Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019

María Jesús Ríos-Blancas(Instituto Nacional de Salud Pública), Victoria Pando‐Robles(Instituto Nacional de Salud Pública), Christian Razo(University of Washington), César Cárcamo(Universidad Peruana Cayetano Heredia), Walter Mendoza(United Nations Population Fund), Kevin Pacheco‐Barrios(Harvard University), J. Jaime Miranda(Universidad Peruana Cayetano Heredia), Van Charles Lansingh(Instituto Mexicano de Oftalmología IAP), Takele Gezahegn Demie(St. Paul's Hospital Millennium Medical College), Manika Saha(Deakin University), Osaretin Christabel Okonji(University of the Western Cape), Arzu Yiğit(Suleyman Demirel University), Lucero Cahuana-Hurtado(Universidad Peruana Cayetano Heredia), Pamela Roxana Chacón-Uscamaita(Universidad Peruana Cayetano Heredia), Eduardo Bernabé(King's College London), Carlos Culquichicón(Universidad Norbert Wiener), Jesús Lorenzo Chirinos-Cáceres(Universidad Peruana Cayetano Heredia), Rosario Cárdenas(Universidad Autónoma Metropolitana), Jacqueline Elizabeth Alcalde‐Rabanal(Instituto Nacional de Salud Pública), Francisco J. Barrera(Harvard University), Beatriz Paulina Ayala Quintanilla(La Trobe University), Seyed Afshin Shorofi(Flinders University), Nuwan Darshana Wickramasinghe(Rajarata University of Sri Lanka), Nuno Ferreira(University of Nicosia), Louay Almidani(University of California, Los Angeles), Vivek Gupta(Macquarie University), Hanie Karimi(Tehran University of Medical Sciences), Daniel Shewaye Alayu(University of Gondar), Catherine P. Benziger(Essentia Health), Takeshi Fukumoto(Kobe University), Ebrahim Mostafavi(Cardiovascular Institute of the South), Elrashdy M. Redwan(King Abdulaziz University), Mesfin Gebrehiwot(Wollo University), Khaled Khatab(Sheffield Hallam University), Ai Koyanagi(Institució Catalana de Recerca i Estudis Avançats), Fiorella Krapp(Universidad Peruana Cayetano Heredia), Seung Lee(Sungkyunkwan University), Maryam Noori(Iran University of Medical Sciences), Ibrahim Qattea(Case Western Reserve University), Víctor Rosenthal, Joseph W. Sakshaug(Institute for Employment Studies), Birhanu Wagaye(Ethiopian Public Health Institute), Iman Zare, Doris V Ortega-Altamirano(Instituto Nacional de Salud Pública), Efrén Murillo‐Zamora(Mexican Social Security Institute), Dominique Vervoort(Johns Hopkins University), Diego Augusto Santos Silva(Universidade Federal de Santa Catarina), Abderrahim Oulhaj(Khalifa University of Science and Technology), Brenda Yuliana Herrera-Serna(Universidad Autonoma de Manizales), Rahul Mehra(Maharishi Markandeshwar University, Mullana), Mehrdad Amir‐Behghadami(Tabriz University of Medical Sciences), Nasrin Adib(Shahid Bahonar University of Kerman), Sandra Cortés(Pontificia Universidad Católica de Chile), Anh Kim Dang(Duy Tan University), Binh Thanh Nguyen(University of Washington), Ali H. Mokdad(University of Washington), Simon I Hay(University of Washington), Christopher J L Murray(University of Washington), Rafael Lozano(University of Washington), Patricia García(Universidad Peruana Cayetano Heredia)
Frontiers in Public Health
June 22, 2023
10.3389/fpubh.2023.1189861
Cited by 30Open Access
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Abstract

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

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