The Global Burden of Disease – The Rise of NCDs – Alessandro R Demaio
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So hello again.
My name is Doctor Alessandro Demaio and welcome
to the second lecture in your week on non-communicable
This lecture is entitled Global Burden Disease,
the rise of NCDs, and builds on an earlier
lecture that Dan Meyrowitsch back at the start
of your course gave you on the Global Burden
of Disease study that was released again,
last year in 2012.
But in particular, we're going to focus on
one aspect of that and that is the rise of
NCDs and the findings relating to a non-communicable
But before we do that, we need to just recap
on one thing.
I want to go over the concept of disability
adjusted life years or DALYs with you one
more time because this is going to be the
main indicator that we use to monitor burden
and disease outcomes for the risk factors
but also diseases associated within non-communicable
So disability adjusted life is, as we explained
at the start of the course, includes years
of life lost plus years of life lost to disability.
That is a normal healthy life will have a
beginning, a middle, and an end.
If someone dies earlier than expected, based
on global projections, then we include those
years they lost to death.
And if they have times of disability or disease
in their life.
We, we use a fraction of a simple measure
to work out how many years of life loss disability
that corresponds to depending on the disease.
So those two combined give us a measure of
disability just in life years, if you've gotten
this, go back and have another look at the
lecture from earlier in the course, but we'll
move on for now.
So what is the Global Burden of Disease? Well
the Global Burden of Disease is an analysis
which provides a comprehensive and comparable
assessment of mortality and the loss of health
for all regions of the world.
The overall burden of disease is assessed
using, as I mentioned, disability adjusted
life years or DALYs.
The original Global Burden of Disease Study
or GBD 1990 Study was commissioned by the
World Bank in 1991 to provide a comprehensive
assessment of the burden of 107 diseases and
And ten selected risk factors for the world
and eight major regions within the world in
The methods of GBD 1990 study created a common
metric to estimate the health lost associated
with morbidity and mortality, globally.
It generated widely published findings and
comparable information on disease and injury
And also gave us a snapshot of insolence and
prevalence for diseases around the world's
It also stimulated numerous national studies
on the burden of disease.
And these results have been used by Government
and non-government agencies to inform priorities
for research development policies and funding
The principle guiding the burden of disease
approach is that the best estimates of incidence,
prevalence and mortality can be generated
by carefully analysing all available sources
of information in a region or in a country.
And by correcting for biases.
So let's have a look now at how the Globe
Burden of Disease Study works in some more
First of all, the Globe Burden of Disease
studies provide an assessment of the health
of the world's populations.
They provide detailed regional and global
estimates for premature mortality, disability
and loss of health for 135 causes.
by age and by sex.
They draw on extensive WHO databases and on
information provided by the Member States.
Today, there's great demand for global burden
And research and advocacy groups have brought
new conditions to the awareness of the public
With that in mind, in 2010, sorry, with that
in mind, the 2010 Global Burden of Disease
study, reviews the magnitude of these conditions
compared to other causes of health burden.
The Global Burden of Disease 2010 is significantly
broad in scope from the previous versions
It includes 291 diseases and injuries, 67
risk factors, 1,160 nonfatal health consequences,
it estimates for 21 regions, it estimates
for 20 age groups, and it uses improved methods
for the estimation of health state severity
Researches have also significantly improved
methods for burden assessment since the original
Global Burden of Disease study in 1990.
And so these new tools can markedly enhance
the validity of estimations, particularly
for ranking risk factors and disabilities.
So let's now skip forward and have a look
at some of the key findings of the 2010.
Globe Awareness Disease study and also compare
these to the findings from 1990 and see how
the world's morbidity, mortality measure through
disability adjusted life years has changed.
So, some of the findings of the 2010 Globe
Burden Disease study published in 2012 include
years lived with disability for 1160 non-fatal
outcomes of 289 diseases and injuries from
the 1990 to 2010 region.
Also it gives healthy life expectancies for
more than a 187 countries.
So we've looked at how global burden of disease
study is structured and why it came about.
Let's have a look at some of the findings.
So, here on the screen you see the top 20
causes of deaths across the globe ranked from
1 to 20 depending on their contribution of
This is both sexes and all ages.
What you notice if you look across the colours,
to begin with blue is NCDs, red is infectious
diseases and also maternal child health and
green is injuries.
What you'll notice is that the leading causes
of death in 1990 and 2010 the top two in fact
haven't changed they are ischemic heart disease
COPD has overshot lower respiratory infections
to become number three.
Lung cancer has increased from number eight
to number five.
And across the globe, are pretty consistent
changes being the increase in rankings for
At the same time, we've seen a decrease in
the ranking of most infectious diseases, malaria,
tuberculosis, diarrheal diseases and lower
respiratory infections, to name a few in the
The standout obviously example of, of running
contrary of this is HIV, which is which we've
seen an enormous increase of in the last 20
If we now change it from global to first developed
we see, the first thing that we notice is
a dramatic change in the colour representation.
