Health improvements occurred worldwide since 2010 despite COVID-19 pandemic, but progress was uneven

(Press-News.org) Rates of early death and poor health caused by HIV/AIDS and diarrhea have been cut in half since 2010, and the rate of disease burden caused by injuries has dropped by a quarter in the same time period, after accounting for differences in age and population size across countries, based on a new study published in The Lancet. The study measures the burden of disease in years lost to early death and poor health. The findings indicate that total rates of global disease burden dropped by 14.2% between 2010 and 2019. However, the researchers found that the COVID-19 pandemic interrupted these downward trends: rates of disease burden increased overall since 2019 by 4.1% in 2020 and by 7.2% in 2021. This is the first study to measure premature death and disability due to the COVID-19 pandemic globally and compare it to other diseases and injuries. 

The study reveals how healthy life expectancy, which is the number of years a person can expect to live in good health, rose from 61.3 years in 2010 to 62.2 years in 2021. Pinpointing the factors driving these trends, the researchers point to rapid improvements within the three different categories of disease burden: communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries. Among communicable, maternal, neonatal, and nutritional diseases, the burden of disease declined for neonatal disorders (diseases and injuries that appear uniquely in the first month of life), lower respiratory infections, diarrhea, malaria, tuberculosis, and HIV/AIDS between 2010 and 2021, ranging from reductions of 17.1% for neonatal disorders to 47.8% for HIV/AIDS. In the category of non-communicable diseases, disease burden from stroke dropped by 16.9%, while disease burden from ischemic heart disease fell by 12.0% during this period.  

For injuries, the years of healthy life lost due to road injuries was slashed by nearly a quarter (22.9%), while disease burden from falls was reduced by 6.9%. Progress in reducing disease burden varied by countries’ Socio-demographic Index – a measure of income, fertility, and education – underscoring inequities. For example, the burden of disease due to stroke dropped by 9.6% from 2010 to 2021 in countries with the lowest Socio-demographic Index, but it declined faster – by 24.9% – among countries with higher Socio-demographic Index. 

“Our study illuminates both the world’s successes and failures,” said Dr. Alize Ferrari, Affiliate Associate Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Honorary Associate Professor at the School of Public Health at the University of Queensland, and co-first author of the study. “It demonstrates how the world made huge strides in expanding treatment for HIV/AIDS and combatting vaccine-preventable diseases and deaths among children under 5. At the same time, it shows how COVID-19 exacerbated inequities, causing the greatest disease burden in countries with the fewest resources, where health systems were strained and vaccines were difficult to secure. Governments should prioritize equitable pandemic preparedness planning and work to preserve the momentum that we’ve seen in improving children’s health.” 

The research presents updated estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The GBD 2021 study analyzes incidence, prevalence, years lived with disability (years lived in less-than-ideal health), and disability-adjusted life years (lost years of healthy life) at global, regional, national, and subnational levels. It presents estimates of health and health loss in age-adjusted rates and total rates per 100,000 people. The study provides globally comparable measures of healthy life expectancy and is the first study to fully evaluate burden of disease amid the first two years of the COVID-19 pandemic. COVID-19 was the single leading cause of disease burden worldwide in 2021, accounting for 7.4% of total disease burden globally. 

The study also examined how the COVID-19 pandemic affected males and females differently. The researchers found that males were more likely than females to die of COVID-19; the age-standardized disease burden rate for COVID-19 among males was nearly twice that of females. However, the secondary effects of the COVID-19 pandemic, including long COVID and mental disorders, hit females hardest. For example, females were twice as likely as males to develop long COVID. Depression, which increased sharply during the pandemic, was most likely to affect females between ages 15 and 65.  Looking at differences between age groups, COVID-19 caused the most disease burden in older adults. For COVID-19, adults 70 years and older had more than double the levels of disease burden compared to adults between the ages of 50 and 69. 

The study highlights not only the diseases and injuries that cut life short and cause poor health, and how the burden of disease from different causes has changed over time, but also examines how these patterns differ across countries and regions. “In essence,” the authors write, the study “provides a comprehensive toolkit to inform and enhance decision-making processes across various levels of governance and practice.”  

