The burden of disease in Italy, 1990-2023: a subnational analysis from the Global Burden of Disease Study 2023

Objectives: to provide a comprehensive and comparable assessment of life expectancy (LE), health-adjusted life expectancy (HALE), Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability-Adjusted Life Years (DALYs) across Italian regions from 1990 to 2023, identify-ing temporal, geographical, and sex-specific patterns to in-form targeted public health strategies. Design: descriptive epidemiological study using estimates from the Global Burden of Disease Study (GBD) 2023. Setting and participants: the analysis covered the Italian population, stratified by sex, five macro-regions, and 21 subnational locations, including 19 Regions and 2 Autono-mous Provinces. Main outcome measures: LE, HALE, all-age and age-standardized rates YLDs, YLLs, and DALYs per 100,000 population; all estimates were presented with their 95% un-certainty intervals. Results: between 1990 and 2023, LE increased substantially across all regions and in both sexes, despite the temporary decline associated with the COVID-19 pandemic. In 2023, the highest LE was recorded in the North-East, with 81.4 years (95%CI 81.1-81.6) for males and 85.8 years (95%CI 85.6-86.1) for females, while the lowest values were found in the Islands, at 79.7 years (95%CI 79.3-80.1) for males and 84.2 years (95%CI 83.9-84.5) for females. However, differences diminished when considering HALE. YLDs increased steadily over time, reflecting not only population ageing but also the expanding burden of chronic and non-fatal conditions. In contrast, YLLs declined markedly in both sexes, driven particularly by substantial reductions in mortality from neoplasms and cardiovascular diseases. However, in 2023, ischemic heart disease remained the leading contributor to all-age DALYs among males, while Alzheimer’s disease was the top cause among females. Anxiety disorders represented the leading cause of age-standardized DALYs in females and showed marked in-creases since 1990. Among males, ischemic heart disease continued to appear as the primary cause of age-standardized DALYs. Conclusions: health in Italy improved substantially over the past three decades, primarily due to declining premature mortality. However, the burden of disability increased, particularly among women, and important geographical and sex-specific inequalities persist. Strengthening prevention policies, addressing behavioural and metabolic risk factors and mental health, improving long-term care, and promoting healthy ageing are essential to reducing health disparities.