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Changing life expectancy in European countries 1990-2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021

2025/3Research article Open access
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datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorGBD 2021 Europe Life Expectancy Collaborators
dc.contributor.authorSteel, Nicholas
dc.contributor.authorBauer-Staeb, Clarissa Maria Mercedes
dc.contributor.authorFord, John A.
dc.contributor.authorAbbafati, Cristiana
dc.contributor.authorAbdalla, Mohammed Altigani
dc.contributor.authorAbdelkader, Atef
dc.contributor.authorAbdi, Parsa
dc.contributor.authorZuñiga, Roberto Ariel Abeldaño
dc.contributor.authorAbiodun, Olugbenga Olusola
dc.contributor.authorAbolhassani, Hassan
dc.contributor.authorAbu-Gharbieh, Eman
dc.contributor.authorAbukhadijah, Hana J.
dc.contributor.authorAbu-Zaid, Ahmed
dc.contributor.authorAddo, Isaac Yeboah
dc.contributor.authorAddolorato, Giovanni
dc.contributor.authorAdekanmbi, Victor
dc.contributor.authorAdetunji, Juliana Bunmi
dc.contributor.authorAdeyeoluwa, Temitayo Esther
dc.contributor.authorAgardh, Emilie E.
dc.contributor.authorAgyemang-Duah, Williams
dc.contributor.authorAhmad, Danish
dc.contributor.authorAhmed, Anisuddin
dc.contributor.authorAhmed, Ayman
dc.contributor.authorAhmed, Syed Anees
dc.contributor.authorAkinosoglou, Karolina
dc.contributor.authorAkkaif, Mohammed Ahmed
dc.contributor.authorAl Awaidy, Salah
dc.contributor.authorAl Hasan, Syed Mahfuz
dc.contributor.authorAl Zaabi, Omar Ali Mohammed
dc.contributor.authorAldridge, Robert W.
dc.contributor.authorAlgammal, Abdelazeem M.
dc.contributor.authorAl-Gheethi, Adel Ali Saeed
dc.contributor.authorAli, Abid
dc.contributor.authorAli, Mohammed Usman
dc.contributor.authorAli, Syed Shujait
dc.contributor.authorAli, Waad
dc.contributor.authorAlicandro, Gianfranco
dc.contributor.authorAlif, Sheikh Mohammad
dc.contributor.authorAl-Jumaily, Adel
dc.contributor.authorAllebeck, Peter
dc.contributor.authorAlrawashdeh, Ahmad
dc.contributor.authorAl-Rifai, Rami H.
dc.contributor.authorAlsabri, Mohammed A.
dc.contributor.authorAlshahrani, Najim Z.
dc.contributor.authorAluh, Deborah Oyine
dc.contributor.authorAl-Wardat, Mohammad
dc.contributor.authorAl-Zyoud, Walid A.
dc.contributor.authorAmiri, Sohrab
dc.contributor.authorAnderlini, Deanna
dc.contributor.authorBettencourt, Paulo J.G.
dc.date.accessioned2025-07-02T10:56:46Z
dc.date.available2025-07-02T10:56:46Z
dc.date.issued2025/3
dc.description.abstractBackground: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021. Interpretation: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Funding: Gates Foundation.eng
dc.identifier.doi10.1016/S2468-2667(25)00009-X
dc.identifier.eid85219099265
dc.identifier.issn2468-2667
dc.identifier.pmcPMC11876102
dc.identifier.pmid39983748
dc.identifier.urihttp://hdl.handle.net/10400.14/53823
dc.language.isoeng
dc.peerreviewedyes
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleChanging life expectancy in European countries 1990-2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021eng
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.endPagee188
oaire.citation.issue3
oaire.citation.startPagee172
oaire.citation.titleThe Lancet Public Health
oaire.citation.volume10
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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