Diabetes Risk Factors Dominate Top Causes of Global Mortality, Heighten COVID-19 Risks

New data estimates from the Global Burden of Disease Study published by The Lancet illustrate how rising rates of chronic disease and public health failures compounded over decades to worsen the coronavirus disease 2019 (COVID-19) pandemic. The comprehensive global study analyzed 286 causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and territories.

In the United States, improvements in health have reversed over the past decade, and overall rates of health loss measured in disability-adjusted life years (DALYs) have increased. Rising rates of obesity, high blood pressure, high blood sugar, slowing declines in smoking, and increases in drug overdose deaths all contributed to the trend.

Although tobacco use was the leading risk factor for total health loss in 2019, claiming 550,000 lives throughout the year, “metabolic risks dominate the other leading risk factors for death—high systolic blood pressure (495,000 deaths in 2019), high blood sugar (439,000), dietary risks (418,000), and high [body mass index] (394,000).”

These metabolic risk factors put millions of Americans at greater risk for developing diabetes. Diabetes is currently the seventh leading cause of death in the United States, but the disease significantly increases the likelihood of developing severe COVID-19 complications. In August, COVID-19 became the third leading cause of death in the United States, trailing behind heart disease and cancer. Meanwhile, severe obesity and hyperglycemia are both independent risk factors for COVID-19 mortality.

“The interaction of COVID-19 with the continued global rise in chronic illness and related risk factors, including obesity, high blood sugar, and outdoor air pollution, over the past 30 years has created a perfect storm, fueling COVID-19 deaths,” authors wrote.

Studies have documented the detrimental effects of air pollution on health for decades prior to the pandemic, and a recent investigation concluded that exposure to air pollutants alters the composition of gut microbiota, which increases the risk of obesity, diabetes, gastrointestinal disorders, and other chronic illnesses.

Authors of the Global Burden of Disease report argued the findings warrant urgent action to address the social factors associated with chronic diseases. “The syndemic nature of the threat we face demands that we not only treat each affliction, but also urgently address the underlying social inequalities that shape them—poverty, housing, education, and race, which are all powerful determinants of health,” said Richard Horton, FRCP, editor-in-chief of The Lancet.

Results show that healthy life expectancy in America has increased more slowly than life expectancy, indicating that Americans are living more years in poor health than they were in 1990. On a global scale, findings suggest the world may be approaching a turning point in life expectancy gains.

Diabetes is among the top 10 contributors to increasing health loss worldwide, particularly among older adults, as it increased by 148% over the past 30 years. In the United Arab Emirates, the number of DALYs due to diabetes rose by more than 1000% from 1990 to 2019. These increases in ill health “threaten to strain health care systems ill-equipped to handle the chronic conditions associated with growing, aging populations.”

However, risks of obesity, high blood sugar, alcohol use, and drug use, which all contribute to the burden of noncommunicable diseases, are highly preventable, underscoring the need for stronger public health efforts.

“Simply providing information on the harms of these risks is not enough”, said Emmanuela Gakidou, PhD, a co-author of the study. “Given that individual choices are influenced by financial considerations, education, and the availability of alternatives, governments should collaborate globally on initiatives to make healthier behavior possible for everyone.”

Worldwide, researchers found the top risks associated with the highest number of deaths for both sexes combined across all ages were: high systolic blood pressure (10.8 million deaths), tobacco (8.71 million deaths), dietary risks (eg, low fruit, high salt) (7.94 million deaths), air pollution (6.67 million deaths), and high fasting plasma glucose (6.50 million deaths).

“The message of the Global Burden of Disease is that unless deeply embedded structural inequities in society are tackled and unless a more liberal approach to immigration policies is adopted, communities will not be protected from future infectious outbreaks and population health will not achieve the gains that global health advocates seek,” authors of an accompanying editorial concluded. “It’s time for the global health community to change direction.”