People in Denmark are living longer, but healthy life expectancy has increased more slowly and a complex mix of fatal and nonfatal ailments cause a tremendous amount of health loss, according to a new analysis of 306 diseases and injuries in 188 countries.
Thanks to marked declines in death and illness caused by HIV/AIDS and malaria in the past decade and significant advances made in addressing communicable, maternal, neonatal, and nutritional disorders, health has improved significantly around the world. Global life expectancy at birth for both sexes rose by 6.2 years (from 65.3 in 1990 to 71.5 in 2013), while healthy life expectancy at birth rose by 5.4 years (from 56.9 in 1990 to 62.3 in 2013).
Healthy life expectancy takes into account not just mortality but the impact of nonfatal conditions and summarizes years lived with disability and years lost due to premature mortality. The increase in healthy life expectancy has not been as dramatic as the growth of life expectancy, and as a result, people are living more years with illness and disability.
This is true in Denmark. Life expectancy gains for men since 1990, 5.5 years, exceeded those for women, 4.2 years, and while men gained 4.6 years of healthy life expectancy women gained 3.2 years. But life expectancy for women in Denmark still outpaces that of men, 82 years compared to 77.8 years.
“Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition” is the first study to examine fatal and nonfatal health loss across countries. Published in The Lancet on August 27, the study was conducted by an international consortium of researchers working on the Global Burden of Disease study and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
For most countries, changes in healthy life expectancy for males and females between 1990 and 2013 were significant and positive, but in dozens of countries, including Botswana, Belize, and Syria, healthy life expectancy in 2013 was not significantly higher than in 1990.
“It’s encouraging to see life expectancy for people in Denmark steadily climbing,” said Dr. Thomas Truelsen of Rigshospitalet, University of Copenhagen Department of Neurology and a co-author of the study. “But healthy life expectancy needs to keep pace if we are going to live both long and healthy lives. These data give us a big-picture view of Danish health to address the causes of health loss that are having the most severe impact.”
The study’s researchers use DALYs, or disability-adjusted life years, to compare the health of different populations and health conditions across time. One DALY equals one lost year of healthy life and is measured by the sum of years of life lost and years lived with disability.
In Denmark, the leading causes of health loss, as measured by DALYs, in 2013 were low back and neck pain, ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), stroke, lung cancer, Alzheimer’s disease, falls, depressive disorders, skin disorders, and colorectal cancer. Many of these conditions, including lung cancer, and Alzheimer’s disease, were not among the leading causes of health loss globally.
The study also examines the role that socio-demographic status – a combination of per capita income, population age, fertility rates, and average years of schooling – plays in determining health loss. Researchers’ findings underscore that this accounts for more than half of the differences seen across countries and over time for certain leading causes of DALYs, including maternal and neonatal disorders. But the study notes that socio-demographic status is much less responsible for the variation seen for ailments including cardiovascular disease and diabetes.
“Factors including income and education have an important impact on health but don’t tell the full story,” said IHME Director Dr. Christopher Murray. “Looking at healthy life expectancy and health loss at the country level can help guide policies to ensure that people everywhere can have long and healthy lives no matter where they live.”
Leading causes of health loss or DALYs in Denmark for both sexes, 2013
- Low back and neck pain
- Ischemic heart disease
- Lung Cancer
- Alzheimer’s disease
- Depressive disorders
- Skin disorders
- Colorectal cancer
Download the study
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.