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BackgroundEconomic growth in low- and middle-income countries (LMIC) has raised interest in how disease burden patterns are related to economic development. Meanwhile, poverty-related diseases are considered to be neglected in terms of research and development (R&D).ObjectivesDeveloping intuitive and meaningful metrics to measure how different diseases are related to poverty and neglected in the current R&D system.DesignWe measured how diseases are related to economic development with the income relation factor (IRF), defined by the ratio of disability-adjusted life-years (DALYs) per 100,000 inhabitants in LMIC versus that in high-income countries. We calculated the IRF for 291 diseases and injuries and 67 risk factors included in the Global Burden of Disease Study 2010. We measured neglect in R&D with the neglect factor (NF), defined by the ratio of disease burden in DALYs (as percentage of the total global disease burden) and R&D expenditure (as percentage of total global health-related R&D expenditure) for 26 diseases.ResultsThe disease burden varies considerably with the level of economic development, shown by the IRF (median: 1.38; interquartile range (IQR): 0.79-6.3). Comparison of IRFs from 1990 to 2010 highlights general patterns of the global epidemiological transition. The 26 poverty-related diseases included in our analysis of neglect in R&D are responsible for 13.8% of the global disease burden, but receive only 1.34% of global health-related R&D expenditure. Within this group, the NF varies considerably (median: 19; IQR: 6-52).ConclusionsThe IRF is an intuitive and meaningful metric to highlight shifts in global disease burden patterns. A large shortfall exists in global R&D spending for poverty-related and neglected diseases, with strong variations between diseases.

Original publication




Journal article


Global health action

Publication Date





Faculty of Medicine, Technische Universität München, Munich, Germany; Universities Allied for Essential Medicines Europe e.V. (UAEM), Berlin, Germany;


Humans, Wounds and Injuries, Risk Factors, Biomedical Research, Developing Countries, Poverty, Socioeconomic Factors, World Health Organization, Economic Development, Neglected Diseases, Global Health