Citation

Murray CJL, Lopez AD. Lancet 1997; 349(9063): 1436-1442.

Affiliation

Harvard School of Public Health, Boston, Massachusetts, USA.

Copyright

(Copyright © 1997, Elsevier Publishing)

DOI

10.1016/S0140-6736(96)07495-8

PMID

9164317

Abstract

The Global Burden of Disease Study used the disability-adjusted life-year (DALY) to compare death and disability from various disorders in developing and developed countries. In 1990, developing countries carried almost 90% of the global disease burden yet were recipients of only 10% of global health care funding. The highest disease burdens were in sub-Saharan Africa (21.4% of global total) and India (20.9%). Communicable, maternal, perinatal, and nutritional disorders (group 1 causes) predominated in sub-Saharan Africa (65.9% of burden), while noncommunicable diseases (group 2 causes) accounted for 80% of the burden in established market economies; injuries (group 3) did not differ substantially across regions. The ratio of group 2 to group 1 disorders can be used as a measure of the epidemiologic transition. Group 2 disorders already surpass group 1 disorders in China, Latin America, and the Caribbean. On a global level, group 1, 2, and 3 causes accounted for 43.9%, 40.9%, and 15.1%, respectively, of DALYs. Overall, the top 3 causes of DALYs in 1990 were lower respiratory infections, diarrheal diseases, and perinatal disorders (low birth weight and birth asphyxia or birth trauma). In developed countries, these causes were ischemic heart disease, unipolar major depression, and cerebrovascular diseases. Malnutrition was the risk factor responsible for the greatest loss of DALYs (15.9%), followed by poor water supply, sanitation, and personal hygiene (6.8%).

Language: en