The burden and costs of chronic diseases in low-income and middle-income countries.
Abstract
This paper estimates the disease burden and loss of economic output associated with chronic diseases-mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes-in 23 selected countries which account for around 80% of the total burden of chronic disease mortality in developing countries. In these 23 selected low-income and middle-income countries, chronic diseases were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries where death registration data are available, the estimated age-standardised death rates for chronic diseases in 2005 were 54% higher for men and 86% higher for women than those for men and women in high-income countries. If nothing is done to reduce the risk of chronic diseases, an estimated US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. Achievement of a global goal for chronic disease prevention and control-an additional 2% yearly reduction in chronic disease death rates over the next 10 years-would avert 24 million deaths in these countries, and would save an estimated $8 billion, which is almost 10% of the projected loss in national income over the next 10 years.
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Epidemiological transitions are defined by a shift from a heavy burden of infectious diseases to a major prevalence of noncommunicable diseases (NCDs).
“Epidemiological transitions are defined by a shift from a heavy burden of infectious diseases to a major prevalence of noncommunicable diseases (NCDs)”
From Colonial transition as a major mediator of global health transition: lessons from the 2024 New Caledonia crisis (2025) · cites this paper as [3]
NCDs currently account for about 80% of all deaths worldwide.
“which currently account for about 80% of all deaths worldwide”
From Colonial transition as a major mediator of global health transition: lessons from the 2024 New Caledonia crisis (2025) · cites this paper as [3]
NCDs are closely connected to the ageing of populations (the demographic transition).
“and are thus closely connected to the ageing of the populations – i.e. the demographic transition [3]”
From Colonial transition as a major mediator of global health transition: lessons from the 2024 New Caledonia crisis (2025) · cites this paper as [3]
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Chronic Diseases in Developing Countries
Nugent, R. A. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1425.027 · Cited by 248 · see citing works
Goudge, J., Gilson, L., Russell, S., Gumede, T., & Mills, A. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-75 · Cited by 165 · see citing works
“study comparing data across 23 low and middle income countries reported death rates from chronic diseases 54% higher for men, and 85% higher for women, than in high income countries [3].”
BackgroundEffects of VEGF temporal and spatial presentation on angiogenesis
Silva, E. A., & Mooney, D. J. (2009) · Biomaterials · doi:10.1016/j.biomaterials.2009.10.052 · Cited by 247 · see citing works
“There is a significant need for new approaches to promote blood vessel formation in ischemic diseases, as these diseases remain the dominant cause of mortality worldwide [1,2].”
BackgroundLi, R., Gao, X., Liu, B., Ge, H., Li, N., Zhao, J., & Liu, J. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14010001 · Cited by 247 · see citing works
“It has been proposed that non-communicable cardiovascular diseases (CVDs) will be the global leading cause of death and disability by 2020 [3], and the number of hypertensive adults will reach 1.”
BackgroundJiang, C., Zhu, F., & Qin, T. (2020) · Current Medical Science · doi:10.1007/s11596-020-2270-5 · Cited by 240 · see citing works
Population genetic differentiation of height and body mass index across Europe
Robinson, M. R., Hemani, G., Medina‐Gómez, C., Mezzavilla, M., Esko, T., Shakhbazov, K., Powell, J. E., Vinkhuyzen, A. A. E., Berndt, S. I., Gustafsson, S., et al. (2015) · Nature Genetics · doi:10.1038/ng.3401 · Cited by 225 · see citing works
An estimate of the prevalence of hypertension in Nigeria
Adeloye, D., Basquill, C., Aderemi, A. V., Thompson, J., & Obi, F. A. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000413 · Cited by 233 · see citing works
Williams, J., Allen, L. N., Wickramasinghe, K. K., Mikkelsen, B., Roberts, N. W., & Townsend, N. P. (2018) · Journal of Global Health · doi:10.7189/jogh.08.020409 · Cited by 229 · see citing works
Cardiovascular disease and periodontitis: an update on the associations and risk
Persson, G. R., & Persson, R. E. (2008) · Journal Of Clinical Periodontology · doi:10.1111/j.1600-051x.2008.01281.x · Cited by 227 · see citing works
“account for around 80% of the total burden of chronic disease mortality in developing countries (Abegunde et al. 2007).”
