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Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015 Publisher Pubmed



Forouzanfar MH1 ; Afshin A1 ; Alexander LT1 ; Biryukov S1 ; Brauer M1, 9 ; Cercy K1 ; Charlson FJ1, 11, 15 ; Cohen AJ1, 16 ; Dandona L1, 18 ; Estep K1 ; Ferrari AJ1, 11, 15 ; Frostad JJ1 ; Fullman N1 ; Godwin WW1 Show All Authors
Authors
  1. Forouzanfar MH1
  2. Afshin A1
  3. Alexander LT1
  4. Biryukov S1
  5. Brauer M1, 9
  6. Cercy K1
  7. Charlson FJ1, 11, 15
  8. Cohen AJ1, 16
  9. Dandona L1, 18
  10. Estep K1
  11. Ferrari AJ1, 11, 15
  12. Frostad JJ1
  13. Fullman N1
  14. Godwin WW1
  15. Griswold M1
  16. Hay SI1, 19
  17. Kyu HH1
  18. Larson HJ1, 25, 44
  19. Lim SS1
  20. Liu PY1
  21. Lopez AD1, 29
  22. Lozano R1, 36
  23. Marczak L1
  24. Mokdad AH1
  25. Moradilakeh M1, 425
  26. Naghavi M1
  27. Reitsma MB1
  28. Roth GA1
  29. Sur PJ1
  30. Vos T1
  31. Wagner JA1
  32. Wang H1
  33. Zhao Y1
  34. Zhou M1, 27
  35. Barber RM1
  36. Bell B1
  37. Blore JD1
  38. Casey DC1
  39. Coates MM1
  40. Cooperrider K1
  41. Cornaby L1
  42. Dicker D1
  43. Erskine HE1, 11, 15
  44. Fleming T1
  45. Foreman K1
  46. Gakidou E1
  47. Haagsma JA1, 286
  48. Johnson CO1
  49. Kemmer L1
  50. Ku T1
  51. Leung J1, 11, 15
  52. Masiye F1, 203, 204
  53. Millear A1
  54. Mirarefin M1
  55. Misganaw A1
  56. Mullany E1
  57. Mumford JE1
  58. Ng M1
  59. Olsen H1
  60. Rao P1
  61. Reinig N1
  62. Roman Y1
  63. Sandar L1
  64. Santomauro DF1, 11, 15
  65. Slepak EL1
  66. Sorensen RJD1
  67. Thomas BA1
  68. Vollset SE1, 52, 447
  69. Whiteford HA1, 11, 15
  70. Zipkin B1
  71. Murray CJL1
  72. Mock CN2
  73. Anderson BO3
  74. Futran ND3
  75. Anderson HR4
  76. Bhutta ZA5, 7
  77. Nisar MI6
  78. Akseer N7, 73
  79. Krueger H8
  80. Gotay CC9
  81. Kissoon N9
  82. Kopec JA9
  83. Pourmalek F9
  84. Burnett R10
  85. Abajobir AA11
  86. Knibbs LD11
  87. Veerman JL11
  88. Lalloo R12
  89. Scott JG13
  90. Alam NKM14, 86
  91. Gouda HN14
  92. Guo Y14
  93. Mcgrath JJ14
  94. Jeemon P17, 226, 335
  95. Dandona R18
  96. Goenka S18
  97. Kumar GA18
  98. Gething PW20
  99. Bisanzio D21
  100. Deribew A21, 222
  101. Darby SC22
  102. Ali R23
  103. Bennett DA23
  104. Jha V23, 337
  105. Kinfu Y24
  106. Mckee M26
  107. Murthy GVS26, 435
  108. Pearce N26
  109. Stockl H26
  110. Duan L27
  111. Jin Y27
  112. Li Y27
  113. Liu S27
  114. Wang L27
  115. Ye P27
  116. Liang X28
  117. Azzopardi P30, 32, 132
  118. Patton GC30, 32
  119. Meretoja A31, 415
  120. Alam K32, 34, 42
  121. Borschmann R32, 34
  122. Colquhoun SM32, 34
  123. Weintraub RG32, 34, 591
  124. Szoeke CEI33
  125. Ademi Z34, 69
  126. Taylor HR34
  127. Wijeratne T34, 593
  128. Batis C35, 218
  129. Barquera S36
  130. Camposnonato IR36, 49
  131. Contreras AG36
  132. Cuevasnasu L36
  133. De V36
  134. Gomezdantes H36
  135. Herediapi IB36
  136. Medina C36
  137. Mejiarodriguez F36
  138. Montanez Hernandez JC36
  139. Razogarcia CA36
  140. Rivera JA36
  141. Rodriguezramirez S36
  142. Sanchezpimienta TG36
  143. Servanmori EE36
  144. Shamah T36
  145. Mensah GA37
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  148. Driscoll TR41
  149. Kemp AH42, 352
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  151. Mekonnen AB42, 410
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  155. Rodriguez A45, 501
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  159. Salomon JA47
  160. Thornelyman AL48, 561
  161. Ajala ON49, 82
  162. Barnighausen T49, 140, 141
  163. Cahill LE49, 186
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  165. Farvid MS49, 254
  166. Khatibzadeh S49
  167. Wagner GR49, 584
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  169. Fitchett JRA51
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  174. Gebremedhin AT54, 264
