​Today, fewer people are dying from tetanus and diarrheal diseases in Pakistan, according to a new, comprehensive analysis of trend data from 188 countries. Mortality from tetanus dropped 93% between 1990 and 2013. At the same time, a number of diseases, including chronic kidney disease and diabetes, claimed more lives in Pakistan in 2013 than in 1990. Life expectancy improved for both men and women in Pakistan, at an average of 3.4 years gained since 1990.

Published in The Lancet on December 18, "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" was conducted by an international consortium of researchers coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The leading killers in Pakistan were ischemic heart disease, stroke, and pneumonia, accounting for 28% of all deaths in 2013. Ischemic heart disease and road injuries were the top two causes of death for people between the ages of 15 and 49, resulting in 40,379 lives lost in 2013. Among individuals 70 and older, ischemic heart disease claimed the most lives that year. The top cause of child mortality was neonatal encephalopathy in 2013, killing 64,388 children under the age of 5.

In Pakistan, chronic kidney disease and diabetes took more lives in 2013 than in 1990, with deaths increasing 182% and 175%, respectively. Mortality from ischemic heart disease also increased 135% between 1990 and 2013.

Since 1990, Pakistan saw marked declines in mortality from a number of diseases that used to take a large toll on the country. For instance, by 2013, mortality from tetanus decreased 93%, and diarrheal diseases caused 50% fewer deaths. In 1990, these diseases killed 161,309 people. Twenty-three years later, they claimed 90,277 fewer lives.

The study also revealed how some diseases and injuries cause different mortality patterns for males and females. For example, in Pakistan, chronic obstructive pulmonary disease (COPD) took a greater toll on men, killing 32,469 males and 10,898 females in 2013. By contrast, stroke claimed 61,289 women’s lives and 57,256 men’s lives.

"While we have made much progress in reducing mortality relkated to diarrheal diseases, Pakistan still loses a large number of children related to pneumonia, prematurity and birth complications related to intra-partum events" said Professor Zulfiqar A Bhutta, the Founding Director of the Centre of Excellence in Women and Child Health at the Aga Khan University. "These findings underscore the need for continued investments in maternal and child health. The overall gains in life expectancy and the high number of deaths related to ischemic heart disease and stroke also underscore the need for parallel investments in reducing the burden of non-communicable diseases, which should receive urgent policy attention at national and provincial level. "

Globally, people live an average of 6.2 years longer than they did in 1990, with life expectancy rising to just under 72 years in 2013. Women showed a slightly larger average gain (an increase of 6.6 years) than men (a rise of 5.8 years). Improvements in health, reduced fertility, and shifts in the world’s age patterns have driven these global gains in life expectancy.

In Pakistan, the average life expectancy for women was 67.3 years in 2013, with men living an average of 64.4 years. By contrast, women lived an average of 62.6 years, and men had a life expectancy of 62.2 years in 1990. Out of the 188 countries included in the study, Pakistan ranked 140th for women and 129th for men for longest life expectancies. In 2013, Andorra had the longest life expectancy for women (86.7 years) and Qatar had the longest for men (81.2 years). Lesotho had the shortest life expectancy for both women (51.2 years) and men (45.6 years).

"The fact that people are living longer in most parts of the world is good news but we must do more to address health disparities," said IHME Director Dr. Christopher Murray. "Only with the best available evidence can we develop policies to improve health and save lives."

Worldwide, ischemic heart disease, stroke, and COPD claimed the most lives, accounting for nearly 32% of all deaths. Much global progress has been made in reducing mortality from diseases such as measles and diarrhea, with 83% and 51% declines, respectively, from 1990 to 2013.

The Global Burden of Disease (GBD) Study 2013 is part of an ongoing effort to produce the most timely and up-to-date understanding of what kills and ails people worldwide. Thousands of collaborators worldwide work together to generate annual estimates of deaths by cause, years of life lost to disability, and rates of premature mortality and illness. To make these data as useful and relevant to policymakers and country leaders as possible, findings from the GBD study can be used at the global, regional, national, and even subnational levels to track trends in health over time.

Researchers found a widening gap between countries with the lowest and highest death rates from a given disease – a potential sign of increasing inequalities in health. They also emphasize the importance of measuring local disease burdens, as the health challenges found in one corner of a country can widely vary from those experienced a few hours away.

Globally, a number of diseases that have received less attention relative to others are some of the biggest causes of premature death, particularly drug use disorders, diabetes, chronic kidney disease, and cirrhosis. The gender gap in death rates for adults between the ages of 20 to 44 is widening, and HIV/AIDS, interpersonal violence, road injuries, and maternal mortality are some of the key conditions responsible. For children under 5, diarrheal diseases, pneumonia, neonatal disorders, and malaria are still among the leading causes of death.

Two diseases, HIV/AIDS and malaria, followed very different mortality trends from other diseases. The global death toll from both diseases peaked around 2005 rather than 1990, with deaths from HIV/AIDS and malaria declining 22% and 30%, respectively, from 2005 to 2013. Malaria mortality in Pakistan peaked in 1988, with 6,429 deaths, but then fell 51% by 2013.

Leading causes of death in Pakistan, with the number of lives lost