Global Burden of Disease (GBD) Related to NCDs

• GBD is a comprehensive regional and global assessment of mortality and disability

• WHO developed it in 1990

• It provides information and projections about disease on a global scale

• GBD aims are:

• To systematically incorporate information on non-fatal outcomes into the assessment
of health status

• To ensure that all estimates and projections were derived on the basis of objective
epidemiological and demographic methods

• To measure the burden of disease using a metric that is a cost effective (DALY)
 Burden of Disease Methodology
 Developed for the 1990 Global Burden of Disease Study by WHO and
Harvard to confront data deficiencies in measuring population health
to guide investment in health

 Estimates levels of mortality and underlying causes of death – from

multiple sources of information and derived consistent and coherent
estimates using demographic techniques and statistical analysis

• Measures the fatal and non-fatal outcomes using Disability Adjusted

Life Years (DALYS)
YLL – years of life lost (Years of life lost due to premature mortality)
YLD – years lived with disability (Years of life lived with any short-term or
long-term health loss)
DALY = YLL + YLD

1 DALY is equal to 1 lost year of healthy life

Explicit values:
- age weights,
- discounting,
- severity weights,
- expected life span
 Global Trends in Mortality and Life Expectancy
• There was rapid progress in life expectancy from 1950 to 2017:
• Males, up from 48 years in 1950 to 71 years in 2017
• Females, up from 53 years in 1950 to 76 years in 2017
• Among age groups, the under-5 age group experienced huge reductions in mortality between
1950 and 2017, while adults have made much less progress, particularly adult males.
• While females tend to live longer than males, the gap in life expectancy between them varies
substantially by level of socioeconomic development.

52 years 60 70 80 85
Females tend to live longer than males
 Total number of global deaths, 1950–2017

0 to 6 days
• The proportion of deaths in those over age 75 increased from 12%
7 to 27 days of total deaths in 1950 to 39% in 2017.
28 to 364
Numbers of deaths in millions

days
1 to 4
5 to 9 • There have been dramatic declines in under-5 mortality, but there
10 to 14 were
15 to 19 still 5.4 million deaths among children under 5 worldwide in 2017.
20 to 24
25 to 29
30 to 34
35 to 39 • Declines in under-5 mortality were fastest among
40 to 44
45 to 49 countries at the lowest level of Socio-demographic
Index (SDI)**
50 to 54
55 to 59
60 to 64
65 to 69
70 to 74
75 to 79
80 to 84
85 to 89
90 to 94
95 plus
Distribution of deaths by leading cause
groups
(males and females, world, 2004)
 Leading causes of early death, 1990 and 2017

Ischemic heart disease, neonatal disorders, stroke, lower respiratory infections, diarrhea, road injuries, and chronic
obstructive pulmonary disease (COPD) accounted for more than 1 million deaths each worldwide in 2017

1990 2017
Communicable, maternal, neonatal, and nutritional
rank** rank
1 Ischemic heart disease diseases
2 Neonatal disorders
3 Stroke
Non-communicable diseases
4 Lower respiratory infections
Injuries
5 Diarrheal diseases
6 Road injuries
7 COPD
Same or increase Decrease
**
Ranking based on number of years
8 HIV/AIDS lived with disability (YLLs) at all
ages
9 Congenital birth defects
10 Malaria
10 Malaria

11 COPD 11 Tuberculosis
19 HIV/AIDS 39 Measles
 Leading causes of disability, 1990 and 2017

Differences in disability by sex

Global all-age YLDs
In general, females have had – and continue to
1990 rank 2017 rank
experience – higher levels of disability than males.
1 Low back pain 1 Low back pain
2 Headache disorders
**
2 Headache
disorders* *
199
0

201
7 Dietary iron deficiency 7
9 Diabetes

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000

**
Headache disorders mainly include migraine.
†
Chronic obstructive pulmonary disease
Female
Male

Age adjusted YLDs per 100,000

While females tend to live longer than males
Many of these extra years are spent in poor health

Extra years lived by females compared to males in good health versus poor
health 2017
Eastern Europe 29%
Central Asia 27%
Tropical Latin America 34%
Southern sub-Saharan Africa 34%
Central Europe 22%
Southeast Asia 32%
High-income Asia Pacific 44%
Central Latin America 33%
Southern Latin America 32%
East 42%
Asia 37%
Oceania 37%
Caribbean 30%
Eastern sub-Saharan Africa 49%
High-income North America 45%
North Africa and Middle 48%
East 41%
Western Europe 35%
Australasia 31%
Central sub-Saharan Africa 34%
Western sub-Saharan Africa 92%
Andean Latin America 0 4 12
South Asia 8
Extra years lived by females

Extra years lived by females in poor health

Extra years lived by females in good health
SDI = Socio-demographic
Index
†
Extra years of life expected at birth
NCDs cause premature deaths in LMICS
Indian scenario

• NCDs contribute to around 5.87 million deaths that account for 60 % of all deaths in India.
• India shares more than two-third of the total deaths due to NCDs in the South-East Asia Region (SEAR) of
WHO.

• The new national estimates for diabetes and other non-communicable diseases (NCD) shows that 31 million more Indians
became diabetic in four years (2019-2021).
• In 2021, a study found that India has 101 million people with diabetes and 136 million people with prediabetes. Diabetic
capital

• Additionally, 315 million people had high blood pressure

• 254 million had generalized obesity, and 351 million had abdominal obesity.