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  176. Abbas KM56
  177. Abdallah F57
  178. Abdulle AM58
  179. Abera SF59, 62, 63
  180. Melaku YA60, 104
  181. Abyu GY61
  182. Betsu BD61
  183. Hailu GB61, 287
  184. Tekle DY61
  185. Yalew AZ61
  186. Abraham B64
  187. Aburaddad LJ65
  188. Adebiyi AO66, 67
  189. Adedeji IA68
  190. Adou AK70
  191. Adsuar JC71
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  202. Aldhahri SF87, 89
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  204. Terkawi AS88, 555, 556
  205. Aldridge RW90
  206. Tillmann T91
  207. Alemu ZA92, 93
  208. Tegegne TK92, 93
  209. Alkerwi A94
  210. Alla F95
  211. Guillemin F95
  212. Allebeck P96
  213. Rabiee RHS96
  214. Fereshtehnejad SM97
  215. Kivipelto M98
  216. Carrero JJ99
  217. Weiderpass E99, 588, 589, 590
  218. Havmoeller R100
  219. Sindi S100
  220. Alsharif U101
  221. Alvarez E102
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  223. Amare AT104, 106
  224. Ciobanu LG105
  225. Taye BW107
  226. Amberbir A108
  227. Amegah AK109
  228. Amini H110, 111
  229. Karema CK112, 346
  230. Ammar W113
  231. Harb HL113
  232. Amrock SM114
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  234. Antonio CAT116
  235. Faraon EJA117, 249
  236. Anwari P118, 119
  237. Arnlov J120, 121
  238. Larsson A120
  239. Artaman A122
  240. Asayesh H123
  241. Asghar RJ124
  242. Assadi R125
  243. Atique S126
  244. Avokpaho EFGA127, 128
  245. Awasthi A129
  246. Ayala BP130, 131
  247. Bacha U133
  248. Bahit MC135
  249. Balakrishnan K136
  250. Barac A137
  251. Barkercollo SL138
  252. Del Pozocruz B139
  253. Mohammed S141, 422
  254. Barregard L142
  255. Petzold M143, 472
  256. Barrero LH144, 145
  257. Basu S146
  258. Del LC146
  259. Bazarganhejazi S147, 148, 149
  260. Beardsley J150
  261. Bedi N151
  262. Beghi E152
  263. Sheth KN153, 315
  264. Bell ML154
  265. Huang JJ154
  266. Bello AK155
  267. Santos IS156
  268. Bensenor IM157
  269. Lotufo PA157
  270. Berhane A158
  271. Wolfe CD159, 594
  272. Bernabe E160
  273. Roba HS161, 271
  274. Beyene AS162
  275. Hassen TA162
  276. Mesfin YM162
  277. Bhala N163, 164
  278. Bhansali A165
  279. Biadgilign S166
  280. Bikbov B167
  281. Bjertness E168
  282. Htet AS169, 308
  283. Boufous S170
  284. Degenhardt L171
  285. Resnikoff S172
  286. Calabria B173, 187
  287. Bourne RRA174
  288. Brainin M175
  289. Brazinova A176, 177
  290. Majdan M176
  291. Shen J178, 523
  292. Breitborde NJK179
  293. Brenner H180
  294. Schottker B180, 515
  295. Broday DM181
  296. Brugha TS182
  297. Brunekreef B183
  298. Kromhout H183
  299. Butt ZA184
  300. Van Donkelaar A185
  301. Martin RV186
  302. Cardenas R188
  303. Carpenter DO189
  304. Castanedaorjuela CA190, 191
  305. Castillo J192, 193
  306. Castro RE194
  307. Catalalopez F195, 196
  308. Chang J197
  309. Chiang PP198
  310. Chibalabala M199
  311. Chimedochir O200
  312. Jiang Y201
  313. Takahashi K202
  314. Chisumpa VH203, 204, 205
  315. Mapoma CC203, 204
  316. Chitheer AA206
  317. Choi JJ207
  318. Christensen H208
  319. Christopher DJ209
  320. Cooper LT210
  321. Crump JA211
  322. Poulton RG212
  323. Damasceno A213
  324. Dargan PI214
  325. Das Neves J215
  326. Davis AC216
  327. Newton JN216
  328. Steel N216, 542
  329. Davletov K217
  330. De Castro EF219
  331. De D220
  332. Dellavalle RP221
  333. Des DC223, 224
  334. Dharmaratne SD225
  335. Dhillon PK227, 436
  336. Lal DK227, 436
  337. Zodpey S227, 436
  338. Diaztorne C228
  339. Dorsey ER229
  340. Doyle KE230
  341. Dubey M231
  342. Rahman MHU231
  343. Ram U231
  344. Singh A231
  345. Yadav AK231
  346. Duncan BB232, 233
  347. Kieling C232, 368
  348. Schmidt MI232
  349. Elyazar I234
  350. Endries AY235
  351. Ermakov SP236, 237
  352. Eshrati B238, 239
