Summary Background China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life ...expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. Findings The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. Interpretation The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Funding Bill & Melinda Gates Foundation.
Summary Non-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and mental disorders, and injuries have become the major causes of morbidity and ...mortality in Pakistan. Tobacco use and hypertension are the leading attributable risk factors for deaths due to cardiovascular diseases, cancers, and respiratory diseases. Pakistan has the sixth highest number of people in the world with diabetes; every fourth adult is overweight or obese; cigarettes are cheap; antismoking and road safety laws are poorly enforced; and a mixed public–private health-care system provides suboptimum care. Furthermore, almost three decades of exposure to sociopolitical instability, economic uncertainty, violence, regional conflict, and dislocation have contributed to a high prevalence of mental health disorders. Projection models based on the Global Burden of Disease 2010 data suggest that there will be about 3·87 million premature deaths by 2025 from cardiovascular diseases, cancers, and chronic respiratory diseases in people aged 30–69 years in Pakistan, with serious economic consequences. Modelling of risk factor reductions also indicate that Pakistan could achieve at least a 20% reduction in the number of these deaths by 2025 by targeting of the major risk factors. We call for policy and legislative changes, and health-system interventions to target readily preventable non-communicable diseases in Pakistan.
Background The trends of COPD mortality and prevalence over the past 2 decades across all provinces remain unknown in China. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to ...estimate the mortality and prevalence of COPD during 1990 to 2013 at a provincial level. Methods Following the general analytic strategy used in GBD 2013, we analyzed the age- sex- and province-specific mortality and prevalence of COPD in China. Levels of and trends in COPD mortality and prevalence were assessed for 33 province-level administrative units during 1990 to 2013. Results In 2013, there were 910,809 deaths from COPD in China, accounting for 31.1% of the total deaths from COPD in the world. From 1990 to 2013, the age-standardized COPD mortality rate decreased in all provinces, with the highest reduction in Heilongjiang (70.2%) and Jilin (70.0%) and the lowest reduction in Guizhou (26.8%). In 2013, the death rate per 100,000 was highest in Guizhou (196.0) and lowest in Tianjin (34.0) among men and highest in Gansu (141.1) and lowest in Beijing (23.7) among women. The number of COPD cases increased dramatically from 32.4 million in 1990 to 54.8 million in 2013. The age-standardized prevalence rate of COPD remained stable overall and varied little for all provinces. Conclusions COPD remains a huge health burden in many western provinces in China. The substantial increase in COPD cases represents an ongoing challenge given the rapidly aging Chinese population. A targeted control and prevention strategy should be developed at a provincial level to reduce the burden caused by COPD.
Abstract Background Since 1990, health priorities in sub-Saharan Africa (SSAF) have been set primarily by epidemics of infectious diseases. For future global health efforts, it is important to ...understand the growing burden of non-communicable diseases (NCDs). Methods For ten major causes of NCDs, the burden of 357 diseases and sequelae was estimated. Cause-specific death rates were estimated by an ensemble method using vital registration and verbal autopsy data. The number of patients was estimated with DisMod III by mathematical modelling of epidemiological measures of each sequela. Disability weights were estimated by an open-access web-based survey, in addition to population-based surveys in Bangladesh, Indonesia, Peru, and the USA. Findings In 2010, more than 2·06 million deaths due to NCDs occurred in SSAF, a 46% (95% CI 41–59) increase from 1990. The risk in terms of age-standardised death rate has declined by about 12% (95% CI 8–14) from 1990 to 2010, with a negligible decline in central SSAF. The total burden of NCDs in terms of disability-adjusted life-years (DALYs) showed a similar pattern, with an increase of 45% (95% CI 41–52) in DALYs and a decrease of 9% (7–12) in standardised DALYs per capita. The fraction of burden of cancers remained at 8% in 2010, while cardiovascular and respiratory diseases decreased slightly from 16% and 12% in 1990 to 15% and 10% in 2010, respectively. Mental and behavioural disorders, musculoskeletal diseases, and diabetes and endocrine diseases increased by 3%, 2%, and 1% in 2010, respectively (from 12%, 9%, and 11% in 1990). In southern SSAF, the proportion of DALYs due to infectious diseases increased by 17% between 1990 and 2010, while the proportion of DALYs due to NCDs and injuries declined by about 20% and 15%, respectively. The decline in the burden of NCDs may be due to the pressure of competing infectious disease risks over this period. Interpretation An increasing burden of NCDs in Africa shows a growing health iceberg hidden under epidemics of infectious diseases. The NCDs with an increasing burden of disease in SSAF are mental and behavioural conditions and musculoskeletal diseases. Funding Bill & Melinda Gates Foundation.
