COVID-19 will undo decades of global health progress and shorten life expectancy

Recent research published in lancet showed the global burden with a breakdown of 288 causes of death and life expectancy.

The Global Disease, Injury and Risk Factor Survey (GBD) has been analyzing causes of human death for more than 30 years and has been used to guide policy, monitor/evaluate health interventions, and reduce risk factors. Assessing trends in cause-specific mortality rates can help inform health policy, which needs to evolve to account for changes in the global health landscape.

While reduction efforts have been successful in some regions, other causes remain in place, and mortality patterns are continually evolving. Additionally, several causes of death have improved over the past 30 years, some of which have become much narrower geographically and concentrated in smaller areas.

study: Global burden of 288 causes of death and life expectancy in 204 countries and territories and 811 metropolitan areas (1990-2021): Systematic analysis for the Global Burden of Disease Study 2021. Image credit: tomertu / Shutterstock

About research

In this study, the researchers presented a breakdown of mortality concentrations and life expectancy. GBD 2021 provides a comprehensive set of fatal disease burdens from 288 causes by sex and age in 204 countries and territories from 1990 to 2021, and replaces previous estimates from 1990 to 2019. Has been updated. The researchers calculated years of life lost (YLL) as the product of the number of deaths for each cause, age, sex, year, and location, and the standard life expectancy at each age.

Cause-specific mortality rates were calculated using cause-of-death ensemble models for most causes of death, and alternative strategies were applied for model causes of death with unusual epidemiology or insufficient data. Illnesses and injuries are categorized into four levels for both non-fatal and fatal causes. Level 1 causes include three broad aggregate categories: 1) noncommunicable diseases (NCDs), 2) communicable, maternal, neonatal, and nutritional (CMNN) diseases, and 3) injuries. It will be.

At Level 2, these categories were divided into 22 clusters, which were further divided into Level 3 and Level 4 causes. To explore cause-specific effects on life expectancy from 1990 to 2021, we disaggregated life expectancy by cause of death, year, and location. We used the coefficient of variation and mortality concentration (proportion of the population affected by 90% of deaths) to estimate concentrated causes. Deaths (number).

Global choropleth map of COVID-19 2021 (A) and OPRM (B). Provides subnational details if available. OPRM=Other Pandemic-Related Mortality.

Investigation result

From 1990 to 2019, the annual rate of change in global all-cause mortality ranged from -0.9% to 2.4%. The corresponding proportions in age-standardized deaths ranged from -3.3 to 0.4%. Despite this, the number of global deaths in 2020 increased by 10.8% compared to 2019. This continued in 2021, with an increase of 7.5% compared to 2020. Similarly, age-standardized mortality rates showed a similar pattern, increasing by 8.1% in 2020 and 5.2% in 2020. 2021.

Each row represents the change in life expectancy from 1990 to 2021 for a particular GBD region. The bar to the right of 0 represents the increase in life expectancy due to a change in a specific cause, and the bar to the left of 0 represents a decrease in life expectancy due to a specific cause. For readability, labels indicating changes in life expectancy from 0 to less than 3 years are not shown. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GBD=Global Burden of Disease, Injury and Risk Factors Study. LRI=lower respiratory tract infection. NCD=non-communicable disease. OPRM=Other Pandemic-Related Mortality. *War and terrorism are not included. †Does not include natural disasters.

From 2020 to 2021, coronavirus disease 2019 (COVID-19) deaths and other pandemic-related deaths (OPRM) changed mortality patterns for the leading causes of age-standardized death. At level 3, the four causes of death with the highest age-standardized rates in 2019 (1. ischemic heart disease, 2. stroke, 3. chronic obstructive pulmonary disease, and 4. lower respiratory tract infections) are ranked in 2019. It was the same as the year. 1990.

However, in 2021, stroke became the third leading cause of age-standardized mortality, overtaking COVID-19 as the second leading cause. Additionally, OPRM was the fifth most common cause, while lower respiratory tract infections were the seventh most common cause. The impact of COVID-19 on age-standardized mortality was similar to that of common obstructive pulmonary diseases in 2020, but increased by 60.2% in 2021.

In 2020 and 2021, approximately 4.8 million people and 7.89 million people died from novel coronavirus infections worldwide, respectively. Age-standardized rates varied widely across the GBD superregions, being highest in sub-Saharan Africa and lowest in Southeast Asia, East Asia, and Oceania. OPRM and COVID-19 deaths also vary significantly by age, with older populations disproportionately affected.

In 1990, the three main causes of YLL worldwide were CMNN disease. Furthermore, while neonatal diseases remained the leading cause in 2019, NCDs, namely ischemic heart disease and stroke, replaced them as the second and third leading causes, respectively. However, in 2021, COVID-19 became the second leading cause of YLL, while neonatal disorders and ischemic heart disease were the first and third leading causes, respectively.

Since the 1990s, there has been a long-term positive trend in global life expectancy. Overall, life expectancy increased by 7.8 years between 1990 and 2019. However, from 2019 to 2021, the period was shortened by 2.2 years due to the impact of the new coronavirus infection and OPRM. Despite this decrease, overall over the study period he increased by 6.2 years.

Reductions in mortality rates from enteric infections (paratyphoid fever, typhoid fever, diarrheal diseases) have influenced an increase in global life expectancy. The next biggest impact was the reduction in deaths from lower respiratory tract infections. From 1990 to 2021, life expectancy increased in all seven superregions.

Southeast Asia, East Asia and Oceania had the highest rate of increase (8.3 years), mainly due to lower mortality rates from chronic respiratory diseases. South Asia had the second largest increase in life expectancy (7.8 years), mainly due to reduced mortality from intestinal infections. Notably, Latin America and the Caribbean saw the largest decline in life expectancy due to COVID-19 (3.6 years).

Declining mortality rates from intestinal diseases has had a major impact on global life expectancy. CMNN disease mortality increased in 160 countries/territories, resulting in mortality concentrations. Deaths were more concentrated in some regions and countries. For example, in 1990, in regions where the population of children under 5 years old was 63%, 90% of deaths from intestinal infections decreased in regions with 51% of the population in 2021. did.

Furthermore, reductions in lower respiratory tract infections had a positive impact on life expectancy in regions such as eastern and western sub-Saharan Africa and Andean Latin America. In addition, life expectancy increased by 0.8 years due to fewer strokes. However, deaths from stroke were not concentrated. Overall, NCDs showed no overall concentration of mortality.

conclusion

In summary, our analysis provided insight into the global disease situation before and during the two years of the coronavirus disease (COVID-19) pandemic. The findings show that after 30 years of improving life expectancy and declining age-standardized mortality rates, COVID-19 has disrupted epidemiological trends and reversed years of progress. .

COVID-19 is the second leading age-standardized cause of death in 2021 and has a significant impact on global life expectancy. Life expectancy has declined almost as much as the decline in infectious diseases and NCDs has improved over the decades. This study suggests that improvements in life expectancy may be achieved by leveraging past successes in reducing mortality.