Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. 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. 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 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. 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 updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

I. Encuentro de la Red de Asentamientos Populares : aportes teórico-metodológicos para la reflexión sobre políticas públicas de acceso al hábitat

Contenidos Introducción / M. Cecilia Marengo, Ana Laura Elorza, Virginia Monayar ; Eje 1. Acceso al hábitat y urbanizaciones informales; Asentamientos (in)formales en pequeñas metrópolis del Cono Sur. Estado de situación y debate actual / Ricardo Apaolaza, Elizabeth Zenteno Torres, Marco Sumiza; Un análisis comparativo sobre la expansión de asentamientos populares en las ciudades patagónicas / Santiago Bachiller, Mariana Giaretto, Pablo Marigo, Natalia Usach ; Acceso al Hábitat para los ¨sin techo¨: la lucha por la tierra en la Ciudad de Posadas-Misiones / Myriam Elena Barone, Jonas Dumas, Mariela Dachary, Celia Draganchuk; El mercado informal de suelo y vivienda en resistencia. El caso del asentamiento en "La Rubita" Resistencia, Argentina / María Andrea Benitez, María Victoria Cazorla; Brazos Unidos un realojo en construcción colectiva / Borelli, Lily, Halich, Verónica; Transformaciones en el hábitat de asentamientos informales y políticas públicas sociales. El caso de barrio nuestro hogar III / Renzo Cáceres; Discursividad mediática sobre el acceso y producción del hábitat popular en el barrio Costanera / Debora Leticia Decima; Trayectorias residenciales y usos de la ciudad como clave de lectura de la lucha por el acceso a la ciudad / María Mercedes Di Virgilio, Natalia Cosacov, Denise Brikman, Mercedes Najman; Asentamientos en el borde metropolitano. Avances de investigación, reflexiones y preguntas / Lucas Jordán Dombroski; Repensando el acceso al hábitat en ciudades medias. La problemática habitacional de Tandil / Agustina Girado; Narrativas de un asentamiento de comienzos de siglo: más allá de la épica y la mafia / María Maneiro; Informalidad y periferia urbana. Derivas de la política habitacional / M. Cecilia Marengo, Virginia Monayar, Florencia Sosa; Sobre las ¿nuevas? ocupaciones de tierras. Notas para una periodización de las tomas en San Francisco Solano, 1981-2002 / Santiago Nardin Memorias villeras en disputa sobre las intervenciones estatales de erradicación en Villa 20 (1976-1983) / Julieta Oxman; El Centro para Erradicación de Villas de Emergencia. Planificación, censo y viviendas, Rosario (1964-1983) / Anahí G. Pagnoni; Ensayo de una cartografía de asentamientos informales en la Ciudad de Córdoba / German Gustavo Rebord, Andrea Karina Stiefkens; Urbanización y prácticas estatales en asentamientos populares en Comodoro Rivadavia. El caso del “Barrio las Américas” / Letizia Vázquez; Eje 2: Derecho a la ciudad: conflictos y disputas por el territorio urbano; La ciudad contra el barrio. El caso de los Barrios del Sur en San José de Costa Rica / Pablo Acuña Quiel; Procesos autogestionarios de hábitat popular y políticas urbanas en la ciudad de Ushuaia. Tierra del Fuego. Argentina / Alicia Delia Alcaráz; Conflictos y tensiones en la ocupación del suelo en Posadas. Misiones, Argentina: procesos de diferenciación / Lucia Mariana Andrujovich, Laura Josefa Krujoski,Myriam Elena Barone; Políticas públicas, exclusión y conformación de identidades colectivas / Sandra Raquel Ávalos; La reurbanización del Playón de Chacarita como problema público. Arenas, actores y políticas públicas / Joaquín Benítez; Relocalización, organización y derecho a la ciudad. El caso de Barrio Nuevo (La Plata) / María Sofía Bernat; Resistencias y disputas político-judiciales en casos de desalojos de asentamientos en Buenos Aires / María Cristina Cravino; Análisis de las herramientas territoriales de la organización ArqCom (LP) en el periodo 2012-2018 / Andrea Di Croce Garay, Nahir Meline Cantar, Ángeles Belén Carrizo Romero, Tamara Dileo; Planificación y urbanización del Barrio 31 y 31 bis / Rosana Karina Espejo; Mercado de suelo: tensiones y ambigüedades. El caso de la zona Norte de Resistencia, Chaco, Argentina / Sebastián Galvaliz, María del Rosario Olmedo; Marta Graciela Giró; Experiencias de urbanización y ciudadanización en La Carbonilla. Una propuesta de análisis en escalas / María Belén Garibotti, Luciana Boroccioni, María Florencia Girola ¿Integración? A la trama formal. De complejidades a desafíos / Carolain Izaguirre, Marion Tejera y Carolina Leiva; ¿Urbanizar o aniquilar? Disyuntivas ontológicas en los procesos de urbanización de las sierras de Córdoba / Denise Mattioli; Conflicto y construcción de resistencias en el asentamiento Barrio Flores / Emilia Elisa Molina; Conflictos territoriales y recualificación de la ribera. Los pescadores artesanales y los espacios