Mortality, disease burden, and exposure to main risk factors in Southeastern Europe  

Abstract
Aim: Focused assessments of long-term risk transitions in Southeastern Europe remain limited. We aimed at analyzing temporal trends in age-standardized mortality, disease burden, and summary exposure values (SEVs) attributable to major groups of risk factors in Southeastern European countries between 1990 and 2023, to identify progress achieved and emerging public health challenges.
Methods: A comparative longitudinal analysis was conducted across Albania, Montenegro, North Macedonia, Bosnia and Herzegovina, Serbia, Croatia, and Slovenia. Age-standardized mortality, disease burden, and SEVs attributable to metabolic, behavioral, and environmental and occupational risks were extracted from the Global Burden of Disease (GBD) framework.
Results: Between 1990 and 2023, all-cause mortality and Disability-Adjusted Life Years (DALYs) attributable to major risk factors declined substantially across all countries, with Slovenia consistently exhibiting the lowest levels. Environmental and occupational risks showed the steepest relative reductions, whereas behavioral risks also declined markedly, particularly in Albania and Slovenia. In contrast, SEVs revealed stagnation or increases in population exposure, especially for metabolic risks, which rose consistently across all countries, signaling a growing cardiometabolic burden.
Conclusion: Notwithstanding major reductions in mortality and disease burden, rising metabolic exposures highlight an emerging public health challenge in Southeastern Europe. Sustained progress will require targeted strategies addressing obesity, diet, and sedentary lifestyles alongside continued environmental and behavioral risk reduction.

 Keywords: behavioral risks, environmental and occupational risks, metabolic risks, risk factors, Southeastern Europe.