A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010

Stephen S. Lim, Theo Vos, Abraham D. Flaxman, Goodarz Danaei, Kenji Shibuya, Heather Adair-Rohani, Markus Amann, H. Ross Anderson, Kathryn G. Andrews, Martin Aryee, Charles Atkinson, Loraine J. Bacchus, Adil N. Bahalim, Kalpana Balakrishnan, John Balmes, Suzanne Barker-Collo, Amanda Baxter, Michelle L. Bell, Jed D. Blore, Fiona BlythCarissa Bonner, Guilherme Borges, Rupert Bourne, Michel Boussinesq, Michael Brauer, Peter Brooks, Nigel G. Bruce, Bert Brunekreef, Claire Bryan-Hancock, Chiara Bucello, Rachelle Buchbinder, Fiona Bull, Richard T. Burnett, Tim E. Byers, Bianca Calabria, Jonathan Carapetis, Emily Carnahan, Zoe Chafe, Fiona Charlson, Honglei Chen, Jian Shen Chen, Andrew Tai Ann Cheng, Jennifer Christine Child, Aaron Cohen, K. Ellicott Colson, Benjamin C. Cowie, Sarah Darby, Susan Darling, Adrian Davis, Louisa Degenhardt, Frank Dentener, Don Des Jarlais, Karen Devries, Mukesh Dherani, Eric L. Ding, E. Ray Dorsey, Tim Driscoll, Karen Edmond, Suad Eltahir Ali, Rebecca E. Engell, Patricia J. Erwin, Saman Fahimi, Gail Falder, Farshad Farzadfar, Alize Ferrari, Mariel M. Finucane, Seth Flaxman, Francis Gerry R. Fowkes, Greg Freedman, Michael K. Freeman, Emmanuela Gakidou, Santu Ghosh, Edward Giovannucci, Gerhard Gmel, Kathryn Graham, Rebecca Grainger, Bridget Grant, David Gunnell, Hialy R. Gutierrez, Wayne Hall, Hans W. Hoek, Anthony Hogan, H. Dean Hosgood, Damian Hoy, Howard Hu, Bryan J. Hubbell, Sally J. Hutchings, Sydney E. Ibeanusi, Gemma L. Jacklyn, Rashmi Jasrasaria, Jost B. Jonas, Haidong Kan, John A. Kanis, Nicholas Kassebaum, Norito Kawakami, Young Ho Khang, Shahab Khatibzadeh, Jon Paul Khoo, Cindy Kok, Francine Laden, Ratilal Lalloo, Qing Lan, Tim Lathlean, Janet L. Leasher, James Leigh, Yang Li, John Kent Lin, Steven E. Lipshultz, Stephanie London, Rafael Lozano, Yuan Lu, Joelle Mak, Reza Malekzadeh, Leslie Mallinger, Wagner Marcenes, Lyn March, Robin Marks, Randall Martin, Paul McGale, John McGrath, Sumi Mehta, George A. Mensah, Tony R. Merriman, Renata Micha, Catherine Michaud, Vinod Mishra, Khayriyyah Mohd Hanafiah, Ali A. Mokdad, Lidia Morawska, Dariush Mozaffarian, Tasha Murphy, Mohsen Naghavi, Bruce Neal, Paul K. Nelson, Joan Miquel Nolla, Rosana Norman, Casey Olives, Saad B. Omer, Jessica Orchard, Richard Osborne, Bart Ostro, Andrew Page, Kiran D. Pandey, Charles D.H. Parry, Erin Passmore, Jayadeep Patra, Neil Pearce, Pamela M. Pelizzari, Max Petzold, Michael R. Phillips, Dan Pope, C. Arden Pope, John Powles, Mayuree Rao, Homie Razavi, Eva A. Rehfuess, Jürgen T. Rehm, Beate Ritz, Frederick P. Rivara, Thomas Roberts, Carolyn Robinson, Jose A. Rodriguez-Portales, Isabelle Romieu, Robin Room, Lisa C. Rosenfeld, Ananya Roy, Lesley Rushton, Joshua A. Salomon, Uchechukwu Sampson, Lidia Sanchez-Riera, Ella Sanman, Amir Sapkota, Soraya Seedat, Peilin Shi, Kevin Shield, Rupak Shivakoti, Gitanjali M. Singh, David A. Sleet, Emma Smith, Kirk R. Smith, Nicolas J.C. Stapelberg, Kyle Steenland, Heidi Stöckl, Lars Jacob Stovner, Kurt Straif, Lahn Straney, George D. Thurston, Jimmy H. Tran, Rita Van Dingenen, Aaron Van Donkelaar, J. Lennert Veerman, Lakshmi Vijayakumar, Robert Weintraub, Myrna M. Weissman, Richard A. White, Harvey Whiteford, Steven T. Wiersma, James D. Wilkinson, Hywel C. Williams, Warwick Williams, Nicholas Wilson, Anthony D. Woolf, Paul Yip, Jan M. Zielinski, Alan D. Lopez, Christopher J.L. Murray, Majid Ezzati

