Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Jeffrey D. Stanaway; Ashkan Afshin; Emmanuela Gakidou; Stephen S. Lim; Degu Abate; Kalkidan Hassell Abate; Cristiana Abbafati; Nooshin Abbasi; Hedayat Abbastabar; Foad Abd-Allah; Jemal Abdela; Ahmed Abdelalim; Ibrahim Abdollahpour; Rizwan Suliankatchi Abdulkader; Molla Abebe; Zegeye Abebe; Semaw F. Abera; Olifan Zewdie Abil; Haftom Niguse Abraha; Aklilu Roba Abrham; Laith Jamal Abu-Raddad; Niveen M. E. Abu-Rmeileh; Manfred Mario Kokou Accrombessi; Dilaram Acharya; Pawan Acharya; Abdu A. Adamu; Akikw Awoke Adane; Oladimeji M. Adebayo; Rufus Adesoji Adedoyin; Victor Adekanmbi; Zanfina Ademi; Olatunji Adetokunboh; Mina G. Adib; Amha Admasie; Jose C. Adsuar; Kossivi Agbelenko Afanvi; Mohsen Afarideh; Gina Agarwal; Anju Aggarwal; Sargis Aghast Aghayan; Anurag Agrawal; Sutapa Agrawal; Alireza Ahmadi; Mehdi Ahmadi; Hamid Ahmadieh; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Mohammad Esmaeil Akbari; Tomi Akinyemiju; Nadia Akseer; Ziyad Al-Aly; Ayman Al-Eyadhy; Hesham M. Al-Mekhlafi; Fares Alandab; Khurshid Alam; Samiah Alam; Tahiya Alam; Alaa Alashi; Seyed Moayed Alavian; Kefyalew Addis Alene; Komal Ali; Syed Mustafa Ali; Mehran Alijanzadeh; Reza Alizadeh-Navaei; Syed Mohamed Aljunid; Ala'a Alkerwi; Francois Alla; Ubai Alsharif; Khalid Altirkawi; Nelson Alvis-Guzman; Azmeraw T. Amare; Walid Ammar; Nahla Hamed Anber; Jason A. Anderson; Catalina Liliana Andrei; Sofia Androudi; Megbaru Debalkie Animut; Mina Anjomshoa; Mustafa Geleto Ansha; Josep M. Anto; Carl Abelardo T. Antonio; Palwasha Anwari; Lambert Tetteh Appiah; Seth Christopher Yaw Appiah; Jalal Arabloo; Olatunde Aremu; Johan Amlov; Al Artaman; Krishna K. Aryal; Hamid Asayesh; Zerihun Ataro; Marcel Ausloos; Euripide F. G. A. Avokpaho; Ashish Awasthi; Beatriz Paulina Ayala Quintanilla; Rakesh Ayer; Tanabe B. Ayuk; Peter S. Azzopardi; GBD 2017 Risk Factor Collaborators; David C Schwebel

doi:10.1016/S0140-6736(18)32225-6

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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Jeffrey D. Stanaway, Ashkan Afshin, Emmanuela Gakidou, Stephen S. Lim, Degu Abate, Kalkidan Hassell Abate, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, …

The Lancet (British edition), Vol.392(10159), pp.1923-1994

11/10/2018

DOI: 10.1016/S0140-6736(18)32225-6

PMCID: PMC6227755

PMID: 30496105

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Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

