Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Christopher J. L. Murray; Aleksandr Y. Aravkin; Peng Zheng; Cristiana Abbafati; Kaja M. Abbas; Mohsen Abbasi-Kangevari; Foad Abd-Allah; Ahmed Abdelalim; Mohammad Abdollahi; Ibrahim Abdollahpour; Kedir Hussein Abegaz; Hassan Abolhassani; Victor Aboyans; Lucas Guimaraes Abreu; Michael R. M. Abrigo; Ahmed Abualhasan; Laith Jamal Abu-Raddad; Abdelrahman I. Abushouk; Maryam Adabi; Victor Adekanmbi; Abiodun Moshood Adeoye; Olatunji O. Adetokunboh; Davoud Adham; Shailesh M. Advani; Gina Agarwal; Seyed Mohammad Kazem Aghamir; Anurag Agrawal; Tauseef Ahmad; Keivan Ahmadi; Mehdi Ahmadi; Hamid Ahmadieh; Muktar Beshir Ahmed; Temesgen Yihunie Akalu; Rufus Olusola Akinyemi; Tomi Akinyemiju; Blessing Akombi; Chisom Joyqueenet Akunna; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Samiah Alam; Tahiya Alam; Fahad Mashhour Alanezi; Turki M. Alanzi; Biresaw Wassihun Alemu; Khalid F. Alhabib; Muhammad Ali; Saqib Ali; Gianfranco Alicandro; Cyrus Alinia; Vahid Alipour; Hesam Alizade; Syed Mohamed Aljunid; Francois Alla; Peter Allebeck; Amir Almasi-Hashiani; Hesham M. Al-Mekhlafi; Jordi Alonso; Khalid A. Altirkawi; Mostafa Amini-Rarani; Fatemeh Amiri; Dickson A. Amugsi; Robert Ancuceanu; Deanna Anderlini; Jason A. Anderson; Catalina Liliana Andrei; Tudorel Andrei; Colin Angus; Mina Anjomshoa; Fereshteh Ansari; Alireza Ansari-Moghaddam; Ippazio Cosimo Antonazzo; Carl Abelardo T. Antonio; Catherine M. Antony; Ernoiz Antriyandarti; Davood Anvari; Razique Anwer; Seth Christopher Yaw Appiah; Jalal Arabloo; Morteza Arab-Zozani; Filippo Ariani; Bahram Armoon; Johan Arnlov; Afsaneh Arzani; Mehran Asadi-Aliabadi; Ali A. Asadi-Pooya; Charlie Ashbaugh; Michael Assmus; Zahra Atafar; Desta Debalkie Atnafu; Maha Moh'd Wahbi Atout; Floriane Ausloos; Marcel Ausloos; Beatriz Paulina Ayala Quintanilla; Getinet Ayano; Martin Amogre Ayanore; Samad Azari; Ghasem Azarian; Zelalem Nigussie Azene; Alaa Badawi; GBD 2019 Risk Factors Collaborators; David C Schwebel

doi:10.1016/S0140-6736(20)30752-2

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Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

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Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Christopher J. L. Murray, Aleksandr Y. Aravkin, Peng Zheng, Cristiana Abbafati, Kaja M. Abbas, Mohsen Abbasi-Kangevari, Foad Abd-Allah, Ahmed Abdelalim, Mohammad Abdollahi, Ibrahim Abdollahpour, …

The Lancet (British edition), Vol.396(10258), pp.1223-1249

10/17/2020

DOI: 10.1016/S0140-6736(20)30752-2

PMCID: PMC7567026

PMID: 33069326

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Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

