¿De qué morimos?

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Entendiendo de qué morimos podremos vivir más y mejor

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Cada año mueren unos 56 millones de personas, una tercera parte de los bebes que nacen. Por eso nuestra población crece, aunque ya no lo hace tan deprisa como hace unos años. Muchas de esas muertes son prematuras o evitables y nos hablan de malas condiciones de vida para millones de personas, incluso para muchos de los que viven en países ricos y desarrollados.

¿Cuál es la causa de estas muertes? ¿Cómo han cambiado las causas de muerte a lo largo del tiempo y cómo difieren entre los distintos países y regiones del mundo? ¿Cuáles son los factores de riesgo que conducen a una muerte prematura o evitable?

Contestar a estas preguntas no solo evitará muertes sino que mejorará la calidad de vida de los que no mueran.

«Entendiendo de qué morimos podremos vivir más y mejor». Edición e IA prompting: Marc Almeida

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Causas globales de muerte

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El total de las enfermedades no transmisibles (ENT) fueron responsables de más de 41 millones de muertes (más del 73% en 2017).

La principal causa de muerte en el mundo fueron las enfermedades cardiovasculares, con un tercio de todas las muertes globales -hipertensión , cardiopatía coronaria (infarto de miocardio); enfermedad cerebrovascular (ictus), insuficiencia cardiaca, y otras. Los cánceres, en conjunto, ocuparon el segundo lugar, con alrededor del 17%, es decir, una de cada seis muertes en todo el mundo.

Existe un importante número de muertes prematuras o evitables, que se dan sobre todo en países pobres: 1,8 millones de recién nacidos debido a complicaciones en el parto; las enfermedades diarreicas -1,6 millones de personas; el paludismo (700.000 muertes). Los accidentes de tráfico figuran entre las principales causas globales de muerte, con 1,2 millones de víctimas.

«Causas globales de muerte». Edición e IA prompting: Marc Almeida

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margin_left=»» fusion_font_family_text_font=»» fusion_font_variant_text_font=»» font_size=»» line_height=»» letter_spacing=»» text_transform=»» text_color=»» animation_type=»» animation_direction=»left» animation_speed=»0.3″ animation_offset=»»]

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Estadísticamente, tú eres tu peor enemigo

”

El número de muertes por suicidio es superior al número de muertes por todas las formas de violencia a nivel mundial, incluyendo homicidios, terrorismo, conflictos y ejecuciones. De hecho, el número de muertes por suicidio es más del doble que el de homicidios a nivel mundial. Como señala Yuval Noah Harari: «Estadísticamente tú eres tu peor enemigo. Al menos, de todas las personas del mundo, tienes más probabilidades de que te mates tu a ti mismo».

Por si fuera poco el suicidio, uno mismo suele estar implicado en otro tipo de muerte auto-infligida: el de las muertes asociadas al estilo de vida. Ese estilo de vida que puede generar diabetes, hipertensión o sobrepeso, es algo que suele poderlo elegir cada uno. Las enfermedades por estilo de vida son la principal causa de muerte en los países ricos o más desarrollados.

«Estadísticamente, tú eres tu peor enemigo». Edición e IA prompting: Marc Almeida

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margin_left=»» fusion_font_family_text_font=»» fusion_font_variant_text_font=»» font_size=»» line_height=»» letter_spacing=»» text_transform=»» text_color=»» animation_type=»» animation_direction=»left» animation_speed=»0.3″ animation_offset=»»]

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El azúcar es mucho más peligroso que las guerras y la violencia armada

”

En términos de salud y mortalidad, lo que el VIH/SIDA fue para los últimos 20 años del siglo XX, la diabetes lo está siendo en los primeros 20 años de este siglo. Pero nos quedamos cortos. En 2001, se estimó que en 2025 habría más de 350 millones de personas en el mundo con diabetes de tipo dos. Esta cifra se superó en 2011. Ahora hay más de 415 millones de personas con diabetes en el mundo, y es probable que se superen las estimaciones actuales de más de 642 millones para 2040. En la actualidad, casi uno de cada 11 habitantes del planeta padece diabetes. El mayor aumento se producirá en los países en desarrollo, donde se prevé que la diabetes se duplique en los próximos 15 años. Padecer diabetes no solo compromete la calidad de vida sino que confiere un riesgo muy grande de cardiopatía coronaria y accidente cerebrovascular.

