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Decision-makingwas prior to 2001, a time series of annual life tables(adjusted if the registration level was incomplete) between1985 and the latest available year was used to projectlevels of child and adult mortality for 2001. For smallcountries with populations of less than 500 000, movingaverages were used to smooth the time series. Projectedvalues of child and adult mortality were then applied to amodified logit life table model 6 , using the most recentnational data as the standard, to predict the full life tablefor 2001, and HIV/AIDS and war deaths were added tototal mortality rates for 2001 where necessary. Thismethod was applied for 40 countries using a total of 711country-years of death registration data.✜ Countries with other information on levels of child andadult mortality. For 37 countries, estimated levels ofchild and adult mortality were applied to a modified logitlife table model 6 , using a global standard, to estimate thefull life table for 2001, and HIV/AIDS deaths and wardeaths were added to total mortality rates as necessary.For most of these countries, data on levels of adultmortality were obtained from death registration data,official life tables, or mortality information derived fromother sources such as censuses and surveys. The allcausemortality envelope for China was derived from atime series analysis of deaths for every household inChina reported in the 1982, 1990, and 2000 censuses.The extent of underreporting of deaths in the 2000census was estimated at about 11.3% for males and18.1% for females 1 . The all-cause mortality envelope forIndia was derived from a time series analysis of agespecificdeath rates from the sample registration systemafter correction for underregistration (88%completeness) 8 .✜ Countries with information on levels of child mortalityonly. For 55 countries, 42 of them in sub-SaharanAfrica, no information was available on levels of adultmortality. Based on the predicted level of child mortalityin 2001, the most likely corresponding level of adultmortality (excluding HIV/AIDS deaths where necessary)was selected, along with uncertainty ranges, based onregression models of child versus adult mortality asobserved in a set of almost 2000 life tables judged to beof good quality 2,6 . These estimated levels of child andadult mortality were then applied to a modified logit lifetable model, using a global standard, to estimate the fulllife table in 2001, and HIV/AIDS deaths and war deathswere added to total mortality rates as necessary.Evidence on adult mortality in sub-Saharan Africancountries remains limited, even in areas with successfulchild and maternal mortality surveys.Classification of causes of disease and injuryDisease and injury causes of death and of burden of diseasewere classified using the same tree structure as in the originalGBD study 7 . The first level of disaggregation comprises thefollowing three broad cause groups:✜ Group I: communicable, maternal, perinatal, andnutritional conditions;✜ Group II: noncommunicable diseases;✜ Group III: injuries.Each group was then divided into major causesubcategories, for example, cardiovascular disease (CVD) andmalignant neoplasms (cancers) are two major causesubcategories of Group II. Beyond this level, two furtherdisaggregation levels were used, resulting in a completecause list of 135 categories of specific diseases and injuries.Group I causes of death consist of the cluster of conditionsthat typically decline at a faster pace than all-cause mortalityduring the epidemiological transition. In high-mortalitypopulations, Group I dominates the cause of death pattern,whereas in low-mortality populations, Group I accounts foronly a small proportion of deaths. The major causesubcategories are closely based on the ICD chapters with afew significant differences. Whereas the ICD classifies chronicrespiratory diseases and acute respiratory infections into thesame chapter, the GBD cause classification includes acuterespiratory infections in Group I and chronic respiratorydiseases in Group II. Note also that the Group I subcategoryof “causes arising in the perinatal period” relates to thecauses included in the corresponding ICD chapter, principallylow birth weight, prematurity, birth asphyxia, and birthtrauma, but does not include all causes of deaths occurringduring the perinatal period, such as infections, congenitalmalformations, and injuries. In addition, the GBD includesonly deaths among children born alive and does notestimate stillbirths.The GBD classification system does not include the ICDcategory “Symptoms, signs, and ill-defined conditions” as oneof the major causes of deaths. The GBD classification schemehas reassigned deaths assigned to this ICD category, as wellas some other codes used for ill-defined conditions, tospecific causes of death. This is important from theperspective of generating useful information to comparecause of death patterns or to inform health policy-making,because it allows unbiased comparisons of cause of deathpatterns across countries or regions.Deaths are categorically attributed to one underlying causeusing ICD rules and conventions. In some cases where theICD rules are ambiguous, the GBD 2001 follows theconventions used by the GBD 1990 study 7 . It should also benoted that a number of causes of death act as risk factors forother diseases. Total mortality attributable to such causesmay be substantially larger than the mortality estimates forthe cause in terms of ICD rules for underlying causes. Forexample, the GBD 2001 estimates that 960 000 deaths weredue to diabetes mellitus as an underlying cause, but whendeaths from CVD and renal failure attributable to diabetes areincluded, the global total of attributable deaths rises to almost3 million 9 . Other causes for which important components ofattributable mortality are included elsewhere in the GBDcause list include hepatitis B or C (attributable liver cancerand renal failure), unipolar or bipolar depressive disordersand schizophrenia (attributable suicide), and blindness(mortality attributable to blindness whether from infectious ornon-infectious causes).164 ✜ Global Forum Update on Research for Health Volume 4
