Changes in life expectancy across selected countries in the Western Pacific Region and their underlying risk factors, 1990-2021.

BACKGROUND: In accordance with the global trend, over the past decades, countries in the Western Pacific Region (WPR) have also experienced substantial improvement in life expectancy. However, this accomplishment was coupled with the differences between countries. METHODS: Using the latest data from the Global Burden of Disease study, we explored the underlying reasons for changes in life expectancy among observed WPR countries. RESULTS: Compared with observed high-income countries, lower-middle-income countries remain disadvantaged with respect to life expectancy, despite their substantial growth over time. The patterns of contribution varied considerably across countries. From 1990 to 2019, in lower-middle-income countries such as Cambodia and Laos, the gains in life expectancy could be mainly explained by reductions in under-5, 5-24, 25-44 mortality from communicable diseases and maternal-neonatal disorders, as well as reductions in mortality from communicable diseases and cardiovascular diseases at 45-84 years. In high-income countries, declines in middle and old-age mortality from cardiovascular diseases and neoplasms were mainly responsible for their life expectancy gains. After 2019, COVID-19 and related outcomes contributed to different magnitude of declines in life expectancy in lower-middle-income countries and Malaysia. In high-income countries, the impact of the pandemic resulted in a stagnation of life expectancy in Singapore and slight decline in life expectancy in South Korea. CONCLUSIONS: Despite the efforts from the government and WHO in the WPR, the gaps between lower-middle-income and high-income countries remain substantial and further enlarged because of the COVID-19 pandemic. Long-term reductions in mortality and gains in life expectancy in all observed countries in the Region require the further modification of the profile of the underlying risks.