Five insights from the Global Burden of Disease Study 2019

doi:10.1016/S0140-6736(20)31404-5

The Lancet

Volume 396, Issue 10258, 17–23 October 2020, Pages 1135-1159

https://doi.org/10.1016/S0140-6736(20)31404-5 Get rights and content

Summary

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.

Section snippets

Double down on catch-up development

In the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), a population's social and economic development status for each location-year is tracked on the basis of the Socio-demographic Index (SDI), which combines information on gross domestic product per capita, average years of schooling among individuals aged older than 25 years, and the total fertility rate among females under the age of 25 years (as a widely available inverse proxy for the status of girls and women in

The Millennium Development Goal health agenda has been working

Since around 2000, the global health community, including donors, has focused on reducing mortality of children and mothers, and the burden from three target conditions: tuberculosis, HIV, and malaria.2, 4, 5 Development Assistance for Health increased profoundly until 2010, but has since stagnated.⁶ The share of this assistance allocated to the Millennium Development Goal agenda has remained constant, even with the expanded Sustainable Development Goal health agenda in place since 2015. This

Health systems need to be more agile to adapt to the rapid shift to NCDs and disabilities

Countries in the low-middle and middle SDI quintiles have had rapid transitions from disease burden dominated by CMNN causes to burden dominated by NCDs and injuries. The low-middle quintile increased from 37·8% of total DALYs caused by NCDs and injuries in 1990 to 66·0% in 2019, with a similar pattern in the middle quintile as well.⁷ The GBD assessment of universal health coverage (UHC) allows disaggregation of coverage into interventions for CMNN diseases and NCDs (figure 3).⁸ Although

Public health is failing to address the increase in crucial global risk factors

The potential to improve health by risk reduction is well reported in GBD 2019.¹⁸ All risks quantified in GBD collectively account for 48% of global DALYs. Exposure to many risks highly correlated with SDI has been steadily decreasing as global SDI has increased, including household air pollution; child growth failure; and unsafe water, sanitation, and handwashing. Additionally, there have been notable decreases in exposure to smoking. Figure 4 shows the annualised rate of change in exposure

Social, fiscal, and geopolitical challenges of inverted population pyramids

As an extension of GBD, Vollset and colleagues²⁵ have developed population scenarios for 195 countries and territories to 2100. In 2019, 34 countries had negative natural rates of increase; in other words, the crude death rate was greater than the crude birth rate. When the natural rate of increase is negative, in the absence of net inmigration, populations will decrease. Two variables, female educational attainment and met contraceptive need, explain 80·5% of the variation in the completed

Conclusion

Success in reducing the disease burden from causes of CMNN diseases by global collective action to fund key programmes should be celebrated. Catch-up social and economic development is fuelling more rapid health progress in the lower SDI quintiles. But there is reason to believe that, although the past 70 years have largely been a story of sustained improvements in health, rising exposure to crucial risks, such as high BMI, high fasting plasma glucose, and ambient particulate matter pollution,

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The findings of this systematic review and meta-analysis indicate that there is an “inadequate” strength of evidence for the association between general individual or prenatal exposure to ambient PM and mtDNA-CN. Future research necessitates studies with more rigorous design, enhanced control of confounding factors, and improved measures of exposure to substantiate our findings.
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Rheumatic heart disease (RHD) is the most common acquired heart disease among children in developing countries. However, there is a lack of systematic studies on the epidemiology of pediatric RHD. This study aimed to report the burden of pediatric RHD at global, regional, and national levels between 1990 and 2019, which may provide some reference for policymakers.
The numbers and age-standardized rates (ASRs) of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for childhood RHD from 1990 to 2019 were analyzed based on data obtained from the Global Burden of Disease Study 2019 (GBD 2019). In addition, Joinpoint regression analysis was used to assess temporal trends in the burden of childhood RHD.
Globally, the number of incidence and prevalence cases of RHD in children increased by 41.89% and 40.88%, respectively, from 1990 to 2019. Age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) increased with an average annual percentage change (AAPC) of 0.75% and 0.66%, respectively. In contrast, the age-standardized DALY rate and age-standardized mortality rate (ASMR) decreased significantly since 1990 by an AAPC of −3.47% and − 2.65%, respectively. Girls had a significantly higher burden of RHD than boys during the study period. At the age level, the RHD burden was significantly highest in the age group of 10–14 years. Moreover, the ASRs of incidence, prevalence, mortality, and DALYs were negatively associated with sociodemographic index (SDI). Nationally, Fiji had the most significant increase in incidence and prevalence, and Philippines had the most remarkable rise in DALYs and mortality rates.
From 1990 to 2019, although the incidence and prevalence of childhood RHD increased globally, DALYs and mortality rates markedly reduced. Countries with lower levels of sociodemographic development shoulder a higher burden of childhood RHD. Children aged 10–14 years are critical populations for whom targeted measures are needed to reduce the RHD burden, while attention to girls cannot be neglected.
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Despite extensive research on the detrimental effects of air pollution on health, limited focus has been directed toward the impact of air pollution on child growth. Utilizing comprehensive data spanning 2759 Chinese counties from 2000 to 2018, this study pioneers an empirical investigation of the causal link between air pollution and child growth. The findings reveal a significant correlation between air pollution and child growth; as air pollution worsens, child growth suffers, evident in stunting, underweight, wasting, and severe wasting. More specifically, the effects of PM_2.5 on stunting, underweight, and severe wasting can persist for up to six years, while its impact on wasting endures for three years. Vulnerable groups include older children, girls, and less-developed geographical regions. Environmental regulations like “Low-Carbon Cities” and “Air Pollution Prevention and Control Action Plan” have yielded positive growth outcomes. Mechanistically, PM_2.5 impairs child growth via metabolic disruption and financial constraints. Collectively, this study offers empirical evidence of the adverse impacts of air pollution on child growth while proposing suggests strategies for addressing this challenge in developing countries.
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The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level.
In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923).
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Research Council of Norway and the Bill & Melinda Gates Foundation.

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^†: Collaborators are listed at the end of the paper

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ViewpointFive insights from the Global Burden of Disease Study 2019

Summary

Section snippets

Double down on catch-up development

The Millennium Development Goal health agenda has been working

Health systems need to be more agile to adapt to the rapid shift to NCDs and disabilities

Public health is failing to address the increase in crucial global risk factors

Social, fiscal, and geopolitical challenges of inverted population pyramids

Conclusion

Lancet

Lancet

Soc Sci Med

Lancet

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Lancet

Investing in development: a practical plan to achieve the millennium development goals

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Lancet

Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

BMC Infect Dis

Financing global health 2018: countries and programs in transition

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Lancet

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Lancet

SDG Indicators—Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development

US health care spending by payer and health condition, 1996–2016

JAMA

Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases

Noncommunicable diseases

Tracking the pharmaceutical pipeline: clinical trials and global disease burden

Clin Transl Sci

Viewpoint
Five insights from the Global Burden of Disease Study 2019