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Europe and Central Asia
Latin America and Caribbean
1 Ischaemic heart disease 15.9% 1 Perinatal conditions 6.0%
2 Cerebrovascular disease 10.8% 2 Unipolar depressive disorders 5.0%
3 Unipolar depressive disorders 3.7% 3 Violence 4.9%
4 Self-inflicted injuries 2.3% 4 Ischaemic heart disease 4.2%
5 Hearing loss, adult onset 2.2% 5 Cerebrovascular disease 3.8%
6 Chronic obstructive
pulmonary disease 2.0% 6 Endocrine disorders 3.0%
7 Trachea, bronchus, lung cancers 2.0% 7 Lower respiratory infections 2.9%
8 Osteoarthritis 2.0% 8 Alcohol use disorders 2.8%
9 Road traffic accidents 1.9% 9 Diabetes mellitus 2.7%
10 Poisonings 1.9% 10 Road traffic accidents 2.6%
Sub-Saharan Africa
Middle East and North Africa
1 HIV/AIDS 16.5% 1 Ischaemic heart disease 6.6%
2 Malaria 10.3% 2 Perinatal conditions 6.3%
3 Lower respiratory infections 8.8% 3 Road traffic accidents 4.6%
4 Diarrhoeal diseases 6.4% 4 Lower respiratory infections 4.5%
5 Perinatal conditions 5.8% 5 Diarrhoeal diseases 3.9%
6 Measles 3.9% 6 Unipolar depressive disorders 3.1%
7 Tuberculosis 2.3% 7 Congenital anomalies 3.1%
8 Road traffic accidents 1.8% 8 Cerebrovascular disease 3.0%
9 Whooping cough 1.8% 9 Vision disorders, age-related 2.7%
10 Protein-energy malnutrition 1.5% 10 Cataracts 2.3%
South Asia
East Asia and Pacific
1 Perinatal conditions 9.2% 1 Cerebrovascular disease 7.5%
2 Lower respiratory infections 8.4% 2 Perinatal conditions 5.4%
3 Ischaemic heart disease 6.3% 3 Chronic obstructive pulmonary disease 5.0%
4 Diarrhoeal diseases 5.4% 4 Ischaemic heart disease 4.1%
5 Unipolar depressive disorders 3.6% 5 Unipolar depressive disorders 4.1%
6 Tuberculosis 3.4% 6 Tuberculosis 3.1%
7 Cerebrovascular disease 3.2% 7 Lower respiratory infections 3.1%
8 Cataracts 2.3% 8 Road traffic accidents 3.0%
9 Chronic obstructive
pulmonary disease 2.3% 9 Cataracts 2.8%
10 Hearing loss, adult onset 2.0% 10 Diarrhoeal diseases 2.5%
Table 9: Leading causes of burden of disease in low- and middle-income countries, by region, 2001
among men. The number of cases of lung cancer increased
nearly 30% since 1990, largely reflecting the emergence of
the tobacco epidemic in low- and middle-income countries.
Stomach cancer, which until recently was the leading site
of cancer mortality worldwide, has been declining in all parts
of the world where trends can be reliably assessed, and in
2001 caused 842 000 deaths, or about two thirds as many
as lung cancer. Liver cancer was the third leading site, with
607 000 deaths in 2001, more than 60% of them in the
East Asia and Pacific region. Among women, the leading
cause of cancer deaths was breast cancer. Breast cancer
survival rates have been improving during the past decade,
but the chance of survival varies according to the coverage of
and access to secondary prevention. Globally, neuropsychiatric
conditions accounted for 19% of the disease burden among
adults, primarily from nonfatal health outcomes.
Injuries: the hidden epidemic
Injuries, both unintentional and intentional, primarily affect
young adults, and often result in severe, disabling sequelae.
In 2001, injuries accounted for 16% of the adult burden of
ill-health and premature death worldwide. In parts of Latin
America and the Caribbean, Europe and Central Asia, and the
Middle East and North Africa more than 30% of the entire
disease and injury burden among male adults age 15 to 44
was attributable to injuries, and road traffic accidents,
violence, and self-inflicted injuries were all among the top 10
leading causes of the burden of disease. Globally, road traffic
accidents were the third leading cause of burden in the same
age and sex group, preceded only by HIV/AIDS and unipolar
depression. The burden of road traffic accidents has been
increasing, especially in the developing countries of sub-
Saharan Africa and South and Southeast Asia, and
particularly affects males.
Intentional injuries, which include self-inflicted injuries and
suicide, violence, and war, accounted for an increasing share
of the burden, especially among economically productive
young adults. In developed countries, suicides accounted for
the largest share of the intentional injury burden, whereas in
developing regions, violence and war were the major sources.
The former Soviet Union and other high-mortality countries of
Eastern Europe have rates of death and disability resulting
from injury among males that are similar to those in sub-
Saharan Africa.
Regional variations in the burden of disease
Table 9 summarizes the 10 leading causes of burden for each
of the low- and middle-income regions.
In 2001, IHD and stroke dominated the burden of disease
in Europe and Central Asia, and together accounted for more
Global Forum Update on Research for Health Volume 4 ✜ 173