Research output: Contribution to journalArticle

Abstract

Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years; DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7 0% [95% uncertainty interval 6 2-7 7] of global DALYs); tobacco smoking including second-hand smoke (6 3% [5 5-7 0]), and alcohol use (5 5% [5 0-5 9]). In 1990, the leading risks were childhood underweight (7 9% [6 8-9 4]), household air pollution from solid fuels; (HAP; 7 0% [5 6-8 3]), and tobacco smoking including second-hand smoke (6 1% [5 4-6 8]). Dietary risk factors and physical inactivity collectively accounted for 10 0% (95% UI 9 2-10 8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water ' and sanitation accounting for 0 9% (0 4-1 6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

Original languageEnglish (US)
Pages (from-to)2224-2260
Number of pages37
JournalThe Lancet
Volume380
Issue number9859
DOIs
StatePublished - Jan 1 2012

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Wounds and Injuries
Tobacco Smoke Pollution
Sanitation
Africa South of the Sahara
Northern Africa
Middle East
Latin America
Thinness
Smoking
Global Burden of Disease
Uncertainty
Communicable Diseases
Water
Cause of Death
Oceania
Alcohols
Australasia
Hypertension
Southern Africa
Vitamin A Deficiency

ASJC Scopus subject areas

  • Medicine(all)

