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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, a framework used by GBD since 2002 that is predicated on a causal web of hierarchically organised, potentially overlapping health risks.29, 37”
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“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 citing paper
“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 citing paper
“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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BackgroundEffectiveness of psychoeducation for depression: A systematic review
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“Forecasts indicate that, in 2020, depression will be the second major cause of global losses among all ages and sexes (Fleck et al., 2009; Kessler et al., 2005; Murray and Lopez, 1997).”
BackgroundLee, T. A., Pickard, A. S., Au, D. H., Bartle, B., & Weiss, K. B. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-6-200809160-00004 · Cited by 170
“Chronic obstructive pulmonary disease (COPD) is associated with substantial burden in terms of prevalence of disease (1), death and disability risk (2, 3), and health care costs (4).”
BackgroundNutrition: Basis for Healthy Children and Mothers in Bangladesh
Faruque, A., Ahmed, A. M. S., Ahmed, T., Islam, M. M., Hossain, M. I., Sk, R., Alam, N., Kabir, I., & Sack, D. A. (2009) · Journal of Health Population and Nutrition · doi:10.3329/jhpn.v26i3.1899 · Cited by 170
“9%) of the global loss of disability-adjusted life years (DALYs) (3) (DALYs represent the sum of years of life lost from premature mortality and years lived with disability adjusted for severity).”
BackgroundMyocardial infarction mediated by endothelin receptor signaling in hypercholesterolemic mice
Caligiuri, G., Levy, B. I., Pernow, J., Thorén, P., & Hansson, G. K. (1999) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.96.12.6920 · Cited by 171
Dunn, B. D. (2012) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1799 · Cited by 168
“During their lifespan, over 16% of the general population are likely to suffer from clinical depression, and it is predicted that by 2020, depression will become the second leading contributor to death and disability in the US (Murray & Lopez, 1997).”
BackgroundZeng, X., Ming-li, T., Liu, D., Zheng, D., Zhang, J., & Leng, W. (2012) · PLoS ONE · doi:10.1371/journal.pone.0046508 · Cited by 168
“COPD includes chronic bronchitis and emphysema, Murray et al has predicted that COPD would become the third most common cause of death and the fourth most important disease leading to disability by 2020 [41,42].”
BackgroundGeyh, S., Peter, C., Müller, R., Bickenbach, J. E., Kostanjsek, N. F. I., Üstün, B., Stucki, G., & Cieza, A. (2010) · Disability and Rehabilitation · doi:10.3109/09638288.2010.523104 · Cited by 168
Gene–gene effects on central processing of aversive stimuli
Smolka, M. N., Fauth‐Bühler, M., Schumann, G., Vollstädt‐Klein, S., Hu, X.-Z., Moayer, M., Zimmer, A., Wrase, J., Flor, H., Mann, K. F., et al. (2007) · Molecular Psychiatry · doi:10.1038/sj.mp.4001946 · Cited by 165
PREVALENCE OF DEPRESSION IN RURAL RWANDA BASED ON SYMPTOM AND FUNCTIONAL CRITERIA
Bolton, P. A., Neugebauer, R., & Ndogoni, L. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200209000-00009 · Cited by 167
“Accordingly, in 1990 unipolar depression ranked as the fourth leading cause of disability worldwide and is projected to be the second leading cause in 2020 (Murray and Lopez, 1997; Ustun, 1999).”
BackgroundWambua, S., Mwangi, T., Kortok, M., Uyoga, S. M., Macharia, A., Mwacharo, J. K., Weatherall, D. J., Snow, R. W., Marsh, K., & Williams, T. N. (2006) · PLoS Medicine · doi:10.1371/journal.pmed.0030158 · Cited by 167
“Although malaria causes more than 200 million episodes of fever among young African children every year, fewer than 1% of these episodes are fatal [1,2].”
BackgroundBiological consequences of zinc deficiency in the pathomechanisms of selected diseases
Jurowski, K., Szewczyk, B., Nowak, G., & Piekoszewski, W. (2014) · JBIC Journal of Biological Inorganic Chemistry · doi:10.1007/s00775-014-1139-0 · Cited by 166
Anderson, J. D., Bagamian, K. H., Muhib, F., Amaya, M. P., Laytner, L. A., Wierzba, T. F., & Rheingans, R. (2019) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30483-2 · Cited by 168
Principles of Social Psychiatry
Knapp, M. R. J., & Beecham, J. K. (2010) · Wiley eBooks · doi:10.1002/9780470684214 · Cited by 172
“In Foucault’s archaeology [3,4], madness was defined in Western modernity as the mere absence of reason, coinciding more or less with moral absence, concluding that madness had nothing to say, no voice, was silenced – to be socially excluded, at a micro- and macro-social level.”
