Table 2-7. – Number of YLLs and age-standardized YLL rates (per 100 000) due to stroke, ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage in 1990 and 2019, and percent change of rates, in Brazil and its Federative Units.
Cause of death and location | 1990 | 2019 | Percent change (95% UI) | ||
---|---|---|---|---|---|
Number (95% UI) | Rate (95% UI) | Number (95% UI) | Rate (95% UI) | ||
B.2.3-Stroke | |||||
Acre | 3638.2 (3310.9;3958.3) | 2093.3 (1918.9;2257.8) | 7523.5 (6798.3;8291.5) | 1189.9 (1074.3;1316.2) | -43.2(-49.5;-35.9) |
Alagoas | 45113 (41108.8;49962.3) | 3155.6 (2866.2;3497.6) | 54270.7 (47737.5;61452.7) | 1686.1 (1482.2;1904) | -46.6(-55.1;-37.1) |
Amapá | 1871.7 (1693.8;2033.1) | 1747.8 (1601.3;1882.8) | 6259.1 (5602.4;6893.9) | 1145.2 (1018.4;1264.8) | -34.5(-41.4;-27.1) |
Amazonas | 18486.3 (16733.1;20143.4) | 2261.8 (2062.1;2447.6) | 31259.9 (27577.8;34979.3) | 1063.1 (935.3;1192.8) | -53(-58.6;-46.5) |
Bahia | 173368.1 (154540.2;193719) | 2433.5 (2163.9;2731.4) | 207268.2 (174444.1;242726.8) | 1281 (1077.7;1498.2) | -47.4(-56.9;-36) |
Brazil | 2590844.4 (2504589.7;2679788.7) | 2778.6 (2659.5;2879.2) | 2578166 (2413609.9;2702585.5) | 1098.7 (1025.8;1153.7) | -60.5(-62.7;-58.4) |
Ceará | 82644.5 (70969;95343.2) | 1924.7 (1649.6;2235.2) | 122875.8 (102778.9;144353.5) | 1232.7 (1030.7;1448.8) | -36(-49.2;-19.8) |
Distrito Federal | 18102.9 (16265.1;20466.9) | 2863 (2605.7;3189.8) | 23254.6 (20647.9;26147.6) | 970.7 (860;1088.3) | -66.1(-70.6;-61.2) |
Espírito Santo | 49253.6 (47109.2;51447.6) | 3243 (3085.3;3392.1) | 51706.5 (45154.4;58160.6) | 1192.4 (1042.7;1341.7) | -63.2(-67.7;-58.7) |
Goiás | 73040.8 (63335.6;85932.2) | 3229.4 (2820.1;3792) | 72966.1 (61930.4;85238.7) | 1039.6 (884.3;1207.4) | -67.8(-73.8;-60.8) |
Maranhão | 72614.6 (60933.2;85134.1) | 2510.2 (2113.8;2938.1) | 113620.3 (96360.6;135605.8) | 1703.6 (1445.6;2028.8) | -32.1(-46.4;-12.5) |
Mato Grosso | 19638.7 (16988.9;22162.1) | 2261.8 (2005.3;2508.2) | 32952.9 (29423.3;36884.6) | 983 (874.9;1104) | -56.5(-62.7;-49.4) |
Mato Grosso do Sul | 26812.2 (24991.9;28638.5) | 2766 (2577.2;2952.7) | 30540.2 (27071.5;34205.2) | 1036.9 (917.8;1162.7) | -62.5(-66.8;-57.5) |
Minas Gerais | 319806.1 (297709.9;348085.7) | 3061.2 (2848.1;3318.7) | 258108.8 (230977.9;288521.3) | 982.5 (879.9;1097.6) | -67.9(-72.1;-63.8) |
Pará | 59420.4 (52481.8;66484.2) | 2749 (2447.2;3053.1) | 88399.9 (77815.3;98126.2) | 1248 (1088.7;1385.5) | -54.6(-60.7;-47.6) |
Paraíba | 47314.8 (41644.2;53264.8) | 2018.2 (1773.1;2272.7) | 53969.6 (46911;61530.8) | 1141.1 (993.1;1300.9) | -43.5(-52.6;-32.1) |
