Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Emmanuela Gakidou; Ashkan Afshin; Amanuel Alemu Abajobir; Kalkidan Hassen Abate; Cristiana Abbafati; Kaja M. Abbas; Foad Abd-Allah; Abdishakur M. Abdulle; Semaw Ferede Abera; Victor Aboyans; Laith J. Abu-Raddad; Niveen M. E. Abu-Rmeileh; Gebre Yitayih Abyu; Isaac Akinkunmi Adedeji; Olatunji Adetokunboh; Mohsen Afarideh; Anurag Agrawal; Sutapa Agrawal; Aliasghar Ahmad Kiadaliri; Hamid Ahmadieh; Muktar Beshir Ahmed; Amani Nidhal Aichour; Ibtihel Aichour; Miloud Taki Eddine Aichour; Rufus Olusola Akinyemi; Nadia Akseer; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Noore Alam; Tahiya Alam; Deena Alasfoor; Kefyalew Addis Alene; Komal Ali; Reza Alizadeh-Navaei; Ala'a Alkerwi; Francois Alla; Peter Allebeck; Rajaa Al-Raddadi; Ubai Alsharif; Khalid A. Altirkawi; Nelson Alvis-Guzman; Azmeraw T. Amare; Erfan Amini; Walid Ammar; Yaw Ampem Amoako; Hossein Ansari; Josep M. Anto; Carl Abelardo T. Antonio; Palwasha Anwari; Nicholas Arian; Johan Arnlov; A. Artaman; Krishna Kumar Aryal; Hamid Asayesh; Solomon Weldegebreal Asgedom; Tesfay Mehari Atey; Leticia Avila-Burgos; Euripide Frinel G. Arthur Avokpaho; Ashish Awasthi; Peter Azzopardi; Umar Bacha; Alaa Badawi; Kalpana Balakrishnan; Shoshana H. Ballew; Aleksandra Barac; Ryan M. Barber; Suzanne L. Barker-Collo; Till Barnighausen; Simon Barquera; Lars Barregard; Lope H. Barrero; Carolina Batis; Katherine E. Battle; Bernhard T. Baune; Justin Beardsley; Neeraj Bedi; Ettore Beghi; Michelle L. Bell; Derrick A. Bennett; James R. Bennett; Isabela M. Bensenor; Adugnaw Berhane; Derbew Fikadu Berhe; Eduardo Bernabe; Balem Demtsu Betsu; Mircea Beuran; Addisu Shunu Beyene; Anil Bhansali; Zulfiqar A. Bhutta; Boris Bikbov; Charles Birungi; Stan Biryukov; Christopher D. Blosser; Dube Jara Boneya; Ibrahim R. Bou-Orm; Michael Brauer; Nicholas J. K. Breitborde; Hermann Brenner; Traolach S. Brugha; GBD 2016 Risk Factors Collaborators; David C Schwebel

doi:10.1016/S0140-6736(17)32366-8

Back

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Journal article

Open access

Peer reviewed

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Emmanuela Gakidou, Ashkan Afshin, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M. Abbas, Foad Abd-Allah, Abdishakur M. Abdulle, Semaw Ferede Abera, Victor Aboyans, …

The Lancet (British edition), Vol.390(10100), pp.1345-1422

09/16/2017

DOI: 10.1016/S0140-6736(17)32366-8

PMCID: PMC5614451

PMID: 28919119

Files and links (1)

url

https://doi.org/10.1016/S0140-6736(17)32366-8View

Published (Version of record) Open Access

Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods We used the comparative risk assessment 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 clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. 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. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124.1 million DALYs [95% UI 111.2 million to 137.0 million]), high systolic blood pressure (122.2 million DALYs [110.3 million to 133.3 million], and low birthweight and short gestation (83.0 million DALYs [78.3 million to 87.7 million]), and for women, were high systolic blood pressure (89.9 million DALYs [80.9 million to 98.2 million]), high body-mass index (64.8 million DALYs [44.4 million to 87.6 million]), and high fasting plasma glucose (63.8 million DALYs [53.2 million to 76.3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9.3% (6.9-11.6) decline in deaths and a 10.8% (8.3-13.1) decrease in DALYs at the global level, while population ageing accounts for 14.9% (12.7-17.5) of deaths and 6.2% (3.9-8.7) of DALYs, and population growth for 12.4% (10.1-14.9) of deaths and 12.4% (10.1-14.9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27.3% (24.9-29.7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