Abstract Background Chronic kidney disease (CKD) is a major health and economic burden globally. This progressive disease is treatable by dialysis and kidney transplantation when the kidneys reach ...CKD stage 5 or end-stage renal disease (ESRD), but these two interventions are very expensive and often unavailable in low-resource settings. The aim of this study is to provide a country-level comparison of dialysis rates, transplantation rates, and untreated CKD stage 5 in order to identify countries and regions with large disparities and unmet treatment need for ESRD. Methods We used a negative binomial Bayesian meta-regression tool to analyse data collected from systematic literature reviews and national renal replacement registries in order to estimate incidence and prevalence of ESRD on dialysis, ESRD with kidney transplantation, and untreated ESRD for 187 countries by year, age, and sex. We then assessed ratios of treated to untreated ESRD to identify countries with extreme unmet need for kidney disease treatment. Findings Both dialysis and kidney transplantation rates have increased considerably since 1990, but there are still significant disparities both within and across countries. Globally in 2010, the proportion of CKD stage 5 and ESRD patients who received dialysis or had kidney transplantation was only 58·9% (95% CI 55·6–61·0), ranging from less than 2% in most of sub-Saharan Africa to over 70% in high-income North America, high-income Asia Pacific, and east Asia. Interpretation These estimates are a crucial factor to help to inform public health policy decisions and the nephrology community, especially in countries previously lacking such estimates. There is an urgent need for better monitoring and data collection of CKD stage 5 in order to better prepare health systems for ESRD treatment needs. Funding Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
Abstract Background Skin diseases are some of the most common human illnesses across geographies and time. Despite this, there are surprisingly few large epidemiological studies that provide accurate ...data on cutaneous disease incidence and prevalence or estimates of the global burden of skin disease. The overall aim of this study was to estimate the global burden of disease attributable to 15 categories of skin disease from 1980 to 2010 for 187 countries, by age and sex, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2010. Methods For each of the following diseases we performed systematic literature reviews and analysed the resulting data using a negative binomial Bayesian meta-regression tool: eczema, psoriasis, acne vulgaris, pruritus, alopecia areata, decubitus ulcer, urticaria, scabies, fungal skin diseases, impetigo, abscess and other bacterial skin diseases, cellulitis, viral warts, molluscum contagiosum, and non-melanoma skin cancer. Once estimates of disease prevalence were generated, we determined appropriate disability attributable to that disease and applied GBD 2010 disability weights to determine non-fatal burden. Findings Three skin conditions are in the top ten most prevalent diseases worldwide, and eight fall into the top 50. When considered collectively, skin conditions range from being the second to the 11th leading causes of years lived with disability at the country level for 2010 and from the third to the 28th leading causes of disability-adjusted life-years. Interpretation Using more data than have ever been used previously, novel methods, and a more parsimonious choice of disease categories, we found that skin conditions are widespread, and the burden due to these diseases is enormous. Such a burden is particularly large for a field that receives relatively little attention in global health. These results suggest an urgent need for the inclusion of skin disease prevention and treatment in future global health efforts. Funding Bill & Melinda Gates Foundation.
Abstract Background The global burden of mental disorders and substance abuse has increased 38% in absolute terms (5·8% per capita) between 1990 and 2010, from 5·3% to 7·4% of total ...disability-adjusted life-years (DALYs). Given the increasing importance of mental disorders worldwide, particularly for young adults, how can we make meaningful comparisons to determine which countries' policies have been effective in reducing their burden? This research will demonstrate new methods for comparative analysis highlighting the burden of mental disorders in the USA. Methods Mental burden estimates were derived as part of the Global Burden of Disease Study (GBD) 2010. To make meaningful comparisons across time, age-standardised DALY rates were utilised to adjust for changes in population size and age structure. Findings Age-standardised DALY rates for mental disorders in the USA increased 13% between 1990 and 2010, from 3162 to 3576 DALYs per 100 000; by contrast, all developed countries increased 5% from 3016 to 3169. This increase in the USA was primarily due to substance abuse (65%) and major depression (13%). Across the 187 countries analysed, with highest rank indicating worst burden, the USA ranked 162nd for mental disorders in 2010. For specific conditions, ordered from highest to lowest burden, the USA ranked 56th for major depression (945 per 100 000), 183rd for drug use (743), 164th for anxiety (594), 138th for alcohol use (354), 179th for schizophrenia (242), and 52nd for bipolar disorder (186). Taking uncertainty into account, drug abuse was the only condition for which the USA performed significantly worse (p<0·0001) compared with the global mean. Interpretation The USA consistently ranks below other developed nations and many developing nations for mental disorders despite spending 17·6% (US$2·5 trillion) of its gross domestic product on health in 2010, with 5% of that on mental health, among the highest of any country. This makes a compelling case for re-examination of how the USA should reprioritise mental health policy and funding. For substance abuse, countries that emphasise harm reduction policies (Netherlands, Belgium, Germany) perform substantially better than do those focused on penalisation (USA, UK, Italy, Spain). For anxiety and depression, prescription of psychotropic drugs in lieu of the more effective types of psychotherapy may have led to little improvement despite large expenditure. Further data collection on prevalence and severity of mental disorders is necessary to improve comparisons between countries. Funding Bill & Melinda Gates Foundation.
