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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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BackgroundAntiplatelet Treatment for Prevention of Cerebrovascular Events in Patients With Vascular Diseases
Gouya, G., Arrich, J., Wolzt, M., Huber, K., Verheugt, F. W. A., Gurbel, P. A., Pirker-Kees, A., & Siller-Matula, J. M. (2013) · Stroke · doi:10.1161/strokeaha.113.002590 · Cited by 73
“492 Stroke is a major healthcare problem attributable to ≈10% of deaths worldwide.(1) In industrialized countries, stroke is the third most common cause of death, and the leading cause of disability, with 20% of survivors requiring institutional care after 3 months and 15% to 30% being permanently disabled.”
BackgroundBaldomero, E. B., Ubago, J. G., Cercós, C. L., Ruiloba, J. V., Calvo, C. G., Lopez, R., & for the ARGOS Study Group (2005) · Depression and Anxiety · doi:10.1002/da.20080 · Cited by 75
Functional recovery differs between ischaemic and haemorrhagic stroke patients
Schepers, V. P. M., Ketelaar, M., Visser‐Meily, A., Groot, V., Twisk, J. W. R., & Lindeman, E. (2008) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0198 · Cited by 74
Household energy, indoor air pollution and child respiratory health in South Africa
Barnes, B. R., Mathee, A., Thomas, L., & Bruce, N. (2009) · Journal of Energy in Southern Africa · doi:10.17159/2413-3051/2009/v20i1a3296 · Cited by 74
“…the single leading cause of death amongst children less than 5 years old worldwide 4 Journal of Energy in Southern Africa • Vol 20 No 1 • February 2009 (Murray and Lopez, 1997) and amongst the top 4 killers of South African children less than five years old (von Schirnding et al., 1991b; Bradshaw…”
BackgroundThe burden of infectious diseases in Europe: a pilot study
van Lier, E., Havelaar, A. H., & Nanda, A. (2007) · Eurosurveillance · doi:10.2807/esm.12.12.00751-en · Cited by 74
Amelioration of TMAO through probiotics and its potential role in atherosclerosis
Din, A. U., Hassan, A., Zhu, Y. S., Yin, T., Gregersen, H. N., & Wang, G. (2019) · Applied Microbiology and Biotechnology · doi:10.1007/s00253-019-10142-4 · Cited by 76
“There are evidences that bacteria play health beneficial role for human and germ-free mice (Murray and Lopez 1997; Sekirov et al. 2010).”
BackgroundNierenberg, A. A., Sylvia, L. G., Leon, A. C., Reilly-Harrington, N. A., Shesler, L. W., McElroy, S. L., Friedman, E. S., Thase, M. E., Shelton, R. C., Bowden, C. L., et al. (2013) · Clinical Trials · doi:10.1177/1740774513512184 · Cited by 70
“Bipolar disorder is among the top 10 causes of disability worldwide [8] with direct and indirect costs estimated at US$151 billion [9].”
BackgroundPiscitelli, P., Iolascon, G., Argentiero, A., Chitano, G., Neglia, C., Marcucci, G., Pulimeno, M., Benvenuto, M., Mundi, S., Marzo, V., et al. (2012) · Clinical Interventions in Aging · doi:10.2147/cia.s36828 · Cited by 82
The burden of alcohol-related ill health in the United Kingdom
Balakrishnan, R., Allender, S. E., Scarborough, P., Webster, P., & Rayner, M. (2009) · Journal of Public Health · doi:10.1093/pubmed/fdp051 · Cited by 74
Validity of the SS-QOL in Germany and in Survivors of Hemorrhagic or Ischemic Stroke
Ewert, T., & Stucki, G. (2007) · Neurorehabilitation and neural repair · doi:10.1177/1545968306292255 · Cited by 73
Ateş, A. H., Canpolat, U., Yorgun, H., Kaya, E. B., Sunman, H., Demiri, E., Taher, A. T., Hazırolan, T., Aytemir, K., Tokgözoğlu, L. S., et al. (2011) · PubMed · Cited by 73
Cognitive impairment in migraine:A systematic review
de Araújo, C. M., Barbosa, I. G., Lemos, S. M. A., Domingues, R. B., & Teixeira, A. L. (2012) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642012dn06020002 · Cited by 73
“The following data were stratified as follows: [1] age; [2] discrimination of studies carried out at neurological care facilities or within the community; [3] number of patients; [4] migraine with or without aura; [5] inclusion of a control group.”
MethodBadenhop, R. F., Moses, M. J., Scimone, A., Mitchell, P. B., Ewen-White, K. R., Rosso, A., Donald, J. A., Adams, L. J., & Schofield, P. R. (2002) · Molecular Psychiatry · doi:10.1038/sj.mp.4001025 · Cited by 73
Treadmill training and body weight support for walking after stroke
Moseley, A. M., Stark, A., Cameron, I., & Pollock, A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002840 · Cited by 75
Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study
Kotwani, P., Kwarisiima, D., Clark, T. D., Kabami, J., Geng, E., Jain, V., Chamie, G., Petersen, M. L., Thirumurthy, H., Kamya, M. R., et al. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1151 · Cited by 73
“This finding adds to accumulating evidence that prevalence of hypertension in sub-Saharan Africa is approaching that in developed nations [6,32-35].”