That is a dominance of NCDs.
We also notice that the top six courses have
largely remained unchanged.
Although we have seen an increase in these
diseases and their mortality course, the rankings
haven't in fact changed.
We have seen melodramatic increase in Alzheimer's
disease, diabetes and cirrhosis liver disease.
We've seen slight reductions in stomach cancer
and also road injuries.
If now we move to developing countries, but
remaining on causes of mortality main rankings.
We see a lot more of a dominance of the red
colour is coming back, so communicable diseases.
We see some quite dramatic changes from 1990
Stroke moves from number two to number one,
ischemic heart disease moves from number five
to number two.
COPD remains constant at number three.
Lower respiratory infections decrease along
with diarrheal diseases, and, and as I've
mentioned earlier, the main one running in
contrary to this trend is, is obviously HIV.
We also see a rapid increase in road traffic
injuries in developing countries and self-harm,
lung diseases, diabetes and hypertensive heart
disease, among others.
And finally here, we're looking at the same
tree map diagram.
But in, the metric in this representing this
diagram is in fact, deaths and not disability
adjusted life years.
So, it's the contribution of the various diseases
to mortality in developing countries, both
sexes and all age groups.
This is 2010.
But we see 10% of total deaths are contributed
by ischemic heart disease and around 10% from
cerebrovascular disease or stroke.
Both of these are we, we combine to make cardiovascular
If you contrast this with diarrheal diseases,
diarrheal diseases contribute around 3 and
a half percent of mortality in developing
Let’s now scour back the time, and compare
these with a picture in 1990.
We see quite different picture, diarrheal
diseases contribute 7%.
So double what they do in 2010.
Stroke contributes around 8% and it's giving
heart disease around 6.
So looking across these three diseases and,
and the trends more widely you can begin to
appreciate the change in disease patterns,
but also global burden contributed by communicable
and non-communicable diseases.
So that gives you an i, that gives you an
idea of the of the data that's available,
and the changes in, in the burden of disease
measured by the various outcomes across specific
regions and globally, in the last 20 years.
Let’s now have a look at some key outcomes
of the 2000 and 2010 Globalizate study.
So in terms of mortality, we found that mortality
rates are falling pretty much across the board
around the world.
That globally 52.8 million deaths occurred
And approximately, this is approximately 13%
more than 1990, and 20% more than 1970.
The global crude death rates have fallen from
11% to 7% per 1,000 population, due to, the
much larger relative increase in the world's
population, from 3.7 billion in 1970 to 6.9
billion in 2010.
We've seen an increase in life expectancy
from from 1970 to 2010.
Global male life expectancy at birth increased
from 56.4 years to 67.5 years.
And females from 61 to 73 years.
In terms of Risk Factor Burden, the findings
indicate that there has been an increase of
burden from blood, from high blood pressure,
high body mass index and high blood sugar.
The dietary respect is physical inactivity
collectively account for around 10% of global
disability adjusted life years in 2010.
Which puts them in the same tier as tobacco
smoking, alcohol use and childhood malnutrition.
In terms of causes of mortality, we've also
seen dramatic changes.
So the world is witnessing a huge shift in
in the leading cause of premature death.
From communicable, maternal, neonatal and
nutritional tau, causes, towards non-communicable
In 1990, 34% of all deaths were due to non-communicable
sorry, were due to communicable, neonatal
and maternal causes.
In 2010, though these largely preventable
diseases account for still one quarter of
the 52 million deaths.
The annual number of deaths from non-communicable
diseases have risen by 8,000,000 to 34,500,000
or two out of three deaths in 2010.
So, now, there're a lot of numbers and a lot
I want to now sort of relay that how does
this link back with your own with your own
And particularly for one of the implications
for you as global health practitioners, but
also global health in the Twenty First Century.
Well, first the health of young people is
As more and more children survive into adulthood,
if it's really must be. We found from the
Global Burden of Disease 2010 study, but efforts
really must be intensified to prevent young
Young adults, especially men, are now dying
at very high rates in Eastern Europe, Central
Asia and Eastern and Southern Africa.
Largely due to epidemics of alcohol related
mortality in the former regions and HIV in
the latter regions.
The second one, the big message is NCDs are
here to stay.
For this reason, policies that effectively
encourage and facilitate lifestyle changes,
especially a more balanced diet.
Increased physical activity would likely have
an enormous impact on global health and health
And finally, the balance of longer lives and
Disability adjusted life years are obviously
a measure of life loss to disability, but
also years of life lost.
And so from the Global Burden Disease 2010
study, and comparing it to 1990, we really
must see that, that over the next decades.
We don't have only a focus on extending lives,
which will likely pass the, the life expectancy
mark of 100 years for many countries.
But also that we focus on making these, these
latter years increasingly free from disability
In strategies that effectively deal with the
And the determinants are likely to be cost
effective but also bring enormous benefits
to populations globally.
So that's it from me, for the Global Burden
And I hope you enjoyed it.