Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.


GBD 2013 Risk Factors Collaborators, ; Forouzanfar, MH; Alexander, L; Anderson, HR; Bachman, VF; Biryukov, S; Brauer, M; Burnett, R; Casey, D; Coates, MM; Cohen, A; Delwiche, K; Estep, K; Frostad, JJ; Astha, KC; Kyu, HH; Moradi-Lakeh, M; Ng, M; Slepak, EL; Thomas, BA; Wagner, J; Aasvang, GM; Abbafati, C; Abbasoglu Ozgoren, A; Abd-Allah, F; Abera, SF; Aboyans, V; Abraham, B; Abraham, JP; Abubakar, I; Abu-Rmeileh, NM; Aburto, TC; Achoki, T; Adelekan, A; Adofo, K; Adou, AK; Adsuar, JC; Afshin, A; Agardh, EE; Al Khabouri, MJ; Al Lami, FH; Alam, SS; Alasfoor, D; Albittar, MI; Alegretti, MA; Aleman, AV; Alemu, ZA; Alfonso-Cristancho, R; Alhabib, S; Ali, R; Ali, MK; Alla, F; Allebeck, P; Allen, PJ; Alsharif, U; Alvarez, E; Alvis-Guzman, N; Amankwaa, AA; Amare, AT; Ameh, EA; Ameli, O; Amini, H; Ammar, W; Anderson, BO; Antonio, CA; Anwari, P; Argeseanu Cunningham, S; Arnlöv, J; Arsenijevic, VS; Artaman, A; Asghar, RJ; Assadi, R; Atkins, LS; Atkinson, C; Avila, MA; Awuah, B; Badawi, A; Bahit, MC; Bakfalouni, T; Balakrishnan, K; Balalla, S; Balu, RK; Banerjee, A; Barber, RM; Barker-Collo, SL; Barquera, S; Barregard, L; Barrero, LH; Barrientos-Gutierrez, T; Basto-Abreu, AC; Basu, A; Basu, S; Basulaiman, MO; Batis Ruvalcaba, C; Beardsley, J; Bedi, N; Bekele, T; Bell, ML; Benjet, C; Bennett, DA; Benzian, H; Bernabé, E; Beyene, TJ; Bhala, N; Bhalla, A; Bhutta, ZA; Bikbov, B; Bin Abdulhak, AA; Blore, JD; Blyth, FM; Bohensky, MA; Bora Başara, B; Borges, G; Bornstein, NM; Bose, D; Boufous, S; Bourne, RR; Brainin, M; Brazinova, A; Breitborde, NJ; Brenner, H; Briggs, AD; Broday, DM; Brooks, PM; Bruce, NG; Brugha, TS; Brunekreef, B; Buchbinder, R; Bui, LN; Bukhman, G; Bulloch, AG; Burch, M; Burney, PG; Campos-Nonato, IR; Campuzano, JC; Cantoral, AJ; Caravanos, J; Cárdenas, R; Cardis, E; Carpenter, DO; Caso, V; Castañeda-Orjuela, CA; Castro, RE; Catalá-López, F; Cavalleri, F; Çavlin, A; Chadha, VK; Chang, JC; Charlson, FJ; Chen, H; Chen, W; Chen, Z; Chiang, PP; Chimed-Ochir, O; Chowdhury, R; Christophi, CA; Chuang, TW; Chugh, SS; Cirillo, M; Claßen, TK; Colistro, V; Colomar, M; Colquhoun, SM; Contreras, AG; Cooper, C; Cooperrider, K; Cooper, LT; Coresh, J; Courville, KJ; Criqui, MH; Cuevas-Nasu, L; Damsere-Derry, J; Danawi, H; Dandona, L; Dandona, R; Dargan, PI; Davis, A; Davitoiu, DV; Dayama, A; de Castro, EF; De la Cruz-Góngora, V; De Leo, D; de Lima, G; Degenhardt, L; del Pozo-Cruz, B; Dellavalle, RP; Deribe, K; Derrett, S; Des Jarlais, DC; Dessalegn, M; deVeber, GA; Devries, KM; Dharmaratne, SD; Dherani, MK; Dicker, D; Ding, EL; Dokova, K; Dorsey, ER; Driscoll, TR; Duan, L; Durrani, AM; Ebel, BE; Ellenbogen, RG; Elshrek, YM; Endres, M; Ermakov, SP; Erskine, HE; Eshrati, B; Esteghamati, A; Fahimi, S; Faraon, EJ; Farzadfar, F; Fay, DF; Feigin, VL; Feigl, AB; Fereshtehnejad, SM; Ferrari, AJ; Ferri, CP; Flaxman, AD; Fleming, TD; Foigt, N; Foreman, KJ; Paleo, UF; Franklin, RC; Gabbe, B; Gaffikin, L; Gakidou, E; Gamkrelidze, A; Gankpé, FG; Gansevoort, RT; García-Guerra, FA; Gasana, E; Geleijnse, JM; Gessner, BD; Gething, P; Gibney, KB; Gillum, RF; Ginawi, IA; Giroud, M; Giussani, G; Goenka, S; Goginashvili, K; Gomez