MORTALITY BY CAUSE FOR 8 REGIONS OF THE WORLD - GLOBAL BURDEN OF DISEASE STUDY

Background Reliable information on causes of death is essential to the development of national and international health policies for prevent ion and control of disease and injury. Medically certified information is available for less than 30% of the estimated 50.5 million deaths t hat occur each year worldwide. However, other data sources can be used to develop cause-of-death estimates for populations. To be useful, es timates must be internally consistent, plausible, and reflect epidemio logical characteristics suggested by community-level data, The Global Burden of Disease Study (GBD) used various data sources and made corre ctions for miscoding of important diseases (eg, ischaemic heart diseas e) to estimate worldwide and regional cause-of-death patterns in 1990 for 14 age-sex groups in eight regions, for 107 causes. Methods Prelim inary estimates were developed with available vital-registration data, sample-registration data for India and China, and small-scale populat ion-study data sources, Registration data were corrected for miscoding , and Lorenz-curve analysis was used to estimate cause-of-death patter ns in areas without registration. Preliminary estimates were modified to reflect the epidemiology of selected diseases and injuries. Final e stimates were checked to ensure that numbers of deaths in specific age -sex groups did not exceed estimates suggested by independent demograp hic methods. Findings 98% of all deaths in children younger than 15 ye ars are in the developing world. 83% and 59% of deaths at 15-59 and 70 years, respectively, are in the developing world. The probability of death between birth and 15 years ranges from 22.0% in sub-Saharan Afri ca to 1.1% in the established market economies. Probabilities of death between 15 and 60 years range from 7.2% for women in established mark et economies to 39.1% for men in sub-Saharan Africa. The probability o f a man or woman dying from a non-communicable disease is higher in su b-Saharan Africa and other developing regions than in established mark et economies. Worldwide in 1990, communicable, maternal, perinatal, an d nutritional disorders accounted for 17.2 million deaths, non-communi cable diseases for 28.1 million deaths and injuries for 5.1 million de aths. The leading causes of death in 1990 were ischaemic heart disease (6.3 million deaths), cerebrovascular accidents (4.4 million deaths), lower respiratory infections (4.3 diseases (2.9 million), perinatal m illion), chronic obstructive pulmonary disease (2.2 million), tubercul osis (2.0 million), measles (1.1 million), road-traffic accidents (1.0 million), and lung cancer (0.9 million). Interpretation Five of the t en leading killers are communicable, perinatal, and nutritional disord ers largely affecting children. Non-communicable diseases are, however , already major public health challenges in all regions, Injuries, whi ch account for 10% of global mortality, are often ignored as a major c ause of death and may require innovative strategies to reduce their to ll. The estimates by cause have wide CIs, but provide a foundation for a more informed debate on public-health priorities.