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

Abstract

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.

Figure 1.

Flowchart of results presentation. O-TFS: Others are detailed in tables, figures, and supplementary materials; ASR: Age-standardized rate; NCDs: Non-communicable diseases; DALYs: Disability-adjusted life years; SDI: Socio-demographic index.

Figure 2.

Global and regional age-standardized disability-adjusted life years (DALYs) for Non-Communicable Diseases (NCDs) and its subtypes in 2021, with trends from 1990. Top row in each cell shows 2021 age-standardized DALY values; bottom row indicates changes from 1990. Black labels highlight increasing trend, white labels denote decreases. X-axis labels (NCD subtypes) are ordered from left to right by descending global age-standardized DALYs in 2021. Y-axis labels (regions) are ordered bottom to top by decreasing NCD age-standardized DALYs in 2021. NCDs: Non-communicable diseases; DALYs: Disability-adjusted life years.

Figure 3.

National age-standardized prevalence in 2021 (A), global Disability-adjusted life years (DALYs) by age and sex in 2021 (B), and regional DALY rates by sociodemographic index (SDI) from 1990 to 2021 (C). (B) Bars represent DALYs, and lines depict age-standardized DALYs per 100 000 population. Error bars and dashed lines indicate the 95% uncertainty intervals. DALYs: Disability-adjusted life years; SDI: Socio-demographic index (c). The 31 points represent each region’s annual age-standardized DALY rates from 1990 to 2021. A solid line illustrates expected values based on sociodemographic indices and disease rates across all regions during this period. Regions plotted above the line have a higher-than-expected disease burden (e.g., Oceania), while those below the line have a lower-than-expected burden (e.g., Andean Latin America). DALYs: Disability-adjusted life years.

Figure 4

Global and regional proportion of age-standardized disability-adjusted life years (DALYs) attributable to risk factors for non-communicable diseases (NCDs) and their subtypes in 2021. Risk factors for each NCD subtype at a specific location are ranked left to right in decreasing order, with the leading risk factor labeled by its DALY percentage. X-axis labels (NCD subtypes) are ordered from left to right by descending global age-standardized DALYs in 2021. Y-axis labels (regions) are ordered bottom to top by decreasing NCD age-standardized DALYs in 2021. NCDs: Non-communicable diseases; DALYs: Disability-adjusted life years.

Figure 5.

Percentage of disability-adjusted life years (DALYs) from non-communicable diseases (NCDs) attributable to level 2 risk factors, by age and sex, in 2021. Top row in each cell displays women’s percentage of DALYs attributed to a specific risk factor; the bottom row shows the percentage difference between sexes (men vs. women). Black labels indicate higher percentages in men; white labels denote lower. Blue rectangles highlight the top risk factor for women at each age stage, and yellow rectangles for men. X-axis labels (risk factors) are ordered from left to right by decreasing percentage of NCD age-standardized DALYs in 2021 at the global level. NCDs: Non-communicable diseases; DALYs: Disability-adjusted life years.