GBD Report Update Part2

8/8/2019 GBD Report Update Part2

http://slidepdf.com/reader/full/gbd-report-update-part2 1/20

Part 2

Causes o death

1. Deaths in 2004: who and where? 8

2. Deaths by broad cause groups 8

3. Leading causes o death 114. Cancer mortality 12

5. Causes o death among children aged under ve years 14

6. Causes o death among adults aged 15–59 years 17

7. Years o li e lost: taking age at death into account 21

8. Projected trends in global mortality: 2004–2030 22



8

World Health Organization

Part 2

1. Deaths in 2004: who and where?

Almost one in fve o all deaths are o children agedunder fve years

In 2004, an estimated 58.8 million deaths occurredglobally, o which 27.7 million were emales and 31.1million males. More than hal o all deaths involvedpeople 60 years and older, o whom 22 million werepeople aged 70 years and older, and 10.7 millionwere people aged 80 years and older. Almost one in

ve deaths in the world was o a child under the ageo ve years(Figure 1).

In A rica, death takes the young; in high-incomecountries, death takes the old

Te distribution o deaths by age di ers markedly between regions. In the A rican Region, 46% o alldeaths were children aged under 15 years, whereasonly 20% were people aged 60 years and over. Incontrast, in the high-income countries, only 1% o deaths were children aged under 15 years, whereas84% were people aged 60 years and older. Tere werealso large di erences in the Asia and Paci c regions.In the South-East Asia Region, 24% o deaths wereo children aged under 15 years, compared with8% in the low- and middle-income countries o theWestern Paci c Region, where 67% o deaths were o people aged 60 years and older (Figure 2).

2. Deaths by broad cause groups

Out o every 10 deaths, 6 are due to noncommunica-ble conditions; 3 to communicable, reproductive ornutritional conditions; and 1 to injuries

Te GBD study classi es disease and injury, causeso death and burden o disease into three broadcause groups:

• Group I – communicable, maternal, perinatal andnutritional conditions

• Group II – noncommunicable diseases• Group III – injuries.

Group I causes are conditions that occur largely inpoorer populations, and typically decline at a asterpace than all-cause mortality during the epidemio-logical transition (in which the pattern o mortality shi s rom high death rates rom Group I causesat younger ages to chronic diseases at older ages).

Among both men and women, most deaths are dueto noncommunicable conditions (Group II), andthey account or about 6 out o 10 deaths globally.Communicable, maternal, perinatal and nutritionalconditions are responsible or just under one thirdo deaths in both males and emales. Te largest di -

erence between the sexes occurs or Group III, withinjuries accounting or almost 1 in 8 male deathsand 1 in 14 emale deaths (Figure 3).

Cardiovascular diseases are the leading cause o death

Figure 4shows the distribution o deaths at all agesor 12 major cause groups (groups responsible or at

least 2% o all deaths, plus maternal conditions). Tisillustrates the relative importance o the respectivecauses o death and o male– emale di erences. Car-diovascular diseases are the leading cause o death inthe world, particularly among women; such diseasescaused almost 32% o all deaths in women and 27%in men in 2004. In ectious and parasitic diseasesare the next leading cause, ollowed by cancers, but

these groupings show much smaller overall sex di -erentials. Te largest di erences between men andwomen are observed or intentional injuries (twiceas high among men) and unintentional injuries.Maternal conditions account or 1.9% o all emaledeaths. Te respiratory in ections are treated by theGBD as a separate cause group rom in ectious andparasitic diseases, and are to be distinguished romrespiratory diseases, which re ers to noncommuni-cable respiratory diseases (re er to Annex Table C3).



