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Public Health
The Australian Burden of Disease Study: measuring the loss of health
from diseases, injuries and risk factors
In 1998-1999 the Australian Institute of Health and Welfare carried
out a national study of the burden of disease and injury in
Australia,1,2
in close collaboration with the Victorian
Department of Human Services, which conducted a parallel analysis
concurrently in Victoria.3,4 Here, the principal
investigators present the key findings.
Colin D Mathers, E Theo Vos, Chris E Stevenson and Stephen J Begg
MJA 2000; 172: 592-596
For editorial comment, see page 572
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Abstract -
Years of life lost due to mortality (YLL) -
Years lost due to disability (YLD) -
Total disease burden (DALYs) -
Projected burden of disease in 2016 -
Burden attributable to risk factors -
Discussion -
Acknowledgements -
References -
Authors' details
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Abstract |
- This is an overview of the first burden of disease and injury studies
carried out in Australia. Methods developed for the World Bank and
World Health Organization Global Burden of Disease Study were
adapted and applied to Australian population health data.
- Depression was found to be the top-ranking cause of
non-fatal disease burden in Australia, causing 8% of the total years
lost due to disability in 1996. Mental disorders overall were
responsible for nearly 30% of the non-fatal disease burden.
- The leading causes of total disease burden
(disability-adjusted life years [DALYs]) were ischaemic heart
disease and stroke, together causing nearly 18% of the total disease
burden. Depression was the fourth leading cause of disease burden,
accounting for 3.7% of the total burden.
- Of the 10 major risk factors to which the disease burden can be
attributed, tobacco smoking causes an estimated 10% of the total
disease burden in Australia, followed by physical inactivity (7%).
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The Australian and Victorian burden of disease and injury studies
were the first comprehensive studies of this type in Australia. Both
studies used methods developed for the Global Burden of Disease Study
(GBD)5 to quantify the loss of
health from a comprehensive set of 176 causes of disease and injury and
for 10 major risk factors. They used a common metric, the
disability-adjusted life year (or DALY), which combines
information on both the impact of premature death and the impact of
disability and other non-fatal health outcomes. One DALY can be
thought of as one lost year of "healthy" life, and the burden of disease
as a measurement of the gap between current health status and an ideal
situation of living into old age free of disease and disability. DALYs
have previously been used to provide a comprehensive assessment of
the global burden of disease and injury for the World Bank,6 to inform global
priority setting for health research,7 and to report on trends in
population health across the world.8
The methodology used in the studies is described in Box 1.
|
Years of life lost due to mortality (YLL) | |
Ischaemic heart disease is by far the largest cause of years of life
lost in both males and females, accounting for 20.5% of the mortality
burden in 1996. Ischaemic heart disease is followed by stroke and
breast cancer in females, and by lung cancer and suicide in males (Box
2A).
Using a small area-based measure of socioeconomic disadvantage, we
found that, in 1996, the most disadvantaged quintile of the
Australian population lost 35% more years of life than the least
disadvantaged quintile. For Australians aged less than 65 years, the
differential burden between the lowest and highest quintiles is even
greater, with a 60% excess burden in the most disadvantaged group.
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Years lost due to disability (YLD) | |
Mental disorders are the leading cause of YLD, accounting for nearly
30% of the non-fatal disease burden in Australia in 1996 (Box 2B).
These are followed by nervous system and sense organ disorders (16%)
and chronic respiratory diseases (9%). In terms of specific
conditions, depression is the leading cause of non-fatal disease
burden in Australia, causing 8% of the total YLD in 1996 (Box 2B).
Hearing loss and alcohol dependence and harmful use of alcohol are the
second and third leading contributors to YLD for males. Dementia and
osteoarthritis are the second and third leading contributors for
females.
In contrast to the mortality burden, the disability burden is smaller
for males than for females. Neurological and sense organ disorders,
mental disorders and musculoskeletal disorders are all more common
in females. The male burden is higher for cardiovascular disease,
diabetes, chronic respiratory diseases and cancers. Females
generally have a greater incidence and prevalence of the more common
non-fatal health problems, whereas males have a greater incidence of
the major diseases and injuries associated with high case fatality.
Thus, some of the years of the longer life span women enjoy are lived
with a lower quality of life.
