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The Global burden of disease:
GeneraTinG evidence,
GuidinG Policy
laTin aMerica & caribbean reGional ediTion
INSTITUTE FOR HEALTH METRICS AND EVALUATION
UNIVERSITY OF WASHINGTON
HUMAN DEVELOPMENT NETWORK
THE WORLD BANK
The Global Burden of Disease:
Generating Evidence,
Guiding Policy
LATIN AMERICA AND CARIBBEAN REGIONAL EDITION
INSTITUTE FOR HEALTH METRICS AND EVALUATION
UNIVERSITY OF WASHINGTON
HUMAN DEVELOPMENT NETWORK
THE WORLD BANK
This report was prepared by the Institute for Health Metrics and Evaluation (IHME)
at the University of Washington and the Human Development Network at the World
Bank based on seven papers for the Global Burden of Disease Study 2010 (GBD
2010) published in The Lancet (2012 Dec 13; 380). GBD 2010 had 488 co-authors
from 303 institutions in 50 countries. The work was made possible through core
funding from the Bill & Melinda Gates Foundation. The views expressed are those of
the authors.
The contents of this publication may be reproduced and redistributed in whole or in
part, provided the intended use is for noncommercial purposes, the contents are not
altered, and full acknowledgment is given to IHME. This work is licensed under the
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To
view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/.
For any usage that falls outside of these license restrictions, contact IHME
Communications at [email protected].
Citation: Institute for Health Metrics and Evaluation, Human Development Network,
The World Bank. The Global Burden of Disease: Generating Evidence, Guiding
Policy – Latin America and Caribbean Regional Edition. Seattle, WA: IHME, 2013.
Institute for Health Metrics and Evaluation
Human Development Network
2301 Fifth Ave., Suite 600
The World Bank
Seattle, WA 98121 1818 H St., NW
USA
Washington, DC 20433
www.healthmetricsandevaluation.org USA
www.worldbank.org
Contact:
Katherine Leach-Kemon
Contact:
Policy Translation Specialist
Anne-Maryse Pierre-Louis
[email protected]
Public Health Cluster Leader
[email protected]
Printed in the United States of America
ISBN 978-0-9840910-9-6
© 2013 Institute for Health Metrics and Evaluation
IHME
GBD
THE GLOBAL BURDEN OF DISEASE:
GENERATING EVIDENCE, GUIDING POLICY
LATIN AMERICA and CARIBBEAN REGIONAL EDITION
Glossary 6
Introduction
7
The GBD approach to tracking health progress and challenges
Rapid health transitions: GBD 2010 results
Using GBD to assess countries’ health progress
Conclusion
Annex
12
16
42
47
49
4 | GBD 2010
ABOUT IHME
The Institute for Health Metrics and Evaluation (IHME) is an independent global
health research center at the University of Washington that provides rigorous and
comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions
about how to allocate resources to best improve population health.
To express interest in collaborating, participating in GBD training workshops, or
receiving updates of GBD or copies of this publication, please contact IHME at:
Institute for Health Metrics and Evaluation
2301 Fifth Ave., Suite 600
Seattle, WA 98121
USA
Telephone: +1-206-897-2800
Fax: +1-206-897-2899
E-mail: [email protected]
www.healthmetricsandevaluation.org
ABOUT THE HUMAN DEVELOPMENT NETWORK AT THE
WORLD BANK GROUP
The World Bank Group is one of the world's largest sources of funding and knowledge for developing countries. It comprises five closely associated institutions: the
International Bank for Reconstruction and Development and the International Development Association (IDA), which together form the World Bank; the International
Finance Corporation (IFC); the Multilateral Investment Guarantee Agency (MIGA);
and the International Centre for Settlement of Investment Disputes (ICSID). Each institution plays a distinct role in the mission to end extreme poverty and build shared
prosperity in the developing world.
The World Bank's Human Development Network (HDN) invests in creating equal opportunities for people to live healthy and productive lives, secure meaningful jobs,
and protect themselves from crises. HDN takes a lifecycle and systems approach to
help developing countries deliver equitable and effective education; health, nutrition, and population; and social protection and labor services. HDN works across
all development sectors and with ministries of finance to demonstrate how these
investments in people promote inclusive development; long, healthy, and productive lives; economic growth; and country competitiveness. HDN focuses on results
through building strong, integrated systems and country capacity; promoting evidence-based policy and program decision-making; and leveraging partnerships with
donors and development agencies, civil society, the private sector, and communities
to deliver country-tailored solutions. HDN's work helps support the most effective
5 | GBD 2010
policies, tools, and instruments to make a real difference toward the broader goal of
ending extreme poverty and building shared prosperity.
For more information, go to www.worldbank.org/health.
ACKNOWLEDGMENTS
The Global Burden of Disease Study 2010 (GBD 2010) was implemented as a collaboration between seven institutions: the Institute for Health Metrics and Evaluation
(IHME) as the coordinating center, the University of Queensland School of Population Health, Harvard School of Public Health, the Johns Hopkins Bloomberg School
of Public Health, the University of Tokyo, Imperial College London, and the World
Health Organization. This summary draws on seven GBD 2010 papers published in
The Lancet (2012 Dec 13; 380). GBD 2010 had 488 co-authors from 303 institutions in
50 countries.
IHME and the World Bank oversaw the production of this publication. In particular,
we thank IHME’s Board for their continued leadership. We are grateful to the report’s
writer and production manager Katherine Leach-Kemon; to Christopher Murray,
Michael MacIntyre, Theo Vos, Rafael Lozano, Bernardo Hernández Prado, Rhonda
Stewart, Mohsen Naghavi, and William Heisel at IHME, Anne-Maryse Pierre-Louis of
the Human Development Network at the World Bank, and Joana Godinho and team
at the World Bank for content guidance; to Ryan Barber and Daniel Dicker for data
analysis; to Brittany Wurtz and Summer Ohno for program coordination; to Patricia
Kiyono for production oversight; to Brian Childress for editorial support; to Kate
Muller for editing; and to Miriam Alvarado, Ian Bolliger, Roy Burstein, Emily Carnahan, Greg Freedman, Nicole Johns, Katherine Lofgren, and Richard Luning for fact
checking. This report would not have been possible without the ongoing contributions of Global Burden of Disease collaborators around the world.
Finally, we would like to extend our gratitude to the Human Development Network at the World Bank for co-financing this report and to the Bill & Melinda Gates
Foundation for generously funding IHME and for its consistent support of the Global
Burden of Disease research.
6 | GBD 2010
Glossary
Years of life lost (YLLs): Years of life lost due to premature mortality.
Years lived with disability (YLDs): Years of life lived with any short-term or longterm health loss, adjusted for severity.
Disability-adjusted life years (DALYs): The sum of years lost due to premature death
(YLLs) and years lived with disability (YLDs). DALYs are also defined as years of
healthy life lost.
Healthy life expectancy, or health-adjusted life expectancy (HALE): The number of
years that a person at a given age can expect to live in good health, taking into account mortality and disability.
Sequelae: Consequences of diseases and injuries.
Health states: Groupings of sequelae that reflect key differences in symptoms and
functioning.
Disability weights: Number on a scale from 0 to 1 that represents the severity of
health loss associated with a health state.
Risk factors: Potentially modifiable causes of disease and injury.
Uncertainty intervals: A range of values that is likely to include the correct estimate
of health loss for a given cause. Narrow uncertainty intervals indicate that evidence
is strong, while wide uncertainty intervals show that evidence is weaker.
7 | GBD 2010
INTRODUCTION
The Global Burden of Disease (GBD) approach is a systematic, scientific effort to
quantify the comparative magnitude of health loss due to diseases, injuries, and
risk factors by age, sex, and geography for specific points in time. Box 1 describes
the history of GBD. The latest iteration of that effort, the Global Burden of Diseases,
Injuries, and Risk Factors Study 2010 (GBD 2010), was published in The Lancet in
December 2012. The intent is to create a global public good that will be useful for
informing the design of health systems and the creation of public health policy. It
estimates premature death and disability due to 291 diseases and injuries, 1,160
sequelae (direct consequences of disease and injury), and 67 risk factors for 20 age
groups and both sexes in 1990, 2005, and 2010. GBD 2010 produced estimates for
187 countries and 21 regions. In total, the study generated over 1 billion estimates of
health outcomes.
GBD 2010 was a collaborative effort among 488 researchers from 50 countries and
303 institutions. The Institute for Health Metrics and Evaluation (IHME) acted as the
coordinating center for the study. The collaboration strengthened both the datagathering effort and the quantitative analysis by bringing together some of the
foremost minds from a wide range of disciplines. Our intention is to build on this
collaboration by enlarging the network in the years to come. Similarly, IHME and its
collaborators hope to expand the list of diseases, injuries, and risk factors included
in GBD and routinely update the GBD estimates. Continual updates will ensure
that the international community can have access to high-quality estimates in the
timeliest fashion. Through sound measurement, we can provide the foundational
evidence that will lead to improved population health.
Over the last two decades, the global health landscape has undergone rapid transformation. People around the world are living longer than ever before, and the
population is getting older. The number of people in the world is growing. Many
countries have made remarkable progress in preventing child deaths. As a result,
disease burden is increasingly defined by disability instead of premature mortality. The leading causes of death and disability have changed from communicable
diseases in children to non-communicable diseases in adults. Eating too much has
overtaken hunger as a leading risk factor for illness. While there are clear trends at
the global level, there is substantial variation across regions and countries. Nowhere
is this contrast more striking than in sub-Saharan Africa, where communicable, maternal, nutritional, and newborn diseases continue to dominate.
In the Latin America and Caribbean region, many of the leading causes of health
loss were non-communicable diseases. Similar to global trends, communicable, maternal, nutritional, and newborn causes are becoming less important in this region
as non-communicable diseases kill more people prematurely and cause increasing
disability. However, HIV/AIDS increased in most countries in Latin America and the
Caribbean over the past 20 years and was a leading cause of loss of healthy life in
8 | GBD 2010
certain countries. Road injuries and violence were also dominant causes of health
loss in the region. High blood pressure, dietary risks, alcohol use, and other risk
factors contributed to the rise of burden from non-communicable diseases in Latin
America and the Caribbean, while risks related to illness in children remained prominent in some countries, including Bolivia and Haiti.
As demographic changes such as population growth and increasing average age
have caused burden from non-communicable diseases to increase in Latin America
and the Caribbean, GBD found that many countries are making progress in some
of these conditions. This progress can be seen when using measurements called
age-standardized rates, which remove the effects of demographic changes to isolate
health improvements. Age-standardized rates of non-communicable diseases, such
as ischemic heart disease and stroke, have declined over time in many countries in
Latin America and the Caribbean. At the same time, age-standardized rates of diabetes, musculoskeletal disorders, and drug use disorders are rising in a large number
of countries, underscoring the mixed success in combatting different non-communicable diseases in the region.
This publication summarizes the global GBD 2010 findings as well as the regional
findings for Latin America and the Caribbean. It also explores intraregional differences in diseases, injuries, and risk factors. The overall findings for the region are
summarized in the next section.
Main findings for Latin America and the Caribbean
• Latin America and the Caribbean made dramatic progress in reducing mortality and prolonging life since 1970. In Brazil, Costa Rica, Dominican Republic,
Ecuador, El Salvador, Honduras, Mexico, Nicaragua, Peru, and Saint Lucia, the
average age of death rose 30 years or more between 1970 and 2010.
• Over the last 20 years, the region has made substantial health progress. Latin
America and the Caribbean succeeded in decreasing premature death and disability from most communicable, newborn, nutritional, and maternal causes.
Diarrheal disease was the number one cause of disease burden in the region
in 1990, but dropped to the 20th leading cause in 2010. HIV/AIDS remains a
persistent challenge. It was one of the top five causes of disease burden in nine
countries in the region in 2010. However, age-standardized rates of HIV/AIDS
began dropping in most countries in the region in 2005.
• Despite improvements, substantial burdens of communicable, newborn, nutritional, and maternal causes persist in low- and lower-middle-income countries
in Latin America and the Caribbean, including Bolivia, Guatemala, Guyana, and
Haiti.
• Between 1990 and 2010, demographic changes and risk factors contributed to
rising disease burden from many non-communicable causes, particularly ischemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and chronic
9 | GBD 2010
Box 1: History of the Global Burden of Disease and innovations in GBD 2010
The first GBD study was published as part of the World Development Report 1993. This
original study generated estimates for 107 diseases, 483 sequelae (non-fatal health consequences), eight regions, and five age groups.
The authors’ inspiration for the study came from the realization that policymakers lacked
comprehensive and standardized data on diseases, injuries, and potentially preventable
risk factors for decision-making. A second source of inspiration was the fact that disease-specific advocates’ estimates of the number of deaths caused by their diseases of
interest far exceeded the total number of global deaths in any given year. GBD authors
chose to pursue a holistic approach to analyzing disease burden to produce scientifically
sound estimates that were independent of the influence of advocates.
The GBD 1990 study had a profound impact on health policy as it exposed the hidden
burden of mental illness around the world. It also shed light on neglected health areas
such as the premature death and disability caused by road traffic injuries. Work from
this study has been cited over 4,000 times since 1993.
The study also sparked substantial controversy. Many disease-specific advocates argued
that the original GBD underestimated burden from the causes they cared about most.
The use of age weighting and discounting also caused extensive debates. Age weighting assumed that a year of life increased in value until age 22, and then decreased
steadily. Discounting counted years of healthy life saved in the present as more valuable
than years of life saved in the future. Also controversial was the use of expert judgment to estimate disability weights (estimations of the severity of non-fatal conditions).
As a result of this feedback and consultation with a network of philosophers, ethicists,
and economists, GBD no longer uses age weighting and discounting. Also, GBD 2010
updated its methods for determining disability weights and used data gathered from
thousands of respondents from different countries around the world.
GBD 2010 shares many of the founding principles of the original GBD 1990 study, such
as using all available data on diseases, injuries, and risk factors; using comparable
metrics to estimate the impact of death and disability on society; and ensuring that the
science of disease burden estimation is not influenced by advocacy.
Despite these similarities, GBD 2010 is broader in scope and involved a larger number
of collaborators than any previous GBD study. While the original study had the participation of 100 collaborators worldwide, GBD 2010 had 488 co-authors. Thanks to that
network, the study includes vast amounts of data on health outcomes and risk factors.
Researchers also made substantial improvements to the GBD methodology, summarized in Box 2 and described in detail in the Annex of this report and in the published
studies. Among these improvements, highlights include using data collected via population surveys to estimate disability weights for the first time, greatly expanding the list of
causes and risk factors analyzed in the study, providing detailed analysis of the effect of
different components of diet on health outcomes, and reporting of uncertainty intervals for all metrics. GBD 2010 researchers reported uncertainty intervals to provide full
transparency about the weaknesses and strengths of the analysis. Narrow uncertainty
intervals indicate that evidence is strong, while wide uncertainty intervals show that
evidence is weaker.
10 | GBD 2010
kidney disease. Diabetes is a major public health problem in the Caribbean,
where it ranked among the top five causes of health loss in many countries. Today, drug and alcohol use disorders are causing more early death and disability
in Latin America and the Caribbean than two decades ago.
• Although health systems in Latin America and the Caribbean are grappling with
a larger burden from non-communicable diseases than ever before, progress is
being made in certain areas. Researchers can remove the impact of demographic changes to isolate what is important for comparisons of health performance.
This involves the use of a health performance metric called age-standardized
rates. Using this metric reveals that many countries in the Latin American and
Caribbean region succeeded in reducing ischemic heart disease and stroke
between 1990 and 2010. At the same time, age-standardized rates of diabetes,
musculoskeletal disorders, and drug use disorders rose in multiple countries
during this period.
• Dietary risks such as low fruit, nut and seed, and whole grain intake and high
sodium consumption are a leading risk factor for premature death and disability
in the region. High body mass index, high blood pressure, high fasting glucose
(blood sugar), and alcohol use are also top contributors to health loss in many
countries. Risk factors that primarily cause illness in children, such as household
air pollution, iron deficiency, and suboptimal breastfeeding, were important in
lower-income countries of the region, including Bolivia and Haiti.
• As countries in Latin America and the Caribbean have become more developed,
road injuries have taken a growing toll on human health. Also, many countries
in the region suffered from increasing levels of health loss as a result of interpersonal violence. Brazilian men, for example, lost nearly 3 million years of
healthy life in 2010 as a result of such violence.
• Disease and injury trends within Latin America and the Caribbean differ dramatically across countries in the region. Ischemic heart disease was the leading
cause of health loss in 12 countries in the region, but the top causes in other
countries were as diverse as interpersonal violence, lower respiratory infections,
diabetes, HIV/AIDS, and road injuries.
• The leading causes of disability in Latin America and the Caribbean, including
low back pain, neck pain, and other musculoskeletal disorders, as well as mental
disorders such as depression and anxiety, largely mirrored global trends. In
contrast to global trends, asthma and drug use disorders were larger causes of
disability in the region, and iron-deficiency anemia and chronic obstructive pulmonary disease were less prominent in the region than in the world as a whole.
• When comparing countries’ health performance, low- and low-middle-income
countries in the region had the highest age-standardized rates of premature
death and disability due to communicable, newborn, nutritional, and maternal conditions while upper-middle-income countries had rates that were more
comparable to developed countries. Generally, upper-middle-income countries
performed better than the regional average for most causes of premature death
while low- and lower-middle-income countries did not tend to perform as well,
but there were important exceptions to this trend.
11 | GBD 2010
Box 2: Global Burden of Disease methodology
GBD uses thousands of data sources from around the world to estimate disease burden.
As a first step, GBD researchers estimate child and adult mortality using data sources
such as vital and sample registration systems, censuses, and household surveys. Years
lost due to premature death from different causes are calculated using data from vital
registration with medical certification of causes of death when available, and sources
such as verbal autopsies in countries where medical certification of causes of death is
lacking. Years lived with disability are estimated using sources such as cancer registries,
data from outpatient and inpatient facilities, and direct measurements of hearing, vision,
and lung function testing. Once they have estimated years lost due to premature death
and years lived with disability, GBD researchers sum the two estimates to obtain disability-adjusted life years. Finally, researchers quantified the amount of premature death and
disability attributable to different risk factors using data on exposure to, and the effects
of, the different risk factors. For more information about the GBD methods, see the Annex of this report as well as the published papers.
12 | GBD 2010
THE GBD APPROACH TO TRACKING HEALTH
PROGRESS AND CHALLENGES
For decision-makers striving to create evidence-based policy, the GBD approach provides numerous advantages over other epidemiological studies. These key features
are further explored in this report.
A CRITICAL RESOURCE FOR INFORMED POLICYMAKING
To ensure a health system is adequately aligned to a population’s true health challenges, policymakers must be able to compare the effects of different diseases
that kill people prematurely and cause ill health. The original GBD study’s creators
developed a single measurement, disability-adjusted life years (DALYs), to quantify
the number of years of life lost as a result of both premature death and disability.
One DALY equals one lost year of healthy life. DALYs will be referred to by their
acronym, as “years of healthy life lost,” and “years lost due to premature death and
disability” throughout this publication. Decision-makers can use DALYs to quickly
compare the impact caused by conditions such as cancer and depression since
the conditions are assessed using a comparable metric. Considering the number
of DALYs instead of causes of death alone provides a more accurate picture of the
main drivers of poor health. Thanks to the use of this public health monitoring tool,
GBD 2010 researchers found that in most countries, as mortality declines, disability
becomes increasingly important. Information about changing disease patterns is a
crucial input for decision-making, as it illustrates the challenges that individuals and
health care providers are facing in different countries.
