Our aim was to calculate the global burden of disease and risk factors for 2001, to
examine regional trends from 1990 to 2001, and to provide a starting point for the
analysis of the Disease Control Priorities Project (DCPP).
We calculated mortality, incidence, prevalence, and disability adjusted life years
(DALYs) for 136 diseases and injuries, for seven income/geographic country groups.
To assess trends, we re-estimated all-cause mortality for 1990 with the same methods
as for 2001. We estimated mortality and disease burden attributable to 19 risk factors.
About 56 million people died in 2001. Of these, 10.6 million were children, 99% of
whom lived in low-and-middle-income countries. More than half of child deaths in 2001
were attributable to acute respiratory infections, measles, diarrhoea, malaria, and
HIV/AIDS. The ten leading diseases for global disease burden were perinatal conditions,
lower respiratory infections, ischaemic heart disease, cerebrovascular disease, HIV/AIDS,
diarrhoeal diseases, unipolar major depression, malaria, chronic obstructive pulmonary
disease, and tuberculosis. There was a 20% reduction in global disease burden per
head due to communicable, maternal, perinatal, and nutritional conditions between
1990 and 2001. Almost half the disease burden in low-and-middle-income countries is
now from non-communicable diseases (disease burden per head in Sub-Saharan Africa
and the low-and-middle-income countries of Europe and Central Asia increased between
1990 and 2001). Undernutrition remains the leading risk factor for health loss. An
estimated 45% of global mortality and 36% of global disease burden are attributable
to the joint hazardous effects of the 19 risk factors studied. Uncertainty in all-cause
mortality estimates ranged from around 1% in high-income countries to 15-20% in Sub-Saharan
Africa. Uncertainty was larger for mortality from specific diseases, and for incidence
and prevalence of non-fatal outcomes.
Despite uncertainties about mortality and burden of disease estimates, our findings
suggest that substantial gains in health have been achieved in most populations, countered
by the HIV/AIDS epidemic in Sub-Saharan Africa and setbacks in adult mortality in
countries of the former Soviet Union. Our results on major disease, injury, and risk
factor causes of loss of health, together with information on the cost-effectiveness
of interventions, can assist in accelerating progress towards better health and reducing
the persistent differentials in health between poor and rich countries.