ResultLongitudinal trends in self-reported anxiety. Effects of age and birth cohort during 25 years
Calling, S., Midlöv, P., Johansson, S.-E., Sundquist, K., & Sundquist, J. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1277-3 · Cited by 73
“Background Mental illness including anxiety is one of the leading causes of disability worldwide [1, 2].”
BackgroundA Systematic Review on Natural Antioxidant Properties of Resveratrol
Colica, C., Milanović, M., Milić, N., Aiello, V., LORENZO, A. D., & Abenavoli, L. (2018) · Natural Product Communications · doi:10.1177/1934578x1801300923 · Cited by 77
“Moreover, it is widely accepted that excessive dietary intake of saturated fats and cholesterol play a role in the onset and development of CVD through changes in plasma low-density lipoprotein-cholesterol (LDL-c) [40, 41].”
BackgroundDepression Risk Prediction for Chinese Microblogs via Deep-Learning Methods: Content Analysis
Wang, X., Chen, S., Li, T., Li, W., Zhou, Y., Zheng, J. H., Chen, Q., Yan, J., & Tang, B. (2020) · JMIR Medical Informatics · doi:10.2196/17958 · Cited by 75
“In 1997, the WHO estimated that depression will be the second most debilitating disease by 2020, behind cardiovascular disease [6].”
BackgroundDepression, psychiatric comorbidities, and psychosocial implications associated with acne vulgaris
Sood, S., Jafferany, M., & kumar, S. V. (2020) · Journal of Cosmetic Dermatology · doi:10.1111/jocd.13753 · Cited by 72
Higher comorbidity of depression and cardiovascular disease in women: A biopsychosocial perspective
Möller-Leimkühler, A. M. (2010) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2010.523481 · Cited by 72
“By the year 2020, it is estimated that disability worldwide will be determined largely by depression and heart disease (Murray and Lopez 1997).”
BackgroundUnexpected high prevalence of 1-month depression in a small Brazilian community: the Bambui Study
Vorcaro, C. M. R., Lima‐Costa, M. F., Barreto, S. M., & Uchôa, E. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00440.x · Cited by 83
Effects of Vitamin D Intake on FEV1 and COPD Exacerbation: A Randomized Clinical Trial Study
Zendehdel, A., Gholami, M., Anbari, K., Ghanadi, K., Bachari, E. C., & Azargoon, A. (2015) · Global Journal of Health Science · doi:10.5539/gjhs.v7n4p243 · Cited by 72
Hoogendoorn, M., Welsing, P. M. J., & Mölken, M. R. (2007) · Current Medical Research and Opinion · doi:10.1185/030079908x242917 · Cited by 72
ICF Core Sets for chronic ischaemic heart disease
Cieza, A., Stucki, A. N., Geyh, S., Berteanu, M., Quittan, M., Simon, A., Kostanjsek, N. F. I., Stucki, G., & Walsh, N. E. (2004) · Journal of Rehabilitation Medicine · doi:10.1080/16501960410016785 · Cited by 70
“In 1990 IHD accounted for 626 million deaths worldwide (3) and was the fifth most important specific cause of global disability-adjusted life years (DALYs) (4).”
Assessing multiple risk behaviors in primary care
Babor, T. F., Sciamanna, C., & Pronk, N. P. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.018 · Cited by 76
New and future migraine therapy
Ramadan, N. M., & Buchanan, T. M. (2006) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2005.04.010 · Cited by 72
Functional Mapping of Protective Domains and Epitopes in the Rotavirus VP6 Protein
Choi, A. H.-C., Basu, M., McNeal, M., Flint, J. A., VanCott, J. L., Clements, J. D., & Ward, R. L. (2000) · Journal of Virology · doi:10.1128/jvi.74.24.11574-11580.2000 · Cited by 72
Nierenberg, A. A., Ostacher, M. J., Huffman, J. C., Ametrano, R. M., Fava, M., & Perlis, R. H. (2008) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e31816b5034 · Cited by 70
“2008;50:428–436) M ajor depressive disorder (MDD) is highly prevalent(1,2) and among the top 10 causes of disability worldwide.(3) Many clinicians under recognize and undertreat MDD,(4) despite substantial evidence that supports the efficacy and effectiveness of pharmacological and psychotherapeutic interventions.”
BackgroundMitchell, A. M., Sakraida, T. J., Kim, Y., Bullian, L., & Chiappetta, L. (2009) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2008.02.007 · Cited by 71
The AGE-RAGE Axis and RAGE Genetics in Chronic Obstructive Pulmonary Disease
Sharma, A., Kaur, S., Sarkar, M. S., Sarin, B., & Changotra, H. (2020) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-020-08815-4 · Cited by 71
“COPD has also been expected to be at the third position in the world to cause mortality by 2030 [11].”
BackgroundEffect of PACAP in Central and Peripheral Nerve Injuries
Tamas, A., Reglodi, D., Farkas, O., Kovesdi, E., Pal, J., Povlishock, J., Schwarcz, A., Czeiter, E., Szántó, Z., Dóczi, T., et al. (2012) · International Journal of Molecular Sciences · doi:10.3390/ijms13078430 · Cited by 75
Factors associated with work, social life and family life disability in bipolar disorder patients
Gutiérrez-Rojas, L., Jurado, D., & Gurpegui, M. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.06.020 · Cited by 74
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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