In addition to comparable information about the impact of fatal and non-fatal conditions, decision-makers need comprehensive data on the causes of ill health that are
most relevant to their country. The hierarchical GBD cause list (available on IHME’s
website at http://ihmeuw.org/gbdcauselist) has been designed to include the diseases, injuries, and sequelae that are most relevant for public health policymaking.
To create this list, researchers reviewed epidemiological and cause of death data to
identify which diseases and injuries resulted in the most ill health. Inpatient and outpatient records were also reviewed to understand the conditions for which patients
sought medical care. For example, researchers added chronic kidney disease to the
GBD cause list after learning that this condition accounted for a large number of
hospital visits and deaths.
GBD provides high-quality estimates of diseases and injuries that are more rigorous
than those published by disease-specific advocates. GBD was created in part due to
researchers’ observation that deaths estimated by different disease-specific studies added up to more than 100% of total deaths when summed. The GBD approach
ensures that deaths are counted only once. First, GBD counts the total number of
deaths in a year. Next, researchers work to assign a single cause to each death using
a variety of innovative methods (see Annex). Estimates of cause-specific mortality
are then compared to estimates of deaths from all causes to ensure that the cause-
13 | GBD 2010
specific numbers do not exceed the total number of deaths in a given year. Other
components of the GBD estimation process are interconnected with similar built-in
safeguards, such as for the estimation of impairments that are caused by more than
one disease.
Beyond providing a comparable and comprehensive picture of causes of premature
death and disability, GBD also estimates the disease burden attributable to different risk factors. The GBD approach goes beyond risk factor prevalence, such as the
number of smokers or heavy drinkers in a population. With comparative risk assessment, GBD incorporates both the prevalence of a given risk factor as well as the relative harm caused by that risk factor. It counts premature death and disability attributable to high blood pressure, tobacco and alcohol use, lack of exercise, air pollution,
poor diet, and other risk factors that lead to ill health.
The flexible design of the GBD machinery allows for regular updates as new data
are made available and epidemiological studies are published. Similar to the way
in which a policymaker uses gross domestic product data to monitor a country’s
economic activity, GBD can be used at the global, national, and local levels to understand health trends over time.
Policymakers in Brazil, Colombia, Mexico, Norway, Saudi Arabia, and the United
Kingdom are exploring collaborations with IHME to adopt different aspects of the
GBD approach. In the past, many countries in the Latin American and Caribbean
region have carried out burden of disease studies, including Brazil, Chile, Colombia,
Costa Rica, Cuba, Ecuador, Mexico, Peru, and Uruguay. In this region, GBD serves as
an important tool for decision-making in health along with other tools such as cost
effectiveness studies of health interventions, social values, and political economy.
Box 3 contains some decision-makers’ and policy-influencers’ reflections about the
value of using GBD tools and results to inform policy discussions.
Box 3: Views on the value of GBD for policymaking
“While the GBD 2010 offers significant epidemiologic findings that will shape policy
debates worldwide, it also limns the gaps in existing disease epidemiology knowledge
and offers new ways to improve public health data collection and assessment.”
Dr. Paul Farmer, Chair, Department of Global Health and Social Medicine, Harvard
Medical School
“With a subnational burden of disease study, Mexico was able to see clearly where it
should focus its limited health resources. Those findings led to a major health reform
that transformed the approach to improving population health through universal coverage.” Julio Frenk, Dean of Harvard School of Public Health and former Minister of Health
in Mexico
“At UNICEF we’ve always had a focus on metrics and outcomes as a driver of the work
we do. We welcome the innovation, energy, and attention that this work is bringing to
the importance of holding ourselves accountable to meaningful outcomes and results.”
Dr. Mickey Chopra, UNICEF Chief of Health/Associate Director of Programmes
14 | GBD 2010
GBD data visualization tools (see Box 4) on the IHME website allow users to interact
with the results in a manner not seen in past versions of the study. Users report that
the visualization tools provide a unique, hands-on opportunity to learn about the
health problems that different countries and regions face, allowing them to explore
seemingly endless combinations of data. The following list illustrates the range of
estimates that can be explored using the GBD data visualization tools:
• Changes between 1990 and 2010 in leading causes of death, premature death,
disability, and DALYs as well as changes in the amount of health loss attributable to different risk factors across age groups, sexes, and locations.
• Rankings for 1990 and 2010 of the leading causes of death, premature death,
disability, and DALYs attributable to risk factors across different countries and
regions, age groups, and sexes.
• Changes in trends for 21 cause groups in 1990 and 2010 in different regions,
sexes, and metrics of health loss.
• The percentage of deaths, premature deaths, disability, or DALYs in a country or
region caused by myriad diseases and injuries for particular age groups, sexes,
and time periods.
• The percentage of health loss by country or region attributable to specific risk
factors by age group, sex, and time period.
In addition to promoting understanding about the major findings of GBD, these visualization tools can help government officials build support for health policy changes,
allow researchers to visualize data prior to analysis, and empower teachers to illustrate key lessons of global health in their classrooms.
To use the GBD data visualization tools, visit www.ihmeuw.org/GBDcountryviz.
Box 4: GBD data visualization tools
For the first time in the history of GBD research, IHME has developed many free data visualization tools that allow individuals to explore health trends for different countries and
regions. The visualization tools allow people to view GBD estimates through hundreds
of different dimensions. Only a few examples are explored in the figures throughout this
document. We encourage you to visit the IHME website to use the GBD data visualization
tools and share them with others.
15 | GBD 2010
THE EGALITARIAN VALUES INHERENT IN GBD
When exploring the possibility of incorporating GBD measurement tools into their
health information systems, policymakers should consider the egalitarian values on
which this approach is founded.
The core principle at the heart of the GBD approach is that everyone should live
a long life in full health. As a result, GBD researchers seek to measure the gap
between this ideal and reality. Calculation of this gap requires estimation of two different components: years of life lost due to premature death (YLLs) and years lived
with disability (YLDs).
To measure years lost to premature death, GBD researchers had to answer the
question: “How long is a ‘long’ life?” For every death, researchers determined that
the most egalitarian answer to this question was to use the highest life expectancy
observed in the age group of the person who died. The Annex contains more information about the estimation of YLLs.
In order to estimate years lived with disability, or YLDs, researchers were confronted
with yet another difficult question: “How do you rank the severity of different types
of disability?” To determine the answer, researchers created disability weights based
on individuals’ perceptions of the impact on people’s lives from a particular disability, everything from tooth decay to schizophrenia.
GBD REGIONAL CLASSIFICATIONS
GBD 2010 created regions based on two criteria: epidemiological similarity and geographic closeness. The GBD regional groupings differ from the World Bank regional
classification system. More information about GBD regional classifications can be
found on the IHME website: www.ihmeuw.org/gbdfaq.
Rather than using the GBD regional classifications, this report provides findings
based on the countries in World Bank’s regional definition of Latin America and the
Caribbean. Figures reflect World Bank regional classifications. GBD, however, does
not produce estimates for territories or countries with fewer than 50,000 people or
countries that have only recently come into existence.
16 | GBD 2010
RAPID HEALTH TRANSITIONS:
GBD 2010 RESULTS
In most countries in the Latin America and Caribbean region, loss of healthy life,
or DALYs, from non-communicable diseases are rising while DALYs from communicable, newborn, nutritional, and maternal causes are declining. To help decisionmakers establish health service priorities within countries when faced with limited
resources, we will explore changes in disease burden around the globe, in the Latin
America and Caribbean region, and in specific countries in this section. In another
section entitled “Using GBD to assess countries’ health progress,” we will compare
how well countries are performing in health relative to other countries in the region
using a metric called age-standardized rates.
In terms of disease burden at the global level, GBD 2010 found that the leading
causes of DALYs have evolved dramatically over the past 20 years. Figure 1 shows
the changes in the global leading causes of DALYs in 1990 and 2010. Communicable,
newborn, maternal, and nutritional causes are shown in red, non-communicable diseases appear in blue, and injuries are shown in green. Dotted lines indicate causes
that have fallen in rank during this period, while solid lines signal causes that have
risen in rank.
Causes associated with ill health and death in adults, such as ischemic heart disease, stroke, and low back pain, increased in rank between 1990 and 2010, while
causes that primarily affect children, such as lower respiratory infections, diarrhea,
preterm birth complications, and protein-energy malnutrition, decreased in rank.
Unlike most of the leading communicable causes, HIV/AIDS and malaria increased
by 353% and 18%, respectively. Since 2005, however, premature mortality and disability from these two causes have begun to decline. Four main trends have driven
changes in the leading causes of DALYs globally: aging populations, increases in
non-communicable diseases, shifts toward disabling causes and away from fatal
causes, and changes in risk factors.
To provide a closer look at the epidemiological changes occurring at the regional
level, Figure 2 shows how DALYs have changed over time in Latin America and the
Caribbean. Figures showing changes in the leading causes of DALYs by country can
be found in the Annex of this report.
Ischemic heart disease was the leading cause of DALYs in Latin America and the
Caribbean in 2010, as it was at the global level, rising from fourth to first place between 1990 and 2010. As a result of the Haiti earthquake, injuries from forces of nature became a main cause of DALYs in this region in 2010. This cause ranked 174th
in 1990. DALYs due to interpersonal violence, another type of injury, increased by
35% between 1990 and 2010 and moved up in rank from the fifth- to the third-largest
17 | GBD 2010
cause of DALYs. This trend reflects epidemics of violence in countries such as Brazil
and Guatemala, where interpersonal violence is a top cause of health loss. As countries in Latin America and the Caribbean have become more developed, DALYs from
road injuries increased by 27% and the cause rose in rank from seventh in 1990 to
fourth in 2010. Road injuries were the leading cause of DALYs in Ecuador in 2010.
Most communicable, newborn, maternal, and nutritional causes of DALYs dropped
in rank in Latin America and the Caribbean as many non-communicable causes rose
in rank, mirroring global trends. However, the burden due to some communicable
diseases remains large: DALYs due to HIV/AIDS increased 94% between 1990 and
Figure 1: Global disability-adjusted life year ranks, top 25 causes, and percentage change,
1990-2010
2010
1990
Mean rank
(95% UI)
Disorder
Disorder
Mean rank
(95% UI)
% change (95% UI)
1.0 (1 to 2)
1 Lower respiratory infections
1 Ischemic heart disease
1.0 (1 to 2)
30 (21 to 34)
2.0 (1 to 2)
2 Diarrheal diseases
2 Lower respiratory infections
2.0 (1 to 3)
-44 (-48 to -39)
3.4 (3 to 5)
3 Preterm birth complications
3 Stroke
3.2 (2 to 5)
21 (5 to 26)
3.8 (3 to 5)
4 Ischemic heart disease
4 Diarrheal diseases
4.8 (4 to 8)
-51 (-57 to -45)
5.2 (4 to 6)
5 Stroke
5 HIV/AIDS
6.5 (4 to 9)
353 (293 to 413)
6.3 (5 to 8)
6 COPD
6 Malaria
6.7 (3 to 11)
18 (-9 to 63)
8.0 (6 to 13)
7 Malaria
7 Low back pain
7.1 (3 to 11)
43 (38 to 48)
9.8 (7 to 13)
8 Tuberculosis
8 Preterm birth complications
7.9 (5 to 11)
-27 (-37 to -16)
10.1 (7 to 14)
9 Protein-energy malnutrition
9 COPD
8.1 (5 to 11)
-2 (-9 to 5)
10.2 (7 to 15)
10 Neonatal encephalopathy
10 Road injury
8.4 (4 to 11)
33 (11 to 63)
11.7 (8 to 15)
11 Road injury
11 Major depressive disorder
10.8 (7 to 14)
37 (25 to 49)
11.9 (7 to 17)
12 Low back pain
12 Neonatal encephalopathy
13.3 (11 to 17)
-17 (-30 to -1)
12.8 (8 to 16)
13 Congenital anomalies
13 Tuberculosis
13.4 (11 to 17)
-18 (-34 to -5)
15.0 (8 to 18)
14 Iron-deficiency anemia
14 Diabetes
14.2 (12 to 16)
70 (59 to 77)
15.2 (11 to 18)
15 Major depressive disorder
15 Iron-deficiency anemia
15.2 (11 to 22)
-3 (-6 to -1)
15.2 (3 to 37)
16 Measles
16 Neonatal sepsis
15.9 (10 to 26)
-4 (-25 to 27)
15.3 (8 to 24)
17 Neonatal sepsis
17 Congenital anomalies
17.3 (14 to 21)
-28 (-43 to -9)
17.3 (15 to 19)
18 Meningitis
18 Self-harm
18.7 (15 to 26)
24 (-1 to 42)
20.0 (17 to 25)
19 Self-harm
19 Falls
19.7 (16 to 25)
37 (20 to 55)
20.6 (18 to 26)
20 Drowning
20 Protein-energy malnutrition
19.9 (16 to 26)
-42 (-51 to -33)
21.1 (18 to 25)
21 Diabetes
21 Neck pain
21.6 (15 to 28)
41 (37 to 46)
23.0 (19 to 28)
22 Falls
22 Lung cancer
21.7 (17 to 27)
38 (18 to 47)
24.1 (21 to 30)
23 Cirrhosis
23 Other musculoskeletal
23.0 (19 to 26)
50 (43 to 57)
25.0 (20 to 32)
24 Lung cancer
24 Cirrhosis
23.0 (19 to 27)
27 (19 to 36)
26.1 (19 to 35)
25 Neck pain
25 Meningitis
24.4 (20 to 27)
-22 (-32 to -12)
29 Other musculoskeletal
32 Drowning
33 HIV/AIDS
56 Measles
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Ascending order in rank
Descending order in rank
Note: Solid lines indicate a cause that has moved up in rank or stayed the same. Broken lines indicate a
cause that has moved down in rank. The causes of DALYs are color coded, with blue for non-communicable
diseases, green for injuries, and red for communicable, newborn, nutritional, and maternal causes of DALYs.
COPD: Chronic obstructive pulmonary disease. To view an interactive version of this figure, visit IHME’s
website: http://ihmeuw.org/gbdarrowdiagram.
18 | GBD 2010
2010, and HIV/AIDS was the leading cause of DALYs in Belize, Jamaica, and Suriname. Worldwide, the increase in HIV/AIDS was even more dramatic and rose 353%
during this 20-year period. At the same time, certain non-communicable diseases
were much more prominent causes of premature death and disability in Latin America and the Caribbean compared to the world as a whole. Depression was the fifth
leading cause of DALYs in this region but was the 11th cause globally. At the country
level, depression ranked among the five leading causes of DALYs in 13 countries in
Latin America and the Caribbean. Diabetes, a leading cause of DALYs in many Caribbean countries, also ranked higher in Latin America and the Caribbean than at the
global level. Chronic kidney disease was the 16th cause of health loss in the region,
but was not one of the top 25 causes of DALYs at the global level. Cirrhosis also
ranked higher in this region compared to the world (15th compared to 23rd), ranking
as high as sixth in Mexico and 10th in Guatemala.
Figure 2: Disability-adjusted life year ranks, top 25 causes, and percentage change in
Latin America and Caribbean, 1990-2010
2010
1990
Mean rank
(95% UI)
Disorder
Disorder
Mean rank
(95% UI)
% change (95% UI)
1.1 (1 to 2)
1 Diarrheal diseases
1 Ischemic heart disease
1.7 (1 to 3)
36 (32 to 41)
1.9 (1 to 2)
2 Lower respiratory infections
2 Forces of nature
2.0 (1 to 7)
. (. to .)
3.0 (3 to 3)
3 Preterm birth complications
3 Interpersonal violence
2.8 (1 to 4)
35 (22 to 48)
4.1 (4 to 5)
4 Ischemic heart disease
4 Road injury
5.5 (3 to 8)
27 (11 to 36)
5.2 (4 to 8)
5 Interpersonal violence
5 Major depressive disorder
5.7 (3 to 9)
40 (21 to 63)
6.5 (5 to 9)
6 Stroke
6 Low back pain
5.8 (3 to 10)
57 (40 to 75)
7.5 (5 to 10)
7 Road injury
7 Stroke
6.5 (4 to 8)
8 (4 to 25)
8.5 (5 to 11)
8 Congenital anomalies
8 Lower respiratory infections
6.8 (5 to 9)
-50 (-57 to -46)
9.3 (6 to 12)
9 Major depressive disorder
9 Diabetes
8.5 (6 to 10)
82 (72 to 97)
9.9 (7 to 12)
10 Neonatal encephalopathy
10 Preterm birth complications
10.0 (9 to 11)
-49 (-57 to -37)
10.6 (6 to 13)
11 Iron-deficiency anemia
11 Congenital anomalies
12.6 (10 to 22)
-18 (-54 to -6)
10.7 (6 to 13)
12 Low back pain
12 COPD
13.1 (11 to 17)
27 (17 to 38)
13.5 (12 to 15)
13 Diabetes
13 HIV/AIDS
15.2 (11 to 23)
94 (57 to 149)
14.3 (13 to 16)
14 COPD
14 Iron-deficiency anemia
15.3 (10 to 22)
-21 (-29 to -15)
16.6 (12 to 28)
15 Neonatal sepsis
15 Cirrhosis
15.8 (12 to 20)
51 (38 to 59)
17.1 (14 to 20)
16 Protein-energy malnutrition
16 Chronic kidney disease
16.2 (13 to 21)
140 (84 to 156)
18.4 (15 to 22)
17 Cirrhosis
17 Other musculoskeletal
16.5 (13 to 20)
71 (60 to 85)
18.7 (14 to 27)
18 Asthma
18 Neck pain
17.3 (11 to 24)
52 (35 to 71)
18.8 (14 to 27)
19 Anxiety disorders
19 Anxiety disorders
17.7 (11 to 24)
38 (15 to 65)
20.6 (15 to 29)
20 Neck pain
20 Diarrheal diseases
19.3 (16 to 23)
-78 (-81 to -75)
21.7 (18 to 26)
21 Tuberculosis
21 Neonatal encephalopathy
20.7 (15 to 25)
-41 (-50 to -29)
22.5 (19 to 27)
22 Other musculoskeletal
22 Alcohol use disorders
22.8 (15 to 28)
50 (21 to 85)
23.2 (19 to 27)
23 Meningitis
23 Asthma
23.0 (15 to 30)
10 (1 to 21)
24.8 (15 to 35)
24 HIV/AIDS
24 Drug use disorders
24.3 (18 to 30)
54 (29 to 84)
26.3 (18 to 35)
25 Alcohol use disorders
25 Migraine
25.0 (18 to 33)
45 (33 to 57)
28 Migraine
29 Neonatal sepsis
29 Drug use disorders
39 Tuberculosis
32 Chronic kidney disease
46 Protein-energy malnutrition
174 Forces of nature
49 Meningitis
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Ascending order in rank
Descending order in rank
Note: Solid lines indicate a cause that has moved up in rank or stayed the same. Broken lines indicate a
cause that has moved down in rank. The causes of DALYs are color coded, with blue for non-communicable
diseases, green for injuries, and red for communicable, newborn, nutritional, and maternal causes.