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Title: Subtitle: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Creators: Jeffrey D. Stanaway - Institute for Health Metrics and Evaluation
Ashkan Afshin - Institute for Health Metrics and Evaluation
Emmanuela Gakidou - Institute for Health Metrics and Evaluation
Stephen S. Lim - Institute for Health Metrics and Evaluation
Degu Abate - Institute for Health Metrics and Evaluation
Kalkidan Hassell Abate
Cristiana Abbafati - Institute for Health Metrics and Evaluation
Nooshin Abbasi - Institute for Health Metrics and Evaluation
Hedayat Abbastabar - Institute for Health Metrics and Evaluation
Foad Abd-Allah - Institute for Health Metrics and Evaluation
Jemal Abdela - Institute for Health Metrics and Evaluation
Ahmed Abdelalim - Institute for Health Metrics and Evaluation
Ibrahim Abdollahpour - Institute for Health Metrics and Evaluation
Rizwan Suliankatchi Abdulkader - Institute for Health Metrics and Evaluation
Molla Abebe - Institute for Health Metrics and Evaluation
Zegeye Abebe - University of Gondar
Semaw F. Abera - Mekelle University
Olifan Zewdie Abil - Wollega University
Haftom Niguse Abraha - Mekelle University
Aklilu Roba Abrham - Haramaya University
Laith Jamal Abu-Raddad - Institute for Health Metrics and Evaluation
Niveen M. E. Abu-Rmeileh - Institute for Health Metrics and Evaluation
Manfred Mario Kokou Accrombessi - Benin Clin Res Inst IRCB, Dept Epidemiol, Cotonou, Benin
Dilaram Acharya - Institute for Health Metrics and Evaluation
Pawan Acharya - Institute for Health Metrics and Evaluation
Abdu A. Adamu - Institute for Health Metrics and Evaluation
Akikw Awoke Adane - University of Gondar
Oladimeji M. Adebayo - Institute for Health Metrics and Evaluation
Rufus Adesoji Adedoyin - Institute for Health Metrics and Evaluation
Victor Adekanmbi - Institute for Health Metrics and Evaluation
Zanfina Ademi - Institute for Health Metrics and Evaluation
Olatunji Adetokunboh - Institute for Health Metrics and Evaluation
Mina G. Adib - Institute for Health Metrics and Evaluation
Amha Admasie - Institute for Health Metrics and Evaluation
Jose C. Adsuar - Institute for Health Metrics and Evaluation
Kossivi Agbelenko Afanvi - Institute for Health Metrics and Evaluation
Mohsen Afarideh - Institute for Health Metrics and Evaluation
Gina Agarwal - Institute for Health Metrics and Evaluation
Anju Aggarwal - Institute for Health Metrics and Evaluation
Sargis Aghast Aghayan - Institute for Health Metrics and Evaluation
Anurag Agrawal - Institute for Health Metrics and Evaluation
Sutapa Agrawal - Institute for Health Metrics and Evaluation
Alireza Ahmadi - Institute for Health Metrics and Evaluation
Mehdi Ahmadi - Institute for Health Metrics and Evaluation
Hamid Ahmadieh - Institute for Health Metrics and Evaluation
Muktar Beshir Ahmed - Institute for Health Metrics and Evaluation
Amani Nidhal Aichour - Institute for Health Metrics and Evaluation
Ibtihel Aichour - Institute for Health Metrics and Evaluation
Miloud Taki Eddine Aichour - Institute for Health Metrics and Evaluation
Mohammad Esmaeil Akbari - Institute for Health Metrics and Evaluation
Tomi Akinyemiju - Institute for Health Metrics and Evaluation
Nadia Akseer - Institute for Health Metrics and Evaluation
Ziyad Al-Aly - Institute for Health Metrics and Evaluation
Ayman Al-Eyadhy - Institute for Health Metrics and Evaluation
Hesham M. Al-Mekhlafi - Institute for Health Metrics and Evaluation
Fares Alandab
Khurshid Alam - Institute for Health Metrics and Evaluation
Samiah Alam - Dalhousie University
Tahiya Alam - University of Washington
Alaa Alashi - Institute for Health Metrics and Evaluation
Seyed Moayed Alavian - Baqiyatallah Univ Med Sci, Baqiyatallah Res Ctr Gastroenterol & Liver Dis, Tehran, Iran
Kefyalew Addis Alene - Institute for Health Metrics and Evaluation
Komal Ali - Institute for Health Metrics and Evaluation
Syed Mustafa Ali - Institute for Health Metrics and Evaluation
Mehran Alijanzadeh - Institute for Health Metrics and Evaluation
Reza Alizadeh-Navaei - Institute for Health Metrics and Evaluation
Syed Mohamed Aljunid - Kuwait University
Ala'a Alkerwi - Luxembourg Inst Hlth, Dept Populat Hlth, Strassen, Luxembourg
Francois Alla - Institute for Health Metrics and Evaluation
Ubai Alsharif - Institute for Health Metrics and Evaluation
Khalid Altirkawi - Institute for Health Metrics and Evaluation
Nelson Alvis-Guzman - Institute for Health Metrics and Evaluation
Azmeraw T. Amare - Institute for Health Metrics and Evaluation
Walid Ammar - Institute for Health Metrics and Evaluation
Nahla Hamed Anber - Institute for Health Metrics and Evaluation
Jason A. Anderson - Institute for Health Metrics and Evaluation
Catalina Liliana Andrei - Institute for Health Metrics and Evaluation
Sofia Androudi - Institute for Health Metrics and Evaluation
Megbaru Debalkie Animut - Institute for Health Metrics and Evaluation
Mina Anjomshoa - Institute for Health Metrics and Evaluation
Mustafa Geleto Ansha - Institute for Health Metrics and Evaluation
Josep M. Anto - Institute for Health Metrics and Evaluation
Carl Abelardo T. Antonio - Institute for Health Metrics and Evaluation
Palwasha Anwari - Institute for Health Metrics and Evaluation
Lambert Tetteh Appiah - Institute for Health Metrics and Evaluation
Seth Christopher Yaw Appiah - Institute for Health Metrics and Evaluation
Jalal Arabloo - Institute for Health Metrics and Evaluation
Olatunde Aremu - Institute for Health Metrics and Evaluation
Johan Amlov
Al Artaman - Institute for Health Metrics and Evaluation
Krishna K. Aryal - Institute for Health Metrics and Evaluation
Hamid Asayesh - Institute for Health Metrics and Evaluation
Zerihun Ataro - Institute for Health Metrics and Evaluation
Marcel Ausloos - Institute for Health Metrics and Evaluation
Euripide F. G. A. Avokpaho - Dongguk University WISE
Ashish Awasthi - Institute for Health Metrics and Evaluation
Beatriz Paulina Ayala Quintanilla - Institute for Health Metrics and Evaluation
Rakesh Ayer - Institute for Health Metrics and Evaluation
Tanabe B. Ayuk - Inst Med Res & Med Plant Studies, Ctr Food & Nutr Res, Yaounde, Cameroon
Peter S. Azzopardi - Institute for Health Metrics and Evaluation
GBD 2017 Risk Factor Collaborators
David C Schwebel (Contributor) - Research Administration
Resource Type: Journal article
Publication Details: The Lancet (British edition), Vol.392(10159), pp.1923-1994
DOI: 10.1016/S0140-6736(18)32225-6
PMID: 30496105
PMCID: PMC6227755
NLM abbreviation: Lancet
ISSN: 0140-6736
eISSN: 1474-547X
Publisher: Elsevier
Number of pages: 72
Grant note: Bill AMP; Melinda Gates Foundation; CGIAR MC_UP_A620_1015; MR/L003120/1; MC_UU_12011/2; MC_U147585827; MC_U137686858; G0400491; MR/M015084/1; MC_U147585819 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC)
Language: English
Date published: 11/10/2018
Academic Unit: Research Administration
Record Identifier: 9984949187902771

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