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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.

BACKGROUNDThe 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 sur... Full description

Journal Title: Lancet (London England), September 16, 2017, Vol.390(10100), pp.1345-1422
Main Author: Gakidou, Emmanuela
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 1474-547X ; DOI: 1474-547X ; DOI: 10.1016/S0140-6736(17)32366-8
Link: http://search.proquest.com/docview/1940195647/?pq-origsite=primo
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title: 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.
format: Article
creator:
  • Gakidou, Emmanuela
subjects:
  • Adolescent–Statistics & Numerical Data
  • Adult–Trends
  • Aged–Mortality
  • Aged, 80 and Over–Statistics & Numerical Data
  • Air Pollution–Statistics & Numerical Data
  • Body Mass Index–Statistics & Numerical Data
  • Cause of Death–Mortality
  • Child–Mortality
  • Child, Preschool–Mortality
  • Communicable Diseases–Mortality
  • Disabled Persons–Standards
  • Environmental Health–Statistics & Numerical Data
  • Female–Statistics & Numerical Data
  • Global Burden of Disease–Statistics & Numerical Data
  • Humans–Statistics & Numerical Data
  • Infant–Statistics & Numerical Data
  • Infant, Newborn–Statistics & Numerical Data
  • Life Expectancy–Statistics & Numerical Data
  • Male–Statistics & Numerical Data
  • Metabolic Diseases–Statistics & Numerical Data
  • Middle Aged–Statistics & Numerical Data
  • Noncommunicable Diseases–Statistics & Numerical Data
  • Occupational Diseases–Statistics & Numerical Data
  • Quality-Adjusted Life Years–Statistics & Numerical Data
  • Risk Assessment–Statistics & Numerical Data
  • Sex Distribution–Statistics & Numerical Data
  • Smoking–Statistics & Numerical Data
  • Water Supply–Statistics & Numerical Data
  • Young Adult–Statistics & Numerical Data
  • Abridged
ispartof: Lancet (London, England), September 16, 2017, Vol.390(10100), pp.1345-1422
description: BACKGROUNDThe 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. METHODSWe 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. FINDINGSSince 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 mill
language: eng
source:
identifier: E-ISSN: 1474-547X ; DOI: 1474-547X ; DOI: 10.1016/S0140-6736(17)32366-8
fulltext: fulltext
issn:
  • 1474547X
  • 1474-547X
url: Link


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titleGlobal, 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.
creatorGakidou, Emmanuela
contributorAfshin, Ashkan (record owner) ; Abajobir, Amanuel Alemu ; Abate, Kalkidan Hassen ; Abbafati, Cristiana ; Abbas, Kaja M ; Abd-Allah, Foad ; Abdulle, Abdishakur M ; Abera, Semaw Ferede ; Aboyans, Victor ; Abu-Raddad, Laith J ; Abu-Rmeileh, Niveen M E ; Abyu, Gebre Yitayih ; Adedeji, Isaac Akinkunmi ; Adetokunboh, Olatunji ; Afarideh, Mohsen ; Agrawal, Anurag ; Agrawal, Sutapa ; Ahmadieh, Hamid ; Ahmed, Muktar Beshir ; Aichour, Miloud Taki Eddine ; Aichour, Amani Nidhal ; Aichour, Ibtihel ; Akinyemi, Rufus Olusola ; Akseer, Nadia ; Alahdab, Fares ; Al-Aly, Ziyad ; Alam, Khurshid ; Alam, Noore ; Alam, Tahiya ; Alasfoor, Deena ; Alene, Kefyalew Addis ; Ali, Komal ; Alizadeh-Navaei, Reza ; Alkerwi, Ala'a ; Alla, François ; Allebeck, Peter ; Al-Raddadi, Rajaa ; Alsharif, Ubai ; Altirkawi, Khalid A ; Alvis-Guzman, Nelson ; Amare, Azmeraw T ; Amini, Erfan ; Ammar, Walid ; Amoako, Yaw Ampem ; Ansari, Hossein ; Antó, Josep M ; Antonio, Carl Abelardo T ; Anwari, Palwasha ; Arian, Nicholas ; 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ispartofLancet (London, England), September 16, 2017, Vol.390(10100), pp.1345-1422
identifier
subject
descriptionBACKGROUNDThe 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. METHODSWe 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. FINDINGSSince 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. INTERPRETATIONIncreasingly 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. FUNDINGThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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creatorcontribGakidou, Emmanuela
titleGlobal, 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.
