1.
GBD 2017: Global Results
November 2018

2.
2
1. Main findings
2. Definitions: GBD and DALYs
3. Population/fertility
4. Mortality
5. Life expectancy
6. Healthy life expectancy (HALE)
7. Years lost due to death and disability (DALYs)
8. Causes of death (YLLs)
9. Morbidity (YLDs)
10. Risk factors
11. SDGs
Outline

3.
Main findings
3
1. In 2017, the top three countries in life expectancy were Singapore
(84.8 years), Japan (84.2 years), and Switzerland (84.0 years); lowest
were Central African Republic (51.9 years), Lesotho (54.7 years), and
Mozambique (58.4 years).
However, the question is whether additional years are spent in good health or poor health –
global trends in non-communicable diseases (NCDs) indicate that more effort is needed to
increase healthy life expectancy.
2. Fertility: In 2017, 91 countries have total fertility rates below the
replacement rate of 2.05, while the opposite is true in 104 countries
where higher total fertility rates which may drive population increases.
3. While females tend to live longer than males, many of these additional
years are spent in poor health.
4. An unintended consequence of greater access to health care globally is
increases in mortality from diseases and disorders linked to antibiotic
resistance.

4.
Main findings (continued)
4
5. Among age groups, the under-5 age group experienced huge
reductions in mortality between 1950 and 2017, while adults
have made much less progress, particularly adult males.
6. HIV remains a massive public health threat, particularly
because global financing has plateaued, domestic health
spending has stayed low among high-burden countries, and its
incidence has not declined as quickly in younger as in older
populations.
7. Risk factors: high blood pressure and smoking are leading
global risk factors linked to early death and disability at all ages.
8. SDGs: Despite progress, achievement of SDGs by 2030 is in
doubt.
To meet SDGs, there is a need to increase progress on health-related
indicators between 2017 and 2030.

5.
What’s new in GBD 2017
5
Improved statistical methods, new and more data sources
1. For the first time, a comprehensive series of population
and fertility estimates were produced
2. Nineteen new causes of death and disability were added, for
a total of 359 causes
3. Mortality
• New population estimates led to substantial changes
in mortality estimates in many countries
• The analysis was extended to start in 1950

6.
5. SDGs: added four new indicators, producing estimates for
41 of 52 health-related SDG indicators
• Subnational analyses of SDGs for subset of countries
and analysis of trends by sex for select indicators
6. Risk factors:
• Bullying victimization added as new risk factor
• Examines how risks change according to level
of development
• More accurate method of estimating smoking risk
What’s new in GBD 2017 (continued)
6

7.
7
What is the Global Burden of Disease?
A systematic, scientific effort to
quantify the comparative magnitude of
health loss due to diseases, injuries,
and risk factors by age, sex, and
geographies for specific points in time.

8.
What is a disability-adjusted life year
(DALY)?
8

9.
Important new feature of GBD: comprehensive population
and fertility estimates produced for the first time.
The GBD study’s new estimates improve upon previously
available estimates in three key ways:
1. Precision. Current standard for population estimates is five-year
age groupings, but GBD estimates are for single years.
2. Standardization. GBD uses the same methodology to estimate
populations across locations, ensuring valid comparisons.
3. Transparency. All data sources/methods are published,
publicly accessible, and free.
Population/fertility
9

10.
Population growth rate, 2010–2017
Recent population growth has been
highest in Africa, Asia, and South America
10
• Global population increased from 2.6 billion in 1950 to 7.6 billion in 2017.
• Despite growth, approximately half of 195 countries recorded total fertility
rates below the replacement rate of approximately 2.05 in 2017.

11.
11
• Immigration can also drive increases in
population despite total fertility rates
below replacement level. This is the
case in several countries in the Middle
East (see top-left quadrant of figure).
• Of the 60 countries with a total fertility
rate of 3.0 or greater in 2017, most are
in sub-Saharan Africa, where the
proportion of women whose
contraceptive needs are being met is
46.5%.
Countries plotted by total fertility rate and population growth rate, 2017

12.
12
Fertility rates for females under 25, by number of countries, 2017
Fertility in females under 25 varies widely by country
• Among countries, total
fertility under age 25 ranged
from a low of 0.08 births to a
high of 2.4 births.
• Since 1990, countries have
achieved nearly universal
declines in fertility under age
25, which is a key indicator
for Sustainable
Development Goal 3.
• Still, in 50 countries, total
fertility was higher in
females younger than 25
than in those 30 or older.

