Global mortality and DALY burden across major disease categories, 1990–2021: Trends, SDI-related distribution, and drivers of DALY changes

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Background Global disease burden is being reshaped by epidemiological and demographic transitions. We assessed global trends, the sociodemographic index (SDI)-related distribution of mortality and disability-adjusted life-year (DALY) rates, and drivers of total DALY changes across major disease categories during 1990–2021. Methods Using Global Burden of Disease Study 2021 data, temporal trends were assessed using Joinpoint regression and summarised by the average annual percentage change (AAPC). The slope index of inequality (SII) and relative concentration index (RCI) were used to characterise the absolute and relative SDI-related gradients, respectively, in all-age crude mortality and DALY rates under existing demographic structures. Decomposition analysis quantified demographic and epidemiological contributions to DALY changes globally and across SDI groups. Results In 2021, cardiovascular diseases had the highest mortality and DALY rates. Neurological disorders showed the largest increase in mortality rates (AAPC = 2.0%), whereas diabetes and kidney diseases showed the largest increase in DALY rates (AAPC = 1.8%). The burden of communicable, maternal, neonatal, and nutritional diseases (CMNNs) remained concentrated towards the lower-SDI end, but gradients were weaker in 2021 than in 1990. From 1990 to 2021, mortality/DALY SII changed from −1025.4/−69,856.9 to −327.9/−27,671.0 per 100,000, while RCI changed from −49.3%/−51.3% to −24.1%/−40.6%. Conversely, non-communicable disease (NCD) burden remained concentrated towards the higher-SDI end, with stronger gradients: SII increased from 494.9/7752.3 to 669.7/12,629.6 per 100,000, and RCI from 16.0%/5.9% to 19.4%/9.5%. NCD-related DALYs increased by 577 million, mainly because of population growth and ageing. Conclusions Neurological disorders and diabetes and kidney diseases showed the largest increases in mortality and DALY rates, respectively. CMNN-related mortality and DALY burdens remained concentrated towards the lower-SDI end, whereas NCD-related burdens remained concentrated towards the higher-SDI end; the gradients were weaker for CMNNs but stronger for NCDs in 2021 than in 1990. Population growth and ageing mainly drove the increase in NCD-related DALYs.

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