GBD PROFILE: BARBADOS

1 GLOBAL BURDEN OF DISEASES, INJURIES, AND RISK FACTORS STUDY 2010 The Global Burden of Disease Study 2010 (GBD 2010) is a collaborative project of nearly 500 researchers in 50 countries led by theInstitute for Health Metrics and Evaluation (IHME) at the University of Washington. It is the largest systematic scientific effort in history toquantify levels and trends of health loss due to diseases, injuries, and risk factors. GBD serves as a global public good to informevidence-based policymaking and health systems OVERVIEWlIn terms of the number of years of life lost (YLLs) due topremature death in BARBADOS , ischemic heart disease, diabetesmellitus, and cerebrovascular disease were the highest rankingcauses in the 25 most important causes of burden, as measured bydisability-adjusted life years (DALYs), preterm birthcomplications showed the largest decrease, falling by 60% from1990 to leading risk factor in BARBADOS is high body-mass MORTALITY RATElThis chart shows the change in mortality rate at every agerange.

2 The points above 0 on the chart indicate positive declinesin the all-cause mortality rate, while points below 0 indicate anincrease in mortality rate between 1990 and greatest reductions in all-cause mortality rate wereexperienced by females aged 1-4 years (52%). Males aged 30-34years saw the largest increase in mortality rate (41%).Percent decline in age-specific mortality rate by sex from 1990-2010 in BarbadosCAUSES OF PREMATURE DEATHY ears of life lost (YLLs) quantify premature mortality by weighting younger deaths more than older chart shows thechange in the top 25causes of YLLs due topremature mortalityfrom 1990 to lines indicate acause has moved up inrank or stayed thesame. Broken linesindicate a cause hasmoved down in causes are colorcoded by blue fornon-communicablediseases, green forinjuries, and red forcommunicable,maternal, neonatal, andnutritional causes PROFILE: | GBD | page 1 40 200204060 Percent decline in age specific mortality rate 1 45 910 1415 1920 2425 2930 3435 3940 4445 4950 5455 5960 6465 6970 7475 7980+Age groupMalesFemales# YLLs in thousands(% of total)Rank and disorder 1990 Rank and disorder 2010# YLLs in thousands(% of total)% change1 ( )13 Breast cancer1 ( )24 Cervical cancer28 Cervical cancer1 ( )21 Chronic kidney disease1 ( )17 Cirrhosis1 ( )20 Colorectal cancer2 ( )8 Congenital anomalies3 ( )4 Diabetes1 ( )18 Drowning30 Drowning2 ( )6 HIV/AIDS1 ( )19 Hypertensive heart disease1 ( )12 Interpersonal violence1 ( )16 Iron-deficiency anemia39 Iron-deficiency anemia5 ( )1 Ischemic heart disease3 ( )5 Lower respiratory infections1 ( )25 Lung cancer2 ( )7 Neonatal encephalopathy1 ( )11 Neonatal sepsis1 ( )23 Non-Hodgkin lymphoma27 Non-Hodgkin lymphoma1 ( )10 Other cardio & circulatory3 ( )3 Preterm birth complications1 ( )

3 14 Prostate cancer1 ( )9 Road injury1 ( )22 Self-harm29 Self-harm1 ( )15 Stomach cancer4 ( )2 Stroke1 ( )11 Breast cancer221 ( )22 Cardiomyopathy1127 Cardiomyopathy1 ( )12 Chronic kidney disease651 ( )16 Cirrhosis61 ( )9 Colorectal cancer861 ( )18 Congenital anomalies-654 ( )2 Diabetes111 ( )19 Drug use disorders6834 Drug use disorders2 ( )5 HIV/AIDS-121 ( )14 Hypertensive heart disease161 ( )7 Interpersonal violence214 ( )1 Ischemic heart disease-181 ( )17 Liver cancer6026 Liver cancer2 ( )4 Lower respiratory infections-140 ( )24 Lung cancer-191 ( )15 Neonatal encephalopathy-581 ( )21 Neonatal sepsis-491 ( )8 Other cardio & circulatory-60 ( )25 Other musculoskeletal10048 Other musculoskeletal1 ( )20 Pancreatic cancer4329 Pancreatic cancer1 ( )10 Preterm birth complications-621 ( )13 Prostate cancer211 ( )6 Road injury-91 ( )23 Stomach cancer-403 ( )3 Stroke-37 Ranks for top 25 causes of YLLs 1990-2010, BarbadosCCCommuni cabl e, maternal , neonatal , and nutri ti onalCCNon-communi cabl eCCInj uri es01,0002,0003,0004.

