Chronic Conditions Dominate Global Health Burden, GBD 2019 Study Reports
Chronic care needs account for the majority of global disease burden—comprising 68% of all disability-adjusted life years (DALYs) and over 86% of years lived with disability (YLDs)—a new Global Burden of Disease (GBD) 2019 study has reported.
Published in Nature Communications in May 2025, the study titled “Characterising Acute and Chronic Care Needs: Insights from the Global Burden of Disease Study 2019” provides a comprehensive reassessment of health system demands by classifying 297 diseases and 379 sequelae as either requiring acute or chronic care. The findings aim to guide health policy planning, resource allocation, and systems-level reforms across 204 countries and territories.
Conducted by the GBD 2019 Acute and Chronic Care Collaborators, this cross-sectional analysis used epidemiological estimates from the Institute for Health Metrics and Evaluation (IHME). Outcomes assessed included:
- Disability-adjusted life years (DALYs)
- Years lived with disability (YLDs)
- Years of life lost (YLLs)
Each disease and sequela was independently classified by clinicians as acute or chronic using structured criteria. The dataset was stratified by age, sex, country, and socio-demographic index (SDI).
Key Findings
Global Disease Burden Skews Heavily Toward Chronic Care
- 68% of DALYs and 86% of YLDs were due to chronic conditions.
- Chronic care needs represented 71% of YLLs.
- Only 27% of total DALYs were attributable to acute conditions.
Sequelae Burden
- Chronic care-related sequelae were responsible for 93.1% of all YLDs globally.
- Type 2 diabetes complications accounted for the highest chronic YLDs.
Age-Related Trends
- Chronic care burden increases significantly after age 25.
- In children under five, acute conditions contributed more substantially to YLLs.
Geographic and Socioeconomic Gradients
- In low-SDI countries, 52% of DALYs were due to acute conditions.
- High-SDI countries had up to 98% of YLDs attributable to chronic sequelae.
- Niger showed the highest acute care burden (72% of DALYs), while Italy had the lowest (6%).
Sex-Based Differences
- DALYs and YLLs were higher in males, especially for acute conditions.
- Women had slightly higher YLDs, particularly in low-SDI regions.
Top Conditions
- Ischemic heart disease, type 2 diabetes, stroke, and major depressive disorder dominated the chronic care burden.
- Out of the top 10 global causes of DALYs, six were chronic.
Health System Implications
The findings suggest that most global health systems, which remain structured around acute care models, are misaligned with the actual needs of their populations. The study supports WHO’s call for integrated and proactive chronic care delivery through frameworks such as the Innovative Care for Chronic Conditions Framework (ICCCF) and Universal Health Coverage (UHC) policies.
Particular emphasis is placed on:
- Reallocating resources to chronic disease management
- Training healthcare professionals for continuity of care
- Community-based support systems for long-term care
- Minimising preventable acute exacerbations of chronic conditions
The authors highlight that chronic conditions, such as diabetes and cardiovascular diseases, often lead to avoidable acute episodes if not managed adequately—creating a feedback loop that further strains under-resourced systems. Future research must explore the intersection of chronic and acute care demands, particularly the management of acute events in chronic disease patients and the growing challenge of multimorbidity. In addition, policy development must factor in economic implications, caregiver burden, gender disparities, and resilience against care disruptions like those seen during the COVID-19 pandemic.
This GBD 2019-based analysis offers a compelling call to action: the global health agenda must now prioritise chronic disease care. With chronic conditions contributing the largest share of health burden across all age groups and SDI strata, health systems must reorient toward sustainable, person-centred care models that bridge gaps across primary, secondary, and community care. Effective transformation will demand multidisciplinary collaboration, robust policy support, and investment in long-term care infrastructure.
Reference: GBD 2019 Acute and Chronic Care Collaborators. Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019. Nature Communications. 2025;16:4235. https://doi.org/10.1038/s41467-025-56910-x