19 | GBD 2010
MOST OF THE WORLD’S POPULATION IS LIVING LONGER AND
DYING AT LOWER RATES
In much of the world, GBD 2010 found that people are living to older ages than ever
before, and the entire population is getting older. Since 1970, the average age of
death has increased 20 years globally. Dramatic changes have occurred during this
period in Latin America, Asia, and the Middle East, where the average age of death
increased by 30 years or more. Sub-Saharan Africa, however, has not made nearly
as much progress as other developing regions, and people in this part of the world
tend to die at much younger ages than in any other region. Progress in sub-Saharan
Africa has in particular been held back by the HIV/AIDS epidemic, maternal deaths,
and child mortality caused by infectious diseases and malnutrition, but some of
these trends have begun to change in the past decade.
Figure 3: Average age of death for countries in Latin America and Caribbean, 1970 compared
with 2010
60
Uruguay
55
Argentina
Mean age at death in 1970 (years)
50
Cuba
Grenada
Jamaica
45
Chile
Suriname
40
Guyana
35
Panama
Belize
Venezuela
30
Brazil
Colombia
Haiti
Mexico
Peru
25
Honduras
Bolivia
Ecuador
Guatemala Dominican Republic
Nicaragua
20
15
Dominica
Costa Rica
Saint Lucia
Saint Vincent and the Grenadines
Paraguay
15
20
25
30
35
40
45
50
55
60
El Salvador
65
70
75
80
Mean age at death in 2010 (years)
Note: Countries falling on the right side of the 45-degree-angle line had a higher average age of death in
2010 compared to 1970.
85
20 | GBD 2010
Figure 4: Global decline in age-specific mortality rate, 1970-2010
80
Male
Female
% decline in mortality rate, 1970 - 2010
70
60
50
40
30
20
10
+80
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<1
1-4
0
Age
Note: Higher values indicate greater declines in mortality; lower values indicate smaller declines in mortality.
Figure 5: Decline in age-specific mortality rate in Latin America and Caribbean, 1970-2010
90
Male
Female
80
% decline in mortality rate, 1970 - 2010
70
60
50
40
30
20
10
+80
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<1
1-4
0
Age
Note: Higher values indicate greater declines in mortality; lower values indicate smaller declines in mortality.
Points below zero indicate an increase in mortality.
21 | GBD 2010
In the Latin America and Caribbean region, the countries that made most progress
in increasing the average age at death between 1970 and 2010 were Brazil, Costa
Rica, Dominican Republic, Ecuador, El Salvador, Honduras, Mexico, Nicaragua, Peru,
and Saint Lucia (Figure 3). These countries achieved gains of 30 years or more. Most
of the other countries in the region succeeded in extending the average age at death
between 20 and 30 years. At the lower end, countries such as Guyana, Haiti, Suriname, and Uruguay increased the average age at death by 15 years or less between
1970 and 2010. On average, people in poorer countries tended to die at younger
ages compared to richer countries in the region. For example, the average age of
death in low-middle-income countries such as Belize, Bolivia, Guatemala, Guyana,
and Honduras was 56 years and younger, but it was over 70 years in upper-middleincome countries such as Cuba, Chile, and Uruguay.
Another way to understand changes in global demographic trends is to explore reductions in mortality rates by sex and age group. Figure 4 shows how global death
rates have declined in all age groups between 1970 and 2010. These changes have
been most dramatic among males and females aged 0 to 9 years, whose death rates
have dropped over 60% since 1970. Among age groups 15 and older, the decrease
in female death rates since 1970 has been greater than the drop in male death rates.
The gap in progress between men and women was largest between the ages of 15
to 54, most likely due to the persistence of higher mortality from injuries and alcohol
and tobacco use among men.
Figure 5 shows decreases in mortality rates in Latin America and the Caribbean,
where death rates declined by more than 80% in both males and females aged 1 to 4
years between 1970 and 2010. As with the global results, women in nearly every age
group in the region experienced greater declines in death rates than men. The most
dramatic differences between males and females appeared in the age groups between 15 and 35. The mortality rate rose by 1% among males aged 15 to 19, largely
due to deaths from road injuries and rising violence in the region.
LEADING CAUSES OF DEATH ARE SHIFTING TO
NON-COMMUNICABLE DISEASES
In part because many people are living longer lives and the population is growing
older, the leading causes of death have changed. Worldwide, the number of people
dying from non-communicable diseases, such as ischemic heart disease and diabetes, has grown by 30% since 1990. To a lesser extent, overall population growth also
contributed to this increase in deaths from non-communicable diseases.
The rise in the total number of deaths from non-communicable diseases has increased the number of healthy years lost, or DALYs, from these conditions. Figure
6 shows global changes in the 25 leading causes of DALYs between 1990 and 2010
ordered from highest to lowest ranking cause from top to bottom.
22 | GBD 2010
Figure 6: Global shifts in leading causes of DALYs, 1990-2010
% change in total DALYs, 1990-2010
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
180
200
ISCHEMIC HEART DISEASE
2
LOWER RESPIRATORY INFECTIONS
3
STROKE
4
DIARRHEAL DISEASES
5
HIV/AIDS
6
MALARIA
7
LOW BACK PAIN
8
PRETERM BIRTH COMPLICATIONS
COPD
9
10
ROAD INJURY
11
MAJOR DEPRESSIVE DISORDER
12
NEONATAL ENCEPHALOPATHY
13
TUBERCULOSIS
14
DIABETES
IRON-DEFICIENCY ANEMIA
15
NEONATAL SEPSIS
16
17
CONGENITAL ANOMALIES
18
19
SELF-HARM
FALLS
20
PROTEIN-ENERGY MALNUTRITION
21 NECK PAIN
22
LUNG CANCER
23
OTHER MUSCULOSKELETAL
24
MENINGITIS
CIRRHOSIS
25
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The leading 25 causes of DALYs are ranked from top to bottom in order of the number of DALYs they
contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs have increased
since 1990. Bars on the left show the percent by which DALYs have decreased. Pointed arrows indicate
causes that have increased by a greater amount than shown on the x-axis.
23 | GBD 2010
Figure 7: Shifts in leading causes of DALYs in Latin America and Caribbean, 1990-2010
% change in total DALYs, 1990-2010
-80
-60
-40
-20
0
20
40
1
60
80
100
120
140
160
ISCHEMIC HEART DISEASE
2 FORCES OF NATURE
3
INTERPERSONAL VIOLENCE
4
ROAD INJURY
5
MAJOR DEPRESSIVE DISORDER
6
LOW BACK PAIN
7
STROKE
8
LOWER RESPIRATORY INFECTIONS
9
DIABETES
10
PRETERM BIRTH COMPLICATIONS
11
CONGENITAL ANOMALIES
12
COPD
13
HIV/AIDS
14
IRON-DEFICIENCY ANEMIA
15
CIRRHOSIS
16
CHRONIC KIDNEY DISEASE
17
OTHER MUSCULOSKELETAL
18
NECK PAIN
19
ANXIETY DISORDERS
20
DIARRHEAL DISEASES
21
NEONATAL ENCEPHALOPATHY
22
23
ALCOHOL USE DISORDERS
ASTHMA
24
25
DRUG USE DISORDERS
MIGRAINE
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The leading 25 causes of DALYs are ranked from top to bottom in order of the number of DALYs they
contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs have increased
since 1990. Bars on the left show the percent by which DALYs have decreased. DALYs were not quantified
for forces of nature in 1990.
24 | GBD 2010
Figure 6 shows that among non-communicable diseases, diabetes and different
types of musculoskeletal disorders, such as low back and other musculoskeletal
disorders, increased the most between 1990 and 2010 in the world as a whole.
Figure 7 shows the changes in the leading causes of DALYs in Latin America and the
Caribbean from 1990 and 2010. Of non-communicable diseases, conditions such as
low back pain, diabetes, cirrhosis, and chronic kidney disease experienced the most
growth in this region.
In many countries, non-communicable diseases account for the majority of DALYs.
Figure 8 shows the percent of healthy years lost from this disease group by country in 2010. In most countries outside of sub-Saharan Africa, non-communicable
diseases caused 50% or more of all healthy years lost, or DALYs. In Australia, Japan,
and richer countries in Western Europe and North America, the percentage was
greater than 80%.
Figure 8 also shows the major role played by non-communicable diseases in Latin
America and the Caribbean. Uruguay had the highest percentage of DALYs due to
non-communicable diseases (81%), while Haiti had the lowest percentage of DALYs
from these conditions (15%).
An in-depth look at the country-level data reveals the specific diseases that are
driving overall shifts from communicable to non-communicable diseases. As an
example, Figure 9 displays the changes in the top 25 causes of DALYs in Mexican
females between 1990 and 2010. The top causes are organized by ranking from top
to bottom. Most non-communicable diseases rose over time, while communicable,
newborn, nutritional, and maternal conditions have fallen during this period. Among
the top five causes in 2010, chronic kidney disease increased the most (230%), followed by other musculoskeletal conditions (an 88% increase) and diabetes (a 71%
increase). Among communicable, nutritional, newborn, and maternal conditions,
lower respiratory infections and diarrheal diseases experienced the most dramatic
declines, falling by 66% and 83%, respectively.
Figure 10 shows similar declines in DALYs among Mexican males from communicable, nutritional, and newborn conditions coupled with increases in non-communicable diseases between 1990 and 2010. Out of all the non-communicable diseases
shown in this figure, chronic kidney disease increased the most over the period
(368%). Increases were also seen in other causes such as diabetes (103%), ischemic
heart disease (100%), and cirrhosis (57%). In addition to displaying the rising prominence of non-communicable diseases, this visualization shows that injuries are
among the most dominant causes of health loss in men in Mexico. Overall, DALYs
caused by interpersonal violence ranked the highest in 2010, while road traffic injuries ranked third.
70−79%
80% +
20−29%
30−39%
CARIBBEAN
60−69%
10−19%
40−49%
50−59%
< 10%
TTO
GRD
DMA
LCA
VCT
ATG
TLS
MDV
BRB
SYC
MUS
COM
PERSIAN GULF
W AFRICA
SGP
MLT
E MED.
BALKAN PENINSULA
FJI
VUT
SLB
MHL
TON
WSM
FSM
KIR
25 | GBD 2010
Figure 8: Percent of global DALYs due to non-communicable diseases, 2010
26 | GBD 2010
Another visualization tool, GBD Compare, displays proportional changes in disease
patterns over time using a treemap diagram. Figures 11a and 11b show how DALYs
have changed in Paraguay between 1990 and 2010. In 1990, non-communicable
diseases accounted for 50% of DALYs in both sexes, while communicable, nutritional, maternal, and newborn causes accounted for 41%. By 2010, they represented
64% and 24% of total disease burden, respectively. Premature death and disability
from most communicable, nutritional, maternal, and newborn causes decreased
during this period, with the exception of conditions including HIV/AIDS and irondeficiency anemia. Diarrheal diseases were the primary cause of health loss in 1990,
Figure 9: Shifts in leading causes of DALYs for females, Mexico, 1990-2010
% change in total DALYs, 1990-2010
-80
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
180
200
DIABETES
2
CHRONIC KIDNEY DISEASE
3
ISCHEMIC HEART DISEASE
4
MAJOR DEPRESSIVE DISORDER
5 OTHER MUSCULOSKELETAL
6
CONGENITAL ANOMALIES
7
LOW BACK PAIN
8 STROKE
9
LOWER RESPIRATORY INFECTIONS
10
NECK PAIN
11
PRETERM BIRTH COMPLICATIONS
12
ROAD INJURY
13
CIRRHOSIS
14
MIGRAINE
15
COPD
16
ANXIETY DISORDERS
17
OSTEOARTHRITIS
18
DIARRHEAL DISEASES
NEONATAL ENCEPHALOPATHY
EPILEPSY
19
20
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The leading 20 causes of DALYs are ranked from top to bottom in order of the number of DALYs they
contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs have increased
since 1990. Bars on the left show the percent by which DALYs have decreased. Pointed arrows indicate
causes that have increased by a greater amount than shown on the x-axis.
27 | GBD 2010
but declined by 64% to the thirteenth-highest cause. Other leading communicable
and newborn causes, such as lower respiratory infections, preterm birth complications, and syphilis, also declined in importance during this period. At the same time,
DALYs from many non-communicable causes rose. Increases occurred in causes
such as ischemic heart disease (82%), stroke (66%), depression (64%), low back
pain (77%), diabetes (199%), chronic kidney disease (230%), and neck pain (71%).
Between 1990 and 2010, health loss from road traffic injuries and interpersonal violence increased 128% and 138%, respectively, while DALYs from self-harm also rose
by 132%.
Figure 10: Shifts in leading causes of DALYs for males, Mexico, 1990-2010
% change in total DALYs, 1990-2010
-80
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
180
200
INTERPERSONAL VIOLENCE
2
ISCHEMIC HEART DISEASE
3
ROAD INJURY
4
DIABETES
5
CIRRHOSIS
6
CHRONIC KIDNEY DISEASE
7
LOWER RESPIRATORY INFECTIONS
8
CONGENITAL ANOMALIES
9 LOW BACK PAIN
10
PRETERM BIRTH COMPLICATIONS
11
STROKE
12
ALCOHOL USE DISORDERS
13
COPD
14
15
16
MAJOR DEPRESSIVE DISORDER
DRUG USE DISORDERS
NECK PAIN
17
NEONATAL ENCEPHALOPATHY
18
EPILEPSY
19
20
SELF-HARM
FALLS
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The leading 20 causes of DALYs are ranked from top to bottom in order of the number of DALYs they
contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs have increased
since 1990. Bars on the left show the percent by which DALYs have decreased. Pointed arrows indicate
causes that have increased by a greater amount than shown on the x-axis.
28 | GBD 2010
Figure 11a: Causes of DALYs, both sexes, all ages, Paraguay, 1990
LIVER
STROKE
STOMACH
OTH NEOPLASM
OTH
UNINTENT
DROWN
ROAD INJURY
MECH
FORCES
VIOLENCE
FIRE
NEONATAL
ENCEPHALOPATHY
PRETERM
BIRTH
COMPLICATIONS
DIARRHEA
LOWER
RESPIRATORY
INFECTIONS
ANXIETY
CERVIX
OTH CIRC CMP
FALLS
MAJOR
DEPRESSIVE
DISORDER
DRUGS
LEUKEMIA
BREAST
ISCHEMIC HEART DISEASE
LUNG
CONDUCT
AA
HTN HEART
CKD
DIABETES
OTH
MUSCULO
LOW BACK
PAIN
MENINGITIS
HIV
PUD
TB
URI
IRON‐DEFICIENCY ANEMIA
SYPHILIS
ALZH
CHAGAS
MATERNAL
EPILEPSY
SCABIES
EDENT
ACNE
ECZEMA
OTH NEURO
WHOOPING
OTITIS
BPH
MIGRAINE
OTH VISION
HEARING
CONGENITAL
ANOMALIES
NEONATAL
SEPSIS
OTH NEO
NECK PAIN
OTH RESP
ASTHMA
OSTEO
COPD
Annual % change, 2005 to 2010, DALYs per 100,000
3%
2%
1%
0%
-1%
-2%
-3%
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The size of each box in this square pie chart represents the percentage of total DALYs caused
by a particular disease or injury. To view an interactive version of this figure, visit IHME’s website:
http://ihmeuw.org/gbdcompare.
29 | GBD 2010
Figure 11b: Causes of DALYs, both sexes, all ages, Paraguay, 2010
PRETERM
BIRTH
COMPLICATIONS
NEONATAL
ENCEPHALOPATHY
DIARRHEA
URI
TUBERCULOSIS
PEM
SYPHILIS
MATERNAL
CHAGAS
IRON‐DEFICIENCY
ANEMIA
OTH INF
CIRRHOSIS
PUD
OTHER NTD
OTH NEO
MENINGITIS
OTH RESP
ASTHMA
EPILEPSY
ALZH
NEONATAL
SEPSIS
HIV
IBD
OTH NEURO
VIOLENCE
COPD
PCO
OTH
ENDO
EDENT
D CARIES
MIGRAINE
OTH VISION
HEARING
ACNE
SELF-HARM
OTH
MUSCULO
CKD
DIABETES
OSTEO
ECZEMA
CONDUCT
BIPOLAR
NECK PAIN
CONGENITAL
ANOMALIES
OTH INTENT
ALCOHOL
SCHIZO
BRAIN
LYMPHOMA
LOW BACK PAIN
FIRE
LOWER
RESPIRATORY
INFECTIONS
PANCREAS
ROAD INJURY
DROWN
HTN HEART
DRUGS
ANXIETY
PROSTATE
CERVIX
AA
COLORECTAL
LEUKEMIA
BREAST
CMP
OTH CIRC
AFIB
MAJOR
DEPRESSIVE
DISORDER
FALLS
LIVER
STOMACH
OTH
NEOPLASM
ISCHEMIC HEART DISEASE
STROKE
LUNG
Annual % change, 2005 to 2010, DALYs per 100,000
3%
2%
1%
0%
-1%
-2%
-3%
Communicable, newborn, nutritional, and maternal
Non-communicable
Injuries
Note: The size of each box in this square pie chart represents the percentage of total DALYs caused
by a particular disease or injury. To view an interactive version of this figure, visit IHME’s website:
http://ihmeuw.org/gbdcompare.
30 | GBD 2010
DISABILITY INCREASES IN MIDDLE- AND
HIGH-INCOME COUNTRIES
Most countries in the world have succeeded in reducing deaths early in life. To a
growing extent, longer lives are redefining “old age” in many countries, and people
in all age groups are dying at lower rates than in the past. Little progress has been
made in reducing the prevalence of disability, so people are living to an older age
but experiencing more ill health. Many people suffer from different forms of disability throughout their lives, such as mental and behavioral health problems starting in
their teens and musculoskeletal disorders beginning in middle age. These findings
have far-reaching implications for health systems. DALYs, or healthy years lost, are
calculated by adding together years lived with disability (YLDs) and years of life lost
(YLLs), also known as years lost to premature death.
Between 1990 and 2010, YLDs increased as a percentage of total DALYs in all areas
of the world except Eastern Europe, southern sub-Saharan Africa, and the Caribbean. This disability transition has been most dramatic in parts of Latin America, the
Middle East, North Africa, and many areas in Asia. The percentage of burden from
YLDs also increased in sub-Saharan Africa with the exception of the southern part of
the region.
Figure 12 tells a detailed story about the different conditions that cause disability
globally. It is important to keep in mind that these estimates reflect both how many
individuals suffer from a particular condition as well as the severity of that condition. Mental and behavioral disorders, such as depression, anxiety, and drug use,
are the primary drivers of disability worldwide and caused over 40 million years
of disability in 20 to 29 year olds. Musculoskeletal conditions, which include low
back pain and neck pain, accounted for the next largest number of years lived with
disability. People aged 45 to 54 were most impacted by these conditions, as musculoskeletal disorders caused over 30 million years of disability in each of these age
groups.
Figure 13 shows disability patterns in Latin America and the Caribbean for 2010.
Mental and behavioral and musculoskeletal disorders are the dominant causes of
disability in this region, as they are globally. Compared to the world as a whole,
however, disability due to nutritional deficiencies in 1 to 4 year olds is lower in Latin
America and the Caribbean.
Another way to view the world’s health challenges is by comparing how different
conditions rank. Figure 14 ranks the leading causes of disability globally and for
each of the six World Bank regions. The colors indicate how high a condition ranks
in a region. Depression is a major cause of disability across regions and is one of
the top three causes of disability in every region. This disorder can cause fatigue,
decreased ability to work or attend school, and suicide. Anxiety, a different type of
mental disorder, is one of the top 10 causes of disability in all regions, but ranks
highest in Latin America and the Caribbean and the Middle East and North Africa.
