Abstract
Background The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. Methods To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modifi ed based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fi t vital registration data corrected for misclassifi cation of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifi cations, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specifi c mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. Findings Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. Interpretation Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. Incidence rates for HIV, tuberculosis, and malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. Funding Bill & Melinda Gates Foundation.
| Original language | English |
|---|---|
| Pages (from-to) | 1005-1070 |
| Number of pages | 66 |
| Journal | The Lancet |
| Volume | 384 |
| Issue number | 9947 |
| DOIs | |
| Publication status | Published - 2014 Jan 1 |
Bibliographical note
Funding Information:We thank the countless individuals who have contributed to the Global Burden of Disease Study 2013 in various capacities. We would like to acknowledge the extensive support from all staff members at the Institute for Health Metrics and Evaluation and specifically thank: Michael F MacIntyre, Peter Speyer, and Summer Lockett Ohno for their management of the Global Burden of Disease Study 2013; Kelsey Pierce for her valuable assistance; Peter Speyer, James Bullard, Serkan Yalcin, Edgar Sioson, Evan Laurie, Charles Atkinson, and Andrew Ernst for their tireless support of the computational infrastructure necessary to produce the results; Linda A Ettinger for her expert administrative support; Peter Speyer, Abigail McLain, James Hancock, Marissa Iannarone, and Eden Stork for their persistent and invaluable work to gain access to and catalogue as much data as possible to inform the estimates; Stan Biryukov for his assistance with the tuberculosis database; Henry Apfel and Madeline Moyer for data extraction and processing; Christopher Margono, Michelle Subart, Lavanya Singh and Margaret Lind for assistance with galleys; Matthew M Coates, Carly E Levitz, Chelsea A Lidell, Meghan D Mooney, and Austin E Schumaker for production of all-cause mortality estimates; Amelia Bertozzi-Villa for review of Python coding of the Spectrum model. We would also like to acknowledge Mary Mahy, Keith Sabin and John Stover for sharing the UNAIDS EPP files with us and especially John Stover for responding to multiple queries regarding Spectrum. Additionally, Ibrahim Abubakar would like to acknowledge the UK National Institute for Health Research and MRC for funding. Laith J Abu-Raddad would like to acknowledge the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-IHME effort. Gabriel Alcalá-Cerra would like to acknowledge institutional support from Health Sciences and Neurosciences (CISNEURO) Research Group. Louisa Degenhardt is supported by an Australian National Health and Medical Research Council Principal Research Fellowship ( #1041742 ). Dr. Des Jarlais would like to acknowledge funding from NIH Grant DA R01 003574 . KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine [ grant number 099876 ]. Prof. Giuseppe Remuzzi would like to acknowledge the International Society of Nephrology (ISN) for their support of his involvement in the GBD 2013. JAS is supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (AHRQ CERTs) U19 HS021110 , National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) P50 AR060772 and U34 AR062891 , National Institute of Aging (NIA) U01 AG018947 , National Cancer Institute (NCI) U10 CA149950 , and research contract CE-1304-6631 from the Patient Centered Outcomes Research Institute (PCORI). JAS is also supported by the resources and the use of facilities at the VA Medical Center at Birmingham, Alabama, USA. Dr. Soneji was supported by the National Center for Advancing Translational Sciences grant number KL2TR001088. Karen M Tabb would like to acknowledge her current support: Lemann Institute Faculty Research Grant, University of Illinois. Andrew J Vallely is supported by a Training Fellowship from the National Health and Medical Research Council (NHMRC), Australia. Gelin Xu is currently funded by the Nature Science Foundation of China ( NSFC, 81070922 ). No individuals acknowledged received additional compensation for their efforts.
ASJC Scopus subject areas
- General Medicine
