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Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Simon I Hay, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, et al. (2017) LANCET. 390(10100). p.1260-1344
abstract
Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
EPIDEMIOLOGIC TRANSITION, PLASMODIUM-FALCIPARUM, MORTALITY, AFRICA, HIV, ASSOCIATION, PREVALENCE, AUSTRALIA, THERAPY, WEIGHTS
journal title
LANCET
Lancet
volume
390
issue
10100
pages
1260 - 1344
Web of Science type
Article
Web of Science id
000410630000005
ISSN
0140-6736
1474-547X
language
English
UGent publication?
yes
classification
A1
copyright statement
Creative Commons Attribution 4.0 International Public License (CC-BY 4.0)
id
8533460
handle
http://hdl.handle.net/1854/LU-8533460
date created
2017-10-06 13:05:49
date last changed
2017-11-10 15:58:52
@article{8533460,
  abstract     = {Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). 
Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. 
Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95\% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3\% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1\% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. 
Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.},
  author       = {Hay, Simon I and Abajobir, Amanuel Alemu and Abate, Kalkidan Hassen and Abbafati, Cristiana and Abbas, Kaja M and Abd-Allah, Foad and Abdulle, Abdishakur M and Abebo, Teshome Abuka and Abera, Semaw Ferede and Aboyans, Victor and Abu-Raddad, Laith J and Ackerman, Ilana N and Adedeji, Isaac A and Adetokunboh, Olatunji and Afshin, Ashkan and Aggarwal, Rakesh and Agrawal, Sutapa and Agrawal, Anurag and Kiadaliri, Aliasghar Ahmad and Ahmed, Muktar Beshir and Aichour, Amani Nidhal and Aichour, Ibtihel and Aichour, Miloud Taki Eddine and Aiyar, Sneha and Akinyemiju, Tomi F and Akseer, Nadia and Al Lami, Faris Hasan and Alahdab, Fares and Al-Aly, Ziyad and Alam, Khurshid and Alam, Noore and Alam, Tahiya and Alasfoor, Deena and Alene, Kefyalew Addis and Ali, Raghib and Alizadeh-Navaei, Reza and Alkaabi, Juma M and Alkerwi, Ala'a and Alla, Francois and Allebeck, Peter and Allen, Christine and Al-Maskari, Fatma and AlMazroa, Mohammad AbdulAziz and Al-Raddadi, Rajaa and Alsharif, Ubai and Alsowaidi, Shirina and Althouse, Benjamin M and Altirkawi, Khalid A and Alvis-Guzman, Nelson and Amare, Azmeraw T and Amini, Erfan and Ammar, Walid and Ampem, Yaw Amoako and Ansha, Mustafa Geleto and Antonio, Carl Abelardo T and Anwari, Palwasha and Arnlov, Johan and Arora, Megha and Al Artaman, Al Artaman and Aryal, Krishna Kumar and Asgedom, Solomon W and Atey, Tesfay Mehari and Atnafu, Niguse Tadele and Avila-Burgos, Leticia and Avokpaho, Euripide Frinel G Arthur and Awasthi, Ashish and Awasthi, Shally and Quintanilla, Beatriz Paulina Ayala and Azarpazhooh, Mahmoud Reza and Azzopardi, Peter and Babalola, Tesleem Kayode and Bacha, Umar and Badawi, Alaa and Balakrishnan, Kalpana and Bannick, Marlena S and Barac, Aleksandra and Barker-Collo, Suzanne L and Barnighausen, Till and Barquera, Simon and Barrero, Lope H and Basu, Sanjay and Battista, Robert and Battle, Katherine E and Baune, Bernhard T and Bazargan-Hejazi, Shahrzad and Beardsley, Justin and Bedi, Neeraj and Bejot, Yannick and Bekele, Bayu Begashaw and Bell, Michelle L and Bennett, Derrick A and Bennett, James R and Bensenor, Isabela M and