Additionally, two other mental disorders, schizophrenia and bipolar disorder, appear
among the top 20 causes of disability in many regions.
31 | GBD 2010
Musculoskeletal disorders play a large role in causing disability worldwide. Low
back pain causes the most disability in East Asia and the Pacific, Europe and Central
Asia, and the Middle East and North Africa. This condition can inhibit people’s ability
to perform different types of work both inside and outside the home and impair their
mobility. In addition to low back pain, neck pain and other musculoskeletal disorders
rank in the top 10 causes of disability in most regions. Another musculoskeletal disorder, osteoarthritis, appears in the top 20 causes of disability in every region.
Figure 12: Global disability patterns by broad cause group and age, 2010
60M
55M
50M
45M
40M
YLDs
35M
30M
25M
20M
15M
10M
5M
80+ YEARS
75-79 YEARS
70-74 YEARS
65-69 YEARS
60-64 YEARS
55-59 YEARS
50-54 YEARS
45-49 YEARS
40-44 YEARS
35-39 YEARS
30-34 YEARS
25-29 YEARS
20-24 YEARS
15-19 YEARS
10-14 YEARS
5-9 YEARS
1-4 YEARS
28-364 DAYS
7-27 DAYS
0-6 DAYS
0.0
AGE
War & disaster
Intentional injuries
Unintentional injuries
Transport injuries
Other non-communicable
Musculoskeletal disorders
Diabetes/urogen/blood/endo
Mental & behavioral disorders
Neurological disorders
Digestive diseases
Cirrhosis
Chronic respiratory diseases
Cardio & circulatory diseases
Cancer
Other communicable
Nutritional deficiencies
Neonatal disorders
Maternal disorders
NTD & malaria
Diarrhea/LRI/other infectious
HIV/AIDS & tuberculosis
Note: The size of the colored portion in each bar represents the number of YLDs attributable to each cause
for a given age group. The height of each bar shows total YLDs for a given age group in 2010. The causes
are aggregated. For example, musculoskeletal disorders include low back pain and neck pain. To view an
interactive version of this figure, visit IHME’s website: http://ihmeuw.org/gbdcausepattern.
32 | GBD 2010
While mental and musculoskeletal disorders rank high among causes of disability
across regions, Figure 14 also reveals substantial regional variation among other
causes. Iron-deficiency anemia is the leading cause of disability in sub-Saharan Africa and South Asia but is less important as a cause of disability in the other regions.
The substantial burden in these two regions contributed to iron-deficiency anemia’s
ranking as the third leading cause of disability at the global level. Iron-deficiency
anemia can lead to fatigue and lowered ability to fight infection and may decrease
cognitive ability.
Figure 13: Disability patterns by broad cause group and age in Latin America and
Caribbean, 2010
5.0M
4.5M
4.0M
3.5M
YLDs
3.0M
2.5M
2.0M
1.5M
1.0M
0.5M
80+ YEARS
75-79 YEARS
70-74 YEARS
65-69 YEARS
60-64 YEARS
55-59 YEARS
50-54 YEARS
45-49 YEARS
40-44 YEARS
35-39 YEARS
30-34 YEARS
25-29 YEARS
20-24 YEARS
15-19 YEARS
10-14 YEARS
5-9 YEARS
1-4 YEARS
28-364 DAYS
7-27 DAYS
0-6 DAYS
0.0
AGE
War & disaster
Intentional injuries
Unintentional injuries
Transport injuries
Other non-communicable
Musculoskeletal disorders
Diabetes/urogen/blood/endo
Mental & behavioral disorders
Neurological disorders
Digestive diseases
Cirrhosis
Chronic respiratory diseases
Cardio & circulatory diseases
Cancer
Other communicable
Nutritional deficiencies
Neonatal disorders
Maternal disorders
NTD & malaria
Diarrhea/LRI/other infectious
HIV/AIDS & tuberculosis
Note: The size of the colored portion in each bar represents the number of YLDs attributable to each cause
for a given age group. The height of each bar shows total YLDs for a given age group in 2010. The causes
are aggregated. For example, musculoskeletal disorders include low back pain and neck pain.
33 | GBD 2010
Chronic obstructive pulmonary disease (COPD), a term used to describe emphysema
and other chronic respiratory diseases, is among the top five causes of disability in
East Asia and Pacific, South Asia, and sub-Saharan Africa, and is the eighth-leading
cause of disability in the Middle East and North Africa.
In Latin America and the Caribbean, many of the leading causes of disability are
similar to global rankings, but there are key differences between the region and
the rest of the world. Certain causes were less prominent in Latin America and the
Caribbean than they were at the global level. Iron-deficiency anemia, for example,
was the third-leading cause of disability worldwide but the fifth in Latin America and
the Caribbean. While COPD ranked as the fifth-leading cause of disability worldwide,
EUROPE & CENTRAL ASIA
LATIN AMERICA & CARIBBEAN
MIDDLE EAST & NORTH AFRICA
SOUTH ASIA
SUB-SAHARAN AFRICA
LOW BACK PAIN
1
1
1
2
1
2
3
MAJOR DEPRESSIVE DISORDER
2
2
2
1
2
3
2
IRON-DEFICIENCY ANEMIA
3
6
5
5
3
1
1
NECK PAIN
4
3
3
3
6
7
6
COPD
5
5
11
13
8
4
4
OTHER MUSCULOSKELETAL
6
4
4
6
7
8
11
ANXIETY DISORDERS
7
10
7
4
4
6
5
MIGRAINE
8
11
8
7
12
5
13
GLOBAL
EAST ASIA & PACIFIC
Figure 14: Rankings of leading causes of disability by region, 2010
DIABETES
FALLS
9
7
6
10
5
10
23
10
9
9
16
11
12
25
OSTEOARTHRITIS
11
8
10
11
9
19
18
DRUG USE DISORDERS
12
17
16
9
10
9
17
OTHER HEARING LOSS
13
12
13
15
16
11
12
ASTHMA
14
23
21
8
13
14
10
ALCOHOL USE DISORDERS
15
13
12
12
37
15
34
ROAD INJURY
16
16
14
21
14
13
22
BIPOLAR DISORDER
17
15
17
17
15
16
20
SCHIZOPHRENIA
18
14
18
18
18
22
29
DYSTHYMIA
19
18
19
19
19
20
26
EPILEPSY
20
20
22
14
20
26
14
ISCHEMIC HEART DISEASE
21
19
15
24
23
31
40
ECZEMA
22
22
23
20
21
21
21
DIARRHEAL DISEASES
23
25
28
22
17
23
15
ALZHEIMER'S DISEASE
24
34
20
26
39
49
62
TUBERCULOSIS
25
21
30
42
22
17
24
1-10
11-20
21-30
31-50
51-90
Note: In this figure, shading is used to indicate the ranking of each cause of disability in a particular region.
34 | GBD 2010
it ranked much lower (13th) in Latin America and the Caribbean. In this region, falls
ranked 16th but ranked 10th globally.
Other causes of disability rank higher in Latin America and the Caribbean than at the
global level. Asthma was the 14th cause of disability globally, but it ranked eighth
in Latin America and the the Caribbean. Drug and alcohol use disorders also ranked
higher in this region compared to the world as a whole. Drug use disorders were the
12th-leading cause of disability globally, but ranked ninth in Latin America and the
Caribbean. Alcohol use disorders ranked 15th globally, but 12th in the region.
Using GBD tools to identify leading causes of disability, such as mental and behavioral disorders and musculoskeletal disorders, can help guide health system planning and medical education. Decision-makers can use GBD’s findings to ensure that
health care systems are designed to address the primary drivers of disability in a
cost effective way.
THE GLOBAL RISK FACTOR TRANSITION
Data on potentially avoidable causes of health loss, or risk factors, can help policymakers and donors prioritize prevention strategies to achieve maximum health
gains. GBD tools estimate the number of deaths, premature deaths, years lived with
disability, and DALYs attributable to 67 risk factors worldwide. This study benefited
from the availability of new data, such as newly available epidemiologic evidence
about the health impacts of different risk factors; population, nutrition, health, and
medical examination surveys; and high-resolution satellite data on air pollution.
Figure 15 shows changes in the 15 leading global risk factors for premature death
and disability, or DALYs, between 1990 and 2010. Over this period, many risk factors that primarily cause communicable diseases in children declined. Examples of
these risk factors are childhood underweight and suboptimal breastfeeding, which
dropped by 61% and 57% from 1990 to 2010, respectively. Childhood underweight
is commonly used to measure malnutrition, and was formerly the leading risk factor
for DALYs in 1990, but ranked eighth in 2010. DALYs attributable to household air
pollution, which contributes to lower respiratory tract infections in children, dropped
by 37% between 1990 and 2010. Unlike other risk factors that primarily cause DALYs
from communicable diseases, progress in reducing premature death and disability
from iron deficiency was much lower, declining by just 7% between 1990 and 2010.
Slow progress in reducing iron deficiency helps explain why iron-deficiency anemia
ranks as the third-leading cause of disability globally.
As most risk factors for communicable diseases in children have declined, many
risks associated with non-communicable diseases have grown. As the leading
global risk factor for premature death and disability, or DALYs, in 2010, dietary risks
increased 30% between 1990 and 2010. Dietary risks include components such as
high sodium intake and lack of fruit, nuts and seeds, and whole grain intake. GBD
found the main diseases linked to dietary risks and physical inactivity are primarily
35 | GBD 2010
cardiovascular diseases as well as cancer and diabetes. While many public health
messages about diet have stressed the importance of eating less saturated fat, the
findings of GBD 2010 indicate that these messages should emphasize a broader
range of dietary components.
GBD 2010 used the most recent data available on the effects of different dietary risk
factors. It is important to note that these data are constantly evolving as new studies
on diet are conducted. Compared to data on the negative health impacts of smoking,
which have been well understood for decades, the scientific evidence surrounding
dietary risk factors is much newer. Future updates of GBD will incorporate new data
on risk factors as they emerge.
The second-leading global risk factor, high blood pressure, increased by 27% as a
cause of DALYs between 1990 and 2010. High blood pressure is a major risk factor
for cardiovascular and circulatory diseases. DALYs attributable to another risk
Figure 15: Global shifts in rankings of DALYs for top 15 risk factors, 1990-2010
% change in total DALYs, 1990-2010
-80
-60
-40
-20
0
20
40
1
60
80
100
120
140
160
DIETARY RISKS
2
HIGH BLOOD PRESSURE
3
SMOKING
4
HOUSEHOLD AIR POLLUTION
5
ALCOHOL USE
6
HIGH BODY MASS INDEX
7
HIGH FASTING PLASMA GLUCOSE
8
CHILDHOOD UNDERWEIGHT
9
AMBIENT PM POLLUTION
10 PHYSICAL INACTIVITY
11
12
IRON DEFICIENCY
13
SUBOPTIMAL BREASTFEEDING
14
15
Air pollution
Smoking
Undernutrition
OCCUPATIONAL RISKS
HIGH TOTAL CHOLESTEROL
DRUG USE
Alcohol & drug use
Physiological risks
Dietary risks
Physical inactivity
Occupational risks
Note: The leading 15 risk factors are ranked from top to bottom in order of the number of DALYs they contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs attributable to different risk factors have increased since 1990. Bars on the left show the percent by which DALYs attributable to
different risk factors have decreased. Attributable DALYs were not quantified for physical inactivity for 1990.
36 | GBD 2010
factor for non-communicable diseases, tobacco smoking, increased slightly by 3%
between 1990 and 2010 and was the third-leading risk factor worldwide. Smoking
increases the risk of chronic respiratory diseases, cardiovascular and circulatory
diseases, and cancer. DALYs attributable to the use of another substance, alcohol,
increased 32% during this period. Alcohol use contributes to cardiovascular and
circulatory diseases, cirrhosis, and cancer. In addition to being a contributor to noncommunicable diseases, alcohol consumption increases the risk of injuries.
High body mass index (BMI), used as an indicator of overweight and obesity, was
another major contributor to DALYs in 2010 and was the sixth-leading risk factor for
premature death and disability. It increased by 82% over the period 1990 to 2010.
High BMI is a leading risk factor for cardiovascular and circulatory diseases as well
as diabetes. It is striking that high BMI was a more important cause of poor health
worldwide than childhood underweight in 2010, whereas childhood underweight
was a much more prominent risk factor than high BMI in 1990.
Figure 16: Shifts in rankings of DALYs in Latin America and Caribbean for top 15 risk
factors, 1990-2010
% change in total DALYs, 1990-2010
-80
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
DIETARY RISKS
2
HIGH BLOOD PRESSURE
3
HIGH BODY MASS INDEX
4 ALCOHOL USE
5
SMOKING
6
HIGH FASTING PLASMA GLUCOSE
7 PHYSICAL INACTIVITY
8
OCCUPATIONAL RISKS
9
HIGH TOTAL CHOLESTEROL
10
IRON DEFICIENCY
11
DRUG USE
12
HOUSEHOLD AIR POLLUTION
SUBOPTIMAL BREASTFEEDING 13
14
LEAD
15 INTIMATE PARTNER VIOLENCE
Air pollution
Other environmental
Smoking
Undernutrition
Alcohol & drug use
Physiological risks
Dietary risks
Physical inactivity
Occupational risks
Sexual abuse & violence
Note: The leading 15 risk factors are ranked from top to bottom in order of the number of DALYs they
contributed in 2010. Bars to the right of the vertical line show the percent by which DALYs attributable to different risk factors have increased since 1990. Bars on the left show the percent by which DALYs attributable
to different risk factors have decreased. Attributable DALYs were not quantified for physical inactivity and
intimate partner violence for 1990.
37 | GBD 2010
Figure 16 shows changes in leading risk factors for Latin America and the Caribbean, where many risk factors for communicable diseases declined between 1990
and 2010, as they did globally. In comparison to the world overall, DALYs attributable to risk factors for non-communicable diseases such as dietary risks, high blood
pressure, high BMI, high fasting plasma glucose, high total cholesterol, and alcohol
use increased by greater amounts in Latin America and the Caribbean. For example,
high BMI rose by 82% worldwide between 1990 and 2010, but it increased by 127%
in Latin America and the Caribbean. High fasting plasma glucose increased 58% at
11
12
9
14
15
22
21
19
17
23
20
25
24
8
16
10
9
13
14
20
22
19
15
24
17
25
23
IRON DEFICIENCY
SUBOPTIMAL BREASTFEEDING
HIGH TOTAL CHOLESTEROL
DRUG USE
INTIMATE PARTNER VIOLENCE
LEAD
SANITATION
VITAMIN A DEFICIENCY
ZINC DEFICIENCY
CHILDHOOD SEXUAL ABUSE
UNIMPROVED WATER
LOW BONE MINERAL DENSITY
OZONE
RADON
21-25
16-20
1-5
6
12
OCCUPATIONAL RISKS
11-15
24
22
25
10
5
PHYSICAL INACTIVITY
6-10
24
25
20
24
19
24
20
24
23
22
23
24
24
23
25
25
20
22
25
25
25
25
25
25
25
25
25
25
25
22
20
17
16
25
19
23
17
21
18
20
19
18
20
23
22
21
21
23
21
17
23
22
24
23
24
22
24
24
24
18
23
20
19
16
17
24
17
21
14
17
17
17
16
16
17
22
18
19
18
7
11
AMBIENT PM POLLUTION
19
21
15
18
16
23
18
21
19
20
20
19
17
19
18
22
24
23
20
21
19
22
22
23
21
22
21
21
21
21
17
23
20
24
21
22
18
21
19
22
23
21
19
22
15
20
16
13
18
18
CHILDHOOD UNDERWEIGHT
14
13
19
14
15
12
14
12
15
13
14
15
14
10
15
16
16
4
HIGH FASTING PLASMA GLUCOSE
15
14
13
15
17
13
15
13
14
14
13
14
20
13
14
11
3
2
HIGH BODY MASS INDEX
11
9
14
11
13
10
13
10
10
10
10
10
16
14
13
1
6
ALCOHOL USE
9
10
9
9
14
8
11
9
11
11
12
13
19
12
12
12
11
12
4
15
12
14
13
15
15
16
7
9
9
15
18
16
11
8
10
7
10
9
11
10
9
8
11
7
9
12
8
8
11
9
7
4
13
11
8
8
7
8
12
14
10
8
6
7
5
21
HOUSEHOLD AIR POLLUTION
6
13
7
SMOKING
10
9
10
7
11
6
8
7
6
5
7
6
11
7
8
12
8
3
13
11
6
13
20
16
20
16
18
9
9
11
12
17
7
17
18
22
10
16
12
18
16
19
16
17
17
18
6
15
6
5
4
5
18
6
8
5
5
6
4
4
3
3
5
3
5
3
3
4
1
4
8
5
4
3
6
2
3
4
3
2
2
4
8
4
4
15
19
12
2
ANTIGUA AND BARBUDA
DIETARY RISKS
7
4
6
2
3
4
9
7
7
3
8
6
5
8
10
5
3
2
2
5
24
5
20
6
15
12
18
23
12
3
16
5
2
3
4
5
5
7
6
5
9
1
2
3
1
1
4
2
1
1
2
2
1
1
3
4
1
1
BELIZE
HIGH BLOOD PRESSURE
CUBA
3
DOMINICA
1
DOMINICAN REPUBLIC
2
GRENADA
23
GUYANA
6
HAITI
7
JAMAICA
1
SAINT LUCIA
2
SAINT VINCENT
AND THE GRENADINES
1
SURINAME
2
BRAZIL
1
PARAGUAY
2
ARGENTINA
1
BOLIVIA
2
VENEZUELA
1
GLOBAL
1
Figure 17: Rankings of DALYs attributable to leading risk factors across select countries in
Latin American and Caribbean, 2010
Note: In this figure, shading is used to indicate the ranking of each risk factor in a particular region. Palestine
is the GBD equivalent of the West Bank and Gaza in the World Bank classification system. To view an interactive version of this figure, visit IHME’s website: http://ihmeuw.org/gbdheatmap.
38 | GBD 2010
the global level but increased by 87% in the region. Alcohol use rose by 35% in the
world as a whole and by 50% in the region. In contrast, smoking increased slightly
worldwide, but it declined by 4% in Latin America and the Caribbean.
