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

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 pa...

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Autores: Vollset, SE, Ababneh, HS, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbastabar, H, Abd Al Magied, AHA, Abd ElHafeez, S, Abdelkader, A, Abdelmasseh, M, Abd-Elsalam, S, Abdi, P, Abdollahi, M, Abdoun, M, Abdullahi, A, Abebe, M, Abiodun, O, Aboagye, RG, Abolhassani, H, Abouzid, M, Aboye, GB, Abreu, LG, Absalan, A, Abualruz, H, Abubakar, B, Abukhadijah, HJJ, Addolorato, G, Adekanmbi, V, Adetunji, CO, Adetunji, JB, Adeyeoluwa, TE, Adha, R, Adhikary, RK, Adnani, QES, Adzigbli, LA, Afrashteh, F, Afzal, MS, Afzal, S, Agbozo, F, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahlstrom, AJ, Ahmad, A, Ahmad, F, Ahmad, MM, Ahmad, S, Ahmed, A, Ahmed, H, Ahmed, S, Ahmed, SA, Akinosoglou, K, Akkaif, MA, Akrami, AE, Akter, E, Al Awaidy, S, Al Hasan, SM, Al Mosa, AS, Al Ta'ani, O, Al Zaabi, OAM, Alahdab, F, Alajlani, MM, Al-Ajlouni, Y, Alalalmeh, SO, Al-Aly, Z, Alam, K, Alam, N, Alam, T, Alam, Z, Al-Amer, RM, Alanezi, FM, Alanzi, TM, Albakri, A, Aldhaleei, WA, Aldridge, RW, Alemohammad, SY, Alemu, YM, Al-Gheethi, AAS, Al-Hanawi, MK, Ali, A, Ali, I, Ali, MU, Ali, R, Ali, SSS, Ali, VE, Ali, W, Al-Ibraheem, A, Alicandro, G, Alif, SM, Aljunid, SM, Alla, F, Almazan, JU, Al-Mekhlafi, HM, Alqutaibi, AY, Alrawashdeh, A, Alrousan, SM, Al-Sabah, SK, Alsabri, MA, Altaany, Z, Al-Tammemi, AB, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Al-Wardat, MS, Al-Worafi, YM, Aly, H, Alyahya, MS, Alzoubi, KH, Al-Zyoud, WA, Amani, R, Ameyaw, EK, Amin, ATT, Amindarolzarbi, A, Amiri, S, Amirzade-Iranaq, MH, Amu, H, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Andrei, T, Andrews, EA, Anil, A, Anil, S, Anoushiravani, A, Antony, CM, Antriyandarti, E, Anuoluwa, BS, Anvari, S, Anyasodor, AE, Appiah, F, Aquilano, M, Arab, JP, Arabloo, J, Arafa, EA, Arafat, M, Aravkin, AY, Ardekani, A, Areda, D, Aregawi, BB, Aremu, A, Ariffin, H, Arkew, M, Armani, K, Artamonov, AA, Arumugam, A, Asghari-Jafarabadi, M, Ashbaugh, C, Astell-Burt, T, Athari, 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Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20064
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/20064
Access Level:acceso abierto
Descripción
Sumario: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 center dot 5th and 97 center dot 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 center dot 1% [95% UI 56 center dot 8-63 center dot 1] of DALYs were from CMNNs in 2022 compared with 35 center dot 8% [31 center dot 0-45 center dot 0] in 2050) and south Asia (31 center dot 7% [29 center dot 2-34 center dot 1] to 15 center dot 5% [13 center dot 7-17 center dot 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 center dot 8% (27 center dot 4-40 center dot 3) to 41 center dot 1% (33 center dot 9-48 center dot 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 center dot 1% (15 center dot 6-25 center dot 3) of DALYs due to YLDs in 2022 to 35 center dot 6% (26 center dot 5-43 center dot 0) in 2050. In the assessment of alternative future scenarios, the combined effects of the