Benson, Jennifer and Berhane, Adugnaw and Berhe, Derbew Fikadu and Bernabe, Eduardo and Betsu, Balem Demtsu and Beuran, Mircea and Beyene, Addisu Shunu and Bhansali, Anil and Bhatt, Samir and Bhutta, Zulfiqar A and Biadgilign, Sibhatu and Bienhoff, Kelly and Bikbov, Boris and Birungi, Charles and Biryukov, Stan and Bisanzio, Donal and Bizuayehu, Habtamu Mellie and Blyth, Fiona M and Boneya, Dube Jara and Bose, Dipan and Bou-Orm, Ibrahim R and Bourne, Rupert RA and Brainin, Michael and Brayne, Carol EG and Brazinova, Alexandra and Breitborde, Nicholas JK and Briant, Paul S and Britton, Gabrielle and Brugha, Traolach S and Buchbinder, Rachelle and Bulto, Lemma Negesa Bulto and Bumgarner, Blair and Butt, Zahid A and Cahuana-Hurtado, Lucero and Cameron, Ewan and Ricardo Campos-Nonato, Ismael and Carabin, Helene and Cardenas, Rosario and Carpenter, David O and Carrero, Juan Jesus and Carter, Austin and Carvalho, Felix and Casey, Daniel and Castaneda-Orjuela, Carlos A and Rivas, Jacqueline Castillo and Castle, Chris D and Catala-Lopez, Ferran and Chang, Jung-Chen and Charlson, Fiona J and Chaturvedi, Pankaj and Chen, Honglei and Chibalabala, Mirriam and Chibueze, Chioma Ezinne and Chisumpa, Vesper Hichilombwe and Chitheer, Abdulaal A and Chowdhury, Rajiv and Christopher, Devasahayam Jesudas and Ciobanu, Liliana G and Cirillo, Massimo and Colombara, Danny and Cooper, Leslie Trumbull and Cooper, Cyrus and Cortesi, Paolo Angelo and Cortinovis, Monica and Criqui, Michael H and Cromwell, Elizabeth A and Cross, Marita and Crump, John A and Dadi, Abel Fekadu and Dalal, Koustuv and Damasceno, Albertino and Dandona, Lalit and Dandona, Rakhi and das Neves, Jose and Davitoiu, Dragos V and Davletov, Kairat and de Courten, Barbora and de Leo, Diego and De Steur, Hans and Degenhardt, Louisa and Deiparine, Selina and Dellavalle, Robert P and Deribe, Kebede and Deribew, Amare and Des Jarlais, Don C and Dey, Subhojit and Dharmaratne, Samath D and Dhillon, Preet K and Dicker, Daniel and Djalalinia, Shirin and Huyen Phuc Do, Huyen Phuc Do and Dokova, Klara and Doku, David Teye and Dorsey, E Ray and Bender dos Santos, Kadine Priscila and Driscoll, Tim R and Dubey, Manisha and Duncan, Bruce Bartholow and Ebel, Beth E and Echko, Michelle and El-Khatib, Ziad Ziad and Enayati, Ahmadali and Endries, Aman Yesuf and Ermakov, Sergey Petrovich and Erskine, Holly E and Eshetie, Setegn and Eshrati, Babak and Esteghamati, Alireza and Estep, Kara and Fanuel, Fanuel Belayneh Bekele and Farag, Tamer and Sofia, Carla and Farinha, Sa and Faro, Andre and Farzadfar, Farshad and Fazeli, Mir Sohail and Feigin, Valery L and Feigl, Andrea B and Fereshtehnejad, Seyed-Mohammad and Fernandes, Joao C and Ferrari, Alize J and Feyissa, Tesfaye Regassa and Filip, Irina and Fischer, Florian and Fitzmaurice, Christina and Flaxman, Abraham D and Foigt, Nataliya and Foreman, Kyle J and Franklin, Richard C and Frostad, Joseph J and Fullman, Nancy and Furst, Thomas and Furtado, Joao M and Futran, Neal D and Gakidou, Emmanuela and Garcia-Basteiro, Alberto L and Gebre, Teshome and Gebregergs, Gebremedhin Berhe and Gebrehiwot, Tsegaye Tewelde and Geleijnse, Johanna M and Geleto, Ayele and Gemechu, Bikila Lencha and Gesesew, Hailay Abrha and Gething, Peter W and Ghajar, Alireza and Gibney, Katherine B and Gillum, Richard F and Ginawi, Ibrahim Abdelmageem Mohamed and Gishu, Melkamu Dedefo and Giussani, Giorgia