Paraná | 165936.3 (158219.6;173304.8) | 3360.2 (3187.9;3518.8) | 146319.8 (128976.3;164812.7) | 1119.8 (985.9;1255.3) | -66.7(-70.7;-62.6) |
Pernambuco | 128500.4 (121005.2;135907.7) | 2776.5 (2609.3;2936) | 137705 (122806;154533.5) | 1369.2 (1220.7;1532.8) | -50.7(-56.6;-44.7) |
Piaui | 38717 (35046;42639.9) | 2686.6 (2441.7;2953.8) | 46373.2 (40842.1;52052.7) | 1229.9 (1082.6;1381.8) | -54.2(-60.2;-47.1) |
Rio de Janeiro | 356654 (340788.2;372187.5) | 3545 (3366.4;3689.2) | 257751.3 (231425.8;285548.3) | 1160.2 (1041;1285) | -67.3(-70.8;-63.3) |
Rio Grande do Norte | 28185.2 (25144.4;31483.9) | 1719.5 (1525.9;1925.1) | 32774.7 (27520.4;38814.4) | 842.2 (707.4;996.9) | -51(-59.9;-40.6) |
Rio Grande do Sul | 177413.9 (168848.5;185603.9) | 2676.3 (2534;2802.4) | 162756.9 (144795.8;181241.8) | 1062.5 (943.6;1183.1) | -60.3(-64.5;-55.8) |
Rondônia | 11663.2 (9984.6;13075.5) | 3402.2 (3073;3718.5) | 17514.3 (15097.2;20285.1) | 1130.3 (975.8;1308.2) | -66.8(-72;-60.6) |
Roraima | 1557.3 (1365.4;1731.4) | 2508.3 (2278.1;2745.1) | 3888.6 (3473.1;4323.7) | 1039.6 (924.2;1150.6) | -58.6(-63.8;-53) |
Santa Catarina | 74479.5 (69924.8;78924.5) | 2941.9 (2754.1;3115.6) | 70469.1 (62180.6;79237) | 891.5 (787.2;997.1) | -69.7(-73.2;-66) |
São Paulo | 565019.3 (533070.5;599374.7) | 2670.9 (2511.6;2833.3) | 500606.4 (446874;554035.6) | 931.3 (830.3;1030.4) | -65.1(-69;-61.1) |
Sergipe | 21056.2 (19196.7;23080.6) | 2649.1 (2408.6;2894.5) | 28150.9 (24094.5;32370.1) | 1249.3 (1068.6;1436.4) | -52.8(-60.5;-44.7) |
Tocantins | 10536.2 (9172.6;11978) | 2567.4 (2248;2886.8) | 18879.7 (16302.6;21715.4) | 1312.8 (1135;1504.7) | -48.9(-57.5;-38.5) |
B.2.3.1-Ischemic stroke | (;) | ||||
Acre | 1241.7 (1095.2;1383.9) | 981.6 (873.1;1086.6) | 2796.4 (2477.3;3173.2) | 532 (469.4;602.9) | -45.8(-53.4;-35.6) |
Alagoas | 18153.8 (15408.7;20916.9) | 1484.1 (1266.6;1704.1) | 23104.8 (19903.4;26376.3) | 775.5 (666.8;885.6) | -47.7(-58.6;-35.5) |
Amapá | 666.5 (605.1;727.3) | 829.8 (747.4;902.6) | 2305.2 (2010.4;2562.1) | 522.6 (452.5;581.9) | -37(-43.8;-29.6) |
Amazonas | 6476 (5852.2;7075.5) | 1033.9 (933.3;1123.7) | 11701.7 (10136.3;13174.3) | 468.4 (404.9;529) | -54.7(-60.2;-48.5) |
Bahia | 65136.9 (55706.7;74484.5) | 1040.2 (891.1;1186.3) | 85232 (70691;100091.3) | 543.1 (450.7;638.6) | -47.8(-59;-33.8) |
Brazil | 947035.1 (895299.9;992583.8) | 1211.1 (1133.8;1268.9) | 1079632.1 (982065;1148602.5) | 479.7 (435.1;510.8) | -60.4(-63.5;-57.3) |
Ceará | 32503 (26515.3;39027.4) | 836.2 (682;1004.7) | 53233.6 (43945.9;63548.2) | 548.9 (452.4;654.6) | -34.4(-49.3;-12.5) |
