New Global Burden of Disease Analysis. NCDs march on, but other diseases still dominate South Asia and most of Sub Saharan Africa

Last month, the Lancet released a series of papers updating the Global Burden of Disease estimates from 1990 for 2010.

It is a mammoth effort involving hundreds of researchers from several institutions.

A fantastic achievement, then, but no real surprises.

The headline for me is that non communicable diseases continue to grab bigger and bigger shares of the global burden of disease (from 43% to 54% over a 20 year period), but that in the poorest regions there is a major case of unfinished business on the communicable disease front.

Here are some of the key things that caught my eye:

Overall

• Between 1990 and 2010, DALYs (disability adjusted life years, combining mortality and morbidity) per 1000 people from 291 diseases and injuries are down in 18 of 21 regions (the three that show increases: Caribbean, High Income Asia Pacific, and Southern Sub-Saharan Africa). This decline is partly due to population ageing and fewer DALYS from communicable maternal, neonatal and nutritional disorders.
• Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from 4th in 1990)
• MDG related causes of the global burden of disease were 742 million DALYs in 2010 (30% of the total), down from 1096 million in 1990 (44%) (How much of this is actually due to the MDGs themselves?)
• The shift in DALYs from communicable to non-communicable diseases continues: in 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively.

Diseases and Injuries (Paper by Murray et al.)

• The top nutrition causes of DALYs at the global level in 2010 were diarrhoea disease, 4th (from 2nd in 1990), "protein energy malnutrition", 20th (from 9th), iron deficiency anemia, 15th (from 14th), and diabetes 14th (from 21st)
• By region: diarrheal disease was the third most important disease burden contributor for South Asia.  Protein energy malnutrition was the 6th, 3rd and 6th most important factor for East, Central and West Sub Saharan Africa respectively (but only 19th for South Asia). Iron deficiency anemia was 9th ranked in South Asia and 11th-12th ranked in east, west, central and south Sub-Saharan Africa.
• Diabetes was the 8th most important factor in South Sub Saharan Africa.

Risk Factors (Paper by Lim et al.)

• Globally, childhood underweight (low weight for age in children under 5) has dropped from the top risk factor in 1990 to the 8th overall in 2010 (out of 67 risk factors in total). Diets low in fruit rose to 5th from 8th, high Body Mass Index (overweight and obesity) rose to 6th from 10th, iron deficiency dropped to 13th from 11th and suboptimal breastfeeding dropped to 14th from 5th.
• In the poorest regions, childhood underweight remains the number one risk factor in Western, Central and Eastern Sub Saharan Africa. In South Asia it is the 4th most important risk factor.
• Diets low in fruits ranked between the 4th-13th most important risk factor in South Asia and Sub-Saharan Africa regions, highlighting it's importance for over and undernutrition, even in the poorest regions.
• High body mass index was in the top ten of risk factors for all 21 regions except South Asia (17th) and East, Central and Western SSA (14th, 18th and 15th respectively).
• Vitamin A and zinc deficiencies fall out of the top 25 risk factors (from 17th and 19th respectively in 1990), globally.
• Globally, drug use is the biggest climber to 19th (from 25th).