The rise in people with chronic illnesses and related risk factors, including obesity, high blood sugar, air pollution and alcohol and drug use, over the past 30 years, has inflamed COVID-19 deaths, according to a recent study.

Findings from the Global Burden of Disease (GBD) study, published in the medical journal The Lancet revealed that the global crisis of chronic diseases and the failure of public health to stem the rise in highly preventable risk factors, left populations vulnerable to health emergencies such as the coronavirus pandemic.

The comprehensive global study analyzed 286 causes of death, 369 diseases and injuries and 87 risk factors in 204 countries and territories, from 1990 to 2019.

It found that most of the common chronic, or noncommunicable diseases, and their risk factors, which were revealed to have contributed significantly to health loss worldwide over the past 30 years, are associated with increased risk of serious illness and death from COVID-19.

These include obesity, diabetes, and cardiovascular disease, among others.

"COVID-19 is an acute-on-chronic health emergency. And the chronicity of the present crisis is being ignored at our future peril," said Richard Horton, Editor-in-Chief of The Lancet.

"Non-communicable diseases have played a critical role in driving the more than one million deaths caused by COVID-19 to date, and will continue to shape health in every country after the pandemic subsides," he added.

Global health loss crisis

According to the study, over the past three decades, the top 10 contributors to increasing health loss worldwide include six causes that largely affect older adults, these are ischemic heart disease (coronary heart disease), diabetes, stroke, chronic kidney disease, lung cancer and age-related hearing loss.

Among the risk factors attributable to health loss, measured in disability-adjusted life-years (DALYs) – or the years lost due to disability, illness, and early death – are high systolic blood pressure, high fasting plasma glucose (blood sugar), high body-mass index (BMI), ambient particulate matter pollution (air pollution), alcohol use, and drug use. These stand out because their rates of exposure are increasing by more than 0.5 percent per year.

These particularly large increases in exposure have caused doctors to raise concerns, as several of them are highly preventable risks, yet they are contributing to the growing burden of non-communicable diseases, highlighting the critical need for stronger public health efforts.

"Most of these risk factors are preventable and treatable and tackling them will bring huge social and economic benefits," said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, who led the research.

"We are failing to change unhealthy behaviors, particularly those related to diet quality, caloric intake and physical activity, in part due to inadequate policy attention and funding for public health and behavioural research," he added.

The study did, however, show that the greatest overall impact on health comes from a rise in metabolic risks, which have risen 1.5 percent a year since 2010. The risks, which include high BMI, high blood sugar, high blood pressure and high cholesterol, accounted for nearly 20 percent of total health loss worldwide in 2019 – 50 percent higher than in 1990 when it accounted for 10.4 percent.

They are also responsible for a huge number of deaths globally – with high blood pressure contributing to one in five deaths (almost 11 million) in 2019, high blood sugar (6.5 million deaths), high BMI (5 million deaths), and high cholesterol (4.4 million deaths).

COVID-19 created a 'perfect storm'

The interaction of COVID-19 with this rise in chronic illnesses and their risk factors created a "perfect storm," fueling deaths from the coronavirus, according to the new study.

Scientists previously made a link between these metabolic risks and COVID-19. In August this year, a study at Tulane University in the U.S. found that patients hospitalized with COVID-19 who had a combination of high blood pressure, obesity and diabetes were more than three times likelier to die from the disease.

The study, which was published in the journal Diabetes Care, was the first to look at the impact of metabolic syndrome on outcomes for COVID-19 patients. Metabolic syndrome is a cluster of at least three of five conditions – hypertension, high blood sugar, obesity, high triglycerides and low HDL cholesterol – that increases risk of cardiovascular disease.

In addition, the Centers for Disease Control and Prevention (CDC), has said that adults of any age are at an increased risk of severe illness from COVID-19 if they have any of the conditions including: cancer, chronic kidney disease, COPD (chronic obstructive pulmonary disease), heart conditions, obesity, smoking and type 2 diabetes mellitus.

The view from Europe

According to The Lancet study, the situation of health loss in Europe over the past 30 years has been, and continues to be, a cause for concern.

Scientists said that across Europe, although healthy life expectancy – the number of years a person can expect to live in good health – has increased steadily over the past 30 years, it has not risen as much as life expectancy at birth, indicating that people are living more years in poor health.

Moreover, the study found that non-communicable, or chronic diseases, are now responsible for more than 80 percent of all premature death and poor health (disability-adjusted life-years or DALYs) across Europe. 

Over the past 30 years, the largest contributors to increases in health loss in Central and Western Europe were diabetes and Alzheimer's Disease and other dementias. In Eastern Europe, ischemic heart disease and cirrhosis and other chronic liver diseases were the biggest rising threats to health.

In 2019, across much of Europe, tobacco and high blood pressure were the leading risk factors for health loss.

The top five risk factors for death in Western Europe last year were high blood pressure (contributing to an estimated 787,000 deaths), tobacco use (697,000 deaths), dietary risks (546,000 deaths), high blood sugar (540,000 deaths), and high BMI (406,000 deaths). 

In Central Europe, the risk factors were high blood pressure (395,000 deaths), dietary risks (318,000 deaths), tobacco use (271,000 deaths), high blood sugar (220,000 deaths) and high BMI (213,000 deaths). While in eastern Europe they were high blood pressure (882,000 deaths), dietary risk (683,000 deaths), high LDL cholesterol (543,000 deaths), tobacco use (484,000 deaths) and high BMI (213,000 deaths).

The scientists behind the study are calling on action to be taken, saying that as many of these risks are preventable, they must be addressed and tackled in order for the world's population to be prepared for the impact of any future pandemics such as COVID-19.

"Simply providing information on the harms of these risks is not enough," said co-author Emmanuela Gakidou from IHME. 

"Given that individual choices are influenced by financial considerations, education, and the availability of alternatives, governments should collaborate globally on initiatives to make healthier behavior possible for everyone. And, drawing lessons from decades of tobacco control, when there is a major risk to population health, such as obesity, concerted government action through regulation, taxation, and subsidies may be required," she added.