ABSTRACT
Background
Alzheimer's disease and other dementias (ADOD) impose a growing burden in aging high‐SDI regions, a composite of income, education, and fertility. Metabolic risks are major modifiable contributors, but region‐specific estimates for Western Europe are limited.
Methods
Using GBD 2023 data, we estimated deaths, disability‐adjusted life years (DALYs), age‐standardized mortality rates (ASMR), and age‐standardized DALYs rates (ASDR) attributable to metabolic risks in 24 countries. Analyses were stratified by sex, age, and Level 2 metabolic risks (high BMI, high FPG). Temporal trends were assessed using estimated annual percentage change (EAPC), and decomposition analysis quantified contributions from population growth, aging, and epidemiological change.
Results
In 2023, ASMR and ASDR were 6.84 (95% UI: 1.38–18.30) and 117.80 (35.67–252.14) per 100 000, increasing 18.8% and 17.6% from 1990; corresponding EAPCs were 0.45 and 0.43. Metabolic risks accounted for 90094.8 deaths (18262.6–241493.9). Females had higher age‐standardized rates; males showed slightly higher EAPCs. High FPG remained dominant, while high BMI increased faster, particularly among males. Monaco had the highest ASMR and ASDR, whereas Germany, Italy, and the United Kingdom contributed the largest absolute burden. Decomposition analysis showed demographic changes primarily drove high FPG burden, while epidemiological changes contributed more to high BMI outcomes.
Conclusions
ADOD burden attributable to metabolic risks continues to rise across Western Europe, with substantial variation across countries, sex, age, and risk factors. High FPG burden is largely demographic‐driven; high BMI burden reflects adverse epidemiological trends. Findings support targeted metabolic interventions, including obesity control and diabetes management integrated into dementia prevention strategies.
Keywords: Alzheimer's disease and other dementias, global burden of disease, metabolic risks, Western Europe
1. Background
Alzheimer's disease and other dementias (ADOD) are major causes of disability, dependency, and mortality among older adults. More than 55 million people are currently living with dementia worldwide, and this number is projected to increase substantially as populations age [1, 2]. The burden is particularly relevant for Western Europe, a high socio‐demographic index (SDI; a composite indicator of income, education, and fertility) region characterized by long life expectancy, rapid population aging, mature but resource‐constrained health systems, and high demand for long‐term care [3, 4, 5, 6, 7]. However, Western Europe should not be viewed as a homogeneous high‐SDI setting because countries within this region differ substantially in population size, age structure, metabolic risk profiles, health‐system organization, and dementia detection capacity.
Increasing evidence indicates that dementia is influenced by modifiable risk factors across the life course. Obesity and diabetes, represented in the GBD framework by high body‐mass index (BMI) and high fasting plasma glucose (FPG), are key metabolic risks linked to cognitive decline and dementia through insulin resistance, vascular injury, inflammation, and cardiometabolic multimorbidity [8, 9, 10, 11, 12, 13, 14]. These risks are highly relevant in Europe, where overweight, obesity, and diabetes remain common and continue to challenge noncommunicable disease prevention [11, 12]. In this study, “metabolic risks” refers specifically to the GBD‐modelled ADOD‐attributable metabolic risks, namely high BMI and high FPG, rather than the full clinical construct of metabolic syndrome.
Although several GBD‐based studies have described the global or national burden of ADOD and selected dementia‐related risk factors, most have focused on global patterns, broad SDI categories, or overall dementia burden [15, 16, 17, 18, 19, 20]. The specific contribution of metabolic risks to ADOD burden within Western Europe remains insufficiently characterized. In particular, previous studies have rarely clarified whether changes in metabolic risk‐attributable ADOD burden within this region are mainly driven by population growth, population aging, or epidemiological change, especially for high BMI and high FPG separately.
To address these gaps, we conducted a Western Europe‐specific analysis of ADOD burden attributable to metabolic risks using GBD 2023 estimates from 1990 to 2023. Rather than simply reconfirming broad patterns previously reported in global GBD studies, this study aimed to determine how these patterns are expressed across 24 Western European countries and whether country‐level differences in demographic and epidemiological drivers can inform more targeted prevention strategies. Specifically, we assessed age‐standardized trends, country‐level heterogeneity, sex‐ and age‐specific patterns, and the relative contributions of population growth, population aging, and epidemiological change to high BMI‐ and high FPG‐attributable burden.
2. Methods
2.1. Data Sources
The GBD 2023 study represents one of the world's largest scientific collaborations, involving more than 17 000 researchers from 167 countries and territories. It provides the most accurate, up‐to‐date, and fully comparable estimates of global health loss [21]. GBD 2023 incorporates the best available data worldwide and includes 11 474 newly added data sources, increasing the total number of sources in the GBD cause‐of‐death database to 55 761. Therefore, the estimates from GBD 2023 supersede all previous rounds [22].
Cause‐specific mortality estimates and corresponding age‐standardized rates per 100 000 population were obtained from GBD 2023. Age‐standardized rates in GBD are calculated using a fixed reference age distribution, which reduces the influence of differences in population age structure and enables comparisons across countries and years. For all measures, 95% uncertainty intervals (UIs) were derived from the 2.5th and 97.5th percentiles of 250 draws. DALYs—a composite metric quantifying overall disease burden—were estimated according to the WHO definition, where one DALY represents 1 year of healthy life lost. Total DALYs for a given condition comprise both years of life lost due to premature mortality and years lived with disability [23].
In the GBD cause‐of‐death framework, deaths are estimated as cause‐specific mortality using the underlying cause of death assigned according to ICD principles. Therefore, ADOD deaths in this study represent deaths for which ADOD was modelled as the underlying cause among individuals who survived to the corresponding age group. Competing mortality risks, such as earlier cardiovascular deaths, were not modelled using an individual‐level competing‐risk framework in the present ecological analysis. Instead, they are indirectly reflected in the observed age‐specific population structure, all‐cause mortality patterns, and cause‐specific mortality estimates incorporated in the GBD modelling process. Accordingly, ASMR and ASDR should be interpreted as observed population‐level cause‐specific burden measures rather than counterfactual estimates of ADOD burden after eliminating competing causes of death.
2.2. Risk Factor Estimation
Risk factors in the GBD framework are organized into four hierarchical levels: Level 1 (overall risk categories), Level 2 (individual risks or clusters), Level 3 (disaggregated components within Level 2 clusters), and Level 4 (the most granular subcomponents). For GBD 2023, relative risks for mortality and morbidity associated with 88 risk factors were estimated primarily using evidence synthesized from randomized controlled trials, cohort studies, and pooled cohort analyses. Attributable burden was calculated using these relative risks combined with population exposure distributions [24]. Because high BMI and high FPG are biologically and epidemiologically related, their attributable burdens should not be interpreted as mutually exclusive or directly additive. These risks may influence ADOD through overlapping cardiometabolic pathways, including insulin resistance, vascular injury, and inflammation. Therefore, the total burden attributable to metabolic risks in the GBD comparative risk assessment framework is not calculated as the simple sum of high BMI‐attributable and high FPG‐attributable burdens.
2.3. Definitions
In GBD 2023, dementia is defined as a progressive, degenerative, and chronic neurological disorder characterized by cognitive decline, memory impairment, and other deficits in neurological functioning. Case definitions follow the diagnostic criteria of the Diagnostic and Statistical Manual (DSM)‐III, DSM‐IV, DSM‐V, or ICD classification systems, as detailed in previously published GBD methodological reports [15, 24]. Relevant ICD codes include ICD‐10: F00, F01, F02, F03, G30, G31 and ICD‐9: 290, 291.2, 291.8, 294, 331.
High FPG was defined based on the population mean FPG level, with elevated exposure defined as any value above the theoretical minimum risk exposure level of 4.9–5.3 mmol/L. High BMI in adults (≥ 20 years) was defined as BMI exceeding 20–21 kg/m2, according to the standards of the Internal National Obesity Task Force [24].
Consistent with the geographical structure of the GBD database, locations were grouped into 21 regions based on epidemiological similarity and geographic proximity. The Western Europe region includes: Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland, and the United Kingdom.
As in GBD 2021, the GBD 2023 dataset contains estimates only for populations aged 40 years and older. Thus, all age‐stratified analyses were conducted for individuals aged ≥ 40 years, categorized into 12 5‐year age groups: 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, and 95+ years.
2.4. Statistical Analysis
We assessed the burden of ADOD attributable to metabolic risks across Western Europe and within each Western European country. Analyses were stratified by Level 2 risk factors, age group, and sex. To minimize the influence of population age structure on observed trends, age‐standardized rates (ASRs) per 100 000 population were calculated using the standard GBD formula: , where A is the number of age groups, αᵢ represents the age‐specific rate for the ith age group, and ɯᵢ is the proportion of the standard population in that age group [25].
Relative percentage change from 1990 to 2023 was calculated as: . Temporal trends in age‐standardized mortality rate (ASMR) and age‐standardized DALYs rate (ASDR) were assessed using the estimated annual percentage change (EAPC) derived from the log‐linear regression model: ln(ASR) = α + β × (calendar year) + ε. The EAPC was computed as: EAPC = 100 × (exp(β) − 1), with 95% confidence intervals (CIs) obtained from the standard error of β. These calculations were applied separately within each analytic stratum. ASMR, ASDR, relative percentage change, and EAPC were estimated by country, sex, and Level 2 metabolic risk factor, including high BMI and high FPG. For age‐stratified analyses, age‐specific rates and counts were reported directly rather than age‐standardized rates. When multiple stratification variables were used in tables, the formulas were applied independently within each subgroup. A positive EAPC with both CI bounds above zero indicated a rising trend, whereas a negative EAPC with both bounds below zero indicated a declining trend. To quantify the contributions of population growth, population aging, and epidemiological change to variations in deaths and DALYs attributable to metabolic risks, high BMI, and high FPG, we conducted a decomposition analysis. All statistical analyses and visualizations were performed using R software (version 4.5.1).
3. Results
3.1. Trends in Age‐Standardized Rates and Absolute Burden
In 2023, the ASMR and ASDR of ADOD attributable to metabolic risks in Western Europe were 6.84 (95% UI: 1.38–18.30) and 117.80 (95% UI: 35.67–252.14) per 100 000, representing increases of 18.8% and 17.6% from 1990, respectively (Figure 1C,D and Table 1). The corresponding EAPCs were 0.45 (95% CI: 0.41–0.50) for ASMR and 0.43 (95% CI: 0.40–0.46) for ASDR (Table 2). In absolute terms, metabolic risks accounted for 90094.8 deaths (95% UI: 18262.6–241493.9) in 2023, a 163.8% increase from 1990 (Figure 1A and Table 1).
FIGURE 1.
Trends of Alzheimer's disease and other dementias attributed to metabolic risks by deaths and DALYs in Western Europe. Total number of deaths (A), percentage of deaths number by sex (B), ASMR (C), ASDR (D), EAPC (E), deaths number and rate in 1990 (F), deaths number and rate in 2023 (G), DALYs number and rate in 1990 (H), DALYs number and rate in 2023 (I). ASMR, age‐standardized mortality rate; ASDR, age‐standardized DALYs rate; DALYs, disability‐adjusted life years; EAPC, estimated annual percentage change.
TABLE 1.
