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The plight of the Monaco microstate in the GBD 2023 study.
Wyper, Grant M A Cuschieri, Sarah
Wyper, Grant M A
Cuschieri, Sarah
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, although invaluable for global health metrics, presents concerning estimates of life expectancy at birth for Monaco. Monaco is a microstate typically synonymous with world-leading levels of life expectancy at birth, with official sources, such as statistics from the Monaco Government and UN reports, consistently placing Monaco's life expectancy among the highest globally. The most recent estimate from the Monegasque Demography Observatory for 2022–24 places life expectancy at birth at 87·0 years; however, GBD estimates are substantially lower, at 80·4 years in 2023.
This sizable discrepancy demands immediate attention. The GBD study's approach, which relies on imputation and statistical modelling for locations with insufficient vital registration data, can be ill-suited for small areas, especially those with unique demographic or socioeconomic compositions. Monaco, for instance, is uniquely characterised by a high proportion of wealthy, non-native residents. This composition appears to render broader modelling assumptions inaccurate in this specific context. To maintain user trust and policy relevance, the GBD study should prioritise explaining sizeable discrepancies with official, publicly available estimates from authoritative sources in a balanced and transparent manner.
This example serves as an important reminder: for less populous and uniquely characterised locations, broader modelling assumptions are far less likely to hold true. When these assumptions fail, there is a risk of inequitable diversion or misallocation of finite resources to the detriment of human health in other regions.
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2026-05-16
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wyper2026_plight.pdf
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Life expectancy #11473#
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BeBOD #1000711#