Declining Death Rates Largely Due To Decreased Tobacco Exposure

Mohammed K. Ali, MBChB, MSc, MBA Associate Professor of Global Health and Epidemiology Rollins School of Public Health Emory University Interview with:
Mohammed K. Ali, MBChB, MSc, MBA
Associate Professor of Global Health and Epidemiology
Rollins School of Public Health
Emory University

Medical Research: What is the background for this study? What are the main findings?

Dr. Ali: The background of this study is that we attempted to provide a comprehensive overview so that readers could see what has been happening for the 4 most common sets of chronic non-communicable diseases (cardiovascular diseases, diabetes, common cancers, and chronic respiratory diseases) over the past 30 years (1980-2012). We looked at one measure: death due to these conditions as that is the longest-standing way to understand what diseases are most common in society and warrant efforts to address them. And, we picked these 4 groups of conditions because together, they account for one out of every two deaths worldwide. We compiled data for 49 countries where over 70% of deaths in the country are documented and reported to the World Health Organization’s Mortality Database. What we found is that:

  • Between 1980 and 2012, death rates for many conditions (heart disease and stroke; cervical and stomach cancers) declined worldwide.
  • Second, deaths due to diabetes, liver cancers, and female lung cancer and female respiratory diseases increased worldwide.
  • And third, there were disparities between high-income countries (like the US, Australia, European countries) and low- and middle-income countries (like Mexico or Eastern European countries) in that these latter countries experienced less impressive declines in deaths due to heart disease, stroke, stomach, and cervical cancers, and actual increases in deaths due to breast cancers and colon cancers.This suggests that we have made important strides in high-income countries, largely due to efforts to lower tobacco exposure, and that awareness, access to healthcare, screening, and earlier treatments seem to be having an effect on prolonging survival from many cancers. Similarly, greater attention to and treatment of cardiovascular risk factors may be yielding benefits. However, more efforts are needed in low- and middle-income countries, and these disparities should not be overlooked.

Medical Research: What should clinicians and patients take away from your report?

R Dr. Ali: In terms of relevance to clinicians and patients IN THIS COUNTRY, the reductions in mortality rates for many conditions (heart disease and stroke; lung, breast, colon, cervical, and stomach cancers) suggests that tobacco policies are having important impacts; and that clinicians and patients together are doing a great job in terms of preventive care – lowering blood pressure and cholesterol levels, encouraging screening (clinicians) and self-screening (patients), and possibly earlier treatments.

The increases in diabetes mortality suggest two things: one that diabetes and obesity are the two cardio-metabolic conditions that we are not managing well, and we have to strive harder to help people adopt healthier lifestyles (better quality diets with some attention to portion size, more exercise). Second, the data suggest that non-cardiovascular impacts of diabetes need more attention – kidney diseases are especially overlooked.

Lastly, while much of this is good news that death rates are declining, that doesn’t mean we have less of these diseases; in fact, with population growth and lower deaths, it means that clinicians have and will increasingly face higher numbers of people with chronic conditions (cancers, diabetes, etc.). So, we are compressing mortality, but expanding morbidity, and we have to figure out how to handle the higher volume of patients clinicians will have to manage. Also, for patients and people at risk, they can help by use modern technologies to learn about their risks (there is more information online now than ever before), engage in their own preventive health care, and try to elongate their healthy years of life.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ali: Since we used a strict definition of including only countries that had reliable death documentation, we were unable to include data from China, India, Indonesia, and most of Sub-Saharan Africa (which together account for 50% of the world’s population. As such, we need to invest in better cause-of-death documentation so that these trends can be monitored for the whole world.

Second, we relied on existing literature to try to understand the trends in death rates for these countries, and while we know a fair amount about how much healthcare has contributed to declining death rates, we need more research to understand if and how much societal interventions like building bike lanes or taxing sodas or other such population-wide policies might affect health. Investing in this sort of research will hopefully help us make informed decisions about which policies to pursue and which to disregard.”


Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates

Mohammed K. Ali, Lindsay M. Jaacks, Alysse J. Kowalski, Karen R. Siegel, and Majid Ezzati

Health Aff September 2015 34:91444-1455;doi:10.1377/hlthaff.2015.0570 is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.

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Mohammed K. Ali, MBChB (2015). Declining Death Rates Largely Due To Decreased Tobacco Exposure 

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