A landmark report shows mortality from chronic diseases fell in the decade preceding the COVID-19 pandemic (2010-2019), but progress has slowed.
Death rates from diseases such as cancer, heart disease and stroke declined in four out of five countries around the world in the decade leading up to the COVID-19 pandemic, but progress has slowed compared to the previous decade.
These are the findings of a major new report tracking global progress to reduce deaths from chronic or 'non-communicable' diseases (NCDs) in 185 countries from 2010-2019.
The analysis, led by researchers at Imperial College London and funded by the UK Medical Research Council, the National Institute for Health and Care Research (NIHR) and NCD Alliance, is published today in The Lancet. It finds that while chronic disease deaths declined for most countries over the period, in almost two thirds (60%) of countries the rate of decline was slower than the preceding decade.
The report is believed to be the most comprehensive assessment of global progress to reduce NCD mortality at the national level, benchmarking countries against their own previous performance as well as against their peer countries in their region.
In most countries, reductions in deaths from cardiovascular diseases (including heart attacks and strokes) were the greatest contributors to declining chronic disease mortality. Reductions in deaths from a range of cancers (stomach, colorectal, cervical, breast, lung and prostate) also contributed to declining mortality. However, increases in deaths from dementia, other neuropsychiatric conditions (including alcohol use disorder), and some other cancers (like pancreatic and liver), counteracted gains.
The authors caution that while the recent worldwide decline in mortality from these conditions is a success story, the slowdown shows an urgent need to further roll out policies and health care guidelines and programmes which led to rapid improvements in the early millennium – including access to preventative medications, screening for early detection of conditions like cancers, and treatment and support services both for long-term conditions like diabetes and acute events like stroke or heart attacks.
Later this month, the report's authors will join leading experts from around the world in New York at UNGA 80 to discuss the implications of their findings in the lead up to the United Nations' Fourth High Level meeting on NCDs.
Professor Majid Ezzati, from the School of Public Health at Imperial College London and Imperial Global Ghana, the study's senior author, said: "Our latest report shows that while the majority of countries around the world are making progress to reduce the risk of dying from chronic disease, compared to the previous decade, progress has slowed, stalled or even reversed in some nations.
"In many countries, effective healthcare programmes like medications for diabetes, hypertension and cholesterol as well as timely cancer screening and heart attack treatment may not be reaching the people who need them, and they are being left out of the health system."
Professor Ezzati added: "If we are to get back to the rapid improvements we saw early in the millennium, we need investment in the types of healthcare programmes and tobacco and alcohol control policies that have been shown to be effective in reducing deaths in many countries. This means not only more resources but also more focus on evidence-based policies with a proven track record."
Leanne Riley, Unit Head of Surveillance, Monitoring and Reporting at the World Health Organization (WHO) and co-author of the study, said: "These data reveal a complex global picture of non-communicable diseases. Encouraging progress is evident in some areas, such as declining mortality from certain cancers and cardiovascular diseases. Yet the overall burden remains unacceptably high. To change course, we must regain momentum and accelerate efforts through effective policies and equitable access to care."
REGIONAL / COUNTRY SPECIFIC FINDINGS
In the latest report, Imperial researchers worked with the WHO and other collaborators to estimate the risk of dying from chronic diseases for 185 countries and territories. They further analysed data for 63 of the countries, mostly those that had high-quality death records, for mortality from specific conditions, to provide a more granular snapshot.[2]
They found that from 2010 to 2019, the risk of dying from a chronic disease between birth and 80 years old decreased in four out of five countries – 152 (82%) countries for women and in 147 (79%) for men.
Chronic disease mortality decreased in all high-income countries in Europe, north America and the Pacific over the period. Globally, Qatar, Azerbaijan and Uzbekistan experienced the greatest declines in mortality for both men and women. The greatest increases over the period were seen in South Sudan, Antigua and Barbuda and Saint Vincent and the Grenadines for women, while the largest increases for men were seen in Cabo Verde, Honduras and Jamaica. However, the authors caution about scarcity of data in most of these countries, and hence the trends should be interpreted as highly uncertain.
High-income industrialised nations
Among high-income industrialised nations there was a general tendency towards a slowdown in progress over the 2010-2019 period.
South Korea was the best-performer and the benchmark for east Asia. The country started with a low baseline risk, driven by large reductions in the previous decade. While declines in 2010-2019 were smaller than the previous period, they were greater than any high-income western country. In 2019, South Korea had the lowest chronic disease mortality risk in the world for females and fourth lowest for males. Reductions were seen in all age groups and in most chronic disease causes of death.
Denmark, Norway and Sweden saw some of the greatest declines in chronic disease mortality in the western wealthy industrialised world. There was also relatively little slowdown in their rate of reduction compared to the preceding decade, with mortality generally declining in both working age and older adults from 2010 to2019. Denmark was the regional benchmark among western nations.
By contrast, Germany performed poorly, with the second smallest decline in chronic disease mortality of any high-income industrialised country after the United States of America (USA). Overall, mortality declined over the period, but women aged between 30-40 and 65-75 years experienced small increases – particularly driven by increases in lung cancer and dementia deaths.
