COVID-19 pandemic and burden of non-communicable diseases: An ecological study on data of 185 countries

M. Reza Azarpazhooh, Negar Morovatdar, Abolfazl Avan, Thanh G. Phan, Afshin A. Divani, Nawaf Yassi, Saverio Stranges, Brian Silver, José Biller, Masoud Tokazebani Belasi, Sepideh Kazemi Neya, Bita Khorram, Asher Frydman, Yongchai Nilanont, Elisa Onorati, Mario Di Napoli*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

90 Citations (Scopus)


Background: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. Methods: We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. Findings: High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. Interpretation: Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.

Original languageEnglish
Article number105089
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
Publication statusPublished - Sept 2020


  • Coronavirus
  • Correlation
  • Incidence
  • Mortality
  • Prevention
  • Stroke


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