# Global Burden of Disease Study

The Global Burden of Disease Study (GBD) is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors. GBD is a collaboration of over 12,000 researchers from more than 160 countries. Under principal investigator Christopher J.L. Murray, GBD is based in the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and funded by the Bill and Melinda Gates Foundation.

## History

The Global Burden of Disease Study began in 1990 as a single World Bank–commissioned study that quantified the health effects of more than 100 diseases and injuries for eight regions of the world, giving estimates of morbidity and mortality by age, sex, and region. It also introduced the disability-adjusted life year (DALY) as a new metric to quantify the burden of diseases, injuries, and risk factors, to aid comparisons. GBD 1990 was "institutionalized" at the World Health Organization (WHO) and the research was "conducted mainly by researchers at Harvard and WHO".
In 2000–2002, the 1990 study was updated by WHO to include a more extensive analysis using a framework known as comparative risk factor assessment.
The WHO estimates were again updated for 2004 in The global burden of disease: 2004 update (published in 2008) and in Global health risks (published in 2009).
Official DALY estimates had not been updated by WHO since 2004 until the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), also known as the Global Burden of Disease Study 2010, was published in December 2012. The work quantified the burdens of 291 major causes of death and disability and 67 risk factors disaggregated by 21 geographic regions and various age–sex groups. GBD 2010 had the Institute for Health Metrics and Evaluation as its coordinating center, but was a collaboration between several institutions including WHO and the Harvard School of Public Health. The work was funded by the Gates Foundation. The GBD 2010 estimates contributed to WHO's own estimates published in 2013, although WHO did not acknowledge the GBD 2010 estimates.
The Global Burden of Disease Study 2013 (GBD 2013) was published in 2014. The first installment, "Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980–2012", was published in the Journal of the American Medical Association in January, and further installments were published throughout the year. IHME continued to act as the coordinating center for the work.
The Global Burden of Disease Study 2017 (GBD 2017) was published in October 2018. The work was still coordinated at IHME. The life of Christopher Murray and the Global Burden of Disease Study is told in Epic Measures: One Doctor. Seven Billion Patients by Jeremey N. Smith.
GBD 2019 was published in The Lancet in October 2020.
GBD 2021 was published in The Lancet in February to May 2024, including an impact assessment of the COVID-19 pandemic as well as projections by 2050. Fact sheets are provided for all topics. The estimates are also available through an online tool and data files, for which a registration is required.

### Growth

The following table summarizes GBD's growth over the years.
| Report | Report | Collaborators | Collaborators | Coverage in report | Coverage in report | Sources |
| GBD | Publication year | Researchers | Countries | Countries | Causes of death | Sources |
| 1990 | 1993 | | | | | |
| 2010 | 2012 | 488 | 50 | 187 | 235 | |
| 2013 | 2014 | more than 1,000 | 106 | 188 | 240 | |
| 2015 | 2016 | 1,870 | 127 | 195 | 249 | |
| 2017 | 2018 | | | | | |
| 2019 | 2020 | Over 5,000 | 152 | 204 | | |
| 2021 | 2024 | Over 12,000 | over 160 | 204 | 288 | |

## Aims

The GBD has three specific aims:
* To systematically incorporate information on non-fatal outcomes into the assessment of the health status (using a time-based measure of healthy years of life lost due either to premature mortality or to years lived with a disability, weighted by the severity of that disability)
* To ensure that all estimates and projections were derived on the basis of objective epidemiological and demographic methods, which were not influenced by advocates.
* To measure the burden of disease using a metric that could also be used to assess the cost-effectiveness of interventions. The metric chosen was the DALY (Disability Adjusted Life Years).
The burden of disease can be viewed as the gap between current health status and an ideal situation in which everyone lives into old age free of disease and disability. Causes of the gap are premature mortality, disability and exposure to certain risk factors that contribute to illness.

## Results

The 2013 report showed that global life expectancy for both sexes increased from 65.3 years in 1990, to 71.5 years in 2013, while the number of deaths increased from 47.5 million to 54.9 million over the same interval. Progress varied widely across demographic and national groups. Reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections and neonatal causes in low-income regions drove the changes. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa.
For most communicable causes of death both numbers of deaths and age-standardised death rates fell, while for most non-communicable causes, demographic shifts increased numbers of deaths but decreased age-standardised death rates.
Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes and malaria remain in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections.
GBD 2015 found that for the first time, annual deaths from measles had fallen below 100,000 in 2013 and 2015. It also found that the global annual rate of new HIV infections has largely stayed the same during the past 10 years.
GBD 2015 also introduced the Socio-demographic Index (SDI) as a measure of a location's socio-demographic development that takes into account average income per person, educational attainment, and total fertility rate.

## Reception

The results of the Global Burden of Disease Study have been cited by The New York Times, The Washington Post, Vox, and The Atlantic.
The World Health Organization did not acknowledge the GBD 2010 estimates.

