The burden of diseases, injuries, and risk factors by voivodship in Poland, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.

Background: Since 1990, major political and economic transformations in Poland have substantially impacted the country's health systems and shaped its health policies. We aimed to better understand the changes in population health in Poland by location and demographic groups, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. Methods: GBD 2023 evaluates outcomes for 375 diseases and injuries, 292 causes of death, and 88 risk factors in 204 countries and territories. We analysed mortality, life expectancy, and risk-attributable burden, years lived with disability (YLDs), years of life lost due to premature death (YLLs), and disability-adjusted life-years (DALYs; overall burden as a sum of years of lost life due to premature death and years lived with disability), and included a decomposition of change in life expectancy by cause and location in Poland and its regions (voivodships) between 1990 and 2023 on the background of selected European countries. Estimates were produced for Poland at the national and subnational level by age (25 age groups), sex (males, females, and all sexes combined), location, and year. Final point estimates are reported with 95% uncertainty intervals (UIs) representing the 2.5th and 97.5th percentile of the distribution from 250 draws for each metric. Findings: Between 1990 and 2023, life expectancy in Poland for male and female sexes combined increased from 71.2 (95% UI 71.1-71.3) to 78.6 (78.5-78.7) years. Male life expectancy increased more than female during this period; male life expectancy increased from 66.8 (66.7-66.9) to 74.9 (74.8-75.0), while female life expectancy increased from 75.7 (75.6-75.8) to 82.2 (82.1-82.3). Reductions in deaths from ischaemic heart disease and stroke drove most improvements; in 1990, there were an estimated 109,000 (104,000-115,000) and 68,300 (63,700-73,600) deaths due to IHD and stroke, respectively, and in 2023 there were 85,400 (76,800-90,800) and 39,500 (35,000-42,900). The voivodship with the highest age-standardised DALY rates per 100,000 in 2023 was Łódzkie with 25,607 (22,602-29,217), while the lowest was Małopolskie with 22,113 (19,290-25,418). Nationally, age-standardised DALYs declined 33.9% (30.7-36.8) from 1990 to 2023. Smoking and high blood pressure were the leading risk factors throughout the period of study, while alcohol use showed the greatest increase in DALY rates between 1990 and 2023 with 35.2% (3.5-65.1). Risk-attributable age-standardised DALYs rates declined for high blood pressure (1990: 5723.8 [4759.8-6578.3]; 2023: 2053.7 [1657.2-2362.4]) and high BMI (1990: 2226.4 [966.8-3512.2]; 2023: 1923.4 [839.0-2907.8]). Interpretation: Since 1990, life expectancy has increased in Poland for both males and females, with males gaining more years of expected life. In 2023 it was higher than in eastern and central Europe but behind western Europe. Results from GBD 2023 highlight the disparities in the burden of disease across voivodships and suggest that risk-attributable burden in Poland, at both the national and voivodship levels, can be addressed by focusing on several modifiable risk factors, especially smoking and alcohol use. Funding: Gates Foundation.