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Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks in 188 Countries, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013 Publisher Pubmed



Forouzanfar MH1 ; Alexander L1 ; Bachman VF1 ; Biryukov S1 ; Brauer M1, 8 ; Casey D1 ; Coates MM1 ; Delwiche K1 ; Estep K1 ; Frostad JJ1 ; Astha KC1 ; Kyu HH1 ; Moradilakeh M1, 11 ; Ng M1 Show All Authors
Authors
  1. Forouzanfar MH1
  2. Alexander L1
  3. Bachman VF1
  4. Biryukov S1
  5. Brauer M1, 8
  6. Casey D1
  7. Coates MM1
  8. Delwiche K1
  9. Estep K1
  10. Frostad JJ1
  11. Astha KC1
  12. Kyu HH1
  13. Moradilakeh M1, 11
  14. Ng M1
  15. Slepak E1
  16. Thomas BA1
  17. Wagner J1
  18. Achoki T1
  19. Atkinson C1
  20. Barber RM1
  21. Cooperrider K1
  22. Dandona L1, 99
  23. Dicker D1
  24. Flaxman AD1
  25. Fleming TD1
  26. Foreman KJ1, 158
  27. Gakidou E1
  28. Hay SI1, 53
  29. Heuton KR1
  30. Iannarone ML1
  31. Ku T1
  32. Larson HJ1, 219
  33. Lim SS1
  34. Lopez AD1, 130
  35. Lozano R1, 32
  36. Macintyre MF1
  37. Margono C1
  38. Mclain A1
  39. Mokdad AH1
  40. Mullany EC1
  41. Murray CJL1
  42. Naghavi M1
  43. Nguyen G1
  44. Pain AW1
  45. Richardson L1
  46. Robinson M1
  47. Sandar L1
  48. Stephens N1
  49. Temesgen AM1
  50. Thomson B1
  51. Vos T1
  52. Wan X1, 176
  53. Wang H1
  54. Wurtz B1
  55. Ebel BE2
  56. Ellenbogen RG3
  57. Wright JL4
  58. Alfonsocristancho R5
  59. Anderson BO5
  60. Jensen PN5
  61. Quistberg DA5
  62. Riederer A5, 286
  63. Vavilala MS5
  64. Zunt JR5
  65. Anderson HR6
  66. Pourmalek F7
  67. Gotay CC8
  68. Burnett R9
  69. Shin HH9
  70. Weichenthal S9
  71. Cohen A10
  72. Knudsen A12
  73. Aasvang G13
  74. Kinge JM13
  75. Skirbekk V13
  76. Vollset S13
  77. Abbafati C14
  78. Abbasoglu Ozgoren A15
  79. Cavlin A15
  80. Kucuk Bicer B16
  81. Abdallah F17
  82. Abera SF18, 20
  83. Melaku YA19
  84. Aboyans V21
  85. Abraham B22
  86. Puthenpurakal Abraham J23
  87. Abraham JP24
  88. Thornelyman AL25
  89. Ding EL26
  90. Fahimi S26
  91. Khatibzadeh S26
  92. Wagner GR26, 540
  93. Bukhman G27
  94. Camposnonato IR28, 32
  95. Feigl AB28
  96. Salomon JA28
  97. Benzian H29, 114
  98. Abubakar I30
  99. Aburmeileh NME31
  100. Aburto TC32
  101. Avila MA32
  102. Barquera S32
  103. Barrientosgutierrez T32
  104. Campuzano JC32
  105. Cantoral AJ32
  106. Contreras AG32
  107. Cuevasnasu L32
  108. De V32
  109. Garciaguerra FA32
  110. Gomez Dantes H32
  111. Gonzalez De Cosio T32
  112. Gonzalezcastell D32
  113. Herediapi IB32
  114. Hernandez L32
  115. Jauregui A32
  116. Medina C32
  117. Mejiarodriguez F32
  118. Montanez Hernandez JC32
  119. Pedraza LS32
  120. Pedroza A32
  121. Quezada AD32
  122. Salvo D32
  123. Sanchez LM32
  124. Sanchezpimienta TG32
  125. Servanmori EE32
  126. Shamah Levy T32
  127. Tellez Rojo MM32
  128. Villalpando S32
  129. Adelekan A33
  130. Adofo K34
  131. Adou AK35
  132. Adsuar JC36
  133. Fra Paleo U36
  134. Afshin A37
  135. Micha R37
  136. Mozaffarian D37
  137. Shahraz S38
  138. Shangguan S38, 494
