Global burden of disease
|This article relies largely or entirely upon a single source. (September 2014)|
The global burden of disease is the collective disease burden produced by all diseases around the world. The Global Burden of Disease Study (GBD) is a comprehensive regional and global research program that assesses mortality and disability from major diseases, injuries, and risk factors. GBD is a collaboration of over 500 researchers representing over 300 institutions and 50 countries. Under principal investigator, Christopher J.L. Murray, GBD is based out of the Institute for Health Metrics and Evaluation at the University of Washington and funded by the Bill and Melinda Gates Foundation.
The 2013 report showed that global life expectancy for both sexes increased from 65.3 years in 1990, to 71.5 years in 2013, while the number of deaths increased from 47.5 million to 54.9 million over the same interval. Progress varied widely across demographic and national groups. Reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections and neonatal causes in low-income regions drove the changes. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell, while for most non-communicable causes, demographic shifts increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes and malaria remain in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections.
The GBD project was commissioned in year 1990 and is a collaborative effort between hundreds of experts worldwide, including researchers at the World Health Organization (WHO), Harvard School of Public Health, The University of Auckland School of Population Health, the Institute for Health Metrics and Evaluation (IHME), and the World Bank. The original project estimated health gaps using disability-adjusted life years (DALYs) for eight regions of the world in 1990. It provided a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.
Official DALY estimates had not been updated by WHO since 2004, until the Global Burden of Disease Study 2010 was published in 2013. The work quantified the burdens of 291 major causes of death and disability and 67 risk factors disaggregated by 21 geographic regions and various age-sex groups.
The GBD has three specific aims:
- To systematically incorporate information on non-fatal outcomes into the assessment of the health status (using a time-based measure of healthy years of life lost due either to premature mortality or to years lived with a disability, weighted by the severity of that disability)
- To ensure that all estimates and projections were derived on the basis of objective epidemiological and demographic methods, which were not influenced by advocates.
- To measure the burden of disease using a metric that could also be used to assess the cost-effectiveness of interventions. The metric chosen was the DALY.
The burden of disease can be viewed as the gap between current health status and an ideal situation in which everyone lives into old age free of disease and disability. Causes of the gap are premature mortality, disability and exposure to certain risk factors that contribute to illness.
- Das, P (2012). "The story of GBD 2010: a "super human" effort". Lancet. 380 (9859): 2067–2070. doi:10.1016/s0140-6736(12)62174-6.
- "What does a $100 million public health data revolution look like?". TEDMED.
- GBD 2013 Mortality and Causes of Death Collaborators (2014). "Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". The Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. ISSN 0140-6736. PMC . PMID 25530442.
- Global Burden of Disease (GBD) at WHO, 2012
- Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. (2013). "Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2197–223. doi:10.1016/S0140-6736(12)61689-4. PMID 23245608.
- Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. (2013). "GBD 2010: design, definitions, and metrics". Lancet. 380 (9859): 2063–6. doi:10.1016/S0140-6736(12)61899-6. PMID 23245602.
- Watts C, Cairncross S (2013). "Should the GBD risk factor rankings be used to guide policy?". Lancet. 380 (9859): 2060–1. doi:10.1016/S0140-6736(12)62121-7. PMID 23245600.
- Global burden of disease at WHO website
- GBD Publications from Harvard School of Public Health
- Global Burden of Disease Mental Disorders and Illicit Drug Use Expert Group at National Drug and Alcohol Research Centre (University of New South Wales, Australia)
- Global Burden of Disease at Institute for Health Metrics and Evaluation website