GBD 2021 shines a light on the different causes of disease burden, showing which ones have improved and which are stagnating or worsening. It also tallies the number of years that people are living healthy lives. Healthy life expectancy rose significantly in 59 countries and territories between 2010 and 2021, with the greatest improvements in countries ranking lowest on the Socio-demographic Index, jumping from 52.2 years in 2010 to 54.4 years in 2021. In contrast, healthy life expectancy showed minimal change among countries in the highest levels of the Socio-demographic Index, decreasing slightly from 68.9 years in 2010 to 68.5 years in 2021. The findings on healthy life expectancy demonstrate that even though people are living longer lives all over the world, they aren’t spending all those years in good health. The researchers found that the main causes of poor health were low back pain, depressive disorders, and headache disorders. 

“With low back pain, the leading cause of poor health globally, we see that the existing treatments aren’t working well to address it,” said Dr. Damian Santomauro, Affiliate Assistant Professor of Health Metrics Sciences at IHME; Stream Lead at Queensland Centre for Mental Health Research; Adjunct Fellow at the School of Public Health at the University of Queensland; and co-first author of the study. “We need better tools to manage this major cause of global disease burden.” 

“In contrast, for depressive disorders, we know what can work: therapy, medication, or both in combination for an adequate period of time. However, most people in the world have little or no access to treatment, unfortunately,” he said. “Considering how depression increased dramatically during the COVID-19 pandemic, it’s urgent to ensure that everyone with this disorder can get treatment.” 

Another way to understand what is making people ill is by looking at which diseases are growing fastest. GBD 2021 reveals that diabetes experienced the most rapid growth among the different causes of poor health, what the researchers call years lived with disability. Age-adjusted years lived with disability due to diabetes rose by 25.9% between 2010 and 2021. Poor health from diabetes increased in every country and territory that the researchers studied.   

“Diabetes is a major contributor to stroke and ischemic heart disease, which are among the top three causes of disease burden worldwide,” said Dr. Theo Vos, Professor Emeritus at IHME and one of the study’s senior authors. “Without intervention, more than 1.3 billion people in the world will be living with diabetes by 2050. To counter the threat of diabetes, we must ensure that people in all countries can access preventive care and treatment, including to anti-obesity medications, which can lower a person’s risk of developing diabetes.”  

For interview requests, journalists may contact media@healthdata.org. For full study results, including the paper and related tables, finalized PDFs are available at bit.ly/GBDDALYs, embargoed until 23:30 UK, 6:30 p.m. EDT on April 17, 2024. The post-embargo link for the paper is https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00757-8/fulltext. An infographic summarizing the study’s findings can be found at https://bit.ly/4aTyVGK.

About the Institute for Health Metrics and Evaluation 

The Institute for Health Metrics and Evaluation (IHME) is an independent research organization at the University of Washington (UW). Its mission is to deliver to the world timely, relevant, and scientifically valid evidence to improve health policy and practice. IHME carries out its mission through a range of projects within different research areas including the Global Burden of Diseases (GBD), Injuries, and Risk Factors; Future Health Scenarios; Cost Effectiveness and Efficiency; Resource Tracking; and Impact Evaluations. 

IHME is committed to providing the evidence base necessary to help solve the world’s most important health problems. This requires creativity and innovation, which are cultivated by an inclusive, diverse, and equitable environment that respects and appreciates differences, embraces collaboration, and invites the voices of all IHME team members. 

About the Global Burden of Disease Study 

The Global Burden of Disease Study (GBD) is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 11,000 collaborators across more than 160 countries and territories. GBD 2021 – the newly published most recent round of GBD results – includes more than 607 billion estimates of 371 diseases and injuries and 88 risk factors in 204 countries and territories. The Institute for Health Metrics and Evaluation coordinates the study. 

