Global, regional, and national trends in the morbidity gap and contributing diseases, injuries, and risk factors, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.
Level 3 - non-randomized controlled study
Systematic descriptive epidemiological modeling of global population health data (level assigned by design analogy).
PubMed 42480564 · doi:10.1016/S2468-2667(26)00098-8
What was done
Using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates for 204 countries and territories from 1990 to 2023, researchers calculated the morbidity gap (life expectancy minus healthy life expectancy [HALE] at birth) and proportional morbidity gap (difference divided by life expectancy). Trends were evaluated globally, by GBD super-region, country, Socio-demographic Index (SDI) quintile, and sex. The morbidity gap was decomposed into cause-specific and risk-specific contributions based on comorbidity-adjusted years lived with disability (YLD), reporting mean estimates and 95% uncertainty intervals (UIs) from 250 or more posterior distribution draws.
What was found
From 1990 to 2023, the global morbidity gap widened by 1.9 years (95% UI 1.3-2.6), or 21.9% (95% UI 16.0-27.9), increasing from 8.8 years (95% UI 6.7-11.2) to 10.7 years (95% UI 8.2-13.7). Point estimates showed widening morbidity gaps in 203 of 204 countries and territories. Globally, the proportion of life spent in poor health rose from 13.6% in 1990 to 14.5% in 2023, with morbidity gaps widening across the adult life course rather than only at the end of life. In 2023, absolute morbidity gaps were largest in the high SDI quintile and smallest in the low SDI quintile. Five non-fatal condition groups accounted for 57.4% of unhealthy years globally in 2023: musculoskeletal disorders (especially low back pain), mental disorders (depressive and anxiety disorders), sense organ diseases (age-related hearing loss), unintentional injuries (falls), and other non-communicable diseases. High fasting plasma glucose, high body-mass index, and child and maternal malnutrition were the leading contributing risk factors.
Why it matters
Global gains in life expectancy continue to outpace reductions in non-fatal health loss, resulting in populations spending a decade or more in poor health. Public health policy and health system evaluation must shift focus from simply prolonging life to extending healthy lifespan and compressing morbidity.
Limits
Estimates are derived from secondary modeling and synthesis of heterogeneous data sources across the GBD framework rather than direct individual-level cohort follow-up. Primary data availability and quality vary substantially across lower-resource regions, and specific country-level estimates are not detailed in the abstract.
Cited by
- contradicts On average, humans spend the last 20% of their lives in poor health or living with disease.