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World Health Stat Q. 1988;41(3-4):255-66.

The global impact of noncommunicable diseases: estimates and projections.

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  • 1Center for Demographic Studies, Duke University, Durham, North Carolina.


With the aging of populations in developing countries there is both a demographic and an epidemiological transition which affects the impact of chronic degenerative diseases on the health status of the populations. Demographic transition takes place in countries where there are effective programmes of disease control which allow for survival during the early years of childhood and adolescence. This results in an increase in life expectancy which places larger proportions of the population in the age range (60 years and older) in which chronic degenerative diseases become the major determinants of health status. Epidemiological transition in diseases may also be brought about by shifts in social and economic patterns which favour detrimental changes in risk factors for the chronic degenerative diseases. Such changes may include health-related behaviour which augments dietary consumption of fats and alcohol, increases obesity, increases smoking and decreases physical activity. Such changes in risk-factor levels increase the prevalence of chronic degenerative diseases which manifest themselves at later ages, and for which early preventive actions could be cost-effective. In order to illustrate the impact of both demographic and risk-factor effects, analyses are made of the impact of increases in life expectancy on cause-specific mortality in both developing and developed countries. It is shown that there is great similarity in the effect of major noncommunicable diseases on the life expectancy of adults in both developed and developing countries. The major differences are seen to be in the proportions of deaths expected from such diseases as cancer, diabetes, heart disease, stroke and cirrhosis; but not in the distribution of age at death which is the better measure of disease impact. Demographic analyses, computing indirect estimates of mortality, also demonstrate that there are currently more chronic disease deaths in developing than developed countries and that as expectation of life increases in developing countries the global chronic disease burden will be greatly concentrated in the developing countries. Analyses of risk-factor reduction by feasible intervention strategies, e.g. smoking cessation campaigns, treatment of high blood pressure, using relationships between risk factors and diseases established in longitudinal studies carried out in developed countries, point out that the effect of risk-factor control in long-living populations can be hidden by the dependency of risk factors and various related causes of death, e.g. smoking has an impact on lung cancer, ischaemic heart disease and emphysema, but at different ages.(ABSTRACT TRUNCATED AT 400 WORDS)


As public health measures decrease the number of deaths due to infectious diseases, life expectancy will increase and chronic and degenerative diseases will claim a greater part of the public health resources. Moreover, many of these diseases are directly related to certain preventable risk factors, which it would be advantageous to identify and eliminate before they become major problems in developing countries. First, demographic analyses, using multiple decrement life tables, were performed to show 1) the survival experience of persons in the population who would die of a disease, given the current cause-specific mortality rates, 2) the life expectancy at any age in the table for a given cause of death, and 3) the gain in life expectancy among persons expected to die of the disease. Second, models were constructed for assessing the effects of risk factors and their change over time. The 1st part of this analysis used hazard functions to relate the risk of disease or death to the values of the risk factor; the 2nd part used linear regression equations to project future values of the risk factors as a function of their past values. Data for the life tables were drawn from World Health Organization cause-specific mortality profiles for cancer, diabetes, cirrhosis, stroke, and heart disease in highly developed, moderately developed, and less developed nations. Data for assessing the effects of various risk factor interventions were drawn from the Framingham Study of cardiovascular disease. Risk factors used were serum cholesterol, blood pressure, smoking, Quetelet index, blood sugar, hemoglobin, vital capacity and age. Demographic analysis showed that the effects of major noncommunicable diseases on life expectancy was not significantly different in developed and developing countries; there were differences in the proportions of deaths from the 5 diseases analyzed but not in the distribution of age at death. Moreover, numerically there are currently more chronic disease deaths in developing than in developed countries, and as life expectancy increases and fertility declines, the impact of noncommunicable diseases will rapidly increase in those countries. Analysis of risk-factor reduction by intervention, such as nonsmoking campaigns and low cholesterol diets, showed that such interventions would be cost-effective, but less so at some ages than at others. Nevertheless, such interventions would be worthwhile if they prevented unhealthful life styles from gaining a foothold in these countries.

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