Feature articles

Global causes of death

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2016) is the most comprehensive worldwide observational epidemiological study to date and is funded by philanthropic grants.  It examines trends from 1990 and makes comparisons across populations. There are numerous articles published in The Lancet available open access at http://www.thelancet.com/gbd

We summarise one of the most relevant research papers here:

Global, regional, national comparative risk assessment of 84 behavioural and occupational, and metabolic risks or clusters of risk: a systematic analysis.

KEY FINDINGS

  • An estimated 72·3% (39·5 million) of all deaths in 2016 were from non-communicable diseases.
  • Smoking and poor diet remain leading risk factors of ill health.
  • Levels of obesity continue to rise worldwide.
  • Diabetes caused 1·43 million deaths in 2016, an increase of 31·1% since 2006.
  • Since 2006, deaths from ischaemic heart disease (IHD) have increased by 19% globally.

Poor diet remains a leading risk factor of ill health.
Poor dietary habits accounted for nearly one in every five deaths. Among all forms of malnutrition, poor dietary habits, particularly low intake of healthy foods, is the leading risk factor for mortality. While maternal and child malnutrition posed the highest level of risk globally, among the middle-high SDI (Socio-Demographic Index) countries dietary risks were number one, followed very closely by high systolic blood pressure. The decade of 2016-25 has been declared as the Decade of Action on Nutrition by the United Nations General Assembly.

Definition of poor diet

Diets low in: Diets high in:
  • fruits  & vegetables
  • legumes & wholegrains
  • nuts and seeds
  • fibre
  • calcium
  • polyunsaturated fatty acids (PUFA)  
  • omega-3 PUFA
  • milk
  • red meat
  • processed meat
  • added sugars
  • sugar-sweetened beverages
  • trans fats
  • sodium

Of note, from 1990 to 2016 SEVs (Summary Exposure Variable) decreased by more than 40% for a diet high in trans fatty acids, and increased more than 40% for a diet high in sugar-sweetened beverages.

What is SDI?
The Socio-Demographic Index (SDI) is a metric that measures a country's level of development.

What is a SEV?
Summary Exposure Variable of 0% reflects no risk exposure in a population and 100% indicates that an entire population is exposed to the maximum possible level for that risk.

Obesity continues to rise
The SEV for high BMI has increased by more than 40% since 1990.

A high BMI is the second leading risk factor in terms of attributable DALYs for women, after high systolic blood pressure (SBP), and this is higher than for men for whom smoking is number one followed by high SBP. High BMI shows an increasing trend with increasing SDI.

Diabetes is rising
Diabetes caused 1·43 million deaths in 2016, an increase of 31·1% since 2006.
Fasting plasma glucose levels have increased globally, and likely tied to the increase in BMI. While prevalence of diabetes is increasing, deaths from diabetes have been declining, probably due to better clinical management.

Heart disease leads the causes of early death
Since 2006, deaths from Ischaemic Heart Disease (IHD) have increased by 19% globally.
IHD is the leading cause of premature mortality in all SDI categories apart from the low SDI grouping. Within the non-communicable disease, IHD caused 93.3% of deaths and 94.4% of DALYs and a high proportion is attributable to measured risk factors.

Behavioural and metabolic risk factors
Metabolic risk factors are those for metabolic disease and include high systolic blood pressure, high BMI, high fasting plasma glucose, high cholesterol, low bone mineral density and impaired kidney function. In 2016 in 113 countries, the leading risk factors in terms of attributable DALYs were metabolic risk factors.

Behavioural risk factors are those that exert strong influence on health, such as diet, physical activity, unsafe sex, alcohol, tobacco and other drug use.

Behavioural risk factors accounted for 32·7% of attributable DALYs, followed by metabolic risk factors at 16·8%, and environmental and occupational at 13·1%. The importance of metabolic risk factors is growing in low and low-middle SDI locations.

Alcohol
Alcohol is estimated to be the 7th leading risk factor globally, in both DALYs and deaths. Minor or non-significant preventive effects of alcohol were found for causes previously thought to have large preventive effects. Alcohol use is positively correlated with SDI.

Changes over time

Metabolic risks have increased
Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks.
Among the risks that are leading causes of burden of disease, metabolic risks such as BMI and high fasting plasma glucose, showed significant increases.

No improvement in mental health
The prevalence of mental health conditions globally shows little improvement since 1990. Indeed, major depressive disorders ranked in the top ten causes of ill health in all but four countries worldwide in 2016.

Conclusions
Poor diet, obesity, high fasting plasma glucose and high systolic blood pressure are the most prominent global risks requiring attention.
The authors highlight the need for comprehensive food system interventions to promote the production, distribution and consumption of healthy foods across nations.

NEXT: The Low FODMAP Diet 

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