TY - JOUR
T1 - Global burden of 87 risk factors in 204 countries and territories, 1990-2019
T2 - a systematic analysis for the Global Burden of Disease Study 2019
AU - GBD 2019 Risk Factors Collaborators
AU - Abbafati, Cristiana
AU - Abbas, Kaja M.
AU - Abbasi-Kangevari, Mohsen
AU - Abd-Allah, Foad
AU - Abdelalim, Ahmed
AU - Abdollahi, Mohammad
AU - Abdollahpour, Ibrahim
AU - Abegaz, Kedir Hussein
AU - Abolhassani, Hassan
AU - Aboyans, Victor
AU - Abreu, Lucas Guimarães
AU - Abrigo, Michael R.M.
AU - Abualhasan, Ahmed
AU - Abu-Raddad, Laith Jamal
AU - Abushouk, Abdelrahman I.
AU - Adabi, Maryam
AU - Adekanmbi, Victor
AU - Adeoye, Abiodun Moshood
AU - Adetokunboh, Olatunji O.
AU - Adham, Davoud
AU - Advani, Shailesh M.
AU - Afshin, Ashkan
AU - Agarwal, Gina
AU - Aghamir, Seyed Mohammad Kazem
AU - Agrawal, Anurag
AU - Ahmad, Tauseef
AU - Ahmadi, Keivan
AU - Ahmadi, Mehdi
AU - Ahmadieh, Hamid
AU - Ahmed, Muktar Beshir
AU - Akalu, Temesgen Yihunie
AU - Akinyemi, Rufus Olusola
AU - Akinyemiju, Tomi
AU - Akombi, Blessing
AU - Akunna, Chisom Joyqueenet
AU - Alahdab, Fares
AU - Al-Aly, Ziyad
AU - Alam, Khurshid
AU - Alam, Samiah
AU - Alam, Tahiya
AU - Alanezi, Fahad Mashhour
AU - Alanzi, Turki M.
AU - Alemu, Biresaw Wassihun
AU - Alhabib, Khalid F.
AU - Ali, Muhammad
AU - Ali, Saqib
AU - Alicandro, Gianfranco
AU - Alinia, Cyrus
AU - Alipour, Vahid
AU - Alizade, Hesam
AU - Aljunid, Syed Mohamed
AU - Alla, François
AU - Allebeck, Peter
AU - Almasi-Hashiani, Amir
AU - Al-Mekhlafi, Hesham M.
AU - Alonso, Jordi
AU - Altirkawi, Khalid A.
AU - Amini-Rarani, Mostafa
AU - Amiri, Fatemeh
AU - Amugsi, Dickson A.
AU - Ancuceanu, Robert
AU - Anderlini, Deanna
AU - Anderson, Jason A.
AU - Andrei, Catalina Liliana
AU - Andrei, Tudorel
AU - Angus, Colin
AU - Anjomshoa, Mina
AU - Ansari, Fereshteh
AU - Ansari-Moghaddam, Alireza
AU - Antonazzo, Ippazio Cosimo
AU - Antonio, Carl Abelardo T.
AU - Antony, Catherine M.
AU - Antriyandarti, Ernoiz
AU - Anvari, Davood
AU - Anwer, Razique
AU - Appiah, Seth Christopher Yaw
AU - Arabloo, Jalal
AU - Arab-Zozani, Morteza
AU - Aravkin, Aleksandr Y.
AU - Ariani, Filippo
AU - Armoon, Bahram
AU - Ärnlöv, Johan
AU - Arzani, Afsaneh
AU - Asadi-Aliabadi, Mehran
AU - Asadi-Pooya, Ali A.
AU - Ashbaugh, Charlie
AU - Assmus, Michael
AU - Atafar, Zahra
AU - Atnafu, Desta Debalkie
AU - Atout, Maha Moh d.Wahbi
AU - Ausloos, Floriane
AU - Ausloos, Marcel
AU - Ayala Quintanilla, Beatriz Paulina
AU - Ayano, Getinet
AU - Ayanore, Martin Amogre
AU - Azari, Samad
AU - Azarian, Ghasem
AU - Azene, Zelalem Nigussie
AU - Badawi, Alaa
AU - Badiye, Ashish D.
AU - Bahrami, Mohammad Amin
AU - Bakhshaei, Mohammad Hossein
AU - Bakhtiari, Ahad
AU - Bakkannavar, Shankar M.
AU - Baldasseroni, Alberto
AU - Ball, Kylie
AU - Ballew, Shoshana H.
AU - Balzi, Daniela
AU - Banach, Maciej
AU - Banerjee, Srikanta K.
AU - Bante, Agegnehu Bante
AU - Baraki, Adhanom Gebreegziabher
AU - Barker-Collo, Suzanne Lyn
AU - Bärnighausen, Till Winfried
AU - Barrero, Lope H.
AU - Barthelemy, Celine M.
AU - Barua, Lingkan
AU - Basu, Sanjay
AU - Baune, Bernhard T.
AU - Bayati, Mohsen
AU - Becker, Jacob S.
AU - Bedi, Neeraj
AU - Beghi, Ettore
AU - Béjot, Yannick
AU - Bell, Michelle L.
AU - Bennitt, Fiona B.
AU - Bensenor, Isabela M.
AU - Berhe, Kidanemaryam
AU - Berman, Adam E.
