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Section C
CRA for GBD 2000: Results!
Adult mortality
(Probability of death ages 15-59 yrs.)
WHO Member States by Mortality Strata, 1999
Child mortality
(Probability of death under 5 years of age)
Source: List of Member States by WHO Region and Mortality Stratum. www.who.int/whr/2002/MembersETC.pdf
3
14 WHO Mortality Subregions
A: very low child and adult mortality
B: low child and adult mortality
C: low child, high adult
D: high child, high adult
E: high child, very high adult
4
Most Populous Countries in Three Major World Regions
1. Developing—high mortality
(2.3 billion people)
Country
% pop.
3. Developed (1.3 billion people)
Country
% pop.
USA
21%
India
44%
Russian Federation
11%
Pakistan
6%
Japan
9%
Bangladesh
6%
Germany
6%
Nigeria
5%
Turkey
5%
Egypt
3%
United Kingdom
4%
Ethiopia
3%
2. Developing—lower mortality
(2.4 billion people)
China
54%
Indonesia
9%
Brazil
7%
Mexico
4%
Vietnam
3%
Philippines
3%
5
Global Distribution of Mortality
Global distribution of mortality attributable to 20 leading selected
risk factors
Data Source: WHO Global Burden of Disease and Risk Factors
6
Global Distribution of Disease Burden
Global distribution of disease burden attributable to 20 leading
selected risk factors
Data Source: WHO Global Burden of Disease and Risk Factors
7
High-Mortality Developing Regions
Data Source: WHO Global Burden of Disease and Risk Factors
8
Developed Regions
Data Source: WHO Global Burden of Disease and Risk Factors
9
Lower-Mortality Developing Regions
Data Source: WHO Global Burden of Disease and Risk Factors
10
Attributable DALYs (000s)
Distribution of Attributable Burden by Exposure Levels
Blood pressure
Cholesterol
BMI
Exposure levels
Commonly used
threshold values for
current definitions
Data Source: WHO Global Burden of Disease and Risk Factors
11
Distribution by Age of Burden: Five Global Risks
Distribution by age of burden due to leading five global risks
Data Source: WHO Global Burden of Disease and Risk Factors
12
Leading 10 Selected Risk Factors & Diseases or Injuries
Developing high mortality (AfrD, AfrE, AmrD, EmrD, SearD)
Risk factor
% DALYs
Disease or injury
% DALYs
Underweight
14.9%
HIV/AIDS
9.0%
Unsafe sex
10.2%
Lower respiratory infections
8.2%
Unsafe water, S&H
5.5%
Diarrheal diseases
6.3%
Indoor smoke
3.7%
Childhood cluster diseases
5.5%
Zinc deficiency
3.2%
Low birth weight
5.0%
Iron deficiency
3.1%
Malaria
4.9%
Vitamin A deficiency
3.0%
Unipolar depressive disorders
3.1%
Blood pressure
2.5%
Ischemic heart disease
3.0%
Tobacco
2.0%
Tuberculosis
2.9%
Cholesterol
1.9%
Road traffic injury
2.0%
13
Leading 10 Selected Risk Factors & Diseases or Injuries
Developing lower mortality (AmrB, EmrB, SearB, WprB)
Risk factor
% DALYs
Disease or injury
% DALYs
Alcohol
6.2%
Unipolar depressive disorders
5.9%
Blood pressure
5.0%
Cerebrovascular disease
4.7%
Tobacco
4.0%
Lower respiratory infections
4.1%
Underweight
3.1%
Road traffic injury
4.1%
Overweight/obesity
2.7%
COPD
3.8%
Cholesterol
2.1%
Ischemic heart disease
3.2%
Low fruit and vegetables
1.9%
Birth asphyxia/trauma
2.6%
Indoor smoke from solid fuels
1.9%
Tuberculosis
2.4%
Iron deficiency
1.8%
Alcohol use disorders
2.3%
Unsafe water, S&H
1.7%
Deafness
2.2%
14
Leading 10 Selected Risk Factors & Diseases or Injuries
Developed (AmrA, EurA, EurB, EurC, WprA)
Risk factor
% DALYs
Disease or injury
% DALYs
Tobacco
12.2%
Ischemic heart disease
9.4%
Blood pressure
10.9%
Unipolar depressive disorders
7.2%
Alcohol
9.2%
Cerebrovascular disease
6.0%
Cholesterol
7.6%
Alcohol use disorders
3.5%
Overweight/obesity
7.4%
Dementia and other CNS
disorders
3.0%
Low fruit and vegetables
3.9%
Deafness
2.8%
Physical inactivity
3.3%
COPD
2.6%
Illicit drugs
1.8%
Road traffic injury
2.5%
Unsafe sex
0.8%
Osteoarthritis
2.5%
Iron deficiency
0.7%
Trachea bronchus & lung
cancers
2.4%
15
Distribution of Attributable Burden by Age
Most or all among children 0–4 years
- Underweight and micronutrient deficiencies, unsafe water,
indoor smoke, lead, climate change
Most or all among adults 15–59 years
- Unsafe sex, tobacco, alcohol, illicit drugs, occupational injuries,
unsafe health care injections, and childhood sexual abuse
outcomes
About half under 60 years, half over 60 years
- Diet-related CVD risks and physical inactivity, urban air
pollution, occupational carcinogens and airborne particulates
16
Benefits of Reducing 20 Leading Risks
Data Source: WHO Global Burden of Disease and Risk Factors
17
Alcohol Trends
Data Source: WHO Global Burden of Disease and Risk Factors
18
GBD 1990 Projections
Data Source: WHO Global Burden of Disease and Risk Factors
19
Attributable Burden and Avoidable Burden
Estimated attributable burden in 2000 and avoidable burden in 2010
and 2020
Data Source: WHO Global Burden of Disease and Risk Factors
20
Conclusions: 1
Role of established risk factors greater than commonly thought
In many world regions, the leading five risk factors [of those
measured] account for more than one-third of mortality and onequarter of DALYs
Risks are widespread—all risk factors have global impact, and the
burden of many occurs almost exclusively in developing countries
21
Conclusions: 2
Large and often unrecognized potential for prevention
- Full impact of risks are often under-measured and, hence,
under-appreciated
-
Risks often occur as a continuum throughout the population
We have affordable interventions to tackle these risks, e.g., for
cardiovascular disease
-
-
Reduced salt in manufactured foods
Combination cardiovascular “cocktail” (BP, cholesterol
lowering, and aspirin)
22
2002 World Health Report
“Reducing risks, promoting healthy life”
- www.who.int/whr
23
Thanks
Thanks to M. Ezzati, A. Lopez, C. Murray, and WHO colleagues for
producing this work
24
