Trends in Death and Disability in Asia and thePacific: Key Findings from the Global Burden of

Disease 2010 Study

Professor Alan Lopez

School of Population Health, The University of Queensland

Brisbane, Australia

a.lopez@sph.uq.edu.au

What is the Global Burden ofDisease 2010?

1) A systematic scientific effort to quantify thecomparative magnitude of health loss due to majordiseases, injuries and risk factors by age, sex, country,for 1990 and 2010; i.e. Amassing the best evidence onthe state of the world’s health.

2) By the numbers: 291 diseases and injuries, 1,160sequelae of these diseases and injuries, and 67 riskfactors or clusters of risk factors.

3) GBD 2010 provides uncertainty intervals for allquantities of interest.

GBD 2010 team

486 authors from 302 institutions in 50 countries

Some GBD terminology

1) Years of life lost due to premature mortality due to adeath at age x is the standard life expectancy at age x.

2) Years lived with disability for a cause in an age-sexgroup equals the prevalence of the condition times thedisability weight for that condition.

3) DALYs = Years of life lost due to premature mortality(YLLs) and years lived with disability (YLDs).

4) In the GBD, disability refers to any short-term orlong-term health loss.

5) In the GBD 2010, DALYs are not discounted orage-weighted.

Initial publication of Study methods andfindings; Lancet Dec, 2012

Chief components of the GBD2010 Study

GBD 2010 Findings I:

Mortality

157 of 187 countries had increases in life expectancyat birth from 1990 to 2010 for males and 166 of 187for females.

Progress in reducing global mortality,1970-2010, by age and sex

Global deaths in 2010 by age andGBD regions

Probability of child death, 2010(per 1000 live births)

Annual rate of decline in Under-5mortality, 1990-2010

Risk of adult death (ages 15-59) per1000 males aged 15, 2010

Female Life Expectancy, 2010

Male Life Expectancy, 2010

Absolute Change in Female LifeExpectancy, 1990-2010

Absolute Change in Male LifeExpectancy, 1990-2010

GBD 2010 Findings II:

Causes of Death

The universe of CoD data

We attempted to identify allavailable data on causes ofdeath for 187 countriesfrom 1980 to 2010

•We have used 9 differentsources of CoD data

•We have collected data onaround 600 million deaths inthe last 30 years

•Data available varies bydisease:

– More of maternal,cancer, injuries

– Less of NTD, diarrheaand LRI pathogens

Type Site years Countries

Vital Registration 2,798 130

Verbal Autopsy 486 66

Cancer registries 2,715 93

Police Reports 1,129 122

Surveys/Census 1,564 82

Maternal Mortality Surveillance 83 8

Deaths in health Facilities 21 9

Burial and Mortuary 32 11

Country−years of vital registration, 1980−2010

Change in broad causes of death inthe last 20 years, World

Leading causes of global death andpremature mortality in 2010

Global death ranks for the top 25 causes and thepercent change between 1990 and 2010

YLL top 25 leading causes across21 GBD regions, 2010

Asia-Pacific: Leading causes of child deathin 2010, ages 0-4Oceania East Asia South Asia Southeast Asia

Lower respiratoryinfections Congenital anomalies

Preterm birthcomplications

Preterm birthcomplications

Preterm birthcomplications

Preterm birthcomplications

Lower respiratoryinfections

Lower respiratoryinfections

Diarrheal diseasesLower respiratoryinfections Diarrheal diseases Diarrheal diseases

Neonatal encephalopathy Neonatal encephalopathy

Sepsis and otherinfectious disorders ofthe newborn baby Neonatal encephalopathy

Congenital anomalies Drowning Neonatal encephalopathy Congenital anomalies

Sepsis and otherinfectious disorders ofthe newborn baby Road injury Congenital anomalies

Sepsis and otherinfectious disorders ofthe newborn baby

Meningitis Leukemia Meningitis Meningitis

Protein-energymalnutrition Falls

Protein-energymalnutrition Measles

Syphilis Diarrheal diseases Measles Drowning

HIV/AIDS Meningitis EncephalitisTyphoid and paratyphoidfevers

Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease Ischemic heart disease Tuberculosis

