Changes in life expectancy and disease burden in Norway, 1990-2019: an analysis of the Global Burden of Disease Study 2019

Abstract

Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties.

Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient.

Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors.

Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.

Funding: Bill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health.

Figure 1

Map of Norway and the 11 counties, including the median ages and population numbers in 2019 The centralisation index shows each county's degree of population centralisation, based on an index of all 356 municipalities from the least centralised (Utsira, 295) to the most centralised in Norway (Oslo, 1000).

Figure 2

Change in life expectancy and HALE at birth by male and female sex in Norway and every Norwegian county, 1990–2019 Oslo is shown in blue to highlight its large change in rank during this period. 95% uncertainty intervals are shown in the appendix (p 3). HALE=healthy life expectancy.

Figure 3

Change in life expectancy at birth in Norway and the 11 Norwegian counties between 1990 and 2019, decomposed into the contribution of GBD level-2 cause groups for male and female sexes combined Data for males and females separately are shown in the appendix (pp 9–10). Causes to the left of the 1990 life expectancy values reflect causes that contributed to reduced life expectancy between 1990 (black lines) and 2019 (red lines). Causes to the right of the 1990 life expectancy values reflect causes that contributed to increased life expectancy between 1990 and 2019. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 4

Age-standardised DALY rates per 100 000 inhabitants in each county for the leading ten level-3 causes in Norway and each Norwegian county, 2019 Data are the age-standardised DALY rates for male and female sexes combined. Data for causes of DALYs, years of life lost, and years lived with disability for males and females separately are shown in the appendix (pp 11–18). Bold rates indicate that the UI of the county estimate does not overlap the UI of the national estimate (upward arrow shows the county rate is higher than the national rate, downward arrow shows the county rate is less than the national rate). COPD=chronic obstructive pulmonary disease. DALY=disability-adjusted life-year. Dementia=Alzheimer's disease and other dementias. Endocrine disorders=endocrine, metabolic, blood, and immune disorders. Lung cancer=tracheal, bronchus, and lung cancer. MSK=musculoskeletal. UI=uncertainty interval. *Percentage change in age-standardised rate between 1990 and 2019.

Figure 5

Leading ten level-2 risk factors for Norway and each Norwegian county by PAF for all-cause DALY rate per 100 000 inhabitants Data shown are age-standardised PAFs for males and females combined. Appendix p 19 shows 95% UIs for population attributable fractions. Appendix pp 19–20 show data for males and females separately. Appendix pp 21–22 show a heatmap and annualised rates of change for summary exposure value between 1990 and 2019. Colour code reflects level-1 risk categories. DALY=disability-adjusted life-year. PAF=population attributable fraction. UI=uncertainty interval. *Percentage change in summary exposure variable between 1990 and 2019.