Global, regional, and national characteristics of the main causes of increased disease burden due to the covid-19 pandemic: time-series modelling analysis of global burden of disease study 2021

Abstract

Objective: To quantify and identify the main causes of increased disease burden due to coronavirus disease 2019 (covid-19) pandemic.

Design: Time-series modelling study.

Data source: Global Burden of Disease Study 2021.

Main outcome measures: Absolute and relative rate differences were calculated, along with their 95% confidence intervals (95% CIs), between the observed and expected rates for 174 causes of increases in incidence, prevalence, disability adjusted life years (DALYs) and deaths in 2020-2021. A statistically significant increase was indicated if the 95% CIs of the rate differences were above 0.

Results: Globally, the rate of age standardised DALYs increased in absolute difference per 100 000 and relative rate difference by 97.9 (95% CI 46.9 to 148.9) and 12.2% (95% CI 5.8% to 18.5%) for malaria, 83.0 (79.2 to 86.8) and 12.2% (11.7% to 12.8%) for depressive disorders, and 73.8 (72.2 to 75.4) and 14.3% (14.0% to 14.7%) for anxiety disorders, which were prominent and statistically significant, followed by stroke, tuberculosis, and ischaemic heart disease. Additionally, the age standardised incidence and prevalence per 100 000 significantly increased for depressive disorders (618.0 (95% CI 589.3 to 646.8) and 414.2 (394.6 to 433.9)) and anxiety disorders (102.4 (101.3 to 103.6) and 628.1 (614.5 to 641.7)), as well as notable rises in age standardised prevalence for ischaemic heart disease (11.3 (5.8 to 16.7)) and stroke (3.0 (1.1 to 4.8)). Furthermore, age standardised mortality due to malaria significantly increased (1.3 (0.5 to 2.1) per 100 000). Depressive and anxiety disorders were the most predominant causes of increased DALY burden globally, especially among females; while malaria had the most severe increased DALY burden in the African region, typically affecting children younger than five years; and stroke and ischaemic heart disease in the European region and in individuals aged 70 and older.

Conclusion: The covid-19 pandemic significantly increased the burden of several non-covid conditions, particularly mental health disorders, malaria in young children in the African region, and stroke and ischaemic heart disease in older adults, with notable disparities across age and sex. These findings underscore the urgent need to strengthen health system resilience, enhance integrated surveillance, and adopt syndemic-informed strategies to support equitable preparedness for future public health emergencies.

Fig 1

Overview of the analytical pipeline for model development and evaluation. ARIMA=autoregressive integrated moving average model; LSTM=long short-term memory (ARIMA-LSTM); MAE=mean absolute error; RMSE=root mean squared error

Fig 2

The global main causes of increased burden during the covid-19 pandemic, by rate difference, standardised by age. (A) Incidence-absolute rate differences; (B) incidence-relative rate differences; (C) prevalence-absolute rate differences; (D) prevalence-relative rate differences; (E) DALYs-absolute rate differences; (F) DALYs-relative rate differences; (G) mortality-absolute rate differences; (H) mortality-relative rate differences. The asterisk (*) denotes statistical significance. AROHL=age related and other hearing loss; BVL=blindness and vision loss; CMNNs=communicable, maternal, neonatal, and nutritional diseases; COPD=chronic obstructive pulmonary disease; DALYs=disability adjusted life years; FSD=fungal skin diseases; HHA=hemoglobinopathies and haemolytic anaemias; IHD=ischaemic heart disease; INI=intestinal nematode infections; NCDs=non-communicable diseases; TBLC=tracheal, bronchus, and lung cancer; UDMI=urinary diseases and male infertility; URIs=upper respiratory infections; VAD=vitamin A deficiency

Fig 3

Main causes with increased burden by sex, standardised by age. (A) Incidence in women and (B) men; (C) prevalence in women and (D) men; (E) DALYs in women and (F) men; (G) mortality in women and (H) men. The orange lines represent an increase in ranking, while the blue lines indicate either no change or a decrease. DALYs=disability adjusted life years.*Statistical significance

Fig 4

Main causes of burden with increased burden by age. (A-E) incidence by age; (F-J) prevalence by age; (K-O) DALYs by age; (P-T) deaths by age; *statistical significance. Alzheimer's disease=Alzheimer's disease and other dementias; Blindness=blindness and vision loss; Cirrhosis=cirrhosis and other chronic liver diseases; COPD=chronic obstructive pulmonary disease; DALYs=disability adjusted life years; Gallbladder disorder=gallbladder and biliary diseases; Haemoglobinopathies=haemoglobinopathies and haemolytic anaemias; Hearing loss=age-related and other hearing loss; Intellectual disability=idiopathic developmental intellectual disability; Malnutrition=protein-energy malnutrition; Nematode infections=intestinal nematode infections; Nutritional deficiencies=other nutritional deficiencies; STIs excluding HIV=sexually transmitted infections excluding HIV; TBLC=tracheal, bronchus, and lung cancer; Trypanosomiasis=African trypanosomiasis; Upper digestive diseases=upper digestive system diseases; URIs=upper respiratory infections; Urinary/infertility=urinary diseases and male infertility

Fig 5

Leading causes of increased disability adjusted life years by countries and territories. The leading causes refer to the causes with the largest absolute rate differences between the observed and predicted rates for 2020-2021, but this does not imply that each rate difference is statistically significant. NA=not available