Heart, kidney, liver and metabolism: the global burden 1990–2023

Summary: In 2023, cardiovascular, kidney, liver and metabolic diseases together cost the world about 627 million healthy life years. Per 100,000 people, the burden fell by 24.4% since 1990 because heart attacks and strokes are less often fatal. At the same time, type 2 diabetes (+37.5%) and obesity (+23.3%) keep rising.

State of the evidence: The study uses estimates from the Global Burden of Disease Study 2023 for the years 1990 to 2023. The authors' PubMed literature search ran until 16 May 2026. The paper was published online on 22 August 2026. This article was written on 17 October 2026; newer studies are not included.

What is it about?

Heart, kidneys, liver and metabolism are closely linked: people with severe overweight or type 2 diabetes more often also have atherosclerosis, chronic kidney disease and fatty liver. The authors combine these five conditions into one framework, the cardiovascular-kidney-liver-metabolic (CKLM) syndemic. The liver component is metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD).

How was it studied?

Researchers from Singapore analysed the Global Burden of Disease Study 2023, which provides estimates for 204 countries and territories. They looked at deaths and DALYs. One DALY is one lost healthy year of life, either through early death or through living with illness. The data were split by age, sex, world region and sociodemographic index (SDI), which combines education, income and fertility of a country. This is a descriptive analysis of existing estimates, not a new study of patients.

What does the study show?

• Total burden 2023: 626.7 million DALYs and 23.2 million deaths; 132.9 million new cases. The absolute number of DALYs rose by 71.2% since 1990, mainly because the world population is growing and ageing.
• Better once age is accounted for: After adjusting for age and population growth, the burden per 100,000 people fell by 24.4% between 1990 and 2023. The main driver is atherosclerosis with heart attack and stroke (−41.5%).
• But: Type 2 diabetes (+37.5%) and obesity (+23.3%) increasingly burden health per person. For fatty liver the increase was +1.8%; uncertainty is large (−33.3% to +37.0%), so the trend is not certain.
• Shares in 2023: atherosclerosis 56.5%, obesity 21.6%, type 2 diabetes 13.8%, kidney disease 7.5%, fatty liver 0.6% of the total burden.
• Liver: The age-standardised MASLD burden was 39.6 DALYs per 100,000 people. It was highest in middle-SDI countries (48.1). MASLD burden peaked at ages 60 to 64, at least five years before atherosclerosis.
• Early life: The burden rose most among 30- to 34-year-olds between 1990 and 2023 (+59.1%). Men were more affected than women (8,102 versus 5,872 DALYs per 100,000).
• Inequality: The atherosclerosis burden fell by 54.0% in high-SDI countries but only by 6.8% in low-SDI countries. In low-middle-SDI regions, the burden attributable to obesity rose by 112.4% and to type 2 diabetes by 74.4%.
• Shared risk factors: In calculation, the burden would fall most if high blood pressure (−32.0%), unhealthy diet (−24.0%), high blood sugar (−21.9%) and high body mass index (−13.8%) were lowered to the theoretical optimum.

Where are the limits?

• The figures are model estimates. In many low- and middle-income countries, reliable data on causes of death and diagnoses are missing, so uncertainty is higher and the true burden may be underestimated.
• The five conditions overlap and cannot be cleanly separated in the data. The total is a sum, not a split without double counting.
• Obesity is counted as a risk factor rather than as a disease in the Global Burden methodology; its values are particularly uncertain.
• Shared risk factors, reverse causation and unequal access to care can distort results. The calculation for the four risk factors assumes independence and is an upper bound.
• Other metabolic disorders such as high blood pressure and lipid disorders are not counted as causes.
• Age-standardised rates use the Global Burden standard population and are lower than with the WHO standard; comparisons with other studies are limited.
• The study is purely descriptive and cannot prove causes.

What does this mean for me?

The study describes the world population and says nothing about your personal risk. It does show that heart, kidneys, liver and metabolism should be considered together: blood pressure, blood sugar, diet and weight affect all four areas. For the liver, this means fatty liver (MASLD) often occurs together with obesity and type 2 diabetes, and its burden peaks already in middle age. If you have such risk factors, you can discuss with your doctor which screening and measures make sense.

This article does not replace medical advice.

Source and notes

• Citation: Jayabaskaran J, Himan HR, Nagarajan S, et al. The global cardiovascular-kidney-liver-metabolic burden from 1990 to 2023. eClinicalMedicine 2026;99:104155. DOI: 10.1016/j.eclinm.2026.104155. Published online 22 August 2026, open access (CC BY-NC-ND).
• Study type: Descriptive epidemiological analysis of the Global Burden of Disease Study 2023 (204 countries and territories, 1990–2023).
• Funding: National Medical Research Council Research Transition Award and CSDU Clinician-Scientist Grant (Singapore). The funders had no role in design, analysis or reporting.
• Conflicts of interest: Several authors report fees, research grants or consulting from pharmaceutical and medical technology companies, including Novo Nordisk, Eli Lilly and Boehringer Ingelheim; one author reports stock holdings. The other authors report no competing interests.