“Each year, the GBD study produces age-specific, sex-specific, and location-specific estimates of all-cause and cause-specific mortality, non-fatal outcomes, overall disease burden (ie, disability-adjusted life-years), and risk factor exposure and attributable burden from 1990 to the current study year.
“This analysis of the health-related SDGs is based on GBD 2017 estimates. Broader GBD 2017 methods are described elsewhere,21,23–27 while further detail on data sources and estimation approaches used for this analysis are available in appendix 1 (part 1). We used previously established GBD methods to generate indicator-specific estimates for 1990–2017, including the Cause of Death Ensemble model for causes of death,23,28 DisMod-MR for many non-fatal causes,26,29 and spatiotemporal Gaussian process regression for most risk factor exposures, measures of intervention coverage, and other SDG indicators (eg, well-certified death registration [SDG indicator 17.19.2c]).21,30
“Each year, GBD includes subnational analyses for a few new countries and continues to provide subnational estimates for countries that were added in previous cycles. Subnational estimation in GBD 2017 includes five new countries (Ethiopia, Iran, New Zealand, Norway, Russia) and countries previously estimated at subnational levels (GBD 2013: China, Mexico, and the UK [regional level]; GBD 2015: Brazil, India, Japan, Kenya, South Africa, Sweden, and the USA; GBD 2016: Indonesia and the UK [local government authority level]). All analyses are at the first level of administrative organisation within each country except for New Zealand (by Māori ethnicity), Sweden (by Stockholm and non-Stockholm), and the UK (by local government authorities). All subnational estimates for these countries were incorporated into model development and evaluation as part of GBD 2017. To meet data use requirements, in this publication we present all subnational estimates excluding those pending publication (Brazil, India, Japan, Kenya, Mexico, Sweden, the UK, and the USA); these results are presented in appendix tables and figures (appendix 2). Subnational estimates for countries with populations larger than 200 million (as measured with our most recent year of published estimates) that have not yet been published elsewhere are presented wherever estimates are illustrated with maps, but are not included in data tables.
“The GBD study uses standardised and replicable methods that comply with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).31 Analyses were done with R version 3.4.4, Python version 2.7.14, or Stata version 13.1. The entire GBD time series is updated annually with improved methods and data sources, and thus GBD 2017 findings, including the SDG analysis presented here, supersede all previous GBD publications.
“Indicators, definitions, and measurement approaches
“The health-related SDG indicators are shown in table 1. GBD 2017 assesses four more indicators than assessed in GBD 2016. The first is health worker density (SDG indicator 3.c.1), which is defined by the UN as health workers per 1000 population, by cadre of health worker. For this analysis, we report estimates for three main groups of health workers: physicians, nurses and midwives, and pharmacists. We used International Standard Classification of Occupations (ISCO) 88 to map cadres of health workers from multiple data sources and coding systems, resulting in comparable and consistently defined groupings of health workers over time and across locations (appendix 1 part 1).
“The second new indicator is sexual violence by nonintimate partners (SDG indicator 5.2.2), which is defined as the prevalence of females aged 15 years and older who have been subjected to sexual violence by non-intimate partners in the past 12 months. The third is the separate reporting of the prevalence of physical and sexual violence (SDG indicator 16.1.3). In March, 2018, the UN Statistical Commission approved refinements to SDG indicator 16.1.3, such that the indicator is now defined as the “proportion of population subjected to (a) physical violence, (b) psychological violence, and (c) sexual violence in the previous 12 months”.32,33 Following the GBD precedent of measuring each component of an SDG indicator (eg, reporting separately on child wasting and overweight [SDG indicators 2.2.2a and 2.2.2b] and on sanitation and access to handwashing facilities [SDG indicators 6.2.1a and 6.2.1b]),5,13 we report the prevalence of physical violence and that of sexual violence separately. Owing to measurement challenges and data sparsity, we did not measure the prevalence of psychological violence.
“The final new indicator is population census status (SDG indicator 17.19.2a), which was defined as covered if a location had conducted a population and housing census within the past 10 years or had an established population registry that routinely captured nationally representative demographic information (appendix 1 part 1). To assess population census status, we used data compiled for GBD 2017 population estimates,24 as well as all available data on population census implementation since 1980 and documentation of population registries.
“As well as adding new indicators, we have improved the measurement of several previously reported indicators. For smoking prevalence (SDG indicator 3.a.1), we now report prevalence of current smoking (daily and occasional smokers) rather than only daily smoking to better align with the UN’s definition (appendix 1 part 1). For vaccine coverage (SDG indicator 3.b.1), we include all eight vaccines in the aggregate measure for each location-year, rather than limiting the aggregate to vaccines expressly included in national vaccine schedules. Additionally, we now take the arithmetic, rather than the geometric, mean across the eight vaccines. These revisions allow better comparability across locations over time, avoid inadvertently penalising countries for introducing and scaling up new vaccines, and provide a better reflection of overall vaccine coverage for target populations.”
Source: GBD 2017 SDG Collaborators. “Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.” Lancet (London, England) vol. 392,10159 (2018): 2091-2138. doi:10.1016/S0140-6736(18)32281-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6227911/
