Question

What are the leading risk factors that contribute to death and disability in low- and middle-income countries, and how do they differ from those found in high-income countries?

Answer 1

According to the World Health Organization, the three leading causes of mortality in lower-middle-income countries (LMIC) are ischemic heart disease (IHD), stroke, and lower respiratory infections (LRIs), causing 111.8, 68.8, and 51.5 annual deaths per 100,000, respectively. Due to barriers to healthcare, patients frequently present in critical stages of these diseases.

The 2010 Global Burden of Disease (GBD) Study indicated that IHD is the leading cause of mortality and loss of disability-adjusted life years (DALYs) worldwide, accounting for roughly seven million deaths and 129 million DALYs annually. Noncommunicable disease processes have been a leading cause of death in high-income countries for decades. However, the previous focus in LMICs has been on communicable diseases and now there is an aging population thought to account for a shift to noncommunicable disease deaths. For example, there have been great improvements in the age-adjusted mortality rates associated with IHD over the past two decades; however, rates in high-income countries are largely accountable for this improvement and rates in the LMIC remain largely unchanged. There have been efforts to decrease mortality in LMIC including communicable and noncommunicable diseases, but they have been primarily focused on preventative methods (clean water, environmental safety measures, safe sexual practices, and prenatal care). Some research suggests that this mortality can be decreased with effective, focused, and evidence-based acute care. Seven out of the top 15 causes of morbidity and mortality worldwide can be reduced through the provision of high-quality, cost-effective emergency care. Delving further, on account of the epidemiologic transition and concurrent decreased access to health care, patients often present in later-stage forms of illness and require more acute interventions. As a result, there must be a greater emphasis on acute care for noncommunicable diseases. A recent systematic review identified quantitative data on the delivery of emergency care in LMICs.