What is the global trend of Disability-Adjusted Life Years (DALYs) connected to non-communicable diseases (NCDs)?

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Global Trends of DALYs Connected to Non-Communicable Diseases

The global burden of disability-adjusted life years (DALYs) from non-communicable diseases (NCDs) has shown a dramatic epidemiological transition, with NCDs rising from 43% of global DALYs in 1990 to 54% by 2010, and continuing to increase to account for 1.73 billion DALYs by 2021, despite declining age-standardized rates. 1, 2

Overall Burden Trajectory

The absolute number of global DALYs has remained relatively stable between 1990 and 2021, hovering around 2.5-2.9 billion total DALYs, but the composition has fundamentally shifted. 1, 3 Key trends include:

  • Total global DALYs increased from 2.63 billion in 2010 to 2.88 billion in 2021, driven primarily by population growth and aging rather than worsening disease rates. 3
  • Age-standardized DALY rates for all causes decreased by 14.2% between 2010 and 2019, indicating genuine health improvements when accounting for demographic changes. 3
  • Crude DALYs per 1,000 population decreased by 23% from 1990 (472 per 1,000) to 2010 (361 per 1,000), demonstrating substantial progress in reducing disease burden relative to population size. 1

The Epidemiological Transition

The shift from communicable to non-communicable diseases represents the most significant global health trend of the past three decades:

  • In 1990, communicable, maternal, neonatal, and nutritional disorders accounted for 47% of global DALYs, while NCDs contributed 43%. 1
  • By 2010, this had reversed to 35% from communicable diseases and 54% from NCDs, with injuries accounting for the remaining 11%. 1
  • NCDs contributed 1.73 billion DALYs in 2021, representing the dominant source of global disease burden. 2

This transition has been accelerated by improvements in the Socio-demographic Index (SDI), which correlates strongly with the increasing importance of NCDs. 4

Age-Standardized Rates: The Real Story

While absolute NCD burden has increased, age-standardized rates tell a more nuanced story:

  • Age-standardized DALY rates for NCDs declined by 6.4% between 2010 and 2021, indicating that when accounting for population aging, NCD burden per capita is actually improving. 3
  • Global age-standardized NCD prevalence rates showed minimal change (-0.1%) from 1990 to 2021, while death rates decreased by 27.9% and DALY rates by 19.4%. 2
  • However, several high-burden NCDs showed concerning increases in age-standardized rates: anxiety disorders (+16.7%), depressive disorders (+16.4%), and diabetes (+14.0%) between 2010 and 2021. 3

Leading NCD Causes

The hierarchy of NCD contributors has evolved significantly:

  • Ischemic heart disease rose from fourth rank in 1990 to the leading cause of DALYs globally by 2010, with a 29% increase in burden. 1
  • In 2021, ischemic heart disease accounted for 188.3 million DALYs, followed by stroke (160.4 million DALYs). 3
  • Cardiovascular diseases had the highest age-standardized DALYs (5,056 per 100,000 population) among NCD subtypes in 2021, followed by neoplasms (2,954 per 100,000) and other NCDs (1,913 per 100,000). 2
  • Diabetes and kidney diseases showed a 25.6% increase in age-standardized DALYs since 1990, representing one of the fastest-growing NCD categories. 2
  • Mental and behavioral disorders increased substantially, with major depressive disorder rising from 15th to 11th rank globally (37% increase). 1

Regional Heterogeneity

Geographic variation in NCD burden reveals stark disparities:

  • YLLs account for approximately 50% of disease burden in high-income regions (high-income Asia Pacific, Western Europe, North America, Australasia), but exceed 80% in sub-Saharan Africa where communicable diseases remain dominant. 1
  • Oceania had the highest age-standardized NCD DALYs (28,782 per 100,000 population) in 2021, while Southern Sub-Saharan Africa experienced the largest increase (+8.0%) since 1990. 2
  • At the national level, Nauru reported the highest age-standardized DALYs (42,754 per 100,000), with Lesotho experiencing the largest increase since 1990 (+38.4%). 2
  • Cardiovascular diseases dominated as the leading NCD subtype in 16 of 21 global regions and 159 of 204 countries. 2

The Disability Component

A critical trend is the shift from premature mortality to years lived with disability:

  • The contribution of deaths and disability among children under 5 years declined from 41% of global DALYs in 1990 to 25% in 2010, reflecting success in reducing early-life mortality. 1
  • More populations are spending more time with functional health loss (absolute expansion of morbidity), even as the proportion of life spent in ill health decreases somewhat with increasing SDI (relative compression of morbidity). 4
  • Healthy life expectancy (HALE) at birth improved from 61.3 years in 2010 to 62.2 years in 2021, though this represents only modest gains. 3

Risk Factor Attribution

The drivers of NCD burden have been clearly identified:

  • High systolic blood pressure contributed to 12.8% of age-standardized NCD DALYs globally, making it the single largest attributable risk factor in 9 regions and 101 countries. 2
  • Dietary risks accounted for 10.0% and tobacco usage for 9.9% of age-standardized DALYs. 2
  • High body-mass index showed the most significant increase (+57.8%) among major risk factors, reflecting the global obesity epidemic. 2

Socioeconomic Gradient

The relationship between development and NCD burden follows predictable patterns:

  • Age-standardized NCD DALYs generally decline across the SDI spectrum, with higher development associated with lower burden when adjusted for age. 2
  • However, the burden is more severe in low-SDI countries and among males, indicating persistent health inequities. 2
  • Between 2010 and 2021, decreases in age-standardized DALY rates accelerated in countries at the lower end of the SDI range, while improvements stagnated or reversed in higher-SDI countries. 5

Recent Disruptions

The COVID-19 pandemic temporarily reversed decades of progress:

  • Global age-standardized all-cause DALY rates increased by 4.1% in 2020 and 7.2% in 2021, reversing the previous decade's declining trend. 3
  • HALE decreased by 2.2% between 2019 and 2021, representing a significant setback in global health gains. 3

Specific NCD Examples

Certain NCDs illustrate broader trends:

  • Between 1990 and 2017, deaths and DALYs attributable to cirrhosis increased, with the proportion of global deaths due to cirrhosis also rising. 6
  • Stroke burden is projected to grow from 38 million DALYs in 1990 to 61 million in 2020, representing 74% of the coronary heart disease burden. 6
  • COPD was projected to move from the 12th cause of DALYs lost worldwide in 1990 to the 5th biggest cause by 2020. 6

Critical Gaps in Response

Despite the growing burden, policy responses remain inadequate:

  • No country has reported a written national or sub-national strategy specifically for addressing major NCDs like NAFLD, reflecting the absence of these conditions from global public health agendas. 6
  • The trend in many countries is a move from communicable to non-communicable disease burden, yet healthcare systems have been slow to transition from acute care models to long-term chronic disease management. 6

References

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Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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