Global, regional, and national burden of NCDs

Globally, in 2021, HFPG-related NCDs accounted for an estimated 5.15 million deaths globally (95% UI: 4.37–5.94 million). Equivalent ASDR is 62.01 per 100,000 people. Additionally, these conditions resulted in approximately 151.95 million DALYs (95% UI: 129.02–175.49 million), with an DALYs rate(age-standardized) of 1,775.66 years per 100,000 population. (Table 1). From 1990 to 2021, global ASDR and DALY rates increased by EAPCs of 0.11 and 0.55, respectively. The low-middle SDI region had the highest rates (85.25 and 2337.33) with EAPCs of 1.13 and 1.23, while the high SDI region had the lowest ASDR (41.67) with a -0.87 EAPC. (Table 1 and Fig. S1). Among 21 GBD regions, Southern Sub-Saharan Africa has the highest EAPC for ASDR (2.12) and age-standardized DALY rate (2.05), while High-income Asia Pacific has the lowest EAPC for ASDR (-2.12) and Australasia for DALY rate(age-standardized) (-0.65) (Table 1 and Fig. 1). Moreover, SDI exhibits a significant negative correlation with ASDR(R = -0.57, P < 0.01) and DALYs rates(age-standardized)(R = -0.54, P < 0.01) across the 21GBD regions (Figure S2). In 2021, among 204 countries and regions, The highest ASDR of 409.34 (95%UI: 330.11, 504.27) and age-standardized DALYs rate of 10,504.66 (95%UI: 8515.21, 12,988.41) were observed in Fiji (Fig. S3 and Table S1-2). Over the past 30 years, Lesotho has had the highest EAPC for both ASDR(3.71) and age-standardized DALYs rates(3.74). (Figure S4 and Table S1-2). Similarly, there is a negative association between SDI and both ASDR(R = -0.43, P < 0.01) and DALYs rates(age-standardized) (R = -0.39, P < 0.01)in 204 different countries and regions (Fig. S5). Over the past 30 years, globally and across the five SDI regions, males have consistently had higher ASDR and DALYs rates compared to females. Around 2005, there was a notable decrease in ASDR in two SDI regions(high and high-middle) (Fig. S6). In contrast, age-standardized DALYs rates have risen notably in middle- and low-middle SDI regions. (Figure S7). From Fig. S8, It can be visualized that both mortality and DALYs rates increase with age and are higher for males than females in practically every age category (Table S3).

Fig. 1

The estimated annual percentage change in age-standardized death rate and DALY rate for non-communicable diseases in global, 5SDI and 21 regions from 1990 to 2021.

Table 1 Death and DALYs of NCDs between 1990 and 2021 in Globally and Regionally.Global, regional, and national burden of neoplasms

Globally in 2021, HFPG-attributable neoplasms caused 0.33 million deaths (ASDR: 3.88; EAPC: 0.87) and 7.05 million DALYs (age-standardized rate: 81.35; EAPC: 0.77) (Table S4). Pancreatic cancer showed the highest mortality burden among six neoplasms (0.13 million deaths; ASDR 1.57), while liver cancer had the fastest-growing burden (EAPC 1.90) (Table S12). Neoplasm ASDR/DALY rates rose with SDI (peaking at 5.72/118.39 in high-SDI regions), with fastest 30-year growth in low-middle SDI areas (EAPCs: 2.32/2.30) (Table S4). Among the 21 GBD regions, Central Europe had the highest ASDR (7.33) and DALYs rate (157.66). North Africa and the Middle East showed the fastest ASDR growth (EAPC: 2.75), while Southern Sub-Saharan Africa had the highest DALYs growth (EAPC: 2.73). In contrast, High-income Asia Pacific exhibited a decline -0.16 EAPC DALYs rate (Table S4). Among 204 countries and regions, the highest EAPC for ASDR was in Egypt at 5.70 (Fig. S9 and Table S10). For the DALYs rate, the highest EAPC was in Lesotho at 5.75 (Fig. S10 and Table S10).

