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Group I
Group II
Group III
6%
7%
Group I
Group II
Group III
36%
54%
87%
10%
Low- and middle-income countries
High-income countries
Figure 1: Deaths by broad cause group, 2001 Source: Mathers et al. 2006
Europe and Central Asia, and Latin America and the
Caribbean, the proportion is well below 20%. The net effect
of these changes in age-specific mortality since 1990 has
been to increase global life expectancy at birth by 0.7 years
for females and by about twice this for males: a modest
scorecard.
Distribution of deaths by major cause group
Worldwide, one death in every three is from a Group I cause.
This proportion remains almost unchanged from 1990 with
one big difference: whereas HIV/AIDS accounted for only 2%
of Group I deaths in 1990, it accounted for 14% of Group I
deaths in 2001. Excluding HIV/AIDS, Group I deaths fell from
33% of total deaths in 1990 to less than 20% in 2001.
Virtually all of the Group I deaths are in low- and middleincome
countries. Just under 10% are from Group III causes
(injuries) and almost 60% of deaths are from Group II causes
(noncommunicable diseases). Figure 1 shows the
proportional distribution of these major cause groups for lowand
middle-income countries and high-income countries.
Group I causes remain the leading cause of child deaths in
all regions, although they are now responsible for fewer child
deaths than Group II and Group III combined in high-income
countries (Figure 2). In contrast, Group II causes are now
responsible for more than 50% of deaths in adults age 15 to
59 in all regions except South Asia and sub-Saharan Africa,
where Group I causes, including HIV/AIDS, remain
responsible for 33 and 67% of deaths, respectively. For
adults age 15 to 59, death rates from Group II causes are
higher for all low- and middle-income regions than for highincome
countries, and in Europe and Central Asia are almost
double the rate for the high-income countries. These results
show that premature mortality from noncommunicable
diseases is higher in populations with high mortality and low
incomes than in the high-income countries.
Leading causes of death
Table 2 shows the top 10 disease and injury causes of death
in 2001 for low- and middle-income countries and for highincome
countries. Ischaemic Heart Disease (IHD) and
cerebrovascular disease (stroke) were the leading causes of
death in both groups of countries in 2001, responsible for 12
million deaths globally, or almost one quarter of the global
total. Only 1.4 million of the 7.1 million who died of IHD
were in the high-income countries. Stroke killed 5.4 million,
of whom less than 1.0 million were in high-income countries.
Whereas lung cancer, predominantly due to tobacco
smoking, remains the third leading cause of death in highincome
countries reflecting high levels of smoking in previous
years, the increasing prevalence of smoking in low- and
middle-income countries has not yet driven lung cancer into
the top 10 causes of death for these countries. HIV/AIDS is
the fourth leading cause of death in low- and middle-income
countries, and HIV/AIDS death rates are projected to continue
to rise, albeit at a slower pace, despite recent increased
efforts to improve access to antiretroviral drugs.
Lower respiratory infections, conditions arising during the
perinatal period, and diarrhoeal diseases remain among the
top 10 causes of death in low- and middle-income countries.
In 2001, these three causes of death together accounted for
nearly 60% of child deaths globally.
Table 3 shows the 10 leading causes of death in low- and
middle-income countries by sex in 2001. Leading causes of
death are generally similar for males and females, although
road traffic accidents appear in the top 10 only for males and
diabetes appears only for females.
Leading causes of death in children
Infectious and parasitic diseases remain the major killers of
children in the developing world. Although notable success
has been achieved in certain areas, for example, polio,
communicable diseases still account for 7 out of the top 10
causes and are responsible for about 60% of all child deaths.
Overall, the 10 leading causes in low- and middle-income
countries represent 80% of all child deaths in those
countries, and also worldwide (Table 4).
Many Latin American and some Asian and Middle Eastern
countries have shifted somewhat towards the cause of death
pattern observed in developed countries. In these countries,
conditions arising during the perinatal period, including birth
asphyxia, birth trauma, and low birth weight, have replaced
infectious diseases as the leading cause of death and are now
Global Forum Update on Research for Health Volume 4 ✜ 167