Non-communicable diseases, in particular heart disease and cancers, are the main cause of death and illness in Spain. Lower back pain and depression also contribute significantly to the burden of disease, especially for women. Smoking, poor diet, and overweight are among the main risk factors of disease and must be addressed with adequate health policies. These are some of the conclusions of a study by a group of researchers of the Global Burden of Disease (GBD) led by ISGlobal and CIBER, which used data from the Global Burden of Disease report of 2019 to provide a detailed health portrait of Spain before the pandemic and provide projections for meeting the Sustainable Development Goal (SDG) health targets by 2030.
“The aim of this study was to better identify unmet health needs in Spain, guide appropriate interventions, and provide insights into future health trends,” explains Jeffrey V Lazarus, Head of Health Systems Research Group and co-director of the Viral and Bacterial Infections Programme at ISGlobal, an institution supported by “la Caixa” Foundation.
A portrait of Spain’s health before the pandemic
The 2019 GBD study includes 369 diseases, injuries and impairments, and 87 risk factors and risk factor combinations. In 2019, almost 90% of death and illness in Spain were due to non-communicable diseases (NCDs), in particular ischaemic heart disease, stroke, COPD, Alzheimer, and lung cancer. Low back pain and depression also contribute considerably to the burden of disease in Spain, particularly for women. The leading risk factors of death and disease were smoking, high body mass index, and hyperglycaemia or diabetes. “The results clearly show the influence of sedentary lifestyles and an ageing population,” says co-author Joan B Soriano, senior co-author of the study and CIBERES researcher at the Pneumology Service of the Hospital Universitario de la Princesa in Madrid. "But it is behavioural risk factors, such as smoking and poor diet, and environmental ones such as air pollution, or sub-optimal environmental temperatures, that added a significant burden to the poor health of the Spanish population," he points out.
Projections for 2030
The research team used 41 indicators (such as smoking prevalence, air pollution, partner violence and vaccine coverage) to measure Spain’s progress towards achieving SDG3 (ensure healthy lives and promote well-being for all at all ages). In 2019, Spain ranked 20 out of 195 countries and territories. By 2030, the country could surpass Japan, the US and the EU in most indicators, although those regarding alcohol use, child overweight, smoking prevalence and child sex abuse will remain low. Also, life expectancy in Spain is expected to reach 84.8 years (87.2 for females and 82.3 for males), although the health and social impacts from COVID-19 have slowed down the decline in death rates.
“Like much of Europe, Spain has experienced rapid levels of population ageing due to increases in life expectancy and decreases in mortality and fertility,” says Lazarus. Addressing this will require a focus on health promotion and elderly care through strengthening long-term care facilities, social support services, and telehealth. Social protection benefits such as pensions and sick leave are key interventions to counter the cost of population ageing, but the authors warn that these policies may not reach those working outside of the formal employment system.
Smoking, poor diets and environmental factors should also be monitored. “The benefits of the Mediterranean diet are threatened by overweight and high glucose levels, which are risk factors for cardiovascular and metabolic diseases,” adds Lazarus. Public policies should be redesigned to tackle sedentary lifestyles.
Finally, the authors point out that a major challenge in Spain is to coordinate the 17 regions and the national government, and to provide regional data disaggregated by specific groups, including migrants and people without home. “These data will help us examine how the 2008 financial crisis and the ongoing COVID pandemic have influenced and will continue to impact on Spain’s health trajectory,” says Lazarus.
This study, conducted by a collaborative group of GBD researchers, involved researchers from ISGlobal, several CIBER areas such as Respiratory Diseases (CIBERES), Mental Health (CIBERSAM) and Epidemiology and Public Health (CIBERESP); from IDIBELL, from Institut Català d’Oncologia e Institut d’Investigació Biomèdica de Bellvitge (ICO-IDIBELL), la Universidad de Barcelona,Hospital Sant Joan de Deu, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Hospital Universitario La Princesa and the University of Washington.
Lazarus JV, Ortiz A, Tyrovolas S, Fernández E, Guy D, White TM, Ma R, Hay SL, Naghavi M, Soriano JB & The GBD 2019 Spain Collaborators. A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain. Scientific Reports. (2022) 12:21154. https://doi.org/10.1038/s41598-022-24719-z