{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:17:13Z","timestamp":1787915833106,"version":"build-2784847793"},"reference-count":37,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Global health inequalities are conventionally assessed through the mortality gap, yet the joint contribution of mortality and disability to health\u2011adjusted life expectancy (HALE) gap and their dynamic evolution remain poorly understood. We aim to decompose the HALE gap between higher\u2011income and lower\u2011income countries into mortality and disability drivers, separate long\u2011term trends from transient fluctuations, and reveal heterogeneity within the low\u2011income group.\nMethods: Using data from the Global Burden of Disease Study for 199 countries (122 higher\u2011income and 77 lower\u2011income) from 2010 to 2019, we decomposed the HALE gap by age and cause via Horiuchi\u2019s method. Empirical mode decomposition separated each contribution time series into a long\u2011term trend and residual fluctuations, enabling classification into dynamic archetypes: mortality catch\u2011up, mortality divergence, disability catch\u2011up, or disability divergence. Principal component analysis and partitioning around medoids clustering explored heterogeneity among lower\u2011income countries, and generalized additive models assessed variation along the Socio\u2011demographic Index (SDI) gradient.\nResults: The HALE gap narrowed from 9.10 to 7.93 years, with mortality contributing 6.87 years and disability 1.06 years in 2019. Mortality catch\u2011up was concentrated in childhood infections and maternal conditions, while mortality divergence occurred for non\u2011communicable diseases in adults. Disability divergence was driven by mental, musculoskeletal, and sense organ disorders. Low\u2011income countries clustered into a high\u2011mortality group (mainly sub\u2011Saharan Africa and South Asia) and a disability\u2011emerging group (Asia, Latin America). Along the development gradient, disability progressively dominated the HALE gap.\nConclusions: The converging HALE gap masks a diverging disability gap. Sustainable progress in global health requires explicitly targeting the growing burden of non\u2011fatal conditions alongside persistent mortality inequalities. The dynamic framework introduced here offers a reusable monitoring tool for health inequality.<\/jats:p>","DOI":"10.5334\/aogh.5458","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:31:44Z","timestamp":1787913104000},"page":"84","source":"Crossref","is-referenced-by-count":0,"title":["Catching Up on Mortality, Falling Behind on Disability: A Dynamic Decomposition of the Health\u2011Adjusted Life Expectancy Gap between Higher\u2011Income and Lower\u2011Income Countries"],"prefix":"10.5334","volume":"92","author":[{"given":"Xue\u2011Qi","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7473-7783","authenticated-orcid":false,"given":"Jun\u2011Yan","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"GBD 2023 Disease and Injury and Risk Factor Collaborators. 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