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

Decision-makingLow- and middle-income countriesHigh-income countriesCause DALYs Cause DALYs(millions) (millions)of yearsof years1 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 obstructivepulmonary 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 obstructivepulmonary 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, 2001total burden of disease borne by adults age 15 to 59 was thesame in both groups of countries, adults older than 60accounted for a significantly larger share of the diseaseburden in high-income countries.Although injuries become more important for boys beyondinfancy, the causes of the burden of disease are broadlysimilar for boys and girls. However, striking genderdifferences emerge in adulthood. In low- and middle-incomecountries, 5 of the 10 leading causes of DALYs for men age15 to 44 are injuries. Indeed, after HIV/AIDS, road trafficaccidents were the second leading cause of the burden ofdisease for men in this age group. Other unintentionalinjuries and violence were the third and fourth leadingcauses, with self-inflicted injuries and war also appearing inthe top 10 causes. Injuries were also important for womenage 15 to 44, although road traffic accidents were the tenthleading cause, preceded by other unintentional injuries infourth place and self-inflicted injuries in sixth place. Unipolardepressive disorders were the second leading cause of theburden for women in this age group, after HIV/AIDS.The growing burden of noncommunicablediseasesThe burden of noncommunicable diseases is increasing,accounting for nearly half the global burden of disease for allages, a 10% increase from estimated levels in 1990. Whilethe proportion of the burden from noncommunicable diseasein high-income countries has remained stable at around85% in adults age 15 and older, the proportion in middleincomecountries has already exceeded 70%. Surprisingly,almost 50% of the adult disease burden in low- and middleincomecountries is now attributable to noncommunicabledisease. Population ageing and changes in the distribution ofrisk factors have accelerated the epidemic ofnoncommunicable disease in many developing countries.CVD accounted for 13% of the disease burden amongadults age 15 and older in 2001. IHD and cerebrovasculardisease (stroke) were the two leading causes of mortality anddisease burden among adults age 60 and older and werealso among the top 10 causes of disease burden in adultsage 15 to 59. In low- and middle-income countries, IHD andcerebrovascular disease (stroke) were together responsiblefor 15% of disease burden in those aged 15 and older, andDALYs rates were higher for men than for women.The proportion of the burden among adults age 15 andolder attributable to cancer was 6% in low- and middleincomecountries and 14% in high-income countries in2001. Of the 7.1 million cancer deaths estimated to haveoccurred in that year, 17%, or 1.2 million, were attributableto lung cancer alone, and of these, three quarters occurred5%2%21%31%0-45-1415-5960+51%42%0-45-1415-5960+42%6%Low- and middle-income countriesHigh-income countriesFigure 3: Age distribution of disease burden (DALYs), by income group, 2001 Source: Mathers et al. 2006172 ✜ Global Forum Update on Research for Health Volume 4