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A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010 : A systematic analysis for the Global Burden of Disease Study 2010. / Lim, Stephen S.; Vos, Theo; Flaxman, Abraham D.; Danaei, Goodarz; Shibuya, Kenji; Adair-Rohani, Heather; Amann, Markus; Anderson, H. Ross; Andrews, Kathryn G.; Aryee, Martin; Atkinson, Charles; Bacchus, Loraine J.; Bahalim, Adil N.; Balakrishnan, Kalpana; Balmes, John; Barker-Collo, Suzanne; Baxter, Amanda; Bell, Michelle L.; Blore, Jed D.; Blyth, Fiona; Bonner, Carissa; Borges, Guilherme; Bourne, Rupert; Boussinesq, Michel; Brauer, Michael; Brooks, Peter; Bruce, Nigel G.; Brunekreef, Bert; Bryan-Hancock, Claire; Bucello, Chiara; Buchbinder, Rachelle; Bull, Fiona; Burnett, Richard T.; Byers, Tim E.; Calabria, Bianca; Carapetis, Jonathan; Carnahan, Emily; Chafe, Zoe; Charlson, Fiona; Chen, Honglei; Chen, Jian Shen; Cheng, Andrew Tai Ann; Child, Jennifer Christine; Cohen, Aaron; Colson, K. Ellicott; Cowie, Benjamin C.; Darby, Sarah; Darling, Susan; Davis, Adrian; Degenhardt, Louisa; Dentener, Frank; Des Jarlais, Don; Devries, Karen; Dherani, Mukesh; Ding, Eric L.; Dorsey, E. Ray; Driscoll, Tim; Edmond, Karen; Ali, Suad Eltahir; Engell, Rebecca E.; Erwin, Patricia J.; Fahimi, Saman; Falder, Gail; Farzadfar, Farshad; Ferrari, Alize; Finucane, Mariel M.; Flaxman, Seth; Fowkes, Francis Gerry R.; Freedman, Greg; Freeman, Michael K.; Gakidou, Emmanuela; Ghosh, Santu; Giovannucci, Edward; Gmel, Gerhard; Graham, Kathryn; Grainger, Rebecca; Grant, Bridget; Gunnell, David; Gutierrez, Hialy R.; Hall, Wayne; Hoek, Hans W.; Hogan, Anthony; Hosgood, H. Dean; Hoy, Damian; Hu, Howard; Hubbell, Bryan J.; Hutchings, Sally J.; Ibeanusi, Sydney E.; Jacklyn, Gemma L.; Jasrasaria, Rashmi; Jonas, Jost B.; Kan, Haidong; Kanis, John A.; Kassebaum, Nicholas; Kawakami, Norito; Khang, Young Ho; Khatibzadeh, Shahab; Khoo, Jon Paul; Kok, Cindy; Laden, Francine; Lalloo, Ratilal; Lan, Qing; Lathlean, Tim; Leasher, Janet L.; Leigh, James; Li, Yang; Lin, John Kent; Lipshultz, Steven E.; London, Stephanie; Lozano, Rafael; Lu, Yuan; Mak, Joelle; Malekzadeh, Reza; Mallinger, Leslie; Marcenes, Wagner; March, Lyn; Marks, Robin; Martin, Randall; McGale, Paul; McGrath, John; Mehta, Sumi; Mensah, George A.; Merriman, Tony R.; Micha, Renata; Michaud, Catherine; Mishra, Vinod; Hanafiah, Khayriyyah Mohd; Mokdad, Ali A.; Morawska, Lidia; Mozaffarian, Dariush; Murphy, Tasha; Naghavi, Mohsen; Neal, Bruce; Nelson, Paul K.; Nolla, Joan Miquel; Norman, Rosana; Olives, Casey; Omer, Saad B.; Orchard, Jessica; Osborne, Richard; Ostro, Bart; Page, Andrew; Pandey, Kiran D.; Parry, Charles D.H.; Passmore, Erin; Patra, Jayadeep; Pearce, Neil; Pelizzari, Pamela M.; Petzold, Max; Phillips, Michael R.; Pope, Dan; Pope, C. Arden; Powles, John; Rao, Mayuree; Razavi, Homie; Rehfuess, Eva A.; Rehm, Jürgen T.; Ritz, Beate; Rivara, Frederick P.; Roberts, Thomas; Robinson, Carolyn; Rodriguez-Portales, Jose A.; Romieu, Isabelle; Room, Robin; Rosenfeld, Lisa C.; Roy, Ananya; Rushton, Lesley; Salomon, Joshua A.; Sampson, Uchechukwu; Sanchez-Riera, Lidia; Sanman, Ella; Sapkota, Amir; Seedat, Soraya; Shi, Peilin; Shield, Kevin; Shivakoti, Rupak; Singh, Gitanjali M.; Sleet, David A.; Smith, Emma; Smith, Kirk R.; Stapelberg, Nicolas J.C.; Steenland, Kyle; Stöckl, Heidi; Stovner, Lars Jacob; Straif, Kurt; Straney, Lahn; Thurston, George D.; Tran, Jimmy H.; Van Dingenen, Rita; Van Donkelaar, Aaron; Veerman, J. Lennert; Vijayakumar, Lakshmi; Weintraub, Robert; Weissman, Myrna M.; White, Richard A.; Whiteford, Harvey; Wiersma, Steven T.; Wilkinson, James D.; Williams, Hywel C.; Williams, Warwick; Wilson, Nicholas; Woolf, Anthony D.; Yip, Paul; Zielinski, Jan M.; Lopez, Alan D.; Murray, Christopher J.L.; Ezzati, Majid.

In: The Lancet, Vol. 380, No. 9859, 01.01.2012, p. 2224-2260.

