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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”
In the citing paper
“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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“Major depression and co-morbid medical illness Major depression (MDD) is a leading cause of disability worldwide and, according to the World Health Organisation, will become the leading cause of disability-adjusted life years by 2030 (Murray & Lopez, 1997; Moussavi et al., 2007; WHO, 2018).”
BackgroundHayes, J. F., Marston, L., Walters, K., Geddes, J. R., King, M., & Osborn, D. P. J. (2016) · World Psychiatry · doi:10.1002/wps.20298 · Cited by 115
Islam, M. M., Alam, M., Tariquzaman, M., Kabir, M. A., Pervin, R., Begum, M., & Khan, M. M. H. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-11 · Cited by 116
“Other determinants of child malnutrition may include social deprivation [23], rural-urban place of residence [18,30], religions [31,32], number of children [1,18], source of drinking water [1] and toilet facility [3,33].”
BackgroundResultMultifaceted strain-specific effects in a mouse model of depression and of antidepressant reversal
Ibargüen-Vargas, Y., Surget, A., Touma, C., Palme, R., & Belzung, C. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.07.010 · Cited by 125
“Major depressive disorder (MDD) is one of the most common and serious health problems of western societies (Murray and Lopez, 1997).”
BackgroundWater and sanitation associated with improved child growth
Merchant, A., Jones, C. Y., Kiure, A. K., Kupka, R., Fitzmaurice, G. M., Herrera, M. G., & Fawzi, W. W. (2003) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601725 · Cited by 114
“In sub-Saharan Africa, the burden of disease attributable to malnutrition is 32.7% and to poor water and sanitation 10.1% (Murray & Lopez, 1997); improved access to safe water and sanitation facilities may therefore have enormous potential to reduce the burden of disease in this region.”
BackgroundInfluentialJc, B., Davidson, J. R., Lecrubier, Y., Nutt, D. J., Kirmayer, L. J., Lépine, J., Lin, K. M., Tajima, O., & Ono, Y. (2001) · PubMed · Cited by 115
The prevalence of Parkinson's disease in rural Tanzania
Dotchin, C., Msuya, O., Kissima, J., Massawe, J., Mhina, A., Moshy, A., Aris, E., Jusabani, A., Whiting, D., Masuki, G., et al. (2008) · Movement Disorders · doi:10.1002/mds.21898 · Cited by 115
“These patients were found through the following sources (number of patients): local village elders (6), medical records search (4), stroke study (2), tracing positive family histories (1), neurology out-patients clinic lists (1) and hospital occupational and physiotherapy records search (0).”
BackgroundAnxiety disorders and bipolar disorder: a review
McIntyre, R. S., Soczynska, J. K., Bottas, A., Bordbar, K., Konarski, J. Z., & Kennedy, S. H. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00355.x · Cited by 113
“mood is anxious, despondent, lachrymose, irritable, occasionally mixed with a certain self-irony (7, 8).”
BackgroundPoppelaars, M., Tak, Y. R., Lichtwarck‐Aschoff, A., Engels, R. C. M. E., Lobel, A., Merry, S., Lucassen, M. F. G., & Granic, I. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.03.005 · Cited by 114
“…Program (Op Volle Kracht) and a Computerized Program (SPARX) Globally depression is among the leading causes of disease burden (Mathers et al., 2004; Murray & Lopez, 1997; Vos et al., 2012), and it is he leading cause of disease burden in young people aged 10 to 24 years old (Gore et al., 2011).”
Inflammation and Atherothrombosis
ROBBIE, L. A., & Libby, P. (2001) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2001.tb03939.x · Cited by 114
“The two major mechanisms explained above account for formation of thrombi over atherosclerotic plaques: (1) endothelial erosion, which pro-”
BackgroundGlobal Initiative for Chronic Obstructive Lung Diseases (GOLD)
Hurd, S. S., & PAUWELS, R. A. (2002) · Pulmonary Pharmacology & Therapeutics · doi:10.1006/pupt.2002.0381 · Cited by 114
Raised plasma oxidised LDL in acute cerebral infarction
Uno, M. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.3.312 · Cited by 114
Virological and clinical characterizations of respiratory infections in hospitalized children
Biçer, S., Giray, T., Çöl, D., Erdağ, G. Ç., Vitrinel, A., Gürol, Y., Çelik, G., Kaspar, Ç., & Küçük, Ö. (2013) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/1824-7288-39-22 · Cited by 114
“These are the major causes of morbidity and mortality with a worldwide disease burden estimated at 112 900 000 and 3.5 million deaths, respectively [1] .”
