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New Global Burden of Disease Study: Mortality Declines, Youth Deaths Rise, Widening Health Inequities
- Global life expectancy in 2023 is more than 20 years higher compared to 1950, and the age-standardized mortality rate is 67% lower, with all 204 countries and territories reporting declines.
- Despite these improvements, the world faces an emerging crisis of higher death rates in adolescents and young adults in North America and Latin America due to suicide and drug and alcohol consumption and in sub-Saharan Africa due to infectious diseases and unintentional injuries.
- Non-communicable diseases account for nearly two-thirds of the world’s total mortality and morbidity, led by ischemic heart disease, stroke, and diabetes, emerging in the top ten causes.
- Half of the world’s disease burden is preventable and driven by 88 modifiable risks, including high blood pressure, air pollution, smoking, and obesity.
- The burden of mental disorders continues to surge globally, with anxiety and depression increasing death and disability by 63% and 26%, respectively.
Global mortality rates are falling but not among youths and young adults, according to the latest Global Burden of Disease (GBD) study published in The Lancet today and presented at the World Health Summit in Berlin. Additionally, non-communicable diseases (NCDs) now account for nearly two-thirds of the world’s total mortality and morbidity, with ischemic heart disease, stroke, and diabetes leading the globe. Researchers also estimate that nearly half of all death and disability could be prevented by modifying some of the leading risk factors, such as reducing high levels of blood sugar and high body mass index (BMI).
“The rapid growth in the world’s aging population and evolving risk factors have ushered in a new era of global health challenges,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine. “The evidence presented in the Global Burden of Disease study is a wake-up call, urging government and health care leaders to respond swiftly and strategically to the disturbing trends that are reshaping public health needs.”
Dr. Murray’s team at IHME and its GBD Collaborator Network of 16,500 scientists and researchers collected and analyzed data and produced estimates for 375 diseases and injuries and 88 risk factors by age and sex globally, regionally, and nationally for 204 countries and territories and 660 subnational locations from 1990 to 2023, making the GBD the most comprehensive research quantifying health loss. Over 310,000 total data sources were used for the latest iteration, 30% of them new to this year’s study. It includes 1,211 location-years of provisional all-age vital registration data, which had not previously been used, and which provide more timely information. The global health assessments outlined in three peer-reviewed capstones cover critical areas of the GBD: a demographic analysis, causes of death, and the burden of diseases, injuries, and risk factors.
Demographic analysis: Global mortality declines, youth deaths climb
Despite population growth and aging, the 2023 global age-standardized mortality rate declined 67% since 1950, and all countries and territories marked declines. Global life expectancy returned to pre-pandemic levels at 76.3 years for females and 71.5 years for males, which is more than 20 years higher compared to 1950. Despite this progress, stark geographic differences remain, with life expectancy ranging from as high as 83 years in high-income regions to as low as 62 years in sub-Saharan Africa.
Among adolescents and young adults, the largest increase in deaths was registered among those aged 20 to 39 in high-income North America from 2011 to 2023, mainly due to suicide, drug overdose, and high quantities of alcohol. During the same period, deaths in the 5–19-year age group increased in Eastern Europe, high-income North America, and the Caribbean.
Over the entire study period, the number of infant deaths declined more than for any other age group. From 2011 to 2023, East Asia recorded the largest decrease of 68% in the mortality rate for the under-5 age group due to better nutrition, vaccines, and stronger health systems.
Advances in modeling for the GBD 2023 study showed mortality in children ages 5–14 in sub-Saharan Africa from 1950 to 2021 was higher than previously estimated, an increase driven by high rates of respiratory infections and tuberculosis, other infectious diseases, and unintentional injuries. New calculations also showed mortality in young adult females ages 15–29 in sub-Saharan Africa was 61% higher than previously estimated, mostly due to maternal mortality, road injuries, and meningitis. Read the capstone on the demographic changes in global health.
