Top Causes of Death in Low and Middle Income Countries

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"We are dealing with the biggest epidemic in
world history. "Without urgent action there
certainly is a real risk of a major wipe-out of
indigenous communities, if not total extinction,
within this century.
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The Growing Burden of Noncommunicable
Diseasesin the Developing World
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Global Burden of Disease 2000, by group
Group III 13
Group II 46
Group I 41

• Group I Communicable, infectious, maternal and
  perinatal
• Group II Noncommunicable, chronic
• Group III Injuries and Violence

Based on the composite indicator, DALYs (YLL
YLD)
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CVD is the leading cause of death in low- and
middle-income countries
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Comparison of low- and high-mortality developing
countries
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NCDs are the leading causes of disability
Based on prevalence, severity, and duration
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NCDs cause a significant burden of disease
Based on the composite indicator, DALYs (YLL
YLD)
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Disease burden, by region
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Demographic and Epidemiologic Transitions

• Demographic transition- coined in 1945 to
  describe changes in birth and death rates which
  accompanied modernization (social and economic
  development)
• Epidemiologic transition- came into use in 1970s
  to describe the change in disease patterns and
  drop in under 5 mortality which led to the
  demographic transition

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The classic description of the epidemiologic
transition

• 1) the age of famine and pestilence
• 2) the age of receding epidemics
• 3) the age of degenerative and human-made
  diseases

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Demographic Epidemiologic Transitions

• The process of the demographic may be much more
  variable then previously thought
• (Coale Watkins, 1986)
• There are no development thresholds
• There is no fixed sequence of events
• There is no fixed interval between events
• In many cases, there is now a double burden of
  non-communicable and communicable diseases

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Burden of Risk Factors

• Less well studied than burden of disease
• Comparative Risk Assessment project

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Health Inequalities

• Among the poorest people, NCDs are still uncommon
• On the other hand, in higher-income countries,
  major RFs (tobacco, etoh, poor diet, and
  inactivity) are directly correlated with poverty.
  
• Relationships are complex and variable
• India rates of HTN, DM, CVD increase with income
• tobacco use, in contrast, is highest among
  the poorest
• Jamaica obesity is highest among the wealthiest
  and poorest

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Risk factors accumulate with time
It is likely that the link between poverty and
NCDs will be more pronounced in the future
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Anticipating the growing burden of NCDs
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Projected Disease Burden
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What do you think?
1) We can wait until infectious diseases are
controlled2) Chronic diseases are diseases of
affluence and age3) Chronic diseases result from
freely adopted risks4) Infectious disease models
are applicable to NCDs