People are living longer, but spending more years in poor health
People around the world are living longer than ever before but spending more of those additional years in poor health, according to a new Global Burden of Disease (GBD) study published in The Lancet Public Health.
Researchers found that the global morbidity gap widened in almost all countries and territories analyzed between 1990 and 2023. Globally, while the share of life spent in poor health increased, trends varied by country, and a smaller number of countries saw this share decline.
Within a generation, the global morbidity gap widened by nearly two years, increasing from 8.8 years in 1990 to 10.7 years in 2023. Globally, people spent an average of 14.5% of their lives in poor health in 2023, up from 13.6% in 1990. Instead of occurring only in the final years of life, the widening morbidity gap was observed across the adult lifespan, suggesting that people are spending more years living with disease and disability throughout adulthood.
The analysis, based on GBD 2023 estimates, examined trends in healthy aging from 1990 to 2023 and assessed changes in life expectancy, healthy life expectancy and the morbidity gap across countries, regions, sex and levels of socio-demographic development, while also identifying the leading conditions and risk factors contributing to years lived in poor health.
Longer lives are not translating into healthier lives
Between 1990 and 2023, global life expectancy at birth increased from 64.6 years to 73.8 years, while healthy life expectancy rose from 55.9 years to 63.1 years. Because gains in survival consistently outpaced gains in healthy years of life, people are spending more years living with chronic disease and disability.
High-income countries face the widest morbidity gaps
The burden of poor health varied substantially across countries and regions, with the longest periods of life spent in poor health generally occurring in places where people live the longest.
In 2023, the United States had the largest national morbidity gap at 14 years, followed by Australia at 13.9 years and Canada at 13.7 years. Countries with higher Socio-demographic Index (SDI) levels generally experienced both longer life expectancy and more years lived in poor health, reflecting gains in lifespan that have not been matched by equivalent gains in healthspan.
The pattern was consistent worldwide. All seven GBD super-regions experienced increases between 1990 and 2023 in both the number of years and the proportion of life spent in poor health. The high-income super-region had the largest morbidity gap in 2023 at 12.7 years, while sub-Saharan Africa had the smallest at 9.0 years.
Women are living longer but spending more years in poor health
Across every region and level of development, women consistently lived longer than men but also spent more years living in poor health. This pattern shows that longer life expectancy among women has not translated into the same gains in healthy years.
“Improving healthy aging will require greater focus on the conditions and risk factors that drive years lived with disability. Addressing these earlier through prevention and better long-term care could have meaningful social, health system and economic impacts.”
Healthy aging will require a greater focus on prevention and chronic care
More than half of all years lived in poor health worldwide were driven by a relatively small group of largely nonfatal chronic conditions, accounting for 57.4% of unhealthy years in 2023.
Musculoskeletal disorders, particularly low back pain, were the largest contributor to the morbidity gap, followed by mental disorders such as depression and anxiety, sense organ diseases including age-related hearing loss, falls and other unintentional injuries, and other chronic noncommunicable diseases.
Many years spent in poor health were linked to preventable or manageable risk factors. Globally, high fasting plasma glucose, high body mass index, child and maternal malnutrition, and tobacco use were the leading risk factors contributing to the morbidity gap. These patterns varied substantially by region and level of development.
In sub-Saharan Africa and other low-SDI settings, child and maternal malnutrition was the leading risk factor, and air pollution also ranked among the top five.
As populations age, greater emphasis is needed on preventing chronic disease, delaying disability and ensuring access to rehabilitation, mental health services and long-term chronic care.
Tackling key risk factors, investing in prevention and strengthening services that reduce years lived in poor health will be essential to improving healthy aging and lessening the growing toll of disability on people, families and health systems worldwide.
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