Causes of death: Shift from infectious to non-communicable diseases
Causes of death are shifting from infectious to non-communicable diseases (NCDs), creating new global health challenges, particularly for low-income countries. After standing as the leading cause of death in 2021, COVID-19 plunged to the 20th place in 2023, putting ischemic heart disease and stroke back at the top, followed by chronic obstructive pulmonary disease, lower respiratory infections, and neonatal disorders. Since 1990, mortality rates for ischemic heart disease and stroke have declined, and so have diarrheal diseases, tuberculosis, stomach cancer, and measles. Conversely, during the same period the death rate increased for diabetes, chronic kidney disease, Alzheimer’s disease, and HIV/AIDS.
While the global mean age at death increased from 46.4 in 1990 to 62.9 years in 2023, geographic inequities were profound. The highest mean age of death was recorded in the high-income super-region, with females reaching 80.5 years and males at 74.4 years. The lowest mean age of death was in sub-Saharan Africa, with females at 37.1 years and males at 34.8 years.
The all-cause probability of dying before age 70 decreased across each GBD super-region and region from 2000 to 2023, with drug use disorders as one of the leading causes. In sub-Saharan Africa, the probability increased for many NCDs, and the mean age of death from NCDs was lower than expected. In the high-income super-region, the probability increased for drug use disorders, and the mean age of death was lower than expected. Read the capstone on the 292 fatal conditions.
Burden of diseases, injuries, and risk factors: Changing certain factors could reduce death and disability
Non-communicable diseases (NCDs) accounted for nearly two-thirds of the world’s total death and disability. The top three causes were ischemic heart disease, stroke, and diabetes. Low-income regions also saw a sharp rise in NCDs, further constraining nations with limited resources.
From 1990 to 2023, the age-standardized rate of disability-adjusted life years (DALYs) fell 36%. This measures total years of healthy life lost by examining the years lost from premature death and years lived with disability. From 2010 to 2023, DALY rates for communicable, maternal, neonatal, and nutritional (CMNN) diseases fell by almost 26%. This was led by rates for diarrheal diseases being cut in half, a 43% decrease in rates for HIV/AIDS, and a 42% drop for tuberculosis. Neonatal disorders and lower respiratory infections remain the top causes of CMNN diseases but have declined 17% and 25%, respectively.
Almost half of the global mortality and morbidity in 2023 was attributable to 88 modifiable risk factors. The 10 risk factors with the highest proportion of health loss were high systolic blood pressure, particulate matter pollution, smoking, high fasting plasma glucose, low birthweight and short gestation, high BMI, high LDL cholesterol, kidney dysfunction, child growth failure, and lead exposure. Between 2010 and 2023, DALY rates for high BMI rose by almost 11%, drug use by nearly 9%, and high blood sugar by 6%.
New GBD modeling methods for lead exposure, the 10th-leading risk, also revealed a direct link to cardiovascular diseases. Removing lead from fuel has contributed to substantial declines in exposure over the years, but it’s still a common environmental contaminant that can be found in paint in older buildings, contaminated soil, water, spices, and many cooking utensils.
Climate-sensitive risks, such as air pollution and heat, continue to have a more significant impact on global health. The DALY rates for the second-leading risk, particulate matter pollution, were highest at the super-region level in South Asia, sub-Saharan Africa, and North Africa and the Middle East. High temperatures are also exacerbating vulnerabilities in that same region, particularly the Sahel, by compounding the effects of drought, food insecurity, and displacement.
Mental health disorders rose steeply, with anxiety disorders increasing by 63% and depressive disorders by 26%. In addition, sexual abuse and intimate partner violence were identified as preventable contributors to depression, anxiety, and other health consequences.
Among children under 5, the 2023 leading risk factors were child and maternal malnutrition, particulate matter pollution, and unsafe water, sanitation, and hygiene (WaSH). For children and adolescents aged 5 to 14 years, iron deficiency was the leading risk, followed by others related to unsafe WaSH and child and maternal malnutrition. For the 15 to 49 age group, the top two risks were unsafe sex and occupational injuries, followed by high BMI, high systolic blood pressure, and smoking. For those 50 to 69 years, high systolic blood pressure was the leading risk, followed by smoking, high blood sugar, high BMI, high LDL cholesterol, and kidney dysfunction.
From 2010 to 2023, injury-related DALY rates decreased by 16% during the same time period. The burden of injuries was higher in males, particularly older children and young adults ages 10 to 24, accounting for more than double the total DALYs compared to that of females.
