7 of top 10 killers pre-Covid were non-communicable diseases: WHO

Geneva - The number of deaths from heart disease increased by more than 2 million since 2000, to nearly 9 million in 2019.

Non-communicable diseases make up seven of the world’s top 10 causes of death, according to WHO’s 2019 Global Health Estimates, published on Wednesday. This is an increase from 4 of the 10 leading causes in 2000. The new data cover the period from 2000 to 2019 inclusive.

The estimates reveal trends over the last two decades in mortality and morbidity caused by diseases and injuries. They clearly highlight the need for an intensified global focus on preventing and treating cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, as well as tackling injuries, in all regions of the world, as set out in the agenda for the UN Sustainable Development Goals.

"These new estimates are another reminder that we need to rapidly step-up prevention, diagnosis and treatment of non-communicable diseases," said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. "They highlight the urgency of drastically improving primary healthcare equitably and holistically. Strong primary healthcare is clearly the foundation on which everything rests, from combatting non-communicable diseases to managing a global pandemic."

Heart disease has remained the leading cause of death at the global level for the last 20 years. However, it is now killing more people than ever before. The number of deaths from heart disease increased by more than 2 million since 2000, to nearly 9 million in 2019. Heart disease now represents 16 per cent of total deaths from all causes. More than half of the 2 million additional deaths were in the WHO Western Pacific region. Conversely, the European region has seen a relative decline in heart disease, with deaths falling by 15 per cent.

Alzheimer’s disease and other forms of dementia are now among the top 10 causes of death worldwide, ranking third in both the Americas and Europe in 2019. Women are disproportionally affected: Globally, 65 per cent of deaths from Alzheimer’s and other forms of dementia are women.

Deaths from diabetes increased by 70 per cent globally between 2000 and 2019, with an 80 per cent rise in deaths among males. In the Eastern Mediterranean, deaths from diabetes have more than doubled and represent the greatest percentage increase of all WHO regions.

In 2019, pneumonia and other lower respiratory infections were the deadliest group of communicable diseases and together ranked as the fourth leading cause of death. However, compared to 2000, lower respiratory infections were claiming fewer lives than in the past, with the global number of deaths decreasing by nearly half a million.

This reduction is in line with a general global decline in the percentage of deaths caused by communicable diseases. For example, HIV/AIDS dropped from the 8th leading cause of death in 2000 to the 19th in 2019, reflecting the success of efforts to prevent infection, test for the virus and treat the disease over the last two decades. While it remains the fourth leading cause of death in Africa, the number of deaths has dropped by more than half, falling from over 1 million in 2000 to 435,000 in 2019 in Africa.

Tuberculosis is also no longer in the global top 10, falling from seventh place in 2000 to 13th in 2019, with a 30 per cent reduction in global deaths. Yet, it remains among the top 10 causes of deaths in the African and South-East Asian regions, where it is the eighth and fifth leading cause respectively. Africa saw an increase in tuberculosis mortality after 2000, though this has started to decline in the last few years.

The new estimates also emphasise the toll that communicable diseases still take in low-income countries: Six of the top 10 causes of death in low-income countries are still communicable diseases, including malaria (6th), tuberculosis (8th) and HIV/AIDS (9th). Meanwhile, in recent years, WHO reports highlight an overall concerning slow-down or plateauing of progress against infectious diseases like HIV, tuberculosis and malaria.

The estimates further confirm the growing trend for longevity: In 2019, people were living more than six years longer than in 2000, with a global average of more than 73 years in 2019 compared to nearly 67 in 2000. But on average, only 5 of those additional years were lived in good health.

Indeed, disability is on the rise. To a large extent, the diseases and health conditions that are causing the most deaths are those that are responsible for the greatest number of healthy life-years lost. Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease were collectively responsible for nearly 100 million additional healthy life-years lost in 2019 compared to 2000.

Injuries are another major cause of disability and death: There has been a significant rise in road traffic injuries in the African region since 2000, with an almost 50 per cent increase in both death and healthy life-years lost. Similar but slightly smaller increases (at around 40 per cent) were also observed for the Eastern Mediterranean region. Globally, deaths from road traffic injuries are 75 per cent male.

In the Americas, drug use has emerged as a significant contributor to both disability and death. There was a nearly threefold increase in deaths from drug use disorders in the Americas between 2000 and 2019. This region is also the only one for which drug use disorder is a top 10 contributor to healthy life-years lost due to premature deaths and disability, while in all other regions, drug use does not make the top 25.

Covid-19 has claimed more than 1.5 million lives. People living with pre-existing health conditions (such as heart disease, diabetes and respiratory conditions) are at higher risk of complications and death due to Covid-19.

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