Research output: Contribution to journalArticle

Lim, SS, Vos, T, Flaxman, AD, Danaei, G, Shibuya, K, Adair-Rohani, H, Amann, M, Anderson, HR, Andrews, KG, Aryee, M, Atkinson, C, Bacchus, LJ, Bahalim, AN, Balakrishnan, K, Balmes, J, Barker-Collo, S, Baxter, A, Bell, ML, Blore, JD, Blyth, F, Bonner, C, Borges, G, Bourne, R, Boussinesq, M, Brauer, M, Brooks, P, Bruce, NG, Brunekreef, B, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Bull, F, Burnett, RT, Byers, TE, Calabria, B, Carapetis, J, Carnahan, E, Chafe, Z, Charlson, F, Chen, H, Chen, JS, Cheng, ATA, Child, JC, Cohen, A, Colson, KE, Cowie, BC, Darby, S, Darling, S, Davis, A, Degenhardt, L, Dentener, F, Des Jarlais, D, Devries, K, Dherani, M, Ding, EL, Dorsey, ER, Driscoll, T, Edmond, K, Ali, SE, Engell, RE, Erwin, PJ, Fahimi, S, Falder, G, Farzadfar, F, Ferrari, A, Finucane, MM, Flaxman, S, Fowkes, FGR, Freedman, G, Freeman, MK, Gakidou, E, Ghosh, S, Giovannucci, E, Gmel, G, Graham, K, Grainger, R, Grant, B, Gunnell, D, Gutierrez, HR, Hall, W, Hoek, HW, Hogan, A, Hosgood, HD, Hoy, D, Hu, H, Hubbell, BJ, Hutchings, SJ, Ibeanusi, SE, Jacklyn, GL, Jasrasaria, R, Jonas, JB, Kan, H, Kanis, JA, Kassebaum, N, Kawakami, N, Khang, YH, Khatibzadeh, S, Khoo, JP, Kok, C, Laden, F, Lalloo, R, Lan, Q, Lathlean, T, Leasher, JL, Leigh, J, Li, Y, Lin, JK, Lipshultz, SE, London, S, Lozano, R, Lu, Y, Mak, J, Malekzadeh, R, Mallinger, L, Marcenes, W, March, L, Marks, R, Martin, R, McGale, P, McGrath, J, Mehta, S, Mensah, GA, Merriman, TR, Micha, R, Michaud, C, Mishra, V, Hanafiah, KM, Mokdad, AA, Morawska, L, Mozaffarian, D, Murphy, T, Naghavi, M, Neal, B, Nelson, PK, Nolla, JM, Norman, R, Olives, C, Omer, SB, Orchard, J, Osborne, R, Ostro, B, Page, A, Pandey, KD, Parry, CDH, Passmore, E, Patra, J, Pearce, N, Pelizzari, PM, Petzold, M, Phillips, MR, Pope, D, Pope, CA, Powles, J, Rao, M, Razavi, H, Rehfuess, EA, Rehm, JT, Ritz, B, Rivara, FP, Roberts, T, Robinson, C, Rodriguez-Portales, JA, Romieu, I, Room, R, Rosenfeld, LC, Roy, A, Rushton, L, Salomon, JA, Sampson, U, Sanchez-Riera, L, Sanman, E, Sapkota, A, Seedat, S, Shi, P, Shield, K, Shivakoti, R, Singh, GM, Sleet, DA, Smith, E, Smith, KR, Stapelberg, NJC, Steenland, K, Stöckl, H, Stovner, LJ, Straif, K, Straney, L, Thurston, GD, Tran, JH, Van Dingenen, R, Van Donkelaar, A, Veerman, JL, Vijayakumar, L, Weintraub, R, Weissman, MM, White, RA, Whiteford, H, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, W, Wilson, N, Woolf, AD, Yip, P, Zielinski, JM, Lopez, AD, Murray, CJL & Ezzati, M 2012, 'A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010', The Lancet, vol. 380, no. 9859, pp. 2224-2260. https://doi.org/10.1016/S0140-6736(12)61766-8
