Global health has undergone historic transformation. The burden of infectious diseases has steadily declined, whereas noncommunicable diseases have become increasingly significant, even in socioeconomically weak countries. However, the impact of COVID, however, highlights how new pathogens can rapidly undo decades of progress. These global gains depend on international collaboration and public spending, both of which are increasingly at risk in the current geopolitical climate, including in Italy.

New data from the Global Burden of Disease study, published in The Lancet at the end of 2025, will provide the most comprehensive quantitative assessment of global health trends through 2023. Led by the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, the collaboration now includes 19,000 researchers across 204 countries and evaluates 375 diseases and injuries and 88 modifiable risk factors.

These findings confirm a historic epidemiologic transition with significant implications for preparedness and equity.

Mortality Shift

The global age-standardized mortality rate declined from 1009 per 100,000 in 2000 to 701.5 per 100,000 in 2023, a reduction of 30.5%. The global life expectancy has increased to 76.3 years for women and 71.5 years for men.

Ischemic cardiovascular disease and stroke remain the leading causes of death worldwide, consistent with trends since 1990, except in 2021, when COVID ranked first. Chronic obstructive pulmonary disease ranks third, followed by lower respiratory infections, neonatal disorders, Alzheimer’s disease, lung cancer, and diabetes.

Mortality rates for most major causes have declined since 1990. Stroke mortality fell from 161.4 to 99.8 deaths per 100,000 individuals. However, diabetes, chronic kidney disease, Alzheimer’s disease, other dementias, and HIV/AIDS showed increased mortality over the same period. Between 2013 and 2023, deaths related to heat and cold exposure increased by 6% annually, drug use disorders by 5%, diabetes by 3%, and conflict and terrorism by 1%.

Pandemic Disruption

Infectious disease mortality has steadily declined over the past few decades. In 2023, lower respiratory infections were the only infectious condition among the top 10 causes of death, with a mortality rate of 50% since 1990. Diarrhea and tuberculosis fell from third and seventh places in 1990 to 13th and 15th places, respectively.

Vaccine-preventable diseases showed a 66.5% reduction in the number of lives lost.

From 2019 through 2023, COVID caused an estimated 18 million deaths worldwide, with mortality peaking in 2021 at 9.42 million deaths. The number of deaths then declined to 2.36 million in 2022 and 797,000 in 2023. The situation has since started to normalize. In 2023, COVID ranked as the 20th leading cause of death globally, and 194 of 204 countries (95.1%) experienced at least a partial recovery in mortality rates. Among these, approximately two thirds (125 countries) returned to their pre-pandemic levels.

Persistent Inequities

In sub-Saharan Africa, deaths from infectious diseases have decreased from 73.4% to 51.4% of total deaths between 1990 and 2023. Life expectancy ranges from approximately 83 years of age in high-income regions to 62-66 years of age in sub-Saharan Africa. Mortality was closely correlated with the sociodemographic index (SDI).

Regions with lower SDIs are beginning to experience significant impacts from noncommunicable disease mortality superimposed on incomplete infectious disease control, for which the health systems in these regions are often unprepared. Age-standardized and cardiovascular mortality rates remain higher in these regions and have not declined at the pace observed in countries with high SDI.

In high-income North America, mortality among individuals aged 30-39 years has increased by 50% since 2011. Researchers attribute much of this increase to deaths from despair, including suicide, substance use, and alcohol-related causes, which disproportionately affect rural, minority, and lower-income populations.

Globally, premature mortality under the age of 70 years has declined between 2000 and 2023, but progress has varied widely. Reductions reached 43.8% for men in East Asia but only 9.6% in high-income North America. The decline in mortality varied according to sex and region. Among men, mortality fell by 43.8% in East Asia but by only 9.6% in high-income North America. Among women, mortality declined by 58.2% in East Asia compared with 2.6% in Oceania.

In contrast, 10 countries recorded sharp increases in mortality among individuals aged < 70 years between 2000 and 2023. The largest increase occurred in Palestine at 33.1%, more than double the increase observed in Lebanon, the second-ranked country, at 15.3%. Researchers have attributed this increase primarily to armed conflicts.

In 2023, Palestine recorded the highest death rate worldwide from conflict and terrorism, at 385.8 deaths per 100,000 population, more than five times higher than the second-highest rate reported in Ukraine at 70.1 per 100,000. Sudan ranked third, followed by Russia and Burkina Faso in the fourth and fifth places, respectively.

This story was translated from Univadis Italy, part of the Medscape Professional Network.