Global Morbidity Gap Widens as Life Expectancy Rises

Key Takeaways

• The global morbidity gap widened from 8.8 years in 1990 to 10.7 years in 2023, and the share of life spent in poor health increased from 13.6% to 14.5%.
• Global life expectancy at birth increased from 64.6 to 73.8 years, while healthy life expectancy increased from 55.9 to 63.1 years between 1990 and 2023; the COVID-19 pandemic temporarily disrupted both trends but did not reverse the broader divergence.
• Higher-income settings generally showed wider morbidity gaps in 2023, including 12.7 years in the high-income super-region versus 9.0 years in sub-Saharan Africa; women also had a larger morbidity gap than men across regions and SDI quintiles (12.1 years vs 9.3 years), and country examples included the United States at 14.0 years, Australia at 13.9 years, and Canada at 13.7 years.

Added years of life have continued to outpace added healthy years globally, leaving a larger span of life lived with disease and disability. In a systematic analysis in The Lancet Public Health, investigators reported that the global morbidity gap reached 10.7 years in 2023, extending a long-running pattern in which survival gains exceeded gains in healthy life expectancy.

The systematic analysis drew on Global Burden of Disease 2023 estimates from 1990 through 2023 and examined trends across countries, regions, sex, and levels of sociodemographic development. Investigators reported that the widening gap was seen in almost all countries and territories and across the adult lifespan rather than being confined to the final years of life, although a smaller number of countries experienced declines in the share of life spent in poor health. Overall, the global pattern was one of longer lives accompanied by more years lived with illness and disability.

Burden was not distributed evenly. Higher-SDI settings generally had the widest morbidity gaps, and country and sex comparisons indicated that the longest periods of life spent in poor health tended to occur where life expectancy was also highest. Women also had a larger morbidity gap than men across regions and SDI quintiles in 2023 (12.1 years vs 9.3 years). The geographic and sex pattern pointed to a consistent imbalance between gains in longevity and gains in healthspan.

The contributors to unhealthy years were relatively concentrated. The analysis found that 57.4% of unhealthy years in 2023 were attributed to a relatively small group of largely non-fatal chronic conditions, led by musculoskeletal disorders and especially low back pain, followed by mental disorders, sense organ diseases, falls and other unintentional injuries, and other chronic non-communicable diseases. Reported risk factors included high fasting plasma glucose, high body mass index, child and maternal malnutrition, and tobacco use, while child and maternal malnutrition and air pollution were more prominent in lower-SDI settings.

Clinician Questions

How much did the global morbidity gap widen between 1990 and 2023 in the GBD 2023 analysis?

In the GBD 2023 global population estimates, the morbidity gap increased from 8.8 years in 1990 to 10.7 years in 2023; the morbidity gap refers to the difference between life expectancy and healthy life expectancy.

How did global life expectancy and healthy life expectancy change from 1990 to 2023?

Global life expectancy at birth increased from 64.6 to 73.8 years between 1990 and 2023, while global healthy life expectancy increased from 55.9 to 63.1 years, indicating that gains in survival outpaced gains in healthy years over the same period.

Which populations had the widest morbidity gaps in 2023?

Higher-SDI and high-income settings had the widest morbidity gaps in 2023, including 12.7 years in the high-income super-region versus 9.0 years in sub-Saharan Africa; country examples included the United States at 14.0 years, Australia at 13.9 years, and Canada at 13.7 years.

What conditions and risk factors accounted for much of the healthspan gap in 2023?

In 2023, 57.4% of unhealthy years were attributed to a relatively small group of largely non-fatal chronic conditions, led by musculoskeletal disorders, particularly low back pain, followed by mental disorders, sense organ diseases, falls and other unintentional injuries, and other chronic non-communicable diseases; reported global risk factors included high fasting plasma glucose, high body mass index, child and maternal malnutrition, and tobacco use, with child and maternal malnutrition and air pollution highlighted in lower-SDI settings.