BackgroundLi, C., & Lumey, L. H. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyx013 · Cited by 222 · see citing works
A wearable haemodialysis device for patients with end-stage renal failure: a pilot study
Davenport, A., Gura, V., Ronco, C., Beizai, M., Ezon, C., & Rambod, E. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61864-9 · Cited by 217 · see citing works
Global public health: a scorecard
Beaglehole, R., & Bonita, R. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61558-5 · Cited by 212 · see citing works
Comorbidity of atrial fibrillation and heart failure
Ling, L., Kistler, P. M., Kalman, J. M., SCHILLING, R. J., & Hunter, R. J. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.191 · Cited by 213 · see citing works
Embedding non-communicable diseases in the post-2015 development agenda
Alleyne, G. A. O., Binagwaho, A., Haines, A., Jahan, S., Nugent, R. A., Rojhani, A., & Stückler, D. (2013) · The Lancet · doi:10.1016/s0140-6736(12)61806-6 · Cited by 211 · see citing works
Sokka, T., Kautiainen, H., Pincus, T., Toloza, S. N., Pinheiro, G. D. R. C., Lazovskis, J., Hetland, M. L., Peets, T., Immonen, K., Maillefert, J.-F., et al. (2009) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2009.109983 · Cited by 207 · see citing works
“17 The burden of chronic diseases, recognised as an important neglected global health issue,(18) is greatest in low and middle income countries.(19) Most chronic diseases occur at substantially higher frequency in individuals of low socioeconomic status, particularly before the age of 65 years.”
BackgroundTrends in prevalence and incidence of chronic respiratory diseases from 1990 to 2017
Xie, M., Liu, X., Cao, X., Guo, M., & Li, X. (2020) · Respiratory Research · doi:10.1186/s12931-020-1291-8 · Cited by 203 · see citing works
Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review
Akinlua, J. T., Meakin, R., Umar, A., & Freemantle, N. (2015) · PLoS ONE · doi:10.1371/journal.pone.0140021 · Cited by 203 · see citing works
Delisle, H. F. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1425.026 · Cited by 201 · see citing works
China's health system performance
Liu, Y., Rao, K. R., Wu, J. H., & Gakidou, E. E. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61362-8 · Cited by 201 · see citing works
Malachias, M. V. B., Plavnik, F., Machado, C., Malta, D. C., Scala, L., & Fuchs, S. C. P. C. (2016) · The Scientific Electronic Library Online (Fundação de Amparo à Pesquisa do Estado de São Paulo) · Cited by 198 · see citing works
Hosseinpoor, A. R., Bergen, N., Mendis, S., Harper, S. B., Verdes, E., Kunst, A. E., & Chatterji, S. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-474 · Cited by 198 · see citing works
“the deaths due to chronic disease in LMICs (from 61% to 71%) [74].”
BackgroundPizarro, G., Fernández‐Friera, L., Fuster, V., Fernández‐Jiménez, R., García-Ruiz, J. M., García‐Álvarez, A., Rodríguez, A. A. M., Barreiro, M. V., Escalera, N., Rodriguez, M. D., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.014 · Cited by 196 · see citing works
Melby, M. K., Loh, L. C., Evert, J., Prater, C. D., Lin, H. C., & Khan, O. A. (2015) · Academic Medicine · doi:10.1097/acm.0000000000001009 · Cited by 194 · see citing works
Malta, D. C., Andrade, S. S. C. D. A., Oliveira, T. P., de Moura, L., do Prado, R. R., & de Souza, M. D. F. M. (2019) · Revista Brasileira de Epidemiologia · doi:10.1590/1980-549720190030 · Cited by 193 · see citing works
Modelling and prediction of global non-communicable diseases
Wang, Y., & Wang, J. (2020) · BMC Public Health · doi:10.1186/s12889-020-08890-4 · Cited by 185 · see citing works
Global Mental Health: From Science to Action
Patel, V. (2012) · Harvard Review of Psychiatry · doi:10.3109/10673229.2012.649108 · Cited by 183 · see citing works
Vancampfort, D., Koyanagi, A., Ward, P. B., Rosenbaum, S., Schuch, F. B., Mugisha, J., Richards, J. A., Firth, J., & Stubbs, B. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0463-5 · Cited by 181 · see citing works
“There is also an increasing recognition that in the years to come, this disease burden and the loss of economic output associated with chronic diseases will be greatest in low- and middle-income countries (LMICs) [12].”
