Addressing such lapses in health equity can pose a burden to under-resourced health care systems and economies. It is increasingly evident that differential access to care, economic inequality, and imbalanced risk factor profiles can and do challenge the ability of health systems to achieve equitable health outcomes in the face of complex and resource-draining diseases and injuries. Across the global landscape, increased non-fatal health loss paradoxically reflects both success in terms of diminishing rates of premature death but also failure in terms of maintaining health care for diseased and injured individuals. In parallel with the increasing complexity of clinical medicine in the past century, measuring non-fatal health loss has necessitated continuous refinement as diagnostic classification systems expand, new diseases emerge, and metrics of disability improve. The evolution of modern health-care systems has led to an increasing number of diseases and injuries being diagnosed and treated in individual patients, and developments such as antihypertensive and statin medications, percutaneous coronary intervention, and antiretroviral therapies have led to averted deaths and longer lives. Measuring non-fatal health loss is one of the most complex endeavours in population health research. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases per 100 000 in males vs s1400 per 100 000 in females), transport injuries (3322 vs 2336 ), and self-harm and interpersonal violence (3265 vs 5643 ). We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes.

The increases for males and females were similar, with increases in all-age YLD rates of 7♹% (6♶–9♲) for males and 6♵% (5♴–7♷) for females. All-cause age-standardised YLD rates decreased by 3♹% (95% uncertainty interval 3♱–4♶) from 1990 to 2017 however, the all-age YLD rate increased by 7♲% (6♰–8♴) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 19. Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 19. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity.

We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.

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