Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021
Authors: Nicholas Steel, Clarissa Maria Mercedes Bauer-Staeb, John A Ford, Cristiana Abbafati, Mohammed Altigani Abdalla, Atef Abdelkader, Parsa Abdi, Roberto Ariel Abeldaño Zuñiga, Olugbenga Olusola Abiodun, Hassan Abolhassani, Eman Abu-Gharbieh, Hana J Abukhadijah, Ahmed Abu-Zaid, Isaac Yeboah Addo, Giovanni Addolorato, Victor Adekanmbi, Juliana Bunmi Adetunji, Temitayo Esther Adeyeoluwa, Emilie E Agardh, Williams Agyemang-Duah, Danish Ahmad, Anisuddin Ahmed, Ayman Ahmed, Syed Anees Ahmed, Karolina Akinosoglou, Mohammed Ahmed Akkaif, Salah Al Awaidy, Syed Mahfuz Al Hasan, Omar Ali Mohammed Al Zaabi, Robert W Aldridge, Abdelazeem M Algammal, Adel Ali Saeed Al-Gheethi, Abid Ali, Mohammed Usman Ali, Syed Shujait Ali, Waad Ali, Gianfranco Alicandro, Sheikh Mohammad Alif, Adel Al-Jumaily, Peter Allebeck, Ahmad Alrawashdeh, Rami H Al-Rifai, Mohammed A Alsabri, Najim Z Alshahrani, Deborah Oyine Aluh, Mohammad Al-Wardat, Walid A Al-Zyoud, Sohrab Amiri, Deanna Anderlini, Catalina Liliana Andrei, Abhishek Anil, Saeid Anvari, Anayochukwu Edward Anyasodor, Seth Christopher Yaw Appiah, Michele Aquilano, Jalal Arabloo, Mosab Arafat, Demelash Areda, Abdulfatai Aremu, Keivan Armani, Benedetta Armocida, Johan Ärnlöv, Muhammad Asaduzzaman, Thomas Astell-Burt, Avinash Aujayeb, Marcel Ausloos, Sina Azadnajafabad, Shahkaar Aziz, Ahmed Y Azzam, Giridhara Rathnaiah Babu, Andreea Corina Badache, Ashish D Badiye, Saeed Bahramian, Atif Amin Baig, Jennifer L Baker, Hansi Bansal, Till Winfried Bärnighausen, Mark Thomaz Ugliara Barone, Amadou Barrow, Sandra Barteit, Shahid Bashir, Hameed Akande Bashiru, João Diogo Basso, Mohammad-Mahdi Bastan, Sanjay Basu, Kavita Batra, Matteo Bauckneht, Bernhard T Baune, Massimiliano Beghi, Maryam Beiranvand, Yannick Béjot, Michelle L Bell, Olorunjuwon Omolaja Bello, Luis Belo, Apostolos Beloukas, Alice A Beneke, Paulo J G Bettencourt, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Sonu Bhaskar, Francesca Bisulli, Tone Bjørge, Aadam Olalekan Bodunrin, Alejandro Botero Carvajal, Souad Bouaoud, Carol Brayne, Hermann Brenner, Adam D M Briggs, Nikolay Ivanovich Briko, Raffaele Bugiardini, Danilo Buonsenso, Reinhard Busse, Yasser Bustanji, Florentino Luciano Caetano dos Santos, Mehtap Çakmak Barsbay, Angelo Capodici, Giulia Carreras, Andrea Carugno, Felix Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Alberico L Catapano, Maria Sofia Cattaruzza, Luca Cegolon, Edina Cenko, Ester Cerin, Sonia Cerrai, Anis Ahmad Chaudhary, Bryan Chong, Sonali Gajanan Choudhari, Dinh-Toi Chu, Isaac Sunday Chukwu, Sheng-Chia Chung, Iolanda Cioffi, Joao Conde, Samuele Cortese, Rosa A S Couto, Michael H Criqui, Natalia Cruz-Martins, Omid Dadras, Mary Anne Teresa Dallat, Emanuele D'Amico, Lucio D'Anna, Samuel Demissie Darcho, Paul I Dargan, Saswati Das, Alejandro de la Torre-Luque, Cristian Del Bo', Andreas K Demetriades, Nikolaos Dervenis, Brecht Devleesschauwer, Arkadeep Dhali, Kuldeep Dhama, Mostafa Dianatinasab, Michael J Diaz, Deepa Dongarwar, Mario D'Oria, Ojas Prakashbhai Doshi, Robert Kokou Dowou, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Arkadiusz Marian Dziedzic, David