Burden and attributable risk factors of non-communicable diseases and subtypes in 204 countries and territories, 1990–2021: a systematic analysis for the global burden of disease study 2021
Authors: Li Jiaying , Pandian Vinciya , Davidson Patricia M , Song Yang , Chen Ningjing , Fong Daniel Yee Tak 
Published: January 2025

Background:
Understanding based on up-to-date data on the burden of non-communicable diseases (NCDs) is limited, especially regarding how subtypes contribute to the overall NCD burden and the attributable risk factors across locations and subtypes. We aimed to report the global, regional, and national burden of NCDs, subtypes, and attributable risk factors in 2021, and trends from 1990 to 2021 by age, sex, and socio-demographic index (SDI).

Materials and methods:
We used data from the Global Burden of Disease Study 2021 to estimate the prevalence, deaths, and disability-adjusted life years (DALYs) for NCDs and subtypes, along with attributable risk factors. Estimates were presented with 95% uncertainty intervals (UI). Relationships between NCD DALYs and SDI across regions and countries were estimated using smoothing splines models.

Results:
In 2021, NCDs accounted for 7.3 trillion global cases, 43.8 million deaths, and 1.73 billion DALYs. Global age-standardized rates showed NCD prevalence at 91 034.0, deaths at 529.7, and DALYs at 20 783.0 per 100 000 population, with changes of −0.1%, −27.9%, and −19.4% from 1990, respectively. Subtypes with the highest age-standardized DALYs were cardiovascular disease (5056), neoplasms (2954), and other NCDs (1913 per 100 000 population), with diabetes and kidney diseases increasing by 25.6% since 1990. Regionally, Oceania had the highest age-standardized DALYs (28 782.0) in 2021, while Southern Sub-Saharan Africa saw the largest increase (+8.0%) since 1990. Nationally, Nauru reported the highest age-standardized DALYs (42 754.3), with Lesotho experiencing the largest increase since 1990 (+38.4%). Cardiovascular diseases had the highest age-standardized DALYs among subtypes across 16 of 21 regions and 159 of 204 countries. Key risk factors globally were high systolic blood pressure (contributing to 12.8% of age-standardized DALYs), dietary risks (10.0%), and tobacco usage (9.9%), with the most significant increase in high body-mass index (+57.8%). High systolic blood pressure was the biggest attributable risk factor for NCDs in 9 regions and 101 countries. Age-standardized data reveal higher NCD prevalence in women and greater mortality and DALYs in men, with DALYs spiking post-45 for both sexes. Men have higher DALYs attributed to most risk factors, excluding those from unsafe sex, intimate partner violence, low physical activity, and high body-mass index. Age-standardized DALYs of NCDs generally decline with the SDI spectrum. Dominant NCD risk factors follow gender-age and SDI-based trajectories.

Conclusion:
Despite declining age-standardized prevalence, death rates, and DALYs for NCDs, they remain a major health issue. Emphasis on managing cardiovascular diseases, cancers, diabetes, kidney diseases, and mental disorders is essential. The burden of NCDs is more severe in low-SDI countries and among males. Prevention efforts should prioritize blood pressure control, dietary improvements, and tobacco reduction, tailoring interventions according to gender-age-based and SDI-development-based trajectories of dominant risk factors.