TY - JOUR
T1 - Changing life expectancy in European countries 1990–2021
T2 - a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021
AU - GBD 2021 Europe Life Expectancy Collaborators
AU - Steel, Nicholas
AU - Bauer-Staeb, Clarissa Maria Mercedes
AU - Ford, John A.
AU - Abbafati, Cristiana
AU - Abdalla, Mohammed Altigani
AU - Abdelkader, Atef
AU - Abdi, Parsa
AU - Abeldaño Zuñiga, Roberto Ariel
AU - Abiodun, Olugbenga Olusola
AU - Abolhassani, Hassan
AU - Abu-Gharbieh, Eman
AU - Abukhadijah, Hana J.
AU - Abu-Zaid, Ahmed
AU - Addo, Isaac Yeboah
AU - Addolorato, Giovanni
AU - Adekanmbi, Victor
AU - Adetunji, Juliana Bunmi
AU - Adeyeoluwa, Temitayo Esther
AU - Agardh, Emilie E.
AU - Agyemang-Duah, Williams
AU - Ahmad, Danish
AU - Ahmed, Anisuddin
AU - Ahmed, Ayman
AU - Ahmed, Syed Anees
AU - Akinosoglou, Karolina
AU - Akkaif, Mohammed Ahmed
AU - Al Awaidy, Salah
AU - Al Hasan, Syed Mahfuz
AU - Al Zaabi, Omar Ali Mohammed
AU - Aldridge, Robert W.
AU - Algammal, Abdelazeem M.
AU - Al-Gheethi, Adel Ali Saeed
AU - Ali, Abid
AU - Ali, Mohammed Usman
AU - Ali, Syed Shujait
AU - Ali, Waad
AU - Alicandro, Gianfranco
AU - Alif, Sheikh Mohammad
AU - Al-Jumaily, Adel
AU - Allebeck, Peter
AU - Alrawashdeh, Ahmad
AU - Al-Rifai, Rami H.
AU - Alsabri, Mohammed A.
AU - Alshahrani, Najim Z.
AU - Aluh, Deborah Oyine
AU - Al-Wardat, Mohammad
AU - Al-Zyoud, Walid A.
AU - Amiri, Sohrab
AU - Anderlini, Deanna
AU - Andrei, Catalina Liliana
AU - Anil, Abhishek
AU - Anvari, Saeid
AU - Anyasodor, Anayochukwu Edward
AU - Appiah, Seth Christopher Yaw
AU - Aquilano, Michele
AU - Arabloo, Jalal
AU - Arafat, Mosab
AU - Areda, Demelash
AU - Aremu, Abdulfatai
AU - Armani, Keivan
AU - Armocida, Benedetta
AU - Ärnlöv, Johan
AU - Asaduzzaman, Muhammad
AU - Astell-Burt, Thomas
AU - Aujayeb, Avinash
AU - Ausloos, Marcel
AU - Azadnajafabad, Sina
AU - Aziz, Shahkaar
AU - Azzam, Ahmed Y.
AU - Babu, Giridhara Rathnaiah
AU - Badache, Andreea Corina
AU - Badiye, Ashish D.
AU - Bahramian, Saeed
AU - Baig, Atif Amin
AU - Baker, Jennifer L.
AU - Bansal, Hansi
AU - Bärnighausen, Till Winfried
AU - Barone, Mark Thomaz Ugliara
AU - Barrow, Amadou
AU - Barteit, Sandra
AU - Bashir, Shahid
AU - Bashiru, Hameed Akande
AU - Basso, João Diogo
AU - Bastan, Mohammad Mahdi
AU - Basu, Sanjay
AU - Batra, Kavita
AU - Bauckneht, Matteo
AU - Baune, Bernhard T.
AU - Beghi, Massimiliano
AU - Beiranvand, Maryam
AU - Béjot, Yannick
AU - Bell, Michelle L.
AU - Bello, Olorunjuwon Omolaja
AU - Belo, Luis
AU - Beloukas, Apostolos
AU - Beneke, Alice A.
AU - Bettencourt, Paulo J.G.
AU - Bhagavathula, Akshaya Srikanth
AU - Bhala, Neeraj
AU - Bhaskar, Sonu
AU - Bisulli, Francesca
AU - Bjørge, Tone
AU - Bodunrin, Aadam Olalekan
AU - Botero Carvajal, Alejandro
AU - Bouaoud, Souad
AU - Brayne, Carol
AU - Brenner, Hermann
AU - Briggs, Adam D.M.
AU - Briko, Nikolay Ivanovich
AU - Bugiardini, Raffaele
AU - Buonsenso, Danilo
AU - Busse, Reinhard
AU - Bustanji, Yasser
AU - Caetano dos Santos, Florentino Luciano
AU - Çakmak Barsbay, Mehtap
AU - Capodici, Angelo
AU - Carreras, Giulia
AU - Carugno, Andrea
AU - Carvalho, Felix
AU - Carvalho, Márcia
AU - Castaldelli-Maia, Joao Mauricio
AU - Castelpietra, Giulio
AU - Catapano, Alberico L.
AU - Cattaruzza, Maria Sofia
AU - Cegolon, Luca
AU - Cenko, Edina
AU - Cerin, Ester
AU - Cerrai, Sonia
AU - Chaudhary, Anis Ahmad
AU - Chong, Bryan
AU - Choudhari, Sonali Gajanan
AU - Chu, Dinh Toi
AU - Chukwu, Isaac Sunday
AU - Chung, Sheng Chia
AU - Cioffi, Iolanda
AU - Conde, Joao
AU - Cortese, Samuele
AU - Couto, Rosa A.S.