La diabetes está vinculada a otros factores de riesgo de cardiopatías y muerte, como la hipertensión, el colesterol alto y la obesidad. Casi el 80% de las personas que mueren de diabetes en los países en desarrollo son menores de 60 años, justo cuando estas personas deberían estar en sus años económicamente más productivos. Aparte del trauma personal y emocional causado por la muerte prematura, el efecto potencial sobre la economía es inconmensurable. La diabetes sigue siendo la causa más común de ceguera en el mundo occidental, la principal causa de insuficiencia renal, diálisis y trasplante, y el factor más común de amputaciones de miembros inferiores.

«El azúcar es mucho más peligroso que las guerras y la violencia armada». Edición e IA prompting: Marc Almeida

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De qué se muere en Estados Unidos

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En comparación con los datos mundiales, una mayor proporción de muertes en EE.UU. está causada por enfermedades no transmisibles (ENT) –casi el 90% de la mortalidad– y una incidencia mucho menor de muertes evitables, algo típico de los países de renta alta.

La mayoría de las muertes en estos países están relacionadas con las denominadas «enfermedades del estilo de vida“(tabaquismo, obesidad, glucemia, ingesta alimentaria y consumo de alcohol), varias ENT, como enfermedades renales, hepáticas y digestivas, y las de edades avanzadas (como el Alzheimer y otras demencias). Este desplazamiento de las causas de muerte hacia las ENT representa la llamada Transición Epidemiológica. En Estados Unidos, los suicidios ocupan un lugar destacado en la lista de causas de mortalidad

«De qué se muere en Estados Unidos». Edición e IA prompting: Marc Almeida

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España o Alemania, países ricos que apenas sufren enfermedades infecciosas

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España o Alemania, representantes de países con un alto nivel de vida, tienen como principales causas de muerte las enfermedades no transmisibles (ENT), la demencia y las enfermedades relacionadas con el hígado, los riñones o el aparato digestivo. Dos tercios de todas las muertes son causadas por enfermedades cardiovasculares y cáncer. Una distinción interesante entre estos países europeos y Estados Unidos es el recuento relativo de muertes en carretera.

Las muertes relacionadas con la carretera en Alemania son mucho menores que en Estados Unidos (0,5% frente al 1,6% de las muertes); de hecho, en Alemania mueren más personas por alcoholismo y casi tantas por enfermedades diarreicas que por accidentes de tráfico. Las muertes por homicidio son también muy bajas, mucho más bajas que en Estados Unidos (0,07 frente a 0,7% en EE.UU.). Esto crea una disparidad aún mayor entre las muertes por suicidio y las muertes violentas: alrededor de 18 veces más personas murieron por suicidio en 2017 que por violencia.

«España o Alemania, países ricos que apenas sufren enfermedades infecciosas». Edición e IA prompting: Marc Almeida

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margin_top=»» margin_right=»» margin_bottom=»» margin_left=»» fusion_font_family_text_font=»» fusion_font_variant_text_font=»» font_size=»» line_height=»» letter_spacing=»» text_transform=»» text_color=»» animation_type=»» animation_direction=»left» animation_speed=»0.3″ animation_offset=»»]

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Brasil, en pleno desarrollo sufre la lacra de los homicidios

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Brasil ofrece un gran contraste con las bajas tasas de homicidio que vemos en Alemania: en este país el homicio ocupa el séptimo lugar entre las principales causas de muerte, cobrándose alrededor de 64.000 vidas (el 4,7% de todas las muertes) en 2016. Como en gran parte de América Latina, el número de homicidios supera ampliamente al de muertes por suicidio. En Brasil, más de cuatro veces más personas murieron por violencia que por suicidio. Brasil, que ha experimentado un impresionante crecimiento económico en las últimas décadas, ocupa ahora una posición intermedia en cuanto a la distribución de las causas de mortalidad.

Al igual que Estados Unidos y Alemania, las principales causas de muerte en Brasil son las enfermedades no transmisibles (ENT) y la demencia. Las causas de muerte que podríamos denominar «evitables en gran medida», como las enfermedades diarreicas y las complicaciones neonatales, se sitúan en el rango medio de causas; no son dominantes, pero siguen siendo significativas. Cabe esperar que, con el desarrollo continuo, su importancia siga disminuyendo.

