People across Pakistan are living longer but spending more time in ill health as rates of nonfatal diseases and injuries – including major depressive disorder, iron-deficiency anemia, and low back pain – decline more slowly than death rates, according to a new analysis of 301 acute and chronic diseases and injuries in 188 countries.
Published in The Lancet, the study ‘Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013’ was conducted by an international consortium of researchers working on the Global Burden of Disease project and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
“The health of Pakistanis is increasingly threatened by non-communicable diseases such as depression, chronic back pain, and migraines,” said Professor Zulfiqar Bhutta, Founding Director of the Centre of Excellence in Women and Child Health at the Aga Khan University and Co-Director at the Center for Global Child Health at The Hospital for Sick Children, and one of the study’s co-authors.
“At the same time, diseases like iron-deficiency anemia, chronic obstructive pulmonary disease, and diabetes are also costing people in Pakistan many years of healthy life. It is critical that we understand which diseases and injuries are causing disability so that we can effectively allocate resources for national planning,” he added.
‘Years lived with disability’ quantifies the impact of health problems that impair mobility, hearing or vision, or cause pain in some way. In 2013, migraines, chronic obstructive pulmonary disease, and diabetes were among the 10 leading causes of YLDs in Pakistan. Other leading causes included hearing loss, anxiety disorders, and neck pain. For both sexes combined, the leading causes of years lived with disability have remained largely the same during this period, but they take an increased toll on health due to population growth and aging.
For women in Pakistan, other musculoskeletal disorders – which include shoulder injuries and fractures from osteoporosis – have replaced diarrheal diseases as a leading cause of years lived with disability. Between 1990 and 2013, YLDs from other musculoskeletal disorders and diabetes increased by 163 and 170 per cent respectively. Iron-deficiency anaemia had the smallest per cent increase among top causes of YLDs at 11 per cent.
Diabetes YLDs also increased for men in Pakistan between 1990 and 2013, climbing 100 per cent. YLDs from depression increased by 94 per cent, and iron-deficiency anemia YLDs decreased by 9 per cent.
Between 1990 and 2013, YLDs increased globally from 537.6 million in 1990 to 764.8 million in 2013 for both sexes. Men and women around the world share the same leading causes of YLDs, with the exception of schizophrenia as a leading cause for men and other musculoskeletal disorders for women. Musculoskeletal disorders, mental and substance use disorders, neurological disorders, and chronic respiratory conditions were the main drivers of YLDs in 2013. The disease burdens of both low back pain and depression have increased more than 50 per cent since 1990.
Researchers found that as people aged they experienced a greater number of ailments resulting from nonfatal diseases and injuries. Many people also suffered from multiple conditions at the same time. The number of people who suffered from 10 or more ailments increased by 52 per cent. And it is not just the elderly who are affected. Although the impact of YLDs increases with age, of the 2.3 billion people who suffered from more than five ailments, 81 per cent of them were younger than 65 years old.
A relatively small number of diseases have a massive impact, researchers found. Just two acute diseases – affecting people for less than three months – caused more than 20 billion new cases of disease globally in 2013: upper respiratory infections (18.8 billion) and diarrheal diseases (2.7 billion). And just eight causes of chronic diseases – affecting people for three months or longer – impacted more than 10 per cent of the world’s population. These included tension-type headaches and iron-deficiency anemia.
In 2013, war and conflict was a leading cause of YLDs in several countries as well, including El Salvador, Guatemala, Lebanon, Peru, and Syria. In three countries – Cambodia, Nicaragua, and Rwanda – war was the top cause of years lived with disability. Other notable causes of YLDs in different regions included falls (Central Europe), asthma (a top-10 cause in many Latin American countries), and opioid dependence (a top-five cause in several Middle Eastern countries). Nonfatal conditions are not yet becoming the dominant source of disease burden in sub-Saharan Africa as they are in other parts of the world, but their impact has grown since 1990.
“What ails you isn’t necessarily what kills you,” said IHME Director Dr Christopher Murray. “As nonfatal illnesses and related ailments affect more people of all ages, countries must look closely at health policy and spending to target these conditions.”
Leading causes of YLDs in Pakistan for both sexes, 2013
1. Major depressive disorder
2. Iron-deficiency anemia
3. Low back pain
4. Chronic obstructive pulmonary disease
5. Diabetes mellitus
6. Age-related and other hearing loss
7. Anxiety disorders
8. Neck pain
9. Diarrheal diseases
Leading causes of YLDs in Pakistan for men, 2013
1. Low back pain
2. Iron-deficiency anemia
3. Major depressive disorder
4. Chronic obstructive pulmonary disease
5. Migraine
6. Age-related and other hearing loss
7. Diabetes mellitus
8. Anxiety disorders
9. Neck pain
10. Diarrheal diseases
Leading causes of YLDS in Pakistan for women, 2013
1. Major depressive disorder
2. Iron-deficiency anemia
3. Migraine
4. Chronic obstructive pulmonary disease
5. Low back pain
6. Anxiety disorders
7. Diabetes mellitus
8. Neck pain
9. Other musculoskeletal disorders
10. Age-related and other hearing loss
