Global Burden of Disease Study Details Ballooning Prevalence of Metabolic Risk Factors


Increases in metabolic risk factors like high blood pressure and BMI have led to a 49.4% increase in global disability-adjusted life years from 2000 to 2021.

Michael Brauer, PhD, ScD | Credit: University of British Columbia

Michael Brauer, PhD, ScD
Credit: University of British Columbia

A recent analysis found the number of people with poor health and premature mortality as a result of cardiometabolic risk factors has risen by 50% since the turn of the century.1

A systematic analysis of the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study, results provide evidence of a 49.4% increase in the number of global disability-adjusted life years (DALYs) attributable to metabolism-related risk factors, such as high blood pressure, elevated BMI, and dyslipidemia, between 2000 and 2021.1

“Though metabolic in nature, developing these risk factors can often be influenced by various lifestyle factors, especially among younger generations,” said Michael Brauer, PhD, ScD, affiliate professor at the Institute for Health Metrics and Evaluation (IHME).2 “They also are indicative of an aging population that is more likely to develop these conditions with time. Targeting the reduction of preventable, non-communicable diseases through modifiable risk factors presents an enormous opportunity to pre-emptively alter the trajectory of global health through policy and education.”

Despite being recognized as a leading cause of death worldwide leading into the 21st century, cardiovascular disease and metabolic illnesses have proven difficult to tackle for the medical community, both in the US and globally. In the current study, Brauer and colleagues sought to quantify the contributions of specific risk factor exposures to specific health outcomes from within the GBD 2021. Leveraging data from 54,561 sources of data, the GBD 2021 provided estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Investigators pointed out the GBD 2021 also detailed age-sex-location-year-specific estimates at global, regional, and national levels.1

For the purpose of analysis, investigators used a comparative risk assessment framework to examine hierarchically organized, potentially combinative, modifiable risks. The primary outcome of interest was the relative risks (RR) for each outcome as a function of risk factor exposure.1

Results of the study suggested particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8.0% (95% UI 6.7 to 9.4) of total DALYs. Further analysis indicated the next greatest contributors were high systolic blood pressure (SBP: 7.8%; 95% UI, 6.4 to 9.2), smoking (5.7%; 95% UI, 4.7 to 6.8]), low birthweight and short gestation (5.6%; 95% UI, 4.8 to 6.3), and high fasting plasma glucose (5.4%; 95% UI, 4.8 to 6.0). When assessing impact among young patient populations results suggested low birthweight and short gestation and unsafe water, sanitation, and handwashing were among the leading risk factors. In contrast, older adults experienced elevated metabolic risks such as high SBP, high BMI, high fasting plasma glucose, and high LDL cholesterol had a greater impact.1

Investigators highlighted an observable shift in global health challenges, with a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20.7%; 95% UI, 13.9 to 27.7) and environmental and occupational risks (decrease of 22.0%; 95% UI, 5.5 to 28.8), coupled with a 49·4% (95% UI, 42.3 to 56.9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Additionally, the age-standardized DALY rates attributable to elevated BMI rose by 15.7% (95% UI, 9.9 to 21.7) and rose by 7.93% (95% UI, 3.3 to 12.9).1

Investigators noted multiple limitations within their trial to consider when interpreting results. These included the potential omission of consequential risk factors and covariates, possibility of bias, and inconsistent availability and variable quality of data.1

“GBD highlights that future trends may be quite different than past trends because of factors such as climate change and increasing obesity and addiction, but at the same time, there are tremendous opportunities to alter the trajectory of health in the next generation,” said Liane Ong, PhD, a lead research scientist at IHME.2


  1. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2162-2203. doi:10.1016/S0140-6736(24)00933-4
  2. EurekAlert! The number of people experiencing poor health and early death caused by metabolism-related risk factors such as high blood pressure, high blood sugar, and high BMI has increased by 50% since 2000, reveals New Global Study. EurekAlert! May 16, 2024. Accessed May 23, 2024.
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