«Brasil, en pleno desarrollo sufre la lacra de los homicidios». Edición e IA prompting: Marc Almeida

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En Sudáfrica y los países vecinos el SIDA es la principal causa de muerte

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Sudáfrica es uno de los pocos países donde las enfermedades cardiovasculares no son la principal causa de muerte. Desde finales de la década de 1990, el VIH/sida ha sido la principal causa de muerte en Sudáfrica, alcanzando un máximo de más de 320.000 muertes al año entre 2006 y 2008. Desde entonces, las muertes relacionadas con el VIH se han reducido en más de la mitad, pero la enfermedad sigue siendo la principal causa de muerte en el país en 2017, con 135.000 fallecimientos (cerca de un tercio de las muertes). Esta cifra casi duplica el número de muertes por enfermedades cardiovasculares. Sudáfrica no está sola. El VIH/sida sigue siendo la principal causa de muerte en varios de sus vecinos, como Namibia, Zambia, Zimbabue, Botsuana, Mozambique y Malaui

«En Sudáfrica y los países vecinos el SIDA es la principal causa de muerte». Edición e IA prompting: Marc Almeida

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Una gran mortalidad en Iraq y los países de Oriente Medio se debe al terrorismo

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En nuestra visión global de las causas de muerte, las muertes relacionadas con el terrorismo tienden a ocupar un lugar muy bajo. Esto no es así en todas partes. Mientras que las muertes relacionadas con el terrorismo se han mantenido relativamente bajas en Occidente, han aumentado en Oriente Medio, el norte de África y, en menor medida, en el sur de Asia. En varios países de Oriente Medio, en particular, las muertes relacionadas con conflictos y terrorismo pueden ocupar un lugar destacado en la lista de causas principales. En Irak el conflicto y el terrorismo ocupan el 4º y 5º lugar respectivamente, con más del 11% de las muertes combinadas.

«Una gran mortalidad en Iraq y los países de Oriente Medio se debe al terrorismo». Edición e IA prompting: Marc Almeida

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Las enfermedades infecciosas pierden terreno como causa de muerte en el mundo

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A nivel mundial la mayoría de las muertes están causadas por enfermedades no transmisibles (ENT, más del 73% del total). A medida que el mundo avanza en la lucha contra las enfermedades infecciosas, y a medida que la población envejece, las ENT son cada vez más predominantes como causa de muerte. Es lo que se conoce como la Transición Epidemiologica. Sin embargo, la creciente resistencia a los antibióticos de cada vez más bacterias peligrosas está poniendo en riesgo nuestra capacidad de controlar algunas enfermedades infecciosas.

«Las enfermedades infecciosas pierden terreno como causa de muerte en el mundo». Edición e IA prompting: Marc Almeida

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Cada vez muere menos gente a una edad temprana

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La edad a la que muere la gente ha cambiado significativamente desde 1990. Cada vez muere menos gente a una edad temprana. En 1990, casi una cuarta parte de todas las muertes se produjeron en niños menores de 5 años. En 2019, este porcentaje se había reducido a algo menos del 9%. La proporción de muertes con más de 70 años ha aumentado de un tercio a la mitad de todas las muertes en 2019. En los países con buena salud, el porcentaje de muertes a una edad temprana es muy bajo. En Japón, más del 85% de las muertes ocurren con 70 años o más.

«Cada vez muere menos gente a una edad temprana». Edición e IA prompting: Marc Almeida

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Hay que distinguir entre causas de muerte y factores de riesgo

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En epidemiología, cada muerte tiene una causa específica. O al menos una causa que inició la serie de acontecimientos que condujeron a la muerte. Esto es diferente de las muertes debidas a factores de riesgo. Los factores de riesgo se estiman a partir de la reducción del número de muertes que se conseguiría si se eliminaran (e.g. tabaquismo, contaminación) o si se llevaran a un nivel óptimo (e.g. índice de masa corporal, disponibilidad de agua potable). Los factores de riesgo se agrupan en cuatro categorías: riesgos conductuales, riesgos ambientales, riesgos laborales y riesgos metabólicos. Todas las estimaciones de factores de riesgo se elaboran de forma independiente. Esto significa que no podemos sumar todas las «muertes atribuidas» y concluir que ese es el número real de muertes. El número de muertes por factor de riesgo supera en muchos casos al de las atribuidas por causa de muerte.