Global and regional rankings of risk factors mask important differences across countries. Figure 17 shows the leading risk factors for DALYs in select Latin American and
Caribbean countries in 2010. Risks for non-communicable diseases such as dietary
Figure 18: DALYs attributable to dietary risks, both sexes, all ages, Colombia, 2010
NEONATAL
ENCEPHALOPATHY
PRETERM
BIRTH
COMPLICATIONS
DIARRHEA
ALZH
URI N SEPSIS OTH
NEO
HIV
IRON‐
DEFICIENCY
ANEMIA
CIRRHOSIS
DALYs attributable
to risk factor
OTH
NEURO
ILEUS
EDENT
D CARIES
EPILEPSY
ACNE
MIGRAINE
OTH VISION
ECZEMA
HEARING
CONGENITAL
ANOMALIES
OTH RESP
BPH
COPD
ASTHMA
OTH ENDO
OSTEO
NECK PAIN
LOWER
RESPIRATORY
INFECTIONS
CHRONIC KIDNEY
DISEASES
DIABETES
OTH
MUSCULO
CONDUCT
SELF-HARM
BIPOLAR
OTH UNINTENT
SCHIZO
VIOLENCE
FIRE
BRAIN
LYMPHOMA
ROAD INJURY
MECH FORCE
ALCOHOL
DRWON
PANCREAS
DRUGS
ANXIETY
PROSTATE
LOW BACK PAIN
MAJOR
DEPRESSIVE
DISORDER
FALLS
LEUKEMIA
AA
CMP
AFIB
HTN HEART
COLORECTAL
BREAST
CERVIX
OTH CIRC
LIVER
STOMACH
OTH NEOPLASM
ISCHEMIC HEART DISEASE
STROKE
LUNG
CANCER
PEM
OTH NTD
OTH INF
DALYs not attributable
to risk factor
Communicable, newborn,
nutritional, and maternal
Communicable, newborn,
nutritional, and maternal
Non-communicable
Injuries
Non-communicable
Injuries
Note: The size of each box represents the percentage of total DALYs caused by a particular disease or injury,
and the proportion of each cause attributable to the risk factor is shaded. To view an interactive version of
this figure, visit IHME’s website: http://ihmeuw.org/gbdcompare.
39 | GBD 2010
risks, high BMI, high blood pressure, and high fasting plasma glucose (an indicator
of diabetes) are among the top five risk factors for most countries in this region. In
nearly all of these countries, other non-communicable disease risk factors, including physical inactivity, alcohol use, and smoking, are some of the top 10 leading risk
factors. Alcohol use ranked particularly high as a risk factor in Brazil and Venezuela,
where it was the third- and fourth-leading contributor to DALYs, respectively.
Figure 19: DALYs attributable to tobacco smoking and second-hand smoke, both sexes,
all ages, Uruguay, 2010
IRON‐
DEFICIENCY
ANEMIA
DALYs attributable
to risk factor
HIV
OTITIS
MS
CIRRHOSIS
OTH NEURO
PUD
EDENT
ALZH
IBD
ACNE
PERIODONTAL
EPILEPSY
PARKINS
ECZEMA
HEARING
NEPHRITIS
MIGRAINE
CONGENITAL
ANOMALIES
OTH RESP
TYPHOID
R ARTHRITIS
ASTHMA
PCO
BPH
PRETERM
OSTEO
COPD
DIARRHEA
NECK PAIN
CKD
DIABETES
LOWER
RESPIRATORY
INFECTIONS
OTH
MUSCULO
OTH
ENDO
LOW BACK PAIN
BIPOLAR
BLADDER
VIOLENCE
LYMPHOMA
RHEUM HD
SELF-HARM
SCHIZO
FIRE
HTN HEART
ROAD INJURY
LARYNX
AA
DRWON
ALCOHOL
AUTISM
KIDNEY
PROSTATE
DRUGS
MECH FORCE
ANXIETY
ESOPHAGUS
LEUKEMIA
OTH CIRC
OTH UNINTENT
DYSTHYMIA
OVARY
PANCREAS
AFIB
CMP
FALLS
STOMACH
COLORECTAL
BREAST
CERVIX
MAJOR
DEPRESSIVE
DISORDER
LIVER
LUNG
CANCER
OTH
NEOPLASM
ISCHEMIC HEART DISEASE
STROKE
CHAGAS
DALYs not attributable
to risk factor
Communicable, newborn,
nutritional, and maternal
Communicable, newborn,
nutritional, and maternal
Non-communicable
Injuries
Non-communicable
Injuries
Note: The size of each box represents the percentage of total DALYs caused by a particular disease or injury,
and the proportion of each cause attributable to the risk factor is shaded. To view an interactive version of
this figure, visit IHME’s website: http://ihmeuw.org/gbdcompare.
40 | GBD 2010
Bolivia, Cuba, and Argentina stand out as countries where smoking is a particularly
large public health problem. Smoking was the second-leading risk factor contributing to DALYs in Bolivia and Cuba in 2010 and was the third-leading risk factor for Argentina. In Bolivia and Haiti, unlike in most countries shown in Figure 17, risk factors
for illness in children, such as household air pollution, suboptimal breastfeeding,
and iron deficiency, remained among the top risk factors.
In addition to allowing users to explore how different risk factors rank across countries, GBD visualization tools show how many DALYs could potentially be averted by
addressing different risk factors. Figure 18 shows the number of DALYs attributable
to dietary risks that contribute to different diseases in Colombia. The percentage of
DALYs that could be averted by reducing dietary risk factors is shaded in a darker
color.
Dietary risks include elements such as low consumption of fruit, nuts and seeds,
and whole grains and high salt intake. The figure indicates how improving people’s
diets could prevent substantial amounts of health loss from ischemic heart disease
and stroke, as indicated by the portion of these causes that are shaded in dark blue.
Reduction of dietary risks could also reduce DALYs from diabetes and colon and
rectal cancers.
Figure 19 shows how, in Uruguay, many DALYs could be averted by eliminating
tobacco smoking, including second-hand smoke.
Most COPD and lung cancer is caused by tobacco smoking and second-hand smoke,
as indicated by the dark blue portion of the boxes representing these causes.
Substantial numbers of healthy years lost from ischemic heart disease, stroke, and
esophageal cancer could be prevented by reducing exposure to these risk factors.
Figure 20 shows the number of DALYs attributable to suboptimal breastfeeding in
children aged 1 to 11 months in Bolivia.
This figure can be used to understand the number of years of healthy life that could
potentially be gained by ensuring that all Bolivian children in this age group are adequately breastfed. Adequate breastfeeding is defined as exclusive breastfeeding of
children for the first six months of life, and continued breastfeeding from the age of
6 months to 2 years. Adequate breastfeeding could prevent nearly 60% of the DALYs
attributable to diarrhea, as indicated by the dark shading in the box representing this
cause. Adequate breastfeeding would also greatly reduce illness from lower respiratory infections among these children.
41 | GBD 2010
Figure 20: DALYs attributable to suboptimal breastfeeding, both sexes, ages 1-11 months,
Bolivia, 2010
IHD
STROKE
OTHER UNINTENTIONAL INJURIES
WHOOPING COUGH
PROTEIN‐ENERGY MALNUTRITION
OTH INF
DALYs attributable
to risk factor
OTH
NUTR
IRON‐DEFICIENCY ANEMIA
NEONATAL SEPSIS
OTHER RESPIRATORY DISEASES
TB
MEASLES
OTHER NEONATAL DISORDERS
COPD
CONGENITAL ANOMALIES
MENINGITIS
NEONATAL ENCEPHALOPATHY
DIARRHEA
LOWER
RESPIRATORY
INFECTIONS
ROAD
INJURY
PRETERM BIRTH COMPLICATIONS
ENDOCARDITIS
CMP
OTH CIRC
FIRE
SYPHILIS
DALYs not attributable
to risk factor
Communicable, newborn,
nutritional, and maternal
Communicable, newborn,
nutritional, and maternal
Non-communicable
Injuries
Non-communicable
Injuries
Note: The size of each box represents the percentage of total DALYs caused by a particular disease or injury,
and the proportion of each cause attributable to the risk factor is shaded. To view an interactive version of
this figure, visit IHME’s website: http://ihmeuw.org/gbdcompare.
42 | GBD 2010
USING GBD TO ASSESS COUNTRIES’
HEALTH PROGRESS
GBD found that factors such as population growth, longer lives, and decreasing
mortality are causing increases in years of healthy life lost, or DALYs, from noncommunicable diseases in many countries. Although non-communicable diseases
are increasing relative to other health problems as a result of these demographic
changes, GBD found that many countries are actually showing improvements in
health as measured by age-standardized DALY rates.
Differences in population growth and ages across countries can make a country with
a younger population appear better in terms of health performance than a country with an older population. Similarly, countries with low population growth will
add less disease burden over time than countries with a fast-growing population.
Researchers can remove the impact of these factors to isolate what is important
for comparisons of health performance using age-standardized rates of DALYs and
YLLs.
For example, many countries in Latin America and the Caribbean have made progress in reducing age-standardized rates of DALYs from meningitis, iron-deficiency
anemia, and maternal disorders, such as Bolivia, Guatemala, Haiti, and Honduras.
Multiple countries in the region generally made progress in reducing age-standardized rates of DALYs from non-communicable diseases including ischemic heart
disease and stroke. Conversely, many countries in Latin America and the Caribbean
experienced rising age-standardized rates of DALYs due to diabetes, musculoskeletal, and drug use disorders. To explore age-standardized DALY rates of diseases and
injuries at the country level between 1990 and 2010, visit IHME’s data visualization
tools at www.ihmeuw.org/GBDcountryviz.
GBD can be used to compare and contrast disease patterns across countries. Figure
21 shows causes of age-standardized DALYs per 100,000 people. Many countries in
Latin America and the Caribbean have rates of DALYs from communicable, maternal, nutritional, and newborn conditions that are much lower than the world as a
whole. Low- and low-middle-income countries in the region such as Belize, Bolivia,
Guatemala, Guyana, and Haiti have the highest rates for these conditions, while
upper-middle-income countries such as Argentina, Chile, Costa Rica, Cuba, and
Uruguay have rates of communicable, maternal, nutritional, and newborn conditions comparable to developed countries as a whole. Even without the enormous
age-standardized DALY rates due to deaths from forces of nature, Haiti had the highest rates from communicable, maternal, nutritional, and newborn conditions among
countries shown in Figure 21. Countries such as Belize, Dominica, Guyana, Haiti, and
Mexico have age-standardized DALY rates of diabetes and urogenital, blood, and
endocrine disorders that are greater than other countries in the region as well as the
global average. Age-standardized DALY rates of intentional injuries in most countries
43 | GBD 2010
Figure 21: Age-standardized DALY rates across select countries in Latin American and
Caribbean, 2010
140k
120k
DALYs (per 100,000)
100k
80k
60k
40k
Mental & behavioral disorders
Neurological disorders
Digestive diseases
Cirrhosis
Chronic respiratory diseases
Cardio & circulatory diseases
Cancer
CHILE
Other communicable
Nutritional deficiencies
Neonatal disorders
Maternal disorders
NTD & malaria
Diarrhea/LRI/other infectious
HIV/AIDS & tuberculosis
Note: The size of the colored portion in each bar represents number of age-standardized DALYs per
100,000 people attributable to each cause. The causes are aggregated. For example, musculoskeletal
disorders include low back pain and neck pain. To view an interactive version of this figure, visit IHME’s
website: http://ihmeuw.org/gbdcausepattern.
COSTA RICA
DEVELOPED
CUBA
URUGUAY
MEXICO
PANAMA
ECUADOR
ARGENTINA
PERU
COLOMBIA
VENEZUELA
BRAZIL
NICARAGUA
JAMAICA
PARAGUAY
EL SALVADOR
DOMINICA
DOMINICAN REPUBLIC
HONDURAS
BELIZE
War & disaster
Intentional injuries
Unintentional injuries
Transport injuries
Other non-communicable
Musculoskeletal disorders
Diabetes/urogen/blood/endo
SURINAME
BOLIVIA
GLOBAL
GUATEMALA
HAITI
0.0
GUYANA
20k
44 | GBD 2010
in Latin America and the Caribbean exceed global rates, especially in Colombia,
El Salvador, Guatemala, Guyana, and Honduras. Many countries in the region are
performing better than global rankings on transport injuries, and the rates of DALYs
due to transport injuries in some developing countries, including Cuba, Guatemala,
Jamaica, Nicaragua, and Uruguay, were lower than those in developed countries.
The GBD approach affords countries a unique opportunity to explore their success
in improving health outcomes over time. GBD can also be used to better understand
how fast a country’s health is improving relative to similar countries. This type of
progress assessment is called benchmarking. Benchmarking is a tool that can help
countries put their health achievements in context and identify areas for improvement. IHME invites countries interested in collaborating on benchmarking exercises
to contact us.
As an example of a benchmarking exercise, Figure 22 ranks levels of years of life
lost in Latin American and Caribbean countries in 2010. The columns are arranged
by the top 30 causes of YLLs in the region. The countries are ordered according to
levels of premature mortality. For each cause, rankings are coded to reflect each
country’s level of age-standardized YLLs relative to the others. The best performers
for each cause are in green, while the worst performers for each cause appear in
red. Yellow shading indicates that the ranking for a particular country does not have
a statistically significant difference from the regional average. Black indicates no
ranking was assigned due to zero YLLs from a given cause.
Figure 22 can be used to compare the performance of Latin American and Caribbean
countries and can help countries identify priority areas for improvement. For example, Cuba performed better than the regional average for most causes of premature
death, but performed poorly in areas such as ischemic heart disease, COPD, and
lung, colorectal, and breast cancers. Jamaica was the top performer in the region for
causes including road injuries, cirrhosis, self-harm, and drowning, but ranked near
the bottom for stroke, diabetes, HIV/AIDS, hypertension, and breast cancer. Country
comparisons can be used for selecting case studies to understand why performance
differs across countries. For example, case studies could potentially reveal why a
lower-middle-income country such as El Salvador performed much better for neonatal encephalopathy and tuberculosis than Peru, an upper-middle-income country.
To further illustrate how benchmarking can be implemented at the country level,
IHME is currently working with public health experts in the United Kingdom to explore changes in population health over time and to compare its health performance
to other countries with similar and higher levels of health spending. Through close
collaboration with decision-makers at the National Health Service and Public Health
England, the IHME-UK benchmarking project is examining the context in which
health progress has occurred, such as the UK’s provision of universal health coverage and its implementation of numerous public health interventions.
3
6
22
STROKE
12
18
26
22
15
4
COLOMBIA
29
7
18
5
EL SALVADOR
DOMINICA
8
14
HAITI
GUYANA
GUATEMALA
29
Note: The columns are ordered by the absolute number of YLLs for that particular year. The numbers
indicate the rank across countries for each cause in terms of age-standardized YLL rates, with 1 as the best
performance and 29 as the worst.
23
29
28
7
18
15
25
27
19
23
13
2
22
26
21
20
9
16
24
8
4
6
3
10
28
25
29
27
22
21
11
14
15
18
20
19
17
9
16
7
23
3
13
10
24
26
12
8
2
5
4
14
21
3
25
23
7
19
5
18
13
28
26
22
12
24
29
8
1
16
20
27
10
11
17
2
6
9
23
26
19
24
12
6
29
28
20
25
9
27
18
22
21
10
17
8
13
7
11
15
16
5
14
3
2
Lower than mean (95% confidence)
26
21
20
23
BELIZE
BOLIVIA
29
6
25
GRENADA
28
9
16
SURINAME
12
16
21
24
25
28
HONDURAS
SAINT VINCENT AND
THE GRENADINES
25
17
14
20
27
PARAGUAY
DOMINICAN REPUBLIC
SAINT LUCIA
13
24
17
BRAZIL
7
27
24
VENEZUELA
28
12
NICARAGUA
19
JAMAICA
19
3
10
5
2
PERU
MEXICO
10
ECUADOR
15
9
13
PANAMA
ARGENTINA
26
14
1
11
ANTIGUA AND BARBUDA
5
ROAD INJURY
17
LOWER RESPIRATORY
INFECTIONS
2
DIABETES
4
PRETERM BIRTH
COMPLICATIONS
8
28
29
21
14
25
27
15
23
8
18
16
13
19
26
10
12
17
24
7
22
9
4
6
11
20
5
3
16
27
29
24
19
15
5
10
22
8
25
17
9
11
20
14
26
1
3
28
18
21
12
4
7
6
23
23
27
18
17
29
13
28
22
24
11
15
20
9
10
14
19
1
26
21
5
16
12
6
25
8
7
4
11
17
24
26
22
18
25
13
6
12
27
15
20
4
9
21
28
14
7
29
23
10
5
19
8
1
3
29
25
10
27
13
18
28
19
16
26
6
20
15
22
21
9
17
23
14
11
12
24
5
8
7
3
1
2
4
6
8
20
23
13
4
2
3
29
5
16
9
18
10
27
21
24
7
28
25
11
12
22
15
1
26
14
19
17
7
29
25
27
28
16
9
14
10
26
4
19
23
21
8
13
20
24
22
15
12
18
11
5
17
3
6
1
2
17
3
3
29
22
14
19
5
28
10
15
6
25
29
24
15
25
6
14
19
26
18
28
11
21
27
9
13
20
12
22
16
5
10
17
23
7
9
8
4
1
2
13
7
12
20
18
1
11
8
21
4
24
16
2
26
27
23
Indistinguishable from mean (95% confidence)
18
28
5
29
13
4
26
14
1
20
21
25
16
9
17
11
27
6
24
22
15
7
19
23
3
8
10
CIRRHOSIS
1
CONGENITAL
ANOMALIES
CHILE
HIV/AIDS
URUGUAY
CHRONIC KIDNEY
DISEASE
2
COPD
16
NEONATAL
ENCEPHALOPATHY
2
DIARRHEAL DISEASES
3
SELF-HARM
2
9
29
28
6
12
16
25
20
26
15
24
7
23
19
14
18
21
17
27
13
8
11
2
10
1
22
3
4
5
4
29
14
25
27
28
21
23
17
26
20
9
13
22
18
12
15
1
16
10
24
7
6
19
5
8
3
2
11
20
7
28
29
10
8
1
6
27
18
21
4
15
13
12
16
19
11
22
5
23
26
9
17
3
14
24
2
25
6
28
24
14
20
23
29
18
26
16
25
11
8
15
27
17
1
5
19
10
7
9
13
21
4
22
12
2
3
22
26
17
2
9
6
24
11
15
1
21
5
10
20
13
25
14
7
19
12
4
3
8
28
18
23
29
16
27
15
27
23
2
17
7
25
12
22
1
13
5
14
26
19
18
16
4
24
9
10
3
6
28
8
21
29
11
20
Higher than mean (95% confidence)
10
5
7
14
21
17
13
9
4
16
3
20
25
15
24
26
6
23
19
12
2
11
27
18
1
29
22
28
8
LUNG CANCER
13
NEONATAL SEPSIS
2
DROWNING
12
HYPERTENSIVE HEART
DISEASE
2
STOMACH CANCER
1
OTHER CARDIO &
CIRCULATORY
1
COLORECTAL CANCER
4
BREAST CANCER
4
12
28
25
4
21
13
29
15
20
10
26
7
2
19
22
27
3
6
18
5
1
14
16
24
8
17
23
9
11
2
29
24
28
27
13
7
11
15
26
10
17
12
18
5
14
16
25
9
23
19
21
20
8
22
4
6
3
1
3
8
26
24
28
22
17
10
18
1
4
25
13
29
19
9
21
27
20
15
14
16
23
11
12
2
6
7
5
4
29
27
23
28
20
14
6
10
18
12
8
19
22
11
16
15
24
2
13
17
25
26
7
21
3
5
9
1
No ranking assigned
11
3
26
29
6
2
4
22
16
14
17
1
28
7
8
15
27
10
23
21
25
24
19
9
5
20
13
12
18
LEUKEMIA
15
CARDIOMYOPATHY
6
PROTEIN-ENERGY
MALNUTRITION
1
CERVICAL CANCER
1
TUBERCULOSIS
11
29
26
22
28
18
17
27
9
7
12
5
24
23
15
14
10
25
19
20
4
16
21
13
11
8
6
2
3
1
MENINGITIS
27
11
ISCHEMIC HEART
DISEASE
CUBA
FORCES OF NATURE
INTERPERSONAL
VIOLENCE
COSTA RICA
45 | GBD 2010
Figure 22: Causes of leading years of life lost, Latin America and Caribbean countries relative
to regional average, 2010
46 | GBD 2010
For the UK, GBD estimates of life expectancy and healthy life expectancy (HALE),
YLLs, YLDs, and DALYs will provide a detailed and comprehensive picture of
changes in health outcomes over time. Comparing GBD estimates across countries
will elucidate areas of health where the UK performs both better and worse than its
peers. In addition, analysis of potentially modifiable risk factors can shed light on
ways that public health policy could address major causes of ill health and premature death. The IHME-UK benchmarking study aims to identify key opportunities to
speed up the pace of health improvements in the nation.