Burden of ADOD attributable to metabolic risks in Western Europe, 1990–2023.
| Location | Risks | Deaths | DALYs | ||||
|---|---|---|---|---|---|---|---|
| Number in 2023 (95% UI) | Percentage change in deaths number | ASMR in 2023 (95% UI) | Percentage change in ASMR | ASDR in 2023 (95% UI) | Percentage change in ASDR | ||
| Western Europe | High BMI | 30039.7 (−9596.5 to 116917.4) | 227.8% | 2.33 (−0.76 to 8.97) | 58.5% | 42.86 (−14.71 to 135.84) | 50.5% |
| High fasting plasma glucose | 65566.1 (16656.5 to 165070.9) | 147.3% | 4.93 (1.26 to 12.51) | 8.6% | 82.68 (36.33 to 170.94) | 8.3% | |
| Metabolic risks | 90094.8 (18262.6 to 241493.9) | 163.8% | 6.84 (1.38 to 18.3) | 18.8% | 117.8 (35.67 to 252.14) | 17.6% | |
| Andorra | High BMI | 3.8 (−1.2 to 15.0) | 660% | 1.67 (−0.51 to 6.61) | 85.6% | 33.63 (−14.53 to 115.84) | 76% |
| High fasting plasma glucose | 8.1 (2.1 to 20.9) | 376.5% | 3.01 (0.74 to 7.94) | −9.9% | 54.86 (22.76 to 112.88) | −5.9% | |
| Metabolic risks | 11.4 (2.2 to 30.4) | 442.9% | 4.42 (0.83 to 11.57) | 7.5% | 83.43 (23.5 to 187.53) | 11.4% | |
| Austria | High BMI | 446.3 (−147.1 to 1752.2) | 132.8% | 1.88 (−0.61 to 7.34) | 27% | 35.46 (−12.19 to 112.7) | 21.9% |
| High fasting plasma glucose | 861.4 (213.7 to 2159.3) | 148.3% | 3.58 (0.89 to 8.88) | 20.1% | 59.06 (23.38 to 127.16) | 20.2% | |
| Metabolic risks | 1245.1 (236.6 to 3367.9) | 140.6% | 5.19 (0.98 to 14.14) | 21% | 89.68 (24.75 to 197.71) | 19.4% | |
| Belgium | High BMI | 673 (−221.8 to 2605.7) | 183% | 2.17 (−0.69 to 8.3) | 51.7% | 40.28 (−13.79 to 124.17) | 41.6% |
| High fasting plasma glucose | 1468.3 (348 to 3758.5) | 148.9% | 4.57 (1.07 to 11.58) | 18.1% | 76.27 (28.16 to 167.8) | 17.5% | |
| Metabolic risks | 2033.5 (405.3 to 5367.6) | 155% | 6.39 (1.26 to 16.87) | 24.8% | 110.17 (32.88 to 238.63) | 22.6% | |
| Cyprus | High BMI | 54.6 (−16.3 to 223.6) | 574.1% | 2.91 (−0.88 to 12.16) | 193.9% | 50.43 (−19.1 to 177.82) | 156.6% |
| High fasting plasma glucose | 78.6 (17.3 to 210.8) | 270.8% | 4.41 (0.96 to 11.8) | 36.1% | 71.48 (24.66 to 164.46) | 37.3% | |
| Metabolic risks | 125.1 (17.9 to 369) | 340.5% | 6.9 (1.03 to 20.48) | 67.5% | 114.39 (26.8 to 272.07) | 64.3% | |
| Denmark | High BMI | 236.1 (−92.5 to 916.7) | 160.6% | 1.6 (−0.62 to 6.16) | 58.4% | 28.75 (−10.02 to 91.39) | 40.3% |
| High fasting plasma glucose | 497.3 (116.2 to 1288.5) | 130.6% | 3.34 (0.78 to 8.64) | 28.5% | 53.1 (18.7 to 120.05) | 23% | |
| Metabolic risks | 701.7 (134.9 to 1899.4) | 136.8% | 4.73 (0.91 to 12.79) | 35.1% | 78.01 (21.44 to 174.92) | 26.9% | |
| Finland | High BMI | 443.3 (−126 to 1754.1) | 321% | 2.64 (−0.75 to 10.42) | 74.8% | 46.32 (−16.66 to 153.02) | 57% |
| High fasting plasma glucose | 1080.5 (275.3 to 2630.6) | 221.9% | 6.33 (1.6 to 15.33) | 17.2% | 102.7 (42.27 to 211.07) | 17.7% | |
| Metabolic risks | 1424.9 (304.8 to 3807.2) | 237.9% | 8.38 (1.8 to 22.49) | 26.4% | 138.87 (43.17 to 315.12) | 24.4% | |
| France | High BMI | 4024.3 (−1311.9 to 15159.4) | 291.5% | 2.01 (−0.65 to 7.46) | 97.1% | 35.64 (−11.8 to 108.9) | 77.2% |
| High fasting plasma glucose | 7078.2 (1755.9 to 18207.1) | 154.8% | 3.43 (0.85 to 8.95) | 23.8% | 55.74 (22.13 to 127.03) | 20.5% | |
| Metabolic risks | 10505.6 (1875.4 to 28173.9) | 185.4% | 5.15 (0.92 to 13.67) | 40.3% | 86.14 (20.82 to 198.13) | 34.6% | |
| Germany | High BMI | 6676.9 (−1812.8 to 26436.2) | 146.5% | 2.46 (−0.69 to 9.44) | 26.8% | 47.27 (−17.45 to 151.27) | 25% |
| High fasting plasma glucose | 16861.6 (4426.1 to 41597.6) | 123% | 6.03 (1.59 to 14.87) | 3.6% | 102.5 (44.91 to 200.4) | 4.7% | |
| Metabolic risks | 22 188 (4701.1 to 54842.1) | 127.3% | 8 (1.66 to 19.76) | 8.1% | 140.63 (44.35 to 289.21) | 9% | |
| Greece | High BMI | 1052.2 (−355.5 to 4180.9) | 439% | 3 (−1.02 to 11.6) | 122.2% | 58.26 (−20.85 to 180.08) | 109.9% |
| High fasting plasma glucose | 1659.5 (406.1 to 4524.8) | 207% | 4.72 (1.15 to 12.57) | 11.6% | 85.89 (34.98 to 177.41) | 14.2% | |
| Metabolic risks | 2514.3 (435.1 to 6640.5) | 256.6% | 7.16 (1.26 to 18.81) | 33.6% | 133.38 (37.49 to 282.65) | 35.1% | |
| Iceland | High BMI | 16 (−5 to 61.8) | 272.1% | 2.34 (−0.73 to 9.03) | 60.3% | 42.62 (−16.82 to 149.96) | 42.9% |
| High fasting plasma glucose | 30.7 (7 to 79) | 201% | 4.43 (1.01 to 11.39) | 24.4% | 75.7 (28.91 to 165.42) | 18.5% | |
| Metabolic risks | 44.1 (7.7 to 115.7) | 215% | 6.38 (1.11 to 16.81) | 32.6% | 111.09 (31 to 251.53) | 24% | |
| Ireland | High BMI | 217.7 (−66.4 to 844.3) | 405.1% | 2.32 (−0.7 to 8.99) | 112.8% | 42.58 (−14.9 to 136.88) | 93.2% |
| High fasting plasma glucose | 394.4 (97 to 1002.7) | 223.5% | 4.21 (1.04 to 10.7) | 19.9% | 69.15 (27.21 to 146.57) | 18.2% | |
| Metabolic risks | 576.9 (106.8 to 1534.8) | 262.1% | 6.15 (1.14 to 16.34) | 38.2% | 105 (28.57 to 232.33) | 35.1% | |
| Israel | High BMI | 349.3 (−101.6 to 1358.7) | 409.9% | 2.32 (−0.7 to 8.99) | 50.6% | 37.88 (−12.99 to 128.63) | 39.7% |
| High fasting plasma glucose | 677 (162.2 to 1675.5) | 367.5% | 4.29 (1.01 to 10.76) | 18.8% | 63.7 (21.52 to 144.63) | 18% | |
| Metabolic risks | 965.9 (182 to 2554.8) | 375.1% | 6.21 (1.15 to 16.4) | 26.2% | 95.11 (22.94 to 221.91) | 23.2% | |
| Italy | High BMI | 5114.1 (−1734.4 to 18 947) | 301.6% | 2.45 (−0.82 to 9.02) | 72.5% | 44.76 (−15.61 to 137.13) | 70.4% |
| High fasting plasma glucose | 11248.3 (2832.1 to 28148.4) | 184.6% | 5.25 (1.33 to 12.97) | 10.8% | 88.27 (37.55 to 180.27) | 14% | |
| Metabolic risks | 15494.1 (3156 to 39898.8) | 207.4% | 7.29 (1.45 to 18.76) | 22.5% | 125.49 (38.66 to 260.69) | 25.6% | |
| Luxembourg | High BMI | 21.8 (−6.8 to 89.5) | 344.9% | 1.81 (−0.56 to 7.36) | 105.7% | 32.98 (−12.07 to 110.18) | 75.1% |
| High fasting plasma glucose | 38.8 (9.2 to 102.2) | 207.9% | 3.22 (0.76 to 8.46) | 23.4% | 54.5 (21.56 to 116.9) | 17.1% | |
| Metabolic risks | 56.8 (9.7 to 152.4) | 240.1% | 4.71 (0.8 to 12.75) | 39.8% | 81.78 (23.03 to 179.15) | 30.2% | |
| Malta | High BMI | 24.8 (−7.8 to 98.0) | 570.3% | 2.15 (−0.68 to 8.42) | 117.2% | 41.73 (−16.13 to 141.17) | 101.7% |
| High fasting plasma glucose | 46.5 (11.5 to 119.9) | 294.1% | 4.09 (1.02 to 10.52) | 12.4% | 69.24 (27.82 to 147.86) | 10.2% | |
| Metabolic risks | 67.3 (12 to 177.6) | 345.7% | 5.89 (1.06 to 15.5) | 31.2% | 104.4 (28.88 to 242.64) | 29.4% | |
| Monaco | High BMI | 5.2 (−1.9 to 20.7) | 205.9% | 3.98 (−1.44 to 16.02) | 108.4% | 63.18 (−26.19 to 219.03) | 76.1% |
| High fasting plasma glucose | 8.4 (2 to 22.3) | 147.1% | 6.41 (1.51 to 17.04) | 59.9% | 95.73 (33.5 to 220.66) | 44.3% | |
| Metabolic risks | 12.7 (2.1 to 33.8) | 164.6% | 9.69 (1.62 to 25.82) | 71.8% | 147.85 (36.77 to 336.63) | 52.3% | |
| Netherlands | High BMI | 1054.4 (−303.5 to 4300) | 327.1% | 2.4 (−0.69 to 9.79) | 98.3% | 43.16 (−15.37 to 144.93) | 91.1% |
| High fasting plasma glucose | 1871 (466.8 to 4801.7) | 162.8% | 4.23 (1.06 to 10.88) | 13.1% | 70.48 (28 to 156.49) | 15.3% | |
| Metabolic risks | 2771.9 (471.5 to 7610.3) | 198.8% | 6.28 (1.07 to 17.24) | 30.8% | 107.4 (27.07 to 248.44) | 32.7% | |
| Norway | High BMI | 222.6 (−84.2 to 897.2) | 90.3% | 1.77 (−0.68 to 7.08) | 14.9% | 33.6 (−12.5 to 104.33) | 7.2% |
| High fasting plasma glucose | 629.5 (154 to 1606.7) | 101.7% | 4.94 (1.21 to 12.61) | 12.3% | 85.1 (33.93 to 181.2) | 10.8% | |
| Metabolic risks | 812.2 (169.6 to 2046.3) | 97.7% | 6.4 (1.32 to 15.98) | 12.5% | 112.73 (38.03 to 230.12) | 9.1% | |
| Portugal | High BMI | 856.5 (−249.1 to 3417.0) | 547.4% | 2.49 (−0.75 to 9.82) | 149% | 44.37 (−15.94 to 148.51) | 128.7% |
| High fasting plasma glucose | 2092.1 (510.6 to 5334.1) | 261% | 5.89 (1.44 to 15.02) | 17.3% | 95.2 (39.31 to 199.91) | 16.2% | |
| Metabolic risks | 2758.8 (604.1 to 7147.7) | 301.5% | 7.83 (1.69 to 20.11) | 34.1% | 129.93 (39.69 to 278.69) | 32.9% | |
| San Marino | High BMI | 2.0 (−0.6 to 7.8) | 566.7% | 1.87 (−0.59 to 7.36) | 98.9% | 34.91 (−14.74 to 116.41) | 86.7% |
| High fasting plasma glucose | 4.3 (1 to 11.2) | 330% | 4.01 (0.93 to 10.34) | 14.9% | 67.81 (26.07 to 147.31) | 14.4% | |
| Metabolic risks | 6.0 (1.2 to 15.8) | 361.5% | 5.55 (1.06 to 14.75) | 29.4% | 96.65 (28.76 to 215.69) | 28.3% | |
| Spain | High BMI | 3942.7 (−1381.1 to 13759.5) | 381.2% | 2.76 (−0.97 to 9.65) | 80.4% | 47.31 (−17.11 to 146.79) | 67.8% |
| High fasting plasma glucose | 6785.2 (1746.1 to 16772.5) | 185.5% | 4.57 (1.2 to 11.21) | −2.8% | 73.68 (29.34 to 159.72) | −6.4% | |
| Metabolic risks | 10019.8 (1709.3 to 26 094) | 227.8% | 6.84 (1.17 to 17.54) | 14.6% | 112.6 (28.68 to 247.25) | 10.2% | |
| Sweden | High BMI | 521.3 (−164.8 to 2128.4) | 143.3% | 1.8 (−0.57 to 7.19) | 45.2% | 32.71 (−10.92 to 107.29) | 35.9% |
| High fasting plasma glucose | 1263.9 (309.4 to 3132.6) | 126.5% | 4.26 (1.04 to 10.63) | 23.8% | 69.85 (28.67 to 145.04) | 24.9% | |
| Metabolic risks | 1696.6 (349.0 to 4447.6) | 128% | 5.75 (1.18 to 15.24) | 27.5% | 97.1 (28.75 to 219.99) | 26.2% | |
| Switzerland | High BMI | 417.5 (−143.2 to 1579.8) | 143.3% | 1.73 (−0.58 to 6.47) | 21% | 33.07 (−11.45 to 101.19) | 11.8% |
| High fasting plasma glucose | 1160.6 (293 to 2919.1) | 152.1% | 4.59 (1.15 to 11.55) | 12.2% | 76.6 (31.88 to 157.02) | 7.3% | |
| Metabolic risks | 1503.2 (320.6 to 4074.5) | 148.8% | 6.01 (1.28 to 16.16) | 13.6% | 103.86 (33.43 to 225.31) | 7.8% | |
| United Kingdom | High BMI | 3637.1 (−1012.7 to 15674.1) | 144.4% | 2.12 (−0.59 to 9.12) | 35.9% | 41.24 (−16.38 to 140.68) | 36% |
| High fasting plasma glucose | 9664.3 (2366.5 to 24653.2) | 99.6% | 5.47 (1.36 to 13.88) | 0.9% | 94.54 (41.6 to 195.31) | 2.9% | |
| Metabolic risks | 12480.4 (2679.6 to 33026.3) | 107.2% | 7.11 (1.52 to 19.2) | 6.8% | 126.62 (43.34 to 274.29) | 9% | |
Note: High BMI‐ and high FPG‐attributable estimates are not mutually exclusive and should not be summed to obtain the estimate for metabolic risks, because these risks are correlated and may act through overlapping cardiometabolic pathways.
