291 diseases and injuries + 67 risk factors + 1,160 non-fatal complications = 650 million estimates of how we age, sicken, and die

December 14, 2012 11:08 AM

As humans live longer, what ails us isn't necessarily what kills us: five data visualizations of how we age, sicken, and die. Causes of death by age, sex, region, and year. Heat map of leading causes and risks by region. Changes in leading causes and risks between 1990 and 2010. Healthy years lost to disability vs. life expectancy in 1990 and 2010. Uncertainties of causes and risks. From the team for the massive Institute for Health Metrics and Evaluation Global Burden of Diseases, Injuries, and Risk Factors Study 2010.

The data visualizations page also includes a large number of static figures from the GBD 2010 study.

The GBD 2010 team at the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington, "spent almost 5 years building [the database of causes of death]; we have included almost 800 million deaths from 1950 to 2010, and the data come from different sources," resulting in "the biggest database for cause of death analysis in the world," according to Rafael Lozano at the University of Washington.

The GBD 2010 includes:

• 291 diseases and injuries
• 67 risk factors
• 1,160 sequelae (nonfatal health consequences)
• Estimates for 21 regions
• Estimates for 20 age groups

Takeaway points from the press release (emphasis mine):

• Child mortality has dropped by more than 60%, falling "so quickly that it has beaten every published prediction," though diarrhea and other infectious diseases still kill well over a million children under the age of 5 every year.
• Deaths among adults aged 15 to 49 increased by 44% between 1970 and 2010, "in part because of increases in violence and the ongoing challenge of HIV/AIDS."
• Undernutrition has "successfully been cut by two-thirds," and now physical inactivity and macronutrient overnutrition contribute to a 10%-and-rising fraction of the disease burden.

However,

• The trends identified in GBD 2010 occur across regions with one notable exception: sub-Saharan Africa, where infectious diseases, childhood illnesses, and maternal causes of death account for as much as 70% of the burden of disease. By comparison, these conditions account for only one-third of the burden in south Asia and Oceania, and less than 20% in all other regions.

Research findings from the main publication summary (emphasis mine):

• In 2010, the three leading risk factors for global disease burden were high blood pressure [...]; followed by tobacco smoking, including secondhand smoke [...]; and alcohol use [...] This reflects a substantial change from 1990 when the leading risk factors were childhood underweight [...]; followed by household air pollution from use of solid fuels [...]; and tobacco smoking, including secondhand smoke [...].
• Regional differences are significant. While much of the world is burdened by obesity and high body mass index, underweight is still the leading risk factor in sub‐Saharan Africa. Other prevalent risk factors in the region include household air pollution and nonexclusive and discontinued breastfeeding.
• Although child undernutrition has fallen significantly as a risk factor for all ages, it remained the leading risk factor worldwide in 2010 for children under 5, accounting for 12.4% of global DALYs [disability‐adjusted life years], followed by nonexclusive or discontinued breastfeeding at 7.6%.
• A number of risks that primarily affect childhood communicable diseases, including unsafe water and sanitation and micronutrient deficiencies, declined in significance in the past 20 years, with unsafe water and sanitation accounting for only 0.9% of global DALYs in 2010.
• At the same time, GBD 2010 findings show the importance of household air pollution from solid fuels and ambient particulate matter pollution as major risk factors. One or both rank in the top 10 as causes of disease burden in 13 of the 21 regions. In south Asia, they are the leading cause of burden.

From the Guardian's reporting (more: 1, 2, 3):

Since 1970 the largest gains in life expectancy have taken place in the Maldives (27.3 years for men and 29.4 years for women) and improvements in life expectancy at birth in excess of 20 years were recorded in Bangladesh, Bhutan, Iran, and Peru. But life expectancy fell by one to seven years in Zimbabwe and Lesotho, where populations were severely affected by HIV/Aids, and for men in Ukraine and Belarus, where an alcohol crisis took hold.

If you'd like to read the papers themselves, the full text is currently available for free (but registration required) at The Lancet.

In addition to the data visualizations, the IHME provides GBD 2010 publication summaries:

• Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
• Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
• A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
• Age‐specific and sex‐specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010
• Years lived with disability (YLDs) for 1,160 sequelae of 289 diseases and injuries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
• 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
• Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010

Each of the data visualizations again:

• Causes of death by age, sex, region, and year
• Heat map of leading causes and risks by region
• Changes in leading causes and risks between 1990 and 2010
• Healthy years lost to disability vs. life expectancy in 1990 and 2010
• Uncertainties of causes and risks

The Institute for Health Metrics and Evaluation adds,

The findings are being announced at the Royal Society in London on Dec. 14 and published in The Lancet, the first time the journal has dedicated an entire triple issue to one study.

The Lancet includes The story of GBD 2010: a “super-human” effort:

“Running the programs to map the data to our cause list of 291 causes and correcting the bias can take days, even using a powerful cluster of more than 100 computers. The data that we have to store after the modelling process can take 3 terabytes.” [Rafael] Lozano estimates that the storage needed for the causes of death data was 400 times bigger than that for GBD 1990 [...]

