The burdens of disease attributable to tobacco smoking including second-hand smoke (6·3 million [5·4 million to 7·0 million] deaths and 6·3% [5·5–7·0] of DALYs) as well as alcohol and drug use (5·0 million [4·7 million to 5·3 million] deaths and 6·5% [6·0–7·0] of DALYs) were substantial in 2010. These burdens are mainly driven by active smoking, which accounts for 87% of the combined burden with second-hand smoke, and alcohol use which accounted for 4·9 million (4·5 million to 5·2 million) deaths and 5·5% (5·0–5·9) of global DALYs in 2010. Of the remaining risk factor clusters, occupational risk factors accounted for 0·9 million (0·7 million to 1·1 million) deaths and 2·5% (2·0–3·0) of global DALYs in 2010, followed by sexual abuse and violence (0·2 million [0·1 million to 0·3 million] deaths and 0·9% [0·7–1·2] DALYs), unimproved water and sanitation, (0·3 million [0 to 0·6 million] deaths and 0·9% [0·04–1·6] DALYs), and other environmental risks (0·7 million [0·6 million to 0·9 million] deaths and 0·6% [0·5–0·8] DALYs).
