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Liver Cancer deaths Double Over last 20 Years & Deaths Due to Cirrhosis Increased 43%
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JAMA July 10 2013
Of the 30 leading diseases and injuries contributing to DALYs, 10 (COPD, major depressive disorders, othermusculoskeletal, diabetes, drug use disorders, Alzheimer, falls, cirrhosis, CKD, and osteoarthritis) increased by more than 30% from 1990 to 2010 (eTable 6 in the Supplement provides detail for the 272 diseases and injuries). Other disorders contributing to DALYs not in the top 30 that have also increased by more than 30% in the past 2 decades include liver cancer, atrial fibrillation, kidney cancers, eating disorders, and poisoning.
DALYs disability-adjusted life-years
HALE healthy life expectancy
YLDs years lived with disability
YLLs years of life lost due to premature mortality
In this analysis, the aggregate of the 14 subcomponents of diet is a more important factor associatedwith disease burden than either physical inactivity or high BMI.
The next 3 leading diseases contributing to YLLs, diabetes, cirrhosis and Alzheimer disease, all increased in rank and the number of YLLs from1990 to 2010. Colorectal cancer (10th), breast cancer (13th for both sexes combined and fifth in women), and pancreatic cancer (18th) are in the top 20 diseases and injuries contributing to premature death. Other large increases in premature mortality were seen for drug use disorders (moving from 44th to 15th), chronic kidney disease (CKD) (from 21st to 16th), kidney cancer (from 35th to 24th), and poisonings (from 31st to 26th); falls (from 33rd to 29th) and liver cancer (from 39th to 30th) also increased. The increase in YLLs associated with liver cancer may be related to a hepatitis C cohort effect.50 Among the 30 leading diseases and injuries contributing to YLLs in 1990, declines of 25% or more were seen for interpersonal violence, preterm birth complications, congenital anomalies, HIV/AIDS, and sudden infant death syndrome.
The YLLs related to HIV decreased by 64% and declined in rank from seventh to 23rd. eTables 3 and 4 in the Supplement provide estimates of deaths and YLLs, respectively, for all 223 diseases and injuries.





Diabetes, Kidney Disease, and Neurological Disorders
The increase in disease burden from diabetes and CKD is particularly noteworthy. We estimate in this study that in 2010, 23.5% of CKD and 76.0% of diabetes DALYs were related to BMI, increases from 18.1% and 64.3% in 1990, respectively. The increase in CKD-related mortality was larger than the increase in mortality related to diabetes, which suggests that other causes of CKD may also be increasing. Given the costs associated with long-term management of diabetes and CKD, these trends are likely to continue to increase health costs.68 Improved survival among persons with diabetes by effective management of major cardiovascular and renal risks such as hyperglycemia, hypertension, and high cholesterol may improve overall population health but will likely increase costs as well. Recent data indicate improvements in the quality of care for diabetes.69 Evidence that diabetes can be substantially prevented or postponed in people with pre diabetes through focused lifestyle or drug therapy has accumulated over the past few years.70
Neurological conditions increased from 2.0% of DALYs in 1990 to 3.0% in 2010. Both Alzheimer disease and Parkinson disease are associated with large increases in DALYs. Although the increase in Alzheimer disease may be confounded by changes in ascertainment and coding practice, these increases suggest an important trend. Migraine and epilepsy are also ranked 14th and 30th as diseases contributing to YLDs, respectively. Both aging and increasing age standardized prevalence rates are contributing to a growing challenge of neurological disease.
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