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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 Publisher Pubmed



Gakidou E1 ; Afshin A1 ; Abajobir AA4 ; Abate KH6 ; Abbafati C7 ; Abbas KM8 ; Abdallah F9 ; Abdulle AM10 ; Abera SF11, 12, 14 ; Aboyans V15 ; Aburaddad LJ16 ; Aburmeileh NME17 ; Abyu GY13 ; Adedeji IA18 Show All Authors
Authors
  1. Gakidou E1
  2. Afshin A1
  3. Abajobir AA4
  4. Abate KH6
  5. Abbafati C7
  6. Abbas KM8
  7. Abdallah F9
  8. Abdulle AM10
  9. Abera SF11, 12, 14
  10. Aboyans V15
  11. Aburaddad LJ16
  12. Aburmeileh NME17
  13. Abyu GY13
  14. Adedeji IA18
  15. Adetokunboh O19
  16. Afarideh M78
  17. Agrawal A20, 21
  18. Agrawal S24
  19. Ahmad Kiadaliri A25
  20. Ahmadieh H27, 29
  21. Ahmed MB6
  22. Aichour AN30
  23. Aichour I31
  24. Aichour MTE32
  25. Akinyemi RO33, 34
  26. Akseer N35, 36
  27. Alahdab F39, 40
  28. Alaly Z41
  29. Alam K42, 46, 47, 488
  30. Alam N48
  31. Alam T1
  32. Alasfoor D49
  33. Alene KA50, 51
  34. Ali K1
  35. Alizadehnavaei R52
  36. Alkerwi A54
  37. Alla F55
  38. Allebeck P56
  39. Alraddadi R60
  40. Alsharif U61
  41. Altirkawi KA62
  42. Alvisguzman N63
  43. Amare AT64, 66
  44. Amini E67, 69
  45. Ammar W79
  46. Amoako YA80
  47. Ansari H81
  48. Anto JM82
  49. Antonio CAT83
  50. Anwari P84
  51. Arian N1
  52. Arnlov J57, 85
  53. Artaman A86
  54. Aryal KK87, 88
  55. Asayesh H89
  56. Asgedom SW13
  57. Atey TM13
  58. Avilaburgos L91
  59. Avokpaho EFGA92, 93
  60. Awasthi A94
  61. Azzopardi P42, 43, 95, 96
  62. Bacha U97
  63. Badawi A37, 98
  64. Balakrishnan K99
  65. Ballew SH100
  66. Barac A101
  67. Barber RM1
  68. Barkercollo SL104
  69. Barnighausen T105, 108, 109
  70. Barquera S91
  71. Barregard L110
  72. Barrero LH111
  73. Batis C90
  74. Battle KE112
  75. Baune BT64
  76. Beardsley J116
  77. Bedi N117
  78. Beghi E118
  79. Bell ML119
  80. Bennett DA114
  81. Bennett JR1
  82. Bensenor IM121
  83. Berhane A122
  84. Berhe DF13, 123
  85. Bernabe E125
  86. Betsu BD13
  87. Beuran M126, 127
  88. Beyene AS128
  89. Bhansali A129
  90. Bhutta ZA35, 130
  91. Bikbov B118
  92. Birungi C132
  93. Biryukov S1
  94. Blosser CD3
  95. Boneya DJ133
  96. Bouorm IR79
  97. Brauer M1, 134
  98. Breitborde NJK135
  99. Brenner H136
  100. Brugha TS137
  101. Bulto LNB128
  102. Baumgarner BR1
  103. Butt ZA138
  104. Cahuanahurtado L91
  105. Cardenas R139
  106. Carrero JJ58
  107. Castanedaorjuela CA140, 141
  108. Catalalopez F142, 143
  109. Cercy K1
  110. Chang HY144, 145
  111. Charlson FJ1, 4, 146
  112. Chimedochir O147
  113. Chisumpa VH148, 149
  114. Chitheer AA150
  115. Christensen H151
  116. Christopher DJ152
  117. Cirillo M153
  118. Cohen AJ1, 154
  119. Comfort H1
  120. Cooper C155, 156
  121. Coresh J100
  122. Cornaby L1
  123. Cortesi PA157