Distrito Federal | 4730.7 (4219.7;5398.6) | 1294 (1172.8;1442.7) | 8959.4 (7866.4;10165) | 484.9 (422.2;546.7) | -62.5(-67.4;-57) |
Espírito Santo | 17951 (16791.8;19054.5) | 1443.5 (1335.2;1530.5) | 21006.8 (18047.5;23863.7) | 517.2 (444.6;586.4) | -64.2(-69;-59.3) |
Goiás | 23231.1 (19865.8;27417.6) | 1336.2 (1158.6;1557.9) | 27989.3 (23581.2;32754.8) | 440.5 (370.5;514.7) | -67(-73.1;-59.9) |
Maranhão | 25999 (19603.3;32038.4) | 1095.2 (848.6;1331.4) | 48031.8 (40676.2;56801.9) | 763.5 (646.1;902.8) | -30.3(-46.8;-2.9) |
Mato Grosso | 6760 (5891.9;7661.8) | 1065.6 (935.9;1193.3) | 12646.5 (11001.1;14370.4) | 432.8 (375.9;491.6) | -59.4(-65.2;-52.5) |
Mato Grosso do Sul | 8498.8 (7759.2;9203.4) | 1137.4 (1029.6;1227.4) | 11876.8 (10349.4;13471.1) | 436.9 (379.4;494.6) | -61.6(-66.2;-56) |
Minas Gerais | 108699.4 (99915.8;118951.1) | 1257.1 (1151.5;1368.4) | 105525.7 (91920.7;118346.2) | 404.8 (352.7;453.6) | -67.8(-71.9;-63.2) |
Pará | 23740.3 (20920.8;26550.4) | 1352.4 (1192.7;1506.7) | 37477.3 (32192.9;42111.1) | 593.8 (509.4;667.4) | -56.1(-62.3;-49) |
Paraíba | 20370.9 (16680.5;24037.9) | 906.2 (745.9;1063.7) | 22708.5 (19399.8;26237.8) | 472.5 (404.1;546.5) | -47.9(-58.3;-33.6) |
Paraná | 64464.8 (60374.7;68432.4) | 1598.9 (1481.9;1695.9) | 69504.9 (60465.7;78336.2) | 559.2 (486.1;627.3) | -65(-69.4;-60.4) |
Pernambuco | 50355.8 (45411.8;55130.7) | 1224.2 (1104.8;1333.5) | 53525 (46384.9;60987.6) | 566.7 (492.7;645.2) | -53.7(-60.7;-46.2) |
Piaui | 14999.3 (12981.2;16969) | 1249.7 (1089.5;1408.4) | 20827 (17690.4;23559.6) | 552.8 (470.1;625.8) | -55.8(-63;-47.4) |
Rio de Janeiro | 122527.2 (114879.3;129568.4) | 1443 (1347.1;1525.5) | 101343.1 (89470.7;112513) | 460.6 (406.7;511.1) | -68.1(-71.6;-64.3) |
Rio Grande do Norte | 12068 (10468.4;13932.6) | 783.6 (678.3;903) | 14096.8 (11589.3;16762) | 367.4 (303;437.1) | -53.1(-62.2;-40.7) |
Rio Grande do Sul | 71869.3 (66775;76379.1) | 1270.7 (1174.6;1352.1) | 78403.3 (67989.1;88418.6) | 508.7 (440.8;573.8) | -60(-64.5;-55.2) |
Rondônia | 3766.2 (3297.1;4198.3) | 1782.2 (1621.8;1942.6) | 7001 (5912.5;8182.5) | 521.9 (441.4;607.5) | -70.7(-75.5;-65.5) |
Roraima | 468.7 (419.6;519.8) | 1237.8 (1123.4;1350.9) | 1442.3 (1258.1;1619.2) | 500 (436.7;556.5) | -59.6(-64.9;-53.9) |
Santa Catarina | 29055.8 (27032.4;31053.7) | 1417.3 (1310.5;1520.9) | 32271.5 (28229.2;36649.5) | 440.8 (384.6;499.4) | -68.9(-72.7;-65) |
São Paulo | 201067 (186754.2;216302.7) | 1168.1 (1074.4;1246.4) | 206713.7 (181100.9;230259.8) | 399.1 (348.7;444.2) | -65.8(-69.3;-61.8) |