Abbreviations: ADOD, alzheimer's disease and other dementias; ASMR, age‐standardized mortality rate; ASDR, age‐standardized DALYs rate; DALYs, disability‐adjusted life years; BMI, body‐mass index; UI, uncertainty interval.
TABLE 2.
EAPC of ASMR and ASDR of ADOD attribute to metabolic risks in Western Europe in 2023.
| Measure | Location | EAPC (95% CI) | ||
|---|---|---|---|---|
| Both | Females | Males | ||
| DALYs | Western Europe | 0.43 (0.4 to 0.46) | 0.46 (0.43 to 0.49) | 0.54 (0.52 to 0.56) |
| Andorra | 0.45 (0.33 to 0.58) | 0.53 (0.41 to 0.66) | 0.3 (0.16 to 0.45) | |
| Austria | 0.42 (0.36 to 0.47) | 0.37 (0.32 to 0.43) | 0.8 (0.77 to 0.84) | |
| Belgium | 0.44 (0.38 to 0.51) | 0.47 (0.4 to 0.53) | 0.55 (0.48 to 0.62) | |
| Cyprus | 1.44 (1.4 to 1.49) | 1.49 (1.44 to 1.54) | 1.39 (1.32 to 1.45) | |
| Denmark | 0.62 (0.55 to 0.69) | 0.64 (0.58 to 0.71) | 0.55 (0.47 to 0.63) | |
| Finland | 0.57 (0.54 to 0.61) | 0.61 (0.58 to 0.64) | 0.81 (0.77 to 0.85) | |
| France | 0.8 (0.76 to 0.85) | 0.8 (0.74 to 0.86) | 0.78 (0.75 to 0.81) | |
| Germany | 0.21 (0.17 to 0.24) | 0.29 (0.26 to 0.31) | 0.31 (0.28 to 0.34) | |
| Greece | 0.9 (0.86 to 0.95) | 0.88 (0.81 to 0.95) | 0.88 (0.86 to 0.91) | |
| Iceland | 0.6 (0.57 to 0.64) | 0.67 (0.63 to 0.71) | 0.55 (0.52 to 0.58) | |
| Ireland | 0.85 (0.8 to 0.91) | 0.81 (0.76 to 0.85) | 1.01 (0.95 to 1.06) | |
| Israel | 0.51 (0.46 to 0.56) | 0.51 (0.45 to 0.56) | 0.47 (0.43 to 0.5) | |
| Italy | 0.6 (0.53 to 0.67) | 0.64 (0.58 to 0.7) | 0.58 (0.48 to 0.67) | |
| Luxembourg | 0.77 (0.73 to 0.8) | 0.83 (0.8 to 0.86) | 0.67 (0.62 to 0.71) | |
| Malta | 0.76 (0.73 to 0.79) | 0.84 (0.81 to 0.87) | 0.62 (0.58 to 0.66) | |
| Monaco | 1.32 (1.21 to 1.43) | 1.41 (1.31 to 1.51) | 1.22 (1.1 to 1.34) | |
| Netherlands | 0.8 (0.77 to 0.82) | 0.86 (0.82 to 0.91) | 0.74 (0.72 to 0.77) | |
| Norway | 0.07 (0.02 to 0.12) | −0.02 (−0.09 to 0.04) | 0.26 (0.23 to 0.29) | |
| Portugal | 0.8 (0.75 to 0.85) | 0.84 (0.78 to 0.9) | 0.75 (0.72 to 0.79) | |
| San Marino | 0.55 (0.44 to 0.65) | 0.65 (0.54 to 0.75) | 0.41 (0.28 to 0.53) | |
| Spain | 0.23 (0.18 to 0.28) | 0.22 (0.17 to 0.27) | 0.4 (0.36 to 0.43) | |
| Sweden | 0.58 (0.54 to 0.62) | 0.63 (0.59 to 0.66) | 0.63 (0.56 to 0.69) | |
| Switzerland | 0.15 (0.09 to 0.2) | 0.27 (0.21 to 0.33) | 0.09 (0.03 to 0.15) | |
| United Kingdom | 0.31 (0.28 to 0.34) | 0.41 (0.39 to 0.43) | 0.46 (0.4 to 0.52) | |
| Deaths | Western Europe | 0.45 (0.41 to 0.5) | 0.5 (0.45 to 0.54) | 0.55 (0.52 to 0.57) |
| Andorra | 0.44 (0.25 to 0.62) | 0.56 (0.36 to 0.75) | 0.22 (0 to 0.43) | |
| Austria | 0.44 (0.38 to 0.5) | 0.42 (0.36 to 0.47) | 0.84 (0.8 to 0.87) | |
| Belgium | 0.5 (0.43 to 0.57) | 0.55 (0.48 to 0.62) | 0.58 (0.51 to 0.65) | |
| Cyprus | 1.49 (1.42 to 1.56) | 1.5 (1.41 to 1.6) | 1.48 (1.41 to 1.55) | |
| Denmark | 0.82 (0.73 to 0.9) | 0.88 (0.8 to 0.96) | 0.66 (0.56 to 0.77) | |
| Finland | 0.6 (0.55 to 0.64) | 0.6 (0.56 to 0.65) | 0.89 (0.84 to 0.94) | |
| France | 0.93 (0.88 to 0.98) | 0.92 (0.87 to 0.96) | 0.92 (0.86 to 0.98) | |
| Germany | 0.12 (0.06 to 0.19) | 0.21 (0.16 to 0.27) | 0.22 (0.18 to 0.27) | |
| Greece | 0.92 (0.87 to 0.97) | 0.86 (0.79 to 0.93) | 0.91 (0.86 to 0.96) | |
| Iceland | 0.77 (0.72 to 0.81) | 0.83 (0.77 to 0.88) | 0.72 (0.67 to 0.77) | |
| Ireland | 0.92 (0.86 to 0.97) | 0.89 (0.84 to 0.94) | 1.05 (1.01 to 1.1) | |
| Israel | 0.57 (0.5 to 0.63) | 0.58 (0.52 to 0.64) | 0.46 (0.41 to 0.5) | |
| Italy | 0.57 (0.5 to 0.65) | 0.63 (0.57 to 0.69) | 0.53 (0.42 to 0.63) | |
| Luxembourg | 1 (0.93 to 1.07) | 1.11 (1.05 to 1.17) | 0.79 (0.72 to 0.86) | |
| Malta | 0.78 (0.75 to 0.81) | 0.89 (0.85 to 0.93) | 0.58 (0.53 to 0.62) | |
| Monaco | 1.69 (1.54 to 1.85) | 1.79 (1.63 to 1.94) | 1.57 (1.39 to 1.76) | |
| Netherlands | 0.75 (0.73 to 0.78) | 0.88 (0.85 to 0.9) | 0.6 (0.56 to 0.63) | |
| Norway | 0.08 (0.01 to 0.14) | 0.01 (−0.06 to 0.09) | 0.25 (0.2 to 0.3) | |
| Portugal | 0.83 (0.78 to 0.89) | 0.88 (0.82 to 0.94) | 0.79 (0.75 to 0.83) | |
| San Marino | 0.52 (0.37 to 0.67) | 0.63 (0.49 to 0.78) | 0.31 (0.13 to 0.49) | |
| Spain | 0.34 (0.29 to 0.39) | 0.35 (0.3 to 0.4) | 0.49 (0.46 to 0.52) | |
| Sweden | 0.62 (0.58 to 0.67) | 0.68 (0.65 to 0.72) | 0.66 (0.58 to 0.73) | |
| Switzerland | 0.26 (0.17 to 0.35) | 0.39 (0.31 to 0.48) | 0.16 (0.08 to 0.25) | |
| United Kingdom | 0.27 (0.23 to 0.31) | 0.38 (0.36 to 0.41) | 0.43 (0.34 to 0.52) | |
Abbreviations: ADOD, Alzheimer's disease and other dementias; ASDR, age‐standardized DALYs rate; ASMR, age‐standardized mortality rate; CI, confidence interval; DALYs, disability‐adjusted life years; EAPC, estimated annual percentage change.
Females had higher age‐standardized rates than males in 2023. Among females, ASMR and ASDR were 7.47 (95% UI: 1.51–19.25) and 128.49 (95% UI: 38.29–267.38) per 100 000, compared with 5.75 (95% UI: 1.14–15.71) and 101.38 (95% UI: 31.25–227.21) per 100 000 among males (Figure 1C,D and Table 3). However, males showed slightly higher EAPCs for both ASMR and ASDR (0.55 and 0.54, respectively) than females (Table 1). In 2023, deaths totaled 61953.6 among females and 28141.2 among males (Figure 1B and Table 3).
TABLE 3.
Sex‐specific burden of ADOD attributable to metabolic risks in Western Europe, 1990–2023.
