Elsevier

The Lancet

Volume 370, Issue 9603, 8–14 December 2007, Pages 1929-1938
The Lancet

Series
The burden and costs of chronic diseases in low-income and middle-income countries

https://doi.org/10.1016/S0140-6736(07)61696-1Get rights and content

Summary

This paper estimates the disease burden and loss of economic output associated with chronic diseases—mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes—in 23 selected countries which account for around 80% of the total burden of chronic disease mortality in developing countries. In these 23 selected low-income and middle-income countries, chronic diseases were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries where death registration data are available, the estimated age-standardised death rates for chronic diseases in 2005 were 54% higher for men and 86% higher for women than those for men and women in high-income countries. If nothing is done to reduce the risk of chronic diseases, an estimated US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. Achievement of a global goal for chronic disease prevention and control—an additional 2% yearly reduction in chronic disease death rates over the next 10 years—would avert 24 million deaths in these countries, and would save an estimated $8 billion, which is almost 10% of the projected loss in national income over the next 10 years.

Introduction

In 2005, WHO re-emphasised the importance of chronic (non-communicable) diseases as a neglected global health issue.1 Chronic diseases—mainly cardiovascular disease, cancer, chronic respiratory diseases, and diabetes—were estimated to cause more than 60% (35 million) of all deaths in 2005; more than 80% of these deaths occurred in low-income and middle-income countries. We previously projected that, in 2015, 41 million people will die from chronic diseases without concerted prevention and control action.2 Achievement of the global goal of reducing chronic disease death rates by an additional 2% every year would avert 36 million deaths between 2005 and 2015.

Most of these averted deaths will be in low-income and middle-income countries, and just less than half will be in people younger than 70 years.2 Moreover, in most countries the poorest people have the highest risk of developing chronic disease and they are least able to cope with the resulting financial consequences.3 When the costs to individuals are summed, the loss to the economy can be substantial. For example, one study for the UK4 suggested that a total of £1·7 billion (about US$3 billion) was spent on prevention or treatment of heart disease in 1999. The investigators argued that people who were ill lost £2·9 billion (about $5·2 billion) in potential earnings, and they valued the time spent by informal carers at a further £2·4 billion (roughly $4·3 billion).4

Although there are now many estimates of the economic effects of different types of chronic diseases, they are not directly comparable because inconsistent methods are used and because different societies have different ways of delivering and financing health services, which directly impinge on costs.5, 6, 7, 8, 9, 10 Accordingly, the overall objective of this Series is to assess more accurately the effect of chronic diseases on health and economic wellbeing with consistent methods, and to provide empirical evidence for possible strategies to reduce their harmful effects, to support low-income and middle-income countries as they respond to the chronic disease epidemics.

In the first paper in this Series, we estimate the burden and loss of economic output associated with chronic diseases in 23 selected countries (figure 1). These countries were selected as leading countries collectively accounting for around 80% of the total mortality burden attributable to chronic diseases in developing countries. We summarise the latest projections of the effect of chronic diseases on mortality in low-income and middle-income countries, focusing on these 23 countries. We then estimate the effect of premature deaths from chronic diseases on the countries' national income, which is measured in gross domestic product (GDP) losses per working-age population. We aggregate estimates from coronary heart disease, stroke, and diabetes, since these disorders represent the greatest burden of the entire group of chronic diseases. All estimates are projected between 2005 and 2015. Finally, we estimate potential gains in GDP that are achievable through meeting the global goal of a 2% additional yearly reduction in mortality rates from chronic diseases.

Key messages

  • In 23 selected countries, which account for around 80% of the total chronic disease mortality burden in developing countries, chronic diseases are responsible for 50% of the total disease burden

  • Age-standardised death rates for chronic diseases are more than 50% higher in the 15 of these countries with death registration data than in high-income countries

  • If nothing is done to reduce risk of chronic diseases, an estimated US$84 billion of national income will be lost from heart disease, stroke, and diabetes alone in the 23 selected countries between 2006 and 2015

  • As little as a 2% yearly additional reduction in mortality rates from chronic diseases would avert 24 million deaths, with almost 80% of the life-years gained coming from deaths averted in people younger than 70 years, and save almost 10% of the expected loss in income and around $8 billion collectively for the 23 countries by 2015

  • Governments have a key role in stimulating the generation of information to reduce the risk of chronic diseases and in ensuring access to preventive and treatment services, especially for poor people

Section snippets

Global epidemiology and burden of chronic diseases

WHO has undertaken a progressive reassessment of the Global Burden of Disease (GBD) study for 2000–02, with consecutive revisions and updates published yearly in WHO World Health Reports.11 These updates make use of a wide variety of data sources to develop internally consistent estimates of incidence, severity, duration, and mortality for more than 130 major causes, for 14 subregions of the world. The methods we use here are generally similar to those of the original GBD study, albeit with

Projections of mortality for 2015 and 2030

We used a set of fairly simple models to project future mortality and burden of disease trends, based largely on projections of economic and social development, and using the historically observed relations between these projections and cause-specific mortality rates, as well as including including updated projections for HIV/AIDS and the tobacco-related epidemic.16 For the projections reported here, historical data for death registration for 107 countries between 1950 and 2002 were used to

The macroeconomic effect of chronic diseases

The macroeconomic costs, or costs to a country as a whole, of chronic disease could be estimated in three ways: the accounting or cost-of-illness method, in which medical and non-medical costs as well as the monetary value of lost labour productivity because of illness or death is assessed and an attempt is made to sum-up across individuals; economic growth models, which assess the effect of chronic diseases on national income through changes in key inputs such as labour supply and savings; and

Potential gains achievable through meeting the global goal

In 2005, to encourage action to prevent chronic diseases, WHO proposed a global goal for reduction of deaths and burden of disease due to chronic disease, which specified an additional 2% yearly decrease in projected age-specific death rates from chronic diseases worldwide.2 Projected yearly rates of change in age-specific and sex-specific death rates for all chronic disease causes were calculated for the mortality projections from 2006 to 2015 and then adjusted by subtraction of an additional

Conclusions

Our results show that population growth and ageing will drive a substantial increase in the numbers of deaths from chronic disease globally, and particularly in low-income and middle-income countries, where we project an 18% increase between 2006 and 2015. These deaths occur at younger ages than chronic disease deaths in high-income countries. Two major factors account for the grim forecasts on the economic effect of chronic diseases: the lost labour units because of deaths from chronic disease

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