Reaction: covid-19 replaced stroke as second leading cause of death globally in 2021

In 2021, covid-19 replaced stroke as the second leading age-standardised cause of death, with 94 deaths per 100,000 people, says a study published in The Lancet. The pandemic changed the ranking of the five leading causes of death that had remained stable since 1990, according to the study, which is based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study. The study found that life expectancy since 1990 increased by 6.2 years, an increase that slowed during the pandemic.  

04/04/2024 - 00:30 CEST
Expert reactions

Jesús Adrián - GBD covid EN

Jesús-Adrián Álvarez

Actuary specialising in longevity at ATP Pension Fund and board member of the Danish Demographic Society

Science Media Centre Spain

The main contribution of this study is in describing global disparities regarding the effect of the Covid-19 pandemic on life expectancy.  

These disparities across countries stem largely from:  

  • their distinct epidemiological compositions (i.e. prevalence of diseases) 
  • differences in healthcare systems and interventions.  

For instance, Latin America was among the world regions that were most severely affected by the Covid-19 pandemic. Hundreds of thousands of Latin Americans died during 2020 and 2021, and this is reflected in substantial losses in life expectancy. This high mortality toll in Latin America could potentially be explained by the co-morbidities prevailing in the region. For example, a large proportion of the Mexican population suffers from diabetes and obesity, among other chronic diseases. The prevalence of these co-morbidities made the population more ‘susceptible’ to death when the Covid-19 pandemic hit this population. 

On the other hand, countries such as Spain, Belgium, Italy, and France showed large declines in life expectancy in 2020, but the following year, they had partially recovered from the Covid-19 shock. In Denmark, Norway, and Finland the effect of Covid-19 on life expectancy was almost null during these two years. Altogether, these comparisons show clear disparities, both in terms of population health and in terms of healthcare systems. 

Covid-19 is a new disease that is now added to the ‘menu’ of diseases that can potentially kill us. The picture painted in this study seems to indicate that this new cause of death could disrupt long-term increases in life expectancy. However, historical data from previous pandemics (e.g., the 1918 Spanish flu, which was way more deadly than the Covid-19 pandemic) shows that life expectancy has recovered once the shock has passed, and the long-term upward trend has continued. Therefore, it is too soon to draw conclusions about the future path of life expectancy. Data becoming available in the coming years will most likely shed light on this issue. 

The author has declared they have no conflicts of interest
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
  • Research article
  • Peer reviewed
The Lancet
Publication date

GBD 2021 Causes of Death Collaborators.

Study types:
  • Research article
  • Peer reviewed
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