## Publications

The following is a table of GBD publications as of October 2020.
"GBD 2010" proper means the paper was published as part of the original triple issue in The Lancet.
| Title | Corresponding GBD | Publication date | Type | Venue |
| "Latest global disease estimates reveal perfect storm of rising chronic diseases and public health failures fuelling COVID-19 pandemic" | 2019 | October 2020 | | Lancet |
| "The burden of mental disorders in the Eastern Mediterranean Region, 1990–2013" | 2013 | January 2017 | | PLOS ONE |
| "Global burden of hypertension and systolic blood pressure of at least 110 to 115 mmHg, 1990–2015" | 2015 | January 2017 | | JAMA |
| "The Global Burden of Disease study and the preventable burden of NCD" | None (cites both 2010 and 2013) | December 2016 | | Global Heart |
| "Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease study" | 2015 | December 2016 | | JAMA Oncology |
| "A subnational analysis of mortality and prevalence of COPD in China from 1990 to 2013" | 2013 | December 2016 | | Chest |
| "Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015" | 2015 | October 2016 | GBD 2015 proper | The Lancet |
| "Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | October 2016 | | The Lancet |
| "Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease study 2015" | 2015 | September 2016 | | The Lancet |
| "Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013" | 2013 | September 2016 | | The Lancet Infectious Diseases |
| "Health in times of uncertainty in the Eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | August 2016 | | The Lancet Global Health |
| "Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013" | 2013 | August 2016 | | The BMJ |
| "Prevention of stroke: a strategic global imperative" | 2013 | July 2016 | | Nature Reviews Neurology |
| "Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015" | 2015 | July 2016 | | The Lancet HIV |
| "The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013" | 2013 | July 2016 | | The Lancet |
| "Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | June 2016 | | The Lancet Neurology |
| "The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies" | 2013 | May 2016 | | The Lancet |
| "The global economic burden of dengue: a systematic analysis" | 2013 | April 2016 | | The Lancet Infectious Diseases |
| "The burden of cancer in Mexico, 1990–2013" | 2013 | March 2016 | | Salud Publica de Mexico |
| "Global burden of cutaneous leishmaniasis: a cross-sectional analysis from the Global Burden of Disease study 2013" | 2013 | February 2016 | | The Lancet Infectious Diseases |
| "The global burden of dengue: an analysis from the Global Burden of Disease study 2013" | 2013 | February 2016 | | The Lancet Infectious Diseases |
| "Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: Findings from the Global Burden of Disease 2013 study" | 2013 | January 2016 | | JAMA Pediatrics |
| "Stroke prevalence, mortality and disability-adjusted life years in children and youth aged 0–19 years: Data from the global and regional burden of stroke 2013" | 2013 | January 2016 | | Neuroepidemiology |
| "The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013" | 2013 | December 2015 | | Injury Prevention |
| "Ambient air pollution exposure estimation for the Global Burden of Disease 2013" | 2013 | November 2015 | | Environmental Science & Technology |
| "Estimating distributions of health state severity for the Global Burden of Disease study" | 2013 | November 2015 | | Population Health Metrics |
| "Stroke prevalence, mortality and disability-adjusted life years in adults aged 20–64 years in 1990–2013: Data from the Global Burden of Disease 2013 study" | 2013 | October 2015 | | Neuroepidemiology |
| "Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 study" | 2013 | October 2015 | | Neuroepidemiology |
| "Atlas of the global burden of stroke (1990–2013): The GBD 2013 Study" | 2013 | October 2015 | | Neuroepidemiology |
| "Sex differences in stroke incidence, prevalence, mortality and disability-adjusted life years: Results from the Global Burden of Disease study 2013" | 2013 | October 2015 | | Neuroepidemiology |
| "Global and regional patterns in cardiovascular mortality from 1990 to 2013" | 2013 | October 2015 | | Circulation |
| "Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013" | 2013 | October 2015 | | The Lancet |
| "Under-5 mortality in 2,851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China" | None (cites both 2010 and 2013) | October 2015 | | The Lancet |
| "Disability weights for the Global Burden of Disease 2013 study" | 2013 | October 2015 | | The Lancet |
| "Methods for estimating the global burden of cerebrovascular diseases" | 2013 | October 2015 | | Neuroepidemiology |
| "Estimates of global and regional premature cardiovascular mortality in 2025" | 2013 | September 2015 | | Circulation |
| "Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | September 2015 | | The Lancet |
| "Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | September 2015 | | The Lancet |
| "Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000–2013" | 2013 | September 2015 | | BMC Medicine |
| "Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition" | 2013 | August 2015 | | The Lancet |
| "Maintenance dialysis throughout the world in years 1990 and 2010" | 2010 | July 2015 | | JASN |
| "Ischemic heart disease worldwide, 1990 to 2013" | 2013 | July 2015 | | Circulation: Cardiovascular Quality and Outcomes |
| "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | June 2015 | | The Lancet |
| "The Global Burden of Cancer 2013" | 2013 | May 2015 | | JAMA Oncology |
| "Demographic and epidemiologic drivers of global cardiovascular mortality" | 2013 | April 2015 | | The New England Journal of Medicine |