Edvardsson, Kristina Edvardsson, Terje Andreas Eikemo, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Rabie Adel El Arab, Frank J Elgar, Muhammed Elhadi, Chadi Eltaha, Francesco Esposito, Natalia Fabin, Adeniyi Francis Fagbamigbe, Omotayo Francis Fagbule, Aliasghar Fakhri-Demeshghieh, Luca Falzone, Carla Sofia e Sá Farinha, Pawan Sirwan Faris, Folorunso Oludayo Fasina, Patrick Fazeli, Timur Fazylov, Alireza Feizkhah, Ginenus Fekadu, Xiaoqi Feng, Seyed-Mohammad Fereshtehnejad, Daniela Ferrante, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Florian Fischer, Marco Fonzo, Arianna Fornari, Daniela Fortuna, Celia Fortuna Rodrigues, Matteo Foschi, Sebastian S Fox, Alberto Freitas, Takeshi Fukumoto, Muktar A Gadanya, Silvano Gallus, Lucia Galluzzo, Balasankar Ganesan, Mohammad Arfat Ganiyani, Xiang Gao, MA Garcia-Gordillo, Federica Gazzelloni, Miglas Welay Gebregergis, Teferi Gebru Gebremeskel, Delaram J Ghadimi, Khalid Yaser Ghailan, Nermin Ghith, Ehsan Gholami, Alessandro Gialluisi, Paramjit Singh Gill, Tara Gillam, Giorgia Giussani, James C Glasbey, Scott D Glenn, Laszlo Göbölös, Mohamad Goldust, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Giuseppe Gorini, Simon Matthew Graham, Robert Griebler, Ashna Grover, Stefano Guicciardi, Sasidhar Gunturu, Vijai Kumar Gupta, Roberth Steven Gutiérrez-Murillo, Awoke Derbie Habteyohannes, Nils Haep, Nguyen Hai Nam, Sebastian Haller, Rifat Hamoudi, Senad Handanagic, Josep Maria Haro, Hamidreza Hasani, Md Saquib Hasnain, Rasmus J Havmoeller, Simon I Hay, Jeffrey J Hebert, Behzad Heibati, Henk B M Hilderink, Yuta Hiraike, Nguyen Quoc Hoan, Mehdi Hosseinzadeh, Sorin Hostiuc, Hanno Hoven, Chengxi Hu, Junjie Huang, Andrew Hughes, Michael Hultström, Kiavash Hushmandi, Javid Hussain, M Azhar Hussain, Adalia Ikiroma, Arit Inok, Md Rabiul Islam, Sheikh Mohammed Shariful Islam, Gaetano Isola, Mahalaxmi Iyer, Louis Jacob, Haitham Jahrami, Ammar Abdulrahman Jairoun, Sanobar Jaka, Mihajlo Jakovljevic, Talha Jawaid, Bijay Mukesh Jeswani, Jost B Jonas, Charity Ehimwenma Joshua, Billingsley Kaambwa, Zubair Kabir, Dler H Hussein Kadir, Rajesh Kamath, Kehinde Kazeem Kanmodi, Neeti Kapoor, Paschalis Karakasis, Marina Karanikolos, Ibraheem M Karaye, Joonas H Kauppila, Sina Kazemian, Emmanuelle Kesse-Guyot, Faham Khamesipour, Ajmal Khan, Shaghayegh Khanmohammadi, Khaled Khatab, Moawiah Mohammad Khatatbeh, Moein Khormali, Atulya Aman Khosla, Majid Khosravi, Mahmood Khosrowjerdi, Jagdish Khubchandani, Kwanghyun Kim, Min Seo Kim, Adnan Kisa, Sezer Kisa, Ann Kristin Skrindo Knudsen, Gerbrand Koren, Md Abdul Kuddus, Ilari Kuitunen, Mukhtar Kulimbet, Rakesh Kumar, Setor K Kunutsor, Om P Kurmi, Dian Kusuma, Ville Kytö, Carlo La Vecchia, Hanpeng Lai, Tea Lallukka, Francesco Lanfranchi, Berthold Langguth, Ariane Laplante-Lévesque, Heidi Jane Larson, Anders O Larsson, Munjae Lee, Paul H Lee, Seung Won Lee, Wei-Chen Lee, Daniel Lindholm, Christine Linehan, Xuefeng Liu, Erand Llanaj, José Francisco López-Gil, Stefan Lorkowski, Giancarlo Lucchetti, Alessandra Lugo, Raimundas Lunevicius, Lisha Luo, Hawraz Ibrahim M Amin, Zheng Feei Ma, Nikolaos Machairas, Monika Machoy, Kashish Malhotra, Ahmad Azam Malik, Ali Mansour, Emmanuel