4 000 YLDs0 6 days7 27 days28 364 days1 4 years5 9 years10 14 years15 19 years20 24 years25 29 years30 34 years35 39 years40 44 years45 49 years50 54 years55 59 years60 64 years65 69 years70 74 years75 79 years80+ yearsWar & disasterIntentional injuriesUnintentional injuriesTransport injuriesOther non communicableMusculoskeletal disordersDiabetes/urogen/blood/endoMenta l & behavioral disordersNeurological disordersDigestive diseasesCirrhosisChronic respiratory diseasesCardio & circulatory diseasesCancerOther communicableNutritional deficienciesNeonatal disordersMaternal disordersNTD & malariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisDIABETESISCHEMIC HEART DISEASESTROKEMAJOR DEPRESSIVE DISORDERLOW BACK PAINROAD INJURYLOWER RESPIRATORY INFECTIONSHIV/AIDSIRON-DEFICIENCY ANEMIAADVERSE MEDICAL TREATMENTOTHER MUSCULOSKELETALASTHMAFALLSDRUG USE DISORDERSOTHER CARDIO & CIRCULATORYINTERPERSONAL VIOLENCENECK PAINPRETERM BIRTH COMPLICATIONSCOLORECTAL CANCERBREAST CANCERCHRONIC KIDNEY DISEASEOSTEOARTHRITISANXIETY DISORDERSPROSTATE CANCERMIGRAINE12 3 45 67 8 910 111213 141516 171819 20 21 222324 25-200-150-100-50050100150200 | GBD | page 2 Percent change 1990-2010 YEARS LIVED WITH DISABILITY (YLDs)Years lived with disability (YLDs) are estimated by weighting the prevalence of different conditions based on severity.

5 The top five leadingcauses of YLDs in BARBADOS are major depressive disorder, low back pain, diabetes mellitus, iron-deficiency anemia, and adverse effectsof medical size of the coloredportion in each barrepresents the number ofYLDs attributable to eachcause. The height of each barshows which age groups hadthe most YLDs in 2010. Thecauses are aggregated. Forexample, musculoskeletaldisorders include low backpain and neck YLDs by cause and age 2010 DISABILITY-ADJUSTED LIFE YEARS (DALYs)Disability-adjusted life years (DALYs) quantify both premature mortality (YLLs) and disability (YLDs) within a population. In BARBADOS , thetop three causes of DALYs in 2010 were diabetes mellitus, ischemic heart disease, and cerebrovascular disease. Two causes thatappeared in the 10 leading causes of DALYs in 2010 and not 1990 were road injury and adverse effects of medical top 25 causes of DALY sare ranked from left to rightin order of the number ofDALYs they contributed in2010.

6 Bars going up show thepercent by which DALYs haveincreased since 1990. Barsgoing down show the percentby which DALYs havedecreased. Globally,non-communicable diseasesand injuries are generally onthe rise, while communicable,maternal, neonatal, andnutritional causes of DALY sare generally on the causes of DALYs and percent change 1990 to 2010 for | GBD | page 3 10123456789101112% DALYs attributable to risk factorsSuboptimal breastfeedingChildhood sexual abuseIntimate partner violenceOccupational risksHigh total cholesterolDrug useAmbient PM pollutionIron deficiencySmokingAlcohol usePhysical inactivityHigh fasting plasma glucoseHigh blood pressureDietary risksHigh body mass indexWar & disasterIntentional injuriesUnintentional injuriesTransport injuriesOther non communicableMusculoskeletal disordersDiabetes/urogen/blood/endoMenta l & behavioral disordersNeurological disordersDigestive diseasesCirrhosisChronic respiratory diseasesCardio & circulatory diseasesCancerOther communicableNutritional deficienciesNeonatal disordersMaternal disordersNTD & malariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisAge-standardized

7 Death rates, YLL rates, YLD rates, and life expectancy at birth and health-adjusted life expectancy at birth for 1990 and 2010, both sexes combinedCountryAge-standardized death rate(per 100,000)Age-standardized YLL rate(per 100,000)Age-standardized YLD rate(per 100,000)Life expectancy at birthHealth-adjusted lifeexpectancy at birth19902010199020101990201019902010199 02010 Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank LE Rank LE Rank HALE Rank HALE RankSlovenia76064654 17,330 49,4915 11,410 5 11,095 Korea81384472 18,830 68,941 3 10,074 19, and Tobago9341288313 24,788 13 21,845 13 12,45812 12,885 14 13 11,703 28,924 2 11,659 7 11,481 Republic87695487 19,311 7 10,997 6 11,015 2 10,759 11,476 1 8,404 1 11,535 6 11,615 22,087 10 13,868 9 12,455 11 11,963 11 11 10 Barbados74455938 21,168 9 15,643 12 12,700 13 12,588 13 10 8 12 Saudi Arabia64135386 17,367 5 12,637 7 12.