descriptionBACKGROUNDThe 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. METHODSWe 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. FINDINGSSince 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. INTERPRETATIONIncreasingly 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. FUNDINGThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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0Adolescent–Statistics & Numerical Data
1Adult–Trends
2Aged–Mortality
3Aged, 80 and Over–Statistics & Numerical Data
4Air Pollution–Statistics & Numerical Data
5Body Mass Index–Statistics & Numerical Data
6Cause of Death–Mortality
7Child–Mortality
8Child, Preschool–Mortality
9Communicable Diseases–Mortality
10Disabled Persons–Standards
11Environmental Health–Statistics & Numerical Data
12Female–Statistics & Numerical Data
13Global Burden of Disease–Statistics & Numerical Data
14Humans–Statistics & Numerical Data
15Infant–Statistics & Numerical Data
16Infant, Newborn–Statistics & Numerical Data
17Life Expectancy–Statistics & Numerical Data
18Male–Statistics & Numerical Data
19Metabolic Diseases–Statistics & Numerical Data
20Middle Aged–Statistics & Numerical Data
21Noncommunicable Diseases–Statistics & Numerical Data
22Occupational Diseases–Statistics & Numerical Data
23Quality-Adjusted Life Years–Statistics & Numerical Data
24Risk Assessment–Statistics & Numerical Data
25Sex Distribution–Statistics & Numerical Data
26Smoking–Statistics & Numerical Data
27Water Supply–Statistics & Numerical Data
28Young Adult–Statistics & Numerical Data
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2Abate, Kalkidan Hassen
3Abbafati, Cristiana
4Abbas, Kaja M
5Abd-Allah, Foad
6Abdulle, Abdishakur M
7Abera, Semaw Ferede
8Aboyans, Victor
9Abu-Raddad, Laith J
10Abu-Rmeileh, Niveen M E
11Abyu, Gebre Yitayih
12Adedeji, Isaac Akinkunmi
13Adetokunboh, Olatunji
14Afarideh, Mohsen
15Agrawal, Anurag
16Agrawal, Sutapa
17Ahmadieh, Hamid
18Ahmed, Muktar Beshir
19Aichour, Miloud Taki Eddine
20Aichour, Amani Nidhal
21Aichour, Ibtihel
22Akinyemi, Rufus Olusola
23Akseer, Nadia
24Alahdab, Fares
25Al-Aly, Ziyad
26Alam, Khurshid
27Alam, Noore
28Alam, Tahiya
29Alasfoor, Deena
30Alene, Kefyalew Addis
31Ali, Komal
32Alizadeh-Navaei, Reza
33Alkerwi, Ala'a
34Alla, François
35Allebeck, Peter
36Al-Raddadi, Rajaa
37Alsharif, Ubai
38Altirkawi, Khalid A
39Alvis-Guzman, Nelson
40Amare, Azmeraw T
41Amini, Erfan
42Ammar, Walid
43Amoako, Yaw Ampem
44Ansari, Hossein
45Antó, Josep M
46Antonio, Carl Abelardo T
47Anwari, Palwasha
48Arian, Nicholas
49Ärnlöv, Johan
50Artaman, Al
51Aryal, Krishna Kumar
52Asayesh, Hamid
53Asgedom, Solomon Weldegebreal
54Atey, Tesfay Mehari
55Avila-Burgos, Leticia
56Avokpaho, Euripide Frinel G Arthur
57Awasthi, Ashish
58Azzopardi, Peter
59Bacha, Umar
60Badawi, Alaa
61Balakrishnan, Kalpana
62Ballew, Shoshana H
63Barac, Aleksandra
64Barber, Ryan M
65Barker-Collo, Suzanne L
66Bärnighausen, Till
67Barquera, Simon
68Barregard, Lars
69Barrero, Lope H
70Batis, Carolina
71Battle, Katherine E
72Baumgarner, Blair R
73Baune, Bernhard T
74Beardsley, Justin
75Bedi, Neeraj
76Beghi, Ettore
77Bell, Michelle L
78Bennett, Derrick A
79Bennett, James R
80Bensenor, Isabela M
81Berhane, Adugnaw
82Berhe, Derbew Fikadu
83Bernabé, Eduardo
84Betsu, Balem Demtsu
85Beuran, Mircea
86Beyene, Addisu Shunu
87Bhansali, Anil
88Bhutta, Zulfiqar A
89Bicer, Burcu Kucuk
90Bikbov, Boris
91Birungi, Charles
92Biryukov, Stan
93Blosser, Christopher D
94Boneya, Dube Jara
95Bou-Orm, Ibrahim R
96Brauer, Michael
97Breitborde, Nicholas J K
98Brenner, Hermann
99Brugha, Traolach S
100...
