Global, regional, and national burden of diseases and ...

1 RESEARCH. Global, regional, and national burden of diseases and injuries BMJ: first published as on 10 March 2022. Downloaded from on 1 May 2023 by guest. Protected by copyright. for adults 70 years and older: systematic analysis for the Global burden of disease 2019 Study on behalf of GBD 2019 Ageing Collaborators Correspondence to: Abstract data coverage was moderate, while limited data N J Kassebaum Objectives were available for various dietary, environmental or Department of Health Metrics To use data from the Global burden of diseases , occupational, and metabolic risks.

2 Sciences, Global Health, and Anesthesiology & Pain Medicine, Injuries, and Risk Factors Study 2019 (GBD 2019) Conclusions Institute for Health Metrics to estimate mortality and disability trends for the Life expectancy at age 70 has continued to rise and Evaluation, University population aged 70 and evaluate patterns in causes of Washington, Seattle, globally, mostly because of decreases in chronic Washington, USA of death, disability, and risk factors. diseases . Adults aged 70 living in high income (ORCID 0000-0002-4299-9348) Design countries and regions with better healthcare access Additional material is published Systematic analysis.

3 And quality were found to experience the highest life online only. To view please visit Setting expectancy and healthy life expectancy. Disability the journal online. Participants were aged 70 from 204 countries and burden , however, remained constant, suggesting Cite this as: BMJ 2022;376:e068208. territories, 1990-2019. the need to enhance public health and intervention bmj 2021 068208 programmes to improve wellbeing among older Main outcomes measures Accepted: 26 January 2022 adults. Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE- Introduction 70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), For the first time in history, most newborns might risk factors, and data coverage index were estimated live into their 70s and With the global based on standardised GBD methods.

4 Population experiencing extra years of life, the health and wellbeing of older adults is paramount so that Results they can continue to be actively engaged in Globally the population of older adults has increased However, if added years are spent in poor health, since 1990 and all cause death rates have decreased health systems will face increased healthcare expenses for men and women. However, mortality rates due due to increased To conceptualise years of to falls increased between 1990 and 2019. The life spent in good health, a variety of ageing indicators probability of death among people aged 70-90.

5 Have been developed. Healthy and successful ageing, decreased, mainly because of reductions in non- and frailty, project high or low wellbeing in older communicable diseases . Globally disability burden was largely driven by functional decline, vision and people, Ageing research suggests hearing loss, and symptoms of pain. LE-70 and HALE- that functional decline and health loss are more 70 showed continuous increases since 1990 globally, reflective of healthy ageing than chronological with certain regional disparities. Globally higher LE-70 Consequently, surveillance of the older population's resulted in higher HALE-70 and slightly increased health is essential to capture its ageing status.

6 PYIH-70. Sociodemographic and healthcare access Variations in the definition of old age exist that account and quality indices were positively correlated with for chronological age or for remaining life HALE-70 and LE-70. For high exposure risk factors, Epidemiological data indicate that population ageing patterns are changing, with people aged 70 and 90. being the fastest growing segment in Europe, Asia, and the United In 1950, older adults represented What is already known on this topic 5% of the global population; this estimate is projected The global population is living longer and the health and wellbeing of older to rise to 16% by Consequently, the health adults has become a major public health issue and wellbeing of ageing populations have become While it is recognised that populations are ageing differently, global important public health issues with wide reaching epidemiological data on the burden of diseases in adults aged 70 are lacking economic implications that affect medical care, in- home care and assistance.

7 And healthcare What this study adds The projected ageing demographics are linked to In 2019, adults aged 70 were found to live more than two years longer increased burden and duration of non-communicable compared with 1990 life expectancy estimates An analysis of the Global burden of disease Sociodemographic development and healthcare access and quality were major (GBD) 2010 data established that the major causes of determinants of life expectancy and healthy life expectancy in adults aged 70; disability for adults aged 60 were musculoskeletal disability burden followed a stable pattern across the development spectrum disorders, cardiovascular diseases , diabetes, and neurological In 2015, the World Health Specific healthy ageing policies are needed with targeted data coverage for Organization declared that the rise in chronic conditions adults aged 70 and consistent collaboration among stakeholders among older adults was a worldwide the bmj | BMJ 2022;376:e068208 | doi: 1.

8 RESEARCH. The management of accumulated chronic conditions ( ). Results are viewable is likely to weigh upon healthcare financing over the online in GBD Compare ( BMJ: first published as on 10 March 2022. Downloaded from on 1 May 2023 by guest. Protected by copyright. next few decades in high income and in low to middle org/gbd-compare/). income Low to middle income regions face an ongoing agenda of communicable diseases and Dimensions of GBD 2019. will have to manage the added burden with limited GBD 2019 includes estimates for 369 diseases resources and infrastructure. Understanding and and injuries, and 87 risk factors for 23 age groups reducing the burden of disease among older people is and both sexes from 1990 to 2019 covering 204.

9 Critical to mitigate the economic burden of ageing and countries and territories 22 of which were analysed build sustainability within the global health system for subnationally hierarchically arranged into 21. the next regions and 7 super regions (supplementary table 2). While ageing draws increasing attention from policy SDI is a composite indicator that uses the following makers and stakeholders, global epidemiological data components: country level income per capita, average on the burden of disease in older adults are limited. educational attainment among people older than 15.

10 Studies from high life expectancy populations do years, and total fertility rate among women younger exist,4 18 19 but most are based on localised sample than 25 SDI ranges from 0 (high fertility, low populations without detailed analyses of adults older education, low income) to 1 (low fertility, high income, than Epidemiological studies from WHO,23 high education). Each GBD location was assigned to a including the recently published world report on ageing single SDI group based on its SDI value in 2019. and health, have highlighted an increasingly ageing All deaths were assigned a single underlying global population and the need for urgent public health cause according to the international classification The GBD 2019 study provides annually of diseases , and each was mapped according to updated global, regional, and national population data a four level mutually exclusive and collectively on mortality, 369 diseases and injuries, and 87 risk exhaustive GBD cause list (supplementary table factors among 204 Therefore, it provides 3).