TY - JOUR
T1 - Progress in health among regions of Ethiopia, 1990–2019
T2 - a subnational country analysis for the Global Burden of Disease Study 2019
AU - GBD 2019 Ethiopia Subnational-Level Disease Burden Initiative Collaborators
AU - Misganaw, Awoke
AU - Naghavi, Mohsen
AU - Walker, Ally
AU - Mirkuzie, Alemnesh H.
AU - Giref, Ababi Zergaw
AU - Berheto, Tezera Moshago
AU - Waktola, Ebba Abate
AU - Kempen, John H.
AU - Eticha, Getachew Tollera
AU - Wolde, Tsigereda Kifle
AU - Deguma, Dereje
AU - Abate, Kalkidan Hassen
AU - Abegaz, Kedir Hussein
AU - Ahmed, Muktar Beshir
AU - Akalu, Yonas
AU - Aklilu, Addis
AU - Alemu, Biresaw Wassihun
AU - Asemahagn, Mulusew A.
AU - Awedew, Atalel Fentahun
AU - Balakrishnan, Senthilkumar
AU - Bekuma, Tariku Tesfaye
AU - Beyene, Addisu Shunu
AU - Beyene, Misrak Getnet
AU - Bezabih, Yihienew Mequanint
AU - Birhanu, Biruk Tesfaye
AU - Chichiabellu, Tesfaye Yitna
AU - Dachew, Berihun Assefa
AU - Dagnew, Amare Belachew
AU - Demeke, Feleke Mekonnen
AU - Demissie, Getu Debalkie
AU - Derbew Molla, Meseret
AU - Dereje, Nebiyu
AU - Deribe, Kebede
AU - Desta, Abebaw Alemayehu
AU - Eshetu, Munir Kassa
AU - Ferede, Tomas Y.
AU - Gebreyohannes, Eyob Alemayehu
AU - Geremew, Abraham
AU - Gesesew, Hailay Abrha
AU - Getacher, Lemma
AU - Glenn, Scott D.
AU - Hafebo, Aregash Samuel
AU - Hashi, Abdiwahab
AU - Hassen, Hamid Yimam
AU - Hay, Simon I.
AU - Hordofa, Diriba Fufa
AU - Huluko, Dawit Hoyiso
AU - Kasa, Ayele Semachew
AU - Kassahun Azene, Getinet
AU - Kebede, Ermiyas Mulu
AU - Kebede, Hafte Kahsay
AU - Kelkay, Bayew
AU - Kidane, Samuel Z.
AU - Legesse, Samson Mideksa
AU - Manamo, Wondimu Ayele
AU - Melaku, Yohannes Adama A.
AU - Mengesha, Endalkachew Worku
AU - Mengesha, Sisay Derso
AU - Merie, Hayimro Edemealem
AU - Mersha, Abera M.
AU - Mersha, Amanual Getnet
AU - Mirutse, Mizan Kiros
AU - Mohammed, Ammas Siraj
AU - Mohammed, Hussen
AU - Mohammed, Salahuddin
AU - Netsere, Henok Biresaw
AU - Nigatu, Dabere
AU - Obsa, Mohammed Suleiman
AU - Odo, Daniel Bogale
AU - Omer, Muktar
AU - Regassa, Lemma Demissie
AU - Sahiledengle, Biniyam
AU - Shaka, Mohammed Feyisso
AU - Shiferaw, Wondimeneh Shibabaw
AU - Sidemo, Negussie Boti
AU - Sinke, Abiy H.
AU - Sintayehu, Yitagesu
AU - Sorrie, Muluken Bekele
AU - Tadesse, Birkneh Tilahun
AU - Tadesse, Eyayou Girma
AU - Tamir, Zemenu
AU - Tamiru, Animut Tagele
AU - Tareke, Amare Abera
AU - Tefera, Yonas Getaye
AU - Tekalegn, Yohannes
AU - Tesema, Ayenew Kassie
AU - Tesema, Tefera Tadele
AU - Tesfay, Fisaha Haile
AU - Tessema, Zemenu Tadesse
AU - Tilahun, Tadesse
AU - Tsegaye, Gebiyaw Wudie
AU - Tusa, Biruk Shalmeno
AU - Weledesemayat, Geremew Tassew
AU - Yazie, Taklo Simeneh
AU - Yeshitila, Yordanos Gizachew
AU - Yirdaw, Birhanu Wubale
AU - Zegeye, Desalegn Tegabu
AU - Murray, Christopher J.L.
AU - Gebremedhin, Lia Tadesse
PY - 2022/4/2
Y1 - 2022/4/2
N2 - Background: Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities. Methods: We gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment. Findings: The SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59–7·20) in 1990 to 4·43 (4·01–4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96–6·86) in Somali to 1·50 (1·26–1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79–22·07), from 46·91 years (45·71–48·11) in 1990 to 68·84 years (67·51–70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91–72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53–66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69–1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities. Interpretation: There were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets.
AB - Background: Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities. Methods: We gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment. Findings: The SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59–7·20) in 1990 to 4·43 (4·01–4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96–6·86) in Somali to 1·50 (1·26–1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79–22·07), from 46·91 years (45·71–48·11) in 1990 to 68·84 years (67·51–70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91–72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53–66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69–1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities. Interpretation: There were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets.
KW - health estimates
KW - Ethiopia
KW - SDI
KW - life expectancy
KW - TFR
KW - premature mortality
KW - disability
KW - risk factors
KW - GBD study
KW - Health care access
UR - http://www.scopus.com/inward/record.url?scp=85127613288&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(21)02868-3
DO - 10.1016/S0140-6736(21)02868-3
M3 - Article
C2 - 35294898
AN - SCOPUS:85127613288
SN - 0140-6736
VL - 399
SP - 1322
EP - 1335
JO - Lancet
JF - Lancet
IS - 10332
ER -