Situation and trends
The causes of death and disability among girls and women vary throughout the life course. In childhood, most deaths and disabilities result from communicable diseases such as HIV, diarrhoeal and respiratory diseases, malaria, and maternal and perinatal conditions. At older ages, patterns of death and disability change to noncommunicable chronic diseases such as heart disease, stroke and cancers. The single exception is in Africa, where communicable diseases remain the chief causes of female deaths up to the age of 60 years. In low-income countries, including those in Africa, HIV/AIDS, maternal conditions and tuberculosis together account for one in every two deaths among adult women in reproductive years. Road traffic accidents and suicide are among the ten leading causes of death among adult women in middle-income and high-income countries. Among adolescents, road traffic accidents, injuries and suicide are leading causes of death across all income groups. An analysis of the underlying risk factors that contribute to death among women in reproductive age group shows that unsafe sex is a leading risk factor with almost 23% of deaths in women attributable to this risk factor, whereas alcohol use is a leading risk factor among women in high-income countries.
Cardiovascular disease, often thought to be a “male” problem, is the main killer of older people of both sexes almost everywhere in the world. In fact, each year cardiovascular disease causes a larger number of deaths in older women than in older men – 7.4 million women over 60 years of age compared to 6.3 million men in 2004. Although cardiovascular diseases are often thought of as diseases of affluence, cardiovascular mortality rates for women age 60 and over are more than twice as high in low- and middle-income countries as in high-income countries. They are particularly high in middle-income European countries, followed by the WHO Eastern Mediterranean and African regions.
Part of the explanation is that cardiovascular mortality rates among women in high-income countries have significantly declined over the past 50 years. These declines are the result of several factors, namely: reductions in risk behaviours such as use of tobacco and lack of physical activity; better management and medication of metabolic risk factors such as high blood pressure and high cholesterol; and improved treatment of existing cardiovascular conditions. In low- and middle-income countries, cardiovascular disease in women is often unrecognized, undiagnosed, in part because they show different symptoms than men. Women are also less likely to seek medical help and therefore may not get appropriate care until it is too late.