  139. Singh GM39
  140. Agardh EE40
  141. Al Khabouri MJ41
  142. Al Lami FH42
  143. Alam S43
  144. Naheed A43
  145. Alasfoor D44
  146. Albittar MI45
  147. Alegretti MA46
  148. Cavalleri F47
  149. Aleman AV48
  150. Colistro V48
  151. Alemu ZA49
  152. Alhabib S50
  153. Chen Z51
  154. Gething P52
  155. Ali R53
  156. Bennett DA53
  157. Briggs ADM53
  158. Rahimi K53
  159. Scarborough P53
  160. Simard EP54
  161. Ali MK55
  162. Argeseanu Cunningham S55
  163. Liu Y55
  164. Narayan KMV55
  165. Omer SB55
  166. Alla F56
  167. Guillemin F56
  168. Allebeck P57
  169. Roy N57, 476
  170. Kivipelto M58
  171. Weiderpass E59
  172. Fereshtehnejad S60
  173. Havmoeller R61
  174. Sindi S61
  175. Allen PJ62
  176. Alsharif U63
  177. Endres M63
  178. Nolte S63, 426
  179. Papachristou C63
  180. Alvarez E64
  181. Alvisguzman N65
  182. Paternina Caicedo AJ65
  183. Amankwaa AA66
  184. Amare AT67, 70
  185. Hoek HW68, 276
  186. Gansevoort RT69
  187. Yenesew M71
  188. Ameh EA72
  189. Ameli O73
  190. Amini H74, 75, 77
  191. Tanner M76
  192. Ammar W78
  193. Harb HL78
  194. Antonio CAT79
  195. Faraon EA80
  196. Panelo CA81
  197. Anwari P82
  198. Arnlov J83, 85
  199. Larsson A84
  200. Arsic Arsenijevic VS86, 87
  201. Artaman A88
  202. Asghar RJ89
  203. Assadi R90
  204. Atkins LS91
  205. Awuah B92
  206. Laryea DO92
  207. Badawi A93
  208. Bahit MC94
  209. Bakfalouni T95
  210. Balakrishnan K96
  211. Balalla S97
  212. Feigin VL97
  213. Te Ao BJ98
  214. Balu R99
  215. Dandona R99
  216. Goenka S99
  217. Kumar G99
  218. Murthy KS99
  219. Reddy K99
  220. Banerjee A100
  221. Barkercollo SL101
  222. Del Pozocruz B102
  223. Barregard L103
  224. Barrero LH104
  225. Bastoabreu AC105
  226. Batis Ruvalcaba C105
  227. De Castro EF105
  228. Lopez N105
  229. Texcalac JL105
  230. Basu A106
  231. Gaffikin L4
  232. Basu S107
  233. Basulaiman MO108
  234. Memish ZA108
  235. Beardsley J109
  236. Bedi N110
  237. Bekele T111
  238. Bell ML112
  239. Huang JJ112
  240. Benjet C113
  241. Borges G113
  242. Gutierrez RA113
  243. Orozco R113
  244. Trasande L4
  245. Hagan H115
  246. Bernabe E116
  247. Wolfe CDA116
  248. Beyene TJ117
  249. Bhala N118, 119
  250. Derrett S120, 212
  251. Bhalla A121, 122
  252. Jha V121, 122
  253. Bhutta ZA123
  254. Nisar MI124
  255. Bikbov B125, 126
  256. Bin Abdulhak AA127
  257. Vijayakumar L128, 537
  258. Chiang PP129
  259. Blore JD130
  260. Brooks PM130
  261. Lakshmana Balaji A130
  262. Colquhoun SM130, 191
  263. Weintraub RG130, 545
  264. Blyth FM131
  265. Meretoja A132, 393
  266. Bohensky MA133
  267. Bora Basara B134
  268. Yentur GK134
  269. Kose MR135
  270. Pekericli A135
  271. Uzun SB135
  272. Bornstein NM136
  273. Bose D137
  274. Boufous S138
  275. Degenhardt L139
  276. Bourne RR140
  277. Brainin M141
  278. Brazinova A142
  279. Majdan M142
  280. Breitborde NJ143, 144
  281. Schottker B145
  282. Brenner H146
  283. Broday DM147
  284. Lunevicius R148, 370
  285. Bruce NG149
  286. Dherani MK149
  287. Pope D149
  288. Brugha TS150
