Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019
Authors: Rios-Blancas Maria Jesus , Pando-Robles Victoria , Razo Christian , Carcamo Cesar P. , Mendoza Walter , Pacheco-Barrios Kevin , Miranda J. Jaime , Lansingh Van Charles , Demie Takele Gezahegn , Saha Manika , Okonji Osaretin Christabel , Yigit Arzu , Cahuana-Hurtado Lucero , Chacón-Uscamaita Pamela R. , Bernabe Eduardo , Culquichicon Carlos , Chirinos-Caceres Jesus Lorenzo , Cárdenas Rosario , Alcalde-Rabanal Jacqueline Elizabeth , Barrera Francisco J. , Quintanilla Beatriz Paulina Ayala , Shorofi Seyed Afshin , Wickramasinghe Nuwan Darshana , Ferreira Nuno , Almidani Louay , Gupta Vivek Kumar , Karimi Hanie , Alayu Daniel Shewaye , Benziger Catherine P. , Fukumoto Takeshi , Mostafavi Ebrahim , Redwan Elrashdy Moustafa Mohamed , Gebrehiwot Mesfin , Khatab Khaled , Koyanagi Ai , Krapp Fiorella , Lee Seung , Noori Maryam , Qattea Ibrahim , Rosenthal Victor Daniel , Sakshaug Joseph W. , Wagaye Birhanu , Zare Iman , Ortega-Altamirano Doris V. , Murillo-Zamora Efrén , Vervoort Dominique , Silva Diego Augusto Santos , Oulhaj Abderrahim , Herrera-Serna Brenda Yuliana , Mehra Rahul , Amir-Behghadami Mehrdad , Adib Nasrin , Cortés Sandra , Dang Anh Kim , Nguyen Binh Thanh , Mokdad Ali H. , Hay Simon I. , Murray Christopher J. L. , Lozano Rafael , García Patricia J. 
Published: June 2023

BackgroundEstimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance.MethodsUsing estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region.ResultsThe Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region.ConclusionIn the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.