9

Global Burden o Disease 2004

Causes o death

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Annex A

Annex B

Annex C

References

Figure 1: Distribution o age at death and numbers o deaths, world, 2004

0–4 years:10.4 million18%



60 years and over:

30.2 million51%

Figure 2: Per cent distribution o age at death by region, 2004

0

10

20

30

40

50

60

70

80

90

100

Africa EasternMediterranean

South-EastAsia

Americas WesternPaci c

Europe High income

P e r c e n t o f

t o t a

l d e a t

h s

60 years and older

15–59 years0–14 years



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Part 2

Figure 4: Distribution o deaths by leading cause groups, males and emales, world, 2004

0 5 10 15 20 25 30 35

Maternal conditions

Diabetes mellitus

Neuropsychiatric disorders

Intentional injuries

Digestive diseases

Perinatal conditions

Unintentional injuries

Respiratory diseases

Respiratory infections

Cancers

Infectious and parasitic diseases

Cardiovascular diseases

Per cent of total deaths

31.5

26.8

15.616.7

11.813.4

7.4

7.1

6.8

6.9

5.08.1

5.5

5.3

3.2

3.8

1.73.8

2.2

2.1

2.3

1.6

1.9

Female

Male

Figure 3: Distribution o deaths in the world by sex, 2004

29.9

0

10

20

30

40

50

60

70

Group I:Communicable, maternal,

perinatal and nutritional conditions

Group II:Noncommunicable diseases

Group III:Injuries

P e r c e n t o

f t o t a

l d e a t

h s

31.4

57.961.5

12.3

7.1

Male

Female



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Causes o death

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Annex A

Annex B

Annex C

References

3. Leading causes o death

Tis report uses 136 categories or disease and injury causes. Te 20 most requent causes o death areshown in Table 1. Ischaemic heart disease and cer-ebrovascular disease are the leading causes o death,

ollowed by lower respiratory in ections (includingpneumonia), chronic obstructive pulmonary diseaseand diarrhoeal diseases. HIV/AIDS and B are thesixth and seventh most common causes o death

respectively, and together caused 3.5 million deathsin 2004.

As may be expected rom the very di erent dis-tributions o deaths by age and sex, there are majordi erences in the ranking o causes between high-and low-income countries (Table 2). In low-incomecountries, the dominant causes are in ectious andparasitic diseases (including malaria), and perinatalconditions. In the high-income countries, 9 out o the 10 leading causes o death are noncommunica-ble conditions, including our types o cancer. In the

middle-income countries, the 10 leading causes o death are again dominated by noncommunicableconditions; they also include road trafc accidentsas the sixth most common cause.

Table 1: Leading causes o death, all ages, 2004

Disease or injuryDeaths

(millions)

Per cento

totaldeaths

1 Ischaemic heart disease 7.2 12.2

2 Cerebrovascular disease 5.7 9.7

3 Lower respiratory in ections 4.2 7.1

4 COPD 3.0 5.1

5 Diarrhoeal diseases 2.2 3.7

6 HIV/AIDS 2.0 3.5

7 Tuberculosis 1.5 2.5

8 Trachea, bronchus, lung cancers 1.3 2.3

9 Road tra c accidents 1.3 2.2

10 Prematurity and low birth weight 1.2 2.0

11 Neonatal in ectionsa 1.1 1.9

12 Diabetes mellitus 1.1 1.9

13 Hypertensive heart disease 1.0 1.7

14 Malaria 0.9 1.5

15 Birth asphyxia and birth trauma 0.9 1.5

16 Sel -inficted injuriesb 0.8 1.4

17 Stomach cancer 0.8 1.4

18 Cirrhosis o the liver 0.8 1.3

19 Nephritis and nephrosis 0.7 1.3

20 Colon and rectum cancers 0.6 1.1

COPD, chronic obstructive pulmonary disease.

a Tis category also includes other non-in ectious causesarising in the perinatal period, apart rom prematurity, lowbirth weight, birth trauma and asphyxia. Tese non-in ect-ious causes are responsible or about 20% o deaths shown inthis category.

b

Sel -in icted injuries resulting in death can also be re erredto as suicides.





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Causes o death

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Annex A

Annex B

Annex C

References

cancers o the mouth and oropharynx are the secondleading cause o cancer deaths.

For women, 15 cancers are ranked or each o theregions. Te most common cancer at the global levelis breast cancer, ollowed by cancers o the trachea,bronchus and lung, and stomach cancer. Breast can-cer is the leading cause in our o the seven regions,second in two regions and h in the Western

Paci c Region. Stomach cancer is the main causeo cancer death among women in that Region, ol-lowed by lung cancer and liver cancer. Cervix utericancer is the number one cause o cancer deaths inthe South-East Asia Region and the A rican Region.Other cancers o the emale reproductive systemare the eighth (ovary) and thirteenth (corpus uteri)leading causes o cancer deaths globally.

