Non-communicable diseases (NCDs) remain the leading cause of death worldwide, and tracking mortality changes over time is central to policy and planning. Using the unconditional probability of dying from an NCD between birth and age 80 years, an analysis across 185 countries shows widespread declines through 2010–2019 yet momentum weakened compared with 2001–2010. Circulatory diseases underpinned much of the improvement and several cancers contributed, while neuropsychiatric conditions and pancreatic and liver cancers often moved in the opposite direction. The picture is heterogeneous across regions and sexes, with notable performance gaps between regional frontrunners and other countries and with changes at working and older ages sometimes pulling in different directions.
Measuring Change Across 185 Countries
NCD mortality was assessed using age-specific death rates and life table methods to derive the unconditional probability of death from birth to age 80 years, independent of population age structure and unaffected by competing non-NCD causes. Based on 2021 WHO Global Health Estimates, the probability of dying from an NCD before age 80 years declined from 2010 to 2019 in 152 of 185 countries for females and 147 for males. Those countries encompassed roughly 72% of the world female population and 73% of the world male population in 2019. Declines were small to moderate in many settings, and in 44 countries for females and 58 for males the reduction was statistically distinct from no change.
Despite broad improvement, comparison with 2001–2010 indicates slower progress for most countries. About 41% of countries for females and 39% for males recorded a more favourable decadal change after 2010, while the remainder saw smaller declines, larger increases or reversals of earlier gains. The slowdown reflected multiple causes rather than a single driver, with many NCDs that had fallen earlier in the millennium decelerating after 2010.
Uneven Progress by Region and Country
Patterns varied substantially by region. All high-income western countries experienced declines for both sexes over 2010–2019, with Denmark recording the largest decline and the USA the smallest among that group. The mean absolute reduction reached about 3 percentage points for females and 5 percentage points for males in this region. Central and eastern Europe posted some of the largest male declines on average, while females in central Asia, Middle East and North Africa saw the greatest average reduction. By contrast, Pacific Island nations registered the smallest declines for both sexes despite starting from high mortality levels in 2010.
At country level, the largest decreases in the probability of dying from an NCD before age 80 years were seen in parts of central Asia, Middle East and North Africa. Azerbaijan, Qatar and Uzbekistan recorded double-digit percentage point reductions for both sexes though uncertainty is higher where underlying data quality was rated low or very low. Moldova also posted large declines. Increases were concentrated in subsets of sub-Saharan Africa and Latin America and the Caribbean, with rises for one or both sexes in countries including Jamaica, Guatemala and Peru, alongside several settings with low or very low data quality where uncertainty is greater.
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Among the most populous countries, trajectories diverged. China, Russia, Nigeria, Egypt and Brazil saw declines for both sexes over 2010–2019, whereas India and Papua New Guinea recorded increases. The USA registered small changes for both sexes. Convergence and divergence also differed by region: convergence occurred within central Asia, Middle East and North Africa and to a lesser extent central and Eastern Europe, while East and Southeast Asia saw divergence as lower-baseline countries such as Singapore and South Korea achieved larger declines.
Cause-Specific Drivers of Change
Decomposition of changes attributed much of the overall improvement to circulatory diseases. Ischaemic heart disease was the largest single contributor to falling NCD mortality in most of the 63 countries analysed for cause-specific patterns, with stroke commonly the second contributor, especially in central and eastern Europe. In several countries, however, rising ischaemic heart disease mortality offset gains and coincided with increases in total NCD mortality, with only a few exceptions where overall NCD mortality still fell despite that rise.
Cancers as a group tended to lower overall NCD mortality in the majority of countries assessed. Lung cancer displayed marked sex and geography contrasts. For males, lung cancer mortality declined in most countries and made a prominent contribution to overall improvement, including in multiple high-income western settings. For females, lung cancer trends were split: improvements in some countries contrasted with increases in central and Eastern Europe and parts of Western Europe and Latin America, where rising female lung cancer mortality diminished national gains or amplified increases. Chronic obstructive pulmonary disease also contributed to declines in several countries.
Not all major causes moved favourably. Neuropsychiatric conditions and pancreatic and liver cancers frequently contributed to higher NCD mortality after 2010. Age patterns mattered as well. In some countries, working-age and older-age mortality shifted in the same direction, producing large overall declines or increases. In others, opposing age-specific trends tempered the net change, illustrating how aggregate progress can mask divergent trajectories within populations.
Sex differences added another layer. Males experienced greater standard deviation in change than females and in just over half of countries male declines exceeded female declines over 2010–2019. Even so, females had lower absolute probabilities of dying from an NCD before age 80 years than males in the vast majority of countries by 2019.
Global NCD mortality fell in four out of five countries between 2010 and 2019 yet gains were generally smaller than in the preceding decade and differed widely by region, sex and cause. Circulatory diseases and several cancers underpinned many of the improvements, while increases in neuropsychiatric conditions and pancreatic and liver cancers, alongside rising female lung cancer in some regions, constrained progress. For health leaders, the findings point to sustained attention on cause- and age-specific patterns, benchmarking against regional best performers and vigilance where earlier declines have slowed or reversed to maintain momentum in reducing premature NCD deaths.
Source: The Lancet
Image Credit: iStock
References:
Bennett JE, O'Driscoll ON, Stevens GA et al. (2025) Benchmarking progress in non-communicable diseases: a global analysis of cause-specific mortality from 2001 to 2019. The Lancet; 406,10509: 1255 – 1282.