| Gender | Location | Risks | Deaths | DALYs | ||||
|---|---|---|---|---|---|---|---|---|
| Number in 2023 (95% UI) | Percentage change in deaths number | ASMR in 2023 (95% UI) | Percentage change in ASMR | ASDR in 2023 (95% UI) | Percentage change in ASDR | |||
| Females | Western Europe | High body‐mass index | 21031.0 (−6806.0 to 80503.9) | 203.6% | 2.63 (−0.87 to 9.7) | 59.4% | 48.14 (−16.3 to 151.36) | 49.8% |
| High fasting plasma glucose | 44671.3 (11683.1 to 106113.1) | 129.5% | 5.3 (1.4 to 12.82) | 10.4% | 88.75 (39.48 to 175.98) | 9.9% | ||
| Metabolic risks | 61953.6 (12721.3 to 162340.9) | 145.2% | 7.47 (1.51 to 19.25) | 20.7% | 128.49 (38.29 to 267.38) | 19.2% | ||
| Andorra | High body‐mass index | 2.5 (−0.7 to 9.9) | 733.3% | 1.98 (−0.6 to 7.89) | 86.8% | 39.41 (−17.01 to 135.32) | 74.8% | |
| High fasting plasma glucose | 4.9 (1.3 to 12.2) | 444.4% | 3.21 (0.83 to 7.89) | −5% | 58.06 (23.77 to 120.9) | −2% | ||
| Metabolic risks | 7.0 (1.4 to 18.5) | 536.4% | 4.91 (0.8 to 12.86) | 13.9% | 91.89 (24.86 to 205.75) | 16.2% | ||
| Austria | High body‐mass index | 315.6 (−102.9 to 1233.4) | 113.8% | 2.15 (−0.68 to 8.3) | 31.9% | 40.12 (−14.06 to 123.75) | 25.8% | |
| High fasting plasma glucose | 575.7 (144.2 to 1379.4) | 111% | 3.76 (0.93 to 8.96) | 16.4% | 61.74 (23.69 to 131.99) | 15.4% | ||
| Metabolic risks | 848.8 (161.3 to 2228.6) | 110.1% | 5.62 (1.02 to 14.74) | 20.1% | 96.68 (25.37 to 209.01) | 17.9% | ||
| Belgium | High body‐mass index | 471.4 (−154.8 to 1759.5) | 161.6% | 2.44 (−0.77 to 8.87) | 52.5% | 44.99 (−15.5 to 139.45) | 39.8% | |
| High fasting plasma glucose | 1008.3 (241.3 to 2485.2) | 131.7% | 4.89 (1.16 to 12.3) | 20.1% | 82.19 (30.03 to 172.29) | 20.4% | ||
| Metabolic risks | 1406.5 (287.1 to 3652.2) | 137.1% | 6.96 (1.38 to 18.06) | 27% | 120.3 (35.72 to 255.18) | 24.4% | ||
| Cyprus | High body‐mass index | 37.6 (−12.0 to 147.5) | 571.4% | 3.46 (−1.1 to 13.75) | 195.7% | 59.15 (−22.3 to 202.92) | 158.1% | |
| High fasting plasma glucose | 50.1 (10.7 to 135.4) | 276.7% | 4.75 (1.03 to 12.76) | 36.9% | 76.46 (26.86 to 176.29) | 40.1% | ||
| Metabolic risks | 82.5 (11.6 to 240.0) | 350.8% | 7.72 (1.12 to 22.4) | 70.4% | 127.19 (27.8 to 295.62) | 69% | ||
| Denmark | High body‐mass index | 151.6 (−61.9 to 532.2) | 154.8% | 1.72 (−0.7 to 6.02) | 67% | 30.29 (−10.58 to 91.34) | 43.8% | |
| High fasting plasma glucose | 302.4 (70.5 to 778.4) | 114.9% | 3.28 (0.76 to 8.44) | 29.1% | 52.19 (18.14 to 115.52) | 23.1% | ||
| Metabolic risks | 435.0 (84.0 to 1158.1) | 124.1% | 4.78 (0.9 to 12.58) | 38.2% | 78.7 (21.43 to 176.18) | 28.2% | ||
| Finland | High body‐mass index | 307.3 (−89.6 to 1179.6) | 269.8% | 2.88 (−0.89 to 10.92) | 69.4% | 50.76 (−16.48 to 164.59) | 51.7% | |
| High fasting plasma glucose | 738.2 (190.1 to 1783.5) | 191.1% | 6.69 (1.74 to 15.99) | 18.4% | 110.06 (44.96 to 221.29) | 20.6% | ||
| Metabolic risks | 976.5 (211.4 to 2560.3) | 203.8% | 8.93 (1.92 to 23.62) | 26.8% | 149.67 (47.79 to 330.1) | 25.9% | ||
| France | High body‐mass index | 2700.6 (−902.5 to 9855.8) | 264.1% | 2.11 (−0.69 to 7.5) | 91.8% | 37.24 (−12.26 to 115.94) | 71.2% | |
| High fasting plasma glucose | 4505.2 (1072.8 to 11572.9) | 136.5% | 3.34 (0.8 to 8.59) | 23.7% | 54.29 (21.52 to 120.8) | 22.1% | ||
| Metabolic risks | 6843.4 (1135.5 to 17692.8) | 166.6% | 5.17 (0.86 to 13.48) | 40.5% | 86.62 (18.82 to 197.29) | 35.5% | ||
| Germany | High body‐mass index | 4741.8 (−1267.5 to 18442.7) | 124.9% | 2.82 (−0.8 to 10.5) | 31.8% | 53.29 (−19.39 to 168.23) | 28.7% | |
| High fasting plasma glucose | 11726.4 (3172.4 to 27206.4) | 100.1% | 6.59 (1.79 to 15.4) | 5.8% | 111.34 (49.27 to 213.92) | 7% | ||
| Metabolic risks | 15530.4 (3312.1 to 37747.2) | 104.8% | 8.86 (1.87 to 21.67) | 11% | 154.63 (48.71 to 316.96) | 11.8% | ||
| High body‐mass index | 732.5 (−249.1 to 2911.6) | 425.8% | 3.48 (−1.19 to 13.42) | 105.9% | 66.8 (−23.8 to 207.1) | 96.9% | ||
| High fasting plasma glucose | 1118.9 (275.7 to 2999.8) | 223.9% | 5.24 (1.29 to 13.75) | 11.7% | 94.68 (39.02 to 198.54) | 15.4% | ||
| Metabolic risks | 1713.4 (294.8 to 4502.2) | 270.1% | 8.07 (1.42 to 20.87) | 31.9% | 149.09 (40.48 to 317.34) | 34.5% | ||
| Iceland | High body‐mass index | 10.5 (−3.3 to 39.9) | 250% | 2.72 (−0.86 to 10.44) | 64.8% | 48.28 (−19.11 to 172.07) | 46.4% | |
| High fasting plasma glucose | 17.9 (4.2 to 44.1) | 171.2% | 4.55 (1.05 to 11.16) | 23.3% | 77.59 (29.49 to 168.41) | 18.9% | ||
| Metabolic risks | 26.7 (4.4 to 71.1) | 190.2% | 6.83 (1.13 to 18.38) | 33.4% | 118.09 (31.78 to 276) | 25.6% | ||
| Ireland | High body‐mass index | 136.7 (−42.4 to 527.7) | 354.2% | 2.47 (−0.79 to 9.46) | 102.5% | 44.35 (−15.13 to 142.18) | 78.8% | |
| High fasting plasma glucose | 253.7 (64.4 to 626.8) | 204.6% | 4.47 (1.13 to 10.98) | 20.2% | 73.57 (28.89 to 152.52) | 18.9% | ||
| Metabolic risks | 368.9 (69.2 to 970.9) | 236.9% | 6.55 (1.22 to 17.28) | 36.7% | 111.14 (30.24 to 242.97) | 32.9% | ||
| Israel | High body‐mass index | 243.3 (−73.1 to 909.4) | 422.1% | 2.76 (−0.89 to 10.18) | 46.8% | 44.44 (−14.96 to 145.23) | 34.9% | |
| High fasting plasma glucose | 439.5 (109.3 to 1083.6) | 401.1% | 4.66 (1.13 to 11.51) | 19.2% | 69.32 (23.33 to 151.74) | 18.9% | ||
| Metabolic risks | 641.1 (117.9 to 1686.3) | 402% | 6.95 (1.25 to 18.52) | 25.9% | 106.19 (25.3 to 249.33) | 22.6% | ||
| Italy | High body‐mass index | 3578.9 (−1274.3 to 12730.2) | 287.7% | 2.74 (−0.96 to 9.74) | 74.5% | 49.89 (−17.81 to 149.56) | 69.2% | |
| High fasting plasma glucose | 7805.0 (2021.9 to 18689.9) | 178.2% | 5.69 (1.48 to 13.56) | 13.6% | 95.33 (41.65 to 187.68) | 16.4% | ||
| Metabolic risks | 10796.4 (2288.3 to 26568.9) | 200% | 7.98 (1.63 to 19.59) | 25.5% | 137.15 (41.25 to 277.23) | 27.8% | ||
| Luxembourg | High body‐mass index | 15.4 (−4.9 to 62.0) | 340% | 2.04 (−0.65 to 8.12) | 117% | 36.36 (−12.58 to 119.7) | 80.3% | |
| High fasting plasma glucose | 25.9 (6.3 to 67.4) | 191% | 3.36 (0.81 to 8.62) | 26.3% | 56.22 (21.82 to 117.93) | 19.2% | ||
| Metabolic risks | 38.8 (6.4 to 103.5) | 226.1% | 5.06 (0.84 to 13.23) | 45.8% | 86.65 (23.55 to 188.02) | 33.8% | ||
| Malta | High body‐mass index | 17.5 (−5.5 to 68.5) | 573.1% | 2.55 (−0.8 to 9.92) | 125.7% | 49.01 (−18.72 to 166.47) | 107.8% | |
| High fasting plasma glucose | 29.1 (7.3 to 72.5) | 288% | 4.16 (1.05 to 10.29) | 12.7% | 70.18 (27.8 to 149.7) | 10.5% | ||
| Metabolic risks | 44.0 (7.4 to 117.3) | 349% | 6.34 (1.05 to 17.12) | 35.8% | 112.12 (28.55 to 264.15) | 33.4% | ||
| Monaco | High body‐mass index | 3.7 (−1.4 to 14.6) | 208.3% | 4.47 (−1.7 to 17.75) | 118% | 70.78 (−29.14 to 241.12) | 83.8% | |
| High fasting plasma glucose | 5.8 (1.4 to 15.6) | 141.7% | 6.86 (1.66 to 18.4) | 66.1% | 102.67 (35.21 to 236.65) | 49.9% | ||
| Metabolic risks | 8.9 (1.5 to 23.9) | 161.8% | 10.58 (1.72 to 27.97) | 79.3% | 161.59 (38.7 to 366.37) | 58.7% | ||
| Netherlands | High body‐mass index | 752.4 (−212.2 to 3048.4) | 297% | 2.84 (−0.82 to 11.33) | 105.8% | 50.22 (−17.94 to 167.15) | 95.1% | |
| High fasting plasma glucose | 1176.8 (298.3 to 3065.4) | 139.8% | 4.3 (1.09 to 11.18) | 15% | 70.56 (28.53 to 155.13) | 16.9% | ||
| Metabolic risks | 1826.6 (297.3 to 4879.3) | 177.7% | 6.75 (1.1 to 18.07) | 36.1% | 114.06 (27.36 to 260.82) | 37.2% | ||
| Norway | High body‐mass index | 154.8 (−53.4 to 609.9) | 77.7% | 2.05 (−0.7 to 7.85) | 15.2% | 38.45 (−14.15 to 118.78) | 5% | |
| High fasting plasma glucose | 378.3 (92.5 to 931.5) | 84.6% | 4.83 (1.18 to 11.91) | 10.3% | 83.69 (33.14 to 178.25) | 9.5% | ||
| Metabolic risks | 507.5 (105.5 to 1283.9) | 81.7% | 6.54 (1.33 to 16.48) | 10.7% | 115.88 (37.23 to 238.46) | 7.4% | ||
| Portugal | High body‐mass index | 599.8 (−184.7 to 2297.7) | 511.4% | 2.78 (−0.91 to 10.25) | 139.7% | 48.05 (−15.75 to 152.82) | 118.2% | |
| High fasting plasma glucose | 1456.2 (360.5 to 3638.7) | 258.9% | 6.39 (1.56 to 16.06) | 20.1% | 100.27 (39.99 to 216.19) | 19.7% | ||
| Metabolic risks | 1924.8 (434.3 to 4919.9) | 296.1% | 8.56 (1.9 to 21.64) | 36.5% | 138.06 (40.62 to 304.98) | 35.5% | ||
| High body‐mass index | 1.3 (−0.4 to 4.9) | 550% | 2.11 (−0.64 to 8.06) | 102.9% | 39.21 (−16.84 to 126.82) | 86.9% | ||
| High fasting plasma glucose | 2.6 (0.6 to 6.7) | 333.3% | 4.04 (0.92 to 10.45) | 14.8% | 68.91 (26.65 to 146.68) | 15.4% | ||
| Metabolic risks | 3.7 (0.7 to 9.6) | 362.5% | 5.79 (1.1 to 15.32) | 31% | 101.66 (28.92 to 224.85) | 30.4% | ||
| Spain | High body‐mass index | 2902.4 (−1036.2 to 9920.7) | 361.3% | 3.22 (−1.15 to 10.96) | 76.9% | 55.09 (−20.06 to 168.96) | 64.6% | |
| High fasting plasma glucose | 4782.6 (1272.4 to 11685.7) | 177.9% | 5.03 (1.36 to 12.23) | −2.9% | 81.22 (32.06 to 170.49) | −6.7% | ||
| Metabolic risks | 7177.3 (1182.9 to 18391.1) | 219.7% | 7.7 (1.26 to 19.24) | 15.1% | 126.86 (32.19 to 270.23) | 10.3% | ||
| Sweden | High body‐mass index | 355.1 (−109.1 to 1460.9) | 134.4% | 2.08 (−0.66 to 8.31) | 51.8% | 37.59 (−12.62 to 121.78) | 39.4% | |
| High fasting plasma glucose | 808.7 (205.6 to 1969.8) | 107.2% | 4.49 (1.14 to 10.97) | 23.7% | 73.42 (30.46 to 150.92) | 25% | ||
| Metabolic risks | 1106.6 (219.9 to 2882.6) | 111.8% | 6.24 (1.22 to 16.69) | 29.2% | 105.12 (30.12 to 231.2) | 27.4% | ||
| Switzerland | High body‐mass index | 273.8 (−97.2 to 982.6) | 130.9% | 1.89 (−0.64 to 6.74) | 25.2% | 36.25 (−12.97 to 109) | 14.8% | |
| High fasting plasma glucose | 837.3 (218.8 to 2017.0) | 140.8% | 5.3 (1.36 to 12.73) | 16.7% | 88.72 (37.78 to 177.03) | 11.1% | ||
| Metabolic risks | 1061.6 (237.4 to 2784.9) | 137.3% | 6.84 (1.51 to 17.72) | 17.7% | 118.55 (38.88 to 246.62) | 11.2% | ||
| United Kingdom | High body‐mass index | 2506.4 (−699.5 to 10657.1) | 113.9% | 2.46 (−0.69 to 10.5) | 38.2% | 48.1 (−19.05 to 160.44) | 36.4% | |
| High fasting plasma glucose | 6582.7 (1618.5 to 16603.8) | 79.9% | 6.1 (1.54 to 15.23) | 6.1% | 106.23 (46.74 to 215.59) | 7.9% | ||