and Godwin, William W and Goel, Kashish and Goenka, Shifalika and Goldberg, Ellen M and Gona, Philimon N and Goodridge, Amador and Gopalani, Sameer Vali and Gosselin, Richard A and Gotay, Carolyn C and Goto, Atsushi and Goulart, Alessandra Carvalho and Graetz, Nicholas and Gugnani, Harish Chander and Gupta, Rajeev and Gupta, Prakash C and Gupta, Tanush and Gupta, Vipin and Gupta, Rahul and Gutierrez, Reyna A and Hachinski, Vladimir and Hafezi-Nejad, Nima and Hailu, Alemayehu Desalegne and Hailu, Gessessew Bugssa and Hamadeh, Randah Ribhi and Hamidi, Samer and Hammami, Mouhanad and Handal, Alexis J and Hankey, Graeme J and Hao, Yuantao and Harb, Hilda L and Hareri, Habtamu Abera and Haro, Josep Maria and Harun, Kimani M and Harvey, James and Hassanvand, Mohammad Sadegh and Havmoeller, Rasmus and Hay, Roderick J and Hedayati, Mohammad T and Hendrie, Delia and Henry, Nathaniel J and Heredia-Pi, Ileana Beatriz and Heydarpour, Pouria and Hoek, Hans W and Hoffman, Howard J and Horino, Masako and Horita, Nobuyuki and Hosgood, H Dean and Hostiuc, Sorin and Hotez, Peter J and Hoy, Damian G and Htet, Aung Soe and Hu, Guoqing and Huang, John J and Huynh, Chantal and Iburg, Kim Moesgaard and Igumbor, Ehimario Uche and Ikeda, Chad and Irvine, Caleb Mackay Salpeter and Jacobsen, Kathryn H and Jahanmehr, Nader and Jakovljevic, Mihajlo B and James, Peter and Jassal, Simerjot K and Javanbakht, Mehdi and Jayaraman, Sudha P and Jeemon, Panniyammakal and Jensen, Paul N and Jha, Vivekanand and Jiang, Guohong and John, Denny and Johnson, Catherine O and Johnson, Sarah Charlotte and Jonas, Jost B and Jurisson, Mikk and Kabir, Zubair and Kadel, Rajendra and Kahsay, Amaha and Kamal, Ritul and Kar, Chittaranjan and Karam, Nadim E and Karch, Andre and Karema, Corine Kakizi and Karimi, Seyed M and Karimkhani, Chante and Kasaeian, Amir and Kassa, Getachew Mullu and Kassebaum, Nicholas J and Kassaw, Nigussie Assefa and Kastor, Anshul and Katikireddi, Srinivasa Vittal and Kaul, Anil and Kawakami, Norito and Keiyoro, Peter Njenga and Kemmer, Laura and Kengne, Andre Pascal and Keren, Andre and Kesavachandran, Chandrasekharan Nair and Khader, Yousef Saleh and Khalil, Ibrahim A and Khan, Ejaz Ahmad and Khang, Young-Ho and Khoja, Abdullah T and Khosravi, Ardeshir and Khubchandani, Jagdish and Kieling, Christian and Kim, Yun Jin and Kim, Daniel and Kimokoti, Ruth W and Kinfu, Yohannes and Kisa, Adnan and Kissimova-Skarbek, Katarzyna A and Kissoon, Niranjan and Kivimaki, Mika and Knudsen, Ann Kristin and Kokubo, Yoshihiro and Kolte, Dhaval and Kopec, Jacek A and Kosen, Soewarta and Kotsakis, Georgios A and Koul, Parvaiz A and Koyanagi, Ai and Kravchenko, Michael and Krohn, Kristopher J and Defo, Barthelemy Kuate and Bicer, Burcu Kucuk and Kumar, G Anil and Kumar, Pushpendra and Kyu, Hmwe H and Lager, Anton Carl Jonas and Lal, Dharmesh Kumar and Lalloo, Ratilal and Lallukka, Tea and Lambert, Nkurunziza and Lan, Qing and Lansingh, Van C and Larsson, Anders and Leasher, Janet L and Lee, Paul H and Leigh, James and Leshargie, Cheru Tesema and Leung, Janni and Leung, Ricky and Levi, Miriam and Li, Yichong and Li, Yongmei and Liang, Xiaofeng and Liben, Misgan Legesse and Lim, Stephen S and Linn, Shai and Liu, Angela and Liu, Patrick Y and Liu, Shiwei and Liu, Yang and Lodha, Rakesh and Logroscino, Giancarlo and Looker, Katharine J and Lopez, Alan D and Lorkowski, Stefan and