Benchmarking Global Progress in Non-Communicable Diseases: A Comprehensive Analysis of Cause-Specific Mortality Trends from 2001 to 2019

Highlights

• Non-communicable disease (NCD) mortality decreased in four out of five countries globally from 2010 to 2019, though progress slowed compared to 2001–2010.
• Circulatory diseases were the largest contributors to mortality declines, with some cancers also showing favorable trends, while neuropsychiatric and pancreatic/liver cancers increased mortality.
• Marked regional variation exists: high-income Western countries had uniform declines; central Asia, Middle East, North Africa, and central/eastern Europe showed notable improvements; Pacific Island nations lagged behind.
• Age-specific mortality trends varied, sometimes offsetting overall improvements; decadal changes demonstrated both improvements and deteriorations across countries and causes.

Background

Non-communicable diseases (NCDs) including cardiovascular diseases, cancers, respiratory diseases, and diabetes represent the leading causes of mortality worldwide. Over the last two decades, global health policies have emphasized control and reduction of NCD mortality to improve population health and achieve sustainable development goals. Understanding how NCD mortality has evolved internationally, and which causes drive these changes, is critical for guiding future interventions and resource allocation.

Key Content

Data Sources and Methodology

The primary analysis relies on the 2021 WHO Global Health Estimates covering 185 countries and territories, disaggregated by sex, age group, and specific NCD causes. The main outcome was the probability of dying from NCD causes between birth and age 80 years, calculated using age-specific death rates and life table methodologies adjusting for competing causes. Two temporal intervals were studied: 2001–2010 and 2010–2019.

To elucidate drivers of change, the Horiuchi decomposition method was applied to 51 countries with high-quality mortality data and 12 populous countries, identifying the contributions of specific NCD causes and age groups to overall mortality change.

Global Trends in NCD Mortality

From 2010 to 2019, 82% of countries saw reductions in female NCD mortality and 79% in males. These declines impacted approximately 72% of the global female and 73% of the male populations. However, 18% of countries for females and 21% for males experienced increases.

High-income Western countries uniformly demonstrated declining NCD mortality, with Denmark achieving the largest reductions and the USA the smallest. Major populous countries outside this region showed mixed results: China, Egypt, Nigeria, Russia, and Brazil reduced mortality for both sexes, while India and Papua New Guinea experienced increases.

Regional analysis revealed females in the Central Asia, Middle East, and North Africa regions exhibited the greatest NCD mortality reductions, followed by central and eastern Europe; for males, central and eastern Europe led, followed by Central Asia and the Middle East/North Africa. The Pacific Islands had the smallest improvements.

Cause-Specific Contributions to Mortality Changes

Declines in mortality from circulatory diseases were the principal driver of NCD mortality reductions in most countries, reflecting advances in prevention, diagnosis, and treatment of cardiovascular conditions. Specific cancers such as stomach and colorectal for both sexes, cervical and breast for females, and lung and prostate for males also contributed positively to mortality trends.

Conversely, neuropsychiatric conditions and pancreatic and liver cancers were associated with increased mortality in most countries during 2010–2019.

Age-Specific Mortality Patterns

Within countries, mortality trends sometimes varied by age group. Parallel declines or increases in working-age adults and older populations (≥65 years) magnified overall change magnitude, whereas contradictory age-group trends attenuated net mortality changes.

Comparisons with the Preceding Decade

Improvement in the rate of change relative to 2001–2010 was observed in 41% of countries for females and 39% for males, covering 29% and 63% of the global female and male populations respectively. This group included both sexes in Russia and Egypt and males in China, India, and Brazil. However, 59% of countries for females and 61% for males experienced deterioration in change, including the USA, Nigeria, Papua New Guinea, and females in China, India, and Brazil.

Deteriorations were concentrated in most high-income Western nations, Latin America, the Caribbean, East and Southeast Asia, and among females in South Asia. Improvements were found generally in central and eastern Europe, central Asia, and parts of the Middle East and North Africa.

Cause-specific decompositions revealed that declines in circulatory disease mortality were generally smaller in 2010–2019 versus 2001–2010, except in central/eastern Europe and some central Asian countries, where declines accelerated. Lung cancer mortality saw decadal improvements in many countries—especially males—while other cancer types showed mixed trends.

Integration of Complementary Evidence

Additional literature emphasizes the importance of lifestyle modifications (e.g., diet quality, as confirmed by meta-analyses assessing Healthy Eating Index, DASH scores), statin use for cardiovascular disease prevention, and cancer survival improvements in influencing NCD mortality trends globally.

Meta-analyses of diet quality (AHEI, DASH) associate high adherence with 18–22% reductions in cardiovascular disease and all-cause mortality. Statin use among people living with HIV has demonstrated mortality reductions, corroborating the role of integrated NCD management even in infectious disease contexts.

Cancer survival meta-analyses highlight regional disparities in breast and colorectal cancer outcomes, tied to developmental indices, screening, and treatment access, aligning with observed mortality trends in the main global analysis.

Expert Commentary

The comprehensive global assessment by the NCD Countdown 2030 Collaborators fills a critical knowledge gap regarding the pace and patterns of NCD mortality change. The findings provide reassurance of widespread, albeit uneven, progress in NCD control globally, while exposing stagnation or reversals in many settings, including some high-income countries.

The dominant contribution of circulatory disease mortality decline underscores the success of multifaceted cardiovascular risk factor management and acute care innovations but also highlights the challenge of sustaining this momentum. The heterogeneous cancer mortality trends suggest ongoing disparities in prevention, early detection, and therapeutics across cancer types and geographies.

Notably, increases in neuropsychiatric and certain cancer mortalities (pancreatic, liver) signal urgent need for focused research and health system responses. Age-specific divergent trends warrant tailored interventions targeting both working-age and older populations.

Methodologically, the use of detailed cause-age-sex decompositions provides nuanced insights but relies heavily on data quality and comparability, limiting granularity in many low- and middle-income regions.

Clinically, these findings imply that global NCD strategies must balance broad cardiovascular disease control with enhanced efforts targeting cancers and emerging contributors to mortality, supported by strengthened health systems and equity-focused policies.

Conclusion

From 2001 to 2019, global progress in reducing NCD mortality has been substantial but decelerating. Most countries achieved declines between 2010 and 2019, particularly due to cardiovascular disease control, yet progress slowed relative to the prior decade. Regional and cause-specific heterogeneity reveal complex epidemiological transitions requiring adaptive, multisectoral responses.

Reducing the global burden of NCD mortality will depend on sustained innovation and scale-up in prevention, early diagnosis, treatments, and health system strengthening, particularly to address cancers, neuropsychiatric disorders, and persistent high-mortality settings. Ongoing surveillance, enhanced data quality, and multisectoral policy engagement remain essential to meet global health targets.

References

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