Sergipe | 8730.4 (7749.7;9702.2) | 1292.3 (1151.2;1427.3) | 11940.9 (10057.6;13906.4) | 570.2 (478;664.6) | -55.9(-63.6;-46.9) |
Tocantins | 3503.7 (2933.1;4088.3) | 1216.2 (1047.7;1386.3) | 7967 (6754.7;9233.1) | 603.5 (512;697.2) | -50.4(-60.1;-39.2) |
B.2.3.2-Intracerebral hemorrhage | (;) | ||||
Acre | 1757.7 (1577.9;1961.3) | 877 (793.1;970.4) | 3337.8 (2971.3;3756) | 484.3 (431.3;543.1) | -44.8(-52.6;-35.3) |
Alagoas | 20756.3 (18072.7;23944.2) | 1342.9 (1164.5;1545.8) | 23503.2 (20270.5;26917.1) | 696.8 (602.7;797.2) | -48.1(-59;-36.1) |
Amapá | 925.7 (822.9;1016.6) | 752.8 (682.5;819.5) | 2845.7 (2495.7;3187.9) | 469.8 (414.2;525.2) | -37.6(-45.2;-28.4) |
Amazonas | 9619.8 (8639.1;10610.1) | 1039.8 (942.8;1143.7) | 14370.5 (12524.1;16340.8) | 453.4 (396.4;515.7) | -56.4(-62.3;-49.4) |
Bahia | 84677.6 (74285.2;96506.6) | 1129.1 (987.5;1292.9) | 90291.3 (74543.4;107505.2) | 549.9 (454.1;654.9) | -51.3(-61.8;-38.9) |
Brazil | 1303555.9 (1249976.5;1374489.1) | 1283.5 (1227.7;1351) | 1086463 (1025413.3;1141541.4) | 449.2 (423.3;472.5) | -65(-67.6;-62.5) |
Ceará | 38358.7 (32448.7;45304.9) | 858.6 (718;1018.3) | 51669 (42481.5;61768.7) | 510.3 (419.3;609.2) | -40.6(-54.8;-23.4) |
Distrito Federal | 10017.7 (8886.2;11645.6) | 1273.3 (1137.5;1448.2) | 9644.7 (8461.1;10976.3) | 339.8 (296.7;385.6) | -73.3(-77.2;-68.4) |
Espírito Santo | 24966.1 (23680.2;26430.9) | 1488.7 (1411.4;1572.5) | 22397.8 (19379;25441) | 493.6 (428;560.4) | -66.8(-71.4;-62.2) |
Goiás | 39798.3 (34140.5;47575.2) | 1575.2 (1358.2;1885) | 32574.2 (27320.6;38124) | 438.6 (369.2;511.5) | -72.2(-77.8;-65.5) |
Maranhão | 34728.9 (27796.6;43087.2) | 1107.8 (881;1382.6) | 47718.5 (39527.8;58098.6) | 697.6 (577.8;850.1) | -37(-52.3;-15.5) |
Mato Grosso | 9773.4 (8348.4;11190) | 971.6 (847.6;1097.2) | 14273.3 (12554.1;16136.1) | 395.1 (348;447.4) | -59.3(-66;-51.2) |
Mato Grosso do Sul | 14514.1 (13377.8;15746.3) | 1346.4 (1249.4;1458.7) | 13450.7 (11797.6;15347.6) | 436 (383.3;495.6) | -67.6(-72;-62.7) |
Minas Gerais | 167435.9 (153866.2;189273.2) | 1474.3 (1357.6;1655.4) | 108433.6 (96309;122277.7) | 407.8 (362.1;459.1) | -72.3(-76.6;-68) |
Pará | 28737 (25168.4;32327.3) | 1183.6 (1047.4;1327) | 37239.6 (32252.1;41938) | 492.7 (426.7;553.4) | -58.4(-64.9;-51) |
Paraíba | 19904.5 (16932.5;23582.1) | 834.9 (707.5;992.8) | 22961.4 (19839.1;26504.6) | 491.2 (424.2;567.4) | -41.2(-53.8;-25.7) |
Paraná | 81687.9 (76990.4;86999.7) | 1468.5 (1382.2;1562.7) | 54832.8 (47517.7;62195.1) | 399.4 (347.3;452.6) | -72.8(-76.5;-68.9) |
