Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar, M.H. and Afshin, A. and Alexander, L.T. and Biryukov, S. and Brauer, M. and Cercy, K. and Charlson, F.J. and Cohen, A.J. and Dandona, L. and Estep, K. and Ferrari, A.J. and Frostad, J.J. and Fullman, N. and Godwin, W.W. and Griswold, M. and Hay, S.I. and Kyu, H.H. and Larson, H.J. and Lim, S.S. and Liu, P.Y. and Lopez, A.D. and Lozano, R. and Marczak, L. and Mokdad, A.H. and Moradi-Lakeh, M. and Naghavi, M. and Reitsma, M.B. and Roth, G.A. and Sur, P.J. and Vos, T. and Wagner, J.A. and Wang, H. and Zhao, Y. and Zhou, M. and Barber, R.M. and Bell, B. and Blore, J.D. and Casey, D.C. and Coates, M.M. and Cooperrider, K. and Cornaby, L. and Dicker, D. and Erskine, H.E. and Fleming, T. and Foreman, K. and Gakidou, E. and Haagsma, J.A. and Johnson, C.O. and Kemmer, L. and Ku, T. and Leung, J. and Masiye, F. and Millear, A. and Mirarefin, M. and Misganaw, A. and Mullany, E. and Mumford, J.E. and Ng, M. and Olsen, H. and Rao, P. and Reinig, N. and Roman, Y. and Sandar, L. and Santomauro, D.F. and Slepak, E.L. and Sorensen, R.J.D. and Thomas, B.A. and Vollset, S.E. and Whiteford, H.A. and Zipkin, B. and Murray, C.J.L. and Mock, C.N. and Anderson, B.O. and Futran, N.D. and Anderson, H.R. and Bhutta, Z.A. and Nisar, M.I. and Akseer, N. and Krueger, H. and Gotay, C.C. and Kissoon, N. and Kopec, J.A. and Pourmalek, F. and Burnett, R. and Abajobir, A.A. and Knibbs, L.D. and Veerman, J.L. and Lalloo, R. and Scott, J.G. and Alam, N.K.M. and Gouda, H.N. and Guo, Y. and McGrath, J.J. and Charlson, F.J. and Jeemon, P. and Dandona, R. and Goenka, S. and Kumar, G.A. and Gething, P.W. and Bisanzio, D. and Deribew, A. and Darby, S.C. and Ali, R. and Bennett, D.A. and Jha, V. and Kinfu, Y. and McKee, M. and Murthy, G.V.S. and Pearce, N. and Stöckl, H. and Duan, L. and Jin, Y. and Li, Y. and Liu, S. and Wang, L. and Ye, P. and Liang, X. and Azzopardi, P. and Patton, G.C. and Meretoja, A. and Alam, K. and Borschmann, R. and Colquhoun, S.M. and Weintraub, R.G. and Szoeke, C.E.I. and Ademi, Z. and Taylor, H.R. and Wijeratne, T. and Batis, C. and Barquera, S. and Campos-Nonato, I.R. and Contreras, A.G. and Cuevas-Nasu, L. and De, V. and Gomez-Dantes, H. and Heredia-Pi, I.B. and Medina, C. and Mejia-Rodriguez, F. and Montañez Hernandez, J.C. and Razo-García, C.A. and Rivera, J.A. and Rodríguez-Ramírez, S. and Sánchez-Pimienta, T.G. and Servan-Mori, E.E. and Shamah, T. and Mensah, G.A. and Hoff, H.J. and Neal, B. and Driscoll, T.R. and Kemp, A.H. and Leigh, J. and Mekonnen, A.B. and Bhatt, S. and Fürst, T. and Piel, F.B. and Rodriguez, A. and Hutchings, S.J. and Majeed, A. and Soljak, M. and Salomon, J.A. and Thorne-Lyman, A.L. and Ajala, O.N. and Bärnighausen, T. and Cahill, L.E. and Ding, E.L. and Farvid, M.S. and Khatibzadeh, S. and Wagner, G.R. and Shrime, M.G. and Fitchett, J.R.A. and Aasvang, G.M. and Savic, M. and Abate, K.H. and Gebrehiwot, T.T. and Gebremedhin, A.T. and Abbafati, C. and Abbas, K.M. and Abd-Allah, F. and Abdulle, A.M. and Abera, S.F. and Melaku, Y.A. and Abyu, G.Y. and Betsu, B.D. and