  124. Criqui MH158
  125. Crump JA159
  126. Dandona L1, 24
  127. Dandona R1, 24
  128. Das Neves J160
  129. Davey G162
  130. Davitoiu DV126
  131. Davletov K163, 164
  132. De Courten B165
  133. Degenhardt L1, 166
  134. Deiparine S1
  135. Dellavalle RP169
  136. Deribe K170, 171
  137. Deshpande A1
  138. Dharmaratne SD172
  139. Ding EL106
  140. Djalalinia S173
  141. Do HP174
  142. Dokova K175
  143. Doku DT176, 177
  144. Dorsey ER178
  145. Driscoll TR47
  146. Dubey M179
  147. Duncan BB180, 181
  148. Duncan S1
  149. Ebert N61
  150. Ebrahimi H68, 73
  151. Elkhatib ZZ56, 182
  152. Enayati A183
  153. Endries AY184
  154. Ermakov SP185, 186
  155. Erskine HE1, 4, 146
  156. Eshrati B187, 188
  157. Eskandarieh S189
  158. Esteghamati A69
  159. Estep K1
  160. Faraon EJA83, 190
  161. Farinha CSES191, 192
  162. Faro A193
  163. Farzadfar F68
  164. Fay K1
  165. Feigin VL194
  166. Fereshtehnejad SM59
  167. Fernandes JC195
  168. Ferrari AJ1, 4, 146
  169. Feyissa TR196
  170. Filip I197
  171. Fischer F198
  172. Fitzmaurice C1, 2, 199
  173. Flaxman AD1
  174. Foigt N200
  175. Foreman KJ1, 202
  176. Frostad JJ1
  177. Fullman N1
  178. Furst T201, 203, 204
  179. Furtado JM205
  180. Ganji M78
  181. Garciabasteiro AL206, 207
  182. Gebrehiwot TT6
  183. Geleijnse JM208
  184. Geleto A128, 209
  185. Gemechu BL210
  186. Gesesew HA6, 211
  187. Gething PW115
  188. Ghajar A78
  189. Gibney KB212
  190. Gill PS213
  191. Gillum RF214
  192. Giref AZ171
  193. Gishu MD128, 215
  194. Giussani G118
  195. Godwin WW1
  196. Gona PN216
  197. Goodridge A217
  198. Gopalani SV218
  199. Goryakin Y219
  200. Goulart AC120, 220
  201. Graetz N1
  202. Gugnani HC221
  203. Guo J1
  204. Gupta R222
  205. Gupta T223, 224
  206. Gupta V225
  207. Gutierrez RA226
  208. Hachinski V227
  209. Hafezinejad N69
  210. Hailu GB13, 228
  211. Hamadeh RR229
  212. Hamidi S230
  213. Hammami M231
  214. Handal AJ232
  215. Hankey GJ233, 234, 235
  216. Harb HL79
  217. Hareri HA171
  218. Hassanvand MS70
  219. Havmoeller R59
  220. Hawley C1
  221. Hay SI1, 113
  222. Hedayati MT53
  223. Hendrie D236
  224. Herediapi IB91
  225. Hoek HW124, 238
  226. Horita N239
  227. Hosgood HD224
  228. Hostiuc S126
  229. Hoy DG240
  230. Hsairi M241
  231. Hu G242
  232. Huang H243
  233. Huang JJ119
  234. Iburg KM244
  235. Ikeda C1
  236. Inoue M245
  237. Irvine CMS1
  238. Jackson MD246
  239. Jacobsen KH247
  240. Jahanmehr N28
  241. Jakovljevic MB3, 248
  242. Jauregui A91
  243. Javanbakht M249
  244. Jeemon P22, 250
  245. Johansson LRK251
  246. Johnson CO1
  247. Jonas JB252
  248. Jurisson M253
  249. Kabir Z254
  250. Kadel R255
  251. Kahsay A13
  252. Kamal R256
  253. Karch A257, 258
  254. Karema CK203, 259
  255. Kasaeian A69, 71
  256. Kassebaum NJ1, 260
