To the Editor The Global Burden of Disease (GBD) project has made important contributions to the field of public health surveillance. However, when providing cause-specific data, the limitations inherent in global estimates become apparent. In the article on the global burden of hypertension, an anomaly is the large number of disability-adjusted life-years from coronary heart disease assigned to sub-Saharan Africa and many parts of Asia.1 It is well established that coronary heart disease remains infrequent to rare in sub-Saharan Africa and much of Asia.2-5 In the supplemental material, the authors stated that the process of risk estimation was “standardized to enhance the comparability of results across risks, outcomes, populations and time,” which implies that the same risk coefficients were used for calculations in all geographic regions. This method will provide biased estimates of cardiovascular outcomes; although the relative risks may be similar across populations, the background of other risk factors, such as smoking and hyperlipidemia, vary and will influence the event rate and the number of deaths from coronary heart disease.5 In populations like those in sub-Saharan Africa and much of Asia, serum lipids remain low and, in Africa at least, smoking is uncommon.2-5 The large population-attributable fractions for these regions are therefore likely to be overestimates.
Cooper RS, Kaufman JS, Bovet P. Global Burden of Disease Attributable to Hypertension. JAMA. 2017;317(19):2017–2018. doi:10.1001/jama.2017.4213
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