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

M.H. H. Forouzanfar, A. Afshin, L.T. T. Alexander, H.R. R. Anderson, Z.A. A. Bhutta, S. Biryukov, M. Brauer, R. Burnett, K. Cercy, F.J. J. Charlson, A.J. J. Cohen, L. Dandona, K. Estep, A.J. J. Ferrari, J.J. J. Frostad, N. Fullman, P.W. W. Gething, W.W. W. Godwin, M. Griswold, Y. Kinfu & 623 others H.H. H. Kyu, H.J. J. Larson, X. Liang, S.S. S. Lim, P.Y. Y. Liu, A.D. D. Lopez, R. Lozano, L. Marczak, G.A. A. Mensah, A.H. H. Mokdad, M. Moradi-Lakeh, M. Naghavi, B. Neal, M.B. B. Reitsma, G.A. A. Roth, J.A. A. Salomon, P.J. J. Sur, T. Vos, J.A. A. Wagner, H. Wang, Y. Zhao, M. Zhou, G.M. M. Aasvang, A.A. A. Abajobir, K.H. H. Abate, C. Abbafati, K.M. M. Abbas, F. Abd-Allah, A.M. M. Abdulle, S.F. F. Abera, B. Abraham, L.J. J. Abu-Raddad, G.Y. Y. Abyu, A.O. O. Adebiyi, I.A. A. Adedeji, Z. Ademi, A.K. K. Adou, J.C. C. Adsuar, E.E. E. Agardh, A. Agarwal, A. Agrawal, A.A. A. Kiadaliri, O.N. N. Ajala, T.F. F. Akinyemiju, Z. Al-Aly, K. Alam, N.K.M. K.M. Alam, S.F. F. Aldhahri, R.W. W. 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M. Broday, T.S. S. Brugha, B. Brunekreef, Z.A. A. Butt, L.E. E. Cahill, B. Calabria, I.R. R. Campos-Nonato, R. Cárdenas, D.O. O. Carpenter, D.C. C. Casey, C.A. A. Castañeda-Orjuela, J.C. C. Rivas, R.E. E. Castro, F. Catalá-López, J.-C. -C. Chang, P.P.-C. P.-C. Chiang, M. Chibalabala, O. Chimed-Ochir, V.H. H. Chisumpa, A.A. A. Chitheer, J.-Y.J. -Y.J. Choi, H. Christensen, D.J. J. Christopher, L.G. G. Ciobanu, M.M. M. Coates, S.M. M. Colquhoun, L.T. T. Cooper, K. Cooperrider, L. Cornaby, M. Cortinovis, J.A. A. Crump, L. Cuevas-Nasu, A. Damasceno, R. Dandona, S.C. C. Darby, P.I. I. Dargan, J. das Neves, A.C. C. Davis, K. Davletov, E.F. F. de Castro, V. De la Cruz-Góngora, D. De Leo, L. Degenhardt, L.C. C. Del Gobbo, B. del Pozo-Cruz, R.P. P. Dellavalle, A. Deribew, D.C.D. C.D. Jarlais, S.D. D. Dharmaratne, P.K. K. Dhillon, C. Diaz-Torné, D. Dicker, E.L. L. Ding, E.R. R. Dorsey, K.E. E. Doyle, T.R. R. Driscoll, L. Duan, M. Dubey, B.B. B. Duncan, I. Elyazar, A.Y. Y. Endries, S.P. P. Ermakov, H.E. E. Erskine, B. Eshrati, A. Esteghamati, S. Fahimi, E.J.A. J.A. Faraon, T.A. A. Farid, C.S.E.S. S.E.S. Farinha, A. Faro, M.S. S. Farvid, F. Farzadfar, V.L. L. Feigin, S.-M. -M. Fereshtehnejad, J.G. G. Fernandes, F. Fischer, J.R.A. R.A. Fitchett, T. Fleming, N. Foigt, K. Foreman, F.G.R. G.R. Fowkes, R.C. C. Franklin, T. Fürst, N.D. D. Futran, E. Gakidou, A.L. L. Garcia-Basteiro, T.T. T. Gebrehiwot, A.T. T. Gebremedhin, J.M. M. Geleijnse, B.D. D. Gessner, A.Z. Z. Giref, M. Giroud, M.D. D. Gishu, S. Goenka, M.C. C. Gomez-Cabrera, H. Gomez-Dantes, P. Gona, A. Goodridge, S.V. V. Gopalani, C.C. C. Gotay, A. Goto, H.N. N. Gouda, H.C. C. Gugnani, F. Guillemin, Y. Guo, R. Gupta, R.A. A. Gutiérrez, J.A. A. Haagsma, N. Hafezi-Nejad, D. Haile, G.B. B. Hailu, Y.A. A. Halasa, R.R. R. Hamadeh, S. Hamidi, A.J. J. Handal, Graeme J. Hankey, Y. Hao, H.L. L. Harb, S. Harikrishnan, J.M. M. Haro, M.S. S. Hassanvand, T.A. A. Hassen, R. Havmoeller, I.B. B. Heredia-Pi, N.F. F. Hernández-Llanes, P. Heydarpour, H.W. W. Hoek, H.J. J. Hoffman, M. Horino, N. Horita, H.D. D. Hosgood, D.G. G. Hoy, M. Hsairi, A.S. S. Htet, G. Hu, J.J. J. Huang, A. Husseini, S.J. J. Hutchings, I. Huybrechts, K.M. M. Iburg, B.T. T. Idrisov, B.V. V. Ileanu, M. Inoue, T.A. A. Jacobs, K.H. H. Jacobsen, N. Jahanmehr, M.B. B. Jakovljevic, H.A.F.M. A.F.M. Jansen, S.K. K. Jassal, M. Javanbakht, A.U. U. Jayatilleke, S.H. H. Jee, P. Jeemon, V. Jha, Y. Jiang, T. Jibat, Y. Jin, C.O. O. Johnson, J.B. B. Jonas, Z. Kabir, Y. Kalkonde, R. Kamal, H. Kan, A. Karch, C.K. K. Karema, C. Karimkhani, A. Kasaeian, A. Kaul, N. Kawakami, D.S. S. Kazi, P.N. N. Keiyoro, A.H. H. Kemp, A.P. P. Kengne, A. Keren, C.N. N. Kesavachandran, Y.S. S. Khader, A.R. R. Khan, E.A. A. Khan, G. Khan, Y.-H. -H. Khang, S. Khatibzadeh, S. Khera, T.A.M. A.M. Khoja, J. Khubchandani, C. Kieling, C.-I. -I. Kim, D. Kim, R.W. W. Kimokoti, N. Kissoon, M. Kivipelto, L.D. D. Knibbs, Y. Kokubo, J.A. A. Kopec, P.A. A. Koul, A. Koyanagi, M. 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    Abstract

    © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licenseBackground 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
    Original languageEnglish
    Pages (from-to)1659-1724
    Number of pages66
    JournalThe Lancet
    Volume388
    Issue number10053
    DOIs
    Publication statusPublished - Oct 2016

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