National and subnational burden of disease attributable to risk factors in Italy, 1990–2023: a systematic analysis from the Global Burden of Disease Study 2023

BACKGROUND: The increasing prevalence of most non-communicable diseases in Italy represents a major public health challenge, largely influenced by modifiable risk factors. This study aims to analyse time trends and subnational differences in the burden of disease attributable to risk factors in Italy, from 1990 to 2023. METHODS: We used estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 to assess the disease burden attributable to risk factors across five Italian macro regions between 1990 and 2023. Burden was measured using disability-adjusted life years (DALYs), reported as all-age and age-standardised rates per 100 000 population. Correlations between the Socio-demographic Index (SDI) and DALYs attributable to behavioural, metabolic, and environmental or occupational risk factors were assessed. FINDINGS: Between 1990 and 2023, metabolic risks in males declined nationally (-7·3% [95% uncertainty interval (UI) -14·1 to -0·2]) but rose in the South and remained stable in the Islands. In females, they were stable overall (-0·4% [-10·3 to 8·4]) but increased in the South and Islands. Behavioural risks decreased across all macro regions in both sexes. DALYs from metabolic risks were strongly and inversely correlated with SDI in both sexes (r=-0·79, p<0·001), whereas behavioural risks correlated negatively with SDI only in males (r=-0·66, p=0·001). During the same time, the proportion of unattributable DALYs increased from 48% to 58% in males and from 60% to 65% in females. INTERPRETATION: Despite overall improvements in attributable burden between 1990 and 2023, substantial geographical disparities and sex differences persist, underscoring the need for stronger tobacco control, gender-sensitive interventions on metabolic risks, and the integration of social determinants into health policy. FUNDING: Gates Foundation and Italian Ministry of Health (Ricerca Corrente) to Institute for Maternal and Child Health - IRCCS Burlo Garofolo.

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Journal
The Lancet Public Health
Published
2026-04-20
DOI
https://doi.org/10.1016/s2468-2667(26)00048-4
Citations
1
Primary Topic
Health Promotion and Cardiovascular Prevention
Type
article
Field-Weighted Citation Impact
26.17

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article

National and subnational burden of disease attributable to risk factors in Italy, 1990–2023: a systematic analysis from the Global Burden of Disease Study 2023

Pietro Ferrara, Benedetta Armocida, Giulia Zamagni, Luciano Nieddu et al.
1 citations
The Lancet Public Health
Health Promotion and Cardiovascular Prevention
26.17
article

National and subnational burden of disease attributable to risk factors in Italy, 1990–2023: a systematic analysis from the Global Burden of Disease Study 2023

Pietro Ferrara, Benedetta Armocida, Giulia Zamagni, Luciano Nieddu, Gianfranco Alicandro, Giulia Carreras, Alberto Raggi, Cristiano Piccinelli, Daniele Urso, Stefano Masi, Daniela Fortuna, Stefano Guicciardi, Giuseppe Remuzzi, Domenico Tricò, Luca Ronfani, Aurora Zanghì, Carla Fornari, Silvano Gallus, Charlie Ashbaugh, Emmanuela Gakidou, Sonia Cerrai, Matilde Leonardi, Eugenio Traini, Lorenzo Monasta, Claudia Cosma, Silvia Deandrea, Emanuele D’Amico, Nicola Luigi Bragazzi, Eleonora Maurel, Lucia Galluzzo, Giovanni Guarducci, Alessio Lachi, Paolo Pedersini, Claudia Carletti, Paola Pani, Roberto Passera, Pasquale Maffia, Michela Sabbatucci, Luana Caselli, Federica Concina, Marco Del Riccio, Mohsen Naghavi, Sara Conti, Giuseppe Grosso, Miriam Levi, Andrea Zovi, Johan Mansson, Norberto Perico, Alessandra Lugo, Ivo Iavicoli
article en
1 citations

Abstract

BACKGROUND: The increasing prevalence of most non-communicable diseases in Italy represents a major public health challenge, largely influenced by modifiable risk factors. This study aims to analyse time trends and subnational differences in the burden of disease attributable to risk factors in Italy, from 1990 to 2023. METHODS: We used estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 to assess the disease burden attributable to risk factors across five Italian macro regions between 1990 and 2023. Burden was measured using disability-adjusted life years (DALYs), reported as all-age and age-standardised rates per 100 000 population. Correlations between the Socio-demographic Index (SDI) and DALYs attributable to behavioural, metabolic, and environmental or occupational risk factors were assessed. FINDINGS: Between 1990 and 2023, metabolic risks in males declined nationally (-7·3% [95% uncertainty interval (UI) -14·1 to -0·2]) but rose in the South and remained stable in the Islands. In females, they were stable overall (-0·4% [-10·3 to 8·4]) but increased in the South and Islands. Behavioural risks decreased across all macro regions in both sexes. DALYs from metabolic risks were strongly and inversely correlated with SDI in both sexes (r=-0·79, p<0·001), whereas behavioural risks correlated negatively with SDI only in males (r=-0·66, p=0·001). During the same time, the proportion of unattributable DALYs increased from 48% to 58% in males and from 60% to 65% in females. INTERPRETATION: Despite overall improvements in attributable burden between 1990 and 2023, substantial geographical disparities and sex differences persist, underscoring the need for stronger tobacco control, gender-sensitive interventions on metabolic risks, and the integration of social determinants into health policy. FUNDING: Gates Foundation and Italian Ministry of Health (Ricerca Corrente) to Institute for Maternal and Child Health - IRCCS Burlo Garofolo.

The Lancet Public HealthVol. 11(5)
University of Siena (IT), Università Cattolica del Sacro Cuore (IT), University of Foggia (IT), University of Pisa (IT), Netherlands Organisation for Applied Scientific Research (NL), University of Milan (IT), York University (CA), Mario Negri Institute for Pharmacological Research (IT), University of Washington (US), Istituto Superiore di Sanità (IT), IRCCS Materno Infantile Burlo Garofolo (IT), Ministero della Salute (IT), Institute for Health Metrics and Evaluation (US), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Saint Camillus International University of Health and Medical Sciences (IT), Regional Health (US), Agenzia Sanitaria e Sociale Regionale (IT), Meyer Children's Hospital (IT), Università degli Studi Internazionali di Roma (IT), University of the Sacred Heart (JP), Istituti di Ricovero e Cura a Carattere Scientifico (IT), National Research Council (IT), Fondazione IRCCS Istituto Neurologico Carlo Besta (IT), Regione Emilia-Romagna, University of Florence (IT), University of Turin (IT), University of Bari Aldo Moro (IT), University of Milano-Bicocca (IT), University of Glasgow (GB), University of Brescia (IT), University of Bologna (IT)
Bill and Melinda Gates Foundation, University of Washington, Università degli Studi di Milano, Università degli Studi di Siena, Institute for Health Metrics and Evaluation, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, York University, University of Glasgow, Università degli Studi di Milano-Bicocca, Ministero della Salute, Istituto Superiore di Sanità, Università degli Studi di Firenze, Università di Catania, Università Cattolica del Sacro Cuore, Università degli Studi di Torino, Università degli Studi di Brescia, Università di Pisa, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Regione Emilia-Romagna
Openalex Percentile: Top 1%
Health Promotion and Cardiovascular Prevention
26.17
DOIOpen Access PDFOpenAlex
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