• 213 million people had hypercholesterolaemia (wherein fat collects in arteries and puts individuals at greater risk of heart
attack and strokes).
• 185 million had high low-density lipoprotein (LDL) cholesterol.
The Socio-economic Burden of NCDs

US$ 170B
is the overall cost for
all developing
countries to scale up
US$ 7T
is the cumulative lost output
action by in developing countries
implementing a set of associated with NCDs between
"best buy" 2011-2025
interventions,
identified as priority
actions by WHO

57 million total deaths in 2008 of which 36 million were due to NCDs

Non-Communicable Diseases(NCDs) and their
causes

Cancer
Diabetes Chronic
Respiratory
Diseases

Cardiovascular
Diseases

Other NCDs

Physical Unhealthy
inactivity diets
Tobacco Harmful use of Malnutrition
Obesity use alcohol
 Projected deaths by cause and income (2004 to 2030)
WHO

30
Intentional injuries
Other unintentional
25
Road traffic accidents
Deaths (millions)

Other NCD
20

Cancers
15

10 CVD

Mat//peri/nutritional
5
Other infectious
HIV, TB, malaria
0
2004 2015 2030 2004 2015 2030 2004 2015 2030
High income Middle income Low income
Noncommunicable Diseases
Burden of disease in disability adjusted life years
(2004)
 Noncommunicable Diseases
Global burden of disease attributable top 20 risk factors

Underweight
Unsafe sex
High blood pressure
Tobacco
Alcohol

World Health Report, 2002)

Unsafe water, S&H
High cholesterol
Indoor smoke from solid fuels
IIron deficiency
High BMI
Zinc deficiency Low and middle income
Low fruit and vegetables
High income
Vitamin A deficiency
Physical inactivity
Occupational injury risks
Lead exposure
Illicit drugs
Unsafe health care injections
Lack of contraception
Childhood sexual abuse

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

Attributable DALYs (% total 1.44 billion)

 Noncommunicable Diseases
Tobacco is a risk factor for 6 of the 8 leading causes of death

(World Health Statistics, 2008)

Tobacco: The poor and uneducated are the ones who smoke the most

Smoking prevalence

Source: Sen, B & Hulme D, 2004

 All countries are at risk

The epidemiology of NCDs is already well advanced

All countries are at risk irrespective of income and socioeconomic

development ONLY numbers varies
 Adult mortality (2004)
High income Cardiovascular diseases
Cancers
Other noncommunicable diseases
Western Pacific
Injuries
HIVAIDS
Americas
Other infectious and parasitic diseases
Maternal and nutritional conditions
Eastern Mediterranean

South East Asia

Europe

Africa

0 2 4 6 8 10 12
Death rate per 1000 adults aged 15–59 years
• DALYs per 100,000 people of the population

• The best health are below 20,000 DALYs per lakh.

• The worst-off regions, particularly in Sub-Saharan

Africa, the rate is higher than 80,000 DALYs per
lakh.

• Recent population growth has been highest in

Africa, Asia, and Latin America
 Human potential loss due to poor health is immense

• To assess the health status of a

population is to focus on mortality

• The sum of mortality and morbidity is

referred to as the 'burden of disease'

• It can be measured by a metric called

'Disability Adjusted Life Years' (DALYs).

• DALYs are measuring lost health

• DALYs allow direct comparisons of

disease burdens of different diseases
across countries, between different
populations, and over time

• One DALY represents one lost year of

healthy life (premature death or disease
or disability)
>60 percent of the burden of disease results from non-
communicable diseases (NCDs)

28 percent from communicable, maternal, neonatal and

nutritional diseases

Nearly 10 percent from injuries

• Globally, in 2017, life expectancy was 73 years, but
healthy life expectancy was only 63 years.

• This means on average 10 years of life were spent

in poor health in 2017.

• Trends in early death and disability,* 1990–2017:

41% decrease in communicable diseases and
neonatal disorders

• 40% increase in non-communicable diseases

• Large disparities persist in health and disease

burden by sex and level of development
Impact of increasing medical costs and the need for prevention

• Total Health Expenditure per capita ranges between US$ 325 to 2750

• Out of pocket spending ranges between 18-23%

• Advanced epidemiological and demographic transitions are expected to result in

a several fold increase in health care spending in in the coming years

• Prevention has to be taken seriously to reduce Catastrophic Expenditures

• Includes
Better management of NCDs
detecting, screening is critical
and treating these diseases, and providing access to palliative care for
people in need.

Sources: WHO WHR 2008,- WHO NHA database, WHO-EMRO,

 Proportion of family income devoted to diabetes care

40
35
30
25 1998
Percent

20
15 2005
10
5
0
Hi Upper Mdl Middle Low
Income level

Source: Ramachandran A Diabetes Care 2007

In Conclusion: If you don’t prevent
NCDs ??

Its A Barrier to Development

• CVDs and other NCDs Will Further Widen the Health Gap between Rich and Poor
Countries

• They Are Killing and Disabling People at Their Peak Productivity

• They Will Slow Economic Growth Rates in Poor Countries

 Future Health Trends in GBD
• Globally, life expectancy is expected to increase by 4.4 years between 2016
and 2040.
• But if less progress is made, life expectancy could decrease by 0.4 yrs for
males and stagnate for females.
• If more progress is made, it could increase by 7.8 years for males and 7.2
years for females.

• There is risk that the progress made in slowing the HIV epidemic could be
reversed without a continued robust investment in health.

• People’s health can improve, but it demands attention, resources, action, and
continued prioritization of these drivers of health.
(reducing key risk factors, increasing educational attainment and income)