Combining health and social protection measures to reach the ultra ...

Decision-making
Low- and middle-income countries
High-income countries
Cause DALYs Cause DALYs
(millions) (millions)
of years
of years
1 Perinatal conditions 89.07 6.4% 1 Ischaemic heart disease 12.39 8.3%
2 Lower respiratory infections 83.61 6.0% 2 Cerebrovascular disease 9.35 6.3%
3 Ischaemic heart disease 71.88 5.2% 3 Unipolar depressive disorders 8.41 5.6%
4 HIV/AIDS 70.80 5.1% 4 Alzheimer and other dementias* 7.47 5.0%
5 Cerebrovascular disease 62.67 4.5% 5 Trachea, bronchus, lung cancers 5.40 3.6%
6 Diarrhoeal diseases 58.70 4.2% 6 Hearing loss, adult onset 5.39 3.6%
7 Unipolar depressive disorders 43.43 3.1% 7 Chronic obstructive
pulmonary disease 5.28 3.5%
8 Malaria 39.96 2.9% 8 Diabetes mellitus 4.19 2.8%
9 Tuberculosis 35.87 2.6% 9 Alcohol use disorders 4.17 2.8%
10 Chronic obstructive
pulmonary disease 33.45 2.4% 10 Osteoarthritis 3.79 2.5%
Table 8: The 10 leading causes of burden of disease, DALYs, by broad income group, 2001
total burden of disease borne by adults age 15 to 59 was the
same in both groups of countries, adults older than 60
accounted for a significantly larger share of the disease
burden in high-income countries.
Although injuries become more important for boys beyond
infancy, the causes of the burden of disease are broadly
similar for boys and girls. However, striking gender
differences emerge in adulthood. In low- and middle-income
countries, 5 of the 10 leading causes of DALYs for men age
15 to 44 are injuries. Indeed, after HIV/AIDS, road traffic
accidents were the second leading cause of the burden of
disease for men in this age group. Other unintentional
injuries and violence were the third and fourth leading
causes, with self-inflicted injuries and war also appearing in
the top 10 causes. Injuries were also important for women
age 15 to 44, although road traffic accidents were the tenth
leading cause, preceded by other unintentional injuries in
fourth place and self-inflicted injuries in sixth place. Unipolar
depressive disorders were the second leading cause of the
burden for women in this age group, after HIV/AIDS.
The growing burden of noncommunicable
diseases
The burden of noncommunicable diseases is increasing,
accounting for nearly half the global burden of disease for all
ages, a 10% increase from estimated levels in 1990. While
the proportion of the burden from noncommunicable disease
in high-income countries has remained stable at around
85% in adults age 15 and older, the proportion in middleincome
countries has already exceeded 70%. Surprisingly,
almost 50% of the adult disease burden in low- and middleincome
countries is now attributable to noncommunicable
disease. Population ageing and changes in the distribution of
risk factors have accelerated the epidemic of
noncommunicable disease in many developing countries.
CVD accounted for 13% of the disease burden among
adults age 15 and older in 2001. IHD and cerebrovascular
disease (stroke) were the two leading causes of mortality and
disease burden among adults age 60 and older and were
also among the top 10 causes of disease burden in adults
age 15 to 59. In low- and middle-income countries, IHD and
cerebrovascular disease (stroke) were together responsible
for 15% of disease burden in those aged 15 and older, and
DALYs rates were higher for men than for women.
The proportion of the burden among adults age 15 and
older attributable to cancer was 6% in low- and middleincome
countries and 14% in high-income countries in
2001. Of the 7.1 million cancer deaths estimated to have
occurred in that year, 17%, or 1.2 million, were attributable
to lung cancer alone, and of these, three quarters occurred
5%
2%
21%
31%
0-4
5-14
15-59
60+
51%
42%
0-4
5-14
15-59
60+
42%
6%
Low- and middle-income countries
High-income countries
Figure 3: Age distribution of disease burden (DALYs), by income group, 2001 Source: Mathers et al. 2006
172 ✜ Global Forum Update on Research for Health Volume 4