The Global Burden of Disease provides detailed data on diseases, injuries, and risk
factors that are essential inputs for evidence-based policymaking. This collaborative
project shows that the world’s health is undergoing rapid change.
47 | GBD 2010
conclusion
GBD 2010 identified major trends in global health that can be summarized by the
three Ds: demographics, disease, and disability. As most countries have made great
strides in reducing child mortality, people are living longer and the population is
growing older. These demographic changes are driving up premature deaths and
disability, or DALYs, from non-communicable diseases. Health problems are increasingly defined not by what kills us, but what ails us. In 1990, childhood underweight
was the leading risk factor for ill health, but high body mass surpassed it in 2010 as
a more important cause of premature death and disability. This finding illustrates
global shifts away from risk factors for communicable disease in children toward
risk factors for non-communicable diseases.
GBD 2010 found that non-communicable diseases and disability caused a greater
share of health loss in 2010 compared to 1990 in most regions of the world. At the
same time, the study revealed that the leading causes of DALYs in sub-Saharan
Africa have changed little over the past 20 years. Still, GBD 2010 provides evidence
of encouraging progress in that region, such as reductions in mortality from malaria,
HIV/AIDS, and maternal conditions.
In Latin America and the Caribbean, GBD 2010 documented important regional
trends that reveal increasing disease burden due to injuries and non-communicable
diseases. Injuries from violence in Brazil, Ecuador, and a number of Central Latin
American countries are driving these regional trends. Road injuries were another
dominant cause of premature death and disability in the region. DALYs due to noncommunicable diseases such as depression, musculoskeletal disorders, chronic
kidney disease, cirrhosis, and alcohol and drug use disorders also increased in this
region between 1990 and 2010.
While disease burden estimates are useful for informing health system planning, an
alternative metric known as age-standardized rates must be used to measure health
progress in the region. Removing the effects of demographic changes by using agestandardized rates shows that most countries in Latin America and the Caribbean
have reduced rates of non-communicable diseases such as ischemic heart disease
and stroke between 1990 and 2010, but diabetes, musculoskeletal disorders, drug
use disorders, and depression remain problem areas in many countries.
Risk factors such as high sodium intake and lack of fruit, nuts and seeds, and whole
grains in the diet, overweight and obesity, high blood pressure, and alcohol use
have become important threats to public health in many countries in Latin America
and the Caribbean. While many countries have reduced health loss from risk factors
related to illness in children, these risk factors persist in countries such as Bolivia
and Haiti.
48 | GBD 2010
While GBD 2010 provides key information about health trends at global and regional
levels, its tools also allow users to view data specific to 187 countries. Similar to
the ways in which governments use financial data to monitor economic trends and
make necessary adjustments to ensure continued growth, decision-makers can use
GBD data to inform health policy. Continual updates of GBD will incorporate the
most recent data on disease patterns as well as the latest science about the effects
of different risk factors on health.
Future updates of GBD will be enriched by widening the network of collaborators.
Expanded collaboration between researchers, staff of ministries of health, and IHME
on national and subnational burden of disease studies will ensure that GBD tools
are used to understand causes of premature death and disability at the community
level. Despite the similarities in epidemiological trends in most regions, GBD illustrates the unique patterns of diseases, injuries, and risk factors that exist in different
countries. Local epidemiological assessment is crucial for informing local priorities. The GBD approach to health measurement can help guide the design of public
health interventions to ensure they are tailored to countries’ specific needs.
IHME is seeking partners interested in conducting in-depth studies of the burden of
disease in countries. Through such partnerships, IHME is helping governments and
donors gain insights into localized health trends to inform planning and policymaking. IHME is committed to building capacity for GBD analysis in countries around
the world and will be conducting a variety of training workshops. Information on
these trainings can be found at http://www.healthmetricsandevaluation.org/gbd/
training.
GBD data visualization tools can display regional and national data from burden of
disease studies. These user-friendly tools are helpful for planning, presentations,
and educational purposes. Also, IHME has designed a variety of data visualization
tools to compare trends between various raw data sources at the national level. By
visualizing all available data, ministry of health officials and researchers can quickly
identify unexpected trends in the data that they may wish to flag for further investigation.
Currently, IHME is working to expand GBD to track expenditure for particular diseases and injuries. Also, IHME is estimating utilization of outpatient and inpatient
facilities and other health services for specific diseases and injuries. Side-to-side
comparisons of these estimates to the number of DALYs from myriad causes will
allow decision-makers to evaluate health system priorities. Data on disease-specific
expenditure and disease burden are essential for policymakers facing difficult decisions about how to allocate limited resources.
49 | GBD 2010
annex
METHODS
The analytical strategy of GBD
The GBD approach contains 18 distinct components, as outlined in Figure A1. The
components of GBD are interconnected. For example, when new data is incorporated into the age-specific mortality rates analysis (component 2), other dependent
components must also be updated, such as rescaling deaths for each cause (component 5), healthy life expectancy or HALE (component 12), YLLs (component 13), and
estimation of YLLs attributable to each risk factor (component 18). The inner workings of key components are briefly described in this publication, and more detailed
descriptions of each component are included in the published articles.
Estimating age- and sex-specific mortality
Researchers identified sources of under-5 and adult mortality data from vital and
sample registration systems as well as from surveys that ask mothers about live
births and deaths of their children and ask people about siblings and their survival.
Researchers processed that data to address biases and estimated the probability
of death between ages 0 and 5 and ages 15 and 60 using statistical models. Finally,
researchers used these probability estimates as well as a model life table system to
estimate age-specific mortality rates by sex between 1970 and 2010.
Figure A1: The 18 components of GBD and their interrelations
1
2
Covariate database
3
Age-specific
mortality rates
12
Cause of death
database
4
5
Healthy life
expectancy
Estimating causes
of death
Rescaling deaths to
equal all-cause mortality
6
13
14
15
Risk factor exposure
database
7
Estimating disease
sequale prevalence,
incidence, duration
YLDs
Estimating prevalence
of risk factor exposure
16
Estimating relative risks
for risk-disease pairs
17
DALY’s attributable
to conditions and
injuries
Theoretical minimum
risk exposure
8
9
11
18
YLLs attributable
to each risk
YLDs attributable
to each risk
Disease sequelae
epidemiology database
YLLs
Comorbidity simulation
DALY’s
attributable
to risk factors
10
Disability weights
Cross-validation of
impairment levels
Nature and external
causes of injury analysis
50 | GBD 2010
Estimating years lost due to premature death
Researchers compiled all available data on causes of death from 187 countries.
Information about causes of death was derived from vital registration systems,
mortality surveillance systems, censuses, surveys, hospital records, police records,
mortuaries, and verbal autopsies. Verbal autopsies are surveys that collect information from individuals familiar with the deceased about the signs and symptoms the
person had prior to death. GBD 2010 researchers closely examined the completeness of the data. For those countries where cause of death data were incomplete,
researchers used statistical techniques to compensate for the inherent biases. They
also standardized causes of death across different data sources by mapping different versions of the International Classification of Diseases coding system to the GBD
cause list.
Next, researchers examined the accuracy of the data, scouring rows and rows of
data for “garbage codes.” Garbage codes are misclassifications of death in the data,
and researchers identified thousands of them. Some garbage codes are instances
when we know the cause listed cannot possibly lead to death. Examples found in
records include “abdominal rigidity,” “senility,” and “yellow nail syndrome.” To
correct these, researchers drew on evidence from medical literature, expert judgment, and statistical techniques to reassign each of these to more probable causes
of death.
After addressing data-quality issues, researchers used a variety of statistical models
to determine the number of deaths from each cause. This approach, named CODEm
Figure A2: Leading causes of death and premature death in Latin America and Caribbean, 2010
Ischemic heart disease
Stroke
Lower respiratory infections
Forces of nature
Diabetes
Interpersonal violence
COPD
Chronic kidney disease
Road injury
Cirrhosis
Hypertensive heart disease
Lung cancer
0
3
6
9
12
15
% total deaths or YLLs
Deaths
YLLs
51 | GBD 2010
(Cause of Death Ensemble modeling), was designed based on statistical techniques
called “ensemble modeling.” Ensemble modeling was made famous by the recipients of the Netflix Prize in 2009, BellKor’s Pragmatic Chaos, who engineered the best
algorithm to predict how much a person would like a film, taking into account their
movie preferences.
To ensure that the number of deaths from each cause does not exceed the total
number of deaths estimated in a separate GBD demographic analysis, researchers
apply a correction technique named CoDCorrect. This technique makes certain that
estimates of the number of deaths from each cause do not add up to more than
100% of deaths in a given year.
After producing estimates of the number of deaths from each of the 235 fatal
outcomes included in the GBD cause list, researchers then calculated years of life
lost to premature death, or YLLs. For every death from a particular cause, researchers estimated the number of years lost based on the highest life expectancy in the
deceased’s age group. For example, if a 20-year-old male died in a car accident in
Brazil in 2010, he has 66 years of life lost, which is the highest remaining life expectancy in 20 year olds, as experienced by 20-year-old females in Japan.
When comparing rankings of the leading causes of death versus YLLs, YLLs place
more weight on the causes of death that occur in younger age groups, as shown in
Figure A2. For example, road injury represents a greater percentage of total YLLs
than total deaths since it is a leading killer of young men. Ischemic heart disease,
by contrast, accounts for a smaller percentage of total YLLs than total deaths as it
primarily kills older people.
Estimating years lived with disability
Researchers estimated the prevalence of each sequela using different sources
of data, including government reports of cases of infectious diseases, data from
population-based disease registries for conditions such as cancers and chronic
kidney diseases, antenatal clinic data, hospital discharge data, data from outpatient
facilities, interview questions, and direct measurements of hearing, vision, and lung
function testing from surveys and other sources.
Confronted with the challenge of data gaps in many regions and for numerous
types of sequelae, they developed a statistical modeling tool named DisMod-MR
(Disease Modeling – Metaregression) to estimate prevalence using available data
on incidence, prevalence, remission, duration, and extra risk of mortality due to the
disease.
Researchers estimated disability weights using data collected from almost 14,000
respondents via household surveys in Bangladesh, Indonesia, Peru, Tanzania, and
the United States. Disability weights measure the severity of different sequelae that
result from disease and injury. Data were also used from an Internet survey of more
than 16,000 people. GBD researchers presented different lay definitions of sequelae
52 | GBD 2010
grouped into 220 unique health states to survey respondents, and respondents were
then asked to rate the severity of the different health states. The results were similar
across all surveys despite cultural and socioeconomic differences. Respondents
consistently placed health states such as mild hearing loss and long-term treated
fractures at the low end of the severity scale, while they ranked acute schizophrenia
and severe multiple sclerosis as very severe.
Finally, years lived with disability, or YLDs, are calculated as prevalence of a sequela
multiplied by the disability weight for that sequela. The number of years lived with
disability for a specific disease or injury are calculated as the sum of the YLDs from
each sequela arising from that cause.
Estimating disability-adjusted life years
DALYs are calculated by adding together YLLs and YLDs. Figure A3 compares the 10
leading diseases and injuries calculated as percentages of both deaths and DALYs
in Latin America and the Caribbean. This figure also shows the top 10 risk factors attributable to deaths and DALYs worldwide. It illustrates how a decision-maker looking only at the top 10 causes of death would fail to see the importance of low back
pain, for example, which was a leading cause of DALYs in 2010. DALYs are a powerful tool for priority setting as they measure disease burden from non-fatal as well
as fatal conditions. Yet another reason why top causes of DALYs differ from leading
causes of death is that DALYs give more weight to death in younger ages, as illustrated by the case of preterm birth complications. In contrast, stroke causes a much
larger percentage of total deaths than DALYs as it primarily impacts older people.
Estimating DALYs attributable to risk factors
To estimate the number of healthy years lost, or DALYs, attributable to potentially
avoidable risk factors, researchers collected detailed data on exposure to different
risk factors. The study used data from sources such as satellite data on air pollution, breastfeeding data from population surveys, and blood and bone lead levels
from medical examination surveys and epidemiological surveys. Researchers then
collected data on the effects of risk factors on disease outcomes through systematic
reviews of epidemiological studies.
All risk factors analyzed met common criteria in four areas:
1. The likely importance of a risk factor for policymaking or disease burden.
2. Availability of sufficient data to estimate exposure to a particular risk factor.
3. Rigorous scientific evidence that specific risk factors cause certain diseases
and injuries.
4. Scientific findings about the effects of different risk factors that are relevant for the general population.
53 | GBD 2010
To calculate the number of DALYs attributable to different risk factors, researchers compared the disease burden in a group exposed to a risk factor to the disease
burden in a group that had zero exposure to that risk factor. When subjects with zero
exposure were impossible to find, as in the case of high blood pressure, for example, researchers established a level of minimum exposure that leads to the best
health outcomes.
Figure A3: The 10 leading diseases and injuries and 10 leading risk factors based on
percentage of deaths and DALYs in Latin America and Caribbean, 2010
10
Dietary risks
8
High blood pressure
High body mass index
6
Alcohol use
Forces of nature
DALYs (%)
Tobacco smoking
Interpersonal violence
Ischemic heart disease
High fasting plasma glucose
Major depressive disorder Lower respiratory
infections
Road injury
4
Stroke
Physical inactivity and low physical activity
Low back pain
Preterm birth Diabetes
complications
COPD
2
High total cholesterol
Iron deficiency
Chronic kidney disease
Cirrhosis Household air pollution from solid fuels
Occupational
risks
Lead exposure
0
0
5
10
15
20
25
Deaths (%)
Diseases and injuries
Risk factors
Note: This figure compares the percent of DALYs and deaths attributable to different diseases and injuries (shown in blue) as well as risk factors (shown in red). Certain causes, such as low back pain, cause a
substantial numbers of DALYs, but do not cause death. DALYs are an important tool for decision-makers
because they capture years of health loss from both fatal and non-fatal causes.
