Global burden of disease attributable to unsafe sex among adults aged 60 years and older, 1990–2023: a secondary analysis of the global burden of disease study 2023
Abstract
Abstract Background Unsafe sex is a major risk factor for HIV/AIDS and cervical cancer, yet its burden among older adults remains poorly characterised. Despite rapid global population ageing, older adults remain underrepresented in sexual health research and policy. We aimed to quantify long-term trends and inequalities in the disease burden attributable to unsafe sex among adults aged 60 years and older. Methods Using data from the Global Burden of Disease Study 2023, we estimated deaths, disability-adjusted life years (DALYs), and age-standardised mortality and DALY rates attributable to unsafe sex among adults aged ≥60 years across 204 countries and territories from 1990 to 2023. Analyses were stratified by sex, age group, region, and socio-demographic index (SDI). Results Globally, attributable deaths increased from 113,842 (95% UI: 97,186–136,215) in 1990 to 242,987 (95% UI: 207,451–288,012) in 2023, while DALYs increased from 2.60 (95% UI: 2.20–3.11) million to 5.89 (95% UI: 5.05–6.97) million. Age-standardised rates declined modestly overall. Cervical cancer remained the leading contributor, although its proportional contribution decreased, whereas HIV/AIDS deaths increased more than fourfold. Population growth among adults aged ≥60 years was the predominant contributor to the increase in absolute burden. Age-standardised mortality rates declined among women but increased among men. Marked geographical and socioeconomic inequalities persisted, with mortality rates in low-SDI regions more than seven times those in high-SDI regions. The highest burden occurred in sub-Saharan Africa, while HIV-related mortality increased rapidly in parts of South and Southeast Asia. Conclusions Unsafe sex remains a substantial burden among older adults, with increasing absolute burden despite modest declines in age-standardised rates. HIV/AIDS contributed increasingly, although cervical cancer remained the largest contributor in 2023. Population growth was the predominant driver, highlighting the need for life-course prevention and disease-control strategies for healthy ageing.