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Total disease burden (DALYs) | |
As shown in Box 3, inclusion of non-fatal health outcomes creates a
substantially different picture to that provided by traditional
mortality statistics: mental disorders are now the third leading
cause of overall burden (14% of total), after cardiovascular
diseases (20%) and cancers (19%). Both the burden of nervous system
disorders (which includes dementia) and that of chronic respiratory
conditions are similar in magnitude to that of injuries. The total
disease burden in males is 13% higher than that in females.
Ischaemic heart disease and stroke head the list of specific causes of
disease burden, together causing nearly 18% of the total (Box 2C).
Chronic obstructive pulmonary disease (COPD) and lung cancer
together account for another 7.3% of the total burden. Depression is
the fourth leading cause of disease burden in Australia, accounting
for nearly 4% of the total burden.
The burden of mental disorders in Australia is dominated by affective
(depression and bipolar disorder), substance use and anxiety
disorders. Substance use disorders are the leading cause of mental
disorders for males, accounting for 33% of their mental health DALYs
(Box 4). The major cause of mental disorders for women is depression,
accounting for 34% of women's mental health DALYs. The large burden
from mental disorders in young adults is partly due to the high
prevalence of these disorders at these ages and partly because the
DALY, as an incidence-based measure, attributes the future stream of
ill-health to the age at incidence (Box 5).
Inclusion of the burden of suicide and ischaemic heart disease
attributable to depression increases the burden of depression from
3% to 5% of total DALYs. Inclusion of the burden of cardiovascular
disease attributable to diabetes increases the diabetes burden also
from 3% to 5%. Depression and diabetes then become equal third leading
causes of the burden of disease in Australia.
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Projected burden of disease in 2016 | |
The Victorian Burden of Disease Study projected a 25% drop in the rate
of all-cause DALYs in men and a 17% drop in women over the next 20 years.
In Victoria, life expectancy is projected to increase by 4.6 years for
men and 3.6 years for women. Mortality is forecasted to drop
considerably faster than disability. The large gap in projected
changes between YLL and YLD rates suggests that some of the further
gains in life expectancy may occur at the expense of quality of life.
Large health gains are expected in all cardiovascular diseases
except cardiomyopathy. Large gains are also predicted for injuries,
COPD in men and in a number of cancers (lung cancer in men; bowel cancer,
stomach cancer and leukaemia in both sexes). Adverse mortality
trends are driving projected increases in the burden rates from lung
cancer and dementia in women and heroin overdose deaths, melanoma and
diabetes in men (Box 6).
Cancer will be the largest cause of disease burden in 2016, as
improvements in cardiovascular health will outpace the slower
improvements in cancer. Population ageing will increase the burden
of neurological, sense organ and musculoskeletal disorders
relative to other conditions. The burden of injuries is expected to
decrease partly due to favourable trends and partly as a consequence
of population ageing.
The burden of dementia will increase for both sexes, and, for women in
Victoria, may take over from ischaemic heart disease as the largest
cause of DALYs in 2016. Diabetes, prostate cancer, hearing loss and
heroin dependence in men, and lung cancer in women, are other
conditions that will move up the ranking order. Stroke in men and
women, and road traffic accidents, suicide and COPD in men, will drop
considerably in their ranking order of projected burden in 2016.
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Burden attributable to risk factors | |
Risk factors such as smoking, alcohol consumption, physical
inactivity, hypertension, high blood cholesterol level, obesity
and inadequate fruit and vegetable consumption are responsible for
large proportions of the overall burden of disease in Australia (Box
7). The leading risk factor is tobacco smoking (responsible for 10% of
the total burden), followed by physical inactivity (7%), then high
blood pressure and obesity. Insufficient intake of fruits and
vegetables (fewer than five servings per day) causes an estimated 3%
of the total burden, and 11% of the cancer burden in Australia.
The net harm associated with alcohol consumption is around 2% of the
total burden, as the ill-health associated with harmful and
hazardous drinking is offset by benefits from alcohol in the
prevention of cardiovascular disease. The protective effect is only
relevant after age 45, whereas the harmful effects of alcohol are
apparent at all ages. For males, illicit drugs are responsible for a
level of harm similar to that of alcohol (2.2% of total male burden of
disease). Just over half this burden is due to premature mortality,
the other half to YLD resulting from drug dependence or harmful use.
