Burden of non-communicable diseases and their attributable risk factors in Africa from 1990 to 2023: a systematic analysis for the Global Burden of Disease Study 2023.

BACKGROUND: The rapid rise in the burden of non-communicable disease (NCDs) in African communities has resulted in a considerable mortality, disability, and economic burden. A comprehensive evaluation of incidence, deaths, disability-adjusted life-years (DALYs), and attributable risk factors related to NCDs by sex, and geographical location is essential for informing policy decisions aimed at controlling these diseases. METHODS: This study used a comprehensive analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 methodology to estimate the incidence, mortality, DALYs (estimated as the sum of years of life lost and years lived with disability [YLDs]), and attributable risk factors of NCDs in Africa. Data were systematically searched for and extracted from various sources, including vital registration, verbal autopsy, surveillance systems, police reports, censuses, surveys, minimally invasive tissue sampling, and sibling history. The analysis employed the Cause of Death Ensemble model, DisMod-MR 2.1, and spatiotemporal Gaussian process regression to estimate both fatal and non-fatal health metrics associated with NCDs in Africa overall, and by region and country. FINDINGS: In 2023, NCDs in Africa accounted for an estimated 2·33 billion (95% uncertainty interval 2·22-2·50) incident cases, 4·70 million (4·47-4·93) deaths, and 263 million (234-293) DALYs. Although absolute numbers increased between 1990 and 2023, age-standardised rates (per 100 000 population) decreased modestly: incidence rate by 2·7% (0·2-5·0), mortality rate by 9·0% (2·5-15·5), and DALY rate by 6·4% (1·2-12·0). The five leading Level 3 causes of death in Africa in 2023 were ischaemic heart disease (801 000 [653 000-965 000]), stroke (700 000 [544 000-863 000]), chronic kidney disease (293 000 [224 000-359 000], hypertensive heart disease (246 000 [170 000-337 000]), and diabetes (245 000 [190 000-314 000]) for all sexes and ages. Leading Level 2 causes of YLDs were mental disorders (30·9 million [22·0-42·2]) and musculoskeletal disorders (17·1 million [12·5-22·7]). Overall, 35·1% (32·4-38·2) of DALYs and 57·4% (54·2-60·4) of deaths due to NCDs were attributable to the 88 GBD 2023 risk factors. High systolic blood pressure contributed the largest proportion at 26·2% (21·6-30·9) of all NCD deaths in Africa, followed by dietary risks (14·7% [5·1-21·6]) and air pollution (14·2% [11·6-16·9]). INTERPRETATION: Our findings underscore the complex and evolving nature of the NCD burden in Africa, where modest declines in age-standardised mortality and DALY rates since 1990 have been substantially offset by rising absolute counts of deaths and DALYs-a paradox driven predominantly by rapid population growth and demographic changes. That more than half of all NCD deaths and over a third of DALYs remain attributable to modifiable risk factors-principally high systolic blood pressure, dietary risks, and air pollution-suggests that a substantial and actionable proportion of this burden is preventable through available and effective interventions, carrying urgent implications for African governments, ministries of health, and global health partners, who must take decisive action to meet health commitments. FUNDING: Gates Foundation.