Introduction

Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs comprise cardiac diseases, stroke, diabetes, respiratory diseases, and cancer WHO, 2015. Among these, the fraction of highest mortality is attributed to cardiovascular diseases, followed by cancer, chronic obstructive pulmonary disease, and diabetes (Murray et al., 2012).

The common risk factors for the top four NCDs (cardiovascular disease, cancer, diabetes, and chronic pulmonary diseases) are smoking, alcohol use, lack of physical activity Lozano et al., 2012, and unhealthy diet Pervaiz et al., 2017. About 80% of deaths from NCDs result from the above 4 diseases Lozano et al., 2012.

According to the estimations of the WHO, NCDs are responsible for 36 million deaths in 2008, which represents 63% of all WHO, 2011. Approximately 80% of these NCD-related mortalities are reported in middle and low Human Development Index (HDI) countries with a high proportion of premature mortality before age 60 WHO, 2013. By 2020, NCDs are predicted to account for 80% of the global burden of diseases; more than two-thirds of deaths will be in developing countries and half of the deaths will be premature deaths (under 70 years of age) according to the WHO data WHO, 2013.

Moreover, according to the WHO estimation, in the next ten years, 17% increase in the global burden of NCDs WHO, 2013. NCDs account for almost half of all deaths in Asia, and represent 47% of the global disease burden WHO, 2013. In developing countries, the mortality of NCDs is very high; for instance, cardiovascular disease and diabetes account for 80% of mortality cases, chronic lung diseases account for 90%, and two-thirds of all cancer deaths are reported from developing countries Hancock et al., 2011.

NCDs are obstacles to socioeconomic development Beaglehole et al., 2011. In developing countries, people are more exposed to behavioral risk factors arising from poverty; consequently, poverty increases due to NCDs Beaglehole & Yach, 2003.

We aim to investigate the correlation between the socioeconomic status of countries and NCD-associated mortality as well as between premature mortality under age 70 years (expressed as % of all NCDs).

Methods

Results

Pearson correlation suggested an inverse correlation between HDI and ASRM in both men (r =-0.305; p<0.001) and women (r=-0.526; p<0.001). Negative correlation was also reported for % of premature mortality and HDI (r=-0.560; p<0.001 for men; r =-0.596; p <0.001 for women).

Correspondingly, linear regression analysis also demonstrated a negative effect of HDI on ASRM (adjusted R2=0.093, β =-0.305, p<0.001 for men and adjusted R2 =0.273, β =-0.526, p<0.001) ( Figure 1A , Figure 1B ). In addition, there was negative effect of HDI on % premature mortality (adjusted R2=0.314, β=-0.560, p<0.001 for men; adjusted R2=0.355, β=-0.596, p<0.001 for women) ( Figure 2A , Figure 2B ).

Tukey post hoc test (p < 0.001) demonstrated that countries with very high HDI have low ASRM and premature mortality than those with high HDI and so on. The highest mortality rate was indicated in low HDI countries ( Table 1 ) ( Figure 3A , Figure 3B ).

Discussion

The results from 183 countries in the world indicated an inverse correlation between NCD-related mortality and HDI. Likewise, it was shown that HDI is inversely related with NCD-associated premature mortality. There is a direct correlation between ASRM and premature mortality (r=0.719, p>0.001). The highest NCD mortality was reported in medium and low HDI countries.

Previous studies have suggested that in high-income countries the proportional mortality from NCD is higher than low and middle HDI countries. The reason for this is that low mortality rates from infectious diseases, and mother and child death rates, are prevalent in the higher income countries. Nevertheless, the absolute number of mortality from NCD is higher in the middle and low HDI countries due to a larger population in these countries. Similarly, the ASRM from NCD in these low and middle HDI countries is high WHO, 2011.

Cardiovascular diseases are the primary cause of death globally (Murray et al., 2012). The ASRM from cardiovascular diseases declined since the 1980s, with the most remarkable decline in high-income countries such as North America, Western Europe, and Australia. While in South Asia and former Soviet Union countries, the ASRM increased in the 1990s and decreased after 2000. Central Asia and Eastern Europe had their highest cardiovascular disease mortality in 2010. On average, higher premature mortality of cardiovascular diseases was reported in South Asia, North Africa, the Middle East, and Sub-Saharan Africa Moran et al., 2014.

Cancer is the second most common cause of death globally after cardiovascular diseases (Murray et al., 2012). County-wide studies have indicated an increasing trend of cancer incidence Pervaiz et al., 2017. The mortality to incidence ratio of cancer is highest in the low and medium income countries of Africa Pervaiz & Faisal, 2017 as well as in other parts of the world Bray et al., 2012.

Conclusion

It is concluded that NCDs represent the largest health burden in low and medium HDI countries. Governments and stakeholders in low- and-medium- HDI countries should make serious efforts in improving economic development in order to control NCDs, which have become a major global health concern.

Abbreviations

ANOVA: Analysis of variance

ASRM: Age-standardized mortality rate

HDI: Human development index

NCDs: Non-communicable diseases

SPSS: Statistical Package for Social Sciences

WHO: World Health Organization

Author Contribution

RP participated in the conception of the study, data acquisition, interpretation and drafting the manuscript. ÖE critically revised the article for important intellectual content.