«Hay que distinguir entre causas de muerte y factores de riesgo». Edición e IA prompting: Marc Almeida

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El estilo de vida y el estado del medio ambiente son los dos factores de riesgo de muerte más importantes

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os factores de riesgo dominantes están relacionados con factores dietéticos y de estilo de vida activo (incluida la presión arterial, la actividad física, el índice de masa corporal, el azúcar en sangre y la ingesta alimentaria); los factores medioambientales, incluidos el agua potable y el saneamiento; la contaminación del aire (tanto exterior como interior); el tabaquismo; y las relaciones sexuales seguras (para la prevención del VIH/SIDA).

En la mayoría de los países de renta alta, los factores de riesgo dominantes son los relacionados con una dieta sana, el tabaquismo y el consumo de alcohol. Otros factores de riesgo como el agua potable, el saneamiento y la emaciación o el retraso del crecimiento infantil son muy bajos. En los países de renta baja ocurre lo contrario.

«El estilo de vida y el estado del medio ambiente son los dos factores de riesgo de muerte más importantes». Edición e IA prompting: Marc Almeida

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Muertes prematuras: la covid-19 nos ha arrebatado millones de años de vida

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La COVID-19 se ha llevado la vida de mas de 7 millones de personas. Una forma alternativa de explorar los impactos en nuestra salud de una enfermedad o un problema ambiental es el número de años de vida perdidos al morir antes de la fecha estadísticamente más probable. Para entender el impacto en la mortalidad de un problema sanitario de origen ambiental como la COVID-19, no basta con el recuento de fallecimientos, sino que hace falta comprender como de prematuras fueron esas muertes.

Las cifras son astronómicas: contabilizando las muertes por COVID-19 que tuvieron lugar hasta principios de 2021 en 81 países para los que hay datos fiables, se han perdido más de 20 millones de años con el millón doscientos mil muertos que hubo en esos países hasta esa fecha. Esto da una media de 16 años de vida perdidos por cada muerte y nos permite afinar más y comprender mejor los riesgos para nuestra salud de alterar el medio ambiente.

«Muertes prematuras: la covid-19 nos ha arrebatado millones de años de vida». Edición e IA prompting: Marc Almeida

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Solo la contaminación atmosférica supone 9 millones de muertes cada año

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Las cifras mas grandes de mortalidad global se deben a problemas ambientales. La contaminación atmosférica causa al menos 9 millones de muertes prematuras anuales, una cifra superior a los fallecidos en la pandemia de de la COVID-19 en tres años (unos 7 millones). Una de cada seis muertes en el mundo está relacionada con la contaminación, cifra que triplica los fallecidos por sida, malaria y tuberculosis, o que multiplica por 15 los fallecidos en guerras, asesinatos y otros hechos violentos

«Solo la contaminación atmosférica supone 9 millones de muertes cada año». Edición e IA prompting: Marc Almeida

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Todos los conflictos armados juntos matan una centésima parte de lo que mata el cambio climático y la crisis ambiental

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Nuestro cerebro y nuestras emociones han sido seleccionados para sentir el riesgo de la violencia y evitarlo. Nos impresionan las muertes en conflictos y guerras. Y gastamos un porcentaje elevadísimo de nuestros presupuestos globales para hacer frente a ello, entorno el 11% del PIB global. Sin embargo, las muertes anuales en todos los conflictos armados del mundo son cien veces menores que las muertes anuales debidas al cambio climático, las distintas formas de contaminación y la pérdida de biodiversidad. Las muertes directas de combatientes en conflictos armados son unas 125.000 al año en promedio para la última década. A esto debemos sumarles la muerte de unos 100.000 bebes y otros 150.000 civiles que se ven afectados directa o indirectamente por estos conflictos. En total unas 375.000 muertes anuales por conflictos armados.