Table 3: Ranking o most common cancers among men and women according to the number o deaths, by cancer site andregion, 2004

WorldHigh

income A rica Americas

EasternMediter-

ranean EuropeSouth-

East AsiaWestern

Pacifc

Men

Trachea, bronchus, lung cancers 1 1 5 2 1 1 1 1

Stomach cancer 2 4 6 3 4 2 5 2

Liver cancer 3 5 2 10 10 10 6 3

Colon and rectum cancers 4 2 8 4 8 3 7 5

Oesophagus cancer 5 8 3 8 6 9 3 4

Prostate cancer 6 3 1 1 9 4 8 11

Mouth and oropharynx cancers 7 11 7 7 5 5 2 7Lymphomas and multiple myeloma 8 6 4 5 3 11 4 9

Leukaemia 9 10 10 6 7 8 9 6

Bladder cancer 10 9 9 11 2 6 10 10

Pancreas cancer 11 7 11 9 11 7 11 8

Melanoma and other skin cancers 12 12 12 12 12 12 12 12

Women

Breast cancer 1 1 2 1 1 1 2 5

Trachea, bronchus, lung cancers 2 2 11 5 10 4 5 2

Stomach cancer 3 6 5 3 5 3 8 1

Colon and rectum cancers 4 3 7 4 8 2 6 6Cervix uteri cancer 5 10 1 2 6 5 1 7

Liver cancer 6 8 3 10 12 11 11 3

Oesophagus cancer 7 13 6 12 2 12 4 4

Ovary cancer 8 7 8 8 9 6 7 10

Lymphomas and multiple myeloma 9 5 4 6 4 10 9 12

Pancreas cancer 10 4 12 7 14 7 12 9

Leukaemia 11 9 10 9 3 8 10 8

Mouth and oropharynx cancers 12 15 9 14 7 15 3 11

Corpus uteri cancer 13 11 15 11 13 9 14 14

Bladder cancer 14 12 13 13 11 14 13 13Melanoma and other skin cancers 15 14 14 15 15 13 15 15



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Part 2

5. Causes o death among childrenaged under fve years

Six causes o death account or 73% o the 10.4 mil-lion deaths among children under the age o veyears worldwide (Figure 5):

• acute respiratory in ections, mainly pneumonia(17%)

• diarrhoeal diseases (17%)• prematurity and low birth weight (11%)•

neonatal in ections such as sepsis (9%)

• birth asphyxia and trauma (8%)• malaria (7%).

Te our communicable disease categories aboveaccount or one hal (50%) o all child deaths. Under-nutrition is an underlying cause in an estimated 30%o all deaths among children under ve (14). In thisanalysis, “undernutrition” re ers to childhood mal-nutrition resulting in stunting and wasting, togetherwith micronutrient de ciencies (iron, iodine, vita-min A and zinc). I the e ects o suboptimal breast-

eeding are also included, an estimated 35% o childdeaths are due to undernutrition.

a Includes other non-communicable diseases (1%) and injur ies (0.3%).b ICD-10 codes Q00-Q99. Another 1.2% o neonatal deaths are due to genetic conditions

classi ed elsewhere.c Other non-in ectious causes arising in the perinatal period.d Includes all neonatal in ections except diarrhoeal diseases and neonatal tetanus.

Figure 5 : Distribution o causes o death among children aged under fve years and within the neonatal period,2004

Injuries (postneonatal)4%

Noncommunicablediseases (postneonatal)

4%Other infectious and

parasitic diseases9%

HIV/AIDS2%

Measles4%

Malaria7%

Diarrhoeal diseases(postneonatal)

16% Acute respiratoryinfections (postneonatal)17%

Neonatal deaths37%

Othera: 3.0%Congenital anomaliesb: 6.7%Neonatal tetanus: 3.4%Diarrhoeal diseases: 2.6%

Other non-infectiousperinatal causesc: 5.7%

Neonatal infectionsd: 25%

Birth asphyxia andbirth trauma: 23%

Prematurity and lowbirth weight: 31%



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Causes o death

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Annex A

Annex B

Annex C

References

Deaths in the neonatal period (0–27 days)account or more than one third o all deaths in chil-dren. Among neonatal deaths, three main causesaccount or 80% o all neonatal deaths: prematurity and low birth weight (31%), neonatal in ections(mainly sepsis and pneumonia and excluding diar-rhoeal diseases) (26%) and birth asphyxia and birthtrauma (23%).