| "Mortality from cardiovascular diseases in sub-Saharan Africa, 1990–2013: a systematic analysis of data from the Global Burden of Disease study 2013: cardiovascular topic" | 2013 | April 2015 | | Cardiovascular Journal Africa |
| "Global burden of untreated caries: a systematic review and metaregression" | 2010 | March 2015 | | Journal of Dental Research |
| "Deconstructing the differences: a comparison of GBD 2010 and CHERG's approach to estimating the mortality burden of diarrhea, pneumonia, and their etiologies" | 2010 | January 2015 | | BMC Infectious Diseases |
| "Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | December 2014 | | The Lancet |
| "The burden of disease in Spain: results from the Global Burden of Disease study 2010" | 2010 | December 2014 | | BioMed Central |
| "Global burden of severe periodontitis in 1990–2010: a systematic review and meta-regression" | 2010 | September 2014 | | Journal of Dental Research |
| "Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis" | 2010 | September 2014 | | BMC Medicine |
| "The Global Burden of Disease Study 2010: Interpretation and implications for the neglected tropical diseases" | 2010 | July 2014 | | PLOS Neglected Tropical Diseases |
| "Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | July 2014 | | The Lancet |
| "Burden of injuries avertable by a basic surgical package in low- and middle-income regions: a systematic analysis from the Global Burden of Disease 2010 Study" | 2010 | July 2014 | | World Journal of Surgery |
| "Comparing cutaneous research funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with 2010 Global Burden of Disease results" | 2010 | July 2014 | | PLOS ONE |
| "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | May 2014 | | The Lancet |
| "Population health and burden of disease profile of Iran among 20 countries in the region: from Afghanistan to Qatar and Lebanon" | 2010 | May 2014 | | Archives of Iranian Medicine |
| "Evaluating causes of death and morbidity in Iran, Global Burden of Diseases, Injuries, and Risk Factors Study 2010" | 2010 | May 2014 | | Archives of Iranian Medicine |
| "Health transition in Iran toward chronic diseases based on results of Global Burden of Disease 2010" | 2010 | May 2014 | | Archives of Iranian Medicine |
| "Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | May 2014 | | The Lancet |
| "Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" | 2013 | May 2014 | | The Lancet |
| "Temporal trends in ischemic heart disease mortality in 21 world regions, 1980–2010: the Global Burden of Disease 2010 Study" | 2010 | February 2014 | | Circulation |
| "The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 Study" | 2010 | February 2014 | | Circulation |
| "The state of health in the Arab world, 1990–2010: an analysis of the burden of diseases, injuries, and risk factors" | 2010 | January 2014 | | The Lancet |
| "Smoking prevalence and cigarette consumption in 187 countries, 1980–2012" | 2013 | January 2014 | | Journal of the American Medical Association |
| "Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide" | 2010 | December 2013 | | BMJ Open |
| "The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions" | 2010 | November 2013 | | Journal of Investigative Dermatology |
| "Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010" | 2010 | November 2013 | | The Lancet |
| "Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010" | 2010 | November 2013 | | PLoS Medicine |
| "Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010" | 2010 | October 2013 | | The Lancet |
| "A systematic analysis of global anemia burden from 1990 to 2010" | 2010 | October 2013 | | Blood |
| "Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010" | 2010 | August 2013 | | The Lancet |
| "The burden of HIV: insights from the Global Burden of Disease Study 2010" | 2010 | August 2013 | | AIDS |
| "Measuring the Global Burden of Disease" | 2010 | August 2013 | | New England Journal of Medicine |
| "The state of US health, 1990–2010: burden of diseases, injuries, and risk factors" | 2010 | July 2013 | | Journal of the American Medical Association |
| "The global prevalence of intimate partner violence against women" | None (does not seem to cite any GBD publication) | June 2013 | | Science |
| "Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010" | 2010 | June 2013 | | The Lancet |
| "Global burden of oral conditions in 1990–2010: a systematic analysis" | 2010 | May 2013 | | Journal of Dental Research |
| "UK health performance: findings of the Global Burden of Disease Study 2010" | 2010 | March 2013 | | The Lancet |
| "Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Years lived with disability (YLDs) for 1,160 sequelae of 289 diseases and injuries, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010" | 2010 | December 2012 | GBD 2010 proper | The Lancet |
| "Global malaria mortality between 1980 and 2010: a systematic analysis" | 2010? | February 2012 | | The Lancet |
| "National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants" | None | February 2011 | | The Lancet |
| "The burden of injuries in Iranian children in 2005" | None | March 2010 | | Population Health Metrics |
| The Global Epidemiology of Infectious Diseases (GBD 1990 volume 4) | 1990 | 2004 | | World Health Organization |
| Health Dimensions of Sex and Reproduction: The Global Burden of Sexually Transmitted Diseases, HIV, Maternal Conditions, Perinatal Disorders, and Congenital Anomalies (GBD 1990 volume 3) | 1990 | 1998 | | Harvard School of Public Health |
| Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions (GBD 1990 volume 2) | 1990 | 1996 | | Harvard School of Public Health |
| Global Burden of Disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 (GBD 1990 volume 1) | 1990 | 1996 | | World Health Organization |