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Discussion |
Burden of disease analysis provides a unique perspective on health,
one that integrates fatal and non-fatal outcomes, yet allows the two
classes of outcomes to be examined separately. Among the top 15 causes
of burden of disease and injury in Australia are four non-fatal or
low-fatality diseases: depression, asthma, osteoarthritis and
hearing loss. The burden of mental illnesses such as depression and
alcohol dependence, and of non-fatal diseases such as
osteoarthritis and hearing loss, has been seriously underestimated
by traditional approaches to disease burden assessment that
disregard disability and take into account only deaths.
The calculation of YLL is straightforward, and the precision of the
estimates is almost entirely dependent on the quality of the data on
the underlying cause of death. The calculation of the disability
burden (YLD) requires much more extensive epidemiological
modelling, drawing on a diverse range of data sources, research
findings and expert opinion. Thus, the precision of the YLD estimates
is not quantifiable in the usual statistical sense. As a next step in
these studies, we plan to model the uncertainty of these burden of
disease estimates using simulation modelling and sensitivity
analyses.
Estimates of the burden attributable to each risk factor are based as
far as possible on studies that controlled for other relevant risk
factors, but it is likely that the complexity of the interaction
between risk factors has not been fully captured. Despite this
reservation, the conclusion remains that each of the risk factors
analysed is responsible for much ill health, similar in magnitude to
the top 10 diseases.
Projections of the burden of disease to 2016 highlight the adverse
trends in tobacco-related diseases for women, and diabetes and
substance abuse for men, and the impact of population ageing in
increasing the disability burden. These findings suggest that
tobacco control, and combating physical inactivity and overweight
and obesity, should be continuing priorities for public health
action.
The extensive epidemiological modelling for over 1200 disease and
sequelae categories resulted in the identification of many gaps and
deficiencies in Australian population health data (even given the
high quality and extensive availability of such data in Australia
compared with many other countries). Rather than avoid areas with
poor or unavailable information, these studies attempt to make the
best possible, internally consistent estimates within a
comprehensive framework.
These studies are a first step in exploring the usefulness of burden of
disease methods for Australia. There are major gaps in our knowledge
about the effectiveness of interventions and the associated costs.
Linking of burden of disease analyses to studies of the
cost-effectiveness of interventions for major health problems will
allow these interventions to be judged both in terms of
cost-effectiveness, and their relative impacts in reducing the
burden of disease and ill-health. Until these analyses can be done,
however, the results reported here provide an indication of the
"unfinished" health agenda in Australia, identifying areas in which
additional health gains can be made.
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Acknowledgements | |
The Australian Burden of Disease Study was carried out with funding
support from the Commonwealth Department of Health and Aged Care. We
thank other members of the Australian and Victorian project teams who
assisted in analyses, data collection and literature reviews: Bruno
Ridolfo, Simon Eckermann, James Morris, Ying Chen, Derrick Bui,
Nittita Prasopa-Plaizier, Bernadette Pound, Anne Magnus and Sean
Tobin.
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References |
- Mathers C, Vos T, Stevenson C. The burden of disease and injury in
Australia. Australian Institute of Health and Welfare. Canberra:
AIHW, 1999. Also at:
<http://www.aihw.gov.au/publications/health/bdia.html>
(accessed 12 May 2000).
-
Mathers C, Vos T, Stevenson C. The burden of disease and injury in
Australia summary report. Australian Institute of Health and
Welfare. Canberra: AIHW, 1999. Also at:
<http://www.aihw.gov.au/publications/health/bdiasr.html>
(accessed 12 May 2000).
-
Vos T, Begg S. The Victorian Burden of Disease Study: Mortality.
Melbourne: Public Health and Development Division, Department of
Human Services, 1999. Also at:
<http://www.dhs.vic.gov.au/phd/9903009/index.htm>
(accessed 12 May 2000).
-
Vos T, Begg S. The Victorian Burden of Disease Study: Morbidity.
Melbourne: Public Health Division, Department of Human Services,
2000. Also at:
<http://www.dhs.vic.gov.au/phd/9909065/index.htm>
(accessed 12 May 2000).
-
Murray CJ, Lopez AD. The Global Burden of Disease: a comprehensive
assessment of mortality and disability from diseases, injuries and
risk factors in 1990 and projected to 2020. Vol 1. Cambridge, Mass:
Harvard School of Public Health on behalf of the World Health
Organization and the World Bank, 1996.
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World Bank. World Development Report 1993: investing in health.
New York: Oxford University Press, 1993.
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Ad Hoc Committee on Health Research Relating to Future
Intervention Options. Investing in health research and
development. Geneva, World Health Organization, 1996.