  257. Kastor A179
  258. Katikireddi SV261
  259. Kawakami N262
  260. Keiyoro PN264, 265
  261. Kelbore SG171
  262. Kemmer L1
  263. Kengne AP268, 271
  264. Kesavachandran CN256
  265. Khader YS272
  266. Khalil IA1
  267. Khan EA273
  268. Khang YH274, 275
  269. Khosravi A68, 276
  270. Khubchandani J277
  271. Kieling C180, 278
  272. Kim D279
  273. Kim JY1
  274. Kim YJ280
  275. Kimokoti RW281
  276. Kinfu Y282
  277. Kisa A283
  278. Kissimovaskarbek KA285
  279. Kivimaki M131, 286
  280. Knibbs LD4
  281. Knudsen AK289, 290
  282. Kopec JA134
  283. Kosen S293
  284. Koul PA294
  285. Koyanagi A295
  286. Kravchenko M296
  287. Krohn KJ1
  288. Kromhout H297
  289. Kuate Defo B298
  290. Kucuk Bicer B299
  291. Kumar GA24
  292. Kutz M1
  293. Kyu HH1
  294. Lal DK24
  295. Lalloo R5
  296. Lallukka T287
  297. Lan Q300
  298. Lansingh VC301, 302
  299. Larsson A303
  300. Lee A1
  301. Lee PH304
  302. Leigh J47, 488
  303. Leung J1, 4
  304. Levi M305
  305. Li Y306
  306. Li Y306
  307. Liang X308
  308. Liben ML310
  309. Linn S311
  310. Liu P1
  311. Lodha R312
  312. Logroscino G313
  313. Looker KJ314
  314. Lopez AD44
  315. Lorkowski S315, 318
  316. Lotufo PA121
  317. Lozano R91
  318. Lunevicius R316, 317
  319. Macarayan ERK107, 319
  320. Magdy Abd El Razek H320
  321. Magdy Abd El Razek M321
  322. Majdan M322
  323. Majdzadeh R72, 323
  324. Majeed A202
  325. Malekzadeh R74
  326. Malhotra R312
  327. Malta DC324
  328. Mamun AA325
  329. Manguerra H1
  330. Mantovani LG326
  331. Mapoma CC148
  332. Martin RV328
  333. Martinezraga J329, 330
  334. Martinsmelo FR331
  335. Mathur MR24, 132
  336. Matsushita K100
  337. Matzopoulos R268, 269
  338. Mazidi M332
  339. Mcalinden C333, 334
  340. Mcgrath JJ244, 335, 336, 337
  341. Mehata S338
  342. Mehndiratta MM339
  343. Meier T340
  344. Melaku YA11, 64
  345. Memiah P341
  346. Memish ZA342, 343
  347. Mendoza W344
  348. Mengesha MM128
  349. Mensah GA345
  350. Mensink GBM346
  351. Mereta ST6
  352. Meretoja A45, 347
  353. Meretoja TJ288, 348
  354. Mezgebe HB13
  355. Micha R349
  356. Millear A1
  357. Miller TR237, 351
  358. Minnig S1
  359. Mirarefin M1, 352
  360. Mirrakhimov EM353, 354
  361. Misganaw A1
  362. Mishra SR5, 355
  363. Mohammad KA356, 357
  364. Mohammed KE12
  365. Mohammed S109, 358
  366. Mohamed Ibrahim N431
  367. Mohan MBV360
  368. Mokdad AH1
  369. Monasta L361
  370. Montanez Hernandez JC91
  371. Montico M361
  372. Moradilakeh M362, 363
  373. Moraga P364
  374. Morawska L365
  375. Morrison SD3
  376. Mountjoyvenning C1
  377. Mueller UO368
  378. Mullany EC1
  379. Muller K1
  380. Murthy GVS23, 369
  381. Musa KI370
  382. Naghavi M1
  383. Naheed A371
  384. Nangia V372
  385. Natarajan G373
  386. Negoi I126, 127
  387. Negoi RI126
  388. Nguyen CT174
