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.