Nepal Burden of Disease 2017
A Country Report based on the Global Burden of Disease 2017 Study
The Global Burden of Disease (GBD) study is a systematic effort to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geographies for specific points in time. It provides a comprehensive picture of total health loss due to disease, injury and death. The Institute of Health Metrics and Evaluation (IHME) at the University of Washington has recently produced GBD 2017 estimates, which highlight Nepal’s health performance in terms of mortality, morbidity and overall disease burden. These have been extracted to produce this Nepal Burden of Disease (BoD) Study 2017 report. The GBD, and thus the Nepal BoD (NBoD) Study 2017, measures overall mortality, causes of mortality, causes of morbidity and risk factors. Overall mortality is expressed in the form of number of deaths due to diseases and injuries and their rates per 100,000 population. Causes of mortality are captured through years of life lost (YLLs), which give years of life lost due to premature death from a disease or injury. Years lived with disability (YLDs) measure causes of morbidity, they are used to indicate the number of years lived with disability due to a non-fatal disease or injury. YLLs and YLDs together give the overall burden of disease or injury. It is expressed in the form of disability adjusted life years (DALYs). Results described in the NBoD 2017 Report reveal that females are expected to live longer (73.3 years) than males (68.7 years). Life expectancy increased from 59 to 73 years for females, and 58 to 69 years for males, between 1990 and 2017. However, not all these additional years gained will be healthy ones. Women are expected to live 62 years of healthy life, while men will live 60 years of healthy life. This discrepancy between life expectancy and healthy life expectancy is due to years of healthy life lost due to ill health and disability.
A total of 182,751 deaths are estimated in Nepal for the year 2017. Non-communicable diseases (NCDs) are the leading causes of death – two-thirds (66%) of deaths are due to NCDs, with an additional 9% due to injuries. The remaining 25% are due to communicable, maternal, neonatal and nutritional (CMNN) diseases. Ischemic heart disease (16.4% of total deaths), chronic obstructive pulmonary diseases (COPD) (9.8% of total deaths), diarrhoeal diseases (5.9% of total deaths), and lower respiratory infections (5.1% of total deaths), were the top causes of death in 2017.
The rise of NCDs is partly due to the changing age structure and life-style changes such as increasing sedentary behavior, tobacco use, changes in eating habits and harmful use of alcohol. Similarly, out of the total (5,850,044) YLLs due to premature death (people dying earlier than their potential life expectancy), 49% are due to NCDs, 39% due to CMNN diseases and the remaining 12% due to injury. The top causes of YLLs due to premature deaths are, ischemic heart disease (11.3% of total YLLs), lower respiratory infections (7.9% of total YLLs), neonatal encephalopathy (5.7% of total YLLs), and COPD (5.5% of total YLLs). The leading causes of morbidity (YLDs) are low back pain, migraine, COPD and other musculoskeletal disorders. Approximately 59% of disease burden (including premature death and disability) in 2017 is due to NCDs, 31% due to CMNN diseases and 10% due to injury. Ischemic heart disease (7.6% of DALYs), COPD (5.4% of DALYs) and lower respiratory infections (5.2% of DALYs) are the top three disease conditions causing most of the disease burden in 2017.
The findings further reveal that short gestation for birth weight (7.5% of total DALYs), high systolic blood pressure (6.7% of total DALYs), smoking (6.5% of total DALYs), high blood glucose levels (5.5% of total DALYs) are the main risk factors driving death and disability in Nepal. From the results presented in the NBoD 2017 report, NCDs are increasingly becoming a major public health issue. Notably, ischemic heart disease and COPD are top causes contributing significantly to the BoD (DALYs). Maternal and child health outcomes are improving but should not be neglected as there is still much progress to be made. Notable risk factors are metabolic risk factors, ambient and household air pollution, and finally, behavioural risk factors such as smoking.
The national BoD profile in 2017 looks vastly different from 1990, or even 2007: these changes must be reviewed and addressed, and Nepal’s health policy priorities, strategies and resource allocations should be adapted accordingly.
Collaborators suggest following steps for refining the BoD estimates for Nepal at federal, provincial, and local level:
- Explore and utilize available national, and local-level data to feed into the next cycles of GBD results produced by IHME.
- Strengthen verbal autopsy and CRVS system to generate local level data on mortality.
- Strengthen the disease registries such as population-based cancer registry and initiate other disease registries to enhance the availability of local data on morbidity and mortality.
- Develop/improve data sharing policy and refine GBD estimates for Nepal.
- Gradually move toward sub-national estimates and local burden of disease.
- Build capacity on understanding, accessing, and using BoD estimates.
- Use GBD estimates to measure progress in SDG-related health indicators as well as in Annual Work Planning and Budgeting of the MoHP.