públicos / Diego Roldán; El Bajo Belgrano: del Barrio de las Latas a la Villa 30 / Valeria Laura Snitcofsky; Líneas de fuga en un barrio de resistencia. Visualización de una lucha / Rafael Ramón Franco Spatuzza; Nuevas legalidades para la reurbanización de villas en CABA. Un desafío para los derechos / Agustín Territoriale, María Julia López; Los Vacíos Urbanos. Dinámicas Urbanas y Respuestas Innovadoras frente al Derecho a la Ciudad / Ezequiel Zeitune, Silvia A Politi, Natalia Czytajlo; Eje 3: Políticas públicas para atender la informalidad y de gestión en el hábitat popular; Tolerancia y precariedad. Advertencias de la política de regularización del Gran Resistencia al RENABAP / Miguel Ángel Barreto, Evelyn Roxana Abildgaard, María Laura Puntel; Adicciones y narcomenudeo, barreras (in) franqueables para los asentamientos informales en Tucumán, Argentina / Paula Boldrini; Políticas de relocalización de villas: ¿qué pasa después? La organización consorcial como práctica comunitaria / María Florencia Bruno, Belén Demoy, Natalia Fainburg, Romina Olejarczyk; La disputa por la participación y la noción de participación en disputa: una reflexión desde el proceso de urbanización de la Villa 31 (2015-2019) / Tomás Capalbo; Economía popular en asentamientos informales del Gran San Miguel de Tucumán / Corina María Cattáneo; La producción de territorialidades en el habitar un asentamiento: procesos de intervención estatal y disociaciones socio espaciales / Magali Chanampa; Estrategias de gestión territorial desde las políticas públicas: replicando el “modelo Medellín” con acento Cordobés / Ana Laura Elorza, Mónica Alvarado Rodríguez, Fani Balcazar, Ernesto Morillo, Mariana Gamboa; Discusiones sobre la conceptualización e identificación de asentamientos informales. Análisis de la realidad en Chubut / María Paula Ferrari, Sergio Andrés Kaminker, Roxana Yanina Velásquez; Barrios autoproducidos en ciudades intermedias. El caso de Río Grande, Tierra del Fuego AIAS / Nadia B. Finck; Luces y sombras del Programa Compra de Vivienda Usada / Elena Inés Gabriel Hernández; Programas de Inclusión Socio-Urbana: ¿Producto de última generación de la Nueva Agenda Urbana? / Fernando Murillo, Gabriel Artese, Andrés Mage; Los dispositivos de espera en las políticas habitacionales / Romina Olejarczyk; Tres debates recurrentes acerca de la vivienda para la población urbana de menores ingresos / Juan Santiago Palero; Nuevos asentamientos precarios: un desafío a la Política Habitacional y Urbana Chilena / Rubén Sepúlveda Ocampo, Felipe Núñez Orrego; Irrumpir con las recetas. Reflexiones en torno a desarrollo, políticas públicas y hábitat popular / Carla Eleonora Pedrazzani, María Inés Sesma.Esta publicación presenta los trabajos del I. Encuentro de la Red de Asentamientos Populares: aportes teórico -metodológicos para la reflexión sobre políticas públicas de acceso al hábitat, desarrollado los días 23 y 24 de mayo de 2019 en la Facultad de Arquitectura, Urbanismo y Diseño de la Universidad Nacional de Córdoba. En las últimas dos décadas, el INVIHAB (Instituto de Investigación de Vivienda y Hábitat) se ha conformado como un espacio de referencia en la investigación, transferencia y formación en temáticas relativas a las políticas de vivienda, territorio, informalidad urbana, ambiente y ciudadanía. Experiencia que ha llevado a la articulación con otros espacios académicos, organizaciones socio-territoriales, gobiernos locales, en el sentido de confluir en la comprensión, reflexión y formulación de propuestas para mitigar las desigualdades socioterritoriales. En este escenario, se viene construyendo una red de investigadores que estudian la informalidad urbana desde diversos enfoques -territoriales, físico-espaciales, sociales, urbanos, laborales, entre otros- tendientes a superar las miradas parciales y locales desde los abordajes teórico metodológicos y propiciar la comprensión del fenómeno desde una perspectiva que abarque la multiplicidad de campos y su complejidad.FIL: Marengo, María Cecilia. Universidad Nacional de Córdoba. Facultad de Arquitectura, Urbanismo y Diseño; Argentina.FIL: Elorza, Ana Laura. Universidad Nacional de Córdoba. Facultad de Arquitectura, Urbanismo y Diseño; Argentina.FIL: Monayar, Virginia. Universidad Nacional de Córdoba. Facultad de Arquitectura, Urbanismo y Diseño; Argentina

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.; We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. 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. 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 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. 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 updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. 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. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.; We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health