Pernambuco | 65139.7 (60440.4;70286) | 1322.6 (1228;1428.4) | 63855 (56085;72426.3) | 612.4 (539.9;694) | -53.7(-60.1;-46.5) |
Piaui | 18213.3 (16144.9;20912.9) | 1151.7 (1020;1313.5) | 18767.4 (16413.5;21459.4) | 498.8 (437.3;570.2) | -56.7(-63.9;-48.1) |
Rio de Janeiro | 189847.8 (178940.3;202216.9) | 1738.9 (1643.7;1847.2) | 117082.3 (103795.5;131957.4) | 517.9 (459.5;584.3) | -70.2(-73.7;-66) |
Rio Grande do Norte | 12755 (11224.4;14401) | 759 (666.5;857.1) | 13759.1 (11229.2;16571.9) | 351.7 (287.4;423.3) | -53.7(-63.2;-42.8) |
Rio Grande do Sul | 86550.1 (81293.4;91677.5) | 1177.9 (1106.3;1248.7) | 63875.4 (55424.1;72522) | 412.8 (357.6;470.1) | -65(-69.4;-60) |
Rondônia | 6250.9 (5307;7125.5) | 1379.4 (1218.2;1535.9) | 7486.2 (6402.6;8872.1) | 445.2 (380.7;522.7) | -67.7(-73.5;-60) |
Roraima | 841.1 (724.7;946.2) | 1067.6 (952.2;1181.9) | 1728 (1517.2;1949.5) | 399.6 (352.9;448.2) | -62.6(-68;-56.5) |
Santa Catarina | 36527.9 (33998.7;39097.7) | 1274.8 (1186.5;1365.9) | 27210.5 (23570;31005.4) | 322.1 (279.3;365.9) | -74.7(-78;-71) |
São Paulo | 284456.9 (263629.8;309048.7) | 1216.8 (1131.4;1310.4) | 202992.4 (179780.6;228623.2) | 366 (324.4;411.6) | -69.9(-73.9;-65.7) |
Sergipe | 9901 (8860.4;11012.8) | 1129.8 (1004.7;1258.2) | 12224.9 (10331.9;14328.5) | 519.8 (440;608.4) | -54(-62.4;-44.6) |
Tocantins | 5412.9 (4570.5;6344.5) | 1100.5 (928;1289.6) | 7937.7 (6755.7;9253.1) | 526.6 (449.1;612.8) | -52.1(-62.5;-39.9) |
B.2.3.3-Subarachnoid hemorrhage | (;) | ||||
Acre | 638.8 (553.3;736.4) | 234.8 (205;268) | 1389.3 (1226.4;1577.6) | 173.7 (153.4;196.9) | -26(-38.1;-10.9) |
Alagoas | 6202.9 (5172.1;7328.1) | 328.6 (273.4;385.4) | 7662.7 (6534.3;8941.3) | 213.9 (182.7;248.4) | -34.9(-49;-16.4) |
Amapá | 279.6 (239.4;323.5) | 165.2 (145;192.4) | 1108.2 (988.3;1270.6) | 152.8 (136;175.3) | -7.5(-21;8.9) |
Amazonas | 2390.6 (2083.9;2722.8) | 188.1 (166;215.7) | 5187.7 (4523.3;6016.3) | 141.4 (123.3;163.9) | -24.9(-37.3;-10.1) |
Bahia | 23553.6 (20282.4;27063.9) | 264.2 (227.7;306.7) | 31744.9 (25977.8;38214.4) | 188 (154.6;225.7) | -28.8(-44.6;-9) |
Brazil | 340253.3 (301621.6;356874.5) | 284 (253.8;297.2) | 412071 (384850.3;438730) | 169.8 (158.3;180.8) | -40.2(-44.9;-32.6) |
Ceará | 11782.8 (9708;14149.8) | 229.9 (189.8;273.3) | 17973.3 (14699.9;22114) | 173.5 (142;212.6) | -24.5(-41.6;1.1) |
Distrito Federal | 3354.5 (2951.9;3778.2) | 295.7 (260.6;333.6) | 4650.5 (3988.1;5365) | 145.9 (124.6;167.3) | -50.6(-58.4;-41) |
Espírito Santo | 6336.6 (5170.6;6918.2) | 310.8 (254.6;338.4) | 8301.9 (7019.7;9774.7) | 181.6 (154.2;212.4) | -41.6(-50.6;-29.5) |
