Findings provide a roadmap to help strengthen health systems for future crises
Disrupted care during the covid-19 pandemic led to sharp increases in other non-covid causes of illness and death, particularly mental health disorders, malaria in young children, and stroke and heart disease in older adults, finds a study published by The BMJ today.
For example, new cases of depressive disorders rose by 23% in 5-14 year-olds and malaria deaths rose by 14% in children under five years old from 2020-2021.
The researchers say future responses to potential pandemics or other public health emergencies of international concern “must extend beyond infection control to address long term, syndemic health impacts.”
Most healthcare services were severely affected during the pandemic, hindering efforts to prevent and control many conditions. Yet an in-depth analysis of the pandemic’s impact on other causes of illness and death is still needed.
To address this, researchers in China used data from the Global Burden of Disease Study 2021 to simulate the burden of 174 health conditions in 2020 and 2021 across various regions, age groups, and sexes.
A total of 204 countries and territories were included in the analysis. The main measures of interest were incidence (number of new cases), prevalence (number of people living with a condition), deaths, and disability adjusted life years (DALYs) – a combined measure of quantity and quality of life.
Depressive and anxiety disorders, along with malaria, were the most notably affected, with a significant rise in disease burden compared with other causes.
For example, age standardised DALY rates for malaria rose by 12% (to 98 per 100,000). DALY rates for depressive and anxiety disorders also rose by 12% (to 83 per 100,000) and 14% (to 74 per 100,000), respectively, especially among females.
Age standardised incidence and prevalence rates for depressive disorders rose by 14% (to 618 per 100,000) and 10% (to 414 per 100,000), respectively, while anxiety disorders saw a 15% rise (to 102 and 628 per 100,000).
Prevalence rates for heart disease also saw notable increases, particularly among individuals aged 70 and above (169 per 100,000 for ischaemic heart disease and 27 per 100,000 for stroke).
There was also a significant (12%) increase in the age standardised death rate due to malaria, particularly among children under five years old in the African region.
The researchers acknowledge that their methods may not fully capture the complexity and variation of pandemic-related disruptions, and say factors such as uneven quality of data across regions, potential underreporting, and delayed diagnoses during the pandemic, may have affected the accuracy of their results.
However, they say their analysis offers broader scope than previous studies and provides actionable, policy relevant recommendations to improve health system preparedness.
As such, they conclude: “These findings underscore the urgent need to strengthen health system resilience, enhance integrated surveillance, and adopt syndemic-informed strategies to support equitable preparedness for future public health emergencies.”
This study highlights how data can guide smarter recovery to ensure that future health crises disrupt lives less and afflict populations more evenly, say researchers in a linked editorial.
By integrating these insights into post-pandemic plans, countries can improve resilience, they write. Concrete steps include allocating budgets for essential services in emergencies, reinforcing primary health care, expanding disease surveillance networks, and prioritising universal health coverage with a focus on disadvantaged or marginalised communities.
“Ultimately, recognising and planning for the pandemic’s indirect toll will save lives and leave health systems stronger and fairer for future public health emergencies,” they conclude.
03/07/2025
Notes for editors
Research: Global, regional, and national characteristics of the main causes of increased disease burden due to the covid-19 pandemic: time-series modelling analysis of global burden of disease study 2021 doi: 10.1136/bmj-2024-083868
Editorial: Addressing the indirect health burden of covid-19 doi: 10.1136/bmj.r1268
Journal: The BMJ
External funding: National Natural Science Foundation of China, Zhejiang Province Vanguard Goose-Leading Initiative, National Key R&D Program of China, Mega-Project of National Science and Technology for the 13th Five-Year Plan of China
Link to Academy of Medical Sciences press release labelling system: http://press.psprings.
Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Systematic review; Opinion
Subjects: People
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