Hailu, G.B. and Tekle, D.Y. and Yalew, A.Z. and Abraham, B. and Abu-Raddad, L.J. and Adebiyi, A.O. and Adedeji, I.A. and Adou, A.K. and Adsuar, J.C. and Agardh, E.E. and Rehm, J. and Badawi, A. and Popova, S. and Agarwal, A. and Ahmad, A. and Akinyemiju, T.F. and Schwebel, D.C. and Singh, J.A. and Al-Aly, Z. and Aldhahri, S.F. and Altirkawi, K.A. and Terkawi, A.S. and Aldridge, R.W. and Tillmann, T. and Alemu, Z.A. and Tegegne, T.K. and Alkerwi, A. and Alla, F. and Guillemin, F. and Allebeck, P. and Rabiee, R.H.S. and Fereshtehnejad, S.M. and Kivipelto, M. and Carrero, J.J. and Weiderpass, E. and Havmoeller, R. and Sindi, S. and Alsharif, U. and Alvarez, E. and Alvis-Guzman, N. and Amare, A.T. and Ciobanu, L.G. and Taye, B.W. and Amberbir, A. and Amegah, A.K. and Amini, H. and Karema, C.K. and Ammar, W. and Harb, H.L. and Amrock, S.M. and Andersen, H.H. and Antonio, C.A.T. and Faraon, E.J.A. and Anwari, P. and �rnlöv, J. and Larsson, A. and Artaman, A. and Asayesh, H. and Asghar, R.J. and Assadi, R. and Atique, S. and Avokpaho, E.F.G.A. and Awasthi, A. and Ayala, B.P. and Bacha, U. and Bahit, M.C. and Balakrishnan, K. and Barac, A. and Barker-Collo, S.L. and del Pozo-Cruz, B. and Mohammed, S. and Barregard, L. and Petzold, M. and Barrero, L.H. and Basu, S. and Del, L.C. and Bazargan-Hejazi, S. and Beardsley, J. and Bedi, N. and Beghi, E. and Sheth, K.N. and Bell, M.L. and Huang, J.J. and Bello, A.K. and Santos, I.S. and Bensenor, I.M. and Lotufo, P.A. and Berhane, A. and Wolfe, C.D. and Bernabé, E. and Roba, H.S. and Beyene, A.S. and Hassen, T.A. and Mesfin, Y.M. and Bhala, N. and Bhansali, A. and Biadgilign, S. and Bikbov, B. and Bjertness, E. and Htet, A.S. and Boufous, S. and Degenhardt, L. and Resnikoff, S. and Calabria, B. and Bourne, R.R.A. and Brainin, M. and Brazinova, A. and Majdan, M. and Shen, J. and Breitborde, N.J.K. and Brenner, H. and Schöttker, B. and Broday, D.M. and Brugha, T.S. and Brunekreef, B. and Kromhout, H. and Butt, Z.A. and van Donkelaar, A. and Martin, R.V. and Cárdenas, R. and Carpenter, D.O. and Castañeda-Orjuela, C.A. and Castillo, J. and Castro, R.E. and Catalá-López, F. and Chang, J. and Chiang, P.P. and Chibalabala, M. and Chimed-Ochir, O. and Jiang, Y. and Takahashi, K. and Chisumpa, V.H. and Mapoma, C.C. and Chitheer, A.A. and Choi, J.J. and Christensen, H. and Christopher, D.J. and Cooper, L.T. and Crump, J.A. and Poulton, R.G. and Damasceno, A. and Dargan, P.I. and das Neves, J. and Davis, A.C. and Newton, J.N. and Steel, N. and Davletov, K. and de Castro, E.F. and De, D. and Dellavalle, R.P. and Des, D.C. and Dharmaratne, S.D. and Dhillon, P.K. and Lal, D.K. and Zodpey, S. and Diaz-Torné, C. and Dorsey, E.R. and Doyle, K.E. and Dubey, M. and Rahman, M.H.U. and Ram, U. and Singh, A. and Yadav, A.K. and Duncan, B.B. and Kieling, C. and Schmidt, M.I. and Elyazar, I. and Endries, A.Y. and Ermakov, S.P. and Eshrati, B. and Farzadfar, F. and Kasaeian, A. and Parsaeian, M. and Esteghamati, A. and Hafezi-Nejad, N. and Sheikhbahaei, S. and Fahimi, S. and Malekzadeh, R. and Roshandel, G. and Sepanlou, S.G. and