GBD PROFILE: CAMBODIA

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 CAMBODIA , lower respiratory infections,ischemic heart disease, and cerebrovascular disease were thehighest ranking causes in the 25 most important causes of burden , as measured bydisability-adjusted life years (DALYs)

2 , diarrheal diseases showedthe largest decrease, falling by 80% from 1990 to leading risk factor in CAMBODIA is dietary MORTALITY RATElThis chart shows the decline in mortality rate at every age higher points on the chart indicate that declines in mortalityrates were faster in those age groups between 1990 and greatest reductions in all-cause mortality rate wereexperienced by females aged 1-4 years (73%). Males aged 80+years saw the smallest decrease in mortality rate (6%).Percent decline in age-specific mortality rate by sex from 1990-2010 in CambodiaCAUSES 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.

3 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 101530456075 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)% change59 ( )15 Asthma54 ( )17 COPD279 ( )5 Congenital anomalies626 ( )2 Diarrheal diseases57 ( )16 Drowning145 ( )11 Ischemic heart disease929 ( )1 Lower respiratory infections467 ( )3 Malaria74 ( )14 Maternal disorders28 Maternal disorders302 ( )6 Measles37 Measles58 ( )

4 19 Mechanical forces32 Mechanical forces118 ( )13 Meningitis161 ( )9 Neonatal encephalopathy46 ( )23 Neonatal sepsis26 Neonatal sepsis42 ( )22 Other cardio & circulatory319 ( )4 Preterm birth complications153 ( )10 Protein-energy malnutrition41 ( )25 Rabies50 ( )18 Rheumatic heart disease49 ( )21 Road injury39 ( )24 Self-harm138 ( )12 Stroke44 ( )20 Syphilis43 Syphilis177 ( )8 Tetanus44 Tetanus180 ( )7 Tuberculosis49 ( )18 Asthma-1647 ( )19 COPD-1244 ( )22 Chronic kidney disease7330 Chronic kidney disease53 ( )15 Cirrhosis7928 Cirrhosis164 ( )5 Congenital anomalies-4151 ( )16 Diabetes9929 Diabetes117 ( )8 Diarrheal diseases-8256 ( )14 Drowning174 ( )12 HIV/AIDS75244 ( )23 Hypertensive heart disease7531 Hypertensive heart disease45 ( )20 Interpersonal violence10833 Interpersonal violence262 ( )2 Ischemic heart disease80357 ( )1 Lower respiratory infections-6197 ( )10 Malaria-7958 ( )13 Meningitis-50117 ( )9 Neonatal encephalopathy-2748 ( )17 Other cardio & circulatory17213 ( )4 Preterm birth complications-3240 ( )24 Protein-energy malnutrition-7339 ( )25 Rheumatic heart disease-20123 ( )6 Road injury16865 ( )11 Self-harm67223 ( )3 Stroke63124 ( )

5 7 Tuberculosis-3053 ( )21 Typhoid fevers8132 Typhoid feversRanks for top 25 causes of YLLs 1990-2010, CambodiaCCCommuni cabl e, maternal , neonatal , and nutri ti onalCCNon-communi cabl eCCInj uri es050,000100,000150,000 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 &

6 MalariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisLOWER RESPIRATORY INFECTIONSISCHEMIC HEART DISEASESTROKEPRETERM BIRTH COMPLICATIONSTUBERCULOSISCONGENITAL ANOMALIESIRON-DEFICIENCY ANEMIAROAD INJURYMAJOR DEPRESSIVE DISORDERDIARRHEAL DISEASESNEONATAL ENCEPHALOPATHYLOW BACK PAINCOPDMALARIAASTHMAHIV/AIDSDIABETESMEN INGITISSELF-HARMDROWNINGNECK PAINCIRRHOSISMIGRAINEOTHER CARDIO & CIRCULATORYCHRONIC KIDNEY DISEASE12 34 5 6 78 910 1112 131415 16 171819 20 21 22 23 24 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.

7 The top five leadingcauses of YLDs in CAMBODIA are iron-deficiency anemia, major depressive disorder, low back pain, chronic obstructive pulmonarydisease, and 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.

8 In CAMBODIA , thetop three causes of DALYs in 2010 were lower respiratory infections, ischemic heart disease, and cerebrovascular disease. The causesthat were in the 10 leading causes of DALYs in 2010 and not 1990 were ischemic heart disease, cerebrovascular disease, road injury, andmajor depressive top 25 causes of DALY sare ranked from left to rightin order of the number ofDALYs they contributed in2010. 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.

9 Andnutritional causes of DALY sare generally on the causes of DALYs and percent change 1990 to 2010 for | GBD | page 3012345678910% DALYs attributable to risk factorsDrug useHigh total cholesterolHigh body mass indexHigh fasting plasma glucosePhysical inactivitySuboptimal breastfeedingAmbient PM pollutionOccupational risksChildhood underweightAlcohol useIron deficiencyHigh blood pressureSmokingHousehold air pollutionDietary risksWar & 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 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)

10 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 RankDjibouti1,18061,129 12 45,440 7 38,655 11 13,493 5 14,182 ,532 15 1,094 10 56,031 13 34,746 8 13,297 4 12,323 13 ,047 29996 33,446 1 30,037 6 12,606 2 12,336 ,11057992 41,735 5 28,295 4 15,584 15 14,781 15 ,296 10 1.