Lotufo, Paulo A and Lozano, Rafael and Lucas, Timothy CD and Lunevicius, Raimundas and Lyons, Ronan A and Macarayan, Erlyn Rachelle King and Maddison, Emilie R and Abd el Razek, Hassan Magdy and Magis-Rodriguez, Carlos and Mahdavi, Mahdi and Majdan, Marek and Majdzadeh, Reza and Majeed, Azeem and Malekzadeh, Reza and Malhotra, Rajesh and Malta, Deborah Carvalho and Mamun, Abdullah A and Manguerra, Helena and Manhertz, Treh and Mantovani, Lorenzo G and Mapoma, Chabila C and March, Lyn M and Marczak, Laurie B and Martinez-Raga, Jose and Henrique, Paulo and Martins, Viegas and Martins-Melo, Francisco Rogerlndio and Martopullo, Ira and Marz, Winfried and Mathur, Manu Raj and Mazidi, Mohsen and McAlinden, Colm and McGaughey, Madeline and McGrath, John J and Mckee, Martin and Mehata, Suresh and Meier, Toni and Meles, Kidanu Gebremariam and Memiah, Peter and Memish, Ziad A and Mendoza, Walter and Mengesha, Melkamu Merid and Mengistie, Mubarek Abera and Mengistu, Desalegn Tadese and Mensah, George A and Meretoja, Atte and Meretoja, Tuomo J and Mezgebe, Haftay Berhane and Micha, Renata and Millear, Anoushka and Miller, Ted R and Minnig, Shawn and Mirarefin, Mojde and Mirrakhimov, Erkin M and Misganaw, Awoke and Mishra, Shiva Raj and Mitchell, Philip B and Mohammad, Karzan Abdulmuhsin and Mohammadi, Alireza and Mohammed, Shafiu and Mohammed, Kedir Endris and Mohammed, Muktar Sano Kedir and Mohan, Murali BV and Mokdad, Ali H and Mollenkopf, Sarah K and Monasta, Lorenzo and Montanez Hernandez, Julio Cesar and Montico, Marcella and Moradi-Lakeh, Maziar and Moraga, Paula and Morawska, Lidia and Mori, Rintaro and Morrison, Shane D and Moses, Mark and Mountjoy-Venning, Cliff and Mruts, Kalayu Birhane and Mueller, Ulrich O and Muller, Kate and Mudoch, Michele E and Murthy, Srinivas and Murthy, Gudlavalleti Venkata Satyanarayana and Musa, Kamarul Imran and Nachega, Jean B and Nagel, Gabriele and Naghavi, Mohsen and Naheed, Aliya and Naidoo, Kovin S and Nangia, Vinay and Nasher, Jamal T and Natarajan, Gopalakrishnan and Negasa, Dumessa Edessa and Negoi, Ionut and Negoi, Ruxandra Irina and Newton, Charles R and Ngunjiri, Josephine Wanjiku and Cuong Tat Nguyen, Cuong Tat Nguyen and Quyen Le Nguyen, Quyen Le Nguyen and Grant Nguyen, Grant Nguyen and Trang Huyen Nguyen, Trang Huyen Nguyen and Minh Nguyen, Minh Nguyen and Nichols, Emma and Ningrum, Dina Nur Anggraini and Vuong Minh Nong, Vuong Minh Nong and Norheim, Ole F and Norrving, Bo and Noubiap, Jean Jacques N and Nyandwi, Alypio and Obermeyer, Carla Makhlouf and O'Donnell, Martin J and Ogbo, Felix Akpojene and Oh, In-Hwan and Okoro, Anselm and Oladimeji, Olanrewaju and Olagunju, Andrew Toyin and Olagunju, Tinuke Oluwasefunmi and Olsen, Helen E and Olusanya, Bolajoko Olubukunola and Olusanya, Jacob Olusegun and Ong, Kanyin and Opio, John Nelson and Oren, Eyal and Ortiz, Alberto and Osborne, Richard H and Osgood-Zimmerman, Aaron and Osman, Majdi and Ota, Erika and Owolabi, Mayowa O and Pa, Mahesh and Pacella, Rosana E and Panda, Basant Kumar and Pandian, Jeyaraj D and Papachristou, Christina and Park, Eun-Kee and Parry, Charles D and Parsaeian, Mahboubeh and Patil, Snehal T and Patten, Scott B and Patton, George C and Paudel, Deepak and Paulson, Katherine and Pearce, Neil and Pereira, David M and Perez, Krystle Marie and Perico, Norberto and Pesudovs, Konrad and Peterson, Carrie Beth and Petri, William Arthur