| Metabolic risks | 8523.2 (1858.3 to 22150.5) | 85.6% | 8.01 (1.72 to 21.45) | 11.7% | 143.74 (48.92 to 305.7) | 13.3% | ||
| Males | Western Europe | High body‐mass index | 9008.6 (−2790.5 to 36413.5) | 303% | 1.82 (−0.56 to 7.32) | 68.5% | 34.94 (−12.31 to 114.96) | 62% |
| High fasting plasma glucose | 20894.8 (4948.4 to 54405.2) | 196.6% | 4.28 (1.02 to 11.1) | 10.6% | 73.14 (31.01 to 156.93) | 10.1% | ||
| Metabolic risks | 28141.2 (5552.7 to 77102.6) | 216.8% | 5.75 (1.14 to 15.71) | 20.8% | 101.38 (31.25 to 227.21) | 20.4% | ||
| Andorra | High body‐mass index | 1.3 (−0.4 to 5.2) | 550% | 1.27 (−0.42 to 5.13) | 74% | 26.88 (−11.68 to 90.29) | 72.3% | |
| High fasting plasma glucose | 3.3 (0.8 to 8.7) | 312.5% | 2.75 (0.63 to 7.3) | −16.4% | 51.11 (20.93 to 104.86) | −10.6% | ||
| Metabolic risks | 4.3 (0.8 to 12.2) | 377.8% | 3.81 (0.7 to 10.98) | −2.6% | 73.54 (23.38 to 167.47) | 4.3% | ||
| Austria | High body‐mass index | 130.7 (−41.9 to 510.2) | 196.4% | 1.43 (−0.44 to 5.64) | 26.5% | 28.31 (−9.53 to 92.42) | 23.4% | |
| High fasting plasma glucose | 285.7 (65.2 to 804.3) | 286.1% | 3.24 (0.74 to 9.02) | 44.6% | 54.46 (21.66 to 120.65) | 43% | ||
| Metabolic risks | 396.3 (74.0 to 1044.6) | 249.2% | 4.45 (0.83 to 11.75) | 36.9% | 78.51 (22.72 to 174.88) | 33.8% | ||
| Belgium | High body‐mass index | 201.7 (−62.6 to 804.4) | 250.2% | 1.72 (−0.54 to 6.78) | 62.3% | 33.18 (−11.32 to 108.03) | 54.3% | |
| High fasting plasma glucose | 460.0 (102.8 to 1211.9) | 197.2% | 4 (0.9 to 10.5) | 19.4% | 67.38 (25.02 to 149.02) | 17.9% | ||
| Metabolic risks | 627.0 (117.7 to 1699.5) | 206.9% | 5.42 (1.02 to 14.6) | 27.2% | 94.94 (28.41 to 209.81) | 25.4% | ||
| Cyprus | High body‐mass index | 16.9 (−4.7 to 76.0) | 576% | 2.04 (−0.59 to 9.19) | 179.5% | 38.15 (−15.14 to 135.89) | 149% | |
| High fasting plasma glucose | 28.5 (5.9 to 82.2) | 256.2% | 3.77 (0.81 to 10.48) | 35.6% | 63.69 (22.49 to 148.13) | 34% | ||
| Metabolic risks | 42.7 (6.1 to 123.7) | 318.6% | 5.48 (0.82 to 16.79) | 60.2% | 95.64 (23.91 to 234.31) | 56.9% | ||
| Denmark | High body‐mass index | 84.5 (−29.4 to 344.6) | 171.7% | 1.39 (−0.48 to 5.78) | 40.4% | 26.19 (−9.07 to 89.87) | 33.8% | |
| High fasting plasma glucose | 194.9 (44.3 to 529.2) | 160.2% | 3.43 (0.79 to 9.48) | 26.6% | 54.2 (18.87 to 124.55) | 22% | ||
| Metabolic risks | 266.7 (48.5 to 727.3) | 160.7% | 4.61 (0.86 to 12.9) | 28.8% | 76.52 (21.37 to 174.26) | 24.1% | ||
| Finland | High body‐mass index | 136.0 (−39.9 to 585.6) | 512.6% | 2.17 (−0.65 to 9.23) | 112.7% | 38.98 (−15.49 to 140.18) | 89.5% | |
| High fasting plasma glucose | 342.3 (78.9 to 905.3) | 316.9% | 5.66 (1.32 to 14.89) | 24.4% | 91.03 (37.69 to 197.38) | 21.7% | ||
| Metabolic risks | 448.4 (92.9 to 1247.0) | 347.1% | 7.35 (1.53 to 20.31) | 36.6% | 121.55 (36.5 to 285.34) | 32.5% | ||
| France | High body‐mass index | 1323.7 (−418.5 to 4887.3) | 362.7% | 1.83 (−0.57 to 6.77) | 108% | 33.05 (−11.05 to 103.82) | 89.4% | |
| High fasting plasma glucose | 2573.0 (622.0 to 6876.3) | 195% | 3.61 (0.88 to 9.61) | 22.4% | 58.3 (23.6 to 133.55) | 16.7% | ||
| Metabolic risks | 3662.3 (685.0 to 10394.8) | 228.8% | 5.11 (0.97 to 14.52) | 38.5% | 85.65 (22.91 to 199.91) | 32.3% | ||
| Germany | High body‐mass index | 1935.1 (−575.1 to 7993.5) | 222.5% | 1.81 (−0.54 to 7.4) | 27.5% | 37.5 (−13.79 to 121.81) | 27.4% | |
| High fasting plasma glucose | 5135.3 (1220.8 to 13657.5) | 201.9% | 5 (1.21 to 13.2) | 8% | 87.94 (38.26 to 183.74) | 8.1% | ||
| Metabolic risks | 6657.6 (1298.0 to 17145.0) | 205.4% | 6.42 (1.25 to 16.28) | 11.5% | 117.81 (38.04 to 246.83) | 12.2% | ||
| Greece | High body‐mass index | 319.8 (−107.3 to 1269.3) | 472.1% | 2.27 (−0.75 to 8.79) | 155.1% | 46.38 (−17.19 to 143.69) | 134.8% | |
| High fasting plasma glucose | 540.6 (130.4 to 1525.8) | 176.9% | 3.93 (0.94 to 11.12) | 9.8% | 73.52 (30.51 to 160.08) | 11.3% | ||
| Metabolic risks | 800.9 (136.9 to 2255.5) | 231% | 5.77 (1 to 16.68) | 33.3% | 111.41 (33.11 to 239.73) | 34.8% | ||
| Iceland | High body‐mass index | 5.5 (−1.6 to 21.5) | 292.9% | 1.83 (−0.55 to 7.13) | 59.1% | 35.39 (−14.03 to 122.89) | 41.5% | |
| High fasting plasma glucose | 12.8 (2.8 to 34.1) | 255.6% | 4.27 (0.94 to 11.43) | 28.6% | 73.36 (28.11 to 157.77) | 19.3% | ||
| Metabolic risks | 17.4 (3.2 to 48.6) | 262.5% | 5.76 (1.08 to 16.19) | 34.6% | 102.25 (30.03 to 229.11) | 23.8% | ||
| Ireland | High body‐mass index | 81.0 (−24.3 to 321.8) | 523.1% | 2.05 (−0.61 to 8.2) | 141.2% | 39.46 (−14.94 to 128.77) | 122.6% | |
| High fasting plasma glucose | 140.7 (31.1 to 367.6) | 264.5% | 3.78 (0.84 to 9.84) | 22.7% | 62.95 (24.55 to 136.2) | 20.3% | ||
| Metabolic risks | 208.0 (34.1 to 565.5) | 317.7% | 5.48 (0.93 to 15.22) | 43.8% | 95.87 (25.65 to 213.42) | 41.8% | ||
| High body‐mass index | 106.0 (−29.0 to 444.5) | 381.8% | 1.69 (−0.47 to 7.16) | 52.3% | 29.03 (−9.83 to 106.22) | 46% | ||
| High fasting plasma glucose | 237.5 (54.8 to 606.1) | 316.7% | 3.75 (0.86 to 9.64) | 16.5% | 56.04 (18.45 to 127.55) | 15.7% | ||
| Metabolic risks | 324.7 (59.8 to 878.1) | 329.5% | 5.15 (0.95 to 13.94) | 23.8% | 80.06 (19.26 to 188.6) | 22.6% | ||
| Italy | High body‐mass index | 1535.2 (−475.8 to 6093.5) | 338.1% | 2 (−0.61 to 7.88) | 75.4% | 37.23 (−12.48 to 120.14) | 76.3% | |
| High fasting plasma glucose | 3443.4 (811.7 to 9204.1) | 200.3% | 4.48 (1.06 to 11.92) | 8% | 76.93 (31.11 to 162.36) | 11.5% | ||
| Metabolic risks | 4697.7 (877.4 to 13137.1) | 226% | 6.11 (1.14 to 17.1) | 19.6% | 107.43 (33.85 to 241.38) | 23.8% | ||
| Luxembourg | High body‐mass index | 6.4 (−1.9 to 27.4) | 357.1% | 1.36 (−0.41 to 5.83) | 78.9% | 27 (−10.56 to 92.82) | 65% | |
| High fasting plasma glucose | 12.9 (2.9 to 35.0) | 248.6% | 2.94 (0.68 to 7.84) | 18.5% | 51.24 (20.51 to 111.32) | 14.8% | ||
| Metabolic risks | 18.1 (3.2 to 50.4) | 269.4% | 4.05 (0.7 to 11.09) | 29.8% | 73.15 (21.04 to 165.13) | 25.3% | ||
| Malta | High body‐mass index | 7.3 (−2.3 to 29.2) | 508.3% | 1.54 (−0.49 to 6.02) | 94.9% | 31.7 (−12.79 to 108.69) | 90.8% | |
| High fasting plasma glucose | 17.4 (4.0 to 45.9) | 304.7% | 3.99 (0.91 to 10.75) | 13.4% | 68.01 (27.45 to 146.76) | 10.7% | ||
| Metabolic risks | 23.3 (4.2 to 62.4) | 339.6% | 5.24 (0.97 to 14.33) | 25.4% | 93.92 (28.13 to 211.7) | 24.6% | ||
| Monaco | High body‐mass index | 1.5 (−0.4 to 6.2) | 200% | 3.12 (−0.93 to 13.17) | 88% | 51.61 (−20.14 to 178.02) | 63.7% | |
| High fasting plasma glucose | 2.5 (0.6 to 7.4) | 150% | 5.65 (1.38 to 15.96) | 51.5% | 85.5 (31.53 to 201.5) | 37.4% | ||
| Metabolic risks | 3.8 (0.6 to 11.6) | 153.3% | 8.17 (1.3 to 25.34) | 59.6% | 127.3 (30.64 to 329.48) | 43.5% | ||
| Netherlands | High body‐mass index | 302.0 (−98.0 to 1251.6) | 426.1% | 1.7 (−0.53 to 7.11) | 100% | 33.11 (−11.48 to 112.45) | 99.7% | |
| High fasting plasma glucose | 694.2 (168.6 to 1851.6) | 213.8% | 4.12 (1 to 10.85) | 10.8% | 70.33 (28.1 to 148.72) | 13.1% | ||
| Metabolic risks | 945.3 (180.3 to 2656.7) | 250.1% | 5.53 (1.08 to 15.32) | 24.5% | 97.95 (28.45 to 224.26) | 28.4% | ||
| Norway | High body‐mass index | 67.8 (−25.5 to 259.7) | 126.8% | 1.35 (−0.53 to 5.22) | 23.9% | 26.82 (−10.51 to 83.62) | 17.9% | |
| High fasting plasma glucose | 251.2 (61.1 to 672.2) | 134.3% | 5.15 (1.25 to 13.78) | 16.8% | 87.57 (35.03 to 185.3) | 13.3% | ||
| Metabolic risks | 304.7 (63.6 to 792.6) | 131.4% | 6.22 (1.3 to 16.28) | 17.4% | 108.88 (38.4 to 227.37) | 13.4% | ||
| Portugal | High body‐mass index | 256.7 (−72.6 to 1079.4) | 648.4% | 2 (−0.57 to 8.5) | 189.9% | 38.62 (−16.13 to 137.08) | 158.5% | |
| High fasting plasma glucose | 635.9 (152.6 to 1711.2) | 265.7% | 5.01 (1.21 to 13.54) | 14.4% | 86.74 (35.6 to 184.75) | 11.7% | ||
| Metabolic risks | 833.9 (164.1 to 2288.8) | 314.3% | 6.56 (1.29 to 18.02) | 33.1% | 116.7 (36.94 to 264.01) | 30.2% | ||
| San Marino | High body‐mass index | 0.7 (−0.2 to 2.8) | 600% | 1.54 (−0.51 to 6.3) | 102.6% | 29.31 (−12.49 to 101.44) | 93.7% | |
| High fasting plasma glucose | 1.7 (0.4 to 4.5) | 325% | 3.96 (0.89 to 10.39) | 14.8% | 66.35 (25.29 to 146.71) | 13.4% | ||
| Metabolic risks | 2.3 (0.4 to 6.2) | 360% | 5.2 (1.01 to 14.04) | 27.5% | 90.12 (27.62 to 204.68) | 26.4% | ||
| Spain | High body‐mass index | 1040.4 (−344.9 to 3983.1) | 447.3% | 1.98 (−0.66 to 7.52) | 106.2% | 35.53 (−12.55 to 110.69) | 88.9% | |
| High fasting plasma glucose | 2002.6 (469.7 to 5191.9) | 205.4% | 3.79 (0.9 to 9.86) | 1.3% | 62.07 (24.71 to 142.86) | −2.2% | ||
| Metabolic risks | 2842.5 (482.5 to 7684.1) | 250% | 5.39 (0.92 to 14.66) | 19.2% | 90.84 (23.45 to 215.58) | 15% | ||
| Sweden | High body‐mass index | 166.2 (−53.1 to 684.5) | 164.6% | 1.39 (−0.44 to 5.78) | 39% | 26.27 (−8.64 to 84.88) | 34.4% | |
| High fasting plasma glucose | 455.2 (103.9 to 1202.6) | 171.1% | 3.88 (0.89 to 10.21) | 29.8% | 64.56 (26.14 to 140.54) | 30.1% | ||
| Metabolic risks | 590.0 (121.9 to 1565.0) | 166.2% | 5.01 (1.04 to 13.32) | 30.1% | 85.97 (25.8 to 189.84) | 29.4% | ||
| Switzerland | High body‐mass index | 143.7 (−44.7 to 569.2) | 170.6% | 1.51 (−0.47 to 6) | 13.5% | 29.02 (−9.69 to 92.02) | 8.3% | |
| High fasting plasma glucose | 323.3 (75.9 to 872.6) | 186.9% | 3.45 (0.81 to 9.24) | 10.6% | 59.05 (24.15 to 126.6) | 6.9% | ||
| Metabolic risks | 441.6 (85.8 to 1233.6) | 181.3% | 4.7 (0.91 to 13.15) | 11.1% | 83.04 (24.28 to 190.49) | 6.8% | ||
| United Kingdom | High body‐mass index | 1130.7 (−320.5 to 4833.2) | 257.3% | 1.61 (−0.46 to 6.91) | 56.3% | 31.98 (−12.89 to 112.98) | 56.8% | |
| High fasting plasma glucose | 3081.7 (733.4 to 8138.8) | 160.6% | 4.44 (1.06 to 11.77) | 0.7% | 77.53 (33.4 to 164.91) | 3% | ||
| Metabolic risks | 3957.2 (813.8 to 10881.2) | 176.4% | 5.69 (1.17 to 15.7) | 9% | 102.33 (34.32 to 229.68) | 12% | ||
Note: High BMI‐ and high FPG‐attributable estimates are not mutually exclusive and should not be summed to obtain the estimate for metabolic risks, because these risks are correlated and may act through overlapping cardiometabolic pathways.