The USA experienced the smallest decline of any high-income industrialised country in the world. Progress stalled over the period, particularly among women and with a near stagnation of progress for men. Almost all age groups saw a slower decline compared to the previous decade, with mortality even increasing among 20- to 45-year-olds.
Central and Eastern Europe
On average, countries in Central and Eastern Europe started the period with a high level of risk but saw some of the greatest reductions in mortality over 2010-2019, for men and women.
Moldova was the benchmark for the region, showing the largest reduction of chronic disease risk, with the fourth largest decline in the world for women and fifth largest decline for males. The progress is believed to have been largely driven by declines in deaths from heart disease.
In Russia and some other countries in eastern Europe, alcohol control policies are believed to be a key driver in declining mortality.
Latin America and Caribbean
In Latin America and the Caribbean region, among the success stories, many countries experienced a slowdown or reversal of chronic disease mortality decline.
In Chile and Colombia, the regional benchmarks for men and women, respectively, declines in mortality accelerated over the period across all or most chronic diseases and age groups.
Chile had the largest decline in mortality from 2010 to 2019 for males and the second largest for females. At the end of the period, the risk of dying from chronic disease was lower in Chile than the USA and some other high-income industrialised countries. Its performance was driven by improvements in stroke, chronic respiratory disease, some cancers and diabetes.
Among the greatest increases in risk over the period were Antigua and Barbuda for women, and Honduras and Jamaica for men. Jamaica's poor performance was driven by rising mortality for most chronic diseases, including cardiovascular disease, kidney disease and many cancers. However, the authors caution that trends may be masked by reduced data availability and quality in some of these countries.
India and China
In India, the probability of dying from chronic disease increased from 2010 to 2019 for both women and men. The picture was worse for women, who had a greater increase in risk than men. Deaths from most causes of chronic disease increased, with heart disease and diabetes contributing heavily.
China showed similar declines to Japan and South Korea over the period across most age groups and causes of death, despite starting with a higher mortality rate. China also experienced the largest reduction in deaths caused by COPD (linked to smoking and air pollution) among countries with high-quality data. Overall, men experienced a larger decline in 2010 to 2019 than in the previous decade. For women, the decline was smaller than the previous decade, with increases in some cancers (pancreatic, lymphomas, multiple myelomas).
SLOWING PROGRESS
Despite global declines in mortality, when compared to the previous decade, 60% of all countries – including nearly all high-income countries in Europe, north America, Australasia and East Asia – experienced a worsening in 2010 to 2019. This was defined by either a slower decline than the preceding decade, or a reversal of the earlier decline.
Working age (below 65-year-olds) and older age adults (65- to 80-year-olds) were both important for determining overall national performance and how much progress continued versus slowed down. Countries which performed well in both age groups performed better overall. For example, Finland, Norway and Denmark all experienced a slower decline in chronic disease deaths in 2010 to 2019 for older ages compared to the previous decade, but this was countered by faster declines in working age adults over the period – which limited overall slowdown and helped them to maintain good performance.
For countries such as the USA, which experienced a slower decline in older ages compared to the previous decade, this was worsened by a stagnation or worsening of mortality in working age adults – which contributed to an overall slowdown and led to poor performance.
According to the authors, the global slowdown was driven by smaller declines in mortality from multiple chronic diseases, compared to the previous period – with the early part of the millennium seeing large declines in disease areas such as cardiovascular diseases and cancer, due to intensive tobacco control, early detection of disease, preventative medicines and timely treatments.
The report highlights that coverage of national screening and preventative medication programmes for high blood pressure and diabetes have plateaued in many countries, as well as a slowdown in the expansion of some cancer screening programmes.
The authors acknowledge some limitations to their study. They highlight that data on death registration and the specific cause of mortality are highly variable between countries and regions, with fewer than one-third of countries having complete death registration – most notably Pacific Island nations and low-income countries in Africa and south Asia. They also highlight the influence of year-on-year variations in mortality, which can have larger influences in smaller populations.
The research was supported by funding from the UK Medical Research Council (MRC) and NCD Alliance. The work at Imperial was supported by the NIHR Imperial Biomedical Research Centre, a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London.
-
'Benchmarking progress in non-communicable diseases: a global analysis of cause-specific mortality from 2001 to 2019' by Bennett, J., O'Driscoll, O., Stevens, G., et al. is published in The Lancet. DOI: 10.1016/S0140-6736(25)01388-1
[2] The report analysed 51 countries with high quality data available: Armenia, Australia, Austria, Belarus, Belgium, Brazil, Canada, Chile, China, Colombia, Costa Rica, Croatia, Cuba, Czechia, Denmark, Finland, Germany, Guatemala, Hungary, Ireland, Israel, Italy, Jamaica, Japan, Kazakhstan, Kyrgyzstan, Lithuania, Mexico, Moldova, Mongolia, Netherlands, New Zealand, Nicaragua, Norway, Panama, Portugal, Puerto Rico, Romania, Russian Federation, Singapore, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Taiwan, Ukraine, United Kingdom, United States of America, Venezuela.
The authors included an additional 12 countries based on size: Argentina, Egypt, France, India, Iran, Nigeria, Papua New Guinea, Peru, Philippines, Poland, South Africa, Türkiye.
