A response to the need for comprehensive, consistent and comparable information on diseases and injuries at global and regional level.

The global burden of disease: 2004 update is a comprehensive assessment of the health of the world's population. It provides detailed global and regional estimates of premature mortality, disability and loss of health for 135 causes by age and sex, drawing on extensive WHO databases and on information provided by Member States.

The Global Burden of Disease: 2004 Update provides a comprehensive assessment of the health of the world‘s population in 2004. Consistent and comparative description of the burden of diseases and injuries is an important input to health decision-making and planning processes. The Global Burden of Disease provides a framework for integrating the available information on mortality and health in populations to assess the comparative importance of diseases and injuries in causing premature death, loss of health and disability in all regions of the world.

This report draws on the extensive databases of the World Health Organization and information provided by Member States to provide detailed estimates of premature mortality, disability and loss of health for 135 causes by age and sex for the world, for regions of the world, and for countries grouped by average income per capita. It builds on previous assessments for the years 2000-2002 published in The World Health Report 2001 to 2004 and World Health Statistics 2006 to 2008.

This report is part of ongoing efforts by WHO to monitor and analyse the global health situation and trends and to foster increased comparability of data between countries. The report builds upon the work of technical programmes within WHO at country, regional and global levels, and collaboration with partners, including UN agencies, the private sector and academic institutions.

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Contents
Tables..................................................... v
Figures.................................................... vi
Abbreviations.............................................vii
Part 1: Introduction 1
Overview of the Global Burden of Disease Study................... 2
What is new in this update for 2004?.......... 3
Regional estimates for 2004.................. 5
Part 2: Causes of death 7
1. Deaths in 2004: who and where?............ 8
2. Deaths by broad cause groups.............. 8
3. Leading causes of death................... 11
4. Cancer mortality........................... 12
5. Causes of death among children aged under five years........... 14
6. Causes of death among adults aged 15–59 years................ 17
7. Years of life lost: taking age at death into account.......... 21
8. Projected trends in global mortality: 2004–2030..................... 22
Part 3: Disease incidence, prevalence and disability 27
9. How many people become sick each year?.............. 28
10. Cancer incidence by site and region.................. 29
11. How many people are sick at any given time?.......................... 31
12. Prevalence of moderate and severe disability................... 31
13. Leading causes of years lost due to disability in 2004.................... 36
Part 4: Burden of disease: DALYs 39
14. Broad cause composition............................................ 40
15. The age distribution of burden of disease........................................... 42
16. Leading causes of burden of disease................... 42
17. The disease and injury burden for women.................. 46
18. The growing burden of noncommunicable disease......................... 47
19. The unequal burden of injury............ 48
20. Projected burden of disease in 2030................... 49

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Overview of the Global Burden of Disease Study

A consistent and comparative description of the burden of diseases and injuries, and risk factors that cause them, is an important input to health decision-making and planning processes. Information that is available on mortality and health in populations in all regions of the world is fragmentary and sometimes inconsistent. Thus, a framework for integrating, validating, analysing and disseminating such information is needed to assess the comparative importance of diseases and injuries in causing premature death, loss of health and disability in different populations.

The first Global Burden of Disease (GBD) Study quantified the health effects of more than 100 diseases and injuries for eight regions of the world in 1990 (1–3). It generated comprehensive and internally consistent estimates of mortality and morbidity by age, sex and region (4). The study also introduced a new metric – the disability-adjusted life year (DALY) – as a single measure to quantify the burden of diseases, injuries and risk factors (5). The DALY is based on years of life lost from premature death and years of life lived in less than full health; more information is given in Box 1.

Drawing on extensive databases and information provided by Member States, the World Health Organization (WHO) prepared updated burden of disease assessments for the years 2000–2002, the most recent version being published in the World health report 2004 (6). Following a country consultation process, country-specific estimates for 2002 were also published on the WHO web site (7). The GBD results for the year 2001 also provided a framework for cost-effectiveness and priority setting analyses carried out for the Disease Control Priorities Project (DCPP), a joint project of the World Bank, WHO and the National Institutes of Health, funded by the Bill & Melinda Gates Foundation (8). The GBD results were documented in detail, with information on data sources and methods, and analyses of uncertainty and sensitivity, in a book published as part of the DCPP (9).

The production and dissemination of health information for health action at the country, regional and global levels are core WHO activities mandated by the Member States in the Constitution. In her speech to the World Health Assembly in May 2007, the WHO Director-General, Dr Margaret Chan, noted, “Reliable health data and statistics are the foundation of health policies, strategies, and evaluation and monitoring”. She also noted, “Evidence is also the foundation for sound health information for the general public”.

World Health Assembly Resolution 60.27 (WHA60.27), adopted at the Assembly in 2007, requested the WHO Director-General to “… strengthen the information and evidence culture of the Organization and to ensure the use of accurate and timely health statistics in order to generate evidence for major policy decisions and recommendations within WHO”. As part of the response to this request, the WHO Department of Health Statistics and Informatics has undertaken an update of the 1990 GBD study to produce comprehensive, comparable and consistent estimates of mortality and burden of disease by cause for all regions of the world in 2004. This update builds on the previous GBD analysis for 2002; revisions, new data and methods are summarized below. The standard DALYs reported here use 3% discounting and non-uniform age weights and differ from the discounted but nonage- weighted DALYs used in the DCPP (9).

The Bill & Melinda Gates Foundation has provided funding for a new GBD 2005 study to be published in late 2010. The study is led by the Institute for Health Metrics and Evaluation at the University of Washington, with key collaborating institutions including WHO, Harvard University, Johns Hopkins University and the University of Queensland (10). The GBD 2005 study will develop improved methods to make full use of the increasing amount of health data, particularly from developing countries, and will include a comprehensive and consistent revision of disability weights. The study will also assess trends in the global burden of disease from 1990 to 2005.

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