Global, regional, and national burden of CVD

Globally, in 2021, HFPG-related CVD caused 2.21 million deaths (ASDR: 26.85, EAPC: -0.47) and 42.95 million DALYs (rate: 504.57, EAPC: -0.34). (Table S5). Among three CVDs, IHD showed the highest mortality burden (1.35million deaths; ASDR 16.27). While IHD and stroke burdens declined, LEPAD increased (EAPC: 0.44) (Table S12).The high SDI region has the lowest disease burden and the sharpest decline, with 2021 ASDR and DALY rates of 15.66 and 295.18, and EAPCs of -2.12 and -1.87. (Table S5). Among the 21 GBD regions, North Africa and the Middle East had the highest ASDR (57.06) and DALYs rate (1037.04), while High-income Asia Pacific had the lowest (ASDR: 8.30; DALYs: 155.76). High-income Asia Pacific showed the sharpest decline (EAPC: -3.69 for ASDR; -3.29 for DALYs), whereas Southern Sub-Saharan Africa experienced the largest increase (EAPC: 1.65 for ASDR; 1.67 for DALYs). (Table S5). Lesotho showed the highest EAPCs for both ASDR (4.09) and age-standardized DALY rates (4.36) among 204 countries/regions (Figs. S9-S10, Table S10).

Global, regional, and national burden of Alzheimer’s disease and other dementias

Globally, in 2021, HFPG-related Alzheimer’s disease and other dementias caused 0.29 million deaths (ASDR: 3.73, EAPC: 1.20) and 5.35 million DALYs (rate: 66.42, EAPC: 1.18). (Table S6). Across SDI regions, disease burden trended upward. ASDR (4.27) and DALYs rates (75.11) are highest in high SDI area. The Low-middle SDI region showed the greatest increases in ASDR(EAPC:1.72) and DALYs rate(EAPC:1.55) (Table S6). Among the 21 GBD regions, High-income North America had the highest ASDR (5.66) and DALYs rate(age-standardized) (99.65) in 2021, while Central Asia had the fastest growth (EAPC: 2.44 for ASDR; 2.50 for DALYs). (Table S6). Among the 204 countries and regions, Georgia has the highest EAPC for both ASDR and DALYs rate(age-standardized), with 3.50 and 3.39, respectively (Fig. S9-10 and Table S10).

Global, regional, and national burden of DM

In 2021, HFPG-induced DM caused 1.66 million global deaths (ASDR: 19.61, EAPC: 0.16) and 78.93 million DALYs (rate: 916.14, EAPC: 0.94) (Table S7). High SDI regions had the lowest ASDR at 9.35, with the most significant decline (EAPC: -1.54). Conversely, low-middle SDI regions had the highest DALYs rate(age-standardized) at 1259.54, showing the greatest increase (EAPC: 1.33) (Table S7). In the 21 GBD regions, the highest and lowest ASDR in 2021 were in Oceania (109.64) and High-income Asia Pacific (3.96), respectively. The region with the most significant decline in disease burden trend was High-income Asia Pacific, with an EAPC of -2.97. The highest and lowest DALYs rates(age-standardized) were in Oceania (3585.13) and Australasia (471.73), respectively. The region with the most significant increase in DALYs burden trend was Southern Sub-Saharan Africa, with an EAPC of 2.13 (Table S7). Mauritius had the highest EAPC in ASDR (3.80), while Lesotho led in age-standardized DALYs EAPC (3.54) among 204 countries/regions (Figs. S9-S10, Table S10)