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Title: Subtitle: Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
Creators: Christopher J. L. Murray - University of Washington
Aleksandr Y. Aravkin - University of Washington
Peng Zheng - University of Washington
Cristiana Abbafati - Univ Roma La Sapienza, Dept Jurid & Econ Studies, Rome, Italy
Kaja M. Abbas - London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England
Mohsen Abbasi-Kangevari - Shahid Beheshti University
Foad Abd-Allah - Cairo University
Ahmed Abdelalim - Cairo University
Mohammad Abdollahi - University of Tehran
Ibrahim Abdollahpour - Isfahan Univ Med Sci, Neurosci Res Ctr, Esfahan, Iran
Kedir Hussein Abegaz - Near East University
Hassan Abolhassani - University of Tehran
Victor Aboyans - Dupuytren Univ Hosp, Dept Cardiol, Limoges, France
Lucas Guimaraes Abreu - Federal Reserve
Michael R. M. Abrigo - Philippine Inst Dev Studies, Dept Res, Quezon City, Philippines
Ahmed Abualhasan - Cairo University
Laith Jamal Abu-Raddad - Weill Cornell Med Coll Qatar, Dept Healthcare Policy & Res, Doha, Qatar
Abdelrahman I. Abushouk - Harvard University
Maryam Adabi - Hamadan Univ Med Sci, Hamadan, Iran
Victor Adekanmbi - Cardiff University
Abiodun Moshood Adeoye - Univ Coll Hosp, Sch Lab Med & Sci, Ibadan, Nigeria
Olatunji O. Adetokunboh - Stellenbosch University
Davoud Adham - Ardabil Univ Med Sci, Sch Hlth, Ardebil, Iran
Shailesh M. Advani - NIH, Social Behav Res Branch, Bldg 10, Bethesda, MD 20892 USA
Gina Agarwal - McMaster University
Seyed Mohammad Kazem Aghamir - University of Tehran
Anurag Agrawal - CSIR, Inst Genom & Integrat Biol, Delhi, India
Tauseef Ahmad - Southeast University
Keivan Ahmadi - University of Nottingham
Mehdi Ahmadi - Ahvaz Jundishapur Univ Med Sci, Environm Hlth Engn, Ahvaz, Iran
Hamid Ahmadieh - Shahid Beheshti University
Muktar Beshir Ahmed - Jimma University
Temesgen Yihunie Akalu - University of Gondar
Rufus Olusola Akinyemi - University of Ibadan
Tomi Akinyemiju - Duke University
Blessing Akombi - UNSW Sydney
Chisom Joyqueenet Akunna - Intercountry Ctr Oral Hlth ICOH Africa, Dept Publ Hlth, Jos, Nigeria
Fares Alahdab - Mayo Clin Fdn Med Educ & Res, Mayo Evidencebased Practice Ctr, Rochester, MN USA
Ziyad Al-Aly - Washington Univ, John T Milliken Dept Internal Med, St Louis, MO 63110 USA
Khurshid Alam - Murdoch University
Samiah Alam - Dalhousie University
Tahiya Alam - University of Washington
Fahad Mashhour Alanezi - Imam Abdulrahman Bin Faisal University
Turki M. Alanzi - Imam Abdulrahman Bin Faisal University
Biresaw Wassihun Alemu - Arba Minch University
Khalid F. Alhabib - King Saud University
Muhammad Ali - Quaid-i-Azam University
Saqib Ali - Sultan Qaboos University
Gianfranco Alicandro - Italian Natl Inst Stat, Directorate Social Stat & Populat Census, Rome, Italy
Cyrus Alinia - Urmia University
Vahid Alipour - Iran Univ Med Sci, Hlth Econ Dept, Tehran, Iran
Hesam Alizade - University of Hormozgan
Syed Mohamed Aljunid - Kuwait University
Francois Alla - Univ Bordeaux, Bordeaux Sch Publ Hlth, Bordeaux, France
Peter Allebeck - Karolinska Institutet
Amir Almasi-Hashiani - Arak University
Hesham M. Al-Mekhlafi - Jazan University
Jordi Alonso - Universitat Pompeu Fabra
Khalid A. Altirkawi - King Saud University
Mostafa Amini-Rarani - Isfahan Univ Med Sci, Hlth Management & Econ Reasearch Ctr, Esfahan, Iran
Fatemeh Amiri - Kermanshah Univ Med Sci, Dept Radiol & Nucl Med, Kermanshah, Iran
Dickson A. Amugsi - African Populat & Hlth Res Ctr, Maternal & Child Wellbeing, Nairobi, Kenya
Robert Ancuceanu - Carol Davila Univ Med & Pharm, Dept Pharm, Bucharest, Romania
Deanna Anderlini - The University of Queensland
