Global Burden of Disease 2016
The medical journal Lancet (volume 390, number 10100, Sep 16, 2017, p 1083-1464) has published a series of articles on global health 2016 that shows the changing pattern of disease in different regions and countries of the world. The executive summary states:
The Global Burden of Disease Study (GBD) is the most comprehensive worldwide observational epidemiological study to date. It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels. Examining trends from 1990 to the present and making comparisons across populations enables understanding of the changing health challenges facing people across the world in the 21st century.
The editors of Middleast4change have selected extracts that might be informative for the region. The full set of articles can be read in The Lancet.
Fig 1. Age-standardised mortality rates (, 1970–2016Each line represents the trend in age-standardised mortality rates from 1970 to 2016 by SDI quintile. Values shown above the lines are ratios between the given SDI quintile and high SDI. SDI=Socio-demographic Index
- As can be seen the reduction in mortality is greatest with countries with the lowest SDI copmared to highest SDI and in men more than women.
In addition to the strong relationship between life expectancy at birth and SDI (correlation of 0·83 for men and 0·87 for women), the figure also shows the strong temporal shift over the decades towards higher life expectancies. This shift is most evident at high SDI and not evident at levels of SDI from 0 to 0·7 (ie, in most low-income and middle-income countries; appendix section 8 p 113).
Unexpected deaths, or what the authors call fatal discontinuities are deaths caused by wars, famines or epidemics. Figure 3 shows the toll of wars and social disruption in the Middle East.
Figure 3. Deaths due to fatal discontinuities by category (A, conflict and terrorism; B, epidemics; C, famine; D, natural disasters) and region from 1980 to 2016, both sexes combined
Leading causes of death
One way of measuring impact of disease is using an index known as year of life lost (YLL). YLL is an estimate of the average years a person would have lived if he or she had not died prematurely. It is, therefore, a measure of premature mortality.
Figure 4. Leading Level 3 causes of total YLLs by country, for all ages, females (A) and males (B)
ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Marshall Isl=Marshall Islands. Solomon Isl=Solomon Islands. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines. YLLs=years of life lost.
The leading cause of YLL in the Middle East is ischaemic heart disease (heart attacks), conflict or terrorism (Syria and Yemen), death around after birth (neonatal problems, Iraq) and lower respiratory infections (Afghanistan).
Sex difference in causes of disability
Years lived with disability (YLD) is a form of quantifying ill health. Figure 5 shows the difference in YLD between men and women by age and disease.
Figure 5. Sex difference in global YLD rates per 100 000 for 21 Level 2 causes by age, 2016
YLDs=years lived with disability.
An Editorial in the Lancet states: Overall, the findings show that the world is becoming healthier, but progress is uneven. People are living longer, but with more disease. As SDI rises, the gap between healthy life expectancy and life expectancy (ie, the time living with ill health) is less for high SDI countries compared with low SDI countries. So, while there is an expansion of morbidity as life expectancy increases, there is a relative compression of morbidity (less time spent with ill health) as a country becomes richer.