The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Bill & Melinda Gates Foundation.

This article analyzes the "Global Burden of Disease Study 2010" and examines the study's implications for neglected tropical diseases

Foodborne diseases are globally important, resulting in considerable morbidity and mortality. Parasitic diseases often result in high burdens of disease in low and middle income countries and are frequently transmitted to humans via contaminated food. This study presents the first estimates of the global and regional human disease burden of 10 helminth diseases and toxoplasmosis that may be attributed to contaminated food. Data were abstracted from 16 systematic reviews or similar studies published between 2010 and 2015; from 5 disease data bases accessed in 2015; and from 79 reports, 73 of which have been published since 2000, 4 published between 1995 and 2000 and 2 published in 1986 and 1981. These included reports from national surveillance systems, journal articles, and national estimates of foodborne diseases. These data were used to estimate the number of infections, sequelae, deaths, and Disability Adjusted Life Years (DALYs), by age and region for 2010. These parasitic diseases, resulted in 48.4 million cases (95% Uncertainty intervals [UI] of 43.4–79.0 million) and 59,724 (95% UI 48,017–83,616) deaths annually resulting in 8.78 million (95% UI 7.62–12.51 million) DALYs. We estimated that 48% (95% UI 38%-56%) of cases of these parasitic diseases were foodborne, resulting in 76% (95% UI 65%-81%) of the DALYs attributable to these diseases. Overall, foodborne parasitic disease, excluding enteric protozoa, caused an estimated 23.2 million (95% UI 18.2–38.1 million) cases and 45,927 (95% UI 34,763–59,933) deaths annually resulting in an estimated 6.64 million (95% UI 5.61–8.41 million) DALYs. Foodborne Ascaris infection (12.3 million cases, 95% UI 8.29–22.0 million) and foodborne toxoplasmosis (10.3 million cases, 95% UI 7.40–14.9 million) were the most common foodborne parasitic diseases. Human cysticercosis with 2.78 million DALYs (95% UI 2.14–3.61 million), foodborne trematodosis with 2.02 million DALYs (95% UI 1.65–2.48 million) and foodborne toxoplasmosis with 825,000 DALYs (95% UI 561,000–1.26 million) resulted in the highest burdens in terms of DALYs, mainly due to years lived with disability. Foodborne enteric protozoa, reported elsewhere, resulted in an additional 67.2 million illnesses or 492,000 DALYs. Major limitations of our study include often substantial data gaps that had to be filled by imputation and suffer from the uncertainties that surround such models. Due to resource limitations it was also not possible to consider all potentially foodborne parasites (for example Trypanosoma cruzi). Parasites are frequently transmitted to humans through contaminated food. These estimates represent an important step forward in understanding the impact of foodborne diseases globally and regionally. The disease burden due to most foodborne parasites is highly focal and results in significant morbidity and mortality among vulnerable populations. Foodborne diseases cause a large burden of illness (morbidity) and death (mortality), worldwide. More than 200 diseases can be transmitted to people through the ingestion of food contaminated by microorganisms (viruses, bacteria, and parasites) or with chemicals. Food can become contaminated on the farms where crops and animals are raised, in food processing plants, and during food storage and preparation at home and in restaurants. Food contamination can be caused by pollution of water and soil by human and animal feces and by poor hygiene practices such as not washing one’s hands after using the toilet or before handling food. Many foodborne diseases present with gastrointestinal symptoms (stomach cramps, diarrhea and vomiting) but some also affect other parts of the body and some have serious sequelae (abnormal bodily conditions or diseases arising from a pre-existing disease). For example, the parasitic tapeworm Taenia solium (which is spread by eating undercooked pork) can cause cysticercosis, an infection of tissues by larval cysts that can result in seizures, stroke and death. National and international efforts to improve food safety need accurate information on foodborne infections so, in 2007, the World Health Organization (WHO) established the Foodborne Disease Burden Epidemiology Reference Group (FERG) to provide estimates of the global and regional burden of disease attributable to foodborne illnesses. Here, researchers involved in one of FERG’s constituent task forces—the Parasitic Diseases Task Force—combine information from many different sources (a data synthesis) to provide estimates of the regional and global disease burden of ten helminth diseases and toxoplasmosis attributable to contaminated food. Examples of helminths (parasitic worms) include roundworms (Ascaris lumbricoides; heavy roundworm infections [ascariosis] can cause signs of malnutrition or even intestinal blockages), tapeworms and flukes (liver and lung flukes cause a condition known as trematodosis; frequently transmitted in undercooked fish crustacea or aquatic vegetables). Toxoplasmosis is caused by a parasite found in undercooked meat and in cat feces. If a woman becomes infected during pregnancy, she can pass the parasite onto her unborn child (congenital toxoplasmosis), thereby causing eye problems and sometimes developmental problems and seizures later in life. The researchers combined national estimates of foodborne diseases, and data from systematic reviews (studies that identify all the research on a topic using predefined criteria), national surveillance programs, and other sources to estimate the number of illnesses, sequelae, and deaths for ten helminth diseases and toxoplasmosis. They also estimated the number of disability adjusted life years (DALYs) globally and regionally for each disease. A DALY is the disease-related loss of one year of full health because of premature death or disability; DALYs provide a measure of the burden of a disease. Together, these diseases caused 48.4 million cases of illness, 59,724 deaths, and 8.78 million DALYs in 2010. The researchers estimated that 48% of these cases of parasitic diseases, resulting in 6.64 million DALYs, were transmitted by contaminated food. The commonest foodborne parasitic diseases were Ascaris infection and toxoplasmosis (12.3 million and 10.3 million cases, respectively). Foodborne cysticercosis, trematodosis and toxoplasmosis resulted in the highest disease burdens, and the largest burden of foodborne parasitic disease occurred in the Western Pacific and African regions. The lack of reliable data on the diseases considered in this study for many regions of the world and the use of expert panels to estimate the proportion of each disease that is foodborne may limit the accuracy of these findings. Moreover, this study does not estimate the global burden of every potentially important foodborne parasitic disease. However, these findings, together with those on three foodborne enteric protozoa (single-celled parasites that infect the intestines) included in a related paper, indicate that parasites are frequently transmitted to people through contaminated food and that, although some parasites result in a low burden of disease, foodborne parasites result in significant illness and death that is often borne by relatively small populations in limited geographical areas. This information, together with other estimates on foodborne disease obtained by FERG, should facilitate the development and implementation of effective national and global food safety policies. This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1001920.

Cystic echinococcosis (CE) is an emerging zoonotic parasitic disease throughout the world. Human incidence and livestock prevalence data of CE were gathered from published literature and the Office International des Epizooties databases. Disability-adjusted life years (DALYs) and monetary losses, resulting from human and livestock CE, were calculated from recorded human and livestock cases. Alternative values, assuming substantial underreporting, are also reported. When no underreporting is assumed, the estimated human burden of disease is 285,407 (95% confidence interval [CI], 218,515–366,133) DALYs or an annual loss of US $193,529,740 (95% CI, $171,567,331–$217,773,513). When underreporting is accounted for, this amount rises to 1,009,662 (95% CI, 862,119–1,175,654) DALYs or US $763,980,979 (95% CI, $676,048,731–$857,982,275). An annual livestock production loss of at least US $141,605,195 (95% CI, $101,011,553–$183,422,465) and possibly up to US $2,190,132,464 (95% CI, $1,572,373,055–$2,951,409,989) is also estimated. This initial valuation demonstrates the necessity for increased monitoring and global control of CE.