GLOBAL AND REGIONAL CAUSE-OF-DEATH PATTERNS IN 1990

Demographic estimation techniques suggest that worldwide about 50 mill ion deaths occur each year, of which about 39 million are in the devel oping countries. In countries with adequate registration of vital stat istics, the age at death and the cause can be reliably determined. Onl y about 30-35% of all deaths are captured by vital registration (exclu ding sample registration schemes); for the remainder, cause-of-death e stimation procedures are required. indirect methods which model the ca use-of-death structure as a function of the level of mortality can pro vide reasonable estimates for broad cause-of-death groups. Such method s are generally unreliable for more specific causes. In this case, est imates can be constructed from community-level mortality surveillance systems or from epidemiological evidence on specific diseases. Some ch eck on the plausibility of the estimates is possible in view of the hi erarchical structure of cause-of-death lists and the well-known age-sp ecific patterns of diseases and injuries. The results of applying thes e methods to estimate the causes of death for over 120 diseases or inj uries, by age, sex and region, are described. The estimates have been derived in order to calculate the years of life lost due to premature death, one of the two components of overall disability-adjusted life y ears (DALYs) calculated for the 1993 World development report. Previou s attempts at cause-of-death estimation have been limited to a few dis eases only, with little age-specific detail. The estimates reported in detail here should serve as a useful reference for further public hea lth research to support the determination of health sector priorities.