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Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study

Murray, Christopher JL, Lopez, Alan D·1997·The Lancet

DOI 10.1016/s0140-6736(96)07495-8

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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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Cellular Mechanisms of Cardioprotection by Calorie Restriction: State of the Science and Future Perspectives
Marzetti, E., Wohlgemuth, S. E., Anton, S. D., Bernabei, R., Carter, C. S., & Leeuwenburgh, C. (2009) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2009.07.002 · Cited by 69
“Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Western countries [1], and it is estimated that by 2020 up to 40% of all deaths will be due to CVD [2].”
Background
Access to water and sanitation among people with disabilities: results from cross-sectional surveys in Bangladesh, Cameroon, India and Malawi
Mactaggart, I., Schmidt, W., Bostoen, K., Chunga, J. J., Danquah, L. O., Halder, A. K., Jolly, S. P., Polack, S., Rahman, M., Snel, M., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020077 · Cited by 65
“Hearing – 142 (33) – 189 (37) – 61 (29)”
The Health Effects of Moderate Alcohol Intake in Humans: An Epidemiologic Review
Meister, K. A., Whelan, E. M., & Kava, R. (2000) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408360091174222 · Cited by 66
Newer treatment studies for bipolar depression
Gao, K., & Calabrese, J. R. (2005) · Bipolar Disorders · doi:10.1111/j.1399-5618.2005.00250.x · Cited by 67
Incorporating Deaths Near the Time of Birth into Estimates of the Global Burden of Disease
Jamison, D. T. T., Shahid-Salles, S., Jamison, J., Lawn, J. E., & Zupan, J. (2006) · Cited by 65
Study on the Association between Ambient Air Pollution and Daily Cardiovascular and Respiratory Mortality in an Urban District of Beijing
Zhang, F., Li, L., Krafft, T., Lv, J., Wang, W., & Pei, D. (2011) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph8062109 · Cited by 65
“Numerous time-series studies have indicated a positive association between short-term variation in ambient levels of particulate matter (PM) and daily mortality counts [4-11].”
Background
Angiotensin receptor blockers and cerebral protection in stroke
Thöne‐Reineke, C., Steckelings, U. M., & Unger, T. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000220416.07235.37 · Cited by 65
Exploration of Pacific perspectives of Pacific models of mental health service delivery in New Zealand.
Suaalii‐Sauni, T., Wheeler, A., Saafi, E., Robinson, G., Agnew, F., Warren, H., Erick, M., & Hingano, T. (2009) · PubMed · Cited by 63
Changes in the Cholinergic System between Bipolar Depression and Euthymia as Measured with [123I]5IA Single Photon Emission Computed Tomography
Hannestad, J. O., Cosgrove, K. P., DellaGioia, N. F., Perkins, E., Bois, F., Bhagwagar, Z., Seibyl, J. P., McClure-Begley, T. D., Picciotto, M. R., & Esterlis, I. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.04.004 · Cited by 63
“It is a leading cause of worldwide disability (1), mostly because of the depressive episodes (2), and is associated with increased risk of suicide, which is highest during depressive episodes.”
Background
Effects of Dutch livestock production on human health and the environment
Post, P., Hogerwerf, L., Bokkers, E. A. M., Baumann, B. A., Fischer, P. H., Rutledge-Jonker, S., Hilderink, H. B. M., Hollander, A., Hoogsteen, M. J. J., Liebman, A., et al. (2020) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2020.139702 · Cited by 64
“This metric consists of the total estimated years of life lost (YLL) due to premature death and the years of life lived with disability (YLD), calculated separately across diseases (Gold et al., 2002; Murray and Lopez, 1997; Murray et al., 2012).”
Method
Predictors of maternal mortality in institutional deliveries in Nigeria.
Fawole, A. O., Shah, A., Fabanwo, A. O., Adegbola, O., Adewunmi, A. A., Eniayewun, A. B., Dara, K., El-Ladan, A. M., Umezulike, A. C., Alu, F. E., et al. (2012) · Europe PMC (PubMed Central) · Cited by 64
Marital therapy for depression
Barbato, A., & D'Avanzo, B. B. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004188.pub2 · Cited by 70
The burden of high blood pressure and related risk factors in urban sub-Saharan Africa: evidences from Douala in Cameroon.
Kengne, A. P., Awah, P. K., Fezeu, L., & Mbanya, J. C. (2007) · PubMed Central · doi:10.5555/afhs.2007.7.1.38 · Cited by 64
Selenoprotein S (SEPS1) gene -105G>A promoter polymorphism influences the susceptibility to gastric cancer in the Japanese population
