COVID-19 dropped out of the world’s 10 leading causes of death in 2023 for the first time since the pandemic began in 2020, and only two years after it topped the list, according to new World Health Organization estimates released Friday.

The virus directly killed an estimated 0.9 million people in 2023, ranking 14th, as global life expectancy climbed back to near its pre-pandemic level. WHO declared an end to COVID-19 as a global health emergency in May that year.

Revised figures now rank COVID-19 as the world’s leading cause of death in 2021, with 9.4 million direct deaths. WHO’s earlier estimates had placed it second that year. Together with 5.3 million deaths in 2020, the new figures put the virus’s direct toll in the first two years of the pandemic at 14.7 million.

Figures WHO published in 2024, based on an earlier round of estimates, showed the pandemic had cut global life expectancy by 1.8 years to 71.4 years between 2019 and 2021, back to 2012 levels.

By 2023, global life expectancy at birth had recovered to 73.3 years, against 73.4 years in 2019. Healthy life expectancy, which counts only years lived in full health, rose to 62.8 years but remained 0.4 years below its 2019 level, when COVID-19 first struck.

The estimates, which track more than 160 diseases and injuries from 2000 to 2023, show “a global health landscape that is both recovering from the pandemic and continuing to evolve,” WHO said.

“Living longer is one of the great achievements of public health,” said Dr Alain Labrique, director of WHO’s Department of Data, Digital Health, Analytics and AI. “The next challenge is to ensure that those additional years are lived in good health, while health systems are equipped to respond to the changing needs of populations.”

Chronic diseases claim three in four lives; heart disease is still the top killer

Eight of the 10 leading causes of death were noncommunicable diseases (NCDs), led by ischaemic heart disease, stroke and chronic obstructive pulmonary disease (COPD). NCDs, which also include cancers, diabetes and dementia, accounted for 74% of deaths in 2023, up from 58% in 2000.

For the first time, communicable diseases caused fewer than half of all deaths in low-income countries, which WHO called another step in the global epidemiological transition.

Ischaemic heart disease killed about 9.5 million people in 2023, or 16% of the 61 million deaths worldwide, according to a WHO fact sheet published alongside the estimates. Deaths from the disease have risen by 3.0 million since 2000, the largest increase of any cause.

Stroke killed 6.8 million people and COPD 3.6 million. Lower respiratory infections ranked fourth with 2.7 million deaths, back at their 2019 level and once again the deadliest communicable disease.

Alzheimer disease and other dementias were the fifth leading cause of death, killing 2.1 million people. The conditions ranked 19th in 2000, and deaths have tripled since. Women accounted for 66% of dementia deaths.

Deaths from HIV and AIDS fell 62% over the period, pushing the disease from seventh to 22nd.

Diabetes, cancer and mental health conditions on the rise

Diabetes deaths more than doubled to 2.0 million, while lung cancer deaths climbed from 1.1 million to 1.8 million. Kidney diseases rose from 17th to ninth, with deaths up 86%.

Individual risk of ischaemic heart disease increased in WHO’s Western Pacific and South-East Asia regions even as the burden fell in much of the world. The risk of dying from diabetes also rose substantially, particularly in South-East Asia.

The age-standardized rate of healthy life lost to depressive disorders rose by about 20% worldwide between 2019 and 2023, and by nearly 45% for anxiety disorders. WHO said mental health conditions and drug use disorders, alongside diabetes and dementia, were “contributing to a growing and changing burden of disease.”

“The value of these estimates is not only in the numbers themselves,” Labrique said. “By showing how causes of death and disease burden are changing over time and across populations, they give countries evidence to help shape health policies and priorities.”

Chronic diseases climb in low- and middle-income countries

In low-income countries, seven of the 10 leading causes of death in 2023 were still communicable diseases. Lower respiratory infections have been the top killer there since around 2010, except in 2021, with more than 350,000 deaths every year since 2000 and no notable downward trend.

Malaria, tuberculosis and HIV remained in the low-income top 10, though deaths from all three fell significantly. HIV deaths dropped 62%, and diarrhoeal disease deaths roughly halved, sliding from first to fifth. COPD, which ranks in the top 10 in every other income group, did not make the list.

Lower-middle-income countries had a more even mix, with five NCDs, four communicable, maternal, neonatal or nutritional conditions and road injuries among their top 10. Deaths from ischaemic heart disease, stroke and COPD roughly doubled to take the top three places.

Diabetes deaths more than tripled, lifting it from 15th to fifth, while HIV fell from sixth to 20th as deaths dropped about 70%.

Upper-middle-income countries recorded the largest absolute rise in heart disease deaths of any group, nearly 1.8 million. Lung cancer deaths there more than doubled, an increase of 520,000 that is more than three times the combined rise in the other three income groups. It is also the only group where COVID-19 remained in the top 10, ranked 10th, though deaths have fallen 85% since the 2021 peak.

Heart disease deaths fall in rich countries as dementia climbs

High-income countries were the only group where deaths from ischaemic heart disease, stroke and stomach cancer fell, by 18%, 26% and 27% respectively. The two cardiovascular conditions still killed a combined 3.4 million people in 2023.

Dementia deaths in high-income countries nearly quadrupled, lifting the conditions from seventh to third and past lung cancer. Hypertensive heart disease deaths more than doubled, rising from 15th to eighth. WHO attributed rising deaths from most leading causes in rich countries primarily to population ageing.

“Understanding why people die is essential to improving how people live,” WHO said, while cautioning that accurate mortality data remain hard to collect in many low-income countries, where recording systems are often fragmented, incomplete or inconsistent.

“When these data are disaggregated by factors such as age, sex and geographic location, they can reveal important inequalities and help identify where interventions are most urgently needed,” WHO said.

Image Credits: Shahin Khalaji/ Unsplash.