  289. Brunekreef B151
  290. Kromhout H151
  291. Buchbinder R152, 153
  292. Gabbe B154
  293. Gibney KB154, 249
  294. Thrift AG154
  295. Bui LN155
  296. Nguyen NT155
  297. Bulloch AG156
  298. Patten SB156
  299. Tonelli M156
  300. Wang J156
  301. Burch M157
  302. Burney PGJ158
  303. Jarvis DL158
  304. Rodriguez A158, 474
  305. Rushton L158
  306. Soljak M158
  307. Williams TN158
  308. Caravanos J159
  309. Nash D159
  310. Cardenas R160
  311. Cardis E161
  312. Nieuwenhuijsen MJ161
  313. Rojasrueda D161
  314. Carpenter DO162
  315. Leung R162
  316. Caso V163
  317. Castanedaorjuela CA164, 165
  318. Castro RE166
  319. Catalalopez F167, 168
  320. Chadha VK169
  321. Chang J170
  322. Scott JG171
  323. Hoy DG172, 284
  324. Knibbs LD173
  325. Charlson FJ174
  326. Erskine HE174
  327. Ferrari AJ174
  328. Gouda HN174
  329. Veerman LJ174
  330. Whiteford HA174
  331. Chen W175
  332. Zou X175
  333. Chen H177, 178
  334. London SJ177, 178
  335. Jiang Y179
  336. Takahashi K180
  337. Chimedochir O181
  338. Chowdhury R182, 183
  339. Powles J182, 183
  340. Christophi CA184
  341. Chuang T185
  342. Chugh SS186
  343. Cirillo M187
  344. Claen TKD188
  345. Kraemer A189
  346. Tobollik M189
  347. Colomar M190
  348. Cooper C192
  349. Cooper LT193
  350. Coresh J194
  351. Matsushita K194
  352. Tran BX195, 526
  353. Courville KJ196
  354. Criqui MH197
  355. Stein MB197
  356. Damserederry J198
  357. Danawi H199
  358. Refaat AH199, 468
  359. Dargan PI200
  360. Davis A201
  361. Fay DFJ201
  362. Schmidt JC201
  363. Davitoiu DV202
  364. Dayama A203
  365. Deleo D204
  366. De Lima G205, 206
  367. Machado VMP206
  368. Nogueira JR207
  369. Teixeira CM207
  370. Dellavalle RP208
  371. Deribe K209, 210
  372. Mekonnen W211
  373. Des Jarlais DC213, 214
  374. Dessalegn M215
  375. Deveber GA216
  376. Lindsay MP217, 364
  377. Hu H218
  378. Devries KM219
  379. Mckee M219
  380. Pearce N219
  381. Stockl H219
  382. Tillmann T219
  383. Watts CH219
  384. Dharmaratne SD220
  385. Dokova K221
  386. Dorsey ER222
  387. Driscoll TR223
  388. Marks GB224
  389. Leigh J225
  390. Duan L226
  391. Li Y226, 362
  392. Liu S226
  393. Ma J226
  394. Wang L226
  395. Ye P226
  396. Zhou M226
  397. Liang X227
  398. Durrani AM228
  399. Elshrek YM229
  400. Ermakov SP230, 231
  401. Soshnikov S231
  402. Eshrati B232
  403. Farzadfar F233
  404. Esteghamati A234
  405. Hafezinejad N234
  406. Sheikhbahaei S234
  407. Sepanlou SG235
  408. Heydarpour P236
  409. Sahraian M236
  410. Rahimimovaghar V237
  411. Ferri CP238, 239
  412. Foigt N240
  413. Franklin RC241
  414. Gamkrelidze A242
  415. Khonelidze I242
  416. Sturua L242
  417. Gankpe FG243, 244
  418. Gasana E245
  419. Sabin N246
  420. Geleijnse JM247
  421. Gessner BD248
  422. Gillum RF250
  423. Ginawi IAM251
  424. Giroud M252
  425. Giussani G253
  426. Goginashvili K254
  427. Gona P255
  428. Goto A256
  429. Guerrant RL4
  430. Terkawi AS257, 517, 518
  431. Gugnani HC258, 259
  432. Gunnell D260
  433. Gupta R261, 262
  434. Hagstromer M263