Shibata, T., Arisawa, T., Tahara, T., Ohkubo, M., Yoshioka, D., Maruyama, N., Fujita, H., Kamiya, Y., Nakamura, M., Nagasaka, M., et al. (2009) · BMC Gastroenterology · doi:10.1186/1471-230x-9-2 · Cited by 64
“Although the incidence and mortality rates of gastric cancer have decreased gradually, gastric cancer is second only to lung cancer as the leading cause of cancer death around the world [1,2].”
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Physical Activity Improves Mental Health
Fontaine, K. R. (2000) · The Physician and Sportsmedicine · doi:10.3810/psm.2000.10.1256 · Cited by 64
Risk factors for noncommunicable chronic diseases in women in China: surveillance efforts
Yichong, L., Wang, L., Jiang, Y., Zhang, M., & Wang, L. (2013) · Bulletin of the World Health Organization · doi:10.2471/blt.13.117549 · Cited by 63
Development of a stir bar sorptive extraction based HPLC-FLD method for the quantification of serotonin reuptake inhibitors in plasma, urine and brain tissue samples
Unceta, N., Ugarte, A., Sánchez, A., Gómez‐Caballero, A., Goicolea, M. A., & Barrio, R. J. (2009) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2009.07.015 · Cited by 64
MiR-132 Inhibits Expression of SIRT1 and Induces Pro-inflammatory Processes of Vascular Endothelial Inflammation through Blockade of the SREBP-1c Metabolic Pathway
Zhang, L., Huang, D., Wang, Q., Shen, D., Wang, Y., Chen, B., Zhang, J., & Gai, L. (2014) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-014-6533-x · Cited by 66
Adverse events associated with intravenous iron infusion (low‐molecular‐weight iron dextran and iron sucrose): a systematic review
Critchley, J., & Dundar, Y. (2007) · Transfusion Alternatives in Transfusion Medicine · doi:10.1111/j.1778-428x.2007.00042.x · Cited by 64
Maternal depression symptoms and internalising problems in the offspring: the role of maternal and family factors
Ahun, M. N., Consoli, A., Pingault, J., Falissard, B., Battaglia, M., Boivin, M., Tremblay, R. E., & Côté, S. M. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1096-6 · Cited by 65
“Depressive and anxiety disorders are among the top ten leading causes of disability in the world [1, 2].”
Background
Inhibition of Endothelial Dysfunction by Dietary Flavonoids and Preventive Effects Against Cardiovascular Disease
Yamagata, K., & Yamori, Y. (2019) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000000757 · Cited by 68
Lower CSF Homovanillic Acid Levels in Depressed Patients with a History of Alcoholism
Sher, L., Oquendo, M. A., Li, S., Huang, Y., Grunebaum, M. F., Burke, A. K., Malone, K. M., & Mann, J. J. (2003) · Neuropsychopharmacology · doi:10.1038/sj.npp.1300231 · Cited by 64
“Recent findings identify both major depression- and alcoholrelated disorders in the top diseases that are associated with disability and costs (Murray and Lopez, 1997).”
Background
Self-Reported Skin Morbidity among Adults: Associations with Quality of Life and General Health in a Norwegian Survey
Dalgard, F. J., Svensson, Å., Holm, J. Ø., & Sundby, J. (2004) · Journal of Investigative Dermatology Symposium Proceedings · doi:10.1046/j.1087-0024.2003.09111.x · Cited by 64
Percepción de la imagen corporal como aproximación cualitativa al estado de nutrición
Madrigal-Fritsch, H., de Irala, J., Martínez‐González, M. Á., Kearney, J. M., Gibney, M. J., & Martínez-Hernández, J. A. (1999) · Salud Pública de México · doi:10.1590/s0036-36341999000600008 · Cited by 64
Altered Resting-State Functional Connectivity of Striatal-Thalamic Circuit in Bipolar Disorder
Teng, S., Lu, C., Wang, P.-S., Li, C., Tu, P., Hung, C., Su, T., & Wu, Y.-T. (2014) · PLoS ONE · doi:10.1371/journal.pone.0096422 · Cited by 64
“Bipolar disorder is a mood disorder exhibiting a prevalence of at least 1%, constituting a considerable health care burden [1,2].”
Background
The Prevalence and Predictors of Severe Depression Among the Elderly in Malaysia
Rashid, A., & Tahir, I. (2014) · Journal of Cross-Cultural Gerontology · doi:10.1007/s10823-014-9248-3 · Cited by 63
Metabolomics and Atherosclerosis
Goonewardena, S. N., Prevette, L. E., & Desai, A. A. (2010) · Current Atherosclerosis Reports · doi:10.1007/s11883-010-0112-9 · Cited by 62
“Traditional risk factors for CAD have been derived from epidemiologic studies [ 29 , 30].”
A Population-Based Longitudinal Study of Recent Stressful Life Events as Risk Factors for Suicidal Behavior in Major Depressive Disorder
Wang, Y., Sareen, J., Afifi, T. O., Bolton, J. M., Johnson, E. A., & Bolton, J. M. (2015) · Archives of Suicide Research · doi:10.1080/13811118.2014.957448 · Cited by 67
“It is expected that MDD will be the second leading cause of morbidity and mortality by the year 2020 (Murray & Lopez, 1997).”
Background
Depression and Bone Metabolism