Science & Technology

Details

Title: Subtitle: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
Creators: Emmanuela Gakidou - Institute for Health Metrics and Evaluation
Ashkan Afshin - Institute for Health Metrics and Evaluation
Amanuel Alemu Abajobir - Institute for Health Metrics and Evaluation
Kalkidan Hassen Abate - Institute for Health Metrics and Evaluation
Cristiana Abbafati - Institute for Health Metrics and Evaluation
Kaja M. Abbas - Institute for Health Metrics and Evaluation
Foad Abd-Allah - Institute for Health Metrics and Evaluation
Abdishakur M. Abdulle - Institute for Health Metrics and Evaluation
Semaw Ferede Abera - Institute for Health Metrics and Evaluation
Victor Aboyans - Institute for Health Metrics and Evaluation
Laith J. Abu-Raddad - Institute for Health Metrics and Evaluation
Niveen M. E. Abu-Rmeileh - Institute for Health Metrics and Evaluation
Gebre Yitayih Abyu - Institute for Health Metrics and Evaluation
Isaac Akinkunmi Adedeji - Institute for Health Metrics and Evaluation
Olatunji Adetokunboh - Institute for Health Metrics and Evaluation
Mohsen Afarideh - Institute for Health Metrics and Evaluation
Anurag Agrawal - Institute for Health Metrics and Evaluation
Sutapa Agrawal - Institute for Health Metrics and Evaluation
Aliasghar Ahmad Kiadaliri - Lund University
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
Rufus Olusola Akinyemi - Institute for Health Metrics and Evaluation
Nadia Akseer - Institute for Health Metrics and Evaluation
Fares Alahdab - Institute for Health Metrics and Evaluation
Ziyad Al-Aly - Institute for Health Metrics and Evaluation
Khurshid Alam - Institute for Health Metrics and Evaluation
Noore Alam - Institute for Health Metrics and Evaluation
Tahiya Alam - University of Washington
Deena Alasfoor - Institute for Health Metrics and Evaluation
Kefyalew Addis Alene - Institute for Health Metrics and Evaluation
Komal Ali - Institute for Health Metrics and Evaluation
Reza Alizadeh-Navaei - Institute for Health Metrics and Evaluation
Ala'a Alkerwi - Luxembourg Inst Hlth, Strassen, Luxembourg
Francois Alla - Institute for Health Metrics and Evaluation
Peter Allebeck - Institute for Health Metrics and Evaluation
Rajaa Al-Raddadi - Institute for Health Metrics and Evaluation
Ubai Alsharif - Institute for Health Metrics and Evaluation
Khalid A. 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
Erfan Amini - Institute for Health Metrics and Evaluation
Walid Ammar - Institute for Health Metrics and Evaluation
Yaw Ampem Amoako - Institute for Health Metrics and Evaluation
Hossein Ansari - 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
Nicholas Arian - Institute for Health Metrics and Evaluation
Johan Arnlov - Institute for Health Metrics and Evaluation
A. Artaman - Institute for Health Metrics and Evaluation
Krishna Kumar Aryal - Institute for Health Metrics and Evaluation
Hamid Asayesh - Institute for Health Metrics and Evaluation
Solomon Weldegebreal Asgedom - Institute for Health Metrics and Evaluation
Tesfay Mehari Atey - Institute for Health Metrics and Evaluation
Leticia Avila-Burgos - Institute for Health Metrics and Evaluation
Euripide Frinel G. Arthur Avokpaho - IRCB, Cotonou, Benin
Ashish Awasthi - Institute for Health Metrics and Evaluation
Peter Azzopardi - Institute for Health Metrics and Evaluation
Umar Bacha - Institute for Health Metrics and Evaluation
Alaa Badawi - Institute for Health Metrics and Evaluation
Kalpana Balakrishnan - Institute for Health Metrics and Evaluation
Shoshana H. Ballew - Institute for Health Metrics and Evaluation
Aleksandra Barac - Institute for Health Metrics and Evaluation
Ryan M. Barber - Institute for Health Metrics and Evaluation
Suzanne L. Barker-Collo - Institute for Health Metrics and Evaluation