The GBD 2023 study highlights the urgent need for policymakers to expand health priorities beyond reducing child mortality to include adolescents and young adults, particularly in areas with higher rates of mortality than previously known.
“Decades of work to close the gap in low-income regions with persistent health inequities are in danger of unraveling due to the recent cuts to international aid,” said Emmanuela Gakidou, senior author and professor at IHME. “These countries rely on global health funding for life-saving primary care, medicine, and vaccines. Without it, the gap is sure to widen.”
The GBD estimates are also available in various interactive data visualization tools, including GBD Compare and GBD Results.
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Terry Slevin is CEO of the Public Health Association of Australia and an Adjunct Professor at both Curtin University and ANU
"A twenty-year increase in life expectancy for humanity achieved over the past 75 years is an extraordinary achievement. Public health measures have been leading drivers of this improved longevity, through better and more accessible food, vaccination, better health care, and improvements in the care of infants and children.
Life expectancy in Australia has specifically increased over the past three decades. As of 2023, women can expect to live to the age of 86 – six years longer than in 1990 – and men to 84, eight years more than in 1990.
An enormous reduction in deaths is attributable to reducing the impact of Ischemic Heart Disease, which caused 176 deaths per 100,000 people in 1990, but just 40 per 100,000 in 2023. This change was largely due to the better management of high blood pressure through statins and by reductions in smoking rates. Consequently, lung cancer death rates have also fallen by more than a third.
The long-term shift in emphasis of our global health challenge from infectious disease control to addressing chronic non-communicable diseases (NCDs) is stark. Two out of every three deaths are now due to NCDs. Half of these deaths are preventable. Future improvements to our longevity, or just to allow us to live more of our years in good health, will rely on action to prevent NCDs. This applies in Australia as it does around the world, and is an important signal for the role of the new Australian Centre for Disease Control.
The new Burden of Disease Study, largely funded by the Gates Foundation, is an extraordinary effort by thousands of scientists, drawing on over 310,000 data sources. The Study is a rich resource to better monitor the health status of the world, and how we can improve it. It shines a light on successes and failures. It provides an essential guide to political and policy choices in Australia and around the world."
Dr Anastasia Mihailidou is a Senior Hospital Scientist in the Department of Cardiology at Royal North Shore Hospital and a Honorary Associate Professor at Macquarie University
"The Global Burden of Disease (GDB) Study is an important and comprehensive analysis for all of us to track how our health is progressing. The new 2023 report has been released and serves as an alarm clock for us to be alert of the challenges to our health and survival so we may intervene. In relation to Australia, we have an increasing aging population with life expectancy in 2023 increasing by just over 7 years from 1990 to average 84 years; with women living to nearly 86 years and men to 82 years.
This will place demands on health systems and our communities. While we are living longer with age-standardised death rates declined, the leading cause of death globally and for Australia remains as ischemic heart disease. This is why it is important to continue with heart health checks and blood pressure measured. For Australia this is followed by Alzheimer’s disease and third is lung cancer. The GBD study also provides important information on how the world’s disease burden can be prevented with modifying risk factors such as high blood pressure, obesity, smoking and air pollution.
The figure below shows the 10 leading risk factors globally with highest proportion of health loss (disability-adjusted life years, DALYs), expressed as a percentage of total years lived with illness or disability. For Australia the leading preventable risk factor has changed from high blood pressure in 1990 to high BMI in 2023 followed second by smoking and third high blood sugar. We still need to be aware as we age that blood pressure may increase and with increasing weight, especially for women.
Air pollution and heat as well as anxiety and depression are also having a significant impact on our global health."
Professor Dr Muhammad Aziz Rahman is Professor of Public Health and Associate Dean of Research from the Institute of Health and Wellbeing at Federation University Australia
"While life expectancy in Australia has significantly improved for both males and females, ischaemic heart disease continues to be the leading cause of death, a trend that has remained unchanged over the past 30 years. To address this issue, it is essential to prioritise primary prevention by tackling modifiable risk factors such as tobacco use, unhealthy diets, and lifestyle choices. Elevating health literacy is crucial, with a focus on recognising symptoms and understanding individual risk factors. Additionally, we must enhance access to cardiovascular risk assessment tools, particularly for disadvantaged groups, including First Nations people, culturally and linguistically diverse (CALD) populations, and those residing in rural areas. Strengthening cardiac rehabilitation through increased home-based support programs will also contribute to effective secondary prevention.
