The rising disabling share of health loss among adults aged 80 years and older: A 34-year GBD 2023 analysis across 10 selected countries, 1990-2023.

Background

Increasing life expectancy has created an epidemiological paradox of declining mortality alongside sustained disability, particularly among the oldest-old. We quantified changes in the fatal and non-fatal composition of health loss among adults aged ≥80 years in 10 selected countries.

Methods

We analyzed Global Burden of Disease (GBD) Study 2023 estimates of years of life lost (YLLs) and years lived with disability (YLDs) from 1990 to 2023. Restricted age-standardized rates (ASRs) were calculated using published GBD 2023 world-standard weights renormalized within ages ≥80 years. We examined the YLD share of disability-adjusted life-years (DALYs), termed the disabling burden ratio (DBR), Level-2 cause composition, Joinpoint trends, descriptive Socio-demographic Index-matched benchmarks, and exploratory time-series projections.

Results

The combined population aged ≥80 years increased from 31.8 million in 1990 to 103.8 million in 2023 (3.26-fold). YLL ASRs declined in all 10 countries (median change, -31.3%), whereas YLD ASRs increased in six (median change, +1.9%). Median DBR increased from 19.0% to 25.9%, although no country reached a YLD-over-YLL crossover. Mean cardiovascular-disease share decreased from 42.3% to 28.6%, while neoplasm and neurological shares increased from 11.7% to 15.7% and from 9.4% to 13.3%, respectively.

Conclusions

Across this purposively selected country sample, health loss at ages ≥80 years shifted toward a larger disabling share while fatal burden remained dominant. The findings support greater emphasis on function-preserving geriatric care and long-term care, but do not by themselves establish individual-level expansion or compression of morbidity.