-
World Health Organization (WHO). The World Health Report 1999.
Geneva: WHO, 1999.
-
Stouthard M, Essink-Bot M, Bonsel G, et al. Disability weights for
diseases in the Netherlands. Rotterdam: Department of Public
Health, Erasmus University, 1997.
-
DisMod [computer program], version 1.0. President and Fellows of
Harvard College. All rights reserved. 1994. The Burden of Disease
Unit, Harvard University. (This software can be downloaded from the
WWW at:
<http://www.hsph.harvard.edu/organizations/bdu/dismod/
index.htm> (accessed 12 May 2000).
-
English DR, Holman CDJ, Milne E. The quantification of drug caused
morbidity and mortality in Australia, 1995 edition. Canberra:
Commonwealth Department of Human Services and Health, 1995.
-
Beaglehole R, Dobson A, Hobbs MS, et al. CHD in Australia and New
Zealand. Int J Epidemiol 1989 18 (3 Suppl 1): S145-S148.
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Authors' details | |
Australian Institute of Health and Welfare, Canberra, ACT.
Colin D Mathers, BSc, PhD, Principal Research Fellow, Health
Division;
Chris E Stevenson, BSc, MSc, Statistician, Health Division.
Department of Human Services, Melbourne, Victoria.
E Theo Vos, MD, MSc, Senior Epidemiologist, Policy
Development and Planning Division;
Stephen J Begg, MPH,
Epidemiologist, Policy Development and Planning Division.
Reprints will not be available from the authors.
Correspondence: Dr E
T Vos, Policy Development and Planning Division, Department of Human
Services, 555 Collins Street, Melbourne, VIC 3000.
Theo.VosATdhs.vic.gov.au
©MJA 2000
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1: Australian burden of disease studies - methodology
The disability-adjusted life year (DALY)
For each disease or health condition, DALYs are calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. The Australian studies depart from the methods used for the Global Burden of Disease Study (GBD) in the following key areas: YLL are calculated using Australian projected life expectancies; age weights are not used; adjustments for the effects of comorbidity are included;1 and disability weights developed recently by Stouthard et al are used.9
The DALY measures the future stream of healthy years of life lost due to each incident case of disease or injury. It is thus an incidence-based measure rather than a prevalence-based measure. Both the GBD and the Australian studies apply a 3% time discount rate to years of life lost in the future to estimate the net present value of years of life lost. Undiscounted DALYs were also calculated, but are not presented here.
Years of life lost due to mortality (YLL)
Adjustments were made to deaths registration data to correct for problems relating to coding of causes of death. Deaths registered in 1996 in which the underlying cause fell into various "ill-defined" and "unknown" categories were proportionately redistributed across other relevant causes of death.1 The YLL for a given age is determined by the average cohort (projected) life expectancy for that age, discounting future years by 3% per annum. Unlike most potential years of life lost (PYLL) measures, YLLs do not exclude deaths above a certain age, and do not give a zero value to years of life lost above that age level.
Years lost due to disability (YLD)
YLD estimates are made for a comprehensive set of 176 disease and injury categories involving analysis of 1260 disease stages, severity levels and sequelae. For some conditions, numbers of incident cases are available directly from disease registers or epidemiological studies, but for most conditions only prevalence data are available. In these cases, a software program, DISMOD, is used to model incidence and duration from estimates of prevalence, remission, case fatality and background mortality.10 For each incident case of a particular condition, YLD is calculated as the product of the average duration of the condition (to remission or death) and a severity weight that quantifies the equivalent loss of healthy years of life due to living with the health condition.
YLD calculations draw upon many different sources of data, including population health data collections, health service data, epidemiological studies (Australian and international), and expert knowledge and judgement. For most disease and injury groups, Australian experts were consulted during the development and revision of YLD estimates.
The disability weights used in DALY calculations represent societal preferences for different health states, ranging from
0 - "good or ideal health" (preferred to all other states) to
1 - "equivalent to being dead". The Australian study uses actual or derived weights from the GBD and from Stouthard et al.9 These studies used similar methods to measure average societal preferences for health states.
Burden attributable to risk factors
Attributable fractions were calculated for risk factors using the methods outlined by English et al,11 based on best estimates of the prevalence of exposure to each risk factor, together with best available evidence of the relative risks of diseases or injury.
