Within a single generation, the global morbidity gap—the difference between life expectancy and healthy life expectancy—expanded from 8.8 years in 1990 to 10.7 years in 2023. During the same period, the proportion of life spent in poor health increased from 13.6% to 14.5%, indicating that people are living longer but spending a greater share of their lives with illness or disability. Rather than being confined to old age, this widening gap now extends throughout adulthood, reflecting an increasing burden of chronic disease and disability across the lifespan.

Using estimates from the Global Burden of Disease (GBD) 2023 study, researchers evaluated global trends in healthy aging between 1990 and 2023. The analysis compared changes in life expectancy, healthy life expectancy, and the morbidity gap across countries, regions, sexes, and socio-demographic development levels, while also identifying the leading diseases and risk factors responsible for years lived in poor health.

Longer Lives, But Not Healthier Ones

From 1990 to 2023, global life expectancy at birth rose from 64.6 to 73.8 years, while healthy life expectancy increased from 55.9 to 63.1 years. However, improvements in survival consistently exceeded gains in healthy years, resulting in more time spent living with chronic illness and disability. Although the COVID-19 pandemic temporarily affected both life expectancy and healthy life expectancy, it did not alter the long-term trend of a growing morbidity gap.

"Our findings suggest that future gains in population health will come not only from helping people live longer, but from helping them live healthier," said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine and senior author of the study. "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."

High-Income Countries Experience the Largest Morbidity Gaps

The burden of poor health differed widely across countries and regions, with the greatest morbidity gaps generally occurring in populations that also enjoy the longest life expectancy. In 2023, the United States recorded the largest national morbidity gap at 14 years, followed by Australia (13.9 years) and Canada (13.7 years). Countries with higher Socio-demographic Index (SDI) levels typically experienced longer lifespans but also more years lived with disease and disability, highlighting that increases in longevity have not been matched by equivalent improvements in healthspan.

This pattern was observed across all seven GBD super-regions. Between 1990 and 2023, every super-region experienced increases in both the number of years and the proportion of life spent in poor health. The high-income super-region reported the largest morbidity gap in 2023 (12.7 years), while sub-Saharan Africa had the smallest (9.0 years).

Women Live Longer, But Spend More Years in Poor Health

Across all regions and levels of socio-demographic development, women consistently outlived men but also spent more years living with illness and disability. In 2023, women experienced an average morbidity gap of 12.1 years, compared with 9.3 years for men. This trend remained consistent across all SDI quintiles, demonstrating that women generally gain more years of life but not necessarily more years of good health.

"Women are living longer than men almost everywhere in the world, but they are also spending more of those additional years in poor health," said Catherine Bisignano, Senior Scientific Writer at IHME and co-author of the study. "Improving healthy aging 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."

Prevention and Chronic Care Are Essential for Healthy Aging

A relatively small group of chronic, largely non-fatal conditions accounted for 57.4% of all years lived in poor health worldwide in 2023. Musculoskeletal disorders—particularly low back pain—were the leading contributors to the morbidity gap, followed by mental health disorders such as depression and anxiety, sense organ diseases including age-related hearing loss, falls and other unintentional injuries, and other chronic non-communicable diseases.

Many of these years lived in poor health were associated with preventable or manageable risk factors. Globally, the leading contributors included high fasting plasma glucose, elevated body mass index (BMI), child and maternal malnutrition, and tobacco use. However, the importance of specific risk factors varied by region and level of development. In sub-Saharan Africa and other low-SDI settings, child and maternal malnutrition remained the leading contributor, while air pollution also ranked among the top risk factors.

As populations continue to age, improving healthy aging will require stronger emphasis on disease prevention, early intervention, disability prevention, and access to rehabilitation, mental health services, and long-term chronic care. Reducing exposure to key risk factors and strengthening health systems that support healthy aging will be critical to narrowing the growing morbidity gap and reducing the burden of disability on individuals, families, and societies.

Source: https://www.news-medical.net/news/20260721/Global-study-reveals-widening-gap-between-lifespan-and-healthspan.aspx