PHARMACIST STEVE

• Death rates from chronic diseases fell in most countries around the world in the last decade.
• Despite a net improvement in such mortality, the U.S. was one of the worst performers among high-income countries, given its rise in deaths from neuropsychiatric conditions.
• A drop in circulatory disease deaths drove the net decline in chronic disease mortality in most countries.

The 2010s marked a decade of continued global health improvement, with most countries reporting fewer deaths from chronic diseases from 2010 to 2019.

The probability of dying from a non-communicable disease (NCD) between birth and age 80 years during this time period fell in about 80% of 185 participating countries and territories around the world included in the study, based on 2021 World Health Organization Global Health Estimates.

Although the U.S. fell into the list of countries that made survival gains in the 2010s, this progress was not much to celebrate as it was nothing like it had been in the 2000s, reported Majid Ezzati, PhD, of Imperial College London, and colleagues in the NCD Countdown 2030 project, in The Lancet

“Females and males in the USA had the smallest declines in the probability of dying from [an NCD] before age 80 years from 2010 to 2019 of any high-income western country; those in Germany had the second smallest for females and third smallest for males. These countries’ poor performance was a consequence of having had some of the largest slowdowns in NCD mortality decline compared with the first decade of the millennium, reaching near-stagnation in the case of males in the USA,” the authors wrote.

“Epidemiologically, the poor performance of the USA from 2010 to 2019 can be summarized as a rise in the probability of dying from neuropsychiatric conditions, which was not offset by the continued declines in cancers and circulatory diseases. Specifically, although mortality from most cancers, ischemic heart disease, and chronic obstructive pulmonary disease declined from 2010 to 2019, most of these declines were smaller than the preceding decade,” they added.

In most countries, a slowdown in circulatory disease deaths drove the net decline in NCD mortality from 2010 to 2019. This decline was more modest during 2010-2019 than it had been during 2001-2010 in most countries — except in countries in central and eastern Europe and some countries in central Asia, where the declines were larger in 2010-2019.

Meanwhile, lung cancer deaths fell substantially in 2010-2019 in many countries, especially for men.

Other cancers also contributed toward fewer NCD deaths from 2010 to 2019, like stomach and colorectal cancers for both sexes, cervical and breast cancers for women, and prostate (in addition to lung) cancer for men, while pancreatic and liver cancers contributed towards higher NCD mortality.

Study authors determined that South Korea, Moldova, Denmark, Mongolia, Kazakhstan, Colombia, and Chile were the countries in their respective regions with exemplary improvements in NCD mortality from 2010 to 2019.

“Our results and the experiences of countries with strong performance indicate that what is needed is investment or reinvestment in programs that increase the coverage of efficacious diagnosis and treatment, and effective policies, such as those related to tobacco and alcohol control that are well established, or emerging ones such as those related to pricing and availability of healthy (e.g., fresh fruits and vegetables) or unhealthy (e.g., trans fat and sugar-sweetened beverages) foods,” according to Ezzati’s group.

“Crucially, these programs should be designed to reach the people that account for the largest number of disease cases and deaths, yet are persistently and increasingly excluded from the benefits of health policies and programs,” they noted.

For their study, Ezzati and colleagues assessed mortality from NCDs such as cancer, cardiovascular disease, diabetes, kidney disease, liver disease, and neurological conditions.

Across high-income western countries, NCD mortality trended downward, with Denmark showing the biggest decline and the U.S. the smallest decline.

Elsewhere, there were notable drops in NCD mortality in China, Egypt, Nigeria, Russia, and Brazil.

India and Papua New Guinea were among the roughly 20% of countries that had NCD deaths rise from 2010 to 2019.