Chronic Disease Deaths Have Fallen Globally, but Progress in U.S. Stalled

Chronic diseases like heart disease, cancer and diabetes are some of the leading causes of death around the world. A new global study shows that deaths from such “noncommunicable” conditions have been declining in most countries — but the pace of that decline, including in high-income countries like the United States, has slowed in recent years.

The probability of dying from a chronic disease between birth and age 80 dropped in about 150 countries from 2010 to 2019, the study, published Wednesday in The Lancet, found. But compared to the previous decade, there was a widespread slowdown — in some cases, even a reversal — in progress.

In the United States, the overall probability of dying from a chronic disease fell markedly between 2001 and 2010 but remained nearly flat over the following nine years. Among younger adults (20 to 45 years old), this probability increased — a rarity among high-income countries. The chance of dying specifically from neuropsychiatric conditions like Alzheimer’s disease and alcohol and drug use disorders also rose in the United States during this period.

Countries in Eastern Europe and Central Asia — including Azerbaijan, Uzbekistan, Moldova and Russia — saw the greatest declines in the probability of death from chronic disease from 2010 to 2019, whereas some countries in Latin America and the Caribbean, Africa and South Asia saw slight increases.

The overall decline in deaths is unquestionably good news, said Dr. Karen Hacker, a former director of chronic disease prevention and health promotion at the Centers for Disease Control and Prevention who was not involved in the research. The bad news, though, is that there are still large numbers of people, in the United States and elsewhere, getting sick and dying from chronic diseases — and more are expected to as populations age.

“These are still the leading causes of death, no matter how you cut it,” said Dr. Hacker, who is now an adjunct professor of public health at Emory University. And there continue to be huge disparities between and within countries, suggesting that effective public health interventions are not reaching everyone.

To some extent, the numbers reflect what might be expected from trends over time, said Magali Barbieri, a researcher in demography at the University of California, Berkeley, who was not involved in the research.

Starting in the 1960s, a number of public health and medical interventions began to bring down death rates from chronic diseases in high-income countries, Dr. Barbieri said. The 1964 Report on Smoking and Health from the U.S. surgeon general led to declines in smoking that had a major effect on deaths from heart disease and cancer. Similarly, the widespread adoption of drugs proven to lower blood pressure, cholesterol and glucose have helped prevent diabetes, heart attacks, strokes and kidney disease, researchers noted.

More recently, clinical guidelines that set lower thresholds for treating these risk factors have helped physicians slow the progression of disease, said Judith Lichtman, a professor of epidemiology at the Yale School of Public Health who was not involved in the study. And patients who are hospitalized for a stroke or heart attack today face much better odds of surviving because of faster and better treatment, Dr. Hacker said.

The overall U.S. cancer mortality rate has also dropped 34 percent over the last 30 years. Much of that was driven by drops in smoking-related lung cancer. The uptake of vaccines that help prevent cancer, including against hepatitis B and the human papillomavirus, also helped. So, too, have screening programs that detect cancer at earlier stages and new treatments that prolong survival, for example for breast and lung cancers.

But as the initial gains from implementing these changes have subsided, progress has slowed, particularly in high-income countries. In the United States, the probability among women of dying from a chronic disease dropped to under 33 percent in 2010 from almost 38 percent in 2001, but fell only slightly, to 31.5 percent, by 2019. Among males the probability fell to 43 percent in 2019, from 43.4 percent in 2010 and 50 percent in 2001.

“The things that were helping have sort of reached their maximum impact,” Dr. Barbieri said, while “the things that are detrimental seem to be increasing.” Metabolic disorders such as obesity, high blood pressure and diabetes are rising; these increase the risk of heart disease, stroke and kidney and liver diseases.

Cigarette smoking among U.S. adults is down to about 12 percent, from 42 percent in 1965; while that could fall further, getting there may require a different strategy and the effect may be mild in comparison to the past.

The rising incidence of some cancers — including pancreatic, liver and early-onset colorectal cancer — also threatens to undermine the progress on cancer mortality.

The Lancet paper included drug use disorders and other neuropsychiatric conditions under the umbrella of chronic diseases. The opioid epidemic may have blunted the decline in deaths from other chronic diseases, Dr. Hacker said.

Majid Ezzati, a professor of global environmental health at Imperial College London and the senior author of The Lancet paper, said the plateauing of progress in the United States and high-income countries across Europe also suggests that public health and medical interventions simply are not reaching certain pockets of the population.

In 2008, Dr. Ezzati and colleagues at Harvard published research showing that life expectancy had actually declined in some U.S. counties, which at the time was unheard of for a wealthy, industrialized country. “There is just a segment of population not getting better, and that segment seems to be spreading,” he said.

Such a result is not necessarily inevitable, Dr. Ezzati said. Denmark, Norway, Sweden, South Korea and Japan — all high-income countries that started off at roughly comparable or lower levels of chronic disease deaths in 2001 to the United States — saw continued overall declines in the probability of such deaths.

The authors pointed to South Korea’s robust primary care network (the country has one of the highest number of doctor consultations per person among peer countries) and rigorous program for diagnosing and treating hypertension and diabetes as possible explanations. They also cited the country’s investments in universal health insurance and broad-based education for addressing some of the social determinants of health.

“South Korea shows that we can actually go really low,” Dr. Ezzati said.