AU - Criqui, Michael H.
AU - Cruz-Martins, Natalia
AU - Dadras, Omid
AU - Dallat, Mary Anne Teresa
AU - D'Amico, Emanuele
AU - D'Anna, Lucio
AU - Darcho, Samuel Demissie
AU - Dargan, Paul I.
AU - Das, Saswati
AU - de la Torre-Luque, Alejandro
AU - Del Bo', Cristian
AU - Demetriades, Andreas K.
AU - Dervenis, Nikolaos
AU - Devleesschauwer, Brecht
AU - Dhali, Arkadeep
AU - Dhama, Kuldeep
AU - Dianatinasab, Mostafa
AU - Diaz, Michael J.
AU - Dongarwar, Deepa
AU - D'Oria, Mario
AU - Doshi, Ojas Prakashbhai
AU - Dowou, Robert Kokou
AU - Duraisamy, Senbagam
AU - Durojaiye, Oyewole Christopher
AU - Dziedzic, Arkadiusz Marian
AU - Edvardsson, David
AU - Edvardsson, Kristina
AU - Eikemo, Terje Andreas
AU - Ekholuenetale, Michael
AU - Ekundayo, Temitope Cyrus
AU - El Arab, Rabie Adel
AU - Elgar, Frank J.
AU - Elhadi, Muhammed
AU - Eltaha, Chadi
AU - Esposito, Francesco
AU - Fabin, Natalia
AU - Fagbamigbe, Adeniyi Francis
AU - Fagbule, Omotayo Francis
AU - Fakhri-Demeshghieh, Aliasghar
AU - Falzone, Luca
AU - Farinha, Carla Sofia e.Sá
AU - Faris, Pawan Sirwan
AU - Fasina, Folorunso Oludayo
AU - Fazeli, Patrick
AU - Fazylov, Timur
AU - Feizkhah, Alireza
AU - Fekadu, Ginenus
AU - Feng, Xiaoqi
AU - Fereshtehnejad, Seyed Mohammad
AU - Ferrante, Daniela
AU - Ferrara, Pietro
AU - Ferreira, Nuno
AU - Fetensa, Getahun
AU - Fischer, Florian
AU - Fonzo, Marco
AU - Fornari, Arianna
AU - Fortuna, Daniela
AU - Fortuna Rodrigues, Celia
AU - Foschi, Matteo
AU - Fox, Sebastian S.
AU - Freitas, Alberto
AU - Fukumoto, Takeshi
AU - Gadanya, Muktar A.
AU - Gallus, Silvano
AU - Galluzzo, Lucia
AU - Ganesan, Balasankar
AU - Ganiyani, Mohammad Arfat
AU - Gao, Xiang
AU - Garcia-Gordillo, M. A.
AU - Gazzelloni, Federica
AU - Gebregergis, Miglas Welay
AU - Gebremeskel, Teferi Gebru
AU - Ghadimi, Delaram J.
AU - Ghailan, Khalid Yaser
AU - Ghith, Nermin
AU - Gholami, Ehsan
AU - Gialluisi, Alessandro
AU - Gill, Paramjit Singh
AU - Gillam, Tara
AU - Giussani, Giorgia
AU - Glasbey, James C.
AU - Glenn, Scott D.
AU - Göbölös, Laszlo
AU - Goldust, Mohamad
AU - Golechha, Mahaveer
AU - Goleij, Pouya
AU - Golinelli, Davide
AU - Gorini, Giuseppe
AU - Graham, Simon Matthew
AU - Griebler, Robert
AU - Grover, Ashna
AU - Guicciardi, Stefano
AU - Gunturu, Sasidhar
AU - Gupta, Vijai Kumar
AU - Gutiérrez-Murillo, Roberth Steven
AU - Habteyohannes, Awoke Derbie
AU - Haep, Nils
AU - Hai Nam, Nguyen
AU - Haller, Sebastian
AU - Hamoudi, Rifat
AU - Handanagic, Senad
AU - Haro, Josep Maria
AU - Hasani, Hamidreza
AU - Hasnain, Md Saquib
AU - Havmoeller, Rasmus J.
AU - Hay, Simon I.
AU - Hebert, Jeffrey J.
AU - Heibati, Behzad
AU - Hilderink, Henk B.M.
AU - Kaambwa, Billingsley
AU - Naik, Ganesh R.
AU - Shorofi, Seyed Afshin
PY - 2025/3
Y1 - 2025/3
N2 - Background: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021. Interpretation: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Funding: Gates Foundation.
AB - Background: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021. Interpretation: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Funding: Gates Foundation.
KW - Global Burden of Disease
KW - Life expectancy
KW - Europe
UR - http://www.scopus.com/inward/record.url?scp=85219099265&partnerID=8YFLogxK
U2 - 10.1016/S2468-2667(25)00009-X
DO - 10.1016/S2468-2667(25)00009-X
M3 - Article
C2 - 39983748
AN - SCOPUS:85219099265
SN - 2468-2667
VL - 10
SP - e172-e188
JO - The Lancet Public Health
JF - The Lancet Public Health
IS - 3
ER -