Lim, Stephen S. ; Vos, Theo ; Flaxman, Abraham D. ; Danaei, Goodarz ; Shibuya, Kenji ; Adair-Rohani, Heather ; Amann, Markus ; Anderson, H. Ross ; Andrews, Kathryn G. ; Aryee, Martin ; Atkinson, Charles ; Bacchus, Loraine J. ; Bahalim, Adil N. ; Balakrishnan, Kalpana ; Balmes, John ; Barker-Collo, Suzanne ; Baxter, Amanda ; Bell, Michelle L. ; Blore, Jed D. ; Blyth, Fiona ; Bonner, Carissa ; Borges, Guilherme ; Bourne, Rupert ; Boussinesq, Michel ; Brauer, Michael ; Brooks, Peter ; Bruce, Nigel G. ; Brunekreef, Bert ; Bryan-Hancock, Claire ; Bucello, Chiara ; Buchbinder, Rachelle ; Bull, Fiona ; Burnett, Richard T. ; Byers, Tim E. ; Calabria, Bianca ; Carapetis, Jonathan ; Carnahan, Emily ; Chafe, Zoe ; Charlson, Fiona ; Chen, Honglei ; Chen, Jian Shen ; Cheng, Andrew Tai Ann ; Child, Jennifer Christine ; Cohen, Aaron ; Colson, K. Ellicott ; Cowie, Benjamin C. ; Darby, Sarah ; Darling, Susan ; Davis, Adrian ; Degenhardt, Louisa ; Dentener, Frank ; Des Jarlais, Don ; Devries, Karen ; Dherani, Mukesh ; Ding, Eric L. ; Dorsey, E. Ray ; Driscoll, Tim ; Edmond, Karen ; Ali, Suad Eltahir ; Engell, Rebecca E. ; Erwin, Patricia J. ; Fahimi, Saman ; Falder, Gail ; Farzadfar, Farshad ; Ferrari, Alize ; Finucane, Mariel M. ; Flaxman, Seth ; Fowkes, Francis Gerry R. ; Freedman, Greg ; Freeman, Michael K. ; Gakidou, Emmanuela ; Ghosh, Santu ; Giovannucci, Edward ; Gmel, Gerhard ; Graham, Kathryn ; Grainger, Rebecca ; Grant, Bridget ; Gunnell, David ; Gutierrez, Hialy R. ; Hall, Wayne ; Hoek, Hans W. ; Hogan, Anthony ; Hosgood, H. Dean ; Hoy, Damian ; Hu, Howard ; Hubbell, Bryan J. ; Hutchings, Sally J. ; Ibeanusi, Sydney E. ; Jacklyn, Gemma L. ; Jasrasaria, Rashmi ; Jonas, Jost B. ; Kan, Haidong ; Kanis, John A. ; Kassebaum, Nicholas ; Kawakami, Norito ; Khang, Young Ho ; Khatibzadeh, Shahab ; Khoo, Jon Paul ; Kok, Cindy ; Laden, Francine ; Lalloo, Ratilal ; Lan, Qing ; Lathlean, Tim ; Leasher, Janet L. ; Leigh, James ; Li, Yang ; Lin, John Kent ; Lipshultz, Steven E. ; London, Stephanie ; Lozano, Rafael ; Lu, Yuan ; Mak, Joelle ; Malekzadeh, Reza ; Mallinger, Leslie ; Marcenes, Wagner ; March, Lyn ; Marks, Robin ; Martin, Randall ; McGale, Paul ; McGrath, John ; Mehta, Sumi ; Mensah, George A. ; Merriman, Tony R. ; Micha, Renata ; Michaud, Catherine ; Mishra, Vinod ; Hanafiah, Khayriyyah Mohd ; Mokdad, Ali A. ; Morawska, Lidia ; Mozaffarian, Dariush ; Murphy, Tasha ; Naghavi, Mohsen ; Neal, Bruce ; Nelson, Paul K. ; Nolla, Joan Miquel ; Norman, Rosana ; Olives, Casey ; Omer, Saad B. ; Orchard, Jessica ; Osborne, Richard ; Ostro, Bart ; Page, Andrew ; Pandey, Kiran D. ; Parry, Charles D.H. ; Passmore, Erin ; Patra, Jayadeep ; Pearce, Neil ; Pelizzari, Pamela M. ; Petzold, Max ; Phillips, Michael R. ; Pope, Dan ; Pope, C. Arden ; Powles, John ; Rao, Mayuree ; Razavi, Homie ; Rehfuess, Eva A. ; Rehm, Jürgen T. ; Ritz, Beate ; Rivara, Frederick P. ; Roberts, Thomas ; Robinson, Carolyn ; Rodriguez-Portales, Jose A. ; Romieu, Isabelle ; Room, Robin ; Rosenfeld, Lisa C. ; Roy, Ananya ; Rushton, Lesley ; Salomon, Joshua A. ; Sampson, Uchechukwu ; Sanchez-Riera, Lidia ; Sanman, Ella ; Sapkota, Amir ; Seedat, Soraya ; Shi, Peilin ; Shield, Kevin ; Shivakoti, Rupak ; Singh, Gitanjali M. ; Sleet, David A. ; Smith, Emma ; Smith, Kirk R. ; Stapelberg, Nicolas J.C. ; Steenland, Kyle ; Stöckl, Heidi ; Stovner, Lars Jacob ; Straif, Kurt ; Straney, Lahn ; Thurston, George D. ; Tran, Jimmy H. ; Van Dingenen, Rita ; Van Donkelaar, Aaron ; Veerman, J. Lennert ; Vijayakumar, Lakshmi ; Weintraub, Robert ; Weissman, Myrna M. ; White, Richard A. ; Whiteford, Harvey ; Wiersma, Steven T. ; Wilkinson, James D. ; Williams, Hywel C. ; Williams, Warwick ; Wilson, Nicholas ; Woolf, Anthony D. ; Yip, Paul ; Zielinski, Jan M. ; Lopez, Alan D. ; Murray, Christopher J.L. ; Ezzati, Majid. / A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010 : A systematic analysis for the Global Burden of Disease Study 2010. In: The Lancet. 2012 ; Vol. 380, No. 9859. pp. 2224-2260.
@article{d885ac0501b6433a8f65cca7922f79b2,
title = "A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010",
abstract = "Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years; DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7 0{\%} [95{\%} uncertainty interval 6 2-7 7] of global DALYs); tobacco smoking including second-hand smoke (6 3{\%} [5 5-7 0]), and alcohol use (5 5{\%} [5 0-5 9]). In 1990, the leading risks were childhood underweight (7 9{\%} [6 8-9 4]), household air pollution from solid fuels; (HAP; 7 0{\%} [5 6-8 3]), and tobacco smoking including second-hand smoke (6 1{\%} [5 4-6 8]). Dietary risk factors and physical inactivity collectively accounted for 10 0{\%} (95{\%} UI 9 2-10 8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water ' and sanitation accounting for 0 9{\%} (0 4-1 6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.",
author = "Lim, {Stephen S.} and Theo Vos and Flaxman, {Abraham D.} and Goodarz Danaei and Kenji Shibuya and Heather Adair-Rohani and Markus Amann and Anderson, {H. Ross} and Andrews, {Kathryn G.} and Martin Aryee and Charles Atkinson and Bacchus, {Loraine J.} and Bahalim, {Adil N.} and Kalpana Balakrishnan and John Balmes and Suzanne Barker-Collo and Amanda Baxter and Bell, {Michelle L.} and Blore, {Jed D.} and Fiona Blyth and Carissa Bonner and Guilherme Borges and Rupert Bourne and Michel Boussinesq and Michael Brauer and Peter Brooks and Bruce, {Nigel G.} and Bert Brunekreef and Claire Bryan-Hancock and Chiara Bucello and Rachelle Buchbinder and Fiona Bull and Burnett, {Richard T.} and Byers, {Tim E.} and Bianca Calabria and Jonathan Carapetis and Emily Carnahan and Zoe Chafe and Fiona Charlson and Honglei Chen and Chen, {Jian Shen} and Cheng, {Andrew Tai Ann} and Child, {Jennifer Christine} and Aaron Cohen and Colson, {K. Ellicott} and Cowie, {Benjamin C.} and Sarah Darby and Susan Darling and Adrian Davis and Louisa Degenhardt and Frank Dentener and {Des Jarlais}, Don and Karen Devries and Mukesh Dherani and Ding, {Eric L.} and Dorsey, {E. Ray} and Tim Driscoll and Karen Edmond and Ali, {Suad Eltahir} and Engell, {Rebecca E.} and Erwin, {Patricia J.} and Saman Fahimi and Gail Falder and Farshad Farzadfar and Alize Ferrari and Finucane, {Mariel M.} and Seth Flaxman and Fowkes, {Francis Gerry R.} and Greg Freedman and Freeman, {Michael K.