  435. Halasa YA264
  436. Idrisov BT264
  437. Hamadeh RR265
  438. Hammami M266
  439. Hankey GJ267
  440. Hao Y268
  441. Zheng Y269
  442. Haregu T270, 271
  443. Van De Vijver S270, 271
  444. Haro J272, 273
  445. Hedayati MT274
  446. Hijar M275
  447. Hoffman HJ277
  448. Mensah GA278
  449. Sampson UK279
  450. Hornberger JC280, 281
  451. Hosgood H282
  452. Hsairi M283
  453. Hu G285
  454. Huang C286
  455. Hubbell BJ287
  456. Huiart L288
  457. Racape L288
  458. Husseini A289
  459. Iburg KM290
  460. Ikeda N291
  461. Innos K292
  462. Inoue M293
  463. Kawakami N294
  464. Shibuya K295
  465. Islami F296
  466. Ismayilova S297
  467. Jacobsen KH298
  468. Jansen HA299
  469. Jassal SK300
  470. Jayaraman S301
  471. Jeemon P302
  472. Prabhakaran D302
  473. Jiang F303
  474. Jiang G304
  475. Phillips MR55, 305
  476. Jonas JB306
  477. Juel K307
  478. She J308
  479. Kan H309
  480. Kany Roseline SS310
  481. Karam NE311
  482. Karch A312, 313
  483. Karema CK314
  484. Karthikeyan G315
  485. Paul VK315
  486. Satpathy M315
  487. Tandon N315
  488. Kaul A316
  489. Kazi DS317
  490. Kemp AH318, 319
  491. Lotufo PA318
  492. Polanczyk GV318
  493. Santos IS318
  494. Kengne AP320, 323
  495. Matzopoulos R320, 322
  496. Parry CD320, 439
  497. Sliwa K321
  498. Mayosi BM323
  499. Stein DJ323, 438
  500. Keren A324
  501. Khader YS325
  502. Ali Hassan Khalifa SE326
  503. Khan EA327, 328
  504. Khang Y329
  505. Kieling C330
  506. Kim D331
  507. Kim S332
  508. Kim Y333
  509. Kimokoti RW334
  510. Kinfu Y335
  511. Kissela BM336
  512. Kokubo Y337
  513. Kosen S338
  514. Warouw TS339
  515. Kravchenko M340
  516. Varakin YY340
  517. Krishnaswami S341
  518. Kuate Defo B342
  519. Kuipers EJ343
  520. Polinder S343
  521. Kulkarni C344
  522. Kulkarni VS345
  523. Kwan GF346
  524. Lai T347
  525. Lalloo R348, 349
  526. Lallukka T350, 352
  527. Shiri R351, 496
  528. Lam H353
  529. Lan Q354
  530. Lansingh VC355, 356
  531. Lavados PM357
  532. Lawrynowicz AE358
  533. Leasher JL359
  534. Lee J360
  535. Yoon S360
  536. Levi M361
  537. Liang J363
  538. Wang Y363
  539. Zhu J363
  540. Lipshultz SE365
  541. Lloyd BK366, 367
  542. Room R367
  543. Logroscino G368
  544. Lortettieulent J369
  545. Ma S371, 372
  546. Phua HP371
  547. Magisrodriguez C373
  548. Mahdi AA374
  549. Malekzadeh R375, 376
  550. Mangalam S377
  551. Mapoma CC378
  552. Masiye F378
  553. Marape M379
  554. Marcenes W380
  555. Meaney PA381, 389
  556. Margolis DJ382
  557. Silberberg DH382
  558. Martin RV383
  559. Marzan MB384
  560. Mashal MT385
  561. Masonjones AJ386
  562. Mazorodze TT387
  563. Mckay AC388
  564. Mehndiratta M390
  565. Meltzer M391
  566. Mendoza W392
  567. Apolinary Mhimbira F394
  568. Miller TR395, 396
  569. Mills EJ397
  570. Mishra S398
  571. Mohamed Ibrahim N399
  572. Mohammad KA400
  573. Mola GL401
  574. Monasta L402
  575. Montico M402
  576. Ronfani L402
  577. Moore AR403
  578. Morawska L404
  579. Norman RE405
  580. Mori R406, 407
  581. Tsilimbaris M408
