A Cross-National Analysis of Premature Non-communicable Diseases (NCD) Mortality Differentials Among 183 Countries

This study firstly used population data from the United Nation (UN) and cause-of-death data from the Global Burden of Disease (GBD) to decompose the change of premature non-communicable disease (NCD) deaths (occurred at age 50–69) into demographic change (population growth and population aging) and epidemiological change among 183 countries. Secondly, this study used country-level data from various sources (such as the World Bank and the World Health Organization (WHO), etc.) and fixed-effects models to examine the major determinants of premature NCD mortality differentials across 183 countries. The determinants include income, education, obesity, tobacco use, alcohol use, physical activity and public health expenditures. The findings from decomposition indicated demographic factors including population growth and population aging have driven up premature NCD deaths significantly over last two decades, while epidemiological change showed the constant progress on declining premature NCD deaths. The fixed-effects models including all major determinants could explain part of NCD mortality differentials across countries. All the risk factors included in the model were positively associated with GDP per capita except smoking, which meant that higher income countries generally had higher prevalence of the risk factors. By controlling these risk factors to predict premature NCD death rates and time-invariant and country-invariant variables, the association between premature NCD mortality rate and socioeconomic development (income, education attainment and public health investments) is not clear. Higher-income countries had lower premature NCD death rate and higher rates of decline of premature NCD death rate, while lower-income countries had higher premature NCD mortality rate and lower rates of decline from period 1990–95 to 2010–15. Thus, the equity gap in terms of premature NCD mortality has widened over the last two decades. To achieve Sustainable Development Goal (SDG), faster declining rate of premature NCD mortality death needs to be achieved to counteract the NCD deaths driven by population aging, and global resources need to be reallocated to close the equity gap.