ArticlesMortality by cause for eight regions of the world: Global Burden of Disease Study
Introduction
This paper, the first of a series of four, reports on the 5-year Global Burden of Disease Study (GBD). (The other three papers will follow in the next three issues of The Lancet.) The study was initiated in 1992 at the request of the World Bank and was done in collaboration with WHO. Preliminary results were used by the World Bank1 and published by WHO.2 The GBD was designed to address three primary goals: to provide information on non-fatal health outcomes for debates on international health policy, which are generally focused on mortality; to develop unbiased epidemiological assessments for major disorders; and to quantify the burden of disease with a measure that could also be used for cost-effectiveness analysis. There were four specific objectives:
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To develop internally consistent estimates of mortality for 107 causes of death by age, sex, and geographic region.
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To develop internally consistent estimates of incidence, prevalence, duration, and case-fatality for 483 disabling sequelae of the 107 causes.
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To estimate the fraction of mortality and disability attributable to ten major risk factors.
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To develop various projection scenarios of mortality and disability estimates by cause, age, sex, and region.
Final results, including chapters on each major condition by the investigators who contributed to this study are available.3, 4 The results published here supersede the preliminary results.2, 3 This paper reports on regional and global patterns of mortality by cause.
Section snippets
Design
The GBD can be divided into five components, which were all studied simultaneously and are interlinked: causes of death, descriptive epidemiology of disabling sequelae, burden attributable to selected risk factors, projections of burden from 1990 to 2020, and sensitivity analysis. In the cause-of-death component, data from vital registration and sample registration systems were combined with the results of population-monitoring laboratories and disease-specific epidemiological studies and
Results
Figure 2 illustrates the distribution of all deaths worldwide by age and region. Because of a much younger population age distribution and higher mortality rates in children, 98% of deaths in children were in the developing world (all study regions except established market economies and formerly socialist economies of Europe). 32% of all deaths in the developing world occurred in children younger than 5 years, and 63% occurred by the age of 60 years. Within developing regions, the age
Discussion
Despite decades of sustained progress through development and targeted health interventions in all regions of the world in the reduction of child mortality due to group 1 causes, five of the ten leading causes of death are still communicable or perinatal disorders. With the exception of tuberculosis, these major causes largely affect children younger than 5 years. Seven disorders (lower respiratory infections, diarrhoeal diseases, perinatal disorders, tuberculosis, measles, malaria, and
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