Mapping drivers of life expectancy change in Asia from 1990 to 2023

Life expectancy is a key indicator of population health and an important guide for health policy^1,2. Although Asia represents approximately 60% of the global population, studies of longitudinal trends in life expectancy and their underlying drivers across Asian countries remain limited, with most previous research focused on western or high-income settings^3-6. Here we provide a comprehensive analysis of life expectancy, cause-specific mortality and risk factors in 1990-2023 across 34 Asian countries and territories, utilizing data from the Global Burden of Disease Study 2023^1,7. Life expectancy increased in all countries and territories between 1990 and 2023, with the largest annual gains observed in South Asia and the smallest annual gains in high-income Asia Pacific countries and territories. Reductions in cardiovascular disease mortality were the primary contributors to life expectancy gains in Central Asia, East Asia and high-income Asia Pacific, whereas declines in diarrhoeal diseases and tuberculosis contributed most in South and Southeast Asia. In 2019-2023, life expectancy declined in several Asian regions, largely driven by the COVID-19 pandemic, with a nearly two-year loss in the first year of the pandemic. The causes of changes in life expectancy and the contributing risk factors varied across regions and countries/territories. Therefore, under the principles of proportional universalism, proactive and effective policies at both regional and national levels are essential to reduce premature mortality and reduce life expectancy inequalities across Asia.