Tables 

Table 1: Leading causes of disease burden, global, 2010 

Rank 

Cause 

Age-standardized rate per 100,000 (2010) 

1 

Neonatal disorders 

3,550 
 

2 

Ischemic heart disease 

2,510 
 

3 

Stroke 

2,270 
 

4 

Lower respiratory infections 

1,950 
 

5 

Diarrheal diseases 

1,580 
 

6 

Chronic obstructive pulmonary disease 

1,080 
 

7 

Road injuries 

1,050 
 

8 

Congenital birth defects 

1,010 
 

9 

Malaria 

999 
 

10 

HIV/AIDS 

951 
 

11 

Tuberculosis 

900 
 

12 

Low back pain 

852 
 

13 

Diabetes mellitus 

803 
 

14 

Cirrhosis and other chronic liver diseases 

667 
 

15 

Tracheal, bronchus, and lung cancer 

604 
 

16 

Headache disorders 

586 
 

17 

Depressive disorders 

585 
 

18 

Falls 

571 
 

19 

Chronic kidney disease 

514 
 

20 

Age-related and other hearing loss 

513 
 

21 

Other musculoskeletal disorders 

505 
 

22 

Self-harm 

502 
 

23 

Dietary iron deficiency 

457 
 

24 

Anxiety disorders 

449 
 

25 

Alzheimer’s disease and other dementias 

443 
 

 

 

Table 2: Leading causes of disease burden, global, 2020 

Rank 

Cause 

Age-standardized rate per 100,000 (2020) 

1 

Neonatal disorders 

3,000 
 

2 

Ischemic heart disease 

2,220 
 

3 

Stroke 

1,900 
 

4 

COVID-19 

1,480 
 

5 

Lower respiratory infections 

1,250 
 

6 

Chronic obstructive pulmonary disease 

947 
 

7 

Diabetes mellitus 

906 
 

8 

Diarrheal diseases 

871 
 

9 

Low back pain 

835 
  

10 

Congenital birth defects 

827 
 

11 

Road injuries 

817 
 

12 

Malaria 

801 
 

13 

Depressive disorders 

677 
 

14 

Tuberculosis 

599 
 

15 

Headache disorders 

589 
 

16 

Cirrhosis and other chronic liver diseases 

550 
 

17 

Falls 

535 
 

18 

Tracheal, bronchus, and lung cancer 

535 
 

19 

Other musculoskeletal disorders 

532 
 

20 

Chronic kidney disease 

528 
 

21 

HIV/AIDS 

527 
 

22 

Age-related and other hearing loss 

526 
 

23 

Anxiety disorders 

505 
 

24 

Alzheimer’s disease and other dementias 

445 
 

25 

Dietary iron deficiency 

426 
 

 

Table 3: Leading causes of disease burden, global, 2021 

Rank 

Cause 

Age-standardized rate per 100,000 (2021) 

1 

Neonatal disorders 

2,940 
 

2 

COVID-19 

2,500 
 

3 

Ischemic heart disease 

2,210 
  

4 

Stroke 

1,890 
 

5 

Lower respiratory infections 

1,170 
 

6 

Chronic obstructive pulmonary disease 

941 
 

7 

Diabetes mellitus 

916 
  

8 

Diarrheal diseases 

838 
 

9 

Low back pain 

832 
 

10 

Road injuries 

809 
 

11 

Malaria 

807 
 

12 

Congenital birth defects 

802 
 

13 

Depressive disorders 

681 
 

14 

Headache disorders 

588 
 

15 

Tuberculosis 

580 
 

16 

Cirrhosis and other chronic liver diseases 

545 
 

17 

Other musculoskeletal disorders 

534 
 

18 

Tracheal, bronchus, and lung cancer 

533 
 

19 

Falls 

531 
 

20 

Chronic kidney disease 

530 
 

21 

Age-related and other hearing loss 

526 
 

22 

Anxiety disorders 

524 
 

23 

HIV/AIDS 

497 
 

24 

Alzheimer’s disease and other dementias 

451 
 

25 

Dietary iron deficiency 

424 
 

 

END