  353. Farzadfar F240
  354. Kasaeian A240, 245
  355. Parsaeian M240, 246
  356. Esteghamati A241
  357. Hafezinejad N241
  358. Sheikhbahaei S241
  359. Fahimi S242
  360. Malekzadeh R242
  361. Roshandel G242, 503
  362. Sepanlou SG242
  363. Hassanvand MS243
  364. Heydarpour P244
  365. Rahimimovaghar V247
  366. Yaseri M248, 324
  367. Farid TA250
  368. Khan AR250
  369. Farinha CSES251, 252
  370. Faro A253
  371. Feigin VL255
  372. Fernandes JG256
  373. Fischer F257
  374. Foigt N258
  375. Shiue I259, 530
  376. Fowkes FGR260
  377. Franklin RC261
  378. Garciabasteiro AL262, 263
  379. Geleijnse JM265
  380. Jibat T266, 269, 336
  381. Gessner BD267
  382. Tefera W268
  383. Giref AZ269
  384. Haile D269
  385. Manamo WAA269
  386. Giroud M270
  387. Gishu MD272, 273
  388. Martinezraga J274, 404
  389. Gomezcabrera MC275, 276
  390. Gona P277
  391. Goodridge A278
  392. Gopalani SV279
  393. Goto A280
  394. Inoue M281, 318
  395. Gugnani HC282
  396. Gupta R283, 284
  397. Gutierrez RA285
  398. Orozco R285
  399. Halasa YA288
  400. Undurraga EA288
  401. Hamadeh RR289
  402. Hamidi S290
  403. Handal AJ291
  404. Hankey GJ292, 293, 294
  405. Hao Y295
  406. Harikrishnan S296
  407. Haro JM297, 298
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  409. Hoek HW300, 302
  410. Tura AK301
  411. Horino M303
  412. Horita N304
  413. Hosgood HD305
  414. Hoy DG306
  415. Hsairi M307
  416. Hu G309
  417. Husseini A310
  418. Huybrechts I311, 312
  419. Iburg KM313
  420. Idrisov BT314
  421. Kwan GF153, 315
  422. Ileanu BV316, 317
  423. Pana A316, 317
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  425. Shibuya K320
  426. Jacobs TA321
  427. Jacobsen KH322
  428. Jahanmehr N323
  429. Jakovljevic MB325, 326
  430. Jansen HAF327
  431. Jassal SK328
  432. Stein MB329
  433. Javanbakht M330
  434. Jayaraman SP331
  435. Jayatilleke AU332, 333
  436. Jee SH334
  437. Jonas JB338
  438. Kabir Z339
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  442. Kan H343
  443. Karch A344, 345
  444. Karimkhani C347
  445. Kaul A348
  446. Kazi DS349
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  448. Parry CD353, 356, 439, 440, 517
  449. Kengne AP354, 357
  450. Matzopoulos R354, 355
  451. Wiysonge CS354, 441
  452. Stein DJ356, 440, 543
  453. Mayosi BM357
  454. Keren A358
  455. Khader YS359
  456. Khan EA360
  457. Khan G361
  458. Khang YH362
  459. Won S363
  460. Khera S364, 365
  461. Tavakkoli M364, 365
  462. Khoja TAM366
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  466. Kimokoti RW371
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  472. Kuate B376, 377
  473. Kuchenbecker RS378, 379
  474. Kucuk B380
  475. Kuipers EJ381
  476. Lallukka T382, 383
  477. Shiri R382
  478. Meretoja TJ384, 416
  479. Lan Q385
  480. Latif AA386
  481. Lawrynowicz AEB387
  482. Leasher JL388
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  484. Li X390
  485. Liang J391
  486. Lloyd BK392, 393, 394
  487. Logroscino G395
  488. Lunevicius R396, 397
  489. Pope D398
  490. Mahdavi M399, 400, 401
  491. Malta DC402
  492. Marcenes W403
  493. Matsushita K405
  494. Nachega JB405, 437, 441
  495. Tran BX406, 572
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  497. Mehari A409
  498. Tedla BA410, 554
  499. Memish ZA411, 412
  500. Mendoza W413
  501. Mensink GBM414
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  504. Mills EJ420
  505. Mohammadi A421
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  517. Seedat S441
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  528. Oh I453
  529. Oladimeji O454, 455
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Source: The Lancet Published:2016


Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
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