  389. Nguyen G1
  390. Nguyen M1
  391. Nguyen QL174
  392. Nguyen TH174
  393. Nichols E1
  394. Ningrum DNA374, 375
  395. Nomura M376
  396. Nong VM174
  397. Norheim OF292
  398. Norrving B26
  399. Noubiap JJN271, 377
  400. Obermeyer CM378
  401. Ogbo FA379
  402. Oh IH381
  403. Oladimeji O382
  404. Olagunju AT65
  405. Olagunju TO227, 383, 384, 385
  406. Olivares PR386
  407. Olsen HE1
  408. Olusanya BO387
  409. Olusanya JO387
  410. Opio JN388
  411. Oren E389
  412. Ortiz A390
  413. Ota E391
  414. Owolabi MO392, 393
  415. Pa M394
  416. Pacella RE366
  417. Pana A395
  418. Panda BK179
  419. Pandajonas S396
  420. Pandian JD397
  421. Papachristou C398
  422. Park EK399
  423. Parry CD19, 266
  424. Patten SB400
  425. Patton GC43
  426. Pereira DM402
  427. Perico N118
  428. Pesudovs K211
  429. Petzold M403, 404
  430. Phillips MR405, 406
  431. Pillay JD407
  432. Piradov MA296
  433. Pishgar F67, 68
  434. Plass D408
  435. Pletcher MA1
  436. Polinder S410
  437. Popova S38
  438. Poulton RG159
  439. Pourmalek F134
  440. Prasad N411
  441. Purcell C1
  442. Qorbani M412
  443. Radfar A413
  444. Rafay A414, 415
  445. Rahimimovaghar A75
  446. Rahimimovaghar V76
  447. Rahman M416
  448. Rahman MHU179
  449. Rahman MA46, 418
  450. Rai RK419
  451. Rajsic S420
  452. Ram U179
  453. Rawaf S202
  454. Rehm CD223
  455. Rehm J36, 421
  456. Reiner RC1
  457. Reitsma MB1
  458. Reynalesshigematsu LM91
  459. Remuzzi G118, 422, 423
  460. Renzaho AMN380
  461. Resnikoff S167, 168
  462. Rezaei S424
  463. Ribeiro AL425
  464. Rivera JA91
  465. Roba KT128
  466. Rojasrueda D426
  467. Roman Y1
  468. Room R417
  469. Roshandel G74, 427
  470. Roth GA1
  471. Rothenbacher D428
  472. Rubagotti E429
  473. Rushton L202
  474. Sadat N1
  475. Safdarian M76
  476. Safi S27
  477. Safiri S430
  478. Sahathevan R432, 433
  479. Salama J1
  480. Salomon JA105
  481. Samy AM434
  482. Sanabria JR435, 437
  483. Sancheznino MD438
  484. Sanchezpimienta TG91
  485. Santomauro D1, 4, 146
  486. Santos IS121
  487. Santric Milicevic MM102, 103
  488. Sartorius B267, 439, 444
  489. Satpathy M441, 465
  490. Sawhney M436
  491. Saxena S202
  492. Schaeffner E61
  493. Schmidt MI180
  494. Schneider IJC442
  495. Schutte AE443, 445
  496. Schwebel DC446
  497. Schwendicke F447
  498. Seedat S19
  499. Sepanlou SG74
  500. Serdar B448
  501. Servanmori EE91
  502. Shaddick G449
  503. Shaheen A450
  504. Shahraz S451
  505. Shaikh MA452
  506. Shamah Levy T91
  507. Shamsipour M77
  508. Shamsizadeh M453
  509. Shariful Islam SM371, 454
  510. Sharma J455
  511. Sharma R456
  512. She J457
  513. Shen J135, 458
  514. Shi P350
  515. Shibuya K263
  516. Shields C1
  517. Shiferaw MS128
  518. Shigematsu M459, 460
  519. Shin MJ461
  520. Shiri R287