Dantes, H; Gona, P; Gonzalez de Cosio, T; González-Castell, D; Gotay, CC; Goto, A; Gouda, HN; Guerrant, RL; Gugnani, HC; Guillemin, F; Gunnell, D; Gupta, R; Gupta, R; Gutiérrez, RA; Hafezi-Nejad, N; Hagan, H; Hagstromer, M; Halasa, YA; Hamadeh, RR; Hammami, M; Hankey, GJ; Hao, Y; Harb, HL; Haregu, TN; Haro, JM; Havmoeller, R; Hay, SI; Hedayati, MT; Heredia-Pi, IB; Hernandez, L; Heuton, KR; Heydarpour, P; Hijar, M; Hoek, HW; Hoffman, HJ; Hornberger, JC; Hosgood, HD; Hoy, DG; Hsairi, M; Hu, G; Hu, H; Huang, C; Huang, JJ; Hubbell, BJ; Huiart, L; Husseini, A; Iannarone, ML; Iburg, KM; Idrisov, BT; Ikeda, N; Innos, K; Inoue, M; Islami, F; Ismayilova, S; Jacobsen, KH; Jansen, HA; Jarvis, DL; Jassal, SK; Jauregui, A; Jayaraman, S; Jeemon, P; Jensen, PN; Jha, V; Jiang, F; Jiang, G; Jiang, Y; Jonas, JB; Juel, K; Kan, H; Kany Roseline, SS; Karam, NE; Karch, A; Karema, CK; Karthikeyan, G; Kaul, A; Kawakami, N; Kazi, DS; Kemp, AH; Kengne, AP; Keren, A; Khader, YS; Khalifa, SE; Khan, EA; Khang, YH; Khatibzadeh, S; Khonelidze, I; Kieling, C; Kim, D; Kim, S; Kim, Y; Kimokoti, RW; Kinfu, Y; Kinge, JM; Kissela, BM; Kivipelto, M; Knibbs, LD; Knudsen, AK; Kokubo, Y; Kose, MR; Kosen, S; Kraemer, A; Kravchenko, M; Krishnaswami, S; Kromhout, H; Ku, T; Kuate Defo, B; Kucuk Bicer, B; Kuipers, EJ; Kulkarni, C; Kulkarni, VS; Kumar, GA; Kwan, GF; Lai, T; Lakshmana Balaji, A; Lalloo, R; Lallukka, T; Lam, H; Lan, Q; Lansingh, VC; Larson, HJ; Larsson, A; Laryea, DO; Lavados, PM; Lawrynowicz, AE; Leasher, JL; Lee, JT; Leigh, J; Leung, R; Levi, M; Li, Y; Li, Y; Liang, J; Liang, X; Lim, SS; Lindsay, MP; Lipshultz, SE; Liu, S; Liu, Y; Lloyd, BK; Logroscino, G; London, SJ; Lopez, N; Lortet-Tieulent, J; Lotufo, PA; Lozano, R; Lunevicius, R; Ma, J; Ma, S; Machado, VM; MacIntyre, MF; Magis-Rodriguez, C; Mahdi, AA; Majdan, M; Malekzadeh, R; Mangalam, S; Mapoma, CC; Marape, M; Marcenes, W; Margolis, DJ; Margono, C; Marks, GB; Martin, RV; Marzan, MB; Mashal, MT; Masiye, F; Mason-Jones, AJ; Matsushita, K; Matzopoulos, R; Mayosi, BM; Mazorodze, TT; McKay, AC; McKee, M; McLain, A; Meaney, PA; Medina, C; Mehndiratta, MM; Mejia-Rodriguez, F; Mekonnen, W; Melaku, YA; Meltzer, M; Memish, ZA; Mendoza, W; Mensah, GA; Meretoja, A; Mhimbira, FA; Micha, R; Miller, TR; Mills, EJ; Misganaw, A; Mishra, S; Mohamed Ibrahim, N; Mohammad, KA; Mokdad, AH; Mola, GL; Monasta, L; Montañez Hernandez, JC; Montico, M; Moore, AR; Morawska, L; Mori, R; Moschandreas, J; Moturi, WN; Mozaffarian, D; Mueller, UO; Mukaigawara, M; Mullany, EC; Murthy, KS; Naghavi, M; Nahas, Z; Naheed, A; Naidoo, KS; Naldi, L; Nand, D; Nangia, V; Narayan, KM; Nash, D; Neal, B; Nejjari, C; Neupane, SP; Newton, CR; Ngalesoni, FN; Ngirabega, JdeD; Nguyen, G; Nguyen, NT; Nieuwenhuijsen, MJ; Nisar, MI; Nogueira, JR; Nolla, JM; Nolte, S; Norheim, OF; Norman, RE; Norrving, B; Nyakarahuka, L; Oh, IH; Ohkubo, T; Olusanya, BO; 