Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Abstract
Background Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.Methods DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed.Findings Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene.Interpretation The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
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The comparative risk assessment approach is predicated on a causal web of hierarchically organised, potentially overlapping health risks.
“the comparative risk assessment approach, a framework used by GBD since 2002 that is predicated on a causal web of hierarchically organised, potentially overlapping health risks.29, 37”
Estimates of the attributable burden of smoking tobacco use have been included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) since its initial publication in 1997.
“Estimates of the attributable burden of smoking tobacco use have been included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) since its initial publication in 1997.”
In the 1990 Global Burden of Disease study, cardiovascular diseases as a group accounted for 9.7% of global disability adjusted life-years.
“In the 1990 GBD study, no specific data for AF was reported, but cardiovascular diseases as a group accounted for 9·7% of the global DALYs with ischemic heart disease being the fifth ranking disorder in total number of DALYS (~47x106) behind lower respiratory infections, diarrheal diseases, perinatal disorders, and unipolar major depression.34”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [34]
In the 1990 Global Burden of Disease study, ischemic heart disease was the fifth ranking disorder in total number of disability adjusted life-years (~47x10^6).
“In the 1990 GBD study, no specific data for AF was reported, but cardiovascular diseases as a group accounted for 9·7% of the global DALYs with ischemic heart disease being the fifth ranking disorder in total number of DALYS (~47x106) behind lower respiratory infections, diarrheal diseases, perinatal disorders, and unipolar major depression.34”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [34]
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- Authors
- Murray, C. J., & Lopez, A. D.
- Affiliations
- Harvard University (US)
- Corresponding author
- Murray, Christopher JL
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1997-05
- Volume
- 349
- Issue
- 9063
- Pages
- 1436-1442
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2019823288
- Cited by
- 4,492
- References
- 22
- Citations by year
- 2026: 51 · 2025: 69 · 2024: 94 · 2023: 94 · 2022: 141 · 2021: 111 · 2020: 117 · 2019: 131 · 2018: 147 · 2017: 155 · 2016: 188 · 2015: 206 · 2014: 238 · 2013: 242 · 2012: 245
- FWCI
- 190.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- global burden of disease, disability-adjusted life years, mortality, risk factors, infectious diseases, non-communicable diseases, injuries, child malnutrition, water, sanitation and hygiene, tobacco use, alcohol consumption, hypertension, physical inactivity, illicit drug use, air pollution, epidemiological transition, neuropsychiatric disorders, cardiovascular disease, traffic accidents, congenital malformations, perinatal disorders, lower respiratory tract infection, diarrhoeal diseases
- MeSH terms
- Adolescent, Adult, Alcohol Drinking, Developing Countries, Diarrhea, Health Expenditures, Female, Persons with Disabilities, Disabled Persons, Humans, Hypertension, Infant, Infant, Newborn, Male, Mortality, Nutrition Disorders, Respiratory Tract Diseases, Risk Factors, Sanitation, Sexual Behavior, Smoking, Global Health, Wounds and Injuries, Developed Countries, Quality-Adjusted Life Years
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