Pandemic fuels burden of non-COVID diseases

Disease burden has significantly increased because of the COVID-19 pandemic, particularly mental health disorders, malaria in young children in the African region, and stroke and ischaemic heart disease in older adults, reports a study.

“These impacts showed notable disparities by sex and age, highlighting vulnerable populations that were disproportionately affected,” the researchers said.

This time-series modelling study obtained data from the Global Burden of Disease Study 2021. The research team calculated absolute and relative rate differences (RRD) between the observed and expected rates for 174 causes of increases in incidence, prevalence, disability-adjusted life years (DALYs, and deaths in 2020‒2021.

The global rate of age-standardized DALYs significantly increased in absolute difference per 100,000 and RRD by 97.9 (95 percent confidence interval [CI], 46.9‒148.9) and 12.2 percent (95 percent CI, 5.8‒18.5) for malaria, 83.0 (95 percent CI, 79.2‒86.8) and 12.2 percent (95 percent CI, 11.7‒12.8) for depressive disorders, and 73.8 (95 percent CI, 72.2‒75.4) and 14.3 percent (95 percent CI, 14.0‒14.7) for anxiety disorders, respectively. [BMJ 2025;390:e083868]

Moreover, the age-standardized incidence and prevalence per 100,000 significantly increased by 618 (95 percent CI, 589.3‒646.8) and 414.2 (95 percent CI, 394.6‒433.9) for depressive disorders and by 102.4 (95 percent CI, 101.3‒103.6) and 628.1 (95 percent CI, 614.5‒641.7) for anxiety disorders, respectively.

Significant increases were also noted in age-standardized prevalence for ischaemic heart disease (11.3, 95 percent CI, 5.8‒16.7) and stroke (3.0, 95 percent CI, 1.1‒4.8). In addition, age-standardized mortality due to malaria rose significantly (1.3 per 100,000, 95 percent CI, 0.5‒2.1).

Mental health

The most predominant causes of increased DALY burden across the globe were depressive and anxiety disorders, particularly among females. In Africa, malaria had the most severe increased DALY burden, affecting children aged <5 years. In Europe, stroke and ischaemic heart disease showed the greatest rise in DALY burden, affecting individuals aged ≥70 years.

“The pandemic led to major setbacks to global health targets, including the WHO Mental Health Action Plan 2013-2030, WHO’s 2030 goals for malaria and tuberculosis,” the researchers said.

“Overall, the COVID-19 pandemic disrupted essential health services, weakened disease surveillance, and widened health inequalities, altogether exposing critical gaps in health system resilience, particularly in low resource settings,” they added.

Disruptions

Public health and social measures implemented during the COVID-19 pandemic, although necessary for preventing viral transmission, could have caused disruptions to routine health services. This potentially impacted the disease burden of other causes. [Stroke 2020;51:1996-2001; Nat Med 2022;28:1314-1324]

“Evidence suggests that a well-chosen combination of public health and social measures, including less disruptive and costly measures (eg, gathering restrictions), can be just as effective as more intrusive and drastic interventions,” the researchers said. “Appropriately implemented measures can also play a synergistic role in controlling specific diseases.” [Nat Hum Behav 2020;4:1303-1312]

Good examples of these measures included mask wearing requirements in public settings, event cancellations, and crowd gathering restrictions, which resulted in a substantial decrease in the incidence of seasonal influenza and respiratory syncytial virus globally. [Science 2024;386:eadq3003; Nat Rev Microbiol 2023;21:195-210]

“Therefore, selection of appropriate measures is crucial by assessing transmission risks, cost effectiveness, and social acceptability in future pandemic responses, which should strive to mitigate these indirect health setbacks while preserving the observed reductions in certain infections,” the researchers said. [Eur Psychiatry 2023;doi:10.1192/j.eurpsy.2023.2467]