Several analyses have shown that the decline inmortality in children aged under ve years is all-ing behind the Millennium Development Goal 4 o

reducing child mortality by two thirds rom 1990levels(15, 16). For some causes – notably or measlesand diarrhoeal diseases – there is evidence o a sub-stantial decline. Te GBD analysis by cause o deathalso shows that renewed e orts will be needed toprevent and control pneumonia and diarrhoea, andto address the underlying cause o undernutrition

in all WHO regions ( Figure 6). In the WHO A ricanRegion, increased e orts to prevent and controlmalaria are essential. Deaths in the neonatal periodmust also be addressed in all regions to achieve theMillennium Development Goal 4. In general, neo-natal mortality becomes more important as mortal-ity levels in children aged under ve years decline.Cost-e ective interventions are available or allmajor causes o death (17).

Deaths in the neonatal period – including prema-turity and low birth weight, birth asphyxia and birth

trauma, and other perinatal conditions based on theGBD cause list – represent between 42% and 54%o child deaths in all regions apart rom the A ricanRegion, where the proportion o neonatal deaths(25%) is depressed by high numbers o postneonataldeaths, particularly those due to malaria ( Figure 6).

Figure 6: Child mortality rates by cause and region, 2004

0 10 20 30 40

Africa

Eastern Mediterranean

South-East Asia

Europe

Western Paci c

Americas

High income

Deaths per 1000 children aged 0–4 years

Perinatal conditions

Diarrhoeal diseases

Respiratory diseases

Malaria

Other



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Part 2

Among the 10.4 million deaths in children agedunder ve years worldwide, 4.7 million (45%) occurin the A rican Region, and an additional 3.1 mil-lion (30%) occur in the South-East Asia Region.Te death rate per 1000 children aged 0–4 yearsin the A rican Region is almost double that o theregion with the next highest rate, the Eastern Medi-terranean, and more than double that o any otherregion (Figure 6). Te two leading communicabledisease killers in all regions are diarrhoeal diseasesand respiratory in ections. Deaths directly attribut-

able to malaria occur almost entirely in the A ricanRegion, representing 16% o all under- ve deaths inthat region.

HIV/AIDS and measles are important causeso death summarized in the “other” category. Glo-bally, estimates suggest that 2.5% o all child deathsare associated with HIV in ection. In the A ricanRegion, however – where more than 9 out o 10 o

the total global number o child deaths due to HIV/AIDS in 2004 occurred – 5% o all child deaths areassociated with HIV. Measles mortality, which hasdeclined considerably in recent years, is estimatedto be responsible or 4% o deaths among childrenaged under ve years worldwide and also 4% o suchdeaths in the A rican Region.

More than 7 out o every 10 child deaths are in A ricaand South-East Asia

Further analyses o under- ve deaths by cause showa burden distribution that is heavily skewed towardA rica (Table 4). More than 9 out o 10 child deathsdirectly attributable to malaria, 9 out o 10 childdeaths due to HIV/AIDS, 4 out o 10 child deathsdue to diarrhoeal diseases and 5 out o 10 childdeaths due to pneumonia occur in the WHO A ri-can Region.

Table 4: Distribution o child deaths or selected causes by selected WHO region, 2004

A rica South-East Asia Rest o the world

All causes

Diarrhoeal diseases

Pneumonia

Malaria

HIV/AIDS

Measles

= about 10% o the world’s child deaths due to a speci c cause; = about 5%.