Manu, Hamid Reza Marateb, Daniela Martini, Miquel Martorell, Roy Rillera Marzo, Yasith Mathangasinghe, Medha Mathur, Fernanda Penido Matozinhos, Richard James Maude, Andrea Maugeri, Juergen May, Mahsa Mayeli, Mohsen Mazidi, Martin McKee, Enkeleint A Mechili, Sepideh Mehravar, Tesfahun Mekene Meto, Hadush Negash Meles, Alexios-Fotios A Mentis, Atte Meretoja, Tuomo J Meretoja, Sachith Mettananda, Georgia Micha, Irmina Maria Michalek, Ted R Miller, Giuseppe Minervini, Antonio Mirijello, Gabriele Mocciaro, Atousa Moghadam Fard, Jama Mohamed, Nouh Saad Mohamed, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Lorenzo Monasta, Stefania Mondello, Mohammad Ali Moni, Paula Moraga, Lidia Morawska, Tilahun Belete Mossie, Rohith Motappa, Sumaira Mubarik, Lorenzo Muccioli, Ulrich Otto Mueller, Faraz Mughal, Francesk Mulita, Daniel Munblit, Yanjinlkham Munkhsaikhan, Christopher J L Murray, Mohsen Naghavi, Pirouz Naghavi, Ganesh R Naik, Soroush Najdaghi, Atta Abbas Naqvi, Delaram Narimani Davani, Gustavo G Nascimento, Abdallah Y Naser, Abdulqadir J Nashwan, Javaid Nauman, Samidi Nirasha Kumari Navaratna, Athare Nazri-Panjaki, Chakib Nejjari, Evangelia Nena, Henok Biresaw Netsere, Anh Hoang Nguyen, Phat Tuan Nguyen, Van Thanh Nguyen, Lawrence Achilles Nnyanzi, Syed Toukir Ahmed Noor, Mehran Nouri, Fred Nugen, Mario Cesare Nurchis, Ogochukwu Janet Nzoputam, Bogdan Oancea, Martin James O'Donnell, Michael Safo Oduro, Oluwaseun Adeolu Ogundijo, Ropo Ebenezer Ogunsakin, Sylvester Reuben Okeke, Osaretin Christabel Okonji, Andrew T Olagunju, Susan Oliver, Isaac Iyinoluwa Olufadewa, Alberto Ortiz, Mayowa O Owolabi, Mahesh Padukudru P A, Jagadish Rao Padubidri, Raul Felipe Felipe Palma-Alvarez, Sujogya Kumar Panda, Songhomitra Panda-Jonas, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Shahina Pardhan, Romil R Parikh, Roberto Passera, Shankargouda Patil, Dimitrios Patoulias, Shrikant Pawar, Umberto Pensato, Gavin Pereira, Norberto Perico, Simone Perna, Fanny Emily Petermann-Rocha, Hoang Nhat Pham, Anil K Philip, Daniela Pierannunzio, Manon Pigeolet, Enrico Pisoni, Dimitri Poddighe, Ramesh Poluru, Maarten J Postma, Jalandhar Pradhan, Elisabetta Pupillo, Jagadeesh Puvvula, Alberto Raggi, Mosiur Rahman, Muhammad Aziz Rahman, Diego Raimondo, Ivano Raimondo, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Rishabh Kumar Rana, Sowmya J Rao, Davide Rasella, Ahmed Mustafa Rashid, Santosh Kumar Rauniyar, Ilari Rautalin, David Laith Rawaf, Salman Rawaf, Murali Mohan Rama Krishna Reddy, Elrashdy M Moustafa Mohamed Redwan, Lennart Reifels, Giuseppe Remuzzi, Mohsen Rezaeian, Ana Isabel Ribeiro, Anupa Rijal, Jefferson Antonio Buendia Rodriguez, Michele Romoli, Luca Ronfani, Kevin T Root, Himanshu Sekhar Rout, Nitai Roy, Michele Russo, Aly M A Saad, Cameron John Sabet, Mamta Sachdeva Dhingra, Umar Saeed, Mehdi Safari, Mahdi Safdarian, Mohamed A Saleh, Mohammed Z Y Salem, Giovanni A Salum, Vijaya Paul Samuel, Abdallah M Samy, Aswini Saravanan, Babak Saravi, Chinmoy Sarkar, Jennifer Saulam, Nikolaos Scarmeas, Benedikt Michael Schaarschmidt, Christophe Schinckus, Markus P Schlaich, Jurgen Carlo Schmidt, Art Schuermans, Austin E Schumacher, Falk Schwendicke, Catherine