Morbidity gap widening across most countries since 1990, study finds

Healthy life expectancy fell short of total life expectancy by 10.7 years in 2023, up from 8.8 years in 1990, revealing that people world over are living longer, but spending more years in poor health, according to a study published in The Lancet Public Health journal.

Estimates also suggest that globally, people spent an average of 14.5 %of their lives in poor health in 2023, up from 13.6% in 1990.

Further, instead of occurring only in the final years of life, the widening morbidity gap — the difference between total life expectancy and healthy life expectancy — was observed across the adult lifespan, suggesting that people are spending more years living with disease and disability throughout adulthood, researchers, including those from the Institute for Health Metrics and Evaluation (IHME) at the US’ University of Washington, said.

In India, morbidity gap in 2023 was 10.6 years, up from 8.4 years in 1990 — total life expectancy was 71.6 years in 2023 and 58.5 years in 1990, while healthy life expectancy was 61.0 years in 2023 and 50.1 years in 1990, the study shows.

“Our findings suggest that future gains in population health will come not only from helping people live longer, but from helping them live healthier,” senior author Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington’s school of medicine.

“Progress in healthy aging should be measured not only by lifespan, but by healthspan, with greater investment in prevention, long-term disease management, and chronic care to reduce years lived in poor health,” Murray said.

The analysis is based on Global Burden of Disease (GBD) 2023 estimates, coordinated by the University of Washington.

Women consistently lived longer than men but also showed a larger morbidity gap compared to men, indicating that women spent more years living in poor health — with disease and disability — across every region and level of development, the analysis revealed.

The pattern shows that longer life expectancy among women has not translated into the same gains in healthy years, the researchers said.

In 2023, women globally experienced an average morbidity gap of 12.1 years, compared with 9.3 years for men.

Morbidity gap for men in India increased from 7.5 years in 1990 to 9.1 years in 2023, while that for women increased from 9.4 years in 1990 to 12 years in 2023.

“Women are living longer than men almost everywhere in the world, but they are also spending more of those additional years in poor health,” co-author Catherine Bisignano, senior scientific writer at IHME, said.

“Improving healthy ageing will require greater focus on the conditions and risk factors that drive years lived with disability. Addressing these earlier through prevention and better long-term care could have meaningful social, health system, and economic impacts,” Bisignano said.

Musculoskeletal disorders, particularly low back pain, were the largest contributor to morbidity gap for both the sexes worldwide, followed by mental disorders such as depression and anxiety.

Years spent in poor health were largely linked to preventable or manageable risk factors — globally, high fasting plasma glucose and high body mass index were the leading risk factors contributing to the morbidity gap.