  582. Moschandreas J409
  583. Moturi WN410
  584. Werdecker A411
  585. Mueller UO412
  586. Westerman R412, 547
  587. Mukaigawara M413
  588. Nahas Z414
  589. Naidoo KS415
  590. Naldi L416
  591. Nand D417
  592. Nangia V418
  593. Neal B419
  594. Nejjari C420
  595. Neupane SP421
  596. Newton CR422
  597. Ngalesoni FN423
  598. Ngirabega JD424
  599. Nolla JM425
  600. Vollset SE427
  601. Norheim OF428
  602. Norrving B429
  603. Nyakarahuka L430
  604. Oh I431
  605. Ohkubo T432
  606. Olusanya BO433
  607. Opio JN434
  608. Pagcatipunan RS435
  609. Pandian JD436
  610. Park E437
  611. Seedat S439
  612. Pavlin BI440
  613. Pejin Stokic L441
  614. Pereira DM442
  615. Perezpadilla R443
  616. Perezruiz F444, 445
  617. Perico N446
  618. Remuzzi G446
  619. Trillini M446
  620. Perry SAL447
  621. Pervaiz A448
  622. Pesudovs K449
  623. Peterson CB450
  624. Petzold M451, 452
  625. Plass D453
  626. Poenaru D454, 455
  627. Pond CD456
  628. Pope C457
  629. Popova S458
  630. Rehm J458
  631. Prasad NM459
  632. Qato DM460
  633. Rafay A461, 462
  634. Rana SM461, 462
  635. Ur Rahman S463
  636. Raju M464
  637. Rakovac I465
  638. Rao M466
  639. Razavi H467
  640. Ribeiro AL469
  641. Velasquezmelendez G470
  642. Riccio PM471, 472
  643. Sposato LA471, 472
  644. Roca A473
  645. Romieu I475
  646. Straif K475
  647. Ruhago GM477
  648. Sunguya BF477
  649. Sacco RL478
  650. Saha S479
  651. Sahathevan R480, 481
  652. Sanabria JR482, 483
  653. Sanchezriera L484
  654. Sapkota A485
  655. Saunders JE486
  656. Soneji S487
  657. Sawhney M488
  658. Saylan MI489
  659. Schneider IJC490
  660. Schwebel DC491
  661. Singh JA491
  662. Serdar B492
  663. Shaddick G493
  664. Shinohara Y495
  665. Shishani K497
  666. Shiue I498, 499
  667. Sigfusdottir ID500
  668. Singh A501
  669. Soreide K502
  670. Sreeramareddy CT503
  671. Stapelberg NJC504
  672. Stathopoulou V505
  673. Steckling N506
  674. Stroumpoulis K507, 508
  675. Swaminathan S509
  676. Swaroop M510
  677. Yano Y510, 556
  678. Sykes BL511
  679. Tabb KM512
  680. Talongwa RT513
  681. Tanne D514, 515
  682. Tavakkoli M516
  683. Thackway SV519
  684. Thurston GD520
  685. Topouzis F521
  686. Towbin JA522, 523
  687. Toyoshima H524
  688. Traebert J525
  689. Trujillo U527
  690. Tsala Dimbuene Z528
  691. Tuzcu E529
  692. Uchendu US530
  693. Ukwaja KN531
  694. Van Dingenen R532
  695. Van Gool CH533
  696. Van Os J534
  697. Vasankari TJ535
  698. Vasconcelos AN536
  699. Violante FS538
  700. Victorovich Vlassov V539
  701. Waller SG541
  702. Wallin MT542, 543
  703. Wang W544
  704. Wessells K546
  705. Wilkinson JD548
  706. Williams HC549
  707. Woldeyohannes SM550
  708. Wong JQ551
  709. Woolf AD552
  710. Xu G553
  711. Yan LL554
  712. Yang G555
  713. Yip P557
  714. Yonemoto N558
  715. Younis MZ559
  716. Younoussi Z560
  717. Yu C561, 562
  718. Zaki ME563
  719. Zhao Y564
  720. Zhu S565

Source: The Lancet Published:2015


Abstract

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
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