and Petzold, Max and Phillips, Michael Robert and Phipps, Geoffrey and Pigott, David M and Pillay, Julian David and Pinho, Christine and Piradov, Michael A and Plass, Dietrich and Pletcher, Martin A and Popova, Svetlana and Poulton, Richie G and Pourmalek, Farshad and Prabhakaran, Dorairaj and Prasad, Narayan and Purcell, Carrie and Purwar, Manorama and Qorbani, Mostafa and Rabiee, Rynaz HS and Radfar, Amir and Rafay, Anwar and Rahimi, Kazem and Rahimi-Movaghar, Afarin and Rahimi-Movaghar, Vafa and Rahman, Mahfuzar and Rahman, Muhammad Aziz and Rahman, Mohammad Hifz Ur and Rai, Rajesh Kumar and Rajsic, Sasa and Ram, Usha and Ranabhat, Chhabi Lal and Rangaswamy, Thara and Rankin, Zane and Rao, Paturi Vishnupriya and Rao, Puja C and Rawaf, Salman and Ray, Sarah E and Reiner, Robert C and Reinig, Nikolas and Reitsma, Marissa and Remuzzi, Giuseppe and Renzaho, Andre MN and Resnikoff, Serge and Rezaei, Satar and Ribeiro, Antonio L and Roba, Hirbo Shore and Robinson, Stephen R and Rojas-Rueda, David and Rokni, Mohammad Bagher and Ronfani, Luca and Roshandel, Gholamreza and Roth, Gregory A and Rothenbacher, Dietrich and Roy, Ambuj and Rubagotti, Enrico and Ruhago, George Mugambage and Saadat, Soheil and Safdarian, Mahdi and Safiri, Saeid and Sagar, Rajesh and Sahathevan, Ramesh and Sahraian, Mohammad Ali and Salama, Joseph and Saleh, Muhammad Muhammad and Salomon, Joshua A and Salvi, Sundeep Santosh and Samy, Abdallah M and Sanabria, Juan Ramon and Dolores Sanchez-Nino, Maria and Santomauro, Damian and Santos, Joao Vasco and Santos, Itamar S and Milicevic, Milena M Santric and Sartorius, Benn and Satpathy, Maheswar and Sawhney, Monika and Saxena, Sonia and Schelonka, Kathryn and Schmidt, Maria Ines and Schneider, Ione JC and Ben Schottker, Ben Schottker and Schutte, Aletta E and Schwebel, David C and Schwendicke, Falk and Seedat, Soraya and Sepanlou, Sadaf G and Servan-Mori, Edson E and Shaheen, Amira and Shaikh, Masood Ali and Shamsipour, Mansour and Islam, Sheikh Mohammed Shariful and Sharma, Rajesh and Sharma, Jayendra and She, Jun and Shi, Peilin and Shibuya, Kenji and Shields, Chloe and Shiferaw, Mekonnen Sisay and Shigematsu, Mika and Shiri, Rahman and Shirkoohi, Reza and Shirude, Shreya and Shishani, Kawkab and Shoman, Haitham and Siabani, Soraya and Sibai, Abla Mehio and Sigfusdottir, Inga Dora and Silberberg, Donald H and Silva, Joao Pedro and Santos Silva, Diego Augusto and Alves Silveira, Dayane Gabriele and Singh, Jasvinder A and Singh, Virendra and Singh, Om Prakash and Singh, Narinder Pal and Sinha, Dhirendra Narain and Skiadaresi, Eirini and Skirbekk, Vegard and Slepak, Erica Leigh and Smith, David L and Smith, Mari and Sobaih, Badr HA and Sobngwi, Eugene and Soljak, Michael and Sorensen, Reed JD and Moraes Sousa, Tatiane Cristina and Sposato, Luciano A and Sufiyan, Muawiyyah Babale and Abdulkader, Rizwan Suliankatchi and Sunguya, Bruno F and Sur, Patrick J and Swaminathan, Soumya and Sykes, Bryan L and Sylte, Dillon and Szoeke, Cassandra EI and Tabares-Seisdedos, Rafael and Tadakamadla, Santosh Kumar and Taffere, Getachew Redae and Takala, Jukka S and Tandon, Nikhil and Tanne, David and Tarekegn, Yihunie L and Tavakkoli, Mohammad and Taveira, Nuno and Taylor, Hugh R and Tegegne, Teketo Kassaw and Tehrani-Banihashemi, Arash and Tekelab, Tesfalidet and Shifa, Girma Temam and Terkawi, Abdullah Sulieman and Tesfaye, Dawit Jember and