Interestingly, in 2023, Alzheimer’s Disease emerged as the second leading cause of death in Australia, while it ranks as the sixth leading cause of death globally, highlighting a significant area for attention. It is vital to raise awareness through dementia risk reduction campaigns that address lifestyle factors. Simultaneously, integrating dementia risk assessments into primary care settings and promoting early diagnosis can help alleviate the burden of this condition.
In 2023, high BMI was identified as the leading risk factor, while smoking maintained its status as the second leading risk factor over the last three decades in Australia. Beyond ongoing population-level initiatives aimed at promoting healthy behaviours to combat overweight and obesity, it is crucial to address policy issues such as implementing taxes on sugar-sweetened beverages and mitigating industry interference in marketing unhealthy foods to children. Furthermore, the prevailing misconception that 'tobacco control is done' among the public and policymakers in Australia is hindering progress. Therefore, smokers, particularly those with higher dependence and those in remote areas, need to have access to adequate smoking cessation support."
Professor Jenny Gunton is Director of the Centre for Diabetes, Obesity and Endocrinology at The Westmead Institute for Medical Research
"The paper shows that diabetes is now one of the top three causes of disability worldwide. There has been a huge and steady increase in disability due to diabetes since 1990, when diabetes was only 20th on the list of causes. Diabetes is also an important cause of cardiovascular disease, with up to 2/3 of people with diabetes dying from cardiovascular causes like heart attack and stroke.
Peak disability years for people with diabetes are between 50 and 69 years, affecting millions of people of working age worldwide, but there is also a worryingly high burden of disability in adolescents and young adults with diabetes."
Professor Valery Feigin, National Institute for Stroke and Applied Neurosciences, AUT, New Zealand
“This study shows that while death rates worldwide keep falling, New Zealand’s mortality is still higher than Australia’s: about 431 deaths per 100,000 people each year compared with 347 in Australia. Our life expectancy is also lower: 81.6 years versus 84.
“Ischaemic heart disease is the number one killer in both countries, but in New Zealand the rate is almost twice that of Australia. Stroke is our second leading cause of death, while in Australia it’s now Alzheimer’s disease.
“The main issue driving these differences between NZ and Australia is risk factors. In both countries, a high body mass index is the top contributor, but it has a bigger impact here in NZ. Our second biggest problem is high blood pressure, while in Australia it’s smoking. That means we’ve done well reducing smoking, but we need stronger measures to control blood pressure and obesity.
“We urgently need more effective prevention strategies for heart disease and stroke – better lifestyle support, early detection, and treatment of risk factors. Without that, the health gap between New Zealand and Australia will continue to grow.”
Associate Professor George Laking, Te Aka Mātauranga Matepukupu Centre for Cancer Research, New Zealand
"This is a magisterial work by the Global Burden of Disease collaborators. It reminds me of the Pale Blue Dot photograph of Earth taken by the Voyager 1 space probe in 1990. All of human life is contained in these numbers. There have been positive gains in life expectancy in many places across the years. But the work is also a stark illustration of global inequality and a collective failure of care on the part of the wealthy.
"Heart disease and stroke remain at the top of the list of global killers. COVID-19 was briefly in first place, in 2021. New Zealand escaped this thanks to bold public policy. My own area of cancer is relatively lower on the list, at positions 7 (lung), 14 (colorectal), and 16 (stomach). It is an indictment on global governance that lung cancer remains up to 90% preventable via tobacco control. Alcohol is also a major preventable cause of many cancers and cardiovascular diseases.
"One way the presentation could be enhanced is by showing the poor health status of less advantaged nations, alongside that of the economically connected affluent. For example, the mortality rate for children under 5 in New Zealand in 2023 sits at 4.4 deaths per 1000. In the Realm Nations of the Cooks, Niue, and Tokelau it is 8.3, 10.9, and 10.4. These statistical deaths were, all too briefly, New Zealand citizens.
