15 Things That Are ‘Stealing’ Years From Life: New Study Reveals Where Global Gaps in Longevity Come From

The gap in life expectancy between countries is a concentration of inequalities in income, infrastructure, and access to basic health care. For the purposes of SDG 3 (“health and well-being”) and universal health coverage programs, the key question is down-to-earth: which causes of death “eat up” years of life – and where will the return on investment be greatest?

What is already known

Over the past 20–30 years, the world has made significant progress in controlling infections and maternal and child mortality: vaccination, HIV/TB/malaria treatment, perinatal care, access to clean water and sanitation have reduced mortality at younger ages. At the same time, non-communicable diseases (NCDs) have come to the forefront – primarily atherosclerosis, strokes, diabetes, as well as road traffic injuries and suicides. However, prioritization is often vague: long lists of causes, different metrics (DALYs, age-standardized rates), little clarity on how many years of life a country specifically loses due to each cause.

The vast majority of the difference in life expectancy between countries is explained by just 15 priority conditions — eight infectious and maternal-child diseases (I-8) and seven non-communicable diseases and injuries (NCD-7). In most regions, they together account for 80% or more of the “minus” to life compared to the standard — Canada and Western Europe. Over two decades, the world has noticeably made up the distance in infections, but non-communicable diseases are now coming to the fore. The study is published in the journal JAMA Network Open.

What was studied

The authors used data from the World Health Organization (Global Health Estimates) and UN projections for overall mortality (World Population Prospects) to calculate what causes of death and at what age shorten people's lives in 165 countries and 7 major regions of the world. The standard was life expectancy in Western Europe and Canada (82 years in 2019) - what can be achieved with high living standards and developed healthcare.

The researchers “broke down” the difference with the standard by causes of death using Pollard’s demographic method – this way you can see how many years each factor takes away.

Two baskets of priorities

I-8 (infections, motherhood and childhood):

• neonatal causes,
• acute respiratory infections of the lower respiratory tract,
• diarrheal diseases,
• HIV/AIDS,
• tuberculosis,
• malaria,
• "childhood infections" (whooping cough, diphtheria, measles, tetanus),
• maternal reasons.

NCD-7 (Noncommunicable Diseases and Injuries):

• atherosclerotic cardiovascular diseases (coronary heart disease, etc.),
• hemorrhagic stroke,
• NCDs closely associated with infections (eg, some cancers and cirrhosis),
• NCDs closely associated with tobacco use
• diabetes,
• road traffic injuries,
• suicide.

The main results - where and what shortens life

• In the median country (2019), I-8 + NCD-7 explain 80% of the gap (interquartile range 71–88%).
• Sub-Saharan Africa: 21.6 years behind the benchmark, of which 11.4 years are in I-8 and 5.0 years in NCD-7. The leading killers are pneumonia, TB, HIV/AIDS, diarrhea, neonatal causes and… increasingly, atherosclerosis.
• India: 11.5 years gap; NCD-7 has already been overtaken by infections (6.35 vs. 4.05 years). Big “minuses” are given by atherosclerosis, tobacco-related diseases, hemorrhagic stroke and diabetes; among infections – diarrhea, neonatal causes, TB, pneumonia.
• China: formal gap 4.3 years, but NCD-7 contribution is 5.5 years (it exceeds the overall gap because China is better than the benchmark for “other” reasons). Main “minuses”: atherosclerosis, hemorrhagic stroke, tobacco-related diseases, infection-related NCDs.
• Central and Eastern Europe: gap 7.6 years, of which 5.9 years - NCD-7 (especially atherosclerosis).
• Middle East and North Africa: 7.7 years gap, of which 5.3 years are NCD-7.
• Latin America and the Caribbean: 7.0 year gap; NCD-7 and violence among "other" causes are prominent.
• USA: 3.3 year gap; about half are NCD-7, and among “others” mental disorders and addictions (including opioids) and neurological diseases in the elderly stand out.

Dynamics for 2000–2019: a great victory over infections, a new front – chronic diseases

• In sub-Saharan Africa, the contribution of infections (I-8) to the gap has declined from about 21.4 out of 31.1 years (in 2000) to 11.4 out of 21.6 years (in 2019). This is a huge progress thanks to vaccination, HIV/TB/malaria treatment, perinatal care, water and sanitation.
• India has undergone an “epidemiological transition”: infections have been replaced as the main source of losses by cardiovascular and other NCDs.
• China has achieved reductions in tobacco-related and infection-related NCDs and hemorrhagic stroke, but the contribution of atherosclerosis has increased.
• By 2021, COVID-19 had widened the gap with the benchmark for most regions; the benchmark itself saw a decline in life expectancy of approximately 0.38 years due to COVID-19.

Why it matters: low resources - need a sight

The study shows that there is no need to “shoot sparrows with a cannon.” If a country has little money for health care, several packages of measures will give the maximum return:

1) Heart and blood vessels (the main “minus” almost everywhere)

• early detection and control of hypertension,
• statins and antithrombotic prophylaxis where indicated,
• combination tablets (polypill) for convenience,
• measures on nutrition, physical activity and smoking cessation.

2) Diabetes

• prevention (including taxes on sugary drinks),
• risk factor screening,
• access to essential drugs and self-monitoring.

3) Tobacco

• excise taxes, bans on advertising and smoking indoors, unbranded packaging,
• clinical support for cessation (NRT, varenicline, etc.).

4) Maternity, neonatology, "childhood" causes and infections

• perinatal care, Kangaroo care, access to oxygen and antibiotics,
• HIV/TB/Malaria: Testing, Early Treatment, Prevention,
• vaccination, clean water and sanitation, nutrition.

5) Roads and injuries

• speed, seat belts/child seats/helmets, drunk driving, infrastructure.

6) Mental Health and Addictions (relevant for the US and parts of LAC)

• treatment of disorders, harm reduction programs, overdose prevention,
• integration of psychiatry into primary care.

7) Data

• Improved registration of deaths and causes - this makes it cheaper and faster to accurately target efforts.

Nuances and limitations

• Periodic LE is a “snapshot.” Recent changes in risk do not immediately “fall through” into it (for example, reducing smoking will yield results later).
• The quality of the data varies: in countries without full mortality registration, models and verbal autopsies are used. But the findings are robust in sensitive analyses.
• The grouping of “tobacco-related” or “infection-related” NCDs is a simplification: locally the picture is more complex (the role of air pollution, diet, alcohol, etc.).
• In a number of countries, the contribution of some “other” causes (for example, violence or drug use) may be critical, although they do not dominate the global picture.

What does this mean for different regions?

• Sub-Saharan Africa: maintain momentum on infections and maternal-child causes, while simultaneously rolling out cardiometabolic programs (hypertension, sugar, lipids).
• India, China, CEE, Middle East, LAC: focus on atherosclerosis, strokes, diabetes, strict tobacco control; in LAC also violence and security.
• US: Beyond NCD-7, scale up addictions care, mental health care, and dementia prevention; road safety.

Summary

The longevity gap between countries is not an abstract “sum of everything.” It is a short list of very specific causes for which cheap and effective solutions already exist. By focusing on these 15 priorities and their key risk factors, governments and donors can give people years back in the fastest way possible.