BackgroundInfluentialSchröder, J., Berger, T., Meyer, B., Lutz, W., Hautzinger, M., Späth, C., Eichenberg, C., Klein, J. P., & Moritz, S. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9850-0 · Cited by 113
Haemoglobin colour scale for anaemia diagnosis where there is no laboratory: a systematic review
Critchley, J., & Bates, I. (2005) · International Journal of Epidemiology · doi:10.1093/ije/dyi195 · Cited by 112
Serum lipid profile and its association with hypertension in Bangladesh
Islam, S., Choudhury, K. N., Mainuddin, A., & Wahiduzzaman, M. (2014) · Vascular Health and Risk Management · doi:10.2147/vhrm.s61019 · Cited by 113
Ferrari, A. J., Baxter, A. J., & Whiteford, H. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.11.007 · Cited by 118
“Due to the early onset of BSD, its chronic nature and high level of impairment, BSD is one of the 6 leading causes of disability worldwide (Murray and Lopez, 1997; Saraceno, 2002).”
BackgroundCigarette smoke-induced pulmonary emphysema in scid-mice. Is the acquired immune system required?
D'hulst, A. I., Maes, T., Bracke, K. R., Demedts, I., Tournoy, K. G., Joos, G., & Brusselle, G. (2005) · Respiratory Research · doi:10.1186/1465-9921-6-147 · Cited by 113
“Background Chronic obstructive pulmonary disease (COPD) is currently listed as the fifth leading cause of death in the world, and is also an important cause of chronic disability and permanent impairment, representing a major economic and social burden worldwide [1,2].”
BackgroundPsychiatric disorders and sexual dysfunction
Waldinger, M. D. (2015) · Handbook of clinical neurology · doi:10.1016/b978-0-444-63247-0.00027-4 · Cited by 117
A systematic review of research examining benzodiazepine-related mortality
Charlson, F., Degenhardt, L., McLaren, J., Hall, W., & Lynskey, M. (2009) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1694 · Cited by 107
“The Global Burden of Disease (GBD), Injuries and Risk Factors Study (GBD Study 2005) is a follow-up from the original GBD Study of 1990.(32,33) It involves a systematic assessment of the data on all diseases and injuries and will produce comprehensive and comparable estimates of the burden of diseases, injuries and ri…”
BackgroundStaying Well with Bipolar Disorder
Russell, S. J., & Browne, J. L. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01542.x · Cited by 140
“Although bipolar mood disorder is a common cause of disability [1], some people develop strategies to stay well and avoid relapses of mania and depression [2].”
BackgroundBilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression
Nahas, Z. H., Anderson, B. S., Borckardt, J. J., Arana, A. B., George, M. S., Reeves, S. T., & Takacs, I. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.08.021 · Cited by 114
“Treatment-resistant depression (TRD) is a recurrent psychiatric illness and a leading cause of premature mortality due to suicide and associated medical conditions (1,2).”
BackgroundWeaver, H., & Roberts, B. (2010) · Substance Use & Misuse · doi:10.3109/10826081003793920 · Cited by 111
“Alcohol is causally related to more than 60 different medical conditions, and an estimated 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension (Murray and Lopez, 1997; Room, Babor, and Rehm, 2005).”
BackgroundChanging the burden of COPD mortality
Mannino, D. M., & Kiri, V. A. (2006) · International Journal of COPD · doi:10.2147/copd.2006.1.3.219 · Cited by 113
The Economic Value of Biodiversity
Hanley, N. D., & Perrings, C. A. (2019) · Annual Review of Resource Economics · doi:10.1146/annurev-resource-100518-093946 · Cited by 128
“In 2013, for example, while India and Sub-Saharan Africa together accounted for 44% of the global burden of disease, they accounted for only 2% of global health expenditures (Murray & Lopez 1997).”
BackgroundMain, B. J., Lee, Y., Ferguson, H. M., Kreppel, K. S., Kihonda, A., Govella, N. J., Collier, T. C., Cornel, A. J., Eskin, E., Kang, E. Y., et al. (2016) · PLoS Genetics · doi:10.1371/journal.pgen.1006303 · Cited by 108
“In particular, mosquito species that feed on human blood pose an enormous public health threat by transmitting numerous pathogens such as dengue virus, Zika virus and malaria, which together kill more than one million people per year [1,2].”
BackgroundSurgery in Developing Countries
Ozgediz, D. (2005) · Archives of Surgery · doi:10.1001/archsurg.140.8.795 · Cited by 111
Khademi, H., Etemadi, A., Kamangar, F., Nouraie, M. S., Shakeri, R., Abaie, B., Pourshams, A., Bagheri, M., Hooshyar, A., Islami, F., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0011183 · Cited by 111
“Several studies have shown that VA gives more valid causes of death than routine death certificate data in many developing countries [11,12,13,14,15].”
Background
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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