Decision-makingDeaths Crude death % of deaths Probability of dying per 1000 Expectation(millions) rate per 1000 under 5 over 60 5q0 45q15 60q0 20q60 of life at birth(years)Low- and middle-income 1990 22.5 10.1 27.9 39.5 98 269 351 712 59.92001 22.5 9.7 21.2 42.2 86 269 341 667 61.2East Asia and Pacific 1990 6.6 8.0 16.3 50.6 54 215 265 699 64.92001 6.9 7.4 10.2 56.2 41 189 228 623 67.8Europe and Central Asia 1990 2.5 11.1 7.9 55.9 45 286 323 696 63.62001 3.0 13.0 3.2 59.6 32 328 353 711 63.0Latin America and 1990 1.7 7.8 19.5 44.7 56 245 294 640 64.5the Caribbean 2001 1.8 7.0 12.4 49.1 38 218 252 572 67.6Middle East and North Africa 1990 1.0 8.2 34.9 34.2 83 247 318 688 62.02001 1.1 6.8 21.6 45.2 56 216 267 674 65.2South Asia 1990 6.8 11.7 32.4 35.0 122 310 407 754 56.42001 7.1 9.9 25.1 39.2 94 285 362 710 59.9Sub-Saharan Africa 1990 3.9 15.6 54.1 17.0 191 386 517 758 49.62001 5.6 16.9 42.2 16.9 178 518 616 760 46.0High-income 1990 3.9 9.1 1.7 76.2 12 148 160 542 72.92001 4.0 8.8 1.0 78.7 7 124 132 469 75.5World 1990 26.4 10.0 24.0 44.8 91 245 323 667 61.72001 29.5 9.6 18.5 47.2 80 243 312 618 63.1Note: a) Estimates for 1990 based on country-level life tables from vital registration data or Modmatch (see methods section)b) Estimates for 2001 derived from Lopez et al. 2002 c) Estimates for child mortality to nearest whole number. Source: Lopez et al. 2006Table 1a: Selected mortality characteristics in males by World Bank region, 1990 and 2001Deaths Crude death % of deaths Probability of dying per 1000 Expectation(millions) rate per 1000 under 5 over 60 5q0 45q15 60q0 20q60 of life at birth(years)Low and middle-income 1990 19.4 8.9 29.7 44.6 95 182 270 585 64.22001 22.8 8.8 22.5 48.3 86 191 271 554 64.9East Asia and Pacific 1990 5.5 7.0 17.8 56.2 53 152 204 577 68.82001 6.1 6.8 11.4 64.6 44 127 171 519 71.3Europe and Central Asia 1990 2.4 9.9 6.4 77.5 37 125 162 503 72.32001 2.7 10.8 2.9 81.5 26 133 159 511 72.8Latin America 1990 1.3 5.7 20.1 53.9 45 138 182 493 71.3the Caribbean 2001 1.4 5.4 12.5 61.3 32 124 155 434 73.9Middle East and North Africa 1990 0.8 6.9 37.7 36.1 76 174 245 593 66.12001 0.8 5.5 23.5 49.7 51 144 193 562 69.5South Asia 1990 6.1 11.2 37.0 33.7 131 243 357 680 57.92001 6.5 9.6 28.3 40.2 101 226 317 645 61.5Sub-Saharan Africa 1990 3.3 12.9 54.8 19.6 168 265 403 664 55.12001 5.2 15.5 40.9 18.3 166 437 545 680 48.9High-income 1990 3.6 8.2 1.3 87.3 9 74 83 346 79.72001 3.9 8.2 0.8 88.3 6 65 73 297 81.6World 1990 23.0 8.8 25.2 51.3 88 161 244 516 66.62001 26.7 8.7 19.3 54.1 80 168 244 487 67.3Note: a) Estimates for 1990 based on country-level life tables from vital registration data or Modmatch (see methods section)b) Estimates for 2001 derived from Lopez et al. 2002 c) Estimates for child mortality to nearest whole number. Source: Lopez et al. 2006Table 1b: Selected mortality characteristics in females by World Bank region, 1990 and 2001Global Forum Update on Research for Health Volume 4 ✜ 165
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Editorial Advisory Board:Luis Gabri
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthStrengthening healt
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Access to healthTraining more healt
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Access to healthimperative for acti
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Access to healthReferences1.Further
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Access to healthDeterminantsAvailab
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Access to healthThe authors are inv
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Access to healthCombining health an
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Access to health100%Availability of
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Access to healthhypothesis that an
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Access to healthMandatory clinical
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Access to healthWhile there are som
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Access to healthItemDefinition/Expl
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Access to healthReferences continue
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Access to healthintegrating individ
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Access to healthA social determinan
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Access to healthemployment conditio
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Access to healthMaking human rights
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Access to healthResources outsideth
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Access to healthReferences1.McCoy D
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Access to healthand financial burde
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Access to healthDiscrimination as a
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Access to health“Two months ago I
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Access to healthsocio-cultural and
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Access to healthIntergovernmental P
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Access to healthand conference stat
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InnovationTowards the development o
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InnovationMajor classificationMajor
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Innovation60% of enterprises5040302
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InnovationUsing the power ofintelle
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Innovationbe adapted - and harnesse
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InnovationFinancing of vaccine R&D-
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InnovationFinancing Ultimate Interm
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Innovationsome of this risk might b
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InnovationChild immunization:accele
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Innovationare revealing previously
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InnovationDeveloping countries % De
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Innovationcapacities. It is indeed
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InnovationSome plausible causes of
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Innovationwhere he was a programme
Page 96 and 97: Research resourcesResearch impact o
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Page 148 and 149: Decision-makingGlobal and regional
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