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
No Legend
Figure 3: Age-standardised all-cause SEV by location, both sexes combined, 2019
No Legend
Figure 4: Percentage change in all-cause age-standardised SEV by SDI, both sexes combined, 1990–2019