13.
Highlights
1. Rapid progress in life expectancy from 1950 to 2017:
• Males, up from 48 years in 1950 to 71 years in 2017
• Females, up from 53 years in 1950 to 76 years in 2017
2. Among age groups, the under-5 age group experienced huge
reductions in mortality between 1950 and 2017, while adults
have made much less progress, particularly adult males.
3. While females tend to live longer than males, the gap in life
expectancy between them varies substantially by level of
socioeconomic development.
13
Mortality

14.
14
Total number of global deaths, 1950–2017
• The proportion of deaths in
those over age 75 increased
from 12% of total deaths in
1950 to 39% in 2017.
• There have been dramatic
declines in under-5 mortality,
but there were still 5.4 million
deaths among children under
5 worldwide in 2017.

15.
15
*SDI captures three different
aspects of development:
income, education, and fertility
Under-5 mortality by level of socioeconomic development, 1990–2017
• Declines in under-5 mortality
were fastest among countries
in the lowest quintile of
Socio-demographic Index
(SDI)*

16.
16
Life expectancy: Number of years a person is expected to live
based on their present age.
Healthy life expectancy (HALE): the number of years that a
person at a given age can expect to live in full health, taking into
account mortality and disability.
Highlights:
1. In 2017 globally, life expectancy at birth was 73 years,
but healthy life expectancy at birth was only 63 years.
• This means on average, 10 years of life were
spent in poor health in 2017.
2. While females tend to live longer than males, the gap in life
expectancy between them varies substantially by level
of socioeconomic development.
Life expectancy and healthy life expectancy

17.
17
Life expectancy at birth, both sexes, 2017
Life expectancy
There was rapid progress in life expectancy from 1950 to 2017:
• Males, up from 48 years in 1950 to 71 years in 2017
• Females, up from 53 years in 1950 to 76 years in 2017

18.
18
Life expectancy at birth by sex and level of socioeconomic development, 2017
Disparities in life expectancy
between males and females
were greatest in countries at
the high-middle and middle
levels of development.

19.
19
Healthy life expectancy at birth, both sexes, 2017
Healthy life expectancy (HALE)
• Globally, in 2017, life expectancy was 73 years, but HALE was only
63 years – on average, 10 years of life were spent in poor health in 2017.

20.
20
Performance in healthy life expectancy across regions
Healthy life expectancy
above or below expected
amount based on level of
development, GBD super-
regions, 2017

21.
21
Extra years lived by females compared to males
in good health versus poor health, 2017
While females tend to live
longer than males, many of
these extra years are spent in
poor health.

22.
22
Early death and disability is measured in terms of
disability-adjusted life years (DALYs).
Highlights
1. From 1990 to 2017, 41% decrease in
communicable diseases and neonatal disorders
2. From 1990 to 2017, 40% increase in
non-communicable diseases
3. Large disparities persist in health and disease
burden by sex and level of development
Disability-adjusted life years (DALYs)

23.
23
‡Ranking based on number of
all-ages DALYs
§SDI captures three different
aspects of development:
income, education, and fertility
COPD = chronic obstructive
pulmonary disease
Leading causes of early death and disability‡ at
lowest and highest levels of development, 2017

24.
24
Highlights
1. Between 1990 and 2017, early death from enteric infections,
respiratory infections and tuberculosis, and maternal and
neonatal disorders dropped, with the greatest declines in the
least developed countries.
2. Progress in reducing mortality from some common diseases
has stalled or reversed, primarily for non-communicable
diseases such as cardiovascular diseases and cancers.
3. An unintended consequence of increased access
to health care globally is increases in mortality from diseases
and disorders linked to antibiotic resistance.
Causes of death

25.
25
Leading causes of early death, 1990–2017
**Ranking based on number of years
lived with disability (YLLs) at all ages