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Causes o death

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Annex A

Annex B

Annex C

References

6. Causes o death among adults aged15–59 years

Te ranking o regions by mortality rates amongadults aged 15–59 years di ers markedly rom therankings by child mortality. Te European Region(low- and middle-income countries) is the WHOregion with the second highest mortality level oradults aged 15–59 years; the mortality level is lowerthan or the A rican Region but higher than that orthe South-East Asia Region ( Figure 7). Te Eastern

Mediterranean Region drops to ourth place or thisage group.Te di erence between the high-income coun-

tries and other regions is less pronounced or adultmortality than or child mortality, due in part to thepopulation structure – high-income countries havea higher proportion o people in the 15–59 yearsage group, and a higher proportion o people at theolder end o this range, than lower income countries.Tese rankings are overshadowed by adult mortality in the A rican Region, which is 40% higher than orthe next highest mortality region, and nearly our

times higher than or high-income countries.Te mortality rate due to noncommunicable dis-

eases is highest in Europe, where nearly two thirds o all deaths at ages 15–59 years or low- and middle-income countries are associated with cardiovascu-lar diseases, cancers and other noncommunicablediseases. Mortality rates due to noncommunicablediseases are second highest in the A rican Region,

ollowed by the Eastern Mediterranean and South-East Asia regions, and lowest in the high-incomecountries. Injury mortality ranges rom 0.5 (high-

income countries) to 1.5 (European Region) per1000 adults aged 15–59 years. Te proportion o deaths in this age group due to injuries ranges rom22% (high-income countries) to 29% (the Americas)o all deaths at ages 15–59, except in A rica, whereit is 13%.

Group I causes o death – which include in ec-tious and parasitic diseases, and maternal andnutritional conditions – account or more than one

h o all deaths in adults aged 15–59 years in tworegions: South-East Asia (29%) and A rica (62%).Tis includes 35% o the adult deaths due to HIV/

Figure 7: Adult mortality rates by major cause group and region, 2004

0 2 4 6 8 10 12

Africa

Europe

South-East Asia

Eastern Mediterranean

Americas

Western Paci c

High income

Deaths per 1000 adults aged 15–59 years


Cancers

Other noncommunicable diseasesInjuries

HIV/AIDS

Other infectious and parasitic diseases

Maternal and nutritional conditions



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Part 2

AIDS in A rica. In act, the mortality rate amongadults due to HIV/AIDS alone in A rica is higherthan mortality at 15–59 years due to all causes inthree other regions: high-income countries, theAmericas and the Western Paci c Region.

Mortality is high among adult men in EasternEurope

Tere are major di erences in adult mortality by sexand major cause grouping ( Figure 8). Overall, mortal-

ity is highest among men and women in the A ri-can Region, mainly because o high mortality due toGroup I causes. Men in the European Region (exclud-ing high-income countries) had the second highestmortality rates at ages 15–59 years, considerably higher than mortality in South-East Asia, the East-ern Mediterranean and the Americas. In all regions,men had higher mortality rates than women. Telargest di erences were observed in Europe (malemortality 2.7 times as high as the emale mortality rate), the Americas (2.0 times as high) and high-income countries (1.9 times as high).

HIV/AIDS is the main cause o adult mortality inA rica

In the A rican Region, mortality among men isslightly higher than among women, due entirely to higher mortality through injuries. Women havehigher mortality due to Group I causes. Figure 9 presents a more detailed look at the mortality ratesin the A rican Region, by sex, or major cause group-ings. At ages 15–59 years, women have much highermortality than men or HIV/AIDS, which causes

more than hal o all deaths in Group I and 40% o all emale deaths. Maternal conditions were associ-ated with 14% o all deaths.

In the South-East Asia Region, di erencesbetween male and emale mortality were relatively small, with similar levels o mortality due to Group Icauses, and somewhat higher mortality or men dueto Group II and III causes. Te Eastern Mediterra-nean Region presents a di erent picture, with muchhigher mortality among men, due almost entirely toGroup III causes; that is, injuries. Figure 10shows thedistribution o male deaths due to Group III causes

Figure 8: Mortality rates among men and women aged 15–59 years, region and cause-o -death group, 2004

0

2

4

6

8

10

12

Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Africa Americas EasternMediterranean

Europe South-EastAsia

Western Paci c High income

D e a t

h s p e r

1 0 0 0 a

d u

l t s a g e

d 1 5

– 5 9 y e a r s

Group III:Injuries

Group II:Noncommunicable diseases

Group I:Communicable, maternaland nutritional conditions



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Causes o death

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Annex A

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Annex C

References

in the Eastern Mediterranean. War and violencecaused almost 40% o these deaths, ollowed by roadtrafc accidents (31%).

