A very interesting study in the journal Lancet looks at diseases, hospital admissions and deaths in 21 countries. (Lancet Article) The data was collected from a prospective, population-based cohort study of people from 35 to 70 years old who were tracked from 2005 to 2016. The participants came from a mix of high-income and lower income countries. In all countries there has been a decline in communicable diseases, but other types of illness have picked up the slack, like heart disease, cancer and diabetes. This study helps give a more detailed perspective on these shifts. Primary outcomes were deaths by cause, heart attacks, strokes, heart failure, cancers, injuries requiring hospitalization, COPD and any hospital admission. Heart disease risk scores were highest in high-income nations and lowest in low-income ones. 5.7% of participants had a heart disease, 3.2% a cancer, 1.8% had pneumonia, 1.1% had COPD and 2.7% an injury requiring hospitalization during the study period. Cancers, injuries and COPD and pneumonia were most common in high-income countries and least common in lower income ones. That is somewhat surprising in regard to injuries, COPD and pneumonia. Cardiovascular disease, however, was most common in low-income nations even though risk scores were comparatively lower. China had a surprisingly high incidence of heart disease. Cardiovascular disease was the leading cost of hospitalization across countries, but rates of admission were greater in high-income countries despite lower incidence rates. In general, low-income nations used hospital services less than did middle-income or high-income ones. Medication use was also higher in high-income nations. 7% of participants died during the study, with the rates in low-income countries being twice those in middle-income ones and four times greater than those in high-income ones. Cardiovascular disease at 40% of the total and cancer at 26% were the most common causes of death. As the income level of a country declined the ratio of cardiovascular deaths to cancer ones rose. As you would expect, the study suggests that the income level of a nation is probably correlated with its citizens’ access to and use of medical services and that in turn is correlated with disease rates and with mortality.