BackgroundThe economic costs of diabetes: a population-based study in Tehran, Iran
Esteghamati, A., Khalilzadeh, O., Anvari, M., Meysamie, A., Abbasi, M., Forouzanfar, M. H., & Alaeddini, F. (2009) · Diabetologia · doi:10.1007/s00125-009-1398-4 · Cited by 180 · see citing works
“Less attention has been given to the economic burden of diabetes in low- and middleincome countries, but in this context diabetes represents one of the most important non-communicable diseases with the potential to significantly impact upon economic growth in such countries [1, 5].”
BackgroundBertram, M. Y., Sweeny, K., Lauer, J. A., Chisholm, D., Sheehan, P., Rasmussen, B., Upreti, S. R., Dixit, L. P., George, K., & Deane, S. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30665-2 · Cited by 175 · see citing works
Global Inequalities in Access to Cardiovascular Health Care
Joshi, R., Jan, S., Wu, Y., & MacMahon, S. W. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.08.049 · Cited by 175 · see citing works
Global economic consequences of selected surgical diseases: a modelling study
Alkire, B. C., Shrime, M. G., Dare, A. J., Vincent, J. R., & Meara, J. G. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(15)70088-4 · Cited by 170 · see citing works
Doenças crônicas não transmissíveis no Brasil: carga e desafios atuais
Schmidt, M. I., Duncan, B. B., Mendonça, G. A. E. S., Menezes, A. M. B., Monteiro, C. A., Barreto, S. M., Chor, D., & Menezes, P. R. (2011) · The Lancet · Cited by 169 · see citing works
Geographical genomics of human leukocyte gene expression variation in southern Morocco
Idaghdour, Y., Czika, W., Shianna, K. V., Lee, S. H., Visscher, P. M., Martin, H. C., Miclaus, K., Jadallah, S. J., Goldstein, D. B., Wolfinger, R. D., et al. (2010) · Nature Genetics · doi:10.1038/ng.495 · Cited by 151 · see citing works
Equity impacts of price policies to promote healthy behaviours
Sassi, F., Belloni, A., Mirelman, A. J., Suhrcke, M., Thomas, A., Salti, N., Vellakkal, S., Visaruthvong, C., Popkin, B. M., & Nugent, R. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30531-2 · Cited by 165 · see citing works
Coyle, C., Cafferty, F. H., Rowley, S. C. S., MacKenzie, M., Berkman, L., Gupta, S., Pramesh, C. S., Gilbert, D. C., Kynaston, H., Cameron, D., et al. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.10.004 · Cited by 161 · see citing works
Liu, J., Bai, R., Chai, Z., Cooper, M. E., Zimmet, P., & Zhang, L. (2022) · Diabetologia · doi:10.1007/s00125-022-05713-6 · Cited by 165 · see citing works
“Our study demonstrated a rapidly growing trend of type 2 diabetes burden in low- and middle-income country settings, although concerns related to type 2 diabetes burden have historically focused on HICs, which was consistent with previous studies [29, 30].”
ResultThe Economic Implications of Non-Communicable Disease for India
Mahal, A. S., Karan, A., & Engelgau, M. M. (2010) · World Bank, Washington, DC eBooks · doi:10.1596/13649 · Cited by 154 · see citing works
“Respiratory Conditions Two recent studies (Murthy and Sastry 2005a, b), along with Abegunde et al. (2007) provide the only available economic analyses of the impact of chronic obstructive pulmonary disease (chronic bronchitis and emphysema), and asthma in India.”
BackgroundResultInfluentialOliveri, S., Ferrari, F., Manfrinati, A., & Pravettoni, G. (2018) · Frontiers in Genetics · doi:10.3389/fgene.2018.00624 · Cited by 153 · see citing works
“Since they will have even larger economic implications in the future, policy-makers have increasingly focused their attention on them (Abegunde et al., 2007; Désesquelles et al., 2014; Mackenbach et al., 2014; Suzman et al., 2015).”
