Global Health Metrics
S2 www.thelancet.com Vol 396 October 17, 2020
Figure 1: Composition of DALYs by constituent Level 2 causes for both sexes combined, 2019
Neglected tropical
diseases and malaria
Nutritional deﬁciencies
HIV/AIDS and sexually
transmitted infections
Respiratory infections
and tuberculosis
Enteric infections
Other infectious diseases
Maternal and neonatal
disorders
Total
sources
Incidence 24948
Prevalence 8671
Remission 7
Causes of death 6303
Other 22449
Table 1:Total sources used in
GBD 2019 estimation
What is new in GBD 2019?
•	 Where applicable, both-sex and wide-age-binned data were split before non-fatal modelling. Adjustment for
alternative study methods and case definitions were applied to data before analysis in DisMod-MR 2.1.
•	 A systematic review found 81 new data sources for both maternal deaths and non-fatal outcomes.
•	 Clinical administrative data processing was revised to better account for the ratio of neonatal inpatient to outpatient visits.
•	 Improved redistribution of sepsis and jaundice garbage-coded deaths led to changes in cause-specific mortality
assessment for neonatal disorders, especially in the post-neonatal period.
•	 Model-specific covariates were updated for both cause-of-death and non-fatal modelling for nutritional deficiencies.
Prevalence Incidence Deaths YLLs YLDs DALYs
Cases
(millions)
Rate (per
100 000)
Cases
(millions)
Rate (per
100 000)
Deaths
(millions)
Rate (per
100 000)
Counts
(millions)
Rate (per
100 000)
Counts
(millions)
Rate (per
100 000)
Counts
(millions)
Rate (per
100 000)
2019
Both sexes 4540
(4420 to
4650)
58 287·4
(56 841·8 to
59 728·8)
26 400
(24 600 to
28 500)
346 347·1
(321 319·5to
374 145·2)
10·2
(9·19 to
11·4)
140·7
(126·8 to
157·9)
564
(498 to
653)
8106·0
(7096·7 to
9392·4)
104
(77·1 to
137)
1377·3
(1016·8 to
1811·6)
669
(593 to
758)
9483·4
(8394·5 to
10 801·7)
Females 2350
(2290 to
2410)
60 553·8
(59 080·0 to
62 023·6)
13 000
(12 100 to
14 000)
342 135·6
(317 260·2to
369 373·5)
4·85
(4·30 to
5·52)
130·7
(115·4 to
148·3)
263
(232 to
301)
7704·8
(6764·5 to
8858·5)
56·0
(41·1 to
74·1)
1484·6
(1088·9 to
1964·8)
319
(283 to
360)
9189·4
(8098·3 to
10 408·1)
Males 2180
(2120 to
2240)
56 034·1
(54 541·1 to
57 546·1)
13 500
(12 500 to
14 500)
350 854·1
(326 058·9
to379 037·3)
5·34
(4·82 to
6·02)
152·7
(137·6 to
171·9)
301
(263 to
350)
8511·9
(7408·9 to
9950·5)
48·3
(35·8 to
63·4)
1272·5
(939·5 to
1668·3)
349
(309 to
399)
9784·5
(8628·8 to
11 226·3)
Percentage change 2010–19
Both sexes 7·1%
(6·3 to
7·9)
–3·5%
(–4·3 to
–2·8)
12·6%
(11·5 to
13·7)
2·5%
(1·6 to
3·4)
–19·3%
(–25·1 to
–12·6)
–27·6%
(–33·0 to
–21·5)
–27·8%
(–34·8 to
–19·5)
–30·9%
(–37·8 to
–22·8)
9·1%
(7·2 to
11·6)
–0·3%
(–2·0 to
1·9)
–23·8%
(–30·1 to
–16·4)
–27·7%
(–34·0 to
–20·4)
Females 8·0%
(7·2 to
8·7)
–3·0%
(–3·8 to
–2·4)
12·6%
(11·5 to
13·8)
2·4%
(1·4 to
3·4)
–19·6%
(–25·6 to
–12·0)
–28·5%
(–34·2 to
–21·8)
–29·0%
(–35·7 to
–21·0)
–32·1%
(–38·9 to
–24·3)
9·2%
(7·3 to
11·3)
–0·5%
(–2·1 to
1·4)
–24·3%
(–30·4 to
–17·3)
–28·4%
(–34·4 to
–21·3)
Males 6·2%
(5·3 to
7·1)
–4·1%
(–4·9 to
–3·3)
12·6%
(11·5 to
13·7)
2·6%
(1·6 to
3·5)
–19·0%
(–25·4 to
–12·1)
–26·9%
(–32·5 to
–20·6)
–26·7%
(–34·2 to
–18·2)
–29·8%
(–37·1 to
–21·2)
9·1%
(6·8 to
12·0)
–0·2%
(–2·3 to
2·4)
–23·2%
(–30·0 to
–15·7)
–27·0%
(–33·6 to
–19·4)
Numbers in parentheses are 95% uncertainty intervals.
