Stein Emil Vollset
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...
Authors
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
Dr Ireneous Soyiri I.N.Soyiri@hull.ac.uk
Senior Lecturer in Epidemiology
Abstract
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.
Citation
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. https://doi.org/10.1016/S0140-6736%2824%2900685-8
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 |
DOI | https://doi.org/10.1016/S0140-6736%2824%2900685-8 |
Public URL | https://hull-repository.worktribe.com/output/4713061 |
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Copyright Statement
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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