Hassanvand, M.S. and Heydarpour, P. and Rahimi-Movaghar, V. and Yaseri, M. and Farid, T.A. and Khan, A.R. and Farinha, C.S.E.S. and Faro, A. and Feigin, V.L. and Fernandes, J.G. and Fischer, F. and Foigt, N. and Shiue, I. and Fowkes, F.G.R. and Franklin, R.C. and Garcia-Basteiro, A.L. and Geleijnse, J.M. and Jibat, T. and Gessner, B.D. and Tefera, W. and Giref, A.Z. and Haile, D. and Manamo, W.A.A. and Giroud, M. and Gishu, M.D. and Martinez-Raga, J. and Gomez-Cabrera, M.C. and Gona, P. and Goodridge, A. and Gopalani, S.V. and Goto, A. and Inoue, M. and Gugnani, H.C. and Gupta, R. and Gutiérrez, R.A. and Orozco, R. and Halasa, Y.A. and Undurraga, E.A. and Hamadeh, R.R. and Hamidi, S. and Handal, A.J. and Hankey, G.J. and Hao, Y. and Harikrishnan, S. and Haro, J.M. and Hernández-Llanes, N.F. and Hoek, H.W. and Tura, A.K. and Horino, M. and Horita, N. and Hosgood, H.D. and Hoy, D.G. and Hsairi, M. and Hu, G. and Husseini, A. and Huybrechts, I. and Iburg, K.M. and Idrisov, B.T. and Kwan, G.F. and Ileanu, B.V. and Pana, A. and Kawakami, N. and Shibuya, K. and Jacobs, T.A. and Jacobsen, K.H. and Jahanmehr, N. and Jakovljevic, M.B. and Jansen, H.A.F. and Jassal, S.K. and Stein, M.B. and Javanbakht, M. and Jayaraman, S.P. and Jayatilleke, A.U. and Jee, S.H. and Jeemon, P. and Jonas, J.B. and Kabir, Z. and Kalkonde, Y. and Kamal, R. and She, J. and Kan, H. and Karch, A. and Karimkhani, C. and Kaul, A. and Kazi, D.S. and Keiyoro, P.N. and Parry, C.D. and Kengne, A.P. and Matzopoulos, R. and Wiysonge, C.S. and Stein, D.J. and Mayosi, B.M. and Keren, A. and Khader, Y.S. and Khan, E.A. and Khan, G. and Khang, Y.H. and Won, S. and Khera, S. and Tavakkoli, M. and Khoja, T.A.M. and Khubchandani, J. and Kim, C. and Kim, D. and Kimokoti, R.W. and Kokubo, Y. and Koul, P.A. and Koyanagi, A. and Kravchenko, M. and Varakin, Y.Y. and Kuate, B. and Kuchenbecker, R.S. and Kucuk, B. and Kuipers, E.J. and Lallukka, T. and Shiri, R. and Meretoja, T.J. and Lan, Q. and Latif, A.A. and Lawrynowicz, A.E.B. and Leasher, J.L. and Levi, M. and Li, X. and Liang, J. and Lloyd, B.K. and Lloyd, B.K. and Lunevicius, R. and Pope, D. and Mahdavi, M. and Mahdavi, M. and Marcenes, W. and Matsushita, K. and Nachega, J.B. and Tran, B.X. and Meaney, P.A. and Mehari, A. and Tedla, B.A. and Memish, Z.A. and Mendoza, W. and Mensink, G.B.M. and Mhimbira, F.A. and Miller, T.R. and Mills, E.J. and Mohammadi, A. and Mola, G.L.D. and Monasta, L. and Morawska, L. and Norman, R.E. and Mori, R. and Mozaff, D. and Shi, P. and Werdecker, A. and Mueller, U.O. and Paternina, A.J. and Westerman, R. and Seedat, S. and Naheed, A. and Nangia, V. and Nassiri, N. and Nguyen, Q.L. and Nkamedjie, P.M. and Norheim, O.F. and Norrving, B. and Nyakarahuka, L. and Obermeyer, C.M. and Ogbo, F.A. and Oh, I. and Oladimeji, O. and Sartorius, B. and Olusanya, B.O. and Olivares, P.R. and Olusanya, J.O. and Opio, J.N. and Oren, E. and Ortiz, A. and Ota, E. and Mahesh, P.A. and Park, E. and Patel, T. and Patil, S.T. and Patten, S.B. and Wang, J. and Pereira, D.M. and Cortinovis, M. and Giussani, G. and Perico, N. and Remuzzi, G. and