Burden of non-communicable diseases in sub-Saharan Africa in 1990 and 2010: Global Burden of Diseases, Injuries, and Risk Factors Study 2010

Abstract

BackgroundSince 1990, health priorities in sub-Saharan Africa (SSAF) have been set primarily by epidemics of infectious diseases. For future global health efforts, it is important to understand the growing burden of non-communicable diseases (NCDs). MethodsFor ten major causes of NCDs, the burden of 357 diseases and sequelae was estimated. Cause-specific death rates were estimated by an ensemble method using vital registration and verbal autopsy data. The number of patients was estimated with DisMod III by mathematical modelling of epidemiological measures of each sequela. Disability weights were estimated by an open-access web-based survey, in addition to population-based surveys in Bangladesh, Indonesia, Peru, and the USA. FindingsIn 2010, more than 2·06 million deaths due to NCDs occurred in SSAF, a 46% (95% CI 41–59) increase from 1990. The risk in terms of age-standardised death rate has declined by about 12% (95% CI 8–14) from 1990 to 2010, with a negligible decline in central SSAF. The total burden of NCDs in terms of disability-adjusted life-years (DALYs) showed a similar pattern, with an increase of 45% (95% CI 41–52) in DALYs and a decrease of 9% (7–12) in standardised DALYs per capita. The fraction of burden of cancers remained at 8% in 2010, while cardiovascular and respiratory diseases decreased slightly from 16% and 12% in 1990 to 15% and 10% in 2010, respectively. Mental and behavioural disorders, musculoskeletal diseases, and diabetes and endocrine diseases increased by 3%, 2%, and 1% in 2010, respectively (from 12%, 9%, and 11% in 1990). In southern SSAF, the proportion of DALYs due to infectious diseases increased by 17% between 1990 and 2010, while the proportion of DALYs due to NCDs and injuries declined by about 20% and 15%, respectively. The decline in the burden of NCDs may be due to the pressure of competing infectious disease risks over this period. InterpretationAn increasing burden of NCDs in Africa shows a growing health iceberg hidden under epidemics of infectious diseases. The NCDs with an increasing burden of disease in SSAF are mental and behavioural conditions and musculoskeletal diseases. FundingBill & Melinda Gates Foundation.