Injuries and cardiovascular diseases are leadingcauses o death among men in Europe

Figure 11illustrates the high levels o mortality amongmen in the low- and middle-income countries o theEuropean Region. Te main reason is the high mor-tality rates due to cardiovascular diseases and inju-

ries, each associated with a mortality rate exceeding2.5 per 1000 adults aged 15–59 years, and together

being responsible or almost two thirds o overallmale mortality in this age group.

Injuries are the main cause o death or adult menin Latin America and the Caribbean

Te most striking data rom the low- andmiddle-income countries o the Americas relate toinjury mortality, which is about 1.6 per 1000 menaged 15–59 years, making it the leading cause group(Figure 12). Intentional injuries account or 57% o

adult mortality due to injuries, while motor vehicleaccidents account or 25% o adult mortality due toinjuries.

Figure 9: Adult mortality rates among those aged 15–59 years in the A rican Region, by sex and major causegroup, 2004

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5

HIV/AIDS

Other infectious andparasitic diseases

Maternal and nutritionalconditions


Cancers

Other noncommunicablediseases

Injuries


Female

Male



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Part 2

Figure 10: Causes o injury deaths among men aged 15–59 years, Eastern Mediterranean Region, 2004

Road tra caccidents30%

Other unintentionalinjuries24%

Violence7%

War31%

Self-in ictedinjuries

7%

Other intentionalinjuries1%

Figure 11: Adult mortality among those aged 15–59 years in the low- and middle-income countries o theEuropean Region by sex and major cause grouping, 2004

0.0 0.5 1.0 1.5 2.0 2.5 3.0

HIV/AIDS




Cancers


Injuries


Female

Male



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Causes o death

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References7. Years o li e lost: taking age at deathinto account

Te years o li e lost (YLL) measure is a measure o premature mortality that takes into account boththe requency o deaths and the age at which deathoccurs, and is an important input in the calcula-

tion o the DALYs or a disease or health condition(see Box 1, page 3). YLL are calculated rom the numbero deaths at each age multiplied by a global standardli e expectancy or the age at which death occurs.

aking into account the age at death causes majorshi s in the proportion o deaths occurring in eacho the WHO Regions (Figure 13). Based on the dis-tribution o the world’s 58.8 million deaths in 2004,the South-East Asia Region has the highest propor-tion o deaths (26%), ollowed by the A rican Region(19%), the Western Paci c Region (18%) and high-income countries (14%). Based on the YLL, however,the A rican Region accounts or 32% o all YLL, ol-lowed by South-East Asia (30%), the Western Paci c

(13%) and the Eastern Mediterranean (9%) regions.Using the YLL increases the relative importance o A rica and South-East Asia in the global picture,because people rom these regions die at a relatively young age. Te relative importance o the East-ern Mediterranean and the Americas change little,and the remaining three regions decline in relative

importance.

Noncommunicable diseases become less important

Figure 14presents similar data on the proportionaldistribution o deaths and YLL or the leadingcauses o death. aking the age at death into accountcauses major shi s in the relative importance o the major causes. Te two most common causes o death – ischaemic heart disease (12.2% o all deaths)and cerebrovascular conditions (9.7% o all deaths)– are responsible or only 5.8% and 4.2% o YLL,respectively. Te main causes o YLL are perinatalconditions (prematurity and low birth weight, birth

Figure 12: Adult mortality among those aged 15–59 years in the low- and middle-income countries o theAmericas by sex and major cause grouping, 2004

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.6 1.8

HIV/AIDS




Cancers


Injuries


Female

Male

1.4



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Part 2

asphyxia and birth trauma, and other perinatal con-ditions), lower respiratory in ections, diarrhoeal dis-eases and HIV/AIDS.

