As life expectancy has steadily risen across Asia over the past three decades, the primary health drivers behind those gains have varied sharply by region, according to a study published in the journal Nature. In high-income Asia-Pacific countries like South Korea and Japan, falling mortality from cardiovascular disease served as the single biggest factor. Conversely, in South and Southeast Asia, the largest life expectancy gains stemmed from significant reductions in deaths from diarrheal diseases and tuberculosis.
An international research team—including Professor Yeon Dong-geon of Kyung Hee University and Professor Kang Ji-seung of Korea University as part of the GBD 2023 Asia Life Expectancy Collaborators—analyzed cause-specific mortality, risk factors, and life expectancy trends across 34 Asian countries and territories from 1990 to 2023, utilizing data from the Global Burden of Disease Study (GBD 2023).
While life expectancy improved across every territory examined, the rate of improvement and underlying causes diverged. The average annual increase was highest in South Asia—including India, Pakistan, Bangladesh, Nepal, and Bhutan—and lowest in high-income Asia-Pacific regions, such as South Korea, Japan, Singapore, and Brunei.
Breaking down regional classifications, the researchers found that declining cardiovascular disease mortality was the primary driver of longer life spans in Central Asia (e.g., Kazakhstan, Mongolia, Uzbekistan), East Asia (e.g., China, North Korea, Taiwan), and high-income Asia-Pacific nations. In contrast, across South Asia and Southeast Asia (e.g., Indonesia, Thailand, Vietnam, Myanmar, the Philippines), steep declines in infectious conditions like diarrheal disease and tuberculosis contributed most to rising longevity.
The COVID-19 pandemic temporarily interrupted this upward trajectory. Life expectancy declined across several Asian regions between 2019 and 2023, dropping by nearly two years in the first year of the pandemic alone.
Shifting focus toward metabolic risks and chronic disease
Medical experts emphasize that the findings highlight distinct public health challenges for wealthier nations moving forward.
"Unlike low- and middle-income regions where life expectancy increased through infectious disease control, declining deaths from cardiovascular disease drove the gains in high-income regions like South Korea," said Professor Lee Sang-yeol of the Division of Endocrinology and Metabolism and the Digital Health Center at Kyung Hee University College of Medicine. "Now, alongside hypertension and smoking, metabolic risks such as high fasting blood glucose are emerging as new burdens."
Lee noted that while South Korea enjoys one of the highest life expectancies globally, its annual rate of increase has slowed. "This study indicates that future gains depend not on managing infectious diseases, but on controlling metabolic and chronic conditions like diabetes and obesity, as well as mental health challenges, particularly suicide," he added.
Tailoring public health through proportional universalism
The study's authors stress that regional differences call for targeted, localized public health strategies rather than a one-size-fits-all policy.
"Because the causes and risk factors behind changes in life expectancy differ by country and region, policy interventions should follow an approach of 'proportional universalism'—adjusting the intensity of public health measures to fit local needs," said Professor Kang Ji-seung of Korea University’s Division of Health and Environmental Convergence Science, a lead author of the paper.
Kang explained that low-income countries with limited healthcare infrastructure must prioritize access to essential medicines, expanded sanitation, and broader vaccination programs. Meanwhile, high-income nations like South Korea—alongside regions facing a surge in chronic illness—should focus on preventive measures, including hypertension control, smoking cessation programs, and air quality management, to equitably extend healthy life expectancy across Asia.