Global, regional, and national burden of CKD

Globally, in 2021, HFPG-related CKD led to 0.66 million deaths (ASDR: 7.95, EAPC: 1.69) and 15.99 million DALYs (rate: 187.46, EAPC: 1.37) (Table S8). In 2021, the highest ASDR and DALY rates were in low (9.98) and low-middle SDI regions (234.50). The fastest increases occurred in high SDI regions, with EAPCs of 2.89 and 2.35, respectively. (Table S8). In the 21 GBD regions, the highest and lowest ASDR in 2021 were in Andean Latin America (20.43) and Eastern Europe (1.66), respectively. The region with the highest DALYs rate(age-standardized) was Central Latin America (481.14), while the lowest was in Eastern Europe (56.35). The region with the most significant increase in disease burden was High-income North America, with an EAPC of 5.14 for ASDR and 4.14 for DALYs rates(age-standardized). (Table S8). Among 204 countries/regions, Ukraine ranked highest in ASDR EAPC (14.25) and Lesotho in age-standardized DALYs EAPC (4.81) (Figs. S9,S10, Table S10).

Global, regional, and national burden of BVL

In 2021, the global DALYs, DALYs rate(age-standardized), and EAPC due to HFPG-induced BVL were: 1.67 million, 19.72, and 0.61, respectively (Table S9). Among the five SDI regions, the highest DALY rate is in low-middle SDI (44.80), while high-middle SDI shows the largest increase (EAPC: 0.97). (Table S9). Among the 21 GBD regions, the highest and lowest DALYs rates(age-standardized) were found in South Asia (53.98) and High-income Asia Pacific (4.29), respectively. The most notable increase was in High-income North America (EAPC:1.89) (Table S9). Among the 204 countries and regions, the EPAC for DALYs rate(age-standardized) is highest in Luxembourg (2.89) (Figs. S10 and Table S10).

Temporal trends, regional disparities, and gender differences in various NCDs

Globally, from 1990 to 2021, CVD triggered by HFPG has been the disease with the persistently highest ASDR, and DM triggered by HFPG has been the disease with the persistently highest age-standardized DALYs rate. Moreover, the burden of DALYs caused by DM is on an upward trend (Fig. 2). From the perspective of different SDI regions, the mortality rates of five different types of NCDs have shown varying degrees of increase over these 30 years, with the exception of CVD and DM, which have seen a decline in regions with High-middle SDI and High SDI (Fig. S11). The DALYs rates have generally shown an increasing trend as well, except for CVD, which has also experienced a decline in High-middle SDI and High SDI regions (Fig. S12). Among different genders, both mortality rates and DALYs rates gradually increase with age (Figs. S13-14 and Table S11).

Fig. 2

Trends in age-standardized death rate and DALY rate for six types of non-communicable diseases from 1990 to 2021 globally.

In 2021, the top three NCDs by ASDR were DM (19.61), IHD (16.27), and stroke (10.26). Except for Alzheimer’s disease and other dementias, ASDR was higher in males. Over three decades, liver cancer, CKD, and pancreatic cancer showed the highest ASDR increases (EAPCs: 1.90, 1.69, 1.34), while IHD and stroke declined (EAPCs: -0.13, -0.98). (Table S12). Among the 13 NCDs, DM, IHD, and stroke lead in age-standardized DALYs (916.14, 303.49, and 194.35, respectively). Except for dementia and BVL, which are higher in females, all other diseases have higher rates in males. Liver cancer, CKD, and pancreatic cancer show the highest DALY increases (EAPCs: 1.65, 1.37, 1.22). (Table S13).

In the 5 SDI regions, DM is the leading cause of death burden in middle, low-middle, and low SDI regions, while IHD is the top cause in high and high-middle SDI regions. (Fig. 3 and Table S14). In the 21 GBD regions, DM or IHD predominantly account for the highest death burden, with the exception of East Asia, where stroke is the leading cause, and the High-income Asia Pacific region, where Alzheimer’s disease and other dementias take the lead (Fig. 3 and Table S14). The disease with the highest disability burden is DM across all five SDI and 21 GBD regions (Fig. S15 and Table S14).

Fig. 3: The death number and age-standardized death rate for twelve types of non-communicable diseases in 2021.

“NO” refers to the number of deaths, and different colors represent different ranges of death rates.