Till Barnighausen - Institute for Health Metrics and Evaluation
Simon Barquera - Institute for Health Metrics and Evaluation
Lars Barregard - Institute for Health Metrics and Evaluation
Lope H. Barrero - Institute for Health Metrics and Evaluation
Carolina Batis - Institute for Health Metrics and Evaluation
Katherine E. Battle - Institute for Health Metrics and Evaluation
Bernhard T. Baune - Institute for Health Metrics and Evaluation
Justin Beardsley - Institute for Health Metrics and Evaluation
Neeraj Bedi - Institute for Health Metrics and Evaluation
Ettore Beghi - Institute for Health Metrics and Evaluation
Michelle L. Bell - Institute for Health Metrics and Evaluation
Derrick A. Bennett - Institute for Health Metrics and Evaluation
James R. Bennett - Institute for Health Metrics and Evaluation
Isabela M. Bensenor - Institute for Health Metrics and Evaluation
Adugnaw Berhane - Institute for Health Metrics and Evaluation
Derbew Fikadu Berhe - Institute for Health Metrics and Evaluation
Eduardo Bernabe - Institute for Health Metrics and Evaluation
Balem Demtsu Betsu - Institute for Health Metrics and Evaluation
Mircea Beuran - Institute for Health Metrics and Evaluation
Addisu Shunu Beyene - Institute for Health Metrics and Evaluation
Anil Bhansali - Institute for Health Metrics and Evaluation
Zulfiqar A. Bhutta - Institute for Health Metrics and Evaluation
Boris Bikbov - Institute for Health Metrics and Evaluation
Charles Birungi - Institute for Health Metrics and Evaluation
Stan Biryukov - Institute for Health Metrics and Evaluation
Christopher D. Blosser - University of Washington
Dube Jara Boneya - Institute for Health Metrics and Evaluation
Ibrahim R. Bou-Orm - Institute for Health Metrics and Evaluation
Michael Brauer - Institute for Health Metrics and Evaluation
Nicholas J. K. Breitborde - Institute for Health Metrics and Evaluation
Hermann Brenner - Institute for Health Metrics and Evaluation
Traolach S. Brugha - Institute for Health Metrics and Evaluation
GBD 2016 Risk Factors Collaborators
David C Schwebel (Contributor) - Research Administration
Resource Type: Journal article
Publication Details: The Lancet (British edition), Vol.390(10100), pp.1345-1422
DOI: 10.1016/S0140-6736(17)32366-8
PMID: 28919119
PMCID: PMC5614451
NLM abbreviation: Lancet
ISSN: 0140-6736
eISSN: 1474-547X
Publisher: Elsevier
Number of pages: 78
Grant note: ES/J023299/1 / Economic and Social Research Council; UK Research & Innovation (UKRI); Economic & Social Research Council (ESRC) ES/J023299/1 / ESRC; UK Research & Innovation (UKRI); Economic & Social Research Council (ESRC) SPHSU15; SCAF/15/02; SPHSU13 / Chief Scientist Office; Chief Scientist Office - Scotland MC_UU_12011/2; G0400491; MC_UU_12011/1; U1475000002; MC_UP_A620_1014; MC_U147585827; MR/K013351/1; MC_U147585819; MC_UU_12017/15; MC_UP_A620_1015; MC_UU_12017/13; MC_U147585824; U1475000001 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) Bill AMP; Melinda Gates Foundation; CGIAR 15K08762 / Grants-in-Aid for Scientific Research; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science; Grants-in-Aid for Scientific Research (KAKENHI) 1499934 / Engineering and Physical Sciences Research Council; UK Research & Innovation (UKRI); Engineering & Physical Sciences Research Council (EPSRC) Bloomberg Philanthropies NF-SI-0508-10082; CDF-2011-04-048; NF-SI-0513-10085 / National Institute for Health Research; National Institutes of Health Research (NIHR) G0400491; MR/K013351/1; MC_UU_12017/13; MC_U147585819; MC_UU_12017/15; MC_U147585827; MC_UU_12011/2; MC_UP_A620_1015 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC)
Language: English
Date published: 09/16/2017
Academic Unit: Research Administration
Record Identifier: 9984949202802771

Metrics

3 Record Views

See more details