Pesudovs, K. and Phillips, M.R. and Pillay, J.D. and Plass, D. and Tobollik, M. and Polinder, S. and Pond, C.D. and Pope, C.A. and Prasad, N.M. and Qorbani, M. and Radfar, A. and Rafay, A. and Rana, S.M. and Rahman, M. and Rahman, S.U. and Rajsic, S. and Rai, R.K. and Raju, M. and Ranganathan, K. and Refaat, A.H. and Rehm, C.D. and Ribeiro, A.L. and Rojas-Rueda, D. and Roy, A. and Satpathy, M. and Tandon, N. and Rothenbacher, D. and Saleh, M.M. and Sanabria, J.R. and Sanchez-Riera, L. and Sanchez-Niño, M.D. and Sarmiento-Suarez, R. and Sawhney, M. and Schmidhuber, J. and Schneider, I.J.C. and Schutte, A.E. and Silva, D.A.S. and Shahraz, S. and Shin, M. and Shaheen, A. and Shaikh, M.A. and Sharma, R. and Shigematsu, M. and Yoon, S. and Shishani, K. and Sigfusdottir, I.D. and Singh, P.K. and Silveira, D.G.A. and Silverberg, J.I. and Yano, Y. and Soneji, S. and Sposato, L.A. and Steckling, N. and Sreeramareddy, C.T. and Stathopoulou, V. and Stroumpoulis, K. and Sunguya, B.F. and Swaminathan, S. and Sykes, B.L. and Tabarés-Seisdedos, R. and Talongwa, R.T. and Tanne, D. and Tuzcu, E.M. and Thakur, J. and Shaddick, G. and Thomas, M.L. and Thrift, A.G. and Thurston, G.D. and Thomson, A.J. and Topor-Madry, R. and Topouzis, F. and Towbin, J.A. and Uthman, O.A. and Tobe-Gai, R. and Tsilimparis, N. and Tsala, Z. and Tyrovolas, S. and Ukwaja, K.N. and van Os, J. and Vasankari, T. and Venketasubramanian, N. and Violante, F.S. and Waller, S.G. and Uneke, C.J. and Wang, Y. and Weichenthal, S. and Woolf, A.D. and Xavier, D. and Xu, G. and Yakob, B. and Yip, P. and Kesavachandran, C.N. and Montico, M. and Ronfani, L. and Yu, C. and Zaidi, Z. and Yonemoto, N. and Younis, M.Z. and Wubshet, M. and Zaidi, Z. and Zuhlke, L.J. and Zaki, M.E. and Zhu, J. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015. This online publication has been corrected..


Download (2MB) | Preview


Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors�the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25 over the same period. All risks jointly evaluated in 2015 accounted for 57·8 (95 CI 56·6�58·8) of global deaths and 41·2 (39·8�42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million 192·7 million to 231·1 million global DALYs), smoking (148·6 million 134·2 million to 163·1 million), high fasting plasma glucose (143·1 million 125·1 million to 163·5 million), high BMI (120·1 million 83·8 million to 158·4 million), childhood undernutrition (113·3 million 103·9 million to 123·4 million), ambient particulate matter (103·1 million 90·8 million to 115·1 million), high total cholesterol (88·7 million 74·6 million to 105·7 million), household air pollution (85·6 million 66·7 million to 106·1 million), alcohol use (85·0 million 77·2 million to 93·0 million), and diets high in sodium (83·0 million 49·3 million to 127·5 million). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Item Type: Article
Subjects: WA Public Health
Depositing User: eprints admin
Date Deposited: 08 Jul 2018 03:21
Last Modified: 12 Oct 2019 05:44

Actions (login required)

View Item View Item