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Research packed with surprises

December 15, 2012

A GIRL born today in the UK can expect to live nearly to the age of 82 on average, while her brother will live to 78. They would have a longer life in Andorra (85 and 79 respectively), but are marginally better off than in the US (81 and 76), while if they lived in the Central African Republic, they would barely make it out of middle-age (49 and 44).

Nonetheless almost everywhere in the world, with the exception of countries such as Lesotho which have been hit by HIV and violence, lifespans are lengthening and the best news is that small children are substantially less likely to die than they were four decades ago. There has been a drop in deaths among under-fives of nearly 60 per cent, from 16.4 million in 1970 to 6.8 million in 2010.

That in itself is justification for the enormous project that the Institute of Health Metrics and Evaluation (IHME) in Seattle has led over the past five years, involving nearly 500 researchers, to assess the global burden of disease. The seven papers published on Wednesday by the Lancet represent a big undertaking and are not without controversy.

IHME has been ambitiously radical in some of its methods. In the absence of death registries or medical records, they have been willing, for instance, to take evidence from verbal autopsies — deciding the cause of death by an interview with the family.

The most startling result has been the malaria figure, released earlier this year. The IHME said 1.2 million die of the disease — twice as many as previously thought. The big increase is in adult deaths. Convention has it that malaria kills mostly children under five.

“The way I was taught as a doctor and everybody else is taught is that in malarial areas, you become semi-immune as an adult,” said Dr Christopher Murray, IHME director and one of the founders of the global burden of disease project.

“We originally went with the prevailing opinion but there has been a shift as we have become more empirical, following the data. African doctors write on hospital records that adults are dying of malaria a lot.” But, he adds, their fever could be something else. The findings have prompted further studies.

Although Margaret Chan, director general of the World Health Organisation, gave the IHME study a warm official welcome, some of the staff are cautious. “We need to be very careful in assessing the validity [of the figures],” said Colin Mathers, a senior scientist in the evidence and information for policy cluster. “We need to wait to be persuaded by evidence.”

One of the main themes, said Murray, was “incredibly rapid change in the leading causes of death and the pace of that change is a lot faster than we expected it to be.”

Reduced fertility and longer life has meant a rise in the mean age of the world’s population in a decade from 26 years old to almost 30. It has been dramatic in Latin America, for instance, where countries like Brazil and Paraguay had a life expectancy of below 30 in 1970 and almost 64 in 2010. That is a 35-year increase in the mean age of death over four decades.

The second theme, entwined with it, is the shift outside of Africa from communicable diseases and the common causes of mother and baby deaths to what are sometimes termed ‘lifestyle’ diseases such as heart disease, stroke, diabetes and cancer — some of which have significant genetic triggers.

The third big finding was, he said “a surprise to us”. That was the sheer extent of disability and the toll it took of people who were living longer but not healthier lives.

“The main causes of disability are different from the ones that kill you,” he said. They were mental health problems such as anxiety and depression, musculoskeletal disorders such as arthritis and lower back pain — complained of in every country in the world — anaemia, sight and hearing loss and skin disease.

In addition, there was substance abuse. “The rates for these are not going down over time,” he said. “We are making no progress in reducing these conditions.” — The Guardian, London