BackgroundNon-Communicable Diseases in Sub-Saharan Africa: The Case for Cohort Studies
Holmes, M. D., Dalal, S., Volmink, J. A., Adebamowo, C., Njelekela, M. A., Fawzi, W. W., Willett, W. C., & Adami, H. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000244 · Cited by 151 · see citing works
“Over 80% of deaths from non-communicable diseases worldwide are estimated to occur in low- and middle-income countries”
BackgroundRoth, G. A., Fihn, S. D., Mokdad, A. H., Aekplakorn, W., Hasegawa, T., & Lim, S. S. (2011) · Bulletin of the World Health Organization · doi:10.2471/blt.10.079947 · Cited by 150 · see citing works
Brinda, E. M., Kowal, P. R., Attermann, J., & Enemark, U. (2015) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2014-204960 · Cited by 148 · see citing works
Simões, E. J., Hallal, P. C., Pratt, M., Ramos, L. R., Munk, M., Damascena, W., Parra, D. C., Hoehner, C. M., Gilbertz, D. A., Malta, D. C., et al. (2008) · American Journal of Public Health · doi:10.2105/ajph.2008.141978 · Cited by 147 · see citing works
Nutritional Evaluation of Five African Indigenous Vegetables
Kamga, R. T., Kouamé, C., Atangana, A. R., Chagomoka, T., & Ndango, R. (2013) · Journal of Horticultural Research · doi:10.2478/johr-2013-0014 · Cited by 146 · see citing works
“It is anticipated that Africa will lose at least a cumulative US $ 4 billion to chronic diseases by 2015 (Abegunde et al. 2007).”
BackgroundSuemoto, C. K., Ferretti‐Rebustini, R. E. D. L., Rodriguez, R. D., Leite, R. E. P., Soterio, L., Brucki, S. M. D., Spera, R. R., Cippiciani, T. M., Farfel, J. M., Filho, A. D. P. C., et al. (2017) · PLoS Medicine · doi:10.1371/journal.pmed.1002267 · Cited by 149 · see citing works
“Much of this increase will be due to a surge in dementia prevalence in low- and middle-income countries (LMICs).”
BackgroundInfluentialVerstraeten, R., Roberfroid, D., Lachat, C., Leroy, J. L., Holdsworth, M., Maes, L., & Kolsteren, P. W. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.035378 · Cited by 208 · see citing works
Leveraging Rapid Community-Based HIV Testing Campaigns for Non-Communicable Diseases in Rural Uganda
Chamie, G., Kwarisiima, D., Clark, T. D., Kabami, J., Jain, V., Geng, E. H., Petersen, M. L., Thirumurthy, H., Kamya, M. R., Havlir, D. V., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043400 · Cited by 145 · see citing works
“[15] Our estimates of hypertension and diabetes prevalence are within the range of published estimates for east Africa.”
ResultHealth transition in Africa: practical policy proposals for primary care
Maher, D., & Sekajugo, J. (2010) · Bulletin of the World Health Organization · doi:10.2471/blt.10.077891 · Cited by 145 · see citing works
Malta, D. C., Bernal, R. T. I., de Souza, M. D. F. M., Szwarcwald, C. L., Lima, M. G., & Barros, M. B. D. A. (2016) · International Journal for Equity in Health · doi:10.1186/s12939-016-0427-4 · Cited by 144 · see citing works
“This may lead to a greater state of poverty for these families [2, 3, 5], which consequently worsens social inequalities [2, 3].”
BackgroundInfluentialSadeghi, M., Haghdoost, A. A., Bahrampour, A., & Dehghani, M. (2017) · Europe PMC (PubMed Central) · Cited by 143 · see citing works
Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory
Husseini, A. S., Abu-Rmeileh, N. M., Mikki, N., Ramahi, T. M., Ghosh, H. A., Barghuthi, N., Khalili, M., Bjertness, E., Holmboe‐Ottesen, G., & Jervell, J. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60109-4 · Cited by 142 · see citing works
- Authors
- Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M., & Strong, K.
- Affiliations
- World Health Organization (CH)
- Corresponding author
- Mathers, Colin D
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-12
- Volume
- 370
- Issue
- 9603
- Pages
- 1929-1938
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1987313755
- Cited by
- 1,603
- References
- 45
- Citations by year
- 2026: 24 · 2025: 44 · 2024: 62 · 2023: 58 · 2022: 87 · 2021: 68 · 2020: 123 · 2019: 104 · 2018: 98 · 2017: 113 · 2016: 111 · 2015: 106 · 2014: 115 · 2013: 106 · 2012: 96
- FWCI
- 10.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Keywords
- chronic disease, disease burden, economic cost of illness, cardiovascular disease, cancer, chronic respiratory disease, diabetes mellitus, low-income countries, middle-income countries, sex differences in mortality, mortality averted, chronic disease prevention, global health goals
- MeSH terms
- Chronic Disease, Developing Countries, Female, Humans, Life Expectancy, Male, Registries, Global Health, Cost of Illness, Age Distribution, Sex Distribution
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