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.
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.
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.
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.