The disease is widespread in the tropical and subtropical regions that exist in a broad band around the equator. This includes much of sub-Saharan Africa, Asia, and Latin America. In 2018 there were 228 million cases of malaria worldwide resulting in an estimated 405,000 deaths. Approximately 93% of the cases and 94% of deaths occurred in Africa. Rates of disease have decreased from 2010 to 2014 but increased from 2015 to 2017, during which there were 231 million cases. Malaria is commonly associated with poverty and has a significant negative effect on economic development. In Africa, it is estimated to result in losses of US$12 billion a year due to increased healthcare costs, lost ability to work, and adverse effects on tourism.