AU - Bhagavathula, Akshaya Srikanth
AU - Bhageerathy, Reshmi
AU - Bhala, Neeraj
AU - Bhandari, Dinesh
AU - Bhattacharyya, Krittika
AU - Bhutta, Zulfiqar A.
AU - Bijani, Ali
AU - Bikbov, Boris
AU - Bin Sayeed, Muhammad Shahdaat
AU - Biondi, Antonio
AU - Birihane, Binyam Minuye
AU - Bisignano, Catherine
AU - Biswas, Raaj Kishore
AU - Bitew, Helen
AU - Bohlouli, Somayeh
AU - Bohluli, Mehdi
AU - Boon-Dooley, Alexandra S.
AU - Borges, Guilherme
AU - Borzì, Antonio Maria
AU - Borzouei, Shiva
AU - Bosetti, Cristina
AU - Boufous, Soufiane
AU - Braithwaite, Dejana
AU - Brauer, Michael
AU - Breitborde, Nicholas J.K.
AU - Breitner, Susanne
AU - Brenner, Hermann
AU - Briant, Paul Svitil
AU - Briko, Andrey Nikolaevich
AU - Briko, Nikolay Ivanovich
AU - Britton, Gabrielle B.
AU - Bryazka, Dana
AU - Bumgarner, Blair R.
AU - Burkart, Katrin
AU - Burnett, Richard Thomas
AU - Burugina Nagaraja, Sharath
AU - Butt, Zahid A.
AU - Caetano Dos Santos, Florentino Luciano
AU - Cahill, Leah E.
AU - Cámera, Luis Alberto
AU - Campos-Nonato, Ismael R.
AU - Cárdenas, Rosario
AU - Carreras, Giulia
AU - Carrero, Juan J.
AU - Carvalho, Felix
AU - Castaldelli-Maia, Joao Mauricio
AU - Castañeda-Orjuela, Carlos A.
AU - Castelpietra, Giulio
AU - Castro, Franz
AU - Causey, Kate
AU - Cederroth, Christopher R.
AU - Cercy, Kelly M.
AU - Cerin, Ester
AU - Chandan, Joht Singh
AU - Chang, Kai Lan
AU - Charlson, Fiona J.
AU - Chattu, Vijay Kumar
AU - Chaturvedi, Sarika
AU - Cherbuin, Nicolas
AU - Chimed-Ochir, Odgerel
AU - Cho, Daniel Youngwhan
AU - Choi, Jee Young Jasmine
AU - Christensen, Hanne
AU - Chu, Dinh Toi
AU - Chung, Michael T.
AU - Chung, Sheng Chia
AU - Cicuttini, Flavia M.
AU - Ciobanu, Liliana G.
AU - Cirillo, Massimo
AU - Classen, Thomas Khaled Dwayne
AU - Cohen, Aaron J.
AU - Compton, Kelly
AU - Cooper, Owen R.
AU - Costa, Vera Marisa
AU - Cousin, Ewerton
AU - Cowden, Richard G.
AU - Cross, Di H.
AU - Cruz, Jessica A.
AU - Dahlawi, Saad M.A.
AU - Damasceno, Albertino Antonio Moura
AU - Damiani, Giovanni
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dangel, William James
AU - Danielsson, Anna Karin
AU - Dargan, Paul I.
AU - Darwesh, Aso Mohammad
AU - Daryani, Ahmad
AU - Das, Jai K.
AU - Das Gupta, Rajat
AU - das Neves, José
AU - Dávila-Cervantes, Claudio Alberto
AU - Davitoiu, Dragos Virgil
AU - De Leo, Diego
AU - Degenhardt, Louisa
AU - DeLang, Marissa
AU - Dellavalle, Robert Paul
AU - Demeke, Feleke Mekonnen
AU - Demoz, Gebre Teklemariam
AU - Demsie, Desalegn Getnet
AU - Denova-Gutiérrez, Edgar
AU - Dervenis, Nikolaos
AU - Dhungana, Govinda Prasad
AU - Dianatinasab, Mostafa
AU - Dias da Silva, Diana
AU - Diaz, Daniel
AU - Dibaji Forooshani, Zahra Sadat
AU - Djalalinia, Shirin
AU - Do, Hoa Thi
AU - Dokova, Klara
AU - Dorostkar, Fariba
AU - Doshmangir, Leila
AU - Driscoll, Tim Robert
AU - Duncan, Bruce B.
AU - Duraes, Andre Rodrigues
AU - Eagan, Arielle Wilder
AU - Edvardsson, David
AU - El Nahas, Nevine
AU - Hankey, Graeme J.
AU - Sahebkar, Amirhossein
AU - Schlaich, Markus P.
AU - Takahashi, Ken
PY - 2020/10/17
Y1 - 2020/10/17
N2 - BACKGROUND: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.METHODS: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.FINDINGS: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older.INTERPRETATION: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.FUNDING: Bill & Melinda Gates Foundation.
AB - BACKGROUND: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.METHODS: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.FINDINGS: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older.INTERPRETATION: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.FUNDING: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85092451099&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(20)30752-2
DO - 10.1016/S0140-6736(20)30752-2
M3 - Article
C2 - 33069327
SN - 0140-6736
VL - 396
SP - 1223
EP - 1249
JO - Lancet
JF - Lancet
IS - 10258
ER -