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HIV to be top health problem within 25 years
AIDS set to become world's biggest problem disease.
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You can read the full study discussion at PLoS,
http://medicine.plosjournals.org
http://www.nature.com/news
Published online: 28 November 2006;
Michael Hopkin
AIDS will become the world's most burdensome disease by 2030, according to predictions released today. Its predicted rise, which will overtake today's top problem of poor perinatal health (such as low birth weight), is being blamed on many countries' failure to impose proper prevention measures since the pandemic was first revealed.
The result is in sharp contrast to the same group's last prediction, made in 1996, that heart disease would be the top global health problem in 2020, with HIV a mere tenth in the list.
"HIV is not going to come down unless we invest more in prevention efforts," says Colin Mathers, one of the researchers at the Geneva-based World Health Organization, who produced the prediction. Even if rates of HIV infection remain constant, growing populations in the developing world will propel it to the top of the rankings at a time when rates of other communicable diseases are set to improve.
According to the report, issued as part of the Global Burden of Disease project, and published in PLoS Medicine1, by 2030 AIDS could account for almost one in every eight years of life lost through death or disability.
Other infectious diseases, however, are set to decrease as control measures improve.
Malaria, diarrhoea and tuberculosis are all due to fall off the top ten list. The bad news is that this spells a relative growth in smoking-related disease, cancer and road injuries.
Wishful thinking
The figures were compiled through examining social and economic trends over the past 50 years, and extrapolating them into the future. To allow comparison, the impacts of different diseases are calculated according to their overall burden - the effects they have through death and through harming quality of life by causing illness or disability.
So although AIDS is not predicted to be the world's biggest killer by 2030 - that will be heart disease - it is likely to be the most burdensome, the report says (see Box). Overall, cases are expected to rise from 2.8 million worldwide in 2002, to 6.5 million in 2030.
The 1996 report was too ready to hope that countries would control the spread of HIV, and did not factor in the explosion of infections in sub-Saharan Africa, Mathers says. "In 1996 we were much more optimistic that the world would take up prevention methods," he says. "But over the past decade, apart from a few countries, efforts have not been made to address prevention."
Up in smokers
Of the roughly 73 million deaths expected to occur during the year 2030, some 69% are predicted to be caused by non-communicable disease, such as cancer, compared with roughly 60% today.
Many of these trends are now inevitable, says Mathers. Ageing populations, and the ever-growing number of smokers, means that the expected rise in cancer has already had its seeds sown. "It's a bit more than just guesswork," he says.
But some trends might still be averted, he adds. The figures assume that current trends of disease management will continue into the future, but the report also includes more optimistic and pessimistic scenarios. Wider provision of anti-HIV drugs, for example, could mean that those already infected are less likely to pass it on. "If governments do ramp up their anti-HIV efforts, it could start to decrease," says Mathers.
The predicted rise of clinical depression will be a product of declines in other, more preventable, diseases, Mathers says. In high-income countries, it is expected to account for almost 10% of all disease burden by 2030. The same goes for road injuries - under the report's 'optimistic' scenario, traffic accidents replaces heart disease in the top three.
Projections of Global Mortality and Burden of Disease from 2002 to 2030
The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015.
PLoS Medicine Nov 2006
Colin D. Mathers*, Dejan Loncar
1 Evidence and Information for Policy Cluster, World Health Organization, Geneva, Switzerland
Background
Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results.
Methods and Findings
Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depressive disorders, and ischaemic heart disease in the baseline and pessimistic scenarios. Road traffic accidents are the fourth leading cause in the baseline scenario, and the third leading cause ahead of ischaemic heart disease in the optimistic scenario. Under the baseline scenario, HIV/AIDS becomes the leading cause of burden of disease in middle- and low-income countries by 2015.
Conclusions
These projections represent a set of three visions of the future for population health, based on certain explicit assumptions. Despite the wide uncertainty ranges around future projections, they enable us to appreciate better the implications for health and health policy of currently observed trends, and the likely impact of fairly certain future trends, such as the ageing of the population, the continued spread of HIV/AIDS in many regions, and the continuation of the epidemiological transition in developing countries. The results depend strongly on the assumption that future mortality trends in poor countries will have a relationship to economic and social development similar to those that have occurred in the higher-income countries.
Funding: Financial support for this project was provided by the World Health Organization (WHO) Department of Chronic Diseases and Health Promotion and the WHO Commission on Intellectual Property Rights, Innovation and Public Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Academic Editor: Jon Samet, Johns Hopkins School of Public Health, United States of America
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