26.
26
Change in mortality* due to extensively drug-resistant tuberculosis, 2007–2017
Since 2007, there have been rapid increases in emerging diseases and
disorders due to antibiotic use or resistance, including extensively
drug-resistant tuberculosis, cellulitis, and Clostridium difficile diarrhea.
*Reflects annual rate of change
in all-ages deaths per 100,000

27.
27
**Death rate at all ages
and for both sexes
Global mortality** from cardiovascular diseases, 2007–2017
• Medications that prevent
deaths from cardiovascular
diseases, such as those that
lower blood pressure and
cholesterol, are among the
most cost-effective
interventions available to
health systems.
• Despite this, mortality
from cardiovascular
diseases has increased
since 2007 worldwide.

28.
28
Years lived with disability (YLDs): Years of life lived with any
short-term or long-term health loss
Highlights
1. Globally, the total burden of YLDs increased by 52%
between 1990 and 2017.
2. The burden of disability was driven mainly by non-
communicable diseases (NCDs), which caused 80% of
YLDs in 2017.
3. Disability from metabolic conditions, such as type 2 diabetes
and fatty liver disease, increased around the world and
across levels of development.
Morbidity

29.
29
Number of total YLDs, global, both sexes, by age group and cause, 2017
• The burden of
disability is most
concentrated in
working-age
people.
• Years lived with
disability (YLDs)
represent time
lived in less-than-
ideal health.

30.
30
**Headache disorders mainly include migraine.
†Chronic obstructive pulmonary disease
Leading causes of global all-age disability, 1990 and 2017
While diabetes emerged as the
fourth-leading cause of disability
globally in 2017, many of the
leading causes of disability in
1990 remain so in 2017, namely
low back pain, headaches, and
depression.

31.
31
Annual change in rate of disability-adjusted life years (DALYs)
attributable to risk factors, both sexes, age-adjusted, 1990–2017
Risk factors: changes in early death and
disability attributable to risk factors

32.
32
Leading risk factors causing early death and disability, by sex, 2017
Risk factors
Smoking and high systolic
blood pressure are global
leading risk factors
*Rank based on number
of all-ages DALYs

33.
33
Regional** trends in high blood pressure and smoking
The disease burden caused by these two risk factors, compared to the burden expected
based on the level of socioeconomic development, varied considerably by super-region.
**GBD super-regions
High blood pressure Smoking

34.
34
About the SDG Index: The SDG index is a composite
measure, ranging from 0 to 100, of overall progress toward
meeting the SDGs. It takes into account 40 performance
indicators for the health-related SDGs.
This analysis of the health-related SDGs is based on
GBD 2017 estimates.
Highlights
1. Based on past trends, most countries’ SDG index scores
are projected to rise between 2017 and 2030.
2. By 2030, the under-5 mortality, neonatal mortality,
maternal mortality ratio, and malaria indicators had the
most countries likely to attain their targets.
Sustainable Development Goals

35.
35
Sustainable Development Goals Index* score, 2017
Global average SDG index score, 2017: 59.4

36.
36
Global rate of new cases
of HIV, 2017**
Global deaths due to
road injuries, 2017
Global prevalence of
alcohol use, 2017
**Median Estimates
†Heavier drinking was weighted more than light drinking
SDGs: Differences by sex in 2017

37.
37
Global under-5 mortality rate
Looking ahead to 2030: despite progress,
achievement of SDGs by 2030 is in doubt
SDG target:
Reduce under-5 mortality to
25 per 100,000 live births or
below by 2030

38.
38
Global maternal mortality ratio
Looking ahead to 2030: despite progress,
achievement of SDGs by 2030 is in doubt
SDG target:
Reduce maternal mortality
ratio to 70 per 100,000 live
births or below by 2030

39.
39
Global prevalence of overweight in children aged 2 to 4
Looking ahead to 2030: despite progress,
achievement of SDGs by 2030 is in doubt
SDG target:
Eliminate child
overweight by 2030

40.
Questions?
Media contacts
• Kelly Bienhoff
+1-206-897-2884 (office)
+1-913-302-3817 (mobile)
kbien@uw.edu
• Dean Owen
+1-206-897-2858 (office)
+1-206-434-5630 (mobile)
dean1227@uw.edu