8. Projected trends in global mortality:2004–2030

WHO has previously published projections o mor-tality rom 2002 to 2030 based on the GBD 2002estimates and using projection methods similar to

those used in the original GBD 1990 study (18, 19).Tese projections have been updated ( Figure 15) usingthe GBD 2004 estimates as a starting-point, togetherwith updated projections o HIV deaths prepared by UNAIDS and WHO (20), and updated orecasts o economic growth by region published by the WorldBank (21) (see Annex B7 or urther in ormation).

Large declines in mortality between 2004 and2030 are projected or all o the principal commu-nicable, maternal, perinatal and nutritional causes,

including HIV/AIDS, B and malaria. Global HIV/AIDS deaths are projected to rise rom 2.2 million in2008 to a maximum o 2.4 million in 2012, and thento decline to 1.2 million in 2030, under a baselinescenario that assumes that coverage with antiretro- viral drugs continues to rise at current rates.

Ageing o populations in low- and middle-incomecountries will result in signi cantly increasing totaldeaths due to most noncommunicable diseases overthe next 25 years. Global cancer deaths are projectedto increase rom 7.4 million in 2004 to 11.8 million

in 2030, and global cardiovascular deaths rom 17.1million in 2004 to 23.4 million in 2030. Overall, non-communicable conditions are projected to account

or just over three quarters o all deaths in 2030.Te projected 28% increase in global deaths due

to injury between 2004 and 2030 is predominantly due to the increasing numbers o road trafc acci-dent deaths, and increases in population numbersare projected to more than o set small declines inage-speci c death rates or other causes o injury.

Figure 13: Comparison o the proportional distribution o deaths and YLL by region, 2004

0

5

10

15

20

25

30

35

0 5 10 15 20 25 30 35Per cent of total global deaths

P e r c e n t o

f t o t a

l g

l o b a

l Y L L

Per cent YLL greater than per cent deaths:people die at younger ages

Per cent deaths greater than per cent YLL:people die at older ages

AmericasEurope

EasternMediterranean

High income

Western Paci c

AfricaSouth-East Asia



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Road trafc accident deaths are projected to increaserom 1.3 million in 2004 to 2.4 million in 2030, pri-

marily due to the increased motor vehicle ownershipand use associated with economic growth in low-and middle-income countries.

Leading causes o death in 2030

Te our leading causes o death globally in 2030are projected to be ischaemic heart disease, cer-ebrovascular disease (stroke), chronic obstructive

pulmonary disease and lower respiratory in ections(mainly pneumonia). otal tobacco-attributabledeaths are projected to rise rom 5.4 million in 2004to 8.3 million in 2030, at which point they will rep-resent almost 10% o all deaths globally.

Apart rom lower respiratory in ections, the 10main causes o death in 2004 included three othercommunicable diseases: diarrhoeal diseases, HIV/AIDS and B. HIV/AIDS deaths are projected to

decrease by 2030, but will remain the tenth leadingcause o death globally. Deaths due to other commu-nicable diseases are projected to decline at a asterrate: B will drop to the twentieth leading cause anddiarrhoeal diseases to twenty-third. Population age-ing will result in signi cant increases in the rank-ings or most noncommunicable diseases, particu-larly cancers. Increasing levels o tobacco smokingin many middle- and low-income countries willcontribute to increased deaths rom cardiovasculardisease, chronic obstructive pulmonary disease and

some cancers. Road trafc accidents are projected torise rom the ninth leading cause o death globally in2004 to the h in 2030.

Figure 16shows projected trends in total numberso global deaths or selected causes o death. Tis

gure clearly illustrates the projected increases innumbers o deaths or important noncommunica-ble causes, and the projected declines or leadingGroup I causes.

Figure 14: Comparison o the proportional distribution o deaths and YLL by leading cause o death, 2004

0

2

4

6

8

10

12

14

0 2 4 6 8 10 12 14Per cent of total global deaths

P e r c e n t o

f t o t a

l g

l o b a

l Y L L

Per cent YLL greater than per cent deaths:people die at younger ages from these causes

Per cent deaths greater than per cent YLL:people die at older ages from these causes