Es difícil estimar las muertes por cambio climático, pero por causas directas e indirectas cabe estimar decenas de millones al año, a las que hay que sumar 9 millones por contaminación atmosférica y un mínimo de tres millones más por enfermedades infecciosas derivadas de un medio ambiente alterado. Hay más muertes que estas asociadas a la crisis ambiental, pero ya solo con esto vemos que las muertes debidas a un medioambiente degradado son del orden de cien veces mayor que las debidas a conflictos armados. Con tanques, fragatas y ejércitos nos defendemos de lo que menos nos amenaza y gastamos entre cinco y diez veces más de dinero que en abordar lo que realmente nos mata.

«Todos los conflictos armados juntos matan una centésima parte de lo que mata el cambio climático y la crisis ambiental ». Edición e IA prompting: Marc Almeida

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Un futuro positivo para la naturaleza y las personas es factible añadiendo justicia

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A pesar de décadas de aumento de la inversión en protección de la naturaleza y en medioambiente, no hemos conseguido “aplanar la curva» de la degradación ambiental y la crisis climática. Ahora sabemos que nos va, literalmente, la vida en ello. Los esfuerzos para las próximas décadas corren el riesgo de repetir este fracaso por tres razones: 1) el descuido de los factores que amenazan el medio ambiente y el clima; 2) las expectativas y plazos poco realistas de recuperación de la biodiversidad y los procesos ecológicos implicados; y 3) la insuficiente atención prestada a la justicia dentro y entre generaciones y países.

Obura y colaboradores (2022 One Earth) lanzan un mensaje esperanzador con su enfoque de la justicia del sistema Tierra. Este enfoque identifica seis conjuntos de acciones que, si se abordan simultáneamente, evitarían que se repita una y otra vez el fracaso. Los seis puntos de acción simultánea son: (1) reducir y revertir las causas directas e indirectas del declive ambiental; (2) detener y revertir la pérdida de biodiversidad; (3) restaurar y regenerar la biodiversidad y los procesos ecológicos hasta un estado seguro; (4) aumentar el bienestar mínimo para todas las personas; (5) eliminar el consumo excesivo y los excesos asociados a la acumulación de capital; y (6) defender y respetar los derechos y responsabilidades de todas las comunidades, presentes y futuras.

Las campañas de conservación, protección y restauración actuales se centran principalmente en las acciones 2 y 3, pero es necesario ampliar urgentemente las acciones 1, 4, 5 y 6 para poder revertir a tiempo y “aplanar la curva” de degradación ambiental y calentamiento global. Con estas acciones, la humanidad podría cumplir los acuerdos mundiales sobre cambio climático, la biodiversidad y avanzar en la agenda global de sostenibilidad establecida para 2030.

«Un futuro positivo para la naturaleza y las personas es factible añadiendo justicia». Edición e IA prompting: Marc Almeida

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4 Comentarios

marc 01/03/2023 en 10:16 pm - Responder

increíble Fernando y equipo, muy buen trabajo, sigue divulgando e inspirándonos a todos/as
- Fernando Valladares 14/03/2023 en 6:06 pm - Responder
  
  Gracias!! nos animan mucho estos comentarios
Alberto Bergareche 14/03/2023 en 5:38 pm - Responder

Una pregunta. Cuando se puede considerar que una muerte es prematura. Hasta que edad?
- Fernando Valladares 14/03/2023 en 6:09 pm - Responder
  
  Hola, las muertes se consideran prematuras cuando ocurren antes de la edad en la que estadísticamente correspondía que uno muera. Según edad, estado de salud etc uno tiene una determinada probabilidad de muerte. Cuando por ejemplo uno muere a los 55 y por sus circunstancias la estadística te daba como edad de muerte 75, es una muerte prematura. Una muerte prematura puede ocurrir a cualquier edad
Anónimo 26/07/2023 en 11:29 am - Responder

Visitor Rating: 5 Stars

¿De qué morimos?

Qué pasaría si… la temperatura subiera 10ºC

QUE PASARÍA SI… No hubiera nubes

5 MINUTOS CON… Efecto mariposa y cambio climático

5 minutos con… Una Salud, la salud planetaria

Defender la democracia en el Idioceno

¿Qué amenaza a la humanidad? Una conversación a tres bandas

Manual contra el negacionismo climático en la década axial

Hielo, glaciares y cambio climático

5 MINUTOS CON: Ventajas y desafíos del vidrio

5 MINUTOS CON… El decrecimiento económico como solución

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¿De qué morimos?

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