Global Burden of Disease - World Health

Global study shows life-expectancy up, but progress not universal

The Lancet recently published the Global Burden of Disease 2015 study. It is the most up-to-date analysis on the state of the world’s health intended to equip governments and donors with evidence to identify national health challenges and priorities for intervention. This massive effort brings together 1870 independent experts in 127 countries and territories as part of the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2015 study collaboration. Middle East Health reports.

The Global Burden of Disease study (GBD 2015) shows that globally, people’s health is improving, but progress has been far from universal. The report highlights areas where improvements must be made.

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.”

Life expectancy
The world population has gained more than a decade of life expectancy since 1980, rising to 69.0 years in men and 74.8 years in women in 2015. An important contributor to this has been large falls in death rates for many communicable diseases particularly in the last 10 years, including HIV/AIDS, malaria, and diarrhoea. The rate of people dying from cardiovascular disease and cancers has also fallen, although at a slower pace.

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).

Health loss
In the past 25 years, the main causes of health loss (measured in years lived with disability, or YLD) have hardly changed – in 2015, low back and neck pain, sense organ disorders (including hearing loss and vision loss), depressive disorders and iron-deficiency anaemia were the leading causes of health loss.

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
Although healthy life expectancy has increased steadily in 191 of 195 countries (by 6.1 years) between 1990 and 2015, it has not risen as much as overall life expectancy (10.1 years), meaning people are living more years 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
Since 1990, there have been particularly large and concerning increases in exposure to high BMI, drug use, occupational carcinogens (e.g. diesel exhaust and benzene), ozone pollution, and high blood sugar, which affect the burden of conditions like diabetes, heart disease and cancers. Additionally, exposure to other risks including dietary risks (e.g. diets high in salt and low in vegetables, fruit, whole grains, nuts and seeds, and seafood which together account for more than 10% of ill health worldwide), high cholesterol, alcohol, and ambient air pollution have changed very little, highlighting huge opportunities for intervention.

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.

Maternal mortality
Worldwide, maternal death rates have been reduced by nearly a third since 1990, falling from 282 deaths per 100,000 live births in 1990 to 196 in 2015, with progress accelerating since 2000. Yet, in 2015 more than 275,000 women died in pregnancy or childbirth in 2015, mostly from preventable causes.

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.

Under-5 mortality
Worldwide, the number of deaths in children under the age of 5 has morethan halved from 12.1 million in 1990 to 5.8 million in 2015, and the gap between groups of countries with the lowest and highest rates of child mortality is shrinking. Accelerated progress since 2000 is mainly as a result of tackling infectious diseases like malaria, diarrhoea and measles. However, the world fell short of the Millennium DevelopmentGoal (MDG) target to reduce child mortality by two thirds between 1990 and 2015.

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.

Global Burden of Disease 2015

The Global Burden of Disease in the Eastern Mediterranean Region

Since 1990, life expectancy has risen and both child and maternal mortality have declined in the Eastern Mediterranean Region, according to the recently published Global Burden of Disease study in The Lancet.

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.”

Heart disease
Ischemic heart disease was the leading killer in 19 of the region’s 22 countries in 2015, resulting in 56,391 deaths in Afghanistan, 30,156 deaths in Morocco, and 15,650 deaths in Saudi Arabia. The leading causes of death in the region’s remaining three countries were pneumonia (668 deaths in Djibouti), diarrheal disease (19,738 deaths in Somalia), and war (54,060 deaths in Syria).

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

  • Over the past 25 years, life expectancy has increased throughout the Eastern Mediterranean Region. In 2015, the life expectancy at birth was 79 years in Bahrain, 72 in Egypt, 66 in Pakistan, and 68 in Sudan.
  • While the world has made great progress in reducing deaths of young children, globally 5.8 million children under the age of 5 died in 2015. Of that global fi gure, 750 of those deaths were in Oman, 2,780 in Tunisia, and 19,910 in Iran.
  • Many countries in the Eastern Mediterranean Region have reduced maternal mortality. For example, the number of maternal deaths in 2015 in Lebanon was 13, down from 24 in 1990. And in Jordan, the ratio of maternal deaths fell from 116 deaths per 100,000 livebirths to 48.
  • In 2015, war was the greatest contributor to disability in Afghanistan, Iraq, Lebanon, and Syria. For Syrian men, life expectancy fell more than 11 years compared to the pre-war year of 2005.
  • Diabetes also causes a disproportionate amount of disability, ranking in the top three leading causes of disability in over half of the countries in the region in 2015 including Egypt, Iraq, and Kuwait.


Data for united Arab Emirates

All data are for all ages and both genders unless otherwise specified.

Top five causes of death 2015:
1. Ischemic heart disease – causes 21.6% of total deaths
2. Motor vehicle road injuries – 9%
3. Hemorrhagic stroke – 6.4%
4. Diabetes – 3.8%
5. Ischemic stroke – 3.6%

Top five causes of years lived with disability (YLDs) 2015:
1. Low back pain – 8.2% of total YLDs
2. Diabetes – 8.1%
3. Major depression – 7.2%
4. Other musculoskeletal – 5.5%
5. Migraine – 5.3%

Top five causes of disability-adjusted life years (DALYs) 2015:
1. Ischemic heart disease – 9.3%
2. Motor vehicle road injuries – 5.8%
3. Diabetes – 5.5%
4. Low back pain – 4.2%
5. Major depression – 3.6%

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:
1. High body-mass index – 12.7%
2. High fasting plasma glucose – 10.3%
3. High systolic blood pressure – 10%
4. High total cholesterol – 7.4%
5. Diet low in whole grains – 5.9%

Maternal mortality
Number of maternal deaths 1990: 15
Number of maternal deaths 2015: 18
Ratio of maternal deaths 1990 (per 100,000 live births): 31.8
Ratio of maternal deaths 2015 (per 100,000 live births): 18
Annualized percentage change of ratio of maternal deaths 1990-2015: -2.3

Under-5 mortality
Number of under 5 deaths 2015: 540
Ratio of under 5 deaths 2015 (per 1,000 live births): 5.5
Annualized percentage change of ratio of under 5 deaths 1990-2015: - 6

Life expectancy females
2005: 77.3
2015: 78

Healthy life expectancy females
2005: 66.2
2015: 67

Life expectancy males
2005: 74.2
2015: 74.5 Health life expectancy males 2005: 64.5 2015: 65

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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