Neonatal conditions

Lower respiratory infections

Diarrhoeal diseases

HIV/AIDS

Roadtra c accidents

Ischaemic heartdisease

Cerebrovasculardisease

Trachea, bronchus,lung cancers



24


Part 2

Figure 15: Projected deaths by cause or high-, middle- and low-income countries

0

5

10

15

20

25

30

35

2004 2015 2030 2004 2015 2030 2004 2015 2030

D e a t h s

( m i l l i o n s ) Suicide, homicide and war

Other unintentional injuriesRoad tra c accidentsOther noncommunicablediseasesCancersCardiovascular diseasesMaternal, perinatal andnutritional conditionsOther infectious diseases

HIV/AIDS, TB and malaria

High income Middle income Low income



25


Causes o death

1

2

3

4

Annex A

Annex B

Annex C

References

Decomposition o projected changes in cause-specifc deaths

Projected changes in numbers o deaths may be dueto changes in age-speci c disease and injury deathrates, or due to demographic changes that alter thesize and age composition o the population, or both.Death rates are strongly age dependent or mostcauses, so changes in the age structure o a popula-tion may result in substantial changes in the numbero deaths, even when the age-speci c rates remain

unchanged.Te relative impact o demographic and epi-demiological change on the projected numbers o deaths by cause is shown in Figure 17. Te change inthe projected numbers o deaths globally rom 2004to 2030 can be divided into three components. Te

rst is population growth, which shows the expectedincrease in deaths due to the increase in the totalsize o the global population, assuming there are nochanges in age distribution. Te second is popula-tion ageing , which shows the additional increase indeaths resulting rom the projected changes in theage distribution o the population rom 2004 to2030. Both the population-related components are

calculated assuming that the age- and sex-speci cdeath rates or causes remain at 2004 levels. Te

nal component, epidemiological change, shows theincrease or decrease in numbers o deaths occurringin the 2030 population due to the projected change

rom 2004 to 2030 in the age- and sex-speci c deathrates or each cause.

For most Group I causes, the projected reductionin global deaths rom 2004 to 2030 is due mostly to epidemiological change, o set to some extentby population growth. Population ageing has lit-

tle e ect. For noncommunicable diseases, demo-graphic changes in all regions will tend to increasetotal deaths substantially, even though age- andsex-speci c death rates are projected to decline ormost causes, other than or lung cancer. Te impacto population ageing is generally much more impor-tant than that o population growth. For injuries,demographic change also dominates the epidemio-logical change. Te total epidemiological change orinjuries is small in most regions, because the projected increase in road trafc atalities is o set by projected decreases in death rates or other uninten-tional injuries.

Figure 16: Projected global deaths or selected causes, 2004–2030

0

2

4

6

8

10

12

14

2000 2005 2010 2015 2020 2025 2030

D e a t h s

( m i l l i o n s )

Year

CancersIschaemic heart diseaseCerebrovascular diseaseAcute respiratory infectionsPerinatal conditionsHIV/AIDS

Road tra c accidentsTuberculosisMalaria




Figure 17: Decompositiona o projected changes in annual numbers o deaths by income group, 2004-2030

-3

-2

-1

0

1

2

3

4

Cardiovasculardiseases

Injuries

-10

-5

0

5

10

15

20

High-income countries

Low- and middle-income countries

Total change

Population growth

Population ageing

Epidemiological change

Total change

Population growth

Population ageing

Epidemiological change

Infectious andparasitic diseases

Other Group Icauses

Noncommunicablediseases

Cancers

Cardiovasculardiseases

InjuriesInfectious andparasitic diseases

Other Group Icauses

Noncommunicablediseases

Cancers

D e a t h s

( m i l l i o n s )

D e a t h s

( m i l l i o n s )

a Te dark blue bars show the total projected change in the annual numbers o deaths (in millions) rom 2004 to 2030 or a givencause group. Te dark orange bars show the change in the annual numbers o deaths that would have occurred due to epide-miological change only (changes in age- and sex-speci c death rates) i the population size and age structure had remainedunchanged. Te light orange bars show the change that would have occurred due to population growth only, i the age structure

had remained unchanged, and age- and sex-speci c death rates had also remained unchanged. Te purple bars show thechange that would have occurred due to changes in the age distribution o the population only, i the size o the population hadremained constant, and the age- and sex-speci c death rates also remained unchanged.

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GBD Report Update Part2

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