Schwinger, Sadaf G Sepanlou, Mahan Shafie, Hamid R Shahsavari, Masood Ali Shaikh, Husain Shakil, Sunder Sham, Muhammad Aaqib Shamim, Nigussie Tadesse Sharew, Amin Sharifan, Amin Shavandi, Rekha Raghuveer Shenoy, Mahabalesh Shetty, Pavanchand H Shetty, Premalatha K Shetty, Mika Shigematsu, Aminu Shittu, Ivy Shiue, Seyed Afshin Shorofi, Rajan Shrestha, Roman Shrestha, Emmanuel Edwar Siddig, João Pedro Silva, Luís Manuel Lopes Rodrigues Silva, Soraia Silva, Puneetpal Singh, Surjit Singh, Jussi O T Sipilä, Anna Aleksandrovna Skryabina, Anton Sokhan, Soroush Soraneh, Joan B Soriano, Ireneous N Soyiri, Michael Spartalis, Paschalis Steiropoulos, Leo Stockfelt, Jing Sun, Johan Sundström, David Sunkersing, Katharina S Sunnerhagen, Chandan Kumar Swain, Lukasz Szarpak, Sree Sudha T Y, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Seyyed Mohammad Tabatabaei, Celine Tabche, Ramin Tabibi, Jabeen Taiba, Manoj Tanwar, Nathan Y Tat, Nuno Taveira, Mohamad-Hani Temsah, Rasiah Thayakaran, Tenaw Yimer Tiruye, Mathilde Touvier, Marcos Roberto Tovani-Palone, Jasmine T Tran, Ngoc Ha Tran, Thang Huu Tran, Domenico Trico, Samuel Joseph Tromans, Evangelia Eirini Tsermpini, Lorainne Tudor Car, Munkhtuya Tumurkhuu, Saeed Ullah, Brigid Unim, Asokan Govindaraj Vaithinathan, Mario Valenti, Jef Van den Eynde, Orsolya Varga, Tommi Juhani Vasankari, Balachandar Vellingiri, Massimiliano Veroux, Dominique Vervoort, Jorge Hugo Villafañe, Francesco S Violante, Giuseppe Vizzielli, Alice Vodden, Stein Emil Vollset, Theo Vos, Hatem A Wafa, Yanzhong Wang, Emebet Gashaw Wassie, Kosala Gayan Weerakoon, Ronny Westerman, Nuwan Darshana Wickramasinghe, Peter Willeit, Marcin W Wojewodzic, Axel Walter Wolf, Charles D A Wolfe, Grant M A Wyper, Xiaoyue Xu, Yuichi Yasufuku, Sanni Yaya, Saber Yezli, Arzu YiÄŸit, Dong Keon Yon, Chuanhua Yu, Fathiah Zakham, Aurora Zanghì, Michael Zastrozhin, Mohammed G M Zeariya, Liqun Zhang, Zhiqiang Zhang, Claire Chenwen Zhong, Bin Zhu, Makan Ziafati, Magdalena Zielińska, Elric Zweck, Sa'ed H Zyoud, John N Newton
Journal: The Lancet Public Health (2025)

Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990-2011, 2011-19, and 2019-21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. All countries showed mean annual improvements in life expectancy in both 1990-2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011-19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011-19 than in 1990-2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990-2011 to 0·23 years (0·21 to 0·26) in 2011-19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from -0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to -0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019-21, there was an overall decrease in mean annual life expectancy across all countries (overall mean -0·18 years [95% UI -0·22 to -0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011-19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019-21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990-2021. The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019-21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019-21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Gates Foundation.