Jason A. Anderson - University of Washington
Catalina Liliana Andrei - Carol Davila Univ Med & Pharm, Dept Cardiol, Bucharest, Romania
Tudorel Andrei - Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania
Colin Angus - University of Sheffield
Mina Anjomshoa - Rafsanjan Univ Med Sci, Social Determinants Hlth Res Ctr, Rafsanjan, Iran
Fereshteh Ansari - Tabriz Univ Med Sci, Res Ctr Evidence Based Med, Tabriz, Iran
Alireza Ansari-Moghaddam - Zahedan Univ Med Sci, Dept Epidemiol & Biostat, Zahedan, Iran
Ippazio Cosimo Antonazzo - University of Milano-Bicocca
Carl Abelardo T. Antonio - University of the Philippines Manila
Catherine M. Antony - University of Washington
Ernoiz Antriyandarti - Sebelas Maret University
Davood Anvari - Mazandaran Univ Med Sci, Dept Parasitol, Sari, Iran
Razique Anwer - Imam Mohammad ibn Saud Islamic University
Seth Christopher Yaw Appiah - Kwame Nkrumah University
Jalal Arabloo - Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran
Morteza Arab-Zozani - Birjand Univ Med Sci, Social Determinants Hlth Res Ctr, Birjand, Iran
Filippo Ariani - Florence (Netherlands)
Bahram Armoon - Saveh Univ Med Sci, Social Determinants Hlth Res Ctr, Saveh, Iran
Johan Arnlov - Karolinska Institutet
Afsaneh Arzani - Babol Univ Med Sci, Sch Nursing & Midwifery, Babol, Iran
Mehran Asadi-Aliabadi - Iran Univ Med Sci, Prevent Med & Publ Hlth Res Ctr, Tehran, Iran
Ali A. Asadi-Pooya - Shiraz University
Charlie Ashbaugh - University of Washington
Michael Assmus - University of Washington
Zahra Atafar - Kermanshah Univ Med Sci, Social Dev & Hlth Promot Res Ctr, Kermanshah, Iran
Desta Debalkie Atnafu - Bahir Dar University
Maha Moh'd Wahbi Atout - Philadelphia Univ, Fac Nursing, Amman, Jordan
Floriane Ausloos - University of Liège
Marcel Ausloos - Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania
Beatriz Paulina Ayala Quintanilla - La Trobe University
Getinet Ayano - Curtin University
Martin Amogre Ayanore - Univ Hlth & Allied Sci, Dept Hlth Policy Planning & Management, Ho, Ghana
Samad Azari - Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran
Ghasem Azarian - Hamadan Univ Med Sci, Dept Environm Hlth Engn, Hamadan, Iran
Zelalem Nigussie Azene - University of Gondar
Alaa Badawi - Publ Hlth Agcy Canada, Publ Hlth Risk Sci Div, Toronto, ON, Canada
GBD 2019 Risk Factors Collaborators
David C Schwebel - Research Administration
Resource Type: Journal article
Publication Details: The Lancet (British edition), Vol.396(10258), pp.1223-1249
DOI: 10.1016/S0140-6736(20)30752-2
PMID: 33069326
PMCID: PMC7567026
NLM abbreviation: Lancet
ISSN: 0140-6736
eISSN: 1474-547X
Publisher: Elsevier
Number of pages: 27
Grant note: SCAF/15/02 / NRS Senior Clinical Fellowship Department of Health 18K10082 / Ministry of Education, Culture, Sports, Science, and Technology of Japan; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT) CP18/00074 / Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, EU) 175087 / Ministry of Education, Science and Technological Development of the Republic of Serbia; Ministry of Education, Science & Technological Development, Serbia Centro de Investigacion en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche) MR/R024227/1; MC_UU_12017/13; MC_UU_00022/2; MC_UU_12017/15; MR/M015084/1; MR/S011676/1 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) R21AG032572; R03AG043052; R01 AG030153 / National Institute on Aging, a division of the NIH Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award - German Federal Ministry of Education and Research
Language: English
Date published: 10/17/2020
Academic Unit: Research Administration
Record Identifier: 9984949190702771

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