Trends in Death and Disability in Asia and the Pacific: Key Findings from the Global Burden of Disease 2010 Study Professor Alan Lopez School of Population Health, The University of Queensland Brisbane, Australia [email protected]
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Trends in Death and Disability in Asia and thePacific: Key Findings from the Global Burden of
Disease 2010 Study
Professor Alan Lopez
School of Population Health, The University of Queensland
Brisbane, Australia
What is the Global Burden ofDisease 2010?
1) A systematic scientific effort to quantify thecomparative magnitude of health loss due to majordiseases, injuries and risk factors by age, sex, country,for 1990 and 2010; i.e. Amassing the best evidence onthe state of the world’s health.
2) By the numbers: 291 diseases and injuries, 1,160sequelae of these diseases and injuries, and 67 riskfactors or clusters of risk factors.
3) GBD 2010 provides uncertainty intervals for allquantities of interest.
GBD 2010 team
486 authors from 302 institutions in 50 countries
Some GBD terminology
1) Years of life lost due to premature mortality due to adeath at age x is the standard life expectancy at age x.
2) Years lived with disability for a cause in an age-sexgroup equals the prevalence of the condition times thedisability weight for that condition.
3) DALYs = Years of life lost due to premature mortality(YLLs) and years lived with disability (YLDs).
4) In the GBD, disability refers to any short-term orlong-term health loss.
5) In the GBD 2010, DALYs are not discounted orage-weighted.
Initial publication of Study methods andfindings; Lancet Dec, 2012
Chief components of the GBD2010 Study
GBD 2010 Findings I:
Mortality
157 of 187 countries had increases in life expectancyat birth from 1990 to 2010 for males and 166 of 187for females.
Progress in reducing global mortality,1970-2010, by age and sex
Global deaths in 2010 by age andGBD regions
Probability of child death, 2010(per 1000 live births)
Annual rate of decline in Under-5mortality, 1990-2010
Risk of adult death (ages 15-59) per1000 males aged 15, 2010
Female Life Expectancy, 2010
Male Life Expectancy, 2010
Absolute Change in Female LifeExpectancy, 1990-2010
Absolute Change in Male LifeExpectancy, 1990-2010
GBD 2010 Findings II:
Causes of Death
The universe of CoD data
We attempted to identify allavailable data on causes ofdeath for 187 countriesfrom 1980 to 2010
•We have used 9 differentsources of CoD data
•We have collected data onaround 600 million deaths inthe last 30 years
•Data available varies bydisease:
– More of maternal,cancer, injuries
– Less of NTD, diarrheaand LRI pathogens
Type Site years Countries
Vital Registration 2,798 130
Verbal Autopsy 486 66
Cancer registries 2,715 93
Police Reports 1,129 122
Surveys/Census 1,564 82
Maternal Mortality Surveillance 83 8
Deaths in health Facilities 21 9
Burial and Mortuary 32 11
Country−years of vital registration, 1980−2010
Change in broad causes of death inthe last 20 years, World
Leading causes of global death andpremature mortality in 2010
Global death ranks for the top 25 causes and thepercent change between 1990 and 2010
YLL top 25 leading causes across21 GBD regions, 2010
Asia-Pacific: Leading causes of child deathin 2010, ages 0-4Oceania East Asia South Asia Southeast Asia
Lower respiratoryinfections Congenital anomalies
Preterm birthcomplications
Preterm birthcomplications
Preterm birthcomplications
Preterm birthcomplications
Lower respiratoryinfections
Lower respiratoryinfections
Diarrheal diseasesLower respiratoryinfections Diarrheal diseases Diarrheal diseases
Neonatal encephalopathy Neonatal encephalopathy
Sepsis and otherinfectious disorders ofthe newborn baby Neonatal encephalopathy
Congenital anomalies Drowning Neonatal encephalopathy Congenital anomalies
Sepsis and otherinfectious disorders ofthe newborn baby Road injury Congenital anomalies
Sepsis and otherinfectious disorders ofthe newborn baby
Meningitis Leukemia Meningitis Meningitis
