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. 2025 Jun;10(6):e456-e466.
doi: 10.1016/S2468-2667(25)00069-6.

The epidemiology and burden of injury in countries of the Association of Southeast Asian Nations (ASEAN), 1990-2021: findings from the Global Burden of Disease Study 2021

GBD 2021 ASEAN Injuries Collaborators
Collaborators

The epidemiology and burden of injury in countries of the Association of Southeast Asian Nations (ASEAN), 1990-2021: findings from the Global Burden of Disease Study 2021

GBD 2021 ASEAN Injuries Collaborators. Lancet Public Health. 2025 Jun.

Abstract

Background: Injuries are among the top causes of mortality and disability in southeast Asia. Although injury prevention is a key health priority in the Post-2015 Health Development Agenda of the Association of Southeast Asian Nations (ASEAN), the focus was placed solely on road injuries. The absence of a broader recognition of injury burden and trends hinders future intervention efforts. This study aims to provide a comprehensive analysis of the burden and epidemiological trends of all injuries across ASEAN countries.

Methods: In this analysis of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, we estimated incidence, cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age, sex, location, and year for ten ASEAN member states (Brunei, Cambodia, Indonesia, Myanmar, Laos, Malaysia, the Philippines, Singapore, Thailand, and Viet Nam) from 1990 to 2021. Incidence and non-fatal disease burden were estimated using disease model Bayesian meta-regression (DisMod-MR) 2.1. Mortality was derived from the GBD Cause of Death Ensemble model. Estimates include 95% uncertainty intervals where appropriate.

Findings: In 2021, an estimated 35·5 million (95% UI 33·5-37·7) injury incident cases were reported in ASEAN, resulting in approximately 317 000 deaths (286 000-350 000). Substantial variation was observed across the region, with the age-standardised mortality ranging from 13·4 per 100 000 people (12·7-14·1) in Singapore to 68·5 per 100 000 (54·4-81·9) in Viet Nam. Road injury was the leading cause of mortality and morbidity in most ASEAN countries, with the highest age-standardised DALY rates in Thailand and Malaysia. Self-harm was the leading cause of mortality in Singapore, whereas interpersonal violence was the leading cause of injury deaths in the Philippines. From 1990 to 2021, the region's age-standardised injury incidence rate declined by 23·0% (21·8-24·1). Age-standardised DALY rates decreased substantially for drowning (60·6% [53·2-66·7]) and road injuries (39·6% [32·1-46·4]), whereas falls saw a smaller and more heterogeneous decline of 12·3% (2·6-21·0) over the past 31 years.

Interpretation: The injury epidemiological landscape in ASEAN is complex, with substantial geographical variations and emerging challenges triggered by the rapid sociodemographic transition in the region. Progress has been uneven. Effective burden reduction across different causes of injury requires strategies addressing the wide range of socioenvironmental determinants and system shortfalls. Prevention programmes need to be customised to each country's unique context and development.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declarations of interests QESA reports grants or contracts from Online Library Data Research funds from Universitas Padjadjaran, Bandung, Indonesia, under contract 2152/UN6.3.1/PT.00/2024 and Acceleration to Associate Professor Grant from Universitas Padjadjaran, Bandung, Indonesia, under contract 1592/UN6.3.1/PT.00/2024, all outside the submitted work. NEI reports leadership or fiduciary roles in other board, society, committee, or advocacy groups, unpaid, as Bursar and Council Member of the Malaysian Academy of Pharmacy, and as a Committee Member of the Education Chapter, Malaysian Pharmacists Society, outside the submitted work. RDGJ reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the International Parkinson's and Movement Disorder Society, Royal Care Hospital, Taiwan Medical University, and HI-Eisai, and support for attending meetings or travel from Torrent Pharma, Innogen, AbbVie, Medtronic, Sun, Natrapharm, and OnePharma, all outside the submitted work. VCFP reports grants or contracts from Sanofi Consumer Healthcare to conduct research on self-care in the Philippines, and payment or honoraria for manuscript writing from the Zuellig Family Foundation to write papers on health systems strengthening, all outside the submitted work. YLS reports grants or contracts from Institute of Epidemiology and Preventive Medicine, National Taiwan University through their post-doctoral fellow contract, leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as co-founder of the Benang Merah Research Center (benangmerah.net), and other financial or non-financial interests in Jago Beasiswa (idebeasiswa.com) as a mentor, all outside the submitted work. JHVT reports leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as co-founder of the Benang Merah Research Center (benangmerah.net), outside the submitted work. All other authors report no competing interests.

Figures

Figure 1
Figure 1
Age-standardised deaths (A) and age-standardised DALYs (B) per 100 000 people attributable to injuries DALY=disability-adjusted life-years.
Figure 2
Figure 2
Relative contribution of level 3 injury DALYs to the total injury DALYs by sex and age group in ASEAN, 2021 ASEAN=Association of Southeast Asian Nations. DALY=disability-adjusted life-years.
See this image and copyright information in PMC

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