Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Feb 20, 2026
Open Peer Review Period: Feb 20, 2026 - Apr 17, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Gender-Based Disparities in Mortality, Disability Adjusted Life Years and Risk Factors Burden in Pakistan: Insights from the Global Burden of Disease Study 2023
ABSTRACT
Background:
Gender disparities in disease burden remain a critical public health concern, particularly in low- and middle-income countries like Pakistan. Existing studies that have explored such inequities in Pakistan have categorized health outcomes only at the broad Level 1 classification, including communicable diseases, NCDs, and injuries, without gender specific data.
Objective:
This study aimed to compare gender-based differences in mortality and disability-adjusted life years for the causes and risk factors in Pakistan in 2023, using data from the Global Burden of Disease.
Methods:
We conducted an ecological study using the Global Burden of Disease dataset for Pakistan, aged ≥20 years. We ranked the gender-aggregated and gender-disaggregated top causes based on mortality and disability-adjusted life years in Pakistan in the year 2023. Additionally, we calculated the absolute difference in cause-specific mortality and DALY rates between females and males. We ranked the risk factors for gender-aggregated and gender-disaggregated data in Pakistan in the year 2023.
Results:
In 2023, ischemic heart disease (IHD) (136; 95% UI: 170.4–105.1) and stroke (80.8; 95% UI: 113.7–57.9) were the leading causes of mortality among adults aged 20 years and above, as well as among males and females in Pakistan. The leading causes of DALYs were also IHD (3727.6; 95% UI: 2877.3–4687.7) and stroke (2175.1; 95% UI: 1598.2–3004.7), among males and females. Males experienced higher DALY losses from tuberculosis (2090.8; 95% UI: 1326–2971.5), road injuries (1706.7; 95% UI: 977.6–2388.1), and self-harm (864.1; 95% UI: 527–1273.6), while females were more affected by low back pain (1554.7; 95% UI: 1079.8–2126.1), depressive disorders (1538.5; 95% UI: 1042.4–2197.4), and dietary iron deficiency (1043.7; 95% UI: 461.9–1863.5). The greatest absolute difference for mortality and DALYs among males was reported for tuberculosis, while for females, rheumatic heart disease was reported for mortality, and lower back pain for DALYs. The leading risk factors for both gender-aggregated and gender-disaggregated mortality were diets low in nuts and seeds and particulate matter pollution for DALYs.
Conclusions:
Our findings show IHD and stroke were the leading causes of mortality and DALYs among adults aged 20 years and above in Pakistan in 2023, reflecting the continued dominance of non-communicable diseases. This highlights the importance of gender-disaggregated analysis in national health reporting. Tailored interventions addressing these disparities are crucial for equitable healthcare planning in Pakistan.
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