} and Emmanuela Gakidou and Santu Ghosh and Edward Giovannucci and Gerhard Gmel and Kathryn Graham and Rebecca Grainger and Bridget Grant and David Gunnell and Gutierrez, {Hialy R.} and Wayne Hall and Hoek, {Hans W.} and Anthony Hogan and Hosgood, {H. Dean} and Damian Hoy and Howard Hu and Hubbell, {Bryan J.} and Hutchings, {Sally J.} and Ibeanusi, {Sydney E.} and Jacklyn, {Gemma L.} and Rashmi Jasrasaria and Jonas, {Jost B.} and Haidong Kan and Kanis, {John A.} and Nicholas Kassebaum and Norito Kawakami and Khang, {Young Ho} and Shahab Khatibzadeh and Khoo, {Jon Paul} and Cindy Kok and Francine Laden and Ratilal Lalloo and Qing Lan and Tim Lathlean and Leasher, {Janet L.} and James Leigh and Yang Li and Lin, {John Kent} and Lipshultz, {Steven E.} and Stephanie London and Rafael Lozano and Yuan Lu and Joelle Mak and Reza Malekzadeh and Leslie Mallinger and Wagner Marcenes and Lyn March and Robin Marks and Randall Martin and Paul McGale and John McGrath and Sumi Mehta and Mensah, {George A.} and Merriman, {Tony R.} and Renata Micha and Catherine Michaud and Vinod Mishra and Hanafiah, {Khayriyyah Mohd} and Mokdad, {Ali A.} and Lidia Morawska and Dariush Mozaffarian and Tasha Murphy and Mohsen Naghavi and Bruce Neal and Nelson, {Paul K.} and Nolla, {Joan Miquel} and Rosana Norman and Casey Olives and Omer, {Saad B.} and Jessica Orchard and Richard Osborne and Bart Ostro and Andrew Page and Pandey, {Kiran D.} and Parry, {Charles D.H.} and Erin Passmore and Jayadeep Patra and Neil Pearce and Pelizzari, {Pamela M.} and Max Petzold and Phillips, {Michael R.} and Dan Pope and Pope, {C. Arden} and John Powles and Mayuree Rao and Homie Razavi and Rehfuess, {Eva A.} and Rehm, {J{\"u}rgen T.} and Beate Ritz and Rivara, {Frederick P.} and Thomas Roberts and Carolyn Robinson and Rodriguez-Portales, {Jose A.} and Isabelle Romieu and Robin Room and Rosenfeld, {Lisa C.} and Ananya Roy and Lesley Rushton and Salomon, {Joshua A.} and Uchechukwu Sampson and Lidia Sanchez-Riera and Ella Sanman and Amir Sapkota and Soraya Seedat and Peilin Shi and Kevin Shield and Rupak Shivakoti and Singh, {Gitanjali M.} and Sleet, {David A.} and Emma Smith and Smith, {Kirk R.} and Stapelberg, {Nicolas J.C.} and Kyle Steenland and Heidi St{\"o}ckl and Stovner, {Lars Jacob} and Kurt Straif and Lahn Straney and Thurston, {George D.} and Tran, {Jimmy H.} and {Van Dingenen}, Rita and {Van Donkelaar}, Aaron and Veerman, {J. Lennert} and Lakshmi Vijayakumar and Robert Weintraub and Weissman, {Myrna M.} and White, {Richard A.} and Harvey Whiteford and Wiersma, {Steven T.} and Wilkinson, {James D.} and Williams, {Hywel C.} and Warwick Williams and Nicholas Wilson and Woolf, {Anthony D.} and Paul Yip and Zielinski, {Jan M.} and Lopez, {Alan D.} and Murray, {Christopher J.L.} and Majid Ezzati",
year = "2012",
month = "1",
day = "1",
doi = "10.1016/S0140-6736(12)61766-8",
language = "English (US)",
volume = "380",
pages = "2224--2260",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9859",