8 745 14 12,489 16,152 39,407 4 11,409 4 11,123 ,133 14 1,187 14 29,858 14 31,195 14 11,681 9 11,259 14 14 Equatorial Guinea2,053 15 1,284 15 79,601 15 53,344 15 15,024 15 14,660 15 15 15 Slovakia8931065211 20,667 8 13,779 8 11,905 10 11,042 23,806 12 15,271 11 11,665 8 11,589 12 23,443 11 13,954 10 11,129 3 11,165 FACTORSO verall, the three risk factors that account for the most disease burden in BARBADOS are high body-mass index, dietary risks, and highblood pressure. The leading risk factors for children under 5 and adults aged 15-49 years were suboptimal breastfeeding and alcohol use,respectively, in graph shows the top 15risk factors for colored portion of eachbar represents the specificdiseases attributable to thatrisk factor while bar sizerepresents the percentage ofDALYs linked to specific of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of BARBADOS DALYsCOUNTRY BENCHMARKING OF BURDEN OF DISEASEU nderstanding the relative performance of BARBADOS against other comparator countries provides key insight into public healthsuccesses and areas where BARBADOS might be falling behind.

9 The table identifies BARBADOS ' rank across 14 other comparator countries,selected and ordered by income per capita, for five metrics of interest, with 1 indicating the best rank and 15 indicating the worst rates are used to make meaningful comparisons across time by adjusting for changes in population size and expectancy incorporates mortality, and health-adjusted life expectancy further incorporates years lived in less than ideal 2010, BARBADOS ranked 8th for age-standardized death rate and 13th for age-standardized YLD | GBD | page 4 Ranking of leading age-standardized rates of disability-adjusted life years (DALYs) relative to comparator countries in 1990 CountrySlovenia53544842944983871965 11 13 13 11 9 South Korea3 10 15 11426413 11 7 10 2 15 8 12 44283 15 1 Trinidad and Tobago11 15 88 11 14 12 11 1 13 10 3 12 12 9 10 13 4 12 13 92 11 4 14 Cyprus412 10 2169 14 528 11 95 12 6 15 59645 10 8 Czech Republic13 5 10 37653 11 85591663772 12 12 10 12 12 Malta78165318 15 261674 14 12 13 2687 15 95 Oman9 13 7 13 10 12 13 789 15 15 46 15 2 10 21 10 43223 Barbados1 14 3 15 14 13 10 15 2 15 12 2 15 14 14 9 15 5 11 15 3 1 14 5 15 Saudi Arabia8 12 4 12 15 11 947 11 11 13 3871 14 13 12 10 5112

10 Portugal2995627 10 13 67 12 5 13 3 13 7 14 10 77 10 97 10 Seychelles10 4 14 11 85 14 12 3 10 142 11 13 393 15 8 14 666 13 Equatorial Guinea6 11 13 14 13 15 15 13 5 14 14 14 13 15 11 52 11 13 14 15 11 434 Slovakia14 66799 11 1 10 386 14 4 10 446815 14 7 14 7 Hungary12 7 12 2 12 73 14 12 797 10 2 12 85893 13 15 12 13 11 Estonia15 2 11 93 10 856 12 13 10 151 11 11 10 14 11 19886 Ranking of leading age-standardized rates of disability-adjusted life years (DALYs) relative to comparator countries in 2010 CountrySlovenia14369 10 336 10 54 15 46476 10 81959 14 South Korea8171434644 15 62713 12 2535582 15 Trinidad and Tobago15 12 14 10 1 11 11 14 15 14 9 11 6 11 10 15 5 13 6 10 14 12 4 14 5 Cyprus10 62 11 13 62816 12 10 7546 13 349716 12 7 Czech Republic2962 10 5729331 12 19765 12 638 11 10 11 Malta351 13 15 16725 10 89921 14 78 12 92 13 56 Oman14 8 10 78 14 13 5 13 92748 13 52814 12 14 10 32 Barbados12 3 4 9 2 8 12 12 14 15 13 15 3 13 15 12 4 12 9 14 11 10 3 13 4 Saudi Arabia13 10 11 12 7 13 10 4 12 7191 10 721 14 21 13 15 14 11 Portugal6255