Documenting the global burden of cardiovascular disease: a major achievement but still a work in progress.

The publication of the 1990 Global Burden of Disease (GBD) was a seminal moment for international health.1 In a world characterized by what has been termed a “scandal of ignorance,”2 where most peoples’ existence was never recorded, the authors undertook the heroic task of estimating not only how many people were dying and from what conditions but also how many were living with disability. By combining these measures to create the disability-adjusted life year, they changed the global health discourse forever. The task was enormous. They had to include all countries, including many that had attracted virtually no attention from health researchers and that lacked vital registration systems. They scoured the world for data, extracting information from dusty archives, and analyzed surveys that had been forgotten. Article see p 1483 and p 1493 However, existing data only went so far; alternatives were needed. The authors created complex (although, for some, virtually incomprehensible) models that established relationships in countries with data for variables such as national income and patterns of disease and then extrapolated to countries and regions or for conditions where data were unavailable to fill the many gaps.3 They also developed ambitious methodologic and empiric approaches to understand associations between mortality and the much less well researched disability and to measure the contribution of different disease states to both.4 These efforts, in turn, have stimulated a massive increase in data collection, with expansions in vital registration systems, sentinel surveillance sites,5 and methodologic refinements of instruments such as verbal autopsy.6 As a result, the 2010 GBD took our understanding of the health of the world’s population to a new level,7 although, as the accompanying articles in this issue of Circulation demonstrate, there are still many issues to be resolved.8,9 However, …