，Mohamed Ibrahim N ，Mohammad KA ，Mokdad AH ，Mola GL ，Monasta L ，Montañez Hernandez JC ，Montico M ，Montine TJ ，Mooney MD ，Moore AR ，Moradi-Lakeh M ，Moran AE ，Mori R ，Moschandreas J ，Moturi WN ，Moyer ML ，Mozaffarian D ，Msemburi WT ，Mueller UO ，Mukaigawara M ，Mullany EC ，Murdoch ME ，Murray J ，Murthy KS ，Naghavi M ，Naheed A ，Naidoo KS ，Naldi L ，Nand D ，Nangia V ，Narayan KM ，Nejjari C ，Neupane SP ，Newton CR ，Ng M ，Ngalesoni FN ，Nguyen G ，Nisar MI ，Nolte S ，Norheim OF ，Norman RE ，Norrving B ，Nyakarahuka L ，Oh IH ，Ohkubo T ，Ohno SL ，Olusanya BO ，Opio JN ，Ortblad K ，Ortiz A ，Pain AW ，Pandian JD ，Panelo CI ，Papachristou C ，Park EK ，Park JH ，Patten SB ，Patton GC ，Paul VK ，Pavlin BI ，Pearce N ，Pereira DM ，Perez-Padilla R ，Perez-Ruiz F ，Perico N ，Pervaiz A ，Pesudovs K ，Peterson CB ，Petzold M ，Phillips MR ，Phillips BK ，Phillips DE ，Piel FB ，Plass D ，Poenaru D ，Polinder S ，Pope D ，Popova S ，Poulton RG ，Pourmalek F ，Prabhakaran D ，Prasad NM ，Pullan RL ，Qato DM ，Quistberg DA ，Rafay A ，Rahimi K ，Rahman SU ，Raju M ，Rana SM ，Razavi H ，Reddy KS ，Refaat A ，Remuzzi G ，Resnikoff S ，Ribeiro AL ，Richardson L ，Richardus JH ，Roberts DA ，Rojas-Rueda D ，Ronfani L ，Roth GA ，Rothenbacher D ，Rothstein DH ，Rowley JT ，Roy N ，Ruhago GM ，Saeedi MY ，Saha S ，Sahraian MA ，Sampson UK ，Sanabria JR ，Sandar L ，Santos IS ，Satpathy M ，Sawhney M ，Scarborough P ，Schneider IJ ，Schöttker B ，Schumacher AE ，Schwebel DC ，Scott JG ，Seedat S ，Sepanlou SG ，Serina PT ，Servan-Mori EE ，Shackelford KA ，Shaheen A ，Shahraz S ，Shamah Levy T ，Shangguan S ，She J ，Sheikhbahaei S ，Shi P ，Shibuya K ，Shinohara Y ，Shiri R ，Shishani K ，Shiue I ，Shrime MG ，Sigfusdottir ID ，Silberberg DH ，Simard EP ，Sindi S ，Singh A ，Singh JA ，Singh L ，Skirbekk V ，Slepak EL ，Sliwa K ，Soneji S ，Søreide K ，Soshnikov S ，Sposato LA ，Sreeramareddy CT ，Stanaway JD ，Stathopoulou V ，Stein DJ ，Stein MB ，Steiner C ，Steiner TJ ，Stevens A ，Stewart A ，Stovner LJ ，Stroumpoulis K ，Sunguya BF ，Swaminathan S ，Swaroop M ，Sykes BL ，Tabb KM ，Takahashi K ，Tandon N ，Tanne D ，Tanner M ，Tavakkoli M ，Taylor HR ，Te Ao BJ ，Tediosi F ，Temesgen AM ，Templin T ，Ten Have M ，Tenkorang EY ，Terkawi AS ，Thomson B ，Thorne-Lyman AL ，Thrift AG ，Thurston GD ，Tillmann T ，Tonelli M ，Topouzis F ，Toyoshima H ，Traebert J ，Tran BX ，Trillini M ，Truelsen T ，Tsilimbaris M ，Tuzcu EM ，Uchendu US ，Ukwaja KN ，Undurraga EA ，Uzun SB ，Van Brakel WH ，Van De Vijver S ，van Gool CH ，Van Os J ，Vasankari TJ ，Venketasubramanian N ，Violante FS ，Vlassov VV ，Vollset SE ，Wagner GR ，Wagner J ，Waller SG ，Wan X ，Wang H ，Wang J ，Wang L ，Warouw TS ，Weichenthal S ，Weiderpass E ，Weintraub RG ，Wenzhi W ，Werdecker A ，Westerman R ，Whiteford HA ，Wilkinson JD ，Williams TN ，Wolfe CD ，Wolock TM ，Woolf AD ，Wulf S ，Wurtz B ，Xu G ，Yan LL ，Yano Y ，Ye P ，Yentür GK ，Yip P ，Yonemoto N ，Yoon SJ ，Younis MZ ，Yu C ，Zaki ME ，Zhao Y ，Zheng Y ，Zonies D ，Zou X ，Salomon JA ，Lopez AD ，Vos T ... -  《-》

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systema

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Bill & Melinda Gates Foundation.

GBD 2021 Diseases and Injuries Collaborators 《-》

UK health performance: findings of the Global Burden of Disease Study 2010.

The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010. We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures. For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4·2 years (95% UI 4·2-4·3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30-34 years, mortality rates have hardly changed (reduction of 3·7%, 95% UI 2·7-4·9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20-54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16-277), cirrhosis (65%, ?15 to 107), and drug use disorders (577%, 71-942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21·5% [95 UI 17·2-26·3] of YLDs), and musculoskeletal disorders (30·5% [25·5-35·7]). The leading risk factor in the UK was tobacco (11·8% [10·5-13·3] of DALYs), followed by increased blood pressure (9·0 % [7·5-10·5]), and high body-mass index (8·6% [7·4-9·8]). Diet and physical inactivity accounted for 14·3% (95% UI 12·8-15·9) of UK DALYs in 2010. The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response. Bill & Melinda Gates Foundation.

Murray CJ ，Richards MA ，Newton JN ，Fenton KA ，Anderson HR ，Atkinson C ，Bennett D ，Bernabé E ，Blencowe H ，Bourne R ，Braithwaite T ，Brayne C ，Bruce NG ，Brugha TS ，Burney P ，Dherani M ，Dolk H ，Edmond K ，Ezzati M ，Flaxman AD ，Fleming TD ，Freedman G ，Gunnell D ，Hay RJ ，Hutchings SJ ，Ohno SL ，Lozano R ，Lyons RA ，Marcenes W ，Naghavi M ，Newton CR ，Pearce N ，Pope D ，Rushton L ，Salomon JA ，Shibuya K ，Vos T ，Wang H ，Williams HC ，Woolf AD ，Lopez AD ，Davis A ... -  《-》

Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021.

GBD 2021 Forecasting Collaborators 《-》