Abbreviations: ADOD, Alzheimer's disease and other dementias; ASDR, age‐standardized DALYs rate; ASMR, age‐standardized mortality rate; BMI, body‐mass index; DALYs, disability‐adjusted life year; UI, uncertainty interval.
Across age groups, age‐specific mortality and DALY rates increased with age, indicating that the rate‐based burden was concentrated in older adults. Absolute deaths and DALYs also rose with age, peaked in older age groups, and then declined at extreme old ages, reflecting increasing age‐specific rates but smaller populations in the oldest groups (Figure 1F–I).
3.2. Country‐Level Variation in Age‐Standardized Rates and Absolute Burden
Marked country‐level heterogeneity was observed in age‐standardized rates and temporal trends. In 2023, Monaco had the highest ASMR and ASDR, at 9.69 (95% UI: 1.62–25.82) and 147.85 (95% UI: 36.77–336.63) per 100 000, respectively, whereas Andorra had the lowest ASMR (4.42 per 100 000) and Denmark had the lowest ASDR (78.01 per 100 000) (Figure 2B,C and Table 1). The wide range between the highest and lowest country‐level ASMR and ASDR suggests substantial heterogeneity in age‐standardized metabolic risk‐attributable ADOD burden across Western Europe.
FIGURE 2.
The number of deaths (A), ASMR (B), ASDR (C), EAPC of ASMR (D), and EAPC of ASDR (E) of Alzheimer's disease and other dementias attributed to metabolic risks in Western Europe in 2023. ASMR, age‐standardized mortality rate; ASDR, age‐standardized DALYs rate; DALYs, disability‐adjusted life years; EAPC, estimated annual percentage change.
Temporal trends also varied across countries. Monaco had the highest EAPC for ASMR (1.69, 95% CI: 1.54–1.85), whereas Norway had the lowest (0.08, 95% CI: 0.01–0.14). For ASDR, Cyprus showed the highest EAPC (1.44, 95% CI: 1.40–1.49), whereas Norway showed the lowest (0.07, 95% CI: 0.02–0.12) (Figure 2D,E and Table 1). These EAPC ranges indicate considerable heterogeneity in the speed of increase across countries.
Absolute burden showed a different pattern. In 2023, Germany had the highest number of deaths attributable to metabolic risks (22188.0, 95% UI: 4701.1–54842.1), followed by Italy and the United Kingdom, reflecting their larger population size and older age structures (Figure 2A and Table 1). Country‐specific estimates stratified by high BMI and high FPG are provided in Table 1; briefly, Monaco had the highest high BMI‐attributable ASMR and ASDR, Cyprus had the largest relative increases in high BMI‐attributable rates, and high FPG‐attributable ASMR and ASDR decreased only in Andorra and Spain.
3.3. Risk‐Specific Trends for High FPG and High BMI
Rate‐based trends differed between high FPG and high BMI. For high FPG‐attributable ADOD, ASMR increased from 4.54 per 100 000 in 1990 to 4.93 per 100 000 in 2023, corresponding to an 8.6% increase and an EAPC of 0.20 (95% CI: 0.16–0.23). ASDR increased from 76.34 to 82.68 per 100 000, corresponding to an 8.3% increase and an EAPC of 0.20 (95% CI: 0.18–0.21). For high BMI‐attributable ADOD, ASMR increased from 1.47 to 2.33 per 100 000, corresponding to a 58.5% increase and an EAPC of 1.29 (95% CI: 1.19–1.38). ASDR increased from 28.48 to 42.86 per 100 000, corresponding to a 50.5% increase and an EAPC of 1.13 (95% CI: 1.04–1.22) (Figure 3D–F, Tables 1 and 4).
FIGURE 3.
Burdens of Alzheimer's disease and other dementias attributed to level 3 risks by deaths and DALYs. Total number of deaths (A), percentage of death numbers in females (B), percentage of death numbers in males (C), ASMR (D), ASDR (E), EAPC of ASDR and ASMR (F), deaths number in age groups in 2023 (G), deaths rate in age groups in 2023 (H), DALYs number in age groups in 2023 (I), DALYs rate in age groups in 2023 (J) in Western Europe. ASMR, age‐standardized mortality rate; ASDR, age‐standardized DALYs rate; DALYs, disability‐adjusted life years; EAPC, estimated annual percentage change.
TABLE 4.
EAPC of ASMR and ASDR of ADOD attribute to High fasting plasma glucose and High body‐mass index in Western Europe in 2023.
| Measure | Risks | Gender | EAPC (95% CI) |
|---|---|---|---|
| Deaths | High fasting plasma glucose | Male | 0.28 (0.26 to 0.3) |
| Female | 0.23 (0.2 to 0.26) | ||
| Both | 0.2 (0.16 to 0.23) | ||
| High body‐mass index | Male | 1.52 (1.45 to 1.59) | |
| Female | 1.3 (1.2 to 1.39) | ||
| Both | 1.29 (1.19 to 1.38) | ||
| DALYs | High fasting plasma glucose | Male | 0.28 (0.27 to 0.29) |
| Female | 0.23 (0.2 to 0.25) | ||
| Both | 0.2 (0.18 to 0.21) | ||
| High body‐mass index | Male | 1.4 (1.32 to 1.48) | |
| Female | 1.1 (1.02 to 1.19) | ||
| Both | 1.13 (1.04 to 1.22) |
Abbreviations: ADOD, Alzheimer's disease and other dementias; ASDR, age‐standardized DALYs rate; ASMR, age‐standardized mortality rate; CI, confidence interval; DALYs, disability‐adjusted life years; EAPC, estimated annual percentage change.
Overall, high FPG had higher ASMR and ASDR than high BMI in 2023, indicating that high FPG remained the dominant metabolic contributor. However, high BMI showed faster increases in age‐standardized rates, with EAPCs of 1.29 (95% CI: 1.19–1.38) for ASMR and 1.13 (95% CI: 1.04–1.22) for ASDR, compared with 0.20 (95% CI: 0.16–0.23) and 0.20 (95% CI: 0.18–0.21) for high FPG, respectively (Figure 3D–F, Tables 1 and 4).
In absolute terms, deaths and DALYs attributable to both high FPG and high BMI increased from 1990 to 2023, with high FPG contributing the larger share of the absolute burden (Figure 3A–C). Age‐specific patterns are described above for overall metabolic risk‐attributable ADOD; detailed age‐specific patterns by high FPG and high BMI are shown in Figure 3G–J.
3.4. Decomposition Analysis
To explain the absolute burden changes described above, decomposition analysis quantified the relative contributions of population aging, population growth, and epidemiological change to changes in deaths and DALYs from 1990 to 2023. At the Western Europe level, population aging contributed the largest share to changes in deaths attributable to metabolic risks and high FPG, accounting for 44.78% and 50.46%, respectively. In contrast, epidemiological change contributed most to high BMI‐attributable deaths (38.03%). For DALYs, population growth contributed most to changes attributable to metabolic risks and high FPG, accounting for 42.40% and 45.72%, respectively, whereas epidemiological change dominated high BMI‐attributable DALYs (Figure 4A–F and Table 5).
FIGURE 4.
Decomposition of changes in death and DALYs of Alzheimer's disease and other dementias attribute to metabolic risks in death (A), high fasting plasma glucose in death (B), high body‐mass index in death (C), metabolic risks in DALYs (D), high fasting plasma glucose in DALYs (E), and high body‐mass index in DALYs (F) in Western Europe. A positive magnitude indicates an increase in numbers attributable to the component, a negative magnitude indicates a decrease in attribution, and a black point represents the overall number. DALYs, disability‐adjusted life years.
TABLE 5.
Decomposition of changes in death and DALYs of ADOD attribute to metabolic risks, high fasting plasma glucose, and high body‐mass index in Western Europe.
