Summary In 2019, the age-standardised rate of DALYs attributable to unsafe water, sanitation, and handwashing was 1244·3 per 100 000 (95% UI 993·2–1544·1). Sub-Saharan Africa had the highest rate (3919·1 [3008·1–4950·6]), more than double the next-highest super-region.
Definition Unsafe water, sanitation, and handwashing is an aggregate risk including exposure to unsafe water sources, unsafe sanitation facilities, and lack of access to handwashing facilities.
Total sources | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Exposure | 1219 | |||||||||||
Relative risk | 109 | |||||||||||
Table 1:
Total sources used in GBD 2019 estimation
What is new in GBD 2019?
- •The relative risk calculations for unsafe water, sanitation, and handwashing were updated using the MR-BRT tool.
- •Three new relative risk data sources were added for unsafe sanitation.
- •For unsafe water and unsafe sanitation, eight new data sources were added to update the exposure model for India and Pakistan, spanning the years 2015–2019.
- •For unsafe water and unsafe sanitation, four data sources for India were re-extracted at a more granular geographical resolution.
- •For unsafe sanitation, the exposure estimation methodology for India was changed from raking to aggregation because of the wealth of available subnational data.
Deaths
|
YLLs
|
YLDs
|
DALYs
|
|||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number
(millions) |
Rate (per
100 000) |
Number
(millions) |
Rate (per
100 000) |
Number
(millions) |
Rate (per
100 000) |
Number
(millions) |
Rate (per
100 000) |
|||||
2019 | ||||||||||||
Both Sexes | 1·66 (1·20 to 2·31) |
22·7 (16·6 to 31·2) |
78·8 (60·8 to 100) |
1129·2 (876·4 to 1425·4) |
8·74 (5·86 to 12·3) |
115·1 (77·3 to 162·2) |
87·5 (69·7 to 109) |
1244·3 (993·2 to 1544·1) |
||||
Females | 0·873 (0·516 to 1·43) |
22·6 (14·1 to 36·1) |
38·4 (27·8 to 54·4) |
1109·5 (820·1 to 1516·4) |
4·31 (2·90 to 6·05) |
113·6 (76·4 to 160·2) |
42·8 (31·8 to 58·4) |
1223·1 (929·1 to 1628·8) |
||||
Males | 0·784 (0·590 to 1·12) |
22·8 (17·2 to 32·4) |
40·4 (31·3 to 52·2) |
1147·3 (890·1 to 1479·3) |
4·44 (2·95 to 6·23) |
116·8 (77·9 to 164·9) |
44·8 (35·3 to 57·0) |
1264·1 (994·3 to 1604·8) |
||||
Percentage change 2010-19 | ||||||||||||
Both Sexes | –21·8% (–32·3 to –9·7) |
–32·1% (–40·7 to –22·7) |
–33·1% (–42·8 to –21·6) |
–36·9% (–46·1 to –25·8) |
17·7% (13·9 to 20·9) |
5·7% (2·3 to 8·6) |
–30·1% (–39·3 to –19·2) |
–34·5% (–43·2 to –24·0) |
||||
Females | –18·7% (–33·3 to –0·8) |
–30·9% (–42·1 to –17·3) |
–32·8% (–44·3 to –19·2) |
–37·2% (–47·5 to –24·9) |
18·3% (14·4 to 21·7) |
5·9% (2·5 to 8·9) |
–29·7% (–40·4 to –17·3) |
–34·7% (–44·3 to –23·3) |
||||
Males | –25·0% (–34·5 to –13·2) |
–34·2% (–42·3 to –24·6) |
–33·4% (–43·6 to –21·6) |
–36·9% (–46·6 to –25·6) |
17·2% (13·2 to 20·6) |
5·3% (1·7 to 8·4) |
–30·5% (–40·3 to –19·3) |
–34·4% (–43·8 to –23·8) |
||||
Numbers in parentheses are 95% uncertainty intervals. |
Table 2:
Attributable global deaths, YLLs, YLDs, and DALYs in counts and age-standardised rates for both sexes combined, females, and males, 2019, with percentage change between 2010 and 2019
Deaths | YLLs | YLDs | DALYs | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
1990 | 6th | 3rd | 11th | 3rd | ||||||||
2010 | 11th | 6th | 12th | 7th | ||||||||
2019 | 12th | 9th | 12th | 10th | ||||||||
Table 3:
Rank among attributable Level 2 risks of global deaths, YLLs, YLDs, and DALYs in 1990, 2010, and 2019 for both sexes combined

Figure 1:
Composition of attributable global DALYs by constituent Level 2 causes for both sexes combined, 2019

Figure 2:
Composition of attributable global DALYs by YLLs and YLDs, age group, and sex, 2019


Figure 3:
Age-standardised all-cause SEV by location, both sexes combined, 2019


Figure 4:
Percentage change in all-cause age-standardised SEV by SDI, both sexes combined, 1990–2019