Burden of Disease - World Health
For the first time, GBD 2015 includes a measure of development (the Socio- Demographic Index, or SDI, which is based on income per capita, educational attainment and total fertility rate) in order to assess a country’s observed performance compared to their expected performance based on their stage of development.
GBD 2015 analyses 249 causes of death, 315 diseases and injuries, and 79 risk factors in 195 countries and territories between 1990 and 2015. Four capstone papers are published alongside two on child and maternal mortality.
“Development drives, but does not determine health,” says Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, the coordinating centre for the GBD collaboration. “We see countries that have improved far faster than can be explained by income, education, or fertility. And we also continue to see countries – including the United States – that are far less healthy than they should be given their resources.”
Commenting on the report, K Srinath Reddy, Public Health Foundation of India, said: “We can celebrate the 10-year rise in global life expectancy from birth, which occurred between 1980 and 2015, especially the upswing since 2005 in sub- Saharan Africa which was devastated by HIV/AIDS in earlier decades. There is, however, a grim pointer that regions affected by conflict are showing a decline in life expectancy – for example, in Syria male life expectancy dropped by 11,3 years in the past decade. It will be tragic if the life expectancy gains accruing fromsocioeconomic development and scientific advance are undermined by conflicts which feed sectarian violence and fuel social disruption. The rise in disability-adjusted life-years lost due to war and interpersonal violence in some regions demands that political processes place a premium on peace, social stability, prevention of crime, and arms control.”
The number of annual deaths has increased from roughly 48 million in 1990 to almost 56 million in 2015. 70% (40 million) of global deaths in 2015 were due to non-communicable diseases (NCDs including ischaemic heart disease, stroke, diabetes, chronic kidney disease, Alzheimer’s disease and other dementias, and drug use disorders). In 2015, an estimated 1.2 million deaths were due to HIV/AIDS (down 33.5% since 2005), and 730,500 were due to malaria (down 37% since 2005).
In 2015, eight causes of chronic disease (affecting people for 3 months or longer) each affected more than 10% of the world population: cavities in permanent teeth (2.3 billion people), tension-type headache (1.5 billion), iron-deficiency anaemia (1.47 billion), hearing loss (1.2 billion), migraine (959 million), genital herpes (846 million), common (refractive) vision problems (819 million) and ascariasis (anintestinal worm; 762 million).
Rates for just 14 chronic conditions fell fast enough to outstrip population growth and ageing and resulted in declines in the actual number of people with that condition including chronic obstructive pulmonary disease (COPD), asthma, cervical cancer, and ischemic heart disease.
Living with illness and disability
The burden of ill health (measured in disability-adjusted life years, or DALYs ie, the burden of years lost to premature death and disability) has shifted from communicable, maternal, neonatal, and nutritional disorders (e.g. HIV/AIDS, malaria, lower respiratory infections, diarrhoeal diseases, measles, and malnutrition) to disabling NCDs (e.g. drug use disorders (particularly opioids and cocaine), hearing and vision loss, and osteoarthritis) – mainly due to increases in population numbers and ageing, a trend with massive implications for health systems and the costs of treatment.
Risk factors for premature
death and ill health
In contrast, marked inroads have been made in reducing exposure to some highly preventable risks such as smoking, unsafe sanitation and water, and household air pollution, although they remain major causes of poor health. Unsafe sanitation, for example, claimed 306,000 fewer lives in 2015 (total deaths 808,000) compared to 2005. Whilst exposure to smoking fell by over a quarter worldwide, it is still ranked among the top five risks associated with health loss in 140 countries claiming 289,000 more lives in 2015 (total deaths 6.4 million) than 2005, and is the leading risk factor for poor health in the UK and the USA.
Two thirds (122) of countries have already met the Sustainable Development Goal (SDG) target to reduce the number of women dying from pregnancyrelated causes to less than 70 for every 100,000 live births by 2030. However, 24 countries have seen increasing maternal death since 2000 – many of these countries have been affected byconfl ict (e.g. Afghanistan and Palestine), but some are also high-income countries like the USA, Greece, and Luxembourg. Moreover, disparities between countries are widening, with the proportion of all maternal deaths rising from 68% in 1990 to 80% in 2015 in the poorest countries, where haemorrhage is the main cause of maternal death and teenage pregnancyis much more common. In contrast, in high-income countries most maternal deaths are related to complications like heart problems, blood clots, and complications of NCDs.
One area that needs special attention is neonatal (in fi rst month life) deaths which are falling more slowly than under-5 deaths and accounted for nearly half (2.6 million) of all deaths in children under 5 in 2015. Pretermbirth complications and birth asphyxia and trauma are now the leading causes of deaths in children younger than 5 years worldwide, highlighting the slower progress in reducing neonatal conditions compared with communicable diseases in childhood. Over a third of countries worldwide still face substantial challenges to reduce neonatal mortality to fewerthan 12 deaths per 1000 livebirths by 2030, especially in low- and low-middle income countries with Mali (40.6), Central African Republic (40.2), and Pakistan (37.9) recording the worst rates in 2015.
Burden of Disease 2015
Global Burden of Disease in the Eastern Mediterranean Region
However, such progress is threatened by increasing numbers of people suffering from serious health challenges related to metabolic risk factors, such as high blood pressure, high body mass index, and high blood sugar.
“We are seeing a rise in noncommunicable disease in the region, mainly due to behavioral changes such as diet and physical activity,” said Dr Ali Mokdad, Director of Middle Eastern Initiatives at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “At the same time, unrest and instability in the region will only further health loss from these diseases as services become limited and infrastructure is destroyed.”
But the conditions that kill are not typically those that make people sick.The top three nonfatal causes of health loss in the Eastern Mediterranean Region overall were iron-defi ciency anaemia, low back pain, and depression.
In north Africa and the Middle East, large discrepancies
occurred between observed Years of Life Lost (YLLs) and those expected
on the basis of the Socio-Demographic Index (SDI), underscoring the region’s
rapid development and inequalities in wealth. Furthermore, because of
the region’s escalating rates of war-¬related mortality, which is not
strictly related to SDI, ratios of observed versus expected YLLs from
war were extremely high. The United Arab Emirates (UAE) and Afghanistan
had themost causes for which observed levels of YLLs exceeded expected
YLLs; these causes ranged from ischaemic heart disease to interpersonal
violence for Afghanistan, and included chronic kidney disease, COPD, diabetes,
and road injuries for the UAE. Many countries in the region recorded substantially
lower YLLs than expected for several causes: 13 had ratios less than 0·60
for lower respiratory infections, including Iraq (0·40) and Palestine
(0·25); eight countries had ratios less than 0·60 for stroke, including
Lebanon (0·45) and Turkey (0·42); and six had ratios less than 0·60 for
preterm birth complications, including Egypt (0·47) and Syria (0·19).
Sample findings from the region
Data for united Arab Emirates
All data are for all ages and both genders unless otherwise specified.
Top five causes of death 2015:
Top five causes of years lived with disability
Top five causes of disability-adjusted
life years (DALYs) 2015:
Note that DALYs are the sum of YLLs and YLDs. One DALY equals one lost year of healthy life.
Top five risk factors in terms
of DALYs 2015:
Life expectancy females
Healthy life expectancy females
Life expectancy males
Note that MDG4 called for countries to decrease under 5 mortality by an annual rate of 4.4%.
|Date of upload: 15th Nov 2016|
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