| Measure | Location | Risks | Aging (%) | Population (%) | Epidemiological change (%) |
|---|---|---|---|---|---|
| DALYs | Western Europe | High body‐mass index | 87595.4 (26.37) | 115090.8 (34.64) | 129514.82 (38.99) |
| High fasting plasma glucose | 251081.6 (44.41) | 258470.3 (45.72) | 55836.69 (9.88) | ||
| Metabolic risks | 322777.3 (38.72) | 353 427 (42.4) | 157361.23 (18.88) | ||
| Andorra | High body‐mass index | 9.4 (16.92) | 27.3 (49.3) | 18.72 (33.79) | |
| High fasting plasma glucose | 33.9 (36.54) | 61.9 (66.81) | −3.1 (−3.34) | ||
| Metabolic risks | 41.8 (29.97) | 85.3 (61.17) | 12.36 (8.87) | ||
| Austria | High body‐mass index | 958.6 (22.86) | 2101.9 (50.12) | 1132.9 (27.02) | |
| High fasting plasma glucose | 2380.1 (31.11) | 3524.4 (46.07) | 1746.15 (22.82) | ||
| Metabolic risks | 3211.8 (28.81) | 5365.4 (48.13) | 2569.74 (23.05) | ||
| Belgium | High body‐mass index | 1732.4 (25.46) | 2436.1 (35.81) | 2635.11 (38.73) | |
| High fasting plasma glucose | 5054.9 (40.16) | 5055.6 (40.17) | 2475.01 (19.67) | ||
| Metabolic risks | 6523.2 (35.97) | 7137.8 (39.36) | 4471.9 (24.66) | ||
| Cyprus | High body‐mass index | 10.7 (1.31) | 398.9 (48.83) | 407.28 (49.86) | |
| High fasting plasma glucose | 49.5 (5.13) | 661.1 (68.57) | 253.56 (26.3) | ||
| Metabolic risks | 58.5 (3.54) | 1005.4 (60.85) | 588.33 (35.61) | ||
| Denmark | High body‐mass index | 551.8 (24.29) | 784.3 (34.52) | 935.66 (41.19) | |
| High fasting plasma glucose | 1370.9 (34.3) | 1530.3 (38.28) | 1096.09 (27.42) | ||
| Metabolic risks | 1852.9 (31.33) | 2218.3 (37.51) | 1842.62 (31.16) | ||
| Finland | High body‐mass index | 1992.8 (38.15) | 1335.6 (25.57) | 1895.75 (36.29) | |
| High fasting plasma glucose | 5878.6 (54.22) | 3316.2 (30.59) | 1647.13 (15.19) | ||
| Metabolic risks | 7447.2 (50.27) | 4377.6 (29.55) | 2990.79 (20.19) | ||
| France | High body‐mass index | 8021.4 (17.53) | 15571.1 (34.03) | 22158.36 (48.43) | |
| High fasting plasma glucose | 17776.2 (29.37) | 29277.8 (48.38) | 13461.05 (22.24) | ||
| Metabolic risks | 24667.1 (24.92) | 42 695 (43.14) | 31605.52 (31.94) | ||
| Germany | High body‐mass index | 26924.9 (41.23) | 20078.2 (30.74) | 18303.54 (28.03) | |
| High fasting plasma glucose | 82120.5 (59.53) | 47942.6 (34.75) | 7882.35 (5.71) | ||
| Metabolic risks | 103655.8 (54.7) | 64197.4 (33.88) | 21648.11 (11.42) | ||
| Greece | High body‐mass index | 4409.5 (30) | 3271.1 (22.25) | 7020.09 (47.75) | |
| High fasting plasma glucose | 9626.2 (53.83) | 5976.4 (33.42) | 2278.71 (12.74) | ||
| Metabolic risks | 13227.6 (44.53) | 8669.5 (29.19) | 7806.23 (26.28) | ||
| Iceland | High body‐mass index | 16.1 (8.28) | 117.2 (60.22) | 61.31 (31.5) | |
| High fasting plasma glucose | 40.8 (12.61) | 226.1 (69.94) | 56.41 (17.45) | ||
| Metabolic risks | 54.3 (11.26) | 324.9 (67.42) | 102.75 (21.32) | ||
| Ireland | High body‐mass index | 217.3 (7.2) | 1473.8 (48.81) | 1328.4 (43.99) | |
| High fasting plasma glucose | 715.5 (16.98) | 2814.8 (66.79) | 683.87 (16.23) | ||
| Metabolic risks | 896.6 (13.33) | 4070.9 (60.53) | 1757.76 (26.14) | ||
| Israel | High body‐mass index | 648.8 (15.67) | 2492.3 (60.18) | 1000.1 (24.15) | |
| High fasting plasma glucose | 1744.1 (24.44) | 4495.1 (63) | 895.65 (12.55) | ||
| Metabolic risks | 2283.4 (21.69) | 6586.8 (62.57) | 1657.17 (15.74) | ||
| Italy | High body‐mass index | 19174.7 (31.5) | 15659.3 (25.73) | 26030.44 (42.77) | |
| High fasting plasma glucose | 54016.9 (50.87) | 36 520 (34.39) | 15645.51 (14.73) | ||
| Metabolic risks | 70 072 (44.88) | 49657.2 (31.8) | 36407.57 (23.32) | ||
| Luxembourg | High body‐mass index | 19 (6.81) | 141.8 (50.92) | 117.68 (42.26) | |
| High fasting plasma glucose | 62.4 (15.67) | 270 (67.82) | 65.74 (16.51) | ||
| Metabolic risks | 78 (12.48) | 389.1 (62.29) | 157.56 (25.22) | ||
| Malta | High body‐mass index | 90.4 (22.9) | 149.7 (37.9) | 154.83 (39.2) | |
| High fasting plasma glucose | 219.4 (38.82) | 299.5 (52.99) | 46.24 (8.18) | ||
| Metabolic risks | 295.6 (33.01) | 426.4 (47.61) | 173.6 (19.38) | ||
| Monaco | High body‐mass index | 4.6 (9.37) | 15.9 (32) | 29.1 (58.63) | |
| High fasting plasma glucose | 8.9 (13.41) | 26.2 (39.49) | 31.25 (47.1) | ||
| Metabolic risks | 12.8 (12.01) | 39.5 (37.12) | 54.08 (50.87) | ||
| Netherlands | High body‐mass index | 3036.4 (22.18) | 4325.7 (31.59) | 6330.03 (46.23) | |
| High fasting plasma glucose | 6854.7 (37.58) | 8512.8 (46.68) | 2870.81 (15.74) | ||
| Metabolic risks | 9463.6 (31.71) | 12240.1 (41.02) | 8137.03 (27.27) | ||
| Norway | High body‐mass index | 159.7 (9.78) | 1267.7 (77.68) | 204.65 (12.54) | |
| High fasting plasma glucose | 801.8 (16.8) | 3177.1 (66.57) | 793.96 (16.64) | ||
| Metabolic risks | 932.5 (15.41) | 4234 (69.97) | 884.77 (14.62) | ||
| Portugal | High body‐mass index | 3031.4 (26.8) | 2779.2 (24.57) | 5502.38 (48.64) | |
| High fasting plasma glucose | 10613.6 (50.37) | 7586.4 (36) | 2872.16 (13.63) | ||
| Metabolic risks | 12988.3 (43.58) | 9783.7 (32.82) | 7034.34 (23.6) | ||
| San Marino | High body‐mass index | 4.6 (16.21) | 13.5 (47.74) | 10.17 (36.05) | |
| High fasting plasma glucose | 13.4 (26.44) | 31.9 (63.03) | 5.34 (10.53) | ||
| Metabolic risks | 17.2 (23.33) | 43.2 (58.59) | 13.33 (18.08) | ||
| Spain | High body‐mass index | 10042.6 (22.06) | 18087.9 (39.73) | 17392.47 (38.21) | |
| High fasting plasma glucose | 25259.5 (44.36) | 36414.2 (63.95) | −4729.18 (−8.3) | ||
| Metabolic risks | 33504.7 (35.58) | 51338.7 (54.51) | 9330.77 (9.91) | ||
| Sweden | High body‐mass index | 1145.5 (23.79) | 1711 (35.54) | 1957.89 (40.67) | |
| High fasting plasma glucose | 3493.8 (33.56) | 3849.8 (36.98) | 3067.61 (29.46) | ||
| Metabolic risks | 4456.9 (31.28) | 5299.9 (37.19) | 4492.98 (31.53) | ||
| Switzerland | High body‐mass index | 930 (23.78) | 2340.9 (59.85) | 640.45 (16.37) | |
| High fasting plasma glucose | 3299.7 (33.42) | 5663 (57.36) | 909.66 (9.21) | ||
| Metabolic risks | 4066.5 (31.22) | 7609.8 (58.43) | 1348.17 (10.35) | ||
| United Kingdom | High body‐mass index | 8153.3 (22.08) | 14823.9 (40.15) | 13945.1 (37.77) | |
| High fasting plasma glucose | 30349.2 (42.06) | 38779.3 (53.75) | 3024.2 (4.19) | ||
| Metabolic risks | 36668.1 (36.63) | 50428.9 (50.37) | 13020.33 (13.01) | ||
| Deaths | Western Europe | High body‐mass index | 6531.1 (31.28) | 6407 (30.69) | 7938.83 (38.03) |
| High fasting plasma glucose | 19709.2 (50.46) | 15778.1 (40.4) | 3570.13 (9.14) | ||
| Metabolic risks | 25054.6 (44.78) | 21048.3 (37.62) | 9842.88 (17.59) | ||
| Andorra | High body‐mass index | 0.8 (23.49) | 1.4 (42.83) | 1.12 (33.68) | |
| High fasting plasma glucose | 3 (45.78) | 3.8 (58.66) | −0.29 (−4.44) | ||
| Metabolic risks | 3.6 (39.06) | 5 (54.02) | 0.64 (6.92) | ||
| Austria | High body‐mass index | 72.4 (28.45) | 112.7 (44.26) | 69.48 (27.29) | |
| High fasting plasma glucose | 195 (37.89) | 213.3 (41.46) | 106.25 (20.65) | ||
| Metabolic risks | 257.7 (35.42) | 311.6 (42.83) | 158.32 (21.76) | ||
| Belgium | High body‐mass index | 132.5 (30.44) | 133.1 (30.58) | 169.66 (38.98) | |
| High fasting plasma glucose | 412.5 (46.96) | 309.2 (35.21) | 156.63 (17.83) | ||
| Metabolic risks | 524.7 (42.45) | 422.7 (34.2) | 288.5 (23.34) | ||
| Cyprus | High body‐mass index | 1.7 (3.72) | 21.2 (45.57) | 23.58 (50.71) | |
| High fasting plasma glucose | 5.9 (10.29) | 37.5 (65.37) | 13.96 (24.33) | ||
| Metabolic risks | 7.4 (7.63) | 55.8 (57.7) | 33.53 (34.67) | ||
| Denmark | High body‐mass index | 35.9 (24.69) | 42.6 (29.27) | 66.99 (46.04) | |
| High fasting plasma glucose | 103.3 (36.67) | 94.4 (33.53) | 83.92 (29.8) | ||
| Metabolic risks | 134.6 (33.2) | 131.7 (32.49) | 139.08 (34.31) | ||
| Finland | High body‐mass index | 136.4 (40.36) | 75.1 (22.21) | 126.53 (37.43) | |
| High fasting plasma glucose | 436.5 (58.61) | 205.3 (27.56) | 102.98 (13.83) | ||
| Metabolic risks | 543.5 (54.18) | 264.5 (26.37) | 195.2 (19.46) | ||
| France | High body‐mass index | 590.8 (19.72) | 911.4 (30.41) | 1494.34 (49.87) | |
| High fasting plasma glucose | 1414 (32.88) | 1885.7 (43.85) | 1001.04 (23.28) | ||
| Metabolic risks | 1921.2 (28.15) | 2669.6 (39.12) | 2234.02 (32.73) | ||
| Germany | High body‐mass index | 1846.9 (46.54) | 1088.3 (27.43) | 1033.02 (26.03) | |
| High fasting plasma glucose | 6035.8 (64.89) | 2897.5 (31.15) | 368.31 (3.96) | ||
| Metabolic risks | 7509 (60.43) | 3772.3 (30.36) | 1144.32 (9.21) | ||
| Greece | High body‐mass index | 308.1 (35.94) | 171 (19.95) | 377.97 (44.1) | |
| High fasting plasma glucose | 688.6 (61.54) | 332 (29.67) | 98.28 (8.78) | ||
| Metabolic risks | 940.3 (51.97) | 472.3 (26.1) | 396.73 (21.93) | ||
| Iceland | High body‐mass index | 1.2 (10.19) | 6.2 (53.41) | 4.26 (36.41) | |
| High fasting plasma glucose | 3.2 (15.84) | 13 (63.59) | 4.22 (20.57) | ||
| Metabolic risks | 4.2 (14.11) | 18.3 (60.82) | 7.55 (25.07) | ||
| Ireland | High body‐mass index | 21.1 (12.1) | 76.3 (43.7) | 77.16 (44.2) | |
| High fasting plasma glucose | 65.4 (24.01) | 164.1 (60.21) | 42.99 (15.78) | ||
| Metabolic risks | 83.1 (19.9) | 228.8 (54.79) | 105.7 (25.31) | ||
| Israel | High body‐mass index | 59.4 (21.17) | 148.7 (52.98) | 72.56 (25.85) | |
| High fasting plasma glucose | 166.5 (31.28) | 302 (56.74) | 63.78 (11.98) | ||
| Metabolic risks | 215.9 (28.31) | 426.4 (55.92) | 120.31 (15.78) | ||
| Italy | High body‐mass index | 1453.7 (37.85) | 894.2 (23.28) | 1492.74 (38.87) | |
| High fasting plasma glucose | 4298.8 (58.92) | 2260.3 (30.98) | 737.04 (10.1) | ||
| Metabolic risks | 5516.6 (52.77) | 3009.6 (28.79) | 1928.12 (18.44) | ||
| Luxembourg | High body‐mass index | 2 (11.96) | 7.4 (43.45) | 7.56 (44.59) | |
| High fasting plasma glucose | 6.1 (23.27) | 15.2 (57.99) | 4.92 (18.74) | ||
| Metabolic risks | 7.8 (19.41) | 21.4 (53.36) | 10.91 (27.23) | ||
| Malta | High body‐mass index | 5.5 (26.04) | 7.4 (34.99) | 8.21 (38.97) | |
| High fasting plasma glucose | 14.9 (43.01) | 16.7 (48.34) | 2.99 (8.65) | ||
| Metabolic risks | 19.5 (37.34) | 23 (43.96) | 9.77 (18.69) | ||
| Monaco | High body‐mass index | 0.3 (8.49) | 1 (27.89) | 2.23 (63.62) | |
| High fasting plasma glucose | 0.7 (13.38) | 1.7 (34.68) | 2.58 (51.94) | ||
| Metabolic risks | 0.9 (11.67) | 2.5 (32.5) | 4.36 (55.83) | ||
| Netherlands | High body‐mass index | 201.5 (24.96) | 240.3 (29.76) | 365.61 (45.28) | |
| High fasting plasma glucose | 495.2 (42.72) | 513.4 (44.29) | 150.49 (12.98) | ||
| Metabolic risks | 668.2 (36.24) | 720.1 (39.05) | 455.79 (24.72) | ||
| Norway | High body‐mass index | 17.2 (16.25) | 66.2 (62.68) | 22.23 (21.06) | |
| High fasting plasma glucose | 80.8 (25.45) | 184.3 (58.04) | 52.4 (16.51) | ||
| Metabolic risks | 94.9 (23.64) | 239.3 (59.63) | 67.11 (16.73) | ||
| Portugal | High body‐mass index | 231 (31.9) | 158 (21.82) | 335.13 (46.28) | |
| High fasting plasma glucose | 847 (56) | 474.4 (31.37) | 191.07 (12.63) | ||
| Metabolic risks | 1027.9 (49.62) | 598.8 (28.91) | 444.83 (21.47) | ||
| San Marino | High body‐mass index | 0.4 (20.99) | 0.7 (43.22) | 0.6 (35.79) | |
| High fasting plasma glucose | 1.1 (31.89) | 1.9 (57.94) | 0.34 (10.17) | ||
| Metabolic risks | 1.4 (28.78) | 2.5 (53.86) | 0.82 (17.36) | ||
| Spain | High body‐mass index | 883.4 (28.28) | 1080 (34.58) | 1160.07 (37.14) | |
| High fasting plasma glucose | 2232.8 (50.64) | 2296.3 (52.09) | −120.33 (−2.73) | ||
| Metabolic risks | 2958.2 (42.49) | 3185.9 (45.76) | 818.7 (11.76) | ||
| Sweden | High body‐mass index | 84.9 (27.64) | 95.3 (31.06) | 126.77 (41.3) | |
| High fasting plasma glucose | 282 (39.96) | 239.7 (33.96) | 184.04 (26.08) | ||
| Metabolic risks | 353.3 (37.09) | 320.2 (33.62) | 279.08 (29.3) | ||
| Switzerland | High body‐mass index | 67.2 (27.33) | 124.6 (50.68) | 54.09 (22) | |
| High fasting plasma glucose | 266 (37.98) | 343.8 (49.1) | 90.52 (12.93) | ||
| Metabolic risks | 321.2 (35.73) | 447 (49.73) | 130.63 (14.53) | ||
| United Kingdom | High body‐mass index | 632.9 (29.45) | 783.1 (36.44) | 732.98 (34.11) | |
| High fasting plasma glucose | 2479.8 (51.41) | 2284.8 (47.37) | 58.73 (1.22) | ||
| Metabolic risks | 2969.3 (45.99) | 2897.4 (44.87) | 590.04 (9.14) |
Abbreviations: ADOD, alzheimer's disease and other dementias; DALYs, disability‐adjusted life years.
