Skip to main content

The impact of fibrotic diseases on global mortality from 1990 to 2019

To the Editor,

Fibrosis, characterized by the excessive production and accumulation of extracellular matrix (ECM) proteins, is an integral part of numerous chronic diseases affecting vital organs such as the lungs, liver, heart, and kidneys [1]. Despite the diversity in their etiological underpinnings and clinical presentations, these disorders all lead to a common process of tissue remodeling and scarring. This results in the deterioration of organ structure, functional impairment, and ultimately organ failure, often requiring transplantation. While there has been a long-standing notion that fibrotic diseases might account for up to 45% of worldwide deaths, this estimate has lacked solid epidemiological backing. To address this knowledge gap, we turned to the 2019 Global Burden of Disease (GBD) study ( [2], aiming to uncover the actual impact of fibrotic diseases on global mortality.

From the myriad causes of death documented in the GBD, we specifically focused on conditions connected to ECM remodeling (Fig. 1A). Based on these data, a conservative estimate posits that fibrotic diseases contributed to 16.5% of all global deaths in 1990, and this percentage steadily increased over time to 17.8% in 2019 (Fig. 1A). However, emerging insights indicate that the majority of neoplasms should also be categorized as fibrotic disorders, as fibrosis plays a key role in tumor growth and metastasis [3,4,5]. When accounting for neoplasms, excluding acute lymphoid leukemia and acute myeloid leukemia, the overall impact of fibrotic diseases on global deaths in 1990 was 28.7%, which subsequently rose to 35.4% in 2019 (Fig. 1A, B). Among all fibrotic disorders, neoplasms and chronic obstructive pulmonary disease consistently ranked as the primary contributors to global mortality during this period (Fig. 1A). In contrast, the impact of various infectious diseases declined over time. For instance, tuberculosis, a significant contributor in 1990, saw its contribution nearly halved by 2019 (Fig. 1A, B), reflecting changing patterns in the global disease landscape over the years.

Fig. 1
figure 1

Impact of Fibrotic Diseases on Global Mortality from 1990 to 2019. A Selected causes of death and their ranking in 1990 and 2019, based on their percentage contribution to global deaths. B Trend of percentage of global deaths attributable to fibrotic diseases from 1990 to 2019

While the impact of fibrotic disorders on global mortality might be smaller than previously estimated, and we recognize that certain deaths involve factors beyond ECM remodeling and fibrosis, it remains evident that fibrotic diseases still contribute significantly to global mortality. This underscores the necessity for sustained research efforts aimed at developing effective antifibrotic treatments, as this critical need remains largely unaddressed.

Availability of data and materials

All data generated or analysed during this study are included in this published article.



Extracellular matrix


Global Burden of Disease


  1. Rockey DC, Bell PD, Hill JA. Fibrosis—a common pathway to organ injury and failure. N Engl J Med. 2015;372(12):1138–49.

    Article  CAS  PubMed  Google Scholar 

  2. Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.

    Article  Google Scholar 

  3. Yamauchi M, Barker TH, Gibbons DL, Kurie JM. The fibrotic tumor stroma. J Clin Invest. 2018;128(1):16–25.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Piersma B, Hayward MK, Weaver VM. Fibrosis and cancer: a strained relationship. Biochim Biophys Acta Rev Cancer. 2020;1873(2): 188356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Boulter L, Bullock E, Mabruk Z, Brunton VG. The fibrotic and immune microenvironments as targetable drivers of metastasis. Br J Cancer. 2021;124(1):27–36.

    Article  PubMed  Google Scholar 

Download references


Not applicable.


This study was supported by the Lundbeck Foundation (R368-2021-726).

Author information

Authors and Affiliations



Conceptualization: HAMM, RN. Formal analysis: all authors. Visualization: HAMM, CM, OP-R. Writing—original draft: HAMM, CM. Writing—review & editing: all authors. Supervision: HAMM, RN. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Henricus A. M. Mutsaers.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mutsaers, H.A.M., Merrild, C., Nørregaard, R. et al. The impact of fibrotic diseases on global mortality from 1990 to 2019. J Transl Med 21, 818 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: