Mortality rates by country for ischemic heart disease (IHD) before and after adjustment for miscoding.

Rising Tide of Affluent Diseases?

The so-called "diseases of affluence"--heart attack, stroke, and cancer--are far more important in the developing world than is generally appreciated, according to a landmark epidemiology study published in Saturday's issue of The Lancet. The report reveals the surprising fact that "the probability of death from a noncommunicable disease is higher in low-income regions such as sub-Saharan Africa than in high-income regions" of Europe and North America.

Christopher J. L. Murray of the Harvard University School of Public Health and Alan D. Lopez of the World Health Organization in Geneva used international health data to draw up an estimate of the probable causes of death in eight regions of the world between 1990 and 2020. Among other provocative findings, they report that deaths from injuries--including accidents, homicides, and war--account for 10% of deaths worldwide, higher than some experts had expected. In China, they note, there is an "unusually high probability of injury death among adult women," mainly a reflection of suicide rates in rural areas. For example, among women aged 15 to 44, suicide is estimated to be the cause of almost one death in four. These results are likely to cause officials at the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) to rethink international health trends and strategies. Melinda Moore, the acting associate director for global health at CDC, said that as soon as the report became available, she distributed it widely. She also helped to arrange a 22 May meeting to discuss the study's consequences for CDC's international programs, including the possibility of exporting U.S. programs designed to prevent deaths from smoking, poor diet, and violence.

The World Bank--which sponsored the disease-burden study--has already begun acting upon Murray and Lopez's findings, a source said. Alerted to the rising risks of heart attack and stroke, the bank recently signed an agreement to help fund a cardiovascular-disease prevention program in Brazil.

Mortality rates by country for ischemic heart disease (IHD) before and after adjustment for miscoding.

But policy-makers must be careful to avoid overreacting, says Robert B. Eiss, the assistant director for international science policy and analysis at the John E. Fogarty Center, NIH's international science office. It would be a mistake, he said, "to allocate research funding based on the actuarial tables alone." Agencies should consider "other factors" like the opportunities for new discoveries, the feasibility of experiments, and the need to sustain basic research.