GBD 2023: The global burden of diseases, injuries, and risk factors

Almost half of the global mortality and morbidity in 2023 was attributable to 88 modifiable risk factors. The 10 risk factors with the highest proportion of health loss were high systolic blood pressure, particulate matter pollution, smoking, high fasting plasma glucose, low birthweight and short gestation, high body mass index, high low-density lipoprotein cholesterol, kidney dysfunction, child growth failure, and lead exposure.

The Global Burden of Disease 2023 study was officially released on October 12, 2025 alongside three capstones published in The Lancet: new findings on global demographics, causes of death, and the burden of diseases, injuries, and risk factors.

IHME Director Dr. Chris Murray discusses the capstone that analyzed the global burden of diseases, injuries, and risk factors.

Video transcript

This transcript has been lightly edited for clarity

In the Global Burden of Disease 2023 study on diseases, injuries, and risk factors, looking at our measure of health loss, which we call disability-adjusted life years, and looking at both diseases contributing to health loss and risk factors, we have a major new update that reflects a large expansion of different data sources, as always, in each cycle of the global burden of disease.

But with each cycle, we’ve also added some more diseases, and we have added some, or we have revised, some of the risk factors. So, for new diseases, we added ulcerative colitis and Crohn’s disease, thyroid diseases, other endocrine and metabolic, blood, and immune disorders, and electrocution as one of the injuries. And then we’ve had quite substantial work done to expand our understanding of the impact of sexual violence against children, intimate partner violence, and lead, in particular.

So that’s the scope of what we’ve been doing in this study. And now let’s talk a little bit about the major findings. So, in terms of causes, diseases and injuries that contribute to health loss, what do we see in 2023? We see that number one is ischemic heart disease, but neonatal disorders, despite 30-plus years of declines in under-5 mortality, the declines in neonatal disorders have been slower – still declines, but it’s still the number two cause of burden in the world.

Then stroke is third, lower respiratory infections or pneumonia at number four, and then diabetes, shooting up the list progressively with each decade, is the number five cause, and then followed by road injuries, chronic obstructive pulmonary disease, falls, low back pain, emphasizing the role of functional health loss to contributing to overall DALYs, and then diarrheal diseases.

So a real mix of non-communicable causes, causes that cause disability, as well as some of the unfinished agenda of tackling communicable causes, particularly in low-resource settings.

Now, when we look at trends in those diseases, there are some marked increases, as we mentioned, in depression, anxiety, as well as in diabetes. And the depression and anxiety, we see it in the data. Certainly, part of that was COVID – there are good studies that suggest the role of COVID in increasing those – but the trend up for depression, anxiety is there even before COVID, and we know it’s there, it’s in the data. There are lots of theories, whether it’s from social media or cell phone use, or many other possible drivers. It’s a little hard to be definitive on the root cause, but we know it’s happening.

The second aspect of the analysis that we have here is looking at risk factors. What are the behavioral risks, environmental risks, metabolic risks that account for the pattern of disease and injury that we see around the world? And when we take a one risk factor at a time view and then say, what are the largest contributors to the burden of disease, what we find is high blood pressure is at the top, then air pollution, particulate matter air pollution, both indoor and outdoor. We split them out, but if you put them together, they’re number two.

Smoking, number three. High blood sugar, four. Low birth weight and short gestation, number five. And then we go into obesity and overweight at number six, kidney dysfunction, high cholesterol, child growth failure, and then lead at number 10.

And I want to call out lead because if you go back to previous versions of the GBD, lead was not in the top 10. And the reason it’s gone up in our assessment as a contributor to burden is not because it’s trending up – it’s because there have been new studies that reach the bar of being convincing evidence of much larger direct effects of lead on cardiovascular disease in particular, which really means that lead has now become both large at the global level, but in some countries lead causes as high as 8% to 9% of all burden of disease. So it’s really a very important risk that we’re now getting a deeper appreciation for.

When we look at trends in risks, in general, the burden attributable to, let’s say, high blood pressure is dropping over time, both because the background causes of illness and death affected by high blood pressure, heart disease, or stroke are trending down, and for other reasons as well, including treatment, access to health care, other risk factors, but also because exposure to high blood pressure in some parts of the world is going down, mostly through treatment.

It’s going up in some places, however; but in aggregate, the burden from high blood pressure is going down. Now there are some of the big risks, two in particular, where the burden attributable to those risks is actually increasing. And that’s high blood sugar and high body mass index – namely overweight and obesity. And clearly those two are linked, because the trend up in overweight and obesity is also driving up high blood sugar.

And why do we think obesity is going up in every region of the world, every country of the world? That’s got to do with both diet as well as physical activity. And it’s some blend of the

two. I think most of the statistical analyses suggest it’s probably more heavily skewed toward dietary trends, both total caloric intake and diet composition. But there’s clearly a role for both physical activity and diet in explaining this really unprecedented rise in a major global risk, for overweight and obesity.

Other risks that I mentioned in the top 10 are going down at a much faster rate, such as child growth failure. But, you know, I think that the level and trend around high blood sugar and overweight and obesity mean that we really need to keep our eye on those challenges as we look into the future.

Now, we like to think of this assessment of the size of burden in terms of loss of healthy life, both due to diseases and injuries, and due to risk factors, as a key tool for helping prioritize public health action. There are other things that need to go into that set of setting priorities, the cost of different programs, the effectiveness of different programs. But you really do need to have an approach, a strategy, for the big diseases and risks, that we see in the data. And that needs to be local. And that’s why much of the work that we do on the burden of disease, partly reflected here, is not just at the national level but at the subnational level. And then there are some locations in the world where the analysis is at a very deep district level as well.

So, we believe that keeping track of the totality of health effects – not just mortality, but both the morbidity disability and premature mortality, and thinking about health problems not just as diseases and injuries, but also as risk factors – will be really key for understanding the future, because there are some smaller risks that are also on the upswing as well, such as burden due to high temperature. And we expect more of that to, of course, come with climate change.