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Sanchez, LM; Sánchez-Pimienta, TG; Sanchez-Riera, L; Sandar, L; Santos, IS; Sapkota, A; Satpathy, M; Saunders, JE; Sawhney, M; Saylan, MI; Scarborough, P; Schmidt, JC; Schneider, IJ; Schöttker, B; Schwebel, DC; Scott, JG; Seedat, S; Sepanlou, SG; Serdar, B; Servan-Mori, EE; Shaddick, G; Shahraz, S; Levy, TS; Shangguan, S; She, J; Sheikhbahaei, S; Shibuya, K; Shin, HH; Shinohara, Y; Shiri, R; Shishani, K; Shiue, I; Sigfusdottir, ID; Silberberg, DH; Simard, EP; Sindi, S; Singh, A; Singh, GM; Singh, JA; Skirbekk, V; Sliwa, K; Soljak, M; Soneji, S; Søreide, K; Soshnikov, S; Sposato, LA; Sreeramareddy, CT; Stapelberg, NJ; Stathopoulou, V; Steckling, N; Stein, DJ; Stein, MB; Stephens, N; Stöckl, H; Straif, K; Stroumpoulis, K; Sturua, L; Sunguya, BF; Swaminathan, S; Swaroop, M; Sykes, BL; Tabb, KM; Takahashi, K; Talongwa, RT; Tandon, N; Tanne, D; Tanner, M; Tavakkoli, M; Te Ao, BJ; Teixeira, CM; Téllez Rojo, MM; Terkawi, AS; Texcalac-Sangrador, JL; Thackway, SV; Thomson, B; Thorne-Lyman, AL; Thrift, AG; Thurston, GD; Tillmann, T; Tobollik, M; Tonelli, M; Topouzis, F; Towbin, JA; Toyoshima, H; Traebert, J; Tran, BX; Trasande, L; Trillini, M; Trujillo, U; Dimbuene, ZT; Tsilimbaris, M; Tuzcu, EM; Uchendu, US; Ukwaja, KN; Uzun, SB; van de Vijver, S; Van Dingenen, R; van Gool, CH; van Os, J; Varakin, YY; Vasankari, TJ; Vasconcelos, AM; Vavilala, MS; Veerman, LJ; Velasquez-Melendez, G; Venketasubramanian, N; Vijayakumar, L; Villalpando, S; Violante, FS; Vlassov, VV; Vollset, SE; Wagner, GR; Waller, SG; Wallin, MT; Wan, X; Wang, H; Wang, J; Wang, L; Wang, W; Wang, Y; Warouw, TS; Watts, CH; Weichenthal, S; Weiderpass, E; Weintraub, RG; Werdecker, A; Wessells, KR; Westerman, R; Whiteford, HA; Wilkinson, JD; Williams, HC; Williams, TN; Woldeyohannes, SM; Wolfe, CD; Wong, JQ; Woolf, AD; Wright, JL; Wurtz, B; Xu, G; Yan, LL; Yang, G; Yano, Y; Ye, P; Yenesew, M; Yentür, GK; Yip, P; Yonemoto, N; Yoon, SJ; Younis, MZ; Younoussi, Z; Yu, C; Zaki, ME; Zhao, Y; Zheng, Y; Zhou, M; Zhu, J; Zhu, S; Zou, X; Zunt, JR; Lopez, AD; Vos, T; Murray, CJ; (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 386 (10010). pp. 2287-323. ISSN 0140-6736 DOI: 10.1016/S0140-6736(15)00128-2

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Abstract

: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.<br/> : Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.<br/> : All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.<br/> : Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.<br/> : Bill & Melinda Gates Foundation.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
Gender Violence and Health Centre
Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
Vaccine Centre
PubMed ID: 26364544
URI: http://researchonline.lshtm.ac.uk/id/eprint/2305201

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