People are living longer but sicker and unhealthier lives

Shobha Shukla, Citizen News Service - CNS
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So says a report published recently in the Lancet by an international consortium of researchers and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" is the first of its kind study to examine the extent, pattern, and trends of nonfatal health losses across countries and provides a comprehensive description of morbidity levels and patterns worldwide.

“Many countries around the world have made great progress in addressing fatal diseases, but nonfatal illnesses pose the next major threat in terms of disease burden,” said Professor Theo Vos of IHME, the study’s lead author. “The need to meet the challenge of nonfatal diseases and injuries only becomes more urgent as the population increases and people live longer.”

Using a measurement known as years lived with disability (YLDs)—a measure of overall disease burden, expressed in terms of number of years lost due to ill health-- researchers have quantified the impact of health problems that impair mobility/hearing/vision, or cause pain but are not fatal.

YLDs per person increased in 139 of the 188 countries (having populations above 50,000) between 1990 and 2013, indicating that while people are living longer they are not living healthy and are spending more time in poor health. Thus non-fatal diseases and injuries are taking a big toll on health worldwide. The leading causes of years lived with disability have remained largely the same during this period, but they are taking an increased toll on health due to population growth and aging.

Here are some other salient features of the report:
  • Globally, only 4·3% of the population had no burden of disease or injury in 2013.

  • Between 1990 and 2013, YLDs increased from 537.6 million in 1990 to 764.8 million in 2013 for both sexes and the proportion of disability-adjusted life years due to YLDs increased from 21.1% to 31.2%.

  • Men and women share the same leading causes of YLDs, with the exception of schizophrenia as a leading cause for men and other musculoskeletal disorders for women.

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In 2013, low back pain and major depressive disorder were among the top 10 leading causes of YLDs in every country. The disease burdens of both these disorders increased more than 50% since 1990.
Other top 10 causes include musculoskeletal disorders, mental and substance use disorders, neurological disorders, chronic respiratory conditions, migraine, COPD, and diabetes. Mental and substance abuse disorders caused one-fifth of disabling conditions. HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa.

War and conflict was another leading cause of YLDs in several countries, and was the top cause in Cambodia, Nicaragua, and Rwanda. Other notable causes of YLDs in different regions included falls (Central Europe), asthma (a top-10 cause in Latin America), and opioid dependence (a top-5 cause in several Middle Eastern countries).

For India, top ten causes of YLDs were (i) major depressive disorder, (ii) back pain, (iii) anemia due to iron deficiency, (iv) migraine, (v) COPD, (vi) hearing impairment, (vii) neck pain, (viii) diabetes, (ix) anxiety, and (x) refraction in that order.

During 1990-2013, the increase in numbers of YLDs was 136% from diabetes; 89% from cardiovascular diseases; 55% from chronic respiratory diseases; 60% from neurological disorders and 45% from mental and substance use disorders.

Compared with 1990, both HIV and malaria YLDs increased in 2013.

Two disorders-- upper respiratory infections and diarrheal diseases—had an incidence of more than 2 billion new cases of disease globally in 2013.

The number of people with anaemia rose from 1·83 billion in 1990 to 1·93 billion in 2013. Worldwide, the number of individuals who had heart failure increased by 96·4%.

Researchers also found that as people aged they experienced a greater number of ailments due to nonfatal diseases and injuries. During 1990-2013, the number of people suffering from 10 or more ailments increased by 52%. Of the 2.3 billion people who suffered from more than five ailments, 81% were below 65 years. Also in the oldest age group, there were 1·4 times more women than men with ten or more ailments.

So while countries have made significant progress in addressing fatality and delaying death, the years of life lived with good health are decreasing too. We have been able to delay death but not ill health. In all countries, there has been a substantial increase in the numbers of individuals with diseases and injuries and the share of disability in total disease burden is increasing because of ageing populations and a much slower decline in YLD rates compared to the decline in mortality rates.

Up-to-date evidence about trends in disease and injury incidence, prevalence, and YLDs is an essential input into global, regional, and national health policies. The nonfatal dimensions of disease and injury will require more and more attention from health systems.

“What ails you is not necessarily what kills you,” said IHME Director Dr Christopher Murray. “As nonfatal illnesses and related ailments affect more people of all ages, countries must look closely at health policies and spending to target these conditions.”

Shobha Shukla, Citizen News Service - CNS
10 June 2015

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