Table 2: Global prevalence, incidence, deaths,YLLs,YLDs, and DALYs in counts and age-standardised rates for both sexes combined, females, and males, 2019, with percentage change
between 2010 and 2019
Deaths YLLs YLDs DALYs
1990 2nd 1st 2nd 1st
2010 2nd 2nd 2nd 2nd
2019 2nd 2nd 2nd 2nd
Table 3: Rank among Level 1 causes for global deaths,YLLs,YLDs, and
DALYs in 1990, 2010, and 2019, for both sexes combined
Communicable, maternal, neonatal, and nutritional diseases—Level 1 cause
SummaryCMNN diseases caused 10·2 million (95% UI 9·19–11·4) deaths, 669 million (593–758) DALYs, and 104 million (77·1–137) YLDs in 2019 globally for all
ages, which represented a 36·3% (29·1–42·3) decrease in deaths, a 44·4% (37·4–50·5) decrease in DALYs, and a 22·1% (18·2–26·8) increase in YLDs from 1990.
Definition This aggregate cause contains seven Level 2 causes: HIV/AIDS and sexually transmitted infections, respiratory infections and tuberculosis, enteric
infections, neglected tropical diseases and malaria, other infectious diseases, maternal and neonatal disorders, and nutritional deficiencies.
Global Health Metrics
S3www.thelancet.com Vol 396 October 17, 2020
Figure 4: Composition of DALYs byYLLs andYLDs, age group, and sex, 2019
YLDs
YLLs
Females
YLDs
YLLs
Males
Earlyneonatal
Lateneonatal
Postneonatal
1–4years
5–9years
10–14years
15–19years
20–24years
25–29years
30–34years
35–39years
40–44years
45–49years
50–54years
55–59years
60–64years
65–69years
70–74years
75–79years
80–84years
85–89years
90–94years
≥95years
Age group
0
50 000
100 000
150 000
200 000
DALYs(inthousands)
Figure 3: Age-standardised DALY rates for each location by SDI, both sexes combined, 2019
Figure 5: Age-standardised DALY rates (per 100 000) by location, both sexes combined, 2019
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0
10
000
20
000
30
000
40
000
50
000
60
000
0 50 100
SDI
DALY
rate
(per
100
000)
Figure2: Percentage of DALYs attributabletotop risk factors for both sexes combined, 2019
Low birthweight
Short gestation
Child wasting
Unsafe water source
Household air pollution from solid fuels
Unsafe sanitation
Unsafe sex
No access to handwashing facility
Iron deﬁciency
Child underweight
0 10 20 30
Percentage
Caribbean and central America Persian Gulf The Balkans Southeast Asia
West Africa
Northern Europe
Eastern
Mediterranean
Latin America and Caribbean
Central Europe, eastern Europe, and central Asia
Sub-Saharan Africa
High income
North Africa and Middle East
South Asia Southeast Asia, east Asia, and Oceania
GBD super-region
<1009·5 3549·8 – <4920·8
1009·5 – <1374·6 4920·8 – <7767·6
1374·6 – <1689·9 7767·6 – <12 806·7
1689·9 – <2578·1 12 806·7 – <21 320·1
2578·1 – <3549·8 21 320·1 – ≤52 129·2