"Much of our agricultural wealth depends on superphosphate, historically imported from Nauru (under 5 mortality 25.8 per 1000), more recently from Western Sahara (occupied by Morocco, where the under 5 mortality rate is 17.6 per 1000). Our agricultural wealth is inextricably connected with early childhood death in these places.
"A visitor from above would be quite right in asking why we as humans are unable to look after our own. The legal fiction of borders must look like a poor excuse. We sit comfortably within our sovereign nation states and benefit from historical and ongoing exploitation of the less advantaged. My hope is that works like this would encourage everyone to take a more global view of health and economic justice."
Professor Jenny Gunton is Director of the Centre for Diabetes, Obesity and Endocrinology at The Westmead Institute for Medical Research
"The paper shows that diabetes is now one of the top three causes of disability worldwide. There has been a huge and steady increase in disability due to diabetes since 1990, when diabetes was only 20th on the list of causes. Diabetes is also an important cause of cardiovascular disease, with up to 2/3 of people with diabetes dying from cardiovascular causes like heart attack and stroke.
Peak disability years for people with diabetes are between 50 and 69 years, affecting millions of people of working age worldwide, but there is also a worryingly high burden of disability in adolescents and young adults with diabetes."
Professor Richard Edwards is the Head of Public Health in the College of Medicine of Public Health at Flinders University
"The Global Burden of Disease (GBD) study demonstrates increasing dominance of non-communicable diseases (NCDs) like heart disease, stroke and diabetes and their risk factors as causes of premature death and disease. Rapidly growing prevalence of anxiety, depression and Alzheimer’s disease is also apparent.
The GBD study also shows some remarkable progress since 1990, including substantial reductions in the burden of disease from communicable diseases and poor nutrition and greatly improved maternal and child health. Unfortunately, recent cuts to resources for development assistance for health threaten to undermine this progress.
Findings from Australia mirror the picture of rapidly increasing health burdens from NCDs; the commonest causes of death are heart disease, stroke and lung cancer and the biggest population health risk factors are obesity, smoking and high blood sugar.
The Ottawa Charter is 40 years old in 2026. The Charter’s advocacy for making healthy choices easy choices through healthy public policies and creating supportive environments is as relevant today as in 1986.
The growing importance of NCDs underlines the enormous potential health gains from introducing preventive evidence-based policy measures such as sugary drinks taxes and denicotinising tobacco products.
With growing misinformation about health and health interventions and increasing abandonment of goals prioritising societal well-being and social justice, what better time for Australia to show leadership and provide inspiration by introducing the pioneering public health policy measures to prevent NCDs which the findings from the GBD study surely demand?"
Dr Yutang Wang is a Senior Lecturer in the School of Applied and Biomedical Sciences at Federation University Australia
"According to the latest Global Burden of Disease (GBD) studies, global age-standardised mortality rates are declining for many of the leading causes of death, including ischemic heart disease and stroke, over the past three decades. In contrast, mortality rates associated with diabetes, kidney disease, hypertensive heart disease, and Alzheimer’s disease are on the rise.
To assess overall health loss, the Disability-Adjusted Life Year (DALY)—an age-standardised metric combining years of life lost due to premature death and years lived with disability—is routinely used. Between 2010 and 2023, DALY rates decreased globally for 22 of the 25 leading risk factors, indicating an overall improvement in population health worldwide. However, three risk factors showed an increase in DALY rates: high body mass index (up 10.5%), drug use (up 8.4%), and high blood sugar (up 6.2%).
Australians are generally healthier than the global average, with lower all-cause mortality rates (418 vs 822 per 100,000 population) and longer life expectancy (83.9 years vs 73.8 years globally). In 2023, the top three risk factors contributing to DALYs in Australia were high body mass index (7.0%), smoking (5.8%), and high blood sugar (5.5%).
These findings highlight the need for continued public health efforts in Australia, particularly in promoting healthier lifestyles. Strategies should include increasing physical activity, reducing overeating, and supporting smoking cessation to further enhance the nation’s health outcomes."
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