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Worldwide Study Finds Big Shift in Causes of Death


The first comprehensive, worldwide study of how people die has produced a number of startling findings, including the prediction that within 25 years smoking will become the single largest cause of death and disability in the world.

A five-year study by an international team headquartered at the Harvard University School of Public Health also found that noncommunicable diseases such as cancer, heart disease and diabetes already cause more deaths in the developing world than infectious diseases. This contradicts the prevailing belief that the noncommunicable diseases primarily strike the affluent.

The study, to be released today, found that depression, also thought to be largely associated with affluence, accounts for a full 10% of productive years lost throughout the world.

One of the bleakest outlooks is for residents of the former Soviet empire. Largely as a result of smoking, alcoholism and accidents, men in that region face a 28% risk of death between the ages of 15 and 60, the highest risk anywhere outside sub-Saharan Africa.

Because of this rapidly changing nature of death, the report argues, international health agencies should curtail their funding of routine vaccination programs and health care delivery and focus instead on research and development to minimize the impact of noncommunicable diseases.

The report is a "historic achievement," said Dr. Barry R. Bloom of the Albert Einstein College of Medicine in New York City. "It shows that health risks will increasingly be shared across countries, that the health differences between countries will be narrowed."

It provides "a global health agenda" that suggests to health agencies how money can best be spent "to get the most healthy life," added Bloom, who is co-chairman of the Board on International Health of the National Academy of Sciences.

The study, called "The Global Burden of Disease," is "an encyclopedic work and an heroic undertaking," added John C. Caldwell, president of the International Union for the Scientific Study of Population. "There are pictures emerging from this book that most of us previously did not even dare to guess about."

The report was necessary because many regions collect no death data at all and lack even the most basic data needed to direct health programs and guide research, according to Dr. Christopher J. L. Murray of Harvard, co-chairman of the committee that prepared the study, which was supported by the World Health Organization.

Most death rates for infectious diseases and other causes in developing countries, he said, are produced by groups trying to raise money to combat that disease and who often exaggerate its importance. If the previously available estimates of disease were all correct, he noted, some people in a given age group or region would have to die at least twice to account for all the deaths claimed.

At the opposite extreme, Murray said, "If there are no advocates for a condition, it never shows up at all."

The team collected all the available government statistics for deaths and disabling conditions. Perhaps more important, in areas where data was not good, the researchers sampled a total of more than 14 million death certificates from which they could project numbers for the country or region as a whole.

The researchers also tabulated years of productive life lost to disability. They were then able to combine the number of years lost to disability with those lost to premature death to get a clearer idea of what they termed "disease burden."

The first two volumes of results (of a projected 10 volumes) total 1,880 pages packed with insights into the ways people die.

Just over 50 million people died in 1990, the base year for the report. Worldwide, one of every three died from either communicable diseases, childbirth or malnutrition. Virtually all of those deaths were in developing regions. One of 10 deaths resulted from injuries caused by accidents, wars, suicides and homicides. About 55.8% of all deaths were from noncommunicable diseases, a proportion that is expected to jump to 73% by 2020.

By that same year, the report says, car accidents will be the world's fifth-leading cause of death and disability as developing nations build more roads and the number of young adults--those most often killed in traffic mishaps--increases.

Surprisingly, Murray said, the team found that noncommunicable diseases were already responsible for more deaths than infectious diseases in all areas of the world except India and sub-Saharan Africa. Many researchers now mistakenly believe that once people in such developing regions get to adulthood, they have a greater chance of surviving than residents of developed countries because they have a low-fat, high-fiber diet, they smoke less and get more exercise, he said. "That's not the case, and we need to find out why."

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