Projections
In the Victorian study, projections of the mortality burden were made by extrapolating age-, sex- and cause-specific mortality trends from 1979 to 1996 by log-linear Poisson regression methods taking expected changes in population size into account, and constraining the total number of deaths to age- and sex-specific projections of all-cause mortality. Lacking time series of the incidence of disease, we assumed that trends in mortality are accompanied by equal changes in disease incidence, with the exception of cardiovascular diseases, for which there is evidence that decreases in case-fatality rates and lower incidence of disease have contributed equally to the drop in mortality.12 A potential source of inaccuracy is the lack of trend data in the occurrence of non-fatal conditions, which forced us to assume a stable incidence.
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| 2: Top 10 causes of the mortality, disability and total disease burden in Australia, 1996 |
| A: Mortality burden: percentage of total years of life lost due to mortality (YLL), by sex |
Persons
(1348233 YLL) |
Percentage
of total |
Males
(752591 YLL) |
Percentage
of total |
Females
(595642 YLL) |
Percentage
of total |
|
|
1 Ischaemic heart disease
2 Stroke
3 Lung cancer
4 Suicide
5 Colorectal cancer
6 COPD*
7 Road traffic accidents
8 Breast cancer
9 Diabetes mellitus†
10 Dementia
|
20.5
8.3
6.3
5.2
4.4
4.0
3.3
2.8
2.1
1.8 |
1 Ischaemic heart disease
2 Lung cancer
3 Suicide
4 Stroke
5 Road traffic accidents
6 COPD*
7 Colorectal cancer
8 Prostate cancer
9 Diabetes mellitus†
10 Cirrhosis
|
21.0
7.3
5.9
5.6
4.5
4.2
3.9
3.0
2.1
1.7 |
1 Ischaemic
heart disease
2 Stroke
3 Breast cancer
4 Lung cancer
5 Colorectal cancer
6 COPD*
7 Dementia
8 Diabetes mellitus†
9 Road traffic accidents
10 Ovary cancer |
19.7
9.5
6.8
4.7
4.4
3.9
2.6
2.5
2.1
2.0 |
| B: Disability burden: percentage of
total years lost due to disability (YLD), by sex |
Persons
(1162041 YLD) |
Percentage
of total |
Males
(578720 YLD) |
Percentage
of total |
Females
(583321 YLD) |
Percentage
of total |
|
|
1 Depression
2 Dementia
3 Asthma
4 Osteoarthritis
5 Adult-onset hearing loss
6 Diabetes mellitus†
7 Alcohol dependence/abuse
8 COPD*
9 Stroke
10 Ischaemic heart disease
|
8.0
5.6
4.8
4.8
4.1
3.8
3.5
3.3
3.3
3.1 |
1 Depression
2 Adult-onset hearing loss
3 Alcohol dependence/abuse
4 Dementia
5 Asthma
6 COPD*
7 Diabetes mellitus†
8 Stroke
9 Osteoarthritis
10 Ischaemic heart disease
|
6.2
5.7
4.9
4.4
4.3
4.2
4.1
3.9
3.9
3.9
|
1 Depression
2 Dementia
3 Osteoarthritis
4 Asthma
5 Generalised anxiety disorder 6 Diabetes
mellitus†
7 Vision disorders
8 Stroke
9 Adult-onset hearing loss
10 COPD*
|
9.8
6.8
5.7
5.3
3.5
3.5
2.9
2.7
2.6
2.5 |
| C: Total burden of disease and injury: percentage of total disability-adjusted life years (DALYs), by sex |
Persons
(2510274 DALYs) |
Percentage
of total |
Males
(1331311 DALYs) |
Percentage
of total |
Females
(1178963 DALYs) |
Percentage
of total |
|
|
1 Ischaemic heart disease
2 Stroke
3 COPD*
4 Depression
5 Lung cancer
6 Dementia
7 Diabetes mellitus†
8 Colorectal cancer
