ArticlesGlobal mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Introduction
In this, the third of a four-article series on the Global Burden of Disease Study (GBD) (see Lancet 1997; 349: 1269–76 and 1347–52, and the next issue) the primary indicator used to summarise the burden of premature mortality and disability (including temporary disability) is the disability-adjusted life year (DALY). The burden of 107 disorders is compared with the burden attributable to ten major risk factors and to selected diseases as risk factors for other conditions. More extensive detail on the estimation of causes of death and development of epidemiological profiles of each disabling sequela have been published.1
DALYs are the sum of life years lost due to premature mortality and years lived with disability adjusted for severity. The value choices incorporated into DALYs and the basis of their selection have been extensively debated and discussed.2, 3, 4 In this article we give more details on the methods used to estimate attributable burden.
Section snippets
Estimation of attributable burden
For the GBD, assessments of the burden attributable to each of the ten major risk factors were made by specialists on each topic: tobacco,5 alcohol,6 illicit drugs,7 occupation,8 air pollution,9 poor water supply, sanitation, and personal and domestic hygiene,10 hypertension,11 physical inactivity,12 malnutrition,13 and unsafe sex.14 Attributable burden in this study has been defined (for a specific risk factor, population, and time) as “the difference between currently observed burden and the
Results
We calculated the regional distribution of the burden of disease and health expenditure worldwide (figure 1). In 1990, nearly 90% of the worldwide burden of disease occurred in devloping regions, where only 10% of health-care funds were spent.23 In terms of overall worldwide burden of disease, sub-Saharan Africa and India had the largest proportions (21·4% and 20·9%, respectively) but very small proportions (0·7% and 1·0%) of health expenditure. Established market economies accounted for 7·2%
Discussion
Three findings from the GBD should be emphasised. First, despite dramatic improvements in child health conditions in the developing world, the three leading contributors to the burden of disease are lower respiratory infections, diarrhoeal diseases, and perinatal disorders. Together with measles, the eighth largest cause of burden, these childhood diseases account for 25% of the whole burden of premature mortality and disability in developing regions. Two important risk factors that contribute
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