Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
Artikel i vetenskaplig tidskrift, 2025
Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions.
Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution.
Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant).
Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.
Funding Gates Foundation and Bloomberg Philanthropies.
Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution.
Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant).
Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.
Funding Gates Foundation and Bloomberg Philanthropies.
Författare
Simon I. Hay
Institute for Health Metrics and Evaluation
School of Medicine
Kanyin Liane Ong
Institute for Health Metrics and Evaluation
Damian Santomauro
Institute for Health Metrics and Evaluation
Queensland Centre for Mental Health Research
University of Queensland
A. Bhoomadevi
Amity University
Mohammad Amin Aalipour
Shahid Beheshti University of Medical Sciences
Hasan Aalruz
Al Zaytoonah University of Jordan
Hazim S. Ababneh
Massachusetts General Hospital
Ukachukwu O. Abaraogu
Nsukka
University of the West of Scotland
Biruk Beletew Abate
Curtin University
Cristiana Abbafati
Sapienza Università di Roma
Nasir Abbas
Chinese Academy of Sciences
Mitra Abbasifard
Rafsanjan University of Medical Sciences
Mohsen Abbasi-Kangevari
Shahid Beheshti University of Medical Sciences
Samar Abd ElHafeez
Alexandria University
Ashraf Nabiel Abdalla
Umm Al-Qura University
Mohammed Altigani Abdalla
University of Hull
Emad M. Abdallah
Qassim University
Barkhad Aden Abdeeq
Nutrition
Nadin M.I. Abdel Razeq
University of Jordan
Ahmed Abdelrahman Abdelgalil
College of Pharmacy
Reda Abdel-Hameed
University of Hail
Al-Azhar University
Michael Abdelmasseh
Marshall University
Mahmoud Abdelnabi
Mayo Clinic
Wael M. Abdel-Rahman
University of Sharjah
Sherief Abd-Elsalam
Tanta University
Sepideh Abdi
Stanford Cancer Institute
Mohammad Abdollahi
Tehran University of Medical Sciences
School of Pharmacy
Meriem Abdoun
University Ferhat Abbas of Setif
Arman Abdous
Islamic Azad University
Jeza Muhamad Abdul Aziz
Komar University of Science and Technology
Baxshin Hospital
Deldar Morad Abdulah
University of Duhok
Rizwan Suliankatchi Abdulkader
Indian Council of Medical Research
Adam Abdullahi
Harvard University
Auwal Abdullahi
Bayero University
Federal University, Wukari
Toufik Abdul-Rahman
Toufik's World Medical Association
Kulmira Abdykerimova
Kazakh National Medical University
Habtamu Abebe Getahun
University of Gondar
Aidin Abedi
University of Southern California
Armita Abedi
Zanjan University of Medical Sciences
Asrat Agalu Abejew
Bahar Dar University
Roberto Ariel Abeldaño Zuñiga
Helsingin Yliopisto
University of Sierra Sur
E.S. Abhilash
Sree Narayana Guru College Chelannur
Shehab Uddin Al Abid
National Heart Foundation Hospital and Research Institute
University of Oxford
Syed Hani Abidi
Nazarbayev University School of Medicine
Alemwork Abie
Bahar Dar University
Olugbenga Olusola Abiodun
Federal Medical Centre
Olumide Abiodun
Babcock University
Richard Gyan Aboagye
University of New South Wales (UNSW)
University of Health and Allied Sciences
Shady Abohashem
Massachusetts General Hospital
Harvard Medical School
Hassan Abolhassani
Tehran University of Medical Sciences
Karolinska Institutet
Ulric Sena Abonie
Northumbria University
Nagah M. Abourashed
University of Hail
Faculty of Science
Mohamed Abouzid
Poznan University of Medical Sciences
Dmitry Abramov
Loma Linda University Medical Center
Lucas Guimarães Abreu
Universidade Federal de Minas Gerais
Dariush Abtahi
Shahid Beheshti University of Medical Sciences
Rana Kamal Abu Farha
Applied Science Private University
Fuad Hamdi A. Abuadas
Al Jouf University
Aminu Kende Abubakar
National Cancer Center Tokyo
St. Luke’s International University
Bilyaminu Abubakar
Usmanu Danfodiyo University
Nigerian Institute of Medical Research
Eman Abu-Gharbieh
University of Sharjah
University of Jordan
Sawsan Abuhammad
University of Sharjah
Public Health and Family Medicine
Ahmad Y. Abuhelwa
University of Sharjah
Hana Jihad Jihad Abukhadijah
Hamad Medical Corporation
Niveen M.E. Abu-Rmeileh
Birzeit University
College of Health Sciences, Qatar University
Salahdein Aburuz
United Arab Emirates University
University of Jordan
Dina Abushanab
Hamad Medical Corporation
Raghu Ram Achar
JSS Academy of Higher Education and Research
Anirudh Balakrishna Acharya
University of Sharjah
Apurba Acharya
Karnali Academy of Health Sciences
Ilana N. Ackerman
Monash University
Juan Manuel Acuna
Florida International University
American University of Antigua
Ousman Adal
Bahar Dar University
Lisa C. Adams
Technische Universität München
Stanford University
Lawan Hassan Adamu
Federal University Dutse
Bayero University
Mesafint Molla Adane
Bahar Dar University
Zenaw Debasu Addisu
Bahar Dar University
Isaac Yeboah Addo
University of New South Wales (UNSW)
University of Sydney
Oluwafemi Atanda Adeagbo Adeagbo
University of KwaZulu-Natal
University of South Carolina
Tajudeen Adesanmi Adebisi
NMC Healthcare
Ladoke Akintola University
Isaac Akinkunmi Adedeji
Olabisi Onabanjo University
David Adedia
University of Health and Allied Sciences
Kamoru Ademola Adedokun
State University of New York (SUNY)
Roswell Park Comprehensive Cancer Center
Rufus Adesoji Adedoyin
Obafemi Awolowo University
Oluwatobi E. Adegbile
Quillen College of Medicine
Center for Cardiovascular Risk Research
Oyelola A. Adegboye
Charles Darwin University
Nurudeen A. Adegoke
The University of Sydney
Olumide Thomas Adeleke
Bowen University Teaching Hospital
Bowen University
Isaac Ayodeji Adesina
University of Medical Sciences
Miracle Ayomikun Adesina
University of Ibadan
Slum and Rural Health Initiative Research Academy
Habeeb Omoponle Adewuyi
University of Ibadan
University of Johannesburg
Temitayo Esther Adeyeoluwa
University of Ibadan
University of Medical Sciences
Olorunsola Israel Adeyomoye
University of Medical Sciences
Kishor Adhikari
Tribhuvan University
Himalayan Environment and Public Health Network (HEPHN)
Ripon Kumar Adhikary
Australian National University
Jashore University of Science and Technology
Usha Adiga
Apollo Institute of Medical Sciences & Research, Chittoor
Mohd Adnan
University of Hail
Qorinah Estiningtyas Sakilah Adnani
Padjadjaran University
Prince Owusu Adoma
University of Education, Winneba
Leticia Akua Adzigbli
University of Health and Allied Sciences
Jakub Morze
Chalmers, Life sciences, Livsmedelsvetenskap
The Lancet
0140-6736 (ISSN) 1474-547X (eISSN)
Vol. 406 10513 1873-1922Ämneskategorier (SSIF 2025)
Folkhälsovetenskap, global hälsa och socialmedicin
DOI
10.1016/S0140-6736(25)01637-X
PubMed
41092926