GBD 2023: Leading causes of death around the world

Causes of death are shifting from infectious to non-communicable diseases, creating new global health challenges, particularly for low-income countries. COVID-19, the leading cause of death in 2021, dropped to 20th place in 2023. Ischemic heart disease and stroke ranked first and second in 2023, followed by chronic obstructive pulmonary disease, lower respiratory infections, and neonatal disorders.  

The Global Burden of Disease 2023 study was officially released on October 12, 2025 alongside three capstones published in The Lancet: new findings on global demographics, causes of death, and the burden of diseases, injuries, and risk factors.  

IHME Director Dr. Chris Murray presents the results from the capstone focused on major causes of death.

Video transcript

This transcript has been lightly edited for clarity

In the Global Burden of Disease 2023 analysis of causes of death, spanning from 1990 to 2023, we make use of vital statistics, with medical certification of causes of death, that cover almost 100 countries. Some of those are not 100% complete, but there’s still rich data for 100 countries. And then we use other sources, depending on the cause, in low-resource settings that don’t have complete vital statistics, things like verbal autopsy, or some surveillance systems that are specific to, let’s say, maternal mortality, or reported injuries, in some sources and surveys, and sometimes even censuses.

So we put all those sources together and we try to come up with that global assessment and country-specific assessment of age-, sex-, and cause-specific mortality, for a long list of causes. Now, if we zoom out and look at the big picture, one of the big stories of the last five years has been the arrival of the COVID pandemic, and then the receding rates of death due to COVID.

Cumulatively, there have been 18 million deaths from COVID that we can find evidence of. And COVID got to be the number one cause of death in the world in 2021. And now, in 2023, it’s down to about the 20th cause of death in the world – so marked reductions in COVID after the huge surge. The big story as we look at the big picture on causes of death is the massive transition in every region of the world, except in sub-Saharan Africa, toward non-communicable diseases deaths.

That transition is really quite rapid in lower-middle-income and upper-middle-income countries. We were already, even in 1990, very far along in that transition in high-income countries, with mortality nearly 80% due to non-communicable diseases. But what’s interesting is the decline in non-communicable disease mortality that we’ve observed until very recently in higher Socio-demographic Index countries, more advanced countries in terms of demography, has continued – maybe a little bit of a plateau recently – but the rates in the low-resource settings, the age-standardized rates, haven’t really declined very much, probably due to access to health care and other interventions, meaning that in 1990 there were higher rates in the top quintile in terms of SDI, Socio-demographic Index. And now it’s inverted, with the lowest quintile with the highest rates.

That change in the rates, combined with population growth and aging of the population, is what’s driving this huge shift in causes of death toward the NCDs. So when we look at the global level, what we see for the top causes of death is ischemic heart disease and stroke are one and two at the global level. And then we have chronic obstructive pulmonary

disease. And then finally, we start to see some of the infectious diseases still in that top five, lower respiratory infections, or pneumonia, and neonatal disorders making up the rest of the top five. But really the shift toward NCDs is steady and profound. Now, in general, the numbers are going up because of aging and population growth, but the rates are either stagnant or dropping for most causes. But there are a few exceptions. There are some causes of death where the rates themselves are tending to go up at the global level, and then very much so at the local level; that’s well documented in the study. So, for example, deaths related to heat and cold exposure are going up. Deaths due to drug use disorders are going up.

And then, depending on where you look, deaths due to some of the other causes that are obesity-related, such as diabetes, may be increasing as well. So there’s this pattern of shift toward NCDs and general progress on the age-specific rates, but health systems still have to deal with this rising toll of NCD mortality.

One of the interesting effects of combining the trends in age-specific rates and demography – the age structure of population – is looking at the mean age of death, which we explore extensively in this study. And that leads to some surprises. For example, if you take something like ischemic heart disease, the mean age of dying from ischemic heart disease is much younger in sub-Saharan Africa than it is, for example, in Europe. And that is because, not that the rates are particularly higher – they’re somewhat higher – but it’s that the population structure is much younger. You put those together, and the average age of death can be 10 years or more younger for some of the chronic diseases than we see in high-income settings.

We try to track closely, on a very regular basis, what’s happening in cause-specific mortality, because what COVID has taught us, what the rise of drug use disorders has taught us, what the rise of suicide in some age groups has taught us, is that things can change very quickly at the local and the age-specific level.

And it’s important for public health authorities, health system leaders, to keep on top of those trends and respond appropriately as new challenges emerge.