Protein-energymalnutrition Falls
Protein-energymalnutrition Measles
Syphilis Diarrheal diseases Measles Drowning
HIV/AIDS Meningitis EncephalitisTyphoid and paratyphoidfevers
Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease Ischemic heart disease Tuberculosis
Diabetes mellitus Road injury Tuberculosis Cerebrovascular disease
Tuberculosis Liver cancer Self-harm Road injury
Ischemic heart disease Ischemic heart disease Road injury Ischemic heart disease
Cirrhosis of the liverTrachea, bronchus, andlung cancers HIV/AIDS HIV/AIDS
HIV/AIDS Self-harmChronic obstructivepulmonary disease Cirrhosis of the liver
Chronic kidney diseases Stomach cancer Diarrheal diseases Diabetes mellitus
Cerebrovascular diseaseChronic obstructivepulmonary disease Cerebrovascular disease
Lower respiratoryinfections
Malaria Cirrhosis of the liver Cirrhosis of the liver Interpersonal violence
Maternal disorders Esophageal cancerFire, heat and hotsubstances Chronic kidney diseases
Asia-Pacific: leading causes of adult death,ages 15-59, 2010
Asia-Pacific: leading causes of YLLs, 2010
Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease
Lower respiratoryinfections Cerebrovascular disease
Diabetes mellitus Ischemic heart diseasePreterm birthcomplications Tuberculosis
Diarrheal diseasesChronic obstructivepulmonary disease Diarrheal diseases
Lower respiratoryinfections
Ischemic heart disease Road injury Ischemic heart disease Ischemic heart disease
Preterm birthcomplications
Trachea, bronchus, andlung cancers
Chronic obstructivepulmonary disease Road injury
Tuberculosis Liver cancerNeonatalencephalopathy Diarrheal diseases
Meningitis Stomach cancer
Sepsis and otherinfectious disorders ofthe newborn baby
Preterm birthcomplications
Malaria Self-harm Tuberculosis Diabetes mellitus
HIV/AIDSLower respiratoryinfections Cerebrovascular disease HIV/AIDS
Cerebrovascular disease Esophageal cancer Self-harmNeonatalencephalopathy
GBD 2010 Findings III:
DALYs/Disease Burden
Leading causes of the Global Burden of Disease(DALYs), 2010
Infectious, neonatal, maternal
Non-communicable
Injuries
Leadingcauses of
globalDALYsshifting
Asia-Pacific: leading causes of DALYs, 2010
Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease
Lower respiratoryinfections Cerebrovascular disease
Diabetes mellitus Ischemic heart diseasePreterm birthcomplications Tuberculosis
TuberculosisChronic obstructivepulmonary disease Diarrheal diseases Ischemic heart disease
Diarrheal diseases Road injury Ischemic heart diseaseLower respiratoryinfections
Ischemic heart disease Low back painChronic obstructivepulmonary disease Road injury
Preterm birthcomplications
Trachea, bronchus, andlung cancers
Neonatalencephalopathy
Major depressivedisorder
Malaria Liver cancer Tuberculosis Low back pain
MeningitisMajor depressivedisorder
Sepsis and otherinfectious disorders ofthe newborn baby Diarrheal diseases
HIV/AIDS Neck pain Low back painChronic obstructivepulmonary disease
Asthma Diabetes mellitus Iron-deficiency anemia Diabetes mellitus
1) Power of comparative analyses of DALYs:10 leading diseases and injuries; 10 leading risks
2) Progressive Disease Transition fromCommunicable to Non-Communicable Causes
3) The Disability Transition: Progressive Shift in Burdenfrom Premature Mortality to Years Lived with Disability
1990 2010
Summary
• Rapid (& sustained) progress in reducing child (andmaternal) mortality throughout Asia over past 20 years
• Large variations across Asia/Pacific in extending lifeexpectancy (ranging from 0 to 20 years since 1990)
• Premature adult mortality now a leading cause of healthloss in all populations in the region, including from majornoncommunicable diseases ( stroke, IHD, COPD, lungand liver cancer), but also TB, lower resp diseases andinjuries ( RTAs, suicide, falls, drowning).
• Progressive rise in burden of disability ( low backpain, depression, injuries and NCDs) across theregion
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