Country‐level decomposition showed substantial heterogeneity in dominant drivers across Western Europe. Detailed country‐by‐risk‐factor decomposition results, including the negative epidemiological contribution for high FPG‐attributable burden in Spain, are provided in Table 5. Overall, high FPG‐attributable ADOD burden was mainly shaped by demographic forces, whereas high BMI‐attributable burden was more closely linked to epidemiological change.
4. Discussion
This Western Europe‐specific analysis showed that ADOD burden attributable to metabolic risks increased in age‐standardized terms from 1990 to 2023, with ASMR and ASDR rising by 18.8% and 17.6%, respectively. Absolute deaths also increased substantially, indicating growing care demand, but these changes should be interpreted together with decomposition analysis because they are strongly influenced by population aging and population growth. These findings are broadly consistent with recent GBD analyses showing that dementia burden and metabolic risk‐attributable noncommunicable disease burden have increased globally over recent decades. Together, our results suggest that Western Europe is embedded in a broader epidemiological transition in which chronic metabolic exposures increasingly shape dementia‐related burden. This likely reflects the combined effects of population aging, longer survival into dementia‐prone ages, persistent exposure to diabetes and obesity, and improved dementia detection in mature health systems.
Our findings should be interpreted in the context of recent global GBD evidence. A GBD 2021 analysis reported that global deaths from ADOD attributable to metabolic risks increased from 98 608 in 1990 to 399 824 in 2021, and that high‐income North America had the highest regional age‐standardized burden [26]. Therefore, the increasing metabolic risk‐attributable ADOD burden observed in Western Europe is not unique in its direction of change, but reflects a broader global and high‐SDI phenomenon. Nevertheless, Western Europe remains distinctive because this global pattern is expressed within a highly aged region with substantial country‐level heterogeneity and divergent demographic versus epidemiological drivers. Thus, the policy relevance of the present study lies less in demonstrating a completely new direction of association than in distinguishing where and why preventable metabolic risk‐attributable burden is concentrated within Western Europe.
High FPG remained the dominant metabolic contributor to ADOD burden in Western Europe, consistent with previous global and high‐SDI findings [26, 27]. This supports the importance of diabetes and hyperglycemia control in dementia prevention, especially because diabetes is strongly associated with all‐cause dementia, Alzheimer's disease, and vascular dementia [28]. However, high BMI showed faster increases in age‐standardized rates than high FPG, indicating that obesity‐related exposure may be an increasingly important driver of future ADOD burden. This pattern is consistent with rising diabetes, obesity, sedentary behaviour, and early‐onset type 2 diabetes in Western Europe [29]. Importantly, high BMI and high FPG should not be interpreted as independent or mutually exclusive risk factors. They are biologically and epidemiologically related and may act through overlapping cardiometabolic pathways, including insulin resistance, vascular injury, and inflammation. Therefore, the ASMR and ASDR estimates for high BMI and high FPG represent risk‐specific attributable burdens within the GBD comparative risk assessment framework, rather than independent effects that can be directly compared as causal estimates or summed to obtain the total metabolic risk burden. Nevertheless, these metabolic risks represent only part of the broader ADOD risk profile; other behavioural, vascular, environmental, social, and genetic factors were outside the scope of this GBD‐defined metabolic risk analysis.
Sex‐ and age‐specific findings further refine the burden profile. Females had higher age‐standardized rates and larger absolute burden, which is consistent with longer life expectancy and survival into ages at highest dementia risk [30]. In Western health systems, women also more frequently survive to very old age with multiple chronic conditions, which may increase the observed burden of dementia and complicate cardiometabolic management in later life. In contrast, males showed slightly faster increases in ASMR and ASDR, suggesting that prevention should also address midlife metabolic risks among men, including central obesity, physical inactivity, and undiagnosed or poorly controlled diabetes [31]. The concentration of burden in older age groups highlights the need for life‐course metabolic risk reduction beginning in midlife, while also strengthening dementia‐sensitive cardiometabolic care for older adults [32]. Country‐level results also demonstrated that Western Europe is not homogeneous: Monaco and several small high‐income states had high age‐standardized rates, whereas Germany, Italy, and the United Kingdom contributed the largest absolute burden because of population size and older age structures. These findings suggest that prevention and care strategies should address older women with high absolute burden and men with faster‐growing metabolic risk‐attributable rates.
The interpretation of ADOD mortality and DALY rates in very old age should also consider competing mortality risks. Because ADOD often occurs late in life, observed ADOD deaths at ages 85 years and older partly depend on survival from other major causes of death, especially cardiovascular disease, during earlier decades. Thus, improvements in cardiovascular survival may increase the number of individuals living long enough to develop or die from dementia. In our study, this issue was partly addressed descriptively through age‐standardized rates and decomposition analysis, which separated the contributions of population aging, population growth, and epidemiological change to changes in absolute burden. However, these methods do not constitute an individual‐level competing‐risk analysis. Therefore, our results should be interpreted as population‐level estimates of observed ADOD burden under real‐world mortality conditions.
Decomposition analysis clarified the drivers of absolute burden change. Population aging contributed substantially to high FPG‐attributable deaths, whereas epidemiological change contributed more prominently to high BMI‐attributable burden. Because aging is non‐modifiable, prevention cannot fully offset the demographic expansion of ADOD burden; instead, the preventable component lies in reducing age‐specific risk, delaying dementia onset, improving cardiometabolic health, and adapting dementia and geriatric care systems to aging populations. Prevention should also be interpreted cautiously in the context of competing mortality risks: reducing cardiovascular mortality may increase survival into ages at which ADOD risk is highest, so metabolic risk control should be viewed as a strategy to promote healthier survival rather than as a guarantee of lower population‐level ADOD mortality. Accordingly, aging‐driven countries such as Germany and Italy should integrate metabolic risk management into dementia and geriatric care pathways, whereas countries with BMI‐related epidemiological worsening require stronger obesity‐prevention policies. The negative epidemiological contribution for high FPG‐attributable burden in Spain may represent a hypothesis‐generating policy signal, but its effectiveness and replicability require further validation [33].
This study has several limitations. GBD 2023 does not provide ADOD incidence, limiting assessment of whether mortality and DALY trends reflect true incidence changes. Some uncertainty intervals included negative lower bounds, and estimates are limited to individuals aged ≥ 40 years, preventing evaluation of earlier‐life metabolic exposure. Within‐country disparities by race, ethnicity, or socioeconomic status could not be assessed. Metabolic risks analysed—high BMI and high FPG—represent only part of the ADOD risk profile; other metabolic syndrome components and non‐metabolic dementia risk factors were not evaluated. GBD estimates depend on data quality, and the 1990–2023 period spans changes in population structure, lifestyle, care access, diagnostic criteria, and treatment availability, which may affect temporal comparability. Policy interpretations, including the discussion of Spain, are ecological and hypothesis‐generating. Individual‐level competing‐risk analyses were not performed, so ADOD burden in oldest age groups may partly reflect survival from other causes, and early‐life metabolic prevention may be offset by reduced cardiovascular mortality. Despite these limitations, the findings provide standardized evidence to guide country‐ and risk‐specific dementia prevention strategies in Western Europe.
5. Conclusion
From 1990 to 2023, ADOD attributable to metabolic risks rose across Western Europe, with ASMR increasing from 5.76 to 6.84 per 100 000 and ASDR from 100.17 to 117.80 per 100 000. Increases varied by country, sex, age, and risk factor. Western Europe‐specific patterns indicate that high‐burden countries need scaled dementia and metabolic care, aging‐driven countries require integration of metabolic risk management into dementia pathways, and countries with BMI‐related worsening need stronger obesity prevention. These findings support targeted strategies linking metabolic risk management with dementia and geriatric care, while recognizing that improved survival from competing causes may partly offset the effects of early‐life cardiometabolic prevention on late‐life ADOD mortality.
Author Contributions
Ning Hao: conceptualization, writing – review and editing, formal analysis, methodology, visualization, writing – original draft, funding acquisition. Ziyi He: software, data curation. Xiaolian Zhang, Jieqi Zhang, and Xiangyu Li: formal analysis, methodology. Gaofeng Zhao and Jiansong Fang: writing – supervision and editing. Wenbin Chen: funding acquisition.
Funding
This research was a achievement of the Guangdong Red Cross Society Research Foundation (202510) and was supported by the Guangdong Basic and Applied Basic Research Foundation (2025A151501299).
Disclosure
All authors declare that AI was not used in the creation of this manuscript.
Ethics Statement
The present study employed data retrieved from publicly accessible databases; all datasets are openly available and thus do not require approval from an ethics committee. No patient identifiable information is presented in the manuscript. All authors have read and approved the final version of the manuscript.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We are grateful for the work of the Global Burden of Disease study 2023 collaborators.
Hao N., Zhang X., He Z., et al., “The Burden of Alzheimer’s Disease and Other Dementias Attribute to Metabolic Risks in Western Europe From 1990 to 2023,” Diabetes, Obesity and Metabolism 28, no. 9 (2026): 8299–8328, 10.1111/dom.70978.
Handling Editor: Huilin Tang
Contributor Information
Gaofeng Zhao, Email: zhaogaofeng_97@163.com.
Jiansong Fang, Email: fangjs@gzucm.edu.cn.
Wenbin Chen, Email: hzzy_zjh@163.com.
Data Availability Statement
The datasets presented in this study can be found in online database. The names of the database can be found below: https://vizhub.healthdata.org/gbd‐results/.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets presented in this study can be found in online database. The names of the database can be found below: https://vizhub.healthdata.org/gbd‐results/.