BackgroundMethodInfluentialGeyh, S., Kurt, T., Brockow, T., Cieza, A., Ewert, T., Omar, Z., & Resch, K. (2004) · Journal of Rehabilitation Medicine · doi:10.1080/16501960410015399 · Cited by 164
Schröder, J., Sautier, L., Kriston, L., Berger, T., Meyer, B., Späth, C., Köther, U., Nestoriuc, Y., Klein, J. P., & Moritz, S. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.044 · Cited by 149
“Depressive disorders are among the most frequent mental disorders and leading causes of disability worldwide (Murray and Lopez, 1997; Wittchen et al., 2011).”
BackgroundHayes, A. M., Beevers, C. G., Feldman, G. C., Laurenceau, J.-P., & Perlman, C. (2005) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1202_9 · Cited by 163
Donor funding priorities for communicable disease control in the developing world
Shiffman, J. (2006) · Health Policy and Planning · doi:10.1093/heapol/czl028 · Cited by 163
“Donor funding priorities for communicable disease control in the developing world”
BackgroundFolate for Depressive Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Taylor, M. J., Carney, S. M., Goodwin, G. M., & Geddes, J. R. (2004) · Journal of Psychopharmacology · doi:10.1177/0269881104042630 · Cited by 163
A Population-based Study of Morbidity and Mortality in Mannose-binding Lectin Deficiency
Dahl, M., Tybjærg‐Hansen, A., Schnohr, P., & Nordestgaard, B. G. (2004) · The Journal of Experimental Medicine · doi:10.1084/jem.20040111 · Cited by 163
“We grouped all diagnoses based on the Global Burden of Disease classification system (1, 2, 33).”
BackgroundMethodKehoe, T., Gmel, G., Shield, K. D., Gmel, G., & Rehm, J. (2012) · Population Health Metrics · doi:10.1186/1478-7954-10-6 · Cited by 160
“Introduction Alcohol consumption is a component cause [1] for over 200 International Classification of Diseases (ICD-10) three-digit codes [2,3].”
BackgroundChronic physical conditions and aging: Is mental health a potential protective factor?
Keyes, C. L. M. (2005) · Ageing International · doi:10.1007/bf02681008 · Cited by 172
“…illness, major (unipolar) depressive episode has been shown to be among the leading specific causes of DALYs, second only to coronary artery disease (Murray & Lopez, 1996, 1997) and it is projected to become the second leading cause of DALYs in developing and developed nations by the year 2020.”
BackgroundJohnston, B., Rivara, F. P., Droesch, R. M., Dunn, C. W., & Copass, M. K. (2002) · PEDIATRICS · doi:10.1542/peds.110.2.267 · Cited by 162
Barriers to adherence to COPD guidelines among primary care providers
Pérez, X., Wisnivesky, J. P., Lurslurchachai, L., Kleinman, L. C., & Kronish, I. M. (2011) · Respiratory Medicine · doi:10.1016/j.rmed.2011.09.010 · Cited by 170
van Nimwegen, M., Speelman, A. D., Overeem, S., van de Warrenburg, B. P. C., Smulders, K., Dontje, M. L., Borm, G. F., BACKX, F. J. G., Bloem, B. R., Munneke, M. A. M., et al. (2013) · BMJ · doi:10.1136/bmj.f576 · Cited by 167
MEDICAL GENETICS IN DEVELOPING COUNTRIES
Christianson, A. L., & Modell, B. (2004) · Annual Review of Genomics and Human Genetics · doi:10.1146/annurev.genom.5.061903.175935 · Cited by 161
Hadley, C., Tegegn, A., Tessema, F., Cowan, J. A., Asefa, M., & Galea, S. (2008) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2007.068460 · Cited by 161
“There is increasing recognition that common mental disorders are a major contributor to the global burden of disease and that the impact of this burden is substantial in developed and developing countries.(1) Global estimates of the burden of disease suggest that the burden of common mental disorders is similar to, an…”
ResultPostpartum Hemorrhage : Prevention and Treatment
Louis, K., Karoshi, M., & B‐Lynch, C. (2008) · Cited by 161
Metadata
- 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 › 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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