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titleGlobal, 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.
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4Air Pollution–Statistics & Numerical Data
5Body Mass Index–Statistics & Numerical Data
6Cause of Death–Mortality
7Child–Mortality
8Child, Preschool–Mortality
9Communicable Diseases–Mortality
10Disabled Persons–Standards
11Environmental Health–Statistics & Numerical Data
12Female–Statistics & Numerical Data
13Global Burden of Disease–Statistics & Numerical Data
14Humans–Statistics & Numerical Data
15Infant–Statistics & Numerical Data
16Infant, Newborn–Statistics & Numerical Data
17Life Expectancy–Statistics & Numerical Data
18Male–Statistics & Numerical Data
19Metabolic Diseases–Statistics & Numerical Data
20Middle Aged–Statistics & Numerical Data
21Noncommunicable Diseases–Statistics & Numerical Data
22Occupational Diseases–Statistics & Numerical Data
23Quality-Adjusted Life Years–Statistics & Numerical Data
24Risk Assessment–Statistics & Numerical Data
25Sex Distribution–Statistics & Numerical Data
26Smoking–Statistics & Numerical Data
27Water Supply–Statistics & Numerical Data
28Young Adult–Statistics & Numerical Data
29Abridged
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0Gakidou, Emmanuela
1Afshin, Ashkan
2Abajobir, Amanuel Alemu
3Abate, Kalkidan Hassen
4Abbafati, Cristiana
5Abbas, Kaja M
6Abd-Allah, Foad
7Abdulle, Abdishakur M
8Abera, Semaw Ferede
9Aboyans, Victor
10Abu-Raddad, Laith J
11Abu-Rmeileh, Niveen M E
12Abyu, Gebre Yitayih
13Adedeji, Isaac Akinkunmi
14Adetokunboh, Olatunji
15Afarideh, Mohsen
16Agrawal, Anurag
17Agrawal, Sutapa
18Ahmadieh, Hamid
19Ahmed, Muktar Beshir
20Aichour, Miloud Taki Eddine
21Aichour, Amani Nidhal
22Aichour, Ibtihel
23Akinyemi, Rufus Olusola
24Akseer, Nadia
25Alahdab, Fares
26Al-Aly, Ziyad
27Alam, Khurshid
28Alam, Noore
29Alam, Tahiya
30Alasfoor, Deena
31Alene, Kefyalew Addis
32Ali, Komal
33Alizadeh-Navaei, Reza
34Alkerwi, Ala'a
35Alla, François
36Allebeck, Peter
37Al-Raddadi, Rajaa
38Alsharif, Ubai
39Altirkawi, Khalid A
40Alvis-Guzman, Nelson
41Amare, Azmeraw T
42Amini, Erfan
43Ammar, Walid
44Amoako, Yaw Ampem
45Ansari, Hossein
46Antó, Josep M
47Antonio, Carl Abelardo T
48Anwari, Palwasha
49Arian, Nicholas
50Ärnlöv, Johan
51Artaman, Al
52Aryal, Krishna Kumar
53Asayesh, Hamid
54Asgedom, Solomon Weldegebreal
55Atey, Tesfay Mehari
56Avila-Burgos, Leticia
57Avokpaho, Euripide Frinel G Arthur
58Awasthi, Ashish
59Azzopardi, Peter
60Bacha, Umar
61Badawi, Alaa
62Balakrishnan, Kalpana
63Ballew, Shoshana H
64Barac, Aleksandra
65Barber, Ryan M
66Barker-Collo, Suzanne L
67Bärnighausen, Till
68Barquera, Simon
69Barregard, Lars
70Barrero, Lope H
71Batis, Carolina
72Battle, Katherine E
73Baumgarner, Blair R
74Baune, Bernhard T
75Beardsley, Justin
76Bedi, Neeraj
77Beghi, Ettore
78Bell, Michelle L
79Bennett, Derrick A
80Bennett, James R
81Bensenor, Isabela M
82Berhane, Adugnaw
83Berhe, Derbew Fikadu
84Bernabé, Eduardo
85Betsu, Balem Demtsu
86Beuran, Mircea
87Beyene, Addisu Shunu
88Bhansali, Anil
89Bhutta, Zulfiqar A
90Bicer, Burcu Kucuk
91Bikbov, Boris
92Birungi, Charles
93Biryukov, Stan
94Blosser, Christopher D
95Boneya, Dube Jara
96Bou-Orm, Ibrahim R
97Brauer, Michael
98Breitborde, Nicholas J K
99Brenner, Hermann
100...