54 | GBD 2010
Table A1: Age-standardized death rates, years of life lost, and years lived with disability, and life
expectancy at birth and healthy life expectancy at birth for 1990 and 2010 for both sexes combined
Country
Age-standardized death rate (per 100,000)
1990
Age-standardized YLL rate (per 100,000)
2010
1990
2010
Rate
Rank
Rate
Rank
Rate
Rank
Rate
Rank
Antigua and Barbuda
728
(688-755)
8
(6-11)
593
(553-626)
9
(6-12)
19,168
(17,688-20,207)
8
(4-10)
13,919
(12,685-14,906)
5
(4-8)
Argentina
731
(725-736)
9
(8-10)
597
(593-602)
8
(8-10)
19,400
(19,003-19,767)
9
(7-10)
14,343
(14,163-14,574)
7
(5-8)
Belize
765
(744-788)
15
(12-16)
805
(755-840)
26
(24-26)
20,556
(19,736-21,501)
11
(10-11)
21,887
(20,335-22,992)
25
(24-25)
Bolivia
1,136
(1,087-1,188)
27
(27-27)
751
(685-816)
22
(20-25)
41,077
(38,858-43,587)
28
(28-28)
23,965
(21,599-26,251)
26
(26-27)
Brazil
854
(846-863)
20
(19-22)
670
(665-674)
17
(15-19)
26,370
(25,718-27,152)
20
(18-24)
17,580
(17,240-17,932)
15
(13-18)
Chile
760
(752-767)
13
(12-16)
490
(482-500)
2
(2-2)
18,210
(17,880-18,511)
4
(4-6)
11,136
(10,920-11,448)
3
(2-3)
Colombia
760
(744-777)
12
(12-16)
617
(596-650)
12
(9-13)
23,157
(22,513-23,791)
14
(13-15)
16,372
(15,704-17,370)
11
(11-14)
Costa Rica
556
(547-561)
1
(1-1)
462
(458-468)
1
(1-1)
13,705
(13,321-14,011)
1
(1-1)
10,447
(10,266-10,723)
1
(1-1)
Cuba
635
(628-639)
3
(2-3)
543
(539-550)
4
(4-6)
15,919
(15,589-16,144)
2
(2-2)
11,088
(10,949-11,312)
2
(2-3)
Dominica
831
(791-862)
19
(17-20)
669
(633-698)
16
(13-19)
24,475
(22,878-25,789)
16
(14-17)
19,240
(17,857-20,438)
20
(18-21)
Dominican Republic
765
(744-784)
16
(12-16)
683
(647-707)
18
(15-19)
23,701
(22,900-24,580)
15
(14-16)
18,385
(17,220-19,211)
18
(16-20)
Ecuador
700
(690-710)
6
(5-7)
522
(503-537)
3
(3-4)
22,420
(21,787-23,068)
12
(12-13)
14,956
(14,197-15,576)
9
(7-10)
El Salvador
809
(796-821)
18
(17-19)
661
(648-673)
15
(14-17)
26,931
(25,998-27,888)
23
(19-25)
18,474
(17,953-19,050)
19
(16-21)
Grenada
904
(864-931)
24
(22-25)
850
(801-881)
27
(26-27)
25,983
(24,460-27,214)
19
(17-23)
21,313
(20,003-22,093)
24
(22-25)
Guatemala
1,061
(1,045-1,081)
26
(26-26)
787
(768-800)
25
(23-26)
36,242
(35,061-37,857)
27
(26-27)
24,337
(23,537-25,018)
27
(26-27)
Guyana
1,199
(1,168-1,226)
28
(28-28)
1,124
(1,029-1,204)
28
(28-28)
35,469
(34,461-36,558)
26
(26-27)
31,305
(28,306-34,444)
28
(28-28)
Haiti
1,717
(1,662-1,780)
29
(29-29)
3,321
(2,404-5,352)
29
(29-29)
61,823
(59,254-64,644)
29
(29-29)
137,295
(92,238-242,719)
29
(29-29)
Honduras
869
(824-905)
21
(20-22)
784
(674-886)
24
(20-27)
26,454
(25,019-27,652)
21
(18-24)
20,507
(17,522-23,158)
21
(18-25)
Jamaica
676
(655-692)
4
(4-5)
610
(546-675)
11
(6-16)
18,618
(17,687-19,484)
6
(4-8)
16,417
(14,769-18,115)
12
(9-16)
Mexico
740
(732-749)
11
(10-12)
604
(599-609)
10
(9-12)
22,775
(22,171-23,502)
13
(12-15)
15,658
(15,365-15,976)
10
(9-11)
Nicaragua
762
(740-787)
14
(12-16)
652
(627-674)
14
(13-16)
25,101
(24,193-26,213)
17
(16-21)
16,911
(16,141-17,602)
13
(11-15)
Panama
634
(612-653)
2
(2-3)
545
(517-572)
5
(4-6)
16,812
(16,180-17,495)
3
(3-3)
14,027
(13,274-14,832)
6
(5-8)
Paraguay
682
(662-704)
5
(4-6)
725
(680-755)
21
(19-22)
18,868
(18,201-19,603)
7
(5-9)
18,059
(16,871-18,867)
17
(14-19)
Peru
803
(772-830)
17
(17-19)
551
(525-586)
6
(4-7)
27,953
(26,604-29,275)
25
(23-25)
14,679
(13,854-15,802)
8
(5-10)
Saint Lucia
891
(855-917)
23
(21-24)
722
(674-765)
20
(18-24)
25,875
(24,517-27,048)
18
(17-22)
17,785
(16,657-18,882)
16
(13-19)
Saint Vincent and the
Grenadines
890
(851-918)
22
(21-24)
753
(715-781)
23
(21-24)
26,567
(25,188-27,741)
22
(18-24)
20,602
(19,344-21,589)
22
(21-24)
Suriname
922
(891-945)
25
(24-25)
693
(657-723)
19
(17-20)
27,022
(25,994-28,010)
24
(20-25)
20,892
(19,769-21,856)
23
(21-25)
Uruguay
731
(722-737)
10
(8-10)
585
(576-597)
7
(7-9)
18,332
(17,966-18,632)
5
(4-7)
13,126
(12,874-13,473)
4
(4-5)
Venezuela
716
(710-723)
7
(7-8)
630
(609-650)
13
(11-14)
19,688
(19,256-20,199)
10
(8-10)
17,271
(16,542-17,901)
14
(12-16)
55 | GBD 2010
Age-standardized YLD rate (per 100,000)
1990
Life expectancy at birth
2010
1990
Health-adjusted life expectancy at birth
2010
1990
2010
Rate
Rank
Rate
Rank
LE
Rank
LE
Rank
HALE
Rank
HALE
Rank
12,425
(10,114-14,947)
15
(5-26)
13,535
(11,001-16,340)
26
(17-28)
73.1
(72.2-73.9)
6
(4-10)
76.5
(75.3-77.8)
7
(4-11)
62.7
(60.4-64.7)
10
(4-12)
64.3
(61.6-66.8)
12
(9-18)
11,154
(9,280-13,517)
4
(2-13)
10,843
(8,885-13,183)
4
(2-14)
72.5
(72.5-72.6)
10
(8-11)
76.0
(75.9-76.0)
9
(7-10)
63.1
(61.2-64.7)
7
(3-11)
66.1
(64.0-67.9)
7
(4-10)
12,951
(10,597-15,751)
22
(9-28)
13,377
(10,984-16,145)
25
(17-28)
72.0
(71.4-72.7)
11
(9-13)
71.2
(70.2-72.3)
24
(22-27)
61.2
(58.9-63.2)
13
(11-16)
60.2
(57.9-62.5)
27
(22-27)
13,140
(10,762-15,753)
25
(12-28)
12,020
(9,912-14,691)
15
(7-23)
62.3
(61.2-63.3)
28
(28-28)
70.7
(68.9-72.6)
26
(21-27)
53.2
(51.2-55.0)
28
(28-28)
60.8
(58.2-63.1)
25
(19-27)
12,016
(9,914-14,293)
8
(6-17)
11,637
(9,670-13,849)
9
(6-17)
69.1
(68.9-69.3)
19
(19-23)
74.1
(73.9-74.3)
16
(14-19)
59.6
(57.8-61.3)
18
(16-20)
64.0
(62.0-65.7)
13
(12-16)
11,185
(9,275-13,408)
3
(2-10)
10,407
(8,562-12,391)
2
(2-8)
72.9
(72.8-73.0)
8
(6-8)
78.5
(78.3-78.8)
2
(2-2)
63.4
(61.5-65.1)
5
(3-10)
68.6
(66.7-70.4)
2
(1-2)
12,110
(10,117-14,453)
10
(5-21)
11,643
(9,671-13,882)
10
(6-17)
71.1
(70.6-71.4)
14
(13-16)
75.0
(74.1-75.9)
12
(9-16)
61.1
(59.2-62.8)
14
(12-16)
64.7
(62.6-66.6)
11
(9-15)
11,672
(9,509-14,109)
6
(2-20)
10,948
(8,973-13,312)
5
(2-15)
76.6
(76.5-76.9)
1
(1-1)
79.4
(79.3-79.6)
1
(1-1)
66.0
(63.7-68.0)
1
(1-1)
68.9
(66.5-70.7)
1
(1-2)
11,765
(9,701-14,144)
7
(3-17)
12,791
(10,606-15,454)
19
(14-26)
74.8
(74.8-74.9)
2
(2-3)
77.9
(77.8-78.0)
3
(3-4)
64.6
(62.5-66.4)
2
(2-3)
66.1
(63.7-68.1)
8
(4-10)
12,486
(10,211-15,200)
17
(6-27)
13,022
(10,598-15,773)
22
(14-27)
70.3
(69.5-71.1)
16
(14-18)
73.8
(72.6-74.9)
17
(12-21)
60.2
(57.9-62.1)
16
(13-20)
62.4
(60.0-64.6)
19
(16-23)
12,154
(10,079-14,515)
11
(5-23)
12,232
(10,027-14,893)
17
(9-23)
70.8
(70.3-71.3)
15
(14-17)
73.7
(72.8-74.7)
19
(12-21)
60.8
(58.8-62.6)
15
(12-17)
63.1
(60.7-65.1)
17
(13-20)
12,265
(10,092-14,749)
13
(6-24)
11,404
(9,398-13,802)
8
(4-16)
72.0
(71.7-72.2)
12
(11-12)
77.0
(76.3-77.8)
4
(4-8)
61.6
(59.5-63.4)
12
(11-15)
66.4
(64.2-68.4)
6
(3-9)
12,585
(10,404-15,075)
18
(6-27)
11,781
(9,628-14,217)
13
(5-22)
69.6
(69.4-69.8)
18
(17-19)
74.2
(73.8-74.6)
15
(13-18)
59.4
(57.3-61.2)
19
(16-24)
63.9
(61.7-65.7)
15
(11-18)
13,149
(10,849-15,692)
24
(11-28)
13,076
(10,621-15,932)
24
(15-27)
68.9
(68.1-69.6)
23
(18-25)
71.0
(70.1-71.8)
25
(23-27)
58.7
(56.8-60.7)
20
(17-25)
60.5
(58.1-62.6)
26
(21-27)
12,800
(10,661-15,434)
20
(11-27)
11,705
(9,739-13,977)
12
(6-18)
64.5
(64.3-64.6)
26
(26-27)
70.5
(70.1-70.9)
27
(25-27)
55.2
(53.3-56.8)
26
(26-27)
61.0
(59.1-62.5)
24
(20-27)
13,663
(11,198-16,537)
28
(18-29)
14,024
(11,510-17,112)
27
(21-28)
64.1
(63.4-64.8)
27
(26-27)
66.0
(64.1-67.9)
28
(28-28)
54.6
(52.5-56.6)
27
(26-27)
55.9
(53.3-58.3)
28
(28-28)
15,059
(12,201-18,249)
29
(27-29)
16,428
(13,131-19,964)
29
(29-29)
54.1
(53.2-55.0)
29
(29-29)
38.0
(26.0-45.9)
29
(29-29)
45.7
(43.9-47.4)
29
(29-29)
32.4
(22.4-38.8)
29
(29-29)
12,940
(10,740-15,593)
23
(10-28)
12,485
(10,455-14,904)
18
(11-26)
68.9
(68.1-69.6)
21
(18-25)
71.9
(69.2-74.4)
23
(14-27)
58.7
(56.7-60.5)
21
(18-25)
61.6
(58.8-64.3)
22
(15-27)
12,075
(9,895-14,594)
9
(3-23)
12,909
(10,470-15,647)
20
(13-27)
73.6
(72.9-74.3)
4
(3-7)
75.4
(72.8-77.7)
11
(4-21)
63.2
(61.1-65.2)
6
(3-11)
63.8
(60.8-66.6)
16
(9-21)
10,092
(8,414-12,094)
1
(1-1)
9,364
(7,762-11,245)
1
(1-1)
71.5
(71.2-71.9)
13
(12-14)
75.5
(75.2-75.7)
10
(9-12)
62.9
(61.1-64.4)
8
(5-11)
66.9
(65.2-68.4)
3
(3-6)
12,459
(10,173-15,019)
16
(5-27)
11,835
(9,676-14,369)
14
(5-22)
70.3
(69.8-70.8)
17
(15-17)
74.4
(73.7-75.0)
14
(12-18)
60.0
(57.9-61.9)
17
(14-21)
64.0
(61.6-65.9)
14
(10-18)
12,186
(10,066-14,758)
12
(4-25)
11,151
(9,167-13,447)
7
(2-16)
74.5
(73.9-75.1)
3
(2-4)
76.7
(75.8-77.6)
5
(4-9)
63.8
(61.6-65.7)
3
(2-9)
66.5
(64.1-68.4)
5
(3-9)
12,337
(10,187-14,701)
14
(6-26)
12,006
(9,966-14,443)
16
(8-22)
73.2
(72.8-73.6)
5
(4-8)
73.2
(72.4-74.1)
20
(17-22)
62.6
(60.5-64.5)
11
(6-12)
62.9
(60.7-64.7)
18
(15-21)
12,854
(10,540-15,507)
21
(10-28)
11,692
(9,610-13,997)
11
(5-21)
68.9
(68.3-69.4)
22
(19-25)
76.4
(75.4-77.4)
8
(4-11)
58.6
(56.5-60.5)
24
(19-25)
65.7
(63.5-67.8)
9
(4-12)
13,328
(10,973-16,233)
27
(14-28)
14,233
(11,621-17,595)
28
(23-28)
68.9
(68.2-69.6)
20
(18-25)
73.7
(72.1-75.5)
18
(11-22)
58.7
(56.4-60.5)
23
(18-25)
61.6
(58.6-64.3)
21
(17-27)
13,233
(10,716-16,044)
26
(10-28)
13,056
(10,686-15,847)
23
(15-27)
68.7
(67.9-69.6)
24
(19-25)
72.0
(71.1-73.0)
22
(20-25)
58.5
(56.4-60.6)
25
(18-25)
61.2
(58.8-63.2)
23
(20-27)
12,827
(10,347-15,593)
19
(8-28)
12,945
(10,510-15,516)
21
(14-27)
68.5
(67.7-69.3)
25
(20-25)
72.6
(71.3-74.0)
21
(16-24)
58.6
(56.5-60.6)
22
(18-25)
61.6
(59.2-64.1)
20
(18-26)
11,007
(9,132-13,189)
2
(2-8)
10,540
(8,708-12,586)
3
(2-7)
73.0
(72.9-73.2)
7
(5-8)
76.5
(76.2-76.9)
6
(5-9)
63.6
(61.7-65.2)
4
(3-8)
66.8
(65.0-68.5)
4
(3-7)
11,583
(9,621-14,158)
5
(2-18)
10,994
(9,072-13,268)
6
(2-15)
72.6
(72.5-72.6)
9
(8-10)
74.5
(73.7-75.3)
13
(11-18)
62.8
(60.6-64.5)
9
(5-11)
64.9
(62.9-66.6)
10
(8-15)
56 | GBD 2010
CHANGES IN LEADING CAUSES OF DALYS BETWEEN 1990 AND
2010 FOR COUNTRIES IN LATIN AMERICA AND CARIBBEAN
In the following figures, pointed arrows indicate causes that have increased by a
greater amount than shown on the x-axis. For more country data, explore IHME’s
data visualization tools online: www.ihmeuw.org/GBDcountryviz.
Shifts in leading causes of DALYs in Antigua and Barbuda, 1990-2010
RankingsoftotalDALYsfortop20causesinAntiguaandBarbuda,1990-2010
%changeintotalDALYs,1990-2010
-40
-20
0
20
40
1
2
3
60
80
100
120
140
DIABETES
ISCHEMICHEARTDISEASE
MAJORDEPRESSIVEDISORDER
4
STROKE
5
LOWBACKPAIN
6
IRON-DEFICIENCYANEMIA
7
PRETERMBIRTHCOMPLICATIONS
8
DRUGUSEDISORDERS
9
ANXIETYDISORDERS
10
ALCOHOLUSEDISORDERS
11
ROADINJURY
12
ADVERSEMEDICALTREATMENT
13
HIV/AIDS
14
LOWERRESPIRATORYINFECTIONS
15 OTHERMUSCULOSKELETAL
16
NECKPAIN
17
18
19
20
FALLS
ASTHMA
OTHERCARDIO&CIRCULATORY
PROSTATECANCER
160
180
200
57 | GBD 2010
Shifts in leading causes of DALYs in Argentina, 1990-2010
RankingsoftotalDALYsfortop20causesinArgentina,1990-2010
%changeintotalDALYs,1990-2010
-50
-40
-30
-20
-10
0
10
1
20
30
40
50
60
70
ISCHEMICHEARTDISEASE
2
STROKE
3
MAJORDEPRESSIVEDISORDER
4
LOWBACKPAIN
5
LOWERRESPIRATORYINFECTIONS
6
ROADINJURY
7
COPD
8
PRETERMBIRTHCOMPLICATIONS
9
DIABETES
10
OTHERMUSCULOSKELETAL
11
NECKPAIN
12
CONGENITALANOMALIES
13
LUNGCANCER
14
ANXIETYDISORDERS
15
SELF-HARM
16
OTHERCARDIO&CIRCULATORY
17
DRUGUSEDISORDERS
18
INTERPERSONALVIOLENCE
19
FALLS
20
CIRRHOSIS
Shifts in leading causes of DALYs in Belize, 1990-2010
RankingsoftotalDALYsfortop20causesinBelize,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
80
1
2
120
ROADINJURY
3
DIABETES
4
5
100
HIV/AIDS
ISCHEMICHEARTDISEASE
IRON-DEFICIENCYANEMIA
6
MAJORDEPRESSIVEDISORDER
7
LOWERRESPIRATORYINFECTIONS
8
INTERPERSONALVIOLENCE
9
PRETERMBIRTHCOMPLICATIONS
10
LOWBACKPAIN
11
CONGENITALANOMALIES
12
STROKE
13
DRUGUSEDISORDERS
14
ASTHMA
15
NEONATALENCEPHALOPATHY
16
DIARRHEALDISEASES
17
18
19
20
DROWNING
NECKPAIN
SELF-HARM
OTHERMUSCULOSKELETAL
140
160
180
200
58 | GBD 2010
Shifts in leading causes of DALYs in Bolivia, 1990-2010
RankingsoftotalDALYsfortop20causesinBolivia,1990-2010
%changeintotalDALYs,1990-2010
-80
-60
-40
-20
0
20
40
60
80
100
120
140
160
180
1
LOWERRESPIRATORYINFECTIONS
2
DIARRHEALDISEASES
3
PRETERMBIRTHCOMPLICATIONS
4
CONGENITALANOMALIES
5
ROADINJURY
6
ISCHEMICHEARTDISEASE
7
IRON-DEFICIENCYANEMIA
8
NEONATALENCEPHALOPATHY
9
STROKE
10
LOWBACKPAIN
11
MAJORDEPRESSIVEDISORDER
12
TUBERCULOSIS
13
DIABETES
14
HIV/AIDS
15
NEONATALSEPSIS
16
COPD
17 CHRONICKIDNEYDISEASE
18
CIRRHOSIS
19
INTERPERSONALVIOLENCE
20
NECKPAIN
Shifts in leading causes of DALYs in Brazil, 1990-2010
RankingsoftotalDALYsfortop20causesinBrazil,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
40
2
LOWBACKPAIN
4
STROKE
5
ROADINJURY
6
MAJORDEPRESSIVEDISORDER
7
8
PRETERMBIRTHCOMPLICATIONS
DIABETES
9
10
COPD
11
HIV/AIDS
12
CONGENITALANOMALIES
13
ANXIETYDISORDERS
14
OTHERMUSCULOSKELETAL
15
NECKPAIN
16
ALCOHOLUSEDISORDERS
17
ASTHMA
18
IRON-DEFICIENCYANEMIA
NEONATALENCEPHALOPATHY
80
INTERPERSONALVIOLENCE
3
LOWERRESPIRATORYINFECTIONS
60
ISCHEMICHEARTDISEASE
CIRRHOSIS
19
20
100
200
59 | GBD 2010
Shifts in leading causes of DALYs in Chile, 1990-2010
RankingsoftotalDALYsfortop20causesinChile,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
180
200
ISCHEMICHEARTDISEASE
2
LOWBACKPAIN
3
STROKE
4
MAJORDEPRESSIVEDISORDER
5
ROADINJURY
6
CIRRHOSIS
7
NECKPAIN
8
OTHERMUSCULOSKELETAL
9
SELF-HARM
10
ANXIETYDISORDERS
11
COPD
12
DIABETES
13
LOWERRESPIRATORYINFECTIONS
14
FALLS
15
ALCOHOLUSEDISORDERS
16
CONGENITALANOMALIES
17
STOMACHCANCER
18 CHRONICKIDNEYDISEASE
19
DRUGUSEDISORDERS
20
ALZHEIMER'SDISEASE
Shifts in leading causes of DALYs in Colombia, 1990-2010
