Global health gains offset by AIDS, malaria
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Although child mortality has dropped in many regions of the world over the past decade, these gains were offset by increasing number of deaths due to HIV/AIDS and malaria, as well as setbacks in adult mortality in countries of the former Soviet Union, according to results of the 2001 Global Burden of Disease (GBD) study.
Dr. Alan D. Lopez, from the University of Queensland in Brisbane, Australia, and his associates analyzed mortality, incidence, and prevalence for 136 diseases and injuries in seven geographical areas. Their findings appear in the The Lancet this week.
Roughly 56 million people died in 2001. Ischemic heart disease—the type that involves restricted blood flow to the heart—and stroke were the leading causes in all regions, accounting for more than one fifth of all deaths worldwide.
One third of deaths were caused by group 1 diseases—communicable, maternal, and perinatal conditions and nutritional deficiencies—similar to what was observed in the 1990 GBD study.
However, among group 1 diseases, HIV/AIDS accounted for 14 percent of deaths, up from 2 percent in 1990. The authors estimate that 97 percent of group 1 deaths not associated with HIV were in low- and middle-income countries.
In high-income countries, cancers, lower respiratory tract infections, COPD, dementia, and diabetes rounded out the 10 leading causes of death.
In lower-income countries, five leading causes of death were infectious diseases. Perinatal conditions, COPD and traffic accidents were also among the top 10.
Although mortality among children up to 4 years old declined in all regions, nearly one out of every five deaths in 2001 were among children. All told, 99 percent of child mortality occurred in lower-income countries, and more than 40 percent in sub-Saharan Africa. Dr. Lopez’s team observes that half of early childhood mortality was due to preventable and treatable conditions (acute respiratory infection, measles, diarrhea, malaria, and HIV/AIDS).
The authors note that injuries were another important cause of death among adults. Violence and war accounted for almost half of deaths in sub-Saharan Africa, Latin America and the Caribbean.
The investigators also examined causes of disability, of which under nutrition was the leading global cause in both 1990 and 2001.
Other principal causes of disability in the lower-income countries were the same as those causing mortality, except that depressive disorders also contributed. In high-income countries, causes of disability included depressive disorders, adult onset hearing loss, alcohol use disorders, and osteoarthritis.
Mortality and disability were substantially associated with behavioral risk factors, such as substance abuse, unsafe sex, smoking, obesity, and child sexual abuse.
Lopez and his associates suggest that “further improvements in health in poor countries could be achieved in a relatively short time.”
The study illustrates the need for various health interventions, they add, and should contribute to the “comprehensive analysis of intervention cost-effectiveness in the Disease Control Priorities Project.”
SOURCE: The Lancet, May 27, 2006.
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