Tesssema, Belay and Thakur, JS and Thamsuwan, Ornwipa and Theadom, Alice M and Theis, Andrew M and Thomas, Katie E and Thomas, Nihal and Thompson, Robert and Thrift, Amanda G and Tobe-Gai, Ruoyan and Tobollik, Myriam and Tonelli, Marcello and Topor-Madry, Roman and Tortajada, Miguel and Touvier, Mathilde and Traebert, Jefferson and Tran, Bach Xuan and Troeger, Christopher and Truelsen, Thomas and Tsoi, Derrick and Tuzcu, Emin Murat and Tymeson, Hayley and Tyrovolas, Stefanos and Ukwaja, Kingsley Nnanna and Undurraga, Eduardo A and Uneke, Chigozie Jesse and Updike, Rachel and Uthman, Olalekan A and Uzochukwu, Benjamin S. Chudi and van Boven, Job FM and Varughese, Santosh and Vasankari, Tommi and Veerman, Lennert J and Venkatesh, S and Venketasubramanian, Narayanaswamy and Vidavalur, Ramesh and Vijayakumar, Lakshmi and Violante, Francesco S and Vishnu, Abhishek and Vladimirov, Sergey K and Vlassov, Vasiliy Victorovich and Vollset, Stein Emil and Vos, Theo and Wadilo, Fiseha and Wakayo, Tolassa and Wallin, Mitchell T and Wang, Yuan-Pang and Weichenthal, Scott and Weiderpass, Elisabete and Weintraub, Robert G and Weiss, Daniel J and Werdecker, Andrea and Westerman, Ronny and Whiteford, Harvey A and Wijeratne, Tissa and Williams, Hywel C and Wiysonge, Charles Shey and Woldeyes, Belete Getahun and Wolfe, Charles DA and Woodbrook, Rachel and Woolf, Anthony D and Workicho, Abdulhalik and Xavier, Denis and Xu, Gelin and Yadgir, Simon and Yaghoubi, Mohsen and Yakob, Bereket and Yan, Lijing L and Yano, Yuichiro and Ye, Pengpeng and Yihdego, Mahari Gidey and Yimam, Hassen Hamid and Yip, Paul and Yonemoto, Naohiro and Yoon, Seok-Jun and Yotebieng, Marcel and Younis, Mustafa Z and Yu, Chuanhua and Zaidi, Zoubida and Zaki, Maysaa El Sayed and Zegeye, Elias Asfaw and Zenebe, Zerihun Menlkalew and Zhang, Xueying and Zheng, Yingfeng and Zhou, Maigeng and Zipkin, Ben and Zodpey, Sanjay and Zoeckler, Leo and Zuhlke, Liesl Joanna and Murray, Christopher JL},
  issn         = {0140-6736},
  journal      = {LANCET},
  keyword      = {EPIDEMIOLOGIC TRANSITION,PLASMODIUM-FALCIPARUM,MORTALITY,AFRICA,HIV,ASSOCIATION,PREVALENCE,AUSTRALIA,THERAPY,WEIGHTS},
  language     = {eng},
  number       = {10100},
  pages        = {1260--1344},
  title        = {Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016},
  volume       = {390},
  year         = {2017},
}

Chicago
Hay, Simon I, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Abdishakur M Abdulle, et al. 2017. “Global, Regional, and National Disability-adjusted Life-years (DALYs) for 333 Diseases and Injuries and Healthy Life Expectancy (HALE) for 195 Countries and Territories, 1990-2016 : a Systematic Analysis for the Global Burden of Disease Study 2016.” Lancet 390 (10100): 1260–1344.
APA
Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., et al. (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016. LANCET, 390(10100), 1260–1344.
Vancouver
1.
Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016. LANCET. 2017;390(10100):1260–344.
MLA
Hay, Simon I, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, et al. “Global, Regional, and National Disability-adjusted Life-years (DALYs) for 333 Diseases and Injuries and Healthy Life Expectancy (HALE) for 195 Countries and Territories, 1990-2016 : a Systematic Analysis for the Global Burden of Disease Study 2016.” LANCET 390.10100 (2017): 1260–1344. Print.