{"doi":"10.1101/2025.11.14.25340145","title":"Instability of Global Burden of Disease Estimates of Deaths and DALYs from Major Risk Factors","abstract":"<h4>Importance</h4>  The Global Burden of Disease (GBD) study provides widely used estimates of mortality and disability-adjusted life years (DALYs) attributable to risk factors. <h4>Objective</h4>  To evaluate the variability and consistency of GBD risk factor estimates for mortality and DALYs. <h4>Data Sources</h4>  GBD Risk Factor collaboration estimates extracted from published tables and IHME repository. <h4>Study Selection</h4>  GBD Risk Factor collaboration publications (2010-2023). <h4>Data Extraction and Synthesis</h4>  Death and DALY estimates were manually extracted by one 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. <h4>Main Outcomes and Measures</h4>  We calculated the fluctuations in deaths and DALYs for each risk factor across GBD iterations for different years (2010-2023), and between the original and subsequently revised estimates for each year (1990-2021) expressed in the ratio of the min-max range to the mean (R/M) and coefficient of variation (CV). We examined in more detail analyses diet and low physical activity. Finally, point estimates were compared to the previous iterations’ estimates 95% uncertainty intervals (95%UI) for GBD 2019, 2021 and 2023. <h4>Results</h4>  Across GBD iterations from 2010 to 2023, the median R/M was 0.8 (range, 0–3.8) for deaths, and 0.7 (range, 0.1–3.3) for DALYs. Among level 2 dietary and child and maternal malnutrition death estimates showed high variability (R/M>1 for 7/16 and 3/8 of risks, respectively). When comparing original estimates with GBD 2019, 2021, and 2023 estimates for the same years, the median R/M was 0.5 (0.0-2.9) for deaths and 0.4 (0-2.9) for DALYs. The CV was above 0.2 for 320/580 (52%) of death and 306/609 of DALY estimates. 70-96% of point estimates for red meat, sugar-sweetened beverages, fruits, vegetables and seafood omega-3 fatty acids in GBD 2021 fell outside the GBD 2019 95%UI. In GBD 2023, only diet high in trans fats had over half of point estimates outside the GBD 2021 95%UI. <h4>Conclusions and Relevance</h4>  GBD estimates show large instability, particularly for behavioral risks, making them unlikely to simply reflect genuine changes over time, and warranting caution in interpretation. <h4>Key Points</h4>  <h4>Question</h4>  How stable and consistent are the Global Burden of Disease (GBD) estimates for mortality and disability-adjusted life years (DALYs) attributable to major risk factors across iterations from 2010 to 2023? <h4>Findings</h4>  In this study comparing estimates across eight GBD iterations, substantial variability was observed. Behavioral, particularly dietary risks showed the greatest instability. Comparing revised estimates across iterations half the estimates had a coefficient of variation exceeding 0.2. A third of estimates for dietary risks in GBD 2021 fell outside the corresponding GBD 2019 uncertainty intervals. <h4>Meaning</h4>  GBD risk factor estimates, especially for behavioral and dietary risks, show marked inconsistency likely reflecting methodological or data changes rather than true burden shifts.","journal":"medRxiv","year":2025,"id":7779,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":1,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.4514,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-11-15","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":4553,"name":"Angelo Maria Pezzullo","orcid":"0000-0002-8252-4654","position":1,"is_corresponding":false},{"id":148,"name":"John P. A. Ioannidis","orcid":"0000-0003-3118-6859","position":2,"is_corresponding":false},{"id":2720,"name":"Emmanuel A. Zavalis","orcid":"0000-0001-6205-1362","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}