Williams, L. J., Pasco, J. A., Jacka, F. N., Henry, M. J., Dodd, S., & Berk, M. (2008) · Psychotherapy and Psychosomatics · doi:10.1159/000162297 · Cited by 64
“Both depression and osteoporosis impose a substantial public health burden in the developed and developing world. As such, both diseases have been recognised as national health priorities in many countries. The status of depression as a leading contributor to the global disease burden [”
Background
Complementary and Alternative Medicine Use for Treatment and Prevention of Late-Life Mood and Cognitive Disorders
Lavretsky, H. (2009) · Aging Health · doi:10.2217/1745509x.5.1.61 · Cited by 63
From the prodrome to chronic schizophrenia: the neurobiology underlying psychotic symptoms and cognitive impairments
Howes, O. D., Fusar-Poli, P., Bloomfield, M. P., Selvaraj, S., & McGuire, P. (2012) · Current pharmaceutical design · doi:10.2174/138161212799316217 · Cited by 61
“Schizophrenia is amongst the most common of the severe mental illnesses [1;2], and one of the top ten causes of global disease burden amongst adults [3].”
Background
Exploring the Relationship Between Absolute and Relative Position and Late-Life Depression: Evidence From 10 European Countries
Ladin, K., Daniels, N., & Kawachi, I. I. (2009) · The Gerontologist · doi:10.1093/geront/gnp065 · Cited by 63
“…overshadowed by measures of physical health in the study of health inequalities, psychosocial morbidity is now gaining more attention as depression is estimated to be the fourth leading cause of morbidity worldwide, projected to rise to the third by the year 2020 ( Murray & Lopez, 1997 ).”
Background
Smoking in immigrants: do socioeconomic gradients follow the pattern expected from the tobacco epidemic?
Nierkens, V., de Vries, H., & Stronks, K. (2006) · Tobacco Control · doi:10.1136/tc.2006.014902 · Cited by 63
Antidepressants for depression in adults with HIV infection
Eshun‐Wilson, I., Siegfried, N., Akena, D. H., Stein, D. J., Obuku, E. A., & Joska, J. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008525.pub3 · Cited by 63
Activation of aldehyde dehydrogenase 2 slows down the progression of atherosclerosis via attenuation of ER stress and apoptosis in smooth muscle cells
Yang, M., Wang, Y., Han, B., Yang, B. Y., Qiang, Y.-W., Zhang, Y., Wang, Z., Huang, X. S., Liu, J., Chen, Y., et al. (2017) · Acta Pharmacologica Sinica · doi:10.1038/aps.2017.81 · Cited by 63
A Role for SERCA Pumps in the Neurobiology of Neuropsychiatric and Neurodegenerative Disorders
Britzolaki, A., Saurine, J., Klocke, B., & Pitychoutis, P. M. (2019) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-12457-1_6 · Cited by 63
Folic acid and the treatment of depression
Abou‐Saleh, M. T., & Coppen, A. J. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.07.007 · Cited by 63
“In folate-deficient depressed patients, CSF amine metabolites were significantly reduced in a subgroup of patients with high plasma homocysteine who also had the lowest levels of red blood cell and CSF folate and CSF SAM [13].”
Background
A Randomized, Placebo-Controlled Trial of Sertraline for Prophylactic Treatment of Highly Recurrent Major Depressive Disorder
Lépine, J.-P., Caillard, V., Bisserbe, J.-C., Troy, S., Hotton, J.-M., Boyer, P., & For the PREVERS Investigators (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.5.836 · Cited by 83
An ecologically valid performance-based social functioning assessment battery for schizophrenia
Shi, C., He, Y., Cheung, E. F. C., Yu, X., & Chan, R. C. K. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.09.023 · Cited by 62
“…and work ability have been shown to deteriorate gradually in patients with schizophrenia resulting in a poor functional outcome and imposing heavy burden upon family members and the society (Knapp et al., 2004; Monte et al., 2008; Murray and Lopez, 1997; Wiersma et al., 2000; Wu et al., 2005).”
Recent time trends in levels of self‐reported anxiety, mental health service use and suicidal behaviour in Stockholm
Kosidou, K., Magnusson, C., Mittendorfer‐Rutz, E., Hallqvist, J., Hellner Gumpert, C., Idrizbegovic, S., Dal, H., & Dalman, C. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01487.x · Cited by 60
“Thus, psychiatric morbidity is highly prevalent and causes significant psychosocial and physical impairment also among adolescents and young adults (2, 5).”
Background

Authors: Murray, C. J., & Lopez, A. D.
Affiliations: Harvard University (US)
Corresponding author: Murray, Christopher JL
ORCID: 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
DOI: 10.1016/s0140-6736(96)07495-8
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study

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