jtitleLancet (London, England)
toplevelpeer_reviewed
delivery
delcategoryRemote Search Resource
fulltextfulltext
addata
aulastGakidou
aufirstEmmanuela
auGakidou, Emmanuela
addau
0Afshin, Ashkan
1Abajobir, Amanuel Alemu
2Abate, Kalkidan Hassen
3Abbafati, Cristiana
4Abbas, Kaja M
5Abd-Allah, Foad
6Abdulle, Abdishakur M
7Abera, Semaw Ferede
8Aboyans, Victor
9Abu-Raddad, Laith J
10Abu-Rmeileh, Niveen M E
11Abyu, Gebre Yitayih
12Adedeji, Isaac Akinkunmi
13Adetokunboh, Olatunji
14Afarideh, Mohsen
15Agrawal, Anurag
16Agrawal, Sutapa
17Ahmadieh, Hamid
18Ahmed, Muktar Beshir
19Aichour, Miloud Taki Eddine
20Aichour, Amani Nidhal
21Aichour, Ibtihel
22Akinyemi, Rufus Olusola
23Akseer, Nadia
24Alahdab, Fares
25Al-Aly, Ziyad
26Alam, Khurshid
27Alam, Noore
28Alam, Tahiya
29Alasfoor, Deena
30Alene, Kefyalew Addis
31Ali, Komal
32Alizadeh-Navaei, Reza
33Alkerwi, Ala'a
34Alla, François
35Allebeck, Peter
36Al-Raddadi, Rajaa
37Alsharif, Ubai
38Altirkawi, Khalid A
39Alvis-Guzman, Nelson
40Amare, Azmeraw T
41Amini, Erfan
42Ammar, Walid
43Amoako, Yaw Ampem
44Ansari, Hossein
45Antó, Josep M
46Antonio, Carl Abelardo T
47Anwari, Palwasha
48Arian, Nicholas
49Ärnlöv, Johan
50Artaman, Al
51Aryal, Krishna Kumar
52Asayesh, Hamid
53Asgedom, Solomon Weldegebreal
54Atey, Tesfay Mehari
55Avila-Burgos, Leticia
56Avokpaho, Euripide Frinel G Arthur
57Awasthi, Ashish
58Azzopardi, Peter
59Bacha, Umar
60Badawi, Alaa
61Balakrishnan, Kalpana
62Ballew, Shoshana H
63Barac, Aleksandra
64Barber, Ryan M
65Barker-Collo, Suzanne L
66Bärnighausen, Till
67Barquera, Simon
68Barregard, Lars
69Barrero, Lope H
70Batis, Carolina
71Battle, Katherine E
72Baumgarner, Blair R
73Baune, Bernhard T
74Beardsley, Justin
75Bedi, Neeraj
76Beghi, Ettore
77Bell, Michelle L
78Bennett, Derrick A
79Bennett, James R
80Bensenor, Isabela M
81Berhane, Adugnaw
82Berhe, Derbew Fikadu
83Bernabé, Eduardo
84Betsu, Balem Demtsu
85Beuran, Mircea
86Beyene, Addisu Shunu
87Bhansali, Anil
88Bhutta, Zulfiqar A
89Bicer, Burcu Kucuk
90Bikbov, Boris
91Birungi, Charles
92Biryukov, Stan
93Blosser, Christopher D
94Boneya, Dube Jara
95Bou-Orm, Ibrahim R
96Brauer, Michael
97Breitborde, Nicholas J K
98Brenner, Hermann
99Brugha, Traolach S
100...
atitleGlobal, 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.
jtitleLancet (London, England)
risdate20170916
volume390
issue10100
spage1345
epage1422
pages1345-1422
eissn1474-547X
formatjournal
genrearticle
ristypeJOUR
abstractBACKGROUNDThe 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. METHODSWe 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. FINDINGSSince 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. INTERPRETATIONIncreasingly 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. FUNDINGThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
doi10.1016/S0140-6736(17)32366-8
urlhttp://search.proquest.com/docview/1940195647/
orcididdiva-portal.org=authority-person:10837
issn01406736
isbn0004106300000
date2017-09-16