Abstract Background Haemoglobinopathies and haemolytic anaemias are genetic diseases leading to deficiencies in structure or function of haemoglobin, and predispose to early death and non-fatal ...disability states of varying severities. As part of the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2010, this is the first comprehensive global study of their epidemiology and disease burden. Methods Following a systematic literature review, we modelled thalassaemias, sickle-cell diseases (SCD), and glucose-6-phosphate dehydrogenase deficiency using DisMod-MR, a Bayesian meta-regression tool developed for GBD 2010. Based on Expert Group data, we modelled the prevalence of associated sequelae and then converted estimates into years lived with disability (YLDs) by incorporating data on age-specific distributions with disability weights from the Institute for Health Metrics and Evaluation's Disability Weights Survey. An overarching Cause of Death Ensemble model for haemoglobinopathies used prevalence times excess mortality of each condition as a covariate to calculate years of life lost. Findings Prevalence of haemoglobinopathies was relatively static from 1990 to 2010. Mortality rate decreased in virtually all GBD regions, and the disability rate (YLDs per capita) did not change appreciably. Coupled with population growth, this translated into increased total disability-adjusted life-years. West and central sub-Saharan Africa had the highest death and disease burden per capita, while south Asia had the highest total deaths and disability. Thalassaemia and SCD were by far the largest component of the overall haemoglobinopathy disease burden. Thalassaemia was the primary problem in North Africa/Middle East and east and south Asia, whereas SCD predominated in sub-Saharan Africa, western Europe, and North America. Interpretation Haemoglobinopathies are a significant source of death and disability in many regions and countries throughout the world. Though it is unclear if public health interventions can address birth prevalence or disability burden, it appears that significant progress has been made in reducing mortality over the last 20 years. Funding Funding for GBD 2010 was provided by the Bill & Melinda Gates Foundation.
Abstract Background Anaemia is associated with increased maternal and neonatal mortality, with young children most at risk of developing long-term ramifications. Most previous studies have been ...geographically limited with little detail about severity or aetiology. In this analysis, we completed the most comprehensive survey of anaemia burden to date. Methods Using publicly available data, we estimated mild, moderate, and severe anaemia in 1990 and 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data and resources of the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2010. Findings Global anaemia prevalence in 2010 was 32·9%, causing 68·36 million years lived with disability (95% CI 40·98–107·54 million; 8·8% of the total for all conditions, 95% CI 6·3–11·7). Prevalence dropped for both sexes from 1990 to 2010, though more so for males. Females' prevalence was higher in most regions and age groups. South Asia and central, west, and east sub-Saharan Africa had the highest burden, while east, southeast, and south Asia saw the greatest reductions. Ten different conditions were among the top three in prevalence, depending on the region. Malaria, schistosomiasis, and chronic kidney disease-related anaemia were the only conditions to increase in prevalence. Haemoglobinopathies made significant contributions to the anaemia burden in both sexes, most regions, and all time periods. Burden was highest in children under 5 years old, the only age groups with negative trends from 1990 to 2010. Interpretation Anaemia is a heterogeneous and complex condition. Despite significant progress, many challenges remain. Regional differences remain stark, some conditions are growing as a proportion of overall anaemia, the gender gap is widening, and the total disease burden remains high. Worryingly, young children, the most vulnerable group, appear to be doing worse over the past 20 years. Targeted surveillance and intervention in high-risk populations should be a greater priority. Funding Funding for GBD 2010 was provided by the Bill & Melinda Gates Foundation.
Abstract Background The Global Burden of Disease (GBD) Study provides detailed information about leading causes of premature mortality and disability to help policy makers assess health in their ...countries. GBD is also a massive and rigorous audit of country data collection systems. Globally, major challenges are posed by missing data on mortality and causes of death and disability, which creates substantial uncertainty in GBD estimates for numerous causes in many countries. This study aims to identify gaps in data sources that are important to fill to improve estimation of disease burden; gaps exist because data are either not collected or not being made available for research. Methods The data used in this study were derived from the GBD Study 2010 (GBD 2010), which compiled secondary data from literature reviews, internet searches, and correspondence and consultations with researchers, staff of national statistics institutes and ministries of health, and other experts. Frequently, literature reviews were not the primary source of data on causes of death and disability. Findings In general, data on mortality and causes of death were sparsest in countries with the fewest resources. Vital registration data with medical certification of causes of death were available from 130 countries. Regions with the greatest data gaps were sub-Saharan Africa and parts of Asia. Cause of death data from verbal autopsy were available only for 486 site-years from 66 countries, just 10% (47 site-years) of which were nationally representative. Gaps in sources of disability data were even more profound. Hospital discharge data coded in International Classification of Disease and Injuries (ICD) formats 9 and 10 were available for just 43 countries, and outpatient data were only available for the USA and Canada. Interpretation The GBD 2010 is a powerful starting point for evidence-based policy making. However, the accuracy of future GBD updates will be enhanced by improvements and expansion in data collection, which will strengthen future decision making and will be essential for monitoring progress toward the Millennium Development Goals and any health-related post-2015 goals. Gaps in mortality and cause of death data could be remedied through increased investment in vital registration and verbal autopsy data collection, particularly in low-resource settings. Training physicians in ICD coding and medical certification is crucial for strengthening the quality of vital registration data. Our findings about disability data scarcity highlight the importance of addressing these gaps, particularly in countries where GBD 2010 has documented the fastest epidemiological transitions. Funding Bill & Melinda Gates Foundation.
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