RankingsoftotalDALYsfortop20causesinColombia,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
80
100
120
1
INTERPERSONALVIOLENCE
2
ISCHEMICHEARTDISEASE
3
MAJORDEPRESSIVEDISORDER
4
HIV/AIDS
5
LOWBACKPAIN
6
ROADINJURY
7
IRON-DEFICIENCYANEMIA
8
LOWERRESPIRATORYINFECTIONS
9
CONGENITALANOMALIES
10
PRETERMBIRTHCOMPLICATIONS
11
STROKE
12 ANXIETYDISORDERS
13
COPD
14
OTHERMUSCULOSKELETAL
15
DIABETES
16
NECKPAIN
17
NEONATALENCEPHALOPATHY
DIARRHEALDISEASES
19
20
18
EPILEPSY
ASTHMA
140
160
180
200
60 | GBD 2010
Shifts in leading causes of DALYs in Costa Rica, 1990-2010
RankingsoftotalDALYsfortop20causesinCostaRica,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
1
60
80
100
120
140
160
180
200
ISCHEMICHEARTDISEASE
2
MAJORDEPRESSIVEDISORDER
3
LOWBACKPAIN
4
ROADINJURY
5
ASTHMA
6
OTHERMUSCULOSKELETAL
7
CONGENITALANOMALIES
8
NECKPAIN
9
COPD
10
INTERPERSONALVIOLENCE
11
STROKE
12
CHRONICKIDNEYDISEASE
13
ANXIETYDISORDERS
14
CIRRHOSIS
15
EPILEPSY
16
SELF-HARM
17
PRETERMBIRTHCOMPLICATIONS
18
DRUGUSEDISORDERS
19
LOWERRESPIRATORYINFECTIONS
20
DIABETES
Shifts in leading causes of DALYs in Cuba, 1990-2010
RankingsoftotalDALYsfortop20causesinCuba,1990-2010
%changeintotalDALYs,1990-2010
-40
-20
0
1
20
40
2
100
120
140
MAJORDEPRESSIVEDISORDER
4
LOWBACKPAIN
5
DIABETES
6
LUNGCANCER
7
COPD
8
LOWERRESPIRATORYINFECTIONS
80
STROKE
3
ROADINJURY
60
ISCHEMICHEARTDISEASE
FALLS
9
10
11
IRON-DEFICIENCYANEMIA
12
ADVERSEMEDICALTREATMENT
13
ASTHMA
14
NECKPAIN
15
OTHERMUSCULOSKELETAL
16
SELF-HARM
17
ANXIETYDISORDERS
19
20
ALZHEIMER'SDISEASE
18
OSTEOARTHRITIS
MIGRAINE
160
180
200
61 | GBD 2010
Shifts in leading causes of DALYs in Dominica, 1990-2010
RankingsoftotalDALYsfortop20causesinDominica,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
1
20
40
60
80
100
120
140
160
180
DIABETES
2
ISCHEMICHEARTDISEASE
3
MAJORDEPRESSIVEDISORDER
4
STROKE
5
ROADINJURY
6
LOWBACKPAIN
7
PRETERMBIRTHCOMPLICATIONS
8
LOWERRESPIRATORYINFECTIONS
9
IRON-DEFICIENCYANEMIA
10
PROSTATECANCER
HIV/AIDS
11
ASTHMA
12
13
OTHERCARDIO&CIRCULATORY
14
ADVERSEMEDICALTREATMENT
15
ALCOHOLUSEDISORDERS
16
NEONATALSEPSIS
17
DRUGUSEDISORDERS
18
OTHERMUSCULOSKELETAL
19
FALLS
20
NECKPAIN
Shifts in leading causes of DALYs in Dominican Republic, 1990-2010
RankingsoftotalDALYsfortop20causesintheDominicanRepublic,1990-2010
%changeintotalDALYs,1990-2010
-50
0
50
1
100
ISCHEMICHEARTDISEASE
2
PRETERMBIRTHCOMPLICATIONS
3
ROADINJURY
4
STROKE
5
HIV/AIDS
6
LOWERRESPIRATORYINFECTIONS
7
DIABETES
8
IRON-DEFICIENCYANEMIA
9
10
MAJORDEPRESSIVEDISORDER
CONGENITALANOMALIES
11
INTERPERSONALVIOLENCE
12
LOWBACKPAIN
13
NEONATALSEPSIS
14
NEONATALENCEPHALOPATHY
15
ADVERSEMEDICALTREATMENT
16
DIARRHEALDISEASES
17
18
ANXIETYDISORDERS
NECKPAIN
19
COPD
20
ASTHMA
150
200
200
62 | GBD 2010
Shifts in leading causes of DALYs in Ecuador, 1990-2010
RankingsoftotalDALYsfortop20causesinEcuador,1990-2010
%changeintotalDALYs,1990-2010
-50
0
50
1
100
150
200
ROADINJURY
2
LOWERRESPIRATORYINFECTIONS
3
INTERPERSONALVIOLENCE
4
ISCHEMICHEARTDISEASE
5
LOWBACKPAIN
6
MAJORDEPRESSIVEDISORDER
7
IRON-DEFICIENCYANEMIA
8
STROKE
9
PRETERMBIRTHCOMPLICATIONS
10
DIABETES
11
CONGENITALANOMALIES
12
HIV/AIDS
13 ANXIETYDISORDERS
14
CHRONICKIDNEYDISEASE
15
NECKPAIN
16
COPD
17 ALCOHOLUSEDISORDERS
18 OTHERMUSCULOSKELETAL
19
SELF-HARM
20
DIARRHEALDISEASES
Shifts in leading causes of DALYs in El Salvador, 1990-2010
RankingsoftotalDALYsfortop20causesinElSalvador,1990-2010
%changeintotalDALYs,1990-2010
-80
-60
-40
-20
0
20
40
1
60
80
100
120
INTERPERSONALVIOLENCE
2
ISCHEMICHEARTDISEASE
3
ROADINJURY
4
MAJORDEPRESSIVEDISORDER
5
LOWERRESPIRATORYINFECTIONS
6
LOWBACKPAIN
7
DIABETES
8
ALCOHOLUSEDISORDERS
9
CONGENITALANOMALIES
10
CHRONICKIDNEYDISEASE
11
PRETERMBIRTHCOMPLICATIONS
12
ASTHMA
13
SELF-HARM
14
CIRRHOSIS
15
IRON-DEFICIENCYANEMIA
16
STROKE
17
18
19
20
OTHERMUSCULOSKELETAL
ANXIETYDISORDERS
NECKPAIN
HIV/AIDS
140
160
180
200
63 | GBD 2010
Shifts in leading causes of DALYs in Grenada, 1990-2010
RankingsoftotalDALYsfortop20causesinGrenada,1990-2010
%changeintotalDALYs,1990-2010
-80
-60
-40
-20
0
20
40
60
80
100
120
140
160
180
200
1
ISCHEMICHEARTDISEASE
2
DIABETES
3
STROKE
MAJORDEPRESSIVEDISORDER 4
5
LOWERRESPIRATORYINFECTIONS
6
IRON-DEFICIENCYANEMIA
7
ROADINJURY
8
LOWBACKPAIN
9
OTHERCARDIO&CIRCULATORY
10
OTHERMUSCULOSKELETAL
11
DRUGUSEDISORDERS
12
HIV/AIDS
13
PRETERMBIRTHCOMPLICATIONS
14
ASTHMA
15
ADVERSEMEDICALTREATMENT
16
NEONATALENCEPHALOPATHY
17
CHRONICKIDNEYDISEASE
18
FALLS
19
ALCOHOLUSEDISORDERS
20
NECKPAIN
Shifts in leading causes of DALYs in Guatemala, 1990-2010
RankingsoftotalDALYsfortop20causesinGuatemala,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
80
2
INTERPERSONALVIOLENCE
3
DIARRHEALDISEASES
4
PRETERMBIRTHCOMPLICATIONS
5
ISCHEMICHEARTDISEASE
6
MAJORDEPRESSIVEDISORDER
7
IRON-DEFICIENCYANEMIA
8
LOWBACKPAIN
9
DIABETES
10
CIRRHOSIS
11
PROTEIN-ENERGYMALNUTRITION
12
CONGENITALANOMALIES
13
HIV/AIDS
14
NEONATALENCEPHALOPATHY
STROKE
15
16
17
18
EPILEPSY
ROADINJURY
ANXIETYDISORDERS
19
NEONATALSEPSIS
100
1
LOWERRESPIRATORYINFECTIONS
CHRONICKIDNEYDISEASE
20
120
140
160
180
200
64 | GBD 2010
Shifts in leading causes of DALYs in Guyana, 1990-2010
RankingsoftotalDALYsfortop20causesinGuyana,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
40
60
80
100
120
140
160
180
ISCHEMICHEARTDISEASE
2
HIV/AIDS
3
DIABETES
4
STROKE
5
SELF-HARM
6
IRON-DEFICIENCYANEMIA
7
PRETERMBIRTHCOMPLICATIONS
8
MAJORDEPRESSIVEDISORDER
9
LOWERRESPIRATORYINFECTIONS
10
ROADINJURY
11
INTERPERSONALVIOLENCE
12
DIARRHEALDISEASES
13
CONGENITALANOMALIES
14
CIRRHOSIS
15
LOWBACKPAIN
16
NEONATALENCEPHALOPATHY
HYPERTENSIVEHEARTDISEASE
17
ASTHMA
18
FALLS
19
20
ANXIETYDISORDERS
Shifts in leading causes of DALYs in Haiti, 1990-2010
RankingsoftotalDALYsfortop20causesinHaiti,1990-2010
%changeintotalDALYs,1990-2010
-80
-60
-40
-20
0
20
40
60
80
1
100
120
FORCESOFNATURE
2
DIARRHEALDISEASES
3
LOWERRESPIRATORYINFECTIONS
4
IRON-DEFICIENCYANEMIA
5
STROKE
6
TUBERCULOSIS
7
DIABETES
8
NEONATALSEPSIS
9
INTERPERSONALVIOLENCE
10
ISCHEMICHEARTDISEASE
11
PRETERMBIRTHCOMPLICATIONS
12
NEONATALENCEPHALOPATHY
13
HIV/AIDS
14
PROTEIN-ENERGYMALNUTRITION
15
MENINGITIS
16
ROADINJURY
17
MAJORDEPRESSIVEDISORDER
18
SYPHILIS
19
CONGENITALANOMALIES
20
LOWBACKPAIN
140
160
180
200
200
65 | GBD 2010
Shifts in leading causes of DALYs in Honduras, 1990-2010
RankingsoftotalDALYsfortop20causesinHonduras,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
1
60
80
100
120
140
160
180
200
INTERPERSONALVIOLENCE
2
ISCHEMICHEARTDISEASE
3 MAJORDEPRESSIVEDISORDER
4
DIARRHEALDISEASES
5
PRETERMBIRTHCOMPLICATIONS
6
STROKE
7
HIV/AIDS
8
LOWERRESPIRATORYINFECTIONS
9
LOWBACKPAIN
10
ROADINJURY
11
NEONATALENCEPHALOPATHY
12
COPD
13
ASTHMA
14
IRON-DEFICIENCYANEMIA
15
EPILEPSY
16
DIABETES
17
ANXIETYDISORDERS
18
OTHERMUSCULOSKELETAL
19
NECKPAIN
20
NEONATALSEPSIS
Shifts in leading causes of DALYs in Jamaica, 1990-2010
RankingsoftotalDALYsfortop20causesinJamaica,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
80
1
2
120
140
DIABETES
3
STROKE
4
INTERPERSONALVIOLENCE
5
ISCHEMICHEARTDISEASE
6
MAJORDEPRESSIVEDISORDER
7
IRON-DEFICIENCYANEMIA
8
LOWBACKPAIN
9
NEONATALENCEPHALOPATHY
10
PRETERMBIRTHCOMPLICATIONS
11
12
ASTHMA
HYPERTENSIVEHEARTDISEASE
13
LOWERRESPIRATORYINFECTIONS
14
ADVERSEMEDICALTREATMENT
15
ANXIETYDISORDERS
16
DIARRHEALDISEASES
CONGENITALANOMALIES
100
HIV/AIDS
NECKPAIN
17
18
FALLS
19
ROADINJURY
20
160
180
200
66 | GBD 2010
Shifts in leading causes of DALYs in Mexico, 1990-2010
RankingsoftotalDALYsfortop20causesinMexico,1990-2010
%changeintotalDALYs,1990-2010
-50
0
50
100
1
DIABETES
2
ISCHEMICHEARTDISEASE
3
150
200
CHRONICKIDNEYDISEASE
4
ROADINJURY
5
INTERPERSONALVIOLENCE
6
CIRRHOSIS
7
CONGENITALANOMALIES
8
LOWERRESPIRATORYINFECTIONS
9
LOWBACKPAIN
10
MAJORDEPRESSIVEDISORDER
11
STROKE
12
PRETERMBIRTHCOMPLICATIONS
13
OTHERMUSCULOSKELETAL
14
NECKPAIN
15
COPD
16
EPILEPSY
17
NEONATALENCEPHALOPATHY
18
DIARRHEALDISEASES
19
MIGRAINE
20
ALCOHOLUSEDISORDERS
Shifts in leading causes of DALYs in Nicaragua, 1990-2010
RankingsoftotalDALYsfortop20causesinNicaragua,1990-2010
%changeintotalDALYs,1990-2010
-80
-60
-40
-20
0
1
20
40
60
80
100
120
ISCHEMICHEARTDISEASE
2
LOWERRESPIRATORYINFECTIONS
3
CONGENITALANOMALIES
4
MAJORDEPRESSIVEDISORDER
5
PRETERMBIRTHCOMPLICATIONS
6
LOWBACKPAIN
7
CHRONICKIDNEYDISEASE
8
DIARRHEALDISEASES
9
DIABETES
10
STROKE
11
NEONATALENCEPHALOPATHY
12
ROADINJURY
13
ALCOHOLUSEDISORDERS
14
INTERPERSONALVIOLENCE
15
IRON-DEFICIENCYANEMIA
16
NEONATALSEPSIS
17
CIRRHOSIS
18
OTHERMUSCULOSKELETAL
19
ASTHMA
ANXIETYDISORDERS
20
140
160
67 | GBD 2010
Shifts in leading causes of DALYs in Panama, 1990-2010
RankingsoftotalDALYsfortop20causesinPanama,1990-2010
%changeintotalDALYs,1990-2010
-40
-20
0
20
40
1
60
80
2
120
140
160
180
200
HIV/AIDS
3
MAJORDEPRESSIVEDISORDER
4
LOWBACKPAIN
5
ROADINJURY
6
STROKE
7
INTERPERSONALVIOLENCE
8
CONGENITALANOMALIES
100
ISCHEMICHEARTDISEASE
DIABETES
9
10
LOWERRESPIRATORYINFECTIONS
11
IRON-DEFICIENCYANEMIA
12
PRETERMBIRTHCOMPLICATIONS
13
ASTHMA
14
OTHERMUSCULOSKELETAL
15
EPILEPSY
16
NECKPAIN
17
CHRONICKIDNEYDISEASE
18
COPD
19
ANXIETYDISORDERS
20
DIARRHEALDISEASES
Shifts in leading causes of DALYs in Paraguay, 1990-2010
RankingsoftotalDALYsfortop20causesinParaguay,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
40
60
80
100
120
2
STROKE
3
MAJORDEPRESSIVEDISORDER
4
ROADINJURY
5
LOWBACKPAIN
6
PRETERMBIRTHCOMPLICATIONS
7
DIABETES
8
LOWERRESPIRATORYINFECTIONS
9
INTERPERSONALVIOLENCE
10
CONGENITALANOMALIES
11
NEONATALENCEPHALOPATHY
DIARRHEALDISEASES
IRON-DEFICIENCYANEMIA
12
13
14
NEONATALSEPSIS
15
NECKPAIN
16
17
COPD
OTHERMUSCULOSKELETAL
18
19
20
140
ISCHEMICHEARTDISEASE
CHRONICKIDNEYDISEASE
MIGRAINE
ALCOHOLUSEDISORDERS
160
180
200
68 | GBD 2010
Shifts in leading causes of DALYs in Peru, 1990-2010
RankingsoftotalDALYsfortop20causesinPeru,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
80
100
120
140
160
180
200
1
LOWERRESPIRATORYINFECTIONS
2
MAJORDEPRESSIVEDISORDER
3
ISCHEMICHEARTDISEASE
4
LOWBACKPAIN
5
ROADINJURY
6
IRON-DEFICIENCYANEMIA
7
PRETERMBIRTHCOMPLICATIONS
8
NEONATALENCEPHALOPATHY
9
STROKE
10
ANXIETYDISORDERS
11
ASTHMA
12
CONGENITALANOMALIES
13
NECKPAIN
14
NEONATALSEPSIS
15
OTHERMUSCULOSKELETAL
16
COPD
17
HIV/AIDS
18
CIRRHOSIS
19
DIABETES
20
TUBERCULOSIS
Shifts in leading causes of DALYs in Saint Lucia, 1990-2010
RankingsoftotalDALYsfortop20causesinSaintLucia,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
40
60
2
STROKE
80
100
120
140
DIABETES
FORCESOFNATURE
3
4
ISCHEMICHEARTDISEASE
5
ROADINJURY
6
PRETERMBIRTHCOMPLICATIONS
7
MAJORDEPRESSIVEDISORDER
8
LOWBACKPAIN
9
IRON-DEFICIENCYANEMIA
10
INTERPERSONALVIOLENCE
11
LOWERRESPIRATORYINFECTIONS
12
HIV/AIDS
13
ASTHMA
14
OTHERCARDIO&CIRCULATORY
15
OTHERMUSCULOSKELETAL
16
NEONATALENCEPHALOPATHY
17
ADVERSEMEDICALTREATMENT
18
CONGENITALANOMALIES
19
20
NECKPAIN
ALCOHOLUSEDISORDERS
160
180
200
69 | GBD 2010
Shifts in leading causes of DALYs in Saint Vincent and the Grenadines, 1990-2010
RankingsoftotalDALYsfortop20causesinSaintVincentandtheGrenadines,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
1
2
40
60
80
100
120
140
160
180
200
ISCHEMICHEARTDISEASE
DIABETES
3
PRETERMBIRTHCOMPLICATIONS
4
STROKE
5
HIV/AIDS
6
MAJORDEPRESSIVEDISORDER
7
IRON-DEFICIENCYANEMIA
8
LOWBACKPAIN
9
INTERPERSONALVIOLENCE
10
LOWERRESPIRATORYINFECTIONS
11
ROADINJURY
12
ALCOHOLUSEDISORDERS
13
CONGENITALANOMALIES
14
FALLS
15
OTHERMUSCULOSKELETAL
16
ASTHMA
17
DRUGUSEDISORDERS
18
ADVERSEMEDICALTREATMENT
19
OTHERCARDIO&CIRCULATORY
20
NECKPAIN
Shifts in leading causes of DALYs in Suriname, 1990-2010
RankingsoftotalDALYsfortop20causesinSuriname,1990-2010
%changeintotalDALYs,1990-2010
-40
-20
0
20
40
1
60
80
100
120
HIV/AIDS
2
STROKE
3
PRETERMBIRTHCOMPLICATIONS
4
ISCHEMICHEARTDISEASE
5
SELF-HARM
6
MAJORDEPRESSIVEDISORDER
7
ROADINJURY
8
DIABETES
9
IRON-DEFICIENCYANEMIA
10
LOWBACKPAIN
11
NEONATALENCEPHALOPATHY
CONGENITALANOMALIES
12
13
LOWERRESPIRATORYINFECTIONS
14
CHRONICKIDNEYDISEASE
15
ADVERSEMEDICALTREATMENT
16
ASTHMA
17
NECKPAIN
18
INTERPERSONALVIOLENCE
19
20
OTHERMUSCULOSKELETAL
FALLS
140
160
180
200
70 | GBD 2010
Shifts in leading causes of DALYs in Uruguay, 1990-2010
RankingsoftotalDALYsfortop20causesinUruguay,1990-2010
%changeintotalDALYs,1990-2010
-50
-40
-30
-20
-10
0
10
20
30
40
50
60
70
80
1
ISCHEMICHEARTDISEASE
2
STROKE
3
LOWBACKPAIN
4
MAJORDEPRESSIVEDISORDER
5
COPD
6
LUNGCANCER
7
DIABETES
8
ROADINJURY
9
OTHERMUSCULOSKELETAL
10
NECKPAIN
11
LOWERRESPIRATORYINFECTIONS
12
ALZHEIMER'SDISEASE
13
SELF-HARM
14
COLORECTALCANCER
15
FALLS
BREASTCANCER
16
OTHERCARDIO&CIRCULATORY
17
18
ANXIETYDISORDERS
19
CONGENITALANOMALIES
20
ASTHMA
Shifts in leading causes of DALYs in Venezuela, 1990-2010
RankingsoftotalDALYsfortop20causesinVenezuela,1990-2010
%changeintotalDALYs,1990-2010
-60
-40
-20
0
20
40
60
1
80
100
120
INTERPERSONALVIOLENCE
2
ISCHEMICHEARTDISEASE
3
ROADINJURY
4
MAJORDEPRESSIVEDISORDER
5
HIV/AIDS
6
LOWBACKPAIN
7
STROKE
8
DIABETES
9
PRETERMBIRTHCOMPLICATIONS
10
LOWERRESPIRATORYINFECTIONS
11
CONGENITALANOMALIES
12
OTHERMUSCULOSKELETAL
13
CHRONICKIDNEYDISEASE
14
15
DIARRHEALDISEASES
17
18
19
20
NECKPAIN
ANXIETYDISORDERS
16
IRON-DEFICIENCYANEMIA
ASTHMA
COPD
EPILEPSY
140
160
180
200