9 Asthma
10 Osteoarthritis
|
12.4
5.4
3.7
3.7
3.6
3.5
3.0
2.7
2.6
2.2 |
1 Ischaemic heart disease
2 Stroke
3 Lung cancer
4 COPD*
5 Suicide
6 Road traffic accidents
7 Diabetes mellitus†
8 Depression
9 Colorectal cancer
10 Dementia
|
13.6
4.8
4.5
4.2
3.3
3.0
3.0
2.7
2.7
2.5 |
1 Ischaemic
heart disease
2 Stroke
3 Depression
4 Dementia
5 Breast cancer
6 COPD*
7 Asthma
8 Diabetes mellitus†
9 Osteoarthritis
10 Colorectal cancer |
11.1
6.1
4.8
4.7
4.6
3.2
3.1
3.0
2.9
2.7 |
|
| *Chronic obstructive pulmonary
disease (chronic bronchitis and emphysema). †Includes type 1 and type 2
diabetes. Total YLL, YLD and DALYs are in parentheses. |
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6: Age-standardised disability-adjusted
life year (DALY) rates per 1000 in Victoria in 1996
and projected to 2016, by selected causes and sex |
| |
Males |
Females |
|
|
|
|
1996 |
2016 |
Difference as
percentage of
1996 rate |
1996 |
2016 |
Difference as
percentage of
1996 rate |
|
All causes
All-cause YLL
All-cause YLD |
144.0
80.1
63.8 |
108.3
51.8
56.5 |
-25%
-35%
-12% |
128.6
64.8
63.8 |
107.0
45.6
61.3 |
-17%
-30%
-4% |
Cardiovascular diseases
Ischaemic heart disease
Stroke
Peripheral vascular disease
Inflammatory heart disease |
31.7
18.9
6.8
1.2
1.5 |
14.4
7.7
2.9
0.6
1.8 |
-54%
-59%
-58%
-54%
26%
|
27.2
13.7
7.8
1.3
0.8 |
13.5
7.0
3.2
0.5
1.2 |
-50%
-49%
-59%
-61%
53% |
Cancer
Lung cancer
Breast cancer
Bowel cancer
Prostate cancer
Stomach cancer
Leukaemia
Melanoma |
29.3
6.8
4.4
3.9
1.3
1.2
1.2 |
24.6
4.2
3.2
4.8
0.6
0.9
1.7 |
-16%
-38%
-26%
22%
-58%
-26%
41% |
26.5
3.4
6.9
3.8
0.9
0.9
0.7 |
23.3
4.3
6.0
2.6
0.4
0.7
0.6 |
-12%
25%
-12%
-32%
-53%
-14%
-20% |
Mental disorders
Depression
Alcohol abuse/dependence
Heroin abuse/dependence |
18.1
4.1
3.3
2.4
|
21.5
4.1
3.1
6.1
|
19%
--
-8%
152% |
18.0
6.1
1.5
0.9
|
17.8
6.1
1.4
0.86 |
-1%
-
-8%
-3%
|
Neurological/sense organ disorders
Dementia |
12.7
3.8 |
12.5
3.9 |
-2%
4% |
14.8
6.3
|
19.0
10.6 |
28%
68%
|
Chronic respiratory diseases
COPD
Asthma |
10.6
6.3
3.3 |
5.9
2.6
2.8 |
-44%
-58%
-15% |
9.2
4.3
3.8 |
7.8
4.1
3.2 |
-15%
-5%
-16% |
|
Injuries
Suicide
Road traffic accidents
Falls
|
13.8
3.9
3.9
1.3 |
6.9
3.0
1.0
0.5 |
-50%
-24%
-74%
-65% |
5.6
1.2
1.5
1.1 |
3.0
0.8
0.6
0.7 |
-47%
-29%
-61%
-42% |
| Diabetes mellitus |
4.7 |
5.8 |
24% |
4.1 |
3.6 |
-13% |
| Musculoskeletal diseases
|
3.8 |
3.8 |
-- |
6.7 |
6.7 |
-- |
|
| YLL=years of life lost due to mortality.
YLD=years of life lost to disability. COPD=chronic obstructive pulmonary
disease. |
|
| Back to text |
| |
| 7: The burden of disease attributable to 10 major risk factors, Australia 1996 |
| |
Percentage
of total DALYs |
| |
|
| |
Persons |
Males |
Females |
|
Tobacco
Physical inactivity
High blood pressure
Alcohol harm
Alcohol benefit
Obesity
Lack of fruit and vegetables
High blood cholesterol level
Illicit drugs
Occupation
Unsafe sex |
9.7
6.7
5.4
4.9
-2.8
4.3
2.7
2.6
1.8
1.7
0.9
|
12.1
6.0
5.1
6.6
-2.4
4.3
3.0
3.2
2.2
2.4
1.1 |
6.8
7.5
5.8
3.1
-3.2
4.3
2.4
1.9
1.3
1.0
0.7
|
|
| DALY=Disability-adjusted life
year. |
|
| Back to text |
|