  521. Shirkoohi R78
  522. Shishani K463
  523. Shoman H202
  524. Shrime MG464
  525. Sigfusdottir ID441, 465
  526. Silva DAS466
  527. Silva JP161
  528. Silveira DGA467
  529. Singh JA446
  530. Singh V468
  531. Sinha DN469, 470
  532. Skiadaresi E471, 472
  533. Slepak EL1
  534. Smith DL1
  535. Smith M1
  536. Sobaih BHA62, 473
  537. Sobngwi E474, 475
  538. Soneji S476
  539. Sorensen RJD1
  540. Sposato LA227
  541. Sreeramareddy CT477
  542. Srinivasan V1
  543. Steel N478, 479
  544. Stein DJ270, 480
  545. Steiner C1
  546. Steinke S481
  547. Stokes MA482
  548. Strub B1
  549. Subart M1
  550. Sufiyan MB359
  551. Suliankatchi RA483
  552. Sur PJ1
  553. Swaminathan S484
  554. Sykes BL485
  555. Szoeke CEI46
  556. Tabaresseisdedos R142
  557. Tadakamadla SK486
  558. Takahashi K487
  559. Takala JS489, 490
  560. Tandon N312
  561. Tanner M204
  562. Tarekegn YL491
  563. Tavakkoli M492
  564. Tegegne TK133
  565. Tehranibanihashemi A362
  566. Terkawi AS493, 494, 495
  567. Tesssema B50
  568. Thakur JS497
  569. Thamsuwan O1
  570. Thankappan KR498
  571. Theis AM1
  572. Thomas ML449
  573. Thomson AJ499
  574. Thrift AG165
  575. Tillmann T132
  576. Tobegai R500
  577. Tobollik M409
  578. Tollanes MC292, 501
  579. Tonelli M401
  580. Topormadry R284, 502
  581. Torre A1
  582. Tortajada M329, 503
  583. Touvier M504
  584. Tran BX100, 505
  585. Truelsen T506
  586. Tuem KB13
  587. Tuzcu EM496
  588. Tyrovolas S507
  589. Ukwaja KN508
  590. Uneke CJ509
  591. Updike R1
  592. Uthman OA510
  593. Van Boven JFM124
  594. Van Donkelaar A327
  595. Varughese S152
  596. Vasankari T511
  597. Veerman LJ4
  598. Venkateswaran V1
  599. Venketasubramanian N512
  600. Violante FS513
  601. Vladimirov SK514
  602. Vlassov VV515
  603. Vollset SE1, 289, 291
  604. Vos T1
  605. Wadilo F516
  606. Wakayo T6
  607. Wallin MT517, 518
  608. Wang YP519
  609. Weichenthal S520
  610. Weiderpass E58, 521, 522, 523
  611. Weintraub RG42, 46, 524
  612. Weiss DJ115
  613. Werdecker A367
  614. Westerman R368, 525
  615. Whiteford HA1, 4, 146
  616. Wiysonge CS19, 526
  617. Woldeyes BG171
  618. Wolfe CDA125, 527
  619. Woodbrook R1
  620. Workicho A6, 528
  621. Wulf Hanson S1
  622. Xavier D529
  623. Xu G530
  624. Yadgir S1
  625. Yakob B440
  626. Yan LL531
  627. Yaseri M27, 78
  628. Yimam HH532
  629. Yip P533, 534
  630. Yonemoto N535
  631. Yoon SJ462
  632. Yotebieng M135, 536
  633. Younis MZ537
  634. Zaidi Z538
  635. El Sayed Zaki M539
  636. Zavalaarciniega L91
  637. Zhang X540
  638. Zimsen SRM1
  639. Zipkin B1
  640. Zodpey S24
  641. Lim SS1
  642. Murray CJL1

Source: The Lancet Published:2017


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. © The Author(s). Published by Elsevier Ltd.
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