}

TY - JOUR

T1 - A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010

T2 - A systematic analysis for the Global Burden of Disease Study 2010

AU - Lim, Stephen S.

AU - Vos, Theo

AU - Flaxman, Abraham D.

AU - Danaei, Goodarz

AU - Shibuya, Kenji

AU - Adair-Rohani, Heather

AU - Amann, Markus

AU - Anderson, H. Ross

AU - Andrews, Kathryn G.

AU - Aryee, Martin

AU - Atkinson, Charles

AU - Bacchus, Loraine J.

AU - Bahalim, Adil N.

AU - Balakrishnan, Kalpana

AU - Balmes, John

AU - Barker-Collo, Suzanne

AU - Baxter, Amanda

AU - Bell, Michelle L.

AU - Blore, Jed D.

AU - Blyth, Fiona

AU - Bonner, Carissa

AU - Borges, Guilherme

AU - Bourne, Rupert

AU - Boussinesq, Michel

AU - Brauer, Michael

AU - Brooks, Peter

AU - Bruce, Nigel G.

AU - Brunekreef, Bert

AU - Bryan-Hancock, Claire

AU - Bucello, Chiara

AU - Buchbinder, Rachelle

AU - Bull, Fiona

AU - Burnett, Richard T.

AU - Byers, Tim E.

AU - Calabria, Bianca

AU - Carapetis, Jonathan

AU - Carnahan, Emily

AU - Chafe, Zoe

AU - Charlson, Fiona

AU - Chen, Honglei

AU - Chen, Jian Shen

AU - Cheng, Andrew Tai Ann

AU - Child, Jennifer Christine

AU - Cohen, Aaron

AU - Colson, K. Ellicott

AU - Cowie, Benjamin C.

AU - Darby, Sarah

AU - Darling, Susan

AU - Davis, Adrian

AU - Degenhardt, Louisa

AU - Dentener, Frank

AU - Des Jarlais, Don

AU - Devries, Karen

AU - Dherani, Mukesh

AU - Ding, Eric L.

AU - Dorsey, E. Ray

AU - Driscoll, Tim

AU - Edmond, Karen

AU - Ali, Suad Eltahir

AU - Engell, Rebecca E.

AU - Erwin, Patricia J.

AU - Fahimi, Saman

AU - Falder, Gail

AU - Farzadfar, Farshad

AU - Ferrari, Alize

AU - Finucane, Mariel M.

AU - Flaxman, Seth

AU - Fowkes, Francis Gerry R.

AU - Freedman, Greg

AU - Freeman, Michael K.

AU - Gakidou, Emmanuela

AU - Ghosh, Santu

AU - Giovannucci, Edward

AU - Gmel, Gerhard

AU - Graham, Kathryn

AU - Grainger, Rebecca

AU - Grant, Bridget

AU - Gunnell, David

AU - Gutierrez, Hialy R.

AU - Hall, Wayne

AU - Hoek, Hans W.

AU - Hogan, Anthony

AU - Hosgood, H. Dean

AU - Hoy, Damian

AU - Hu, Howard

AU - Hubbell, Bryan J.

AU - Hutchings, Sally J.

AU - Ibeanusi, Sydney E.

AU - Jacklyn, Gemma L.

AU - Jasrasaria, Rashmi

AU - Jonas, Jost B.

AU - Kan, Haidong

AU - Kanis, John A.

AU - Kassebaum, Nicholas

AU - Kawakami, Norito

AU - Khang, Young Ho

AU - Khatibzadeh, Shahab

AU - Khoo, Jon Paul

AU - Kok, Cindy

AU - Laden, Francine

AU - Lalloo, Ratilal

AU - Lan, Qing

AU - Lathlean, Tim

AU - Leasher, Janet L.

AU - Leigh, James

AU - Li, Yang

AU - Lin, John Kent

AU - Lipshultz, Steven E.

AU - London, Stephanie

AU - Lozano, Rafael

AU - Lu, Yuan

AU - Mak, Joelle

AU - Malekzadeh, Reza

AU - Mallinger, Leslie

AU - Marcenes, Wagner

AU - March, Lyn

AU - Marks, Robin

AU - Martin, Randall

AU - McGale, Paul

AU - McGrath, John

AU - Mehta, Sumi

AU - Mensah, George A.

AU - Merriman, Tony R.

AU - Micha, Renata

AU - Michaud, Catherine

AU - Mishra, Vinod

AU - Hanafiah, Khayriyyah Mohd

AU - Mokdad, Ali A.

AU - Morawska, Lidia

AU - Mozaffarian, Dariush

AU - Murphy, Tasha

AU - Naghavi, Mohsen

AU - Neal, Bruce

AU - Nelson, Paul K.

AU - Nolla, Joan Miquel

AU - Norman, Rosana

AU - Olives, Casey

