An updated analysis of serious health-related suffering from 2021 to 2023.

Abstract

Assessment of the global burden of serious health-related suffering (SHS) is critical to determining the need for palliative care. This burden is disproportionately concentrated in low- and middle-income countries (LMICs), where palliative care access is suboptimal or entirely lacking. Previous SHS estimations have provided a vital indicator for health system performance assessment and a framework for tracking progress on palliative care - a cornerstone of universal health coverage (UHC). This brief report provides updated SHS estimates for 2021 and 2023, anchored in mortality and prevalence data from Global Burden of Disease (GBD) 2023. Specifically, it presents the global burden of SHS in 2023 and analyzes shifts between 2021 and 2023 across associated health condition, country-income group, and geographic region. Utilizing previously published SHS 2.0 methodology, condition-specific multipliers are applied to GBD 2023 data to generate updated estimates of palliative care need across 21 health conditions, distinguishing between decedents (accounted for in mortality figures) and non-decedents (accounted for in prevalence figures). The analysis compares 2021 and 2023 estimates, stratified by condition, country income group, geographic region and decedents versus non-decedents, to identify trends in SHS independent of population growth. In 2023, an estimated 73.6 million individuals experienced SHS, with 76.2% of this burden concentrated in LMICs. Non-decedents comprised the majority of global SHS (62.4%), reaching as high as 71.0% in low-income countries (LICs). Regionally, sub-Saharan Africa accounted for the largest share of global SHS (25.8%) and the highest per capita burden. While cancer was the leading driver of SHS in high-income countries (HICs) (42.7%), HIV/AIDS remained the top cause across all LMICs (20.2%). Between 2021 and 2023, global SHS grew by 3.9% - outpacing population growth (1.8%) - driven by sharp increases in upper-middle-income countries (UMICs) (5.5%) and HICs (5.2%) and notable condition-specific increases in SHS associated with lung disease (18.2%), inflammatory disease of the central nervous system (11.4%), and dementia (7.9%). Moreover, increases in SHS due to cancer were particularly stark in LICs (17.8%), while injuries markedly rose in HICs (15.9%). Our findings provide empirical evidence of the expanding need for palliative care globally, establishing SHS as an essential benchmark for health system strengthening. Identified trends in the SHS burden can inform targeted interventions and facilitate the achievement of universal palliative care.