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

Abstract

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