Majid Ezzati, chair in global and environmental health at the School of Public Health, Imperial College London, UK, told The Lancet,

As researchers, we tend to believe that more ‘data’ are better than less. I still believe so. But more data, but not all the perfect data we could wish for, means that we need to fundamentally think differently about when to stop searching for more and how to use it [...] The study brought out the well-known but far too frequently overlooked issue that people of different scientific traditions—clinicians, basic scientists, epidemiologists, and quantitative scientists—think and speak differently about the same problem. This can of course be a very powerful resource for bringing together different ways of looking at a problem and solving in the most comprehensive and interesting way—a true systems approach. It can also be a challenge, and at times a source of tension.

(Previously on the Institute for Health Metrics and Evaluation: Is there a market for years?)

posted by hat (11 comments total)

We western civilization participants sure have figured out not dying of diarrhea. The importance of well-maintained federal water and sanitation infrastructure could not be demonstrated better than flipping back and forth between high income and low income regions of the globe and watch under-20 deaths from diarrhea and other ailments associated with bad drinking water alternately skyrocket and vanish.
posted by tehloki at 11:13 AM on December 14, 2012 [8 favorites]

Child mortality has dropped by more than 60%, falling "so quickly that it has beaten every published prediction,"

This is good news for the planet. Infant mortality is the prime reason for large families and explosive population growth - parents hedge their bets and try to have as many kids as possible.
posted by KokuRyu at 12:09 PM on December 14, 2012 [4 favorites]

Oh man, you can go to the Leading causes and risks page, dial in your age, sex, and location, and there's your current health risk. Dial forward to the next age group and see your upcoming health risks. Yeah, I am working to improve my cardiovascular health, but how am I supposed to improve my liver health? I suppose Cirrhosis is only a high risk for long-term alcoholics my age, or chronic Hepatitis cases. I also note that the #4 risk is self-harm. Note to self: do not harm self.
posted by charlie don't surf at 12:24 PM on December 14, 2012

(This is an excellent post.)
posted by maxwelton at 12:26 PM on December 14, 2012 [3 favorites]

Yeah, I am working to improve my cardiovascular health, but how am I supposed to improve my liver health?

Don't drink, avoid acetaminophen, get vaccinated for Hep A/B/C if you can, don't do IV drugs or have sex with people who do. That's the standard advice anyway.
posted by Kadin2048 at 12:40 PM on December 14, 2012

Thank you for this post. You've taken interesting...and distilled it down to digestible interesting...which makes it excellent.
posted by jnnla at 2:13 PM on December 14, 2012

If, like me, you're a male living in the west, you feel a bit like the Tin Man. Where does one get a new heart anyway?
posted by blue_beetle at 4:03 PM on December 14, 2012

"Yeah, I am working to improve my cardiovascular health, but how am I supposed to improve my liver health?"

... all the above advice, *AND* lower your fats and non-complex carb intake, to avoid this.
posted by markkraft at 7:07 PM on December 14, 2012

Deaths among adults aged 15 to 49 increased by 44% between 1970 and 2010, "in part because of increases in violence and the ongoing challenge of HIV/AIDS."

That's pretty interesting and unexpected, one wouldn't expect the world is becoming more deadly for this age group.
posted by stbalbach at 9:25 PM on December 14, 2012

markkraft: "... all the above advice, *AND* lower your fats and non-complex carb intake, to avoid this"
("this" being "fatty liver disease")

Those with fatty liver disease won't know for certain they have the disease without a scan, be it ultrasound or some other modality. Usually fatty liver disease causes no symptoms. Yet those who have it are more likely to suffer heart attacks and strokes, more likely to develop liver cirrhosis, more likely to have high blood pressure and diabetes. ..So why isn't it necessarily a real disease?..
The problem comes into focus when you realise these same hazards and recommendations can be invoked for any other manifestation of being overweight. Take fatty elbow disease. As far as I'm aware, I'm the first to describe it, but I think it could take off. It's associated with being overweight and underactive and it carries with it the same range of real risks. Sufferers are often asymptomatic, unaware of their illness..Fatty liver disease, I suspect, comes from our mixed feelings over modern lifestyles and who to blame for them. It's not good for us to spend too much time eating and sitting and not enough fasting or running around, but is it really a disease? I think we're unsure and bad at facing up to our uncertainty. Moral ambivalence, more than calories, might be driving our contemporary pandemic of fatty liver disease.
posted by Jakey at 3:36 PM on December 16, 2012

I missed this earlier, but it is fascinating!

I suppose Cirrhosis is only a high risk for long-term alcoholics my age, or chronic Hepatitis cases.

Don't be too sure. I rarely drink, and for a while was thought to have an autoimmune disorder known as primary biliary cirrhosis. All of the liver consequences, none of the fun getting there! Yippee.*

I hope there are some studies in the works to follow up on the information in these charts. I'm especially interested in the surge in endocrine-related diseases and deaths among women my age and older in the last twenty years. I know so many women with thyroid issues! Hysterectomies are on the rise as well, as are chronic health conditions like fibromyalgia and autoimmune disorders. I feel like there has to be a connection.

The recent rise in Autism and Alzheimer's reported cases (which could partly be a case of greater awareness of these conditions) also makes studies like this one even more interesting to me, as it seems likely they will help us unravel the puzzle of which environmental and genetic factors contribute to those conditions.

*Lupus was also a strong contender. But, as House says, it's never Lupus. .
posted by misha at 12:17 PM on December 17, 2012