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Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Vollset, Stein Emil; Ababneh, Hazim S.; Abate, Yohannes Habtegiorgis; Abbafati, Cristiana; Abbasgholizadeh, Rouzbeh; Abbasian, Mohammadreza; Abbastabar, Hedayat; Abd Al Magied, Abdallah H.A.; Abd ElHafeez, Samar; Abdelkader, Atef; Abdelmasseh, Michael; Abd-Elsalam, Sherief; Abdi, Parsa; Abdollahi, Mohammad; Abdoun, Meriem; Abdullahi, Auwal; Abebe, Mesfin; Abiodun, Olumide; Aboagye, Richard Gyan; Abolhassani, Hassan; Abouzid, Mohamed; Aboye, Girma Beressa; Abreu, Lucas Guimarães; Absalan, Abdorrahim; Abualruz, Hasan; Abubakar, Bilyaminu; Abukhadijah, Hana Jihad Jihad; Addolorato, Giovanni; Adekanmbi, Victor; Adetunji, Charles Oluwaseun; Adetunji, Juliana Bunmi; Adeyeoluwa, Temitayo Esther; Adha, Rishan; Adhikary, Ripon Kumar; Adnani, Qorinah Estiningtyas Sakilah; Adzigbli, Leticia Akua; Afrashteh, Fatemeh; Afzal, Muhammad Sohail; Afzal, Saira; Agbozo, Faith; Agodi, Antonella; Agrawal, Anurag; Agyemang-Duah, Williams; Ahinkorah, Bright Opoku; Ahlstrom, Austin J.; Ahmad, Aqeel; Ahmad, Fir...


Stein Emil Vollset

Hazim S. Ababneh

Yohannes Habtegiorgis Abate

Cristiana Abbafati

Rouzbeh Abbasgholizadeh

Mohammadreza Abbasian

Hedayat Abbastabar

Abdallah H.A. Abd Al Magied

Samar Abd ElHafeez

Atef Abdelkader

Michael Abdelmasseh

Sherief Abd-Elsalam

Parsa Abdi

Mohammad Abdollahi

Meriem Abdoun

Auwal Abdullahi

Mesfin Abebe

Olumide Abiodun

Richard Gyan Aboagye

Hassan Abolhassani

Mohamed Abouzid

Girma Beressa Aboye

Lucas Guimarães Abreu

Abdorrahim Absalan

Hasan Abualruz

Bilyaminu Abubakar

Hana Jihad Jihad Abukhadijah

Giovanni Addolorato

Victor Adekanmbi

Charles Oluwaseun Adetunji

Juliana Bunmi Adetunji

Temitayo Esther Adeyeoluwa

Rishan Adha

Ripon Kumar Adhikary

Qorinah Estiningtyas Sakilah Adnani

Leticia Akua Adzigbli

Fatemeh Afrashteh

Muhammad Sohail Afzal

Saira Afzal

Faith Agbozo

Antonella Agodi

Anurag Agrawal

Williams Agyemang-Duah

Bright Opoku Ahinkorah

Austin J. Ahlstrom

Aqeel Ahmad

Firdos Ahmad

Muayyad M. Ahmad

Sajjad Ahmad

Shahzaib Ahmad

Anisuddin Ahmed

Ayman Ahmed

Haroon Ahmed

Safoora Ahmed

Syed Anees Ahmed

Karolina Akinosoglou

Mohammed Ahmed Akkaif

Ashley E. Akrami

Ema Akter

Salah Al Awaidy

Syed Mahfuz Al Hasan

Amjad S. Al Mosa

Omar Al Ta'ani

Omar Ali Mohammed Al Zaabi

Fares Alahdab

Muaaz M. Alajlani

Yazan Al-Ajlouni

Samer O. Alalalmeh

Ziyad Al-Aly

Khurshid Alam

Noore Alam

Tahiya Alam

Zufishan Alam

Rasmieh Mustafa Al-amer

Fahad Mashhour Alanezi

Turki M. Alanzi

Almaza Albakri

Wafa A. Aldhaleei

Robert W. Aldridge

Seyedeh Yasaman Alemohammad

Yihun Mulugeta Alemu

Adel Ali Saeed Al-Gheethi

Mohammed Khaled Al-Hanawi

Abid Ali

Amjad Ali

Iman Ali

Mohammed Usman Ali

Rafat Ali

Syed Shujait Shujait Ali

Victor Ekoche Ali

Waad Ali

Akram Al-Ibraheem

Gianfranco Alicandro

Sheikh Mohammad Alif

Syed Mohamed Aljunid

François Alla

Joseph Uy Almazan

Hesham M. Al-Mekhlafi

Ahmed Yaseen Alqutaibi

Ahmad Alrawashdeh


Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. Funding: Bill & Melinda Gates Foundation.


Vollset, S. E., Ababneh, H. S., Abate, Y. H., Abbafati, C., Abbasgholizadeh, R., Abbasian, M., …Soyiri, I. (2024). Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet, 403(10440), 2204-2256.

Journal Article Type Article
Acceptance Date May 18, 2024
Publication Date May 18, 2024
Deposit Date Jun 19, 2024
Publicly Available Date Jun 27, 2024
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 403
Issue 10440
Pages 2204-2256
Public URL


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