title: Estimating the global disease burden due to ultraviolet radiation exposure.
abstract: BACKGROUND
  WHO's global burden of disease studies, undertaken since 1996, apportion the total global disease burden, measured in disability-adjusted life years (DALYs), to specific diseases and injuries. Recent assessments of the relative burden due to specific environmental risk factors, plus an understanding of the nature of the risk factor, may guide resource allocation in risk factor management. We report here the global disease burden due to ultraviolet radiation (UVR) exposure.
  
  
  METHODS
  A systematic literature review identified nine diseases with sufficient evidence of a causal relationship with UVR exposure and for which the population attributable fraction (PAF) for UVR could be estimated. For cutaneous malignant melanoma and cataract, the PAF was directly applied to disease burdens already calculated by WHO. For seven other diseases, we developed population-level exposure-disease relationships and used these to calculate disease incidence and mortality, and thence disease burden. We also estimated the disease burden from rickets, osteomalacia and osteoporosis that might result if global UVR exposure was reduced to very low levels.
  
  
  RESULTS
  UVR exposure is a minor contributor to the world's disease burden, causing an estimated annual loss of 1.6 million DALYs; i.e. 0.1% of the total global disease burden. A markedly larger annual disease burden, 3.3 billion DALYs, might result from reduction in global UVR exposure to very low levels.
  
  
  CONCLUSIONS
  Sun protection messages are important to prevent diseases of UVR exposure. However, without high dietary (or supplemental) intake of vitamin D, some sun exposure is essential to avoid diseases of vitamin D insufficiency.
authors.affiliation: National Centre for Epidemiology and Population Health, The Australian National University, Australia. robyn.lucas@anu.edu.au
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Lucas
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: McMichael
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Armstrong
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Smith
mesh_terms: D002280:Basal Cell Carcinoma / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000209:etiology; D002386:Cataract / Q000209:etiology; D003625:Data Collection; D004781:Environmental Exposure; D005134:Eye Neoplasms / Q000209:etiology; D014943:Global Health; D006560:Herpes Labialis; D006801:Humans; D019057:Quality-Adjusted Life Years; D011832:Radiation Injuries / Q000150:complications; D012878:Skin Neoplasms / Q000209:etiology; D013471:Sunburn / Q000209:etiology; D014466:Ultraviolet Rays / Q000009:adverse effects*; D014775:Virus Activation; D014808:Vitamin D Deficiency / Q000209:etiology