Instability of Global Burden of Disease Estimates of Deaths and Disability-Adjusted Life-Years From Major Risk Factors: A Meta-Epidemiological Analysis
Abstract
Importance: The Global Burden of Disease (GBD) reports widely used estimates of mortality and disability-adjusted life-years (DALYs) and related risk factors. However, the overall reliability of these estimates between GBD iterations has not been assessed.
Objective: To evaluate the instability and inconsistency of GBD risk factor estimates for mortality and DALYs across GBD iterations.
Data sources: GBD risk factor collaboration estimates extracted from the published tables of GBD iterations and the Institute for Health Metrics and Evaluation repository.
Study selection: GBD risk factor collaboration publications published for 2010 through 2023.
Data extraction and synthesis: Death and DALY estimates were manually extracted by 1 reviewer with independent validation of a random sample of 100 by another with no discrepancies. Risk factor naming was harmonized across iterations to ensure comparability; those with inconsistent definitions were excluded.
Main outcomes and measures: Fluctuations were calculated for numbers of deaths and DALYs for each risk factor across GBD iterations during the study period (2010-2023) and between the original and subsequently revised estimates for each year (1990-2021). Differences were expressed as a ratio of the minimum to maximum range to the mean (R:M) and coefficient of variation. Detail analyses assessed diet and low physical activity. Point estimates were compared to the previous iterations' estimates 95% uncertainty intervals (95% UI)…
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