Diabetes mellitus Road injury Tuberculosis Cerebrovascular disease

Tuberculosis Liver cancer Self-harm Road injury

Ischemic heart disease Ischemic heart disease Road injury Ischemic heart disease

Cirrhosis of the liverTrachea, bronchus, andlung cancers HIV/AIDS HIV/AIDS

HIV/AIDS Self-harmChronic obstructivepulmonary disease Cirrhosis of the liver

Chronic kidney diseases Stomach cancer Diarrheal diseases Diabetes mellitus

Cerebrovascular diseaseChronic obstructivepulmonary disease Cerebrovascular disease

Lower respiratoryinfections

Malaria Cirrhosis of the liver Cirrhosis of the liver Interpersonal violence

Maternal disorders Esophageal cancerFire, heat and hotsubstances Chronic kidney diseases

Asia-Pacific: leading causes of adult death,ages 15-59, 2010

Asia-Pacific: leading causes of YLLs, 2010

Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease

Lower respiratoryinfections Cerebrovascular disease

Diabetes mellitus Ischemic heart diseasePreterm birthcomplications Tuberculosis

Diarrheal diseasesChronic obstructivepulmonary disease Diarrheal diseases

Lower respiratoryinfections

Ischemic heart disease Road injury Ischemic heart disease Ischemic heart disease

Preterm birthcomplications

Trachea, bronchus, andlung cancers

Chronic obstructivepulmonary disease Road injury

Tuberculosis Liver cancerNeonatalencephalopathy Diarrheal diseases

Meningitis Stomach cancer

Sepsis and otherinfectious disorders ofthe newborn baby

Preterm birthcomplications

Malaria Self-harm Tuberculosis Diabetes mellitus

HIV/AIDSLower respiratoryinfections Cerebrovascular disease HIV/AIDS

Cerebrovascular disease Esophageal cancer Self-harmNeonatalencephalopathy

GBD 2010 Findings III:

DALYs/Disease Burden

Leading causes of the Global Burden of Disease(DALYs), 2010

Infectious, neonatal, maternal

Non-communicable

Injuries

Leadingcauses of

globalDALYsshifting

Asia-Pacific: leading causes of DALYs, 2010

Oceania East Asia South Asia Southeast AsiaLower respiratoryinfections Cerebrovascular disease

Lower respiratoryinfections Cerebrovascular disease

Diabetes mellitus Ischemic heart diseasePreterm birthcomplications Tuberculosis

TuberculosisChronic obstructivepulmonary disease Diarrheal diseases Ischemic heart disease

Diarrheal diseases Road injury Ischemic heart diseaseLower respiratoryinfections

Ischemic heart disease Low back painChronic obstructivepulmonary disease Road injury

Preterm birthcomplications

Trachea, bronchus, andlung cancers

Neonatalencephalopathy

Major depressivedisorder

Malaria Liver cancer Tuberculosis Low back pain

MeningitisMajor depressivedisorder

Sepsis and otherinfectious disorders ofthe newborn baby Diarrheal diseases

HIV/AIDS Neck pain Low back painChronic obstructivepulmonary disease

Asthma Diabetes mellitus Iron-deficiency anemia Diabetes mellitus

1) Power of comparative analyses of DALYs:10 leading diseases and injuries; 10 leading risks

2) Progressive Disease Transition fromCommunicable to Non-Communicable Causes

3) The Disability Transition: Progressive Shift in Burdenfrom Premature Mortality to Years Lived with Disability

1990 2010

Summary

• Rapid (& sustained) progress in reducing child (andmaternal) mortality throughout Asia over past 20 years

• Large variations across Asia/Pacific in extending lifeexpectancy (ranging from 0 to 20 years since 1990)

• Premature adult mortality now a leading cause of healthloss in all populations in the region, including from majornoncommunicable diseases ( stroke, IHD, COPD, lungand liver cancer), but also TB, lower resp diseases andinjuries ( RTAs, suicide, falls, drowning).

• Progressive rise in burden of disability ( low backpain, depression, injuries and NCDs) across theregion