Elsevier

The Lancet

Volume 349, Issue 9061, 3 May 1997, Pages 1269-1276
The Lancet

Articles
Mortality by cause for eight regions of the world: Global Burden of Disease Study

https://doi.org/10.1016/S0140-6736(96)07493-4Get rights and content

Summary

Background

Reliable information on causes of death is essential to the development of national and international health policies for prevention and control of disease and injury. Medically certified information is available for less than 30% of the estimated 50·5 million deaths that occur each year worldwide. However, other data sources can be used to develop cause-of-death estimates for populations. To be useful, estimates must be internally consistent, plausible, and reflect epidemiological characteristics suggested by community-level data. The Global Burden of Disease Study (GBD) used various data sources and made corrections for miscoding of important diseases (eg, ischaemic heart disease) to estimate worldwide and regional cause-of-death patterns in 1990 for 14 age-sex groups in eight regions, for 107 causes.

Methods

Preliminary estimates were developed with available vital-registration data, sample-registration data for India and China, and small-scale population-study data sources. Registration data were corrected for miscoding, and Lorenz-curve analysis was used to estimate cause-of-death patterns in areas without registration. Preliminary estimates were modified to reflect the epidemiology of selected diseases and injuries. Final estimates were checked to ensure that numbers of deaths in specific age-sex groups did not exceed estimates suggested by independent demographic methods.

Findings

98% of all deaths in children younger than 15 years are in the developing world. 83% and 59% of deaths at 15–59 and 70 years, respectively, are in the developing world. The probability of death between birth and 15 years ranges from 22·0% in sub-Saharan Africa to 1·1% in the established market economies. Probabilities of death between 15 and 60 years range from 7·2% for women in established market economies to 39·1% for men in sub-Saharan Africa. The probability of a man or woman dying from a non-communicable disease is higher in sub-Saharan Africa and other developing regions than in established market economies. Worldwide in 1990, communicable, maternal, perinatal, and nutritional disorders accounted for 17·2 million deaths, non-communicable diseases for 28·1 million deaths and injuries for 5·1 million deaths. The leading causes of death in 1990 were ischaemic heart disease (6·3 million deaths), cerebrovascular accidents (4·4 million deaths), lower respiratory infections (4·3 million), diarrhoeal diseases (2·9 million), perinatal disorders (2·4 million), chronic obstructive pulmonary disease (2·2 million), tuberculosis (2·0 million), measles (1·1 million), road-traffic accidents (1·0 million), and lung cancer (0·9 million).

Interpretation

Five of the ten leading killers are communicable, perinatal, and nutritional disorders largely affecting children. Non-communicable diseases are, however, already major public health challenges in all regions. Injuries, which account for 10% of global mortality, are often ignored as a major cause of death and may require innovative strategies to reduce their toll. The estimates by cause have wide Cls, but provide a foundation for a more informed debate on public-health priorities.

Introduction

This paper, the first of a series of four, reports on the 5-year Global Burden of Disease Study (GBD). (The other three papers will follow in the next three issues of The Lancet.) The study was initiated in 1992 at the request of the World Bank and was done in collaboration with WHO. Preliminary results were used by the World Bank1 and published by WHO.2 The GBD was designed to address three primary goals: to provide information on non-fatal health outcomes for debates on international health policy, which are generally focused on mortality; to develop unbiased epidemiological assessments for major disorders; and to quantify the burden of disease with a measure that could also be used for cost-effectiveness analysis. There were four specific objectives:

  • To develop internally consistent estimates of mortality for 107 causes of death by age, sex, and geographic region.

  • To develop internally consistent estimates of incidence, prevalence, duration, and case-fatality for 483 disabling sequelae of the 107 causes.

  • To estimate the fraction of mortality and disability attributable to ten major risk factors.

  • To develop various projection scenarios of mortality and disability estimates by cause, age, sex, and region.

Final results, including chapters on each major condition by the investigators who contributed to this study are available.3, 4 The results published here supersede the preliminary results.2, 3 This paper reports on regional and global patterns of mortality by cause.

Section snippets

Design

The GBD can be divided into five components, which were all studied simultaneously and are interlinked: causes of death, descriptive epidemiology of disabling sequelae, burden attributable to selected risk factors, projections of burden from 1990 to 2020, and sensitivity analysis. In the cause-of-death component, data from vital registration and sample registration systems were combined with the results of population-monitoring laboratories and disease-specific epidemiological studies and

Results

Figure 2 illustrates the distribution of all deaths worldwide by age and region. Because of a much younger population age distribution and higher mortality rates in children, 98% of deaths in children were in the developing world (all study regions except established market economies and formerly socialist economies of Europe). 32% of all deaths in the developing world occurred in children younger than 5 years, and 63% occurred by the age of 60 years. Within developing regions, the age

Discussion

Despite decades of sustained progress through development and targeted health interventions in all regions of the world in the reduction of child mortality due to group 1 causes, five of the ten leading causes of death are still communicable or perinatal disorders. With the exception of tuberculosis, these major causes largely affect children younger than 5 years. Seven disorders (lower respiratory infections, diarrhoeal diseases, perinatal disorders, tuberculosis, measles, malaria, and

References (30)

  • WE Stehbens

    An appraisal of the epidemic rise of coronary heart disease and its decline

    Lancet

    (1987)
  • M Garenne et al.

    Child mortality after high-titre measles vaccines: prospective study in Senegal

    Lancet

    (1991)
  • World development report 1993: investing in health

    (1993)
  • CJL Murray et al.

    Global health statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions

    (1996)
  • CJL Murray et al.

    Global health statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions

    (1996)
  • CJL Murray

    Quantifying the burden of disease: the technical basis for disability-adjusted life years

    Bull World Health Organ

    (1994)
  • Anand S, Hansen K. Disability-adjusted life years: a critical review. J Health Economics (in...
  • CJL Murray et al.

    Adult mortality: levels, patterns and causes

  • AR Omran

    The epidemiological transition: a theory of the epidemiology of population change

    Milbank Q

    (1971)
  • World Population prospects 1992 assessment

    (1992)
  • Hill K, Yazbeck A. Trends in child mortality 1960–90: estimates for 84 developing countries. The World Bank World...
  • I Timaeus

    Adult mortality

  • SH Preston

    Mortality patterns in national populations

    (1976)
  • Cited by (3487)

    View all citing articles on Scopus
    View full text