Goiás | 10011.5 (8705.3;11624.9) | 318 (275.8;370) | 12402.6 (10301.2;14840.8) | 160.5 (133.8;190.7) | -49.5(-59.9;-37.5) |
Maranhão | 11886.7 (8770.9;15728.3) | 307.3 (228.6;399.9) | 17869.9 (14341;21910.3) | 242.5 (195.1;298.1) | -21.1(-43.6;9.7) |
Mato Grosso | 3105.3 (2559.7;3680) | 224.6 (190.2;262.6) | 6033.1 (5267.1;6920.4) | 155.1 (135.6;178.1) | -30.9(-43.3;-14.6) |
Mato Grosso do Sul | 3799.2 (3420.5;4170.8) | 282.1 (254.3;309.2) | 5212.8 (4497.3;5959.5) | 164 (141.9;187.1) | -41.9(-50.3;-31.9) |
Minas Gerais | 43670.8 (37136.2;47942.6) | 329.8 (283.9;362) | 44149.6 (38291.3;50524.6) | 170 (147.6;194) | -48.5(-55.6;-39.3) |
Pará | 6943.1 (5981.5;7928.9) | 213 (184.9;245) | 13683 (11958.7;15648.5) | 161.6 (141.3;184.9) | -24.1(-37;-8) |
Paraíba | 7039.5 (6024;8166.2) | 277.2 (236.8;324) | 8299.7 (7006;9682) | 177.4 (149.9;206.9) | -36(-49.6;-19.4) |
Paraná | 19783.6 (17429.1;21454.1) | 292.8 (259.2;317.4) | 21982.1 (18625.7;25543.5) | 161.2 (137.6;187.1) | -44.9(-53.3;-35.9) |
Pernambuco | 13004.9 (11647.3;14757.9) | 229.7 (205.5;263.4) | 20325 (17670.8;23381) | 190.1 (165.4;218.8) | -17.3(-31;-1.2) |
Piaui | 5504.3 (4717;6353.5) | 285.2 (246.2;325.6) | 6778.8 (5793.9;7860.2) | 178.2 (152.6;206.3) | -37.5(-49.6;-22.1) |
Rio de Janeiro | 44279 (33962.9;48808.5) | 363.1 (283.3;399.4) | 39325.9 (34177.3;44894.3) | 181.7 (158.8;207.1) | -49.9(-57.8;-35) |
Rio Grande do Norte | 3362.3 (2890.3;4087.5) | 176.8 (150.3;218.8) | 4918.8 (3993.1;6328.9) | 123.1 (100;157.3) | -30.4(-45.1;-11.2) |
Rio Grande do Sul | 18994.6 (17368.3;20855.9) | 227.8 (208.6;250.4) | 20478.2 (17663.2;23770.2) | 141 (122.3;162.6) | -38.1(-46.9;-27.7) |
Rondônia | 1646.1 (1305.3;1948.2) | 240.6 (199.8;277.8) | 3027.1 (2591.3;3565.5) | 163.2 (140.1;191.8) | -32.2(-45;-13.4) |
Roraima | 247.5 (203.2;289.8) | 202.9 (172.7;233.4) | 718.3 (628.4;855.1) | 140 (122.8;165.9) | -31(-42.6;-16.3) |
Santa Catarina | 8895.8 (8096.2;9718.4) | 249.7 (227.1;273.2) | 10987.1 (9521;12815.9) | 128.6 (111.7;149.5) | -48.5(-55.9;-39) |
São Paulo | 79495.5 (68778.8;86635.1) | 286 (251.5;311.9) | 90900.3 (79393.9;103394.2) | 166.1 (145.3;188.7) | -41.9(-49.9;-31.7) |
Sergipe | 2424.8 (2108.6;2782.6) | 227 (197;261.6) | 3985.1 (3284.1;4788.7) | 159.3 (131.8;191.9) | -29.8(-44.6;-11.8) |
Tocantins | 1619.6 (1328.1;1906.4) | 250.7 (210.1;292.7) | 2975 (2491.9;3503) | 182.6 (153.7;215.9) | -27.1(-41.6;-7.4) |
Source: Data derived from Global Burden of Disease Study 2019, Institute for Health Metrics and Evaluation, University of Washington. 46