Introduction to Public Health January 29,

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Learning Objectives for January 29 Introduce the Global Burden of Disease (GBD) Study Learn the Meaning of: 1) Years of Life Lost, 2) Years Lost to Disability, and 3) Disability-adjusted life years lost as measures of mortality and morbidity 4

Learning Objectives Review global trends in mortality andmorbidity Compare trends in KSA to global trends Identify the major causes of death and disability globally and in KSA Identify the major risk factors that cause death and disability 5

The Global Burden of Disease Study GBD was launched in 2007 to develop systematic global data on morbidity, mortality, and their causes. It is directed by a consortium of seven partners, including Harvard University, the Institute for Health Metrics and Evaluation, and the WHO. It’s mission is to provide systematic global data on disease, injuries, and risk 6

The Global Burden of Disease Study GBD 2010 was a massive effort to report mortality and morbidity data for 187 countries Data were reported for 235 diseases and injuries, along with 67 behavioral, medical, and environmental causes. Almost all of the December 15, 2012 issue of The Lancet is devoted to results from GBD. 7

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Sources Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study Lancet 2012; 380: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study Lancet 2012; 380: 2224–60 The Global Burden of Disease: Generating Evidence, Guiding Policy. Institute for Health Metrics and Evaluation, 2010 IHME Website: 9

Years of Life Lost Years of Life Lost (YLL) is calculated by comparing the years lost by a premature death relative to the highest life expectancy for males or females in any country for that age group. Example: If a 20-year old male died in a car accident in KSA in 2010, he lost 66 years of expected life based on the highest life expectancy among 20-year-olds, namely, 86 years for 20-year old females in Japan. 10

Data Visualization The Institute for Health Metrics and Evaluation website provides many tools for displaying the results of the GBD study. One such tool is GBD compare. It displays health levels and trends in one interactive tool. It also enables comparisons between and within countries. To begin, we display the numbers of years of life lost by cause of death for all countries combined. 11

Causes of YLL Globally:

Causes of YLL Globally:

GBD Display GBD Compare 14

Causes of YLL in KSA:

Causes of YLL in KSA:

Comparing KSA to Global BD:

Comparing KSA to Western Europe 18

Years of Life Lost 19

Global Trends in YLL 1990 to

Trends in YLL in KSA 1990 to

10 Leading Causes of YLL in KSA in 2010 PercentGlobal Rank Road Injury 16 8 Ischemic Heart Disease 12 1 Preterm Birth Complications 11 7 Stroke 13 3 Congenital Anomalies 6 14 Lower Resp Infections 4 2 Chronic Kidney Disease 3 24 Diabetes 3 19 Neonatal Encephalopathy 2 10 Neonatal Sepsis

Global Highlights Life expectancy is increasing for both men and women The burdens of HIV and malaria are falling Far fewer children younger than 5 are dying Infectious diseases are being controlled Huge global disparities Tuberculosis and malaria each killed 1.2M people in 2010 Deaths by road traffic injuries have increased by 50% 23

Years Lost to Disability (YLDs) YLD was developed to account for the health burden of disability. Each disability is assigned a weight. The years lost due to that disability (YLDs) are calculated as the duration of a disability multiplied by the disability weight. A weight of 0 represents perfect health, a weight of 1 is equivalent to death For example, if the disability weight after myocardial infarction is and life expectancy after MI is 20, YLD = 0.439*20 =

Global YLD:

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Years Lost to Disability 28

10 Leading Causes of YLD in KSA PercentGlobal Rank Major Depressive Disorder 11 2 Low Back Pain 10 1 Diabetes 8 9 Iron-Deficiency Anemia 5 3 Anxiety Disorders 5 7 Neck Pain 3 4 Osteoarthritis 3 11 Drug Use Disorders 3 12 Other Musculoskeletal 3 6 COPD

The 10 leading causes of death and YLD in Saudi Arabia Deaths (%) YLD (%) Occupational Drug Use Iron Deficiency High BMI Ambient AP High Blood Pressure Dietary Smoking High Fasting Plasma Glucose Physical Inactivity 30

Disability Adjusted Life Years (DALYs) DALYs is the sum of years of life lost (YLL) and years of healthy life lost to disability (YLD) DALYs = YLL + YLD 31

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Leading Causes of Lost DALYs in KSA PercentGlobal Rank Road Injury 9 10 Ischemic Heart Disease 6 1 Major Depressive Disorder 6 11 Diabetes 6 14 Low Back Pain 5 7 Preterm Birth 5 8 Stroke 3 3 Congenital Anomalies 3 17 Iron-Deficiency Anemia 3 15 Anxiety Disorders

The 10 leading diseases globally in 2010 based on percentages of deaths and DALYs 35

The 10 leading diseases in Saudi Arabia in 2010 based on percentages of deaths and DALYs Ischemic Heart Disease Road Injury Stroke Preterm Birth Lower Resp Infections Chronic Kidney Disease Diabetes Hypertension Congenital Anomalies Other Cardiac/Circulatory 36

Discussion Point What do these data tell us about the major health problems in Saudi Arabia? What are the major risk factors For YLL? For YLD? 37

The 10 leading diseases and injuries globally in 2010, and the 10 leading causes based on percentages of deaths and DALYs 38

The 10 leading diseases and injuries in Saudi Arabia in 2010, and the 10 leading causes based on percentages of deaths and DALYs Ischemic Heart Disease Road Injury Stroke Preterm Birth Lower Resp Infections Chronic Kidney Disease Diabetes Hypertension Congenital Anomalies Other Cardiac/Circulatory High Body Mass Index Dietary Risks High Fasting Plasma Glucose High BP Physical Inactivity Ambient PM Pollution Smoking Drug Use Occupational Iron Deficiency 39

GBD Cause Patterns 40

Demography KSA has the largest and fastest growing population in the GCC. The total KSA population will reach 31.6 million by 2016, of which 22.8 million will be Saudi nationals. 41