ArticlesAlternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study
Introduction
Future health scenarios that are likely, or probable, or merely possible can have an important role in shaping public-health policy. Studies on health projections1, 2, 3 provide an indication of the strong interest shown by scientific and public-health communities in the definition and quantification of scenarios of future health. There have, however, been few comprehensive efforts to project health scenarios for a population4 and none for the entire world or for major regions. In this paper, the last of four on the Global Burden of Disease Study (GBD) (see Lancet 1997; 349: 1269–76; 1347–52; and 1436–42) we describe how we created three scenarios of future mortality and disability by cause, which may have important public policy implications.
Our scenarios were based on future health status as a function of projected changes in key socioeconomic variables, which influence health states. Uncertainties in the projections arise from the validity of these relational models, assumptions about their invariance over time, and, of course, uncertainty about the future rates and distribution of factors that currently influence health and survival. Despite these uncertainties, several robust projections—due largely to demographic change and the future effects of current smoking patterns—emerge from our analysis. Further detail on the methods used to estimate causes of death, to develop epidemiological profiles of each disabling sequela, to assess the burden attributable to major risk factors, and to project the burden of premature mortality and disability has been published.5
Section snippets
Projection methods
We used 12 separate analytical or computational steps to construct a baseline scenario, and optimistic and pessimistic scenarios. Separate projection models for both sexes and seven age-groups—0–4, 5–14, 15–29, 30–44, 45–59, 60–69, and 70 years or older—were developed to produce parsimonious equations for nine cause-of-death clusters: all group 1 (communicable, maternal, perinatal, and nutritional disorders); malignant neoplasms, cardiovascular diseases, digestive diseases, chronic respiratory
Results
Life expectancy at birth (figure 1) for women in all three scenarios was projected to increase in all regions, with the largest gains expected in sub-Saharan Africa, India, and other Asia and islands. Life expectancy for women in established market economies may reach close to 90 years—this is especially plausible since Asian women in the USA already have a life expectancy at birth of over 86 years.25 The smallest gain for women is projected for formerly socialist economies of Europe.
Discussion
In all three scenarios, substantial changes were predicted in regional patterns of mortality and disability. Some major themes are worth emphasising. The distribution of deaths by age will shift from younger to older ages. A major decline in the mortality and disability from communicable, maternal, perinatal, and nutritional disorders was predicted in all three scenarios, although the declines in the optimistic and baseline scenarios were much greater than in the pessimistic scenario. Deaths
References (25)
A way through the maze: what futurists do and how they do it
Futures
(1993)- et al.
Maternal education and child survival in developing countries
Soc Sci Med
(1988) Mortality from tobacco in developed countries: indirect estimation of national vital statistics
Lancet
(1992)Health care: thinking ahead
World Health Forum
(1994)Health futures in support of health for all: report of an international consultation convened by the World Health Organization, Geneva, 19–23 July, 1993
(1993)- et al.
Public health status and forecasts: the health status of the Dutch population over the period 1950–2010
(1994) - et al.
The Penn World Tables (Mark 50): an expanded set of international comparisons 1950–1988
Q J Economics
(1991) Education as a factor in mortality decline: an examination of Nigerian data
Popul Stud
(1979)- et al.
Economic growth in a cross-section of countries: NBER working paper
(1993)
An econometric model for forecasting age-and cause-specific mortality rates
Mortality patterns in national populations
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