Trends in Death and Disability in Asia and the Pacific: Key Findings from the Global Burden of Disease 2010 Study

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1 Trends in Death and Disability in Asia and the Pacific: Key Findings from the Global Burden of Disease 2010 Study Professor Alan Lopez School of Population Health, The University of Queensland Brisbane, Australia

2 What is the Global Burden of Disease 2010? 1) A systematic scientific effort to quantify the comparative magnitude of health loss due to major diseases, injuries and risk factors by age, sex, country, for 1990 and 2010; i.e. Amassing the best evidence on the state of the world s health. 2) By the numbers: 291 diseases and injuries, 1,160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors. 3) GBD 2010 provides uncertainty intervals for all quantities of interest.

3 GBD 2010 team 486 authors from 302 institutions in 50 countries

4 Some GBD terminology 1) Years of life lost due to premature mortality due to a death at age x is the standard life expectancy at age x. 2) Years lived with disability for a cause in an age-sex group equals the prevalence of the condition times the disability 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 or long-term health loss. 5) In the GBD 2010, DALYs are not discounted or age-weighted.

5 Initial publication of Study methods and findings; Lancet Dec, 2012

6 Chief components of the GBD2010 Study

7 GBD 2010 Findings I: Mortality

8 Progress in reducing global mortality, , by age and sex 157 of 187 countries had increases in life expectancy at birth from 1990 to 2010 for males and 166 of 187 for females.

9 Global deaths in 2010 by age and GBD regions

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

11 Annual rate of decline in Under-5 mortality,

12 Risk of adult death (ages 15-59) per 1000 males aged 15, 2010

13 Female Life Expectancy, 2010

14 Male Life Expectancy, 2010

15 Absolute Change in Female Life Expectancy,

16 Absolute Change in Male Life Expectancy,

17 GBD 2010 Findings II: Causes of Death

18 The universe of CoD data Type We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 We have used 9 different sources of CoD data We have collected data on around 600 million deaths in the last 30 years Data available varies by disease: More of maternal, cancer, injuries Less of NTD, diarrhea and LRI pathogens Site years Countries 2, Cancer registries 2, Police Reports 1, Surveys/Census 1, Maternal Mortality Surveillance 83 8 Deaths in health Facilities 21 9 Burial and Mortuary Vital Registration Verbal Autopsy Country years of vital registration,

19 Change in broad causes of death in the last 20 years, World

20 Leading causes of global death and premature mortality in 2010

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

22 YLL top 25 leading causes across 21 GBD regions, 2010

23 Asia-Pacific: Leading causes of child death Oceania ineast2010, Asia ages South0-4 Asia Southeast Asia Lower respiratory infections Preterm birth complications Diarrheal diseases Congenital anomalies Preterm birth complications Lower respiratory infections Preterm birth complications Lower respiratory infections Diarrheal diseases Sepsis and other infectious disorders of Neonatal encephalopathy Neonatal encephalopathy the newborn baby Congenital anomalies Sepsis and other infectious disorders of the newborn baby Drowning Meningitis Protein-energy malnutrition Leukemia Road injury Preterm birth complications Lower respiratory infections Diarrheal diseases Neonatal encephalopathy Neonatal encephalopathy Congenital anomalies Sepsis and other infectious disorders of Congenital anomalies the newborn baby Meningitis Falls Meningitis Protein-energy malnutrition Syphilis Diarrheal diseases Measles HIV/AIDS Meningitis Encephalitis Drowning Typhoid and paratyphoid fevers Measles

24 Asia-Pacific: leading causes of adult death, ages 15-59, 2010 Oceania East Asia South Asia Southeast Asia Lower respiratory infections 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 Trachea, bronchus, and lung cancers HIV/AIDS Chronic obstructive Self-harm pulmonary disease Cirrhosis of the liver HIV/AIDS Chronic kidney diseases Stomach cancer Chronic obstructive Cerebrovascular disease pulmonary disease Diarrheal diseases Malaria Cirrhosis of the liver Maternal disorders Esophageal cancer Cirrhosis of the liver Fire, heat and hot substances Ischemic heart disease HIV/AIDS Cirrhosis of the liver Diabetes mellitus Lower respiratory Cerebrovascular disease infections Interpersonal violence Chronic kidney diseases

25 Asia-Pacific: leading causes of YLLs, 2010 Oceania Lower respiratory infections Diabetes mellitus Diarrheal diseases East Asia South Asia Lower respiratory Cerebrovascular disease infections Preterm birth Ischemic heart disease complications Chronic obstructive pulmonary disease Diarrheal diseases Southeast Asia Cerebrovascular disease Tuberculosis Lower respiratory infections Ischemic heart disease Road injury Ischemic heart disease Preterm birth Trachea, bronchus, and Chronic obstructive complications lung cancers pulmonary disease Neonatal Tuberculosis Liver cancer encephalopathy Sepsis and other infectious disorders of Meningitis Stomach cancer the newborn baby Ischemic heart disease Malaria Diabetes mellitus HIV/AIDS Self-harm Lower respiratory infections Cerebrovascular disease Esophageal cancer Tuberculosis Road injury Diarrheal diseases Preterm birth complications Cerebrovascular disease HIV/AIDS Neonatal Self-harm encephalopathy

26 GBD 2010 Findings III: DALYs/Disease Burden

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

28 Leading causes of global DALYs shifting Infectious, neonatal, maternal Non-communicable Injuries

29 Asia-Pacific: leading causes of DALYs, 2010 Oceania Lower respiratory infections East Asia South Asia Southeast Asia Tuberculosis Lower respiratory Cerebrovascular disease infections Preterm birth Ischemic heart disease complications Chronic obstructive pulmonary disease Diarrheal diseases Malaria Liver cancer Meningitis Major depressive disorder Tuberculosis Sepsis and other infectious disorders of the newborn baby HIV/AIDS Neck pain Low back pain Asthma Diabetes mellitus Iron-deficiency anemia Diabetes mellitus Diabetes mellitus Cerebrovascular disease Tuberculosis Ischemic heart disease Lower respiratory Diarrheal diseases Road injury Ischemic heart disease infections Chronic obstructive Ischemic heart disease Low back pain pulmonary disease Road injury Preterm birth Trachea, bronchus, and Neonatal Major depressive complications lung cancers encephalopathy disorder Low back pain Diarrheal diseases Chronic obstructive pulmonary disease

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

31 2) Progressive Disease Transition from Communicable to Non-Communicable Causes

32 3) The Disability Transition: Progressive Shift in Burden from Premature Mortality to Years Lived with Disability

33 Summary Rapid (& sustained) progress in reducing child (and maternal) mortality throughout Asia over past 20 years Large variations across Asia/Pacific in extending life expectancy (ranging from 0 to 20 years since 1990) Premature adult mortality now a leading cause of health loss in all populations in the region, including from major noncommunicable diseases ( stroke, IHD, COPD, lung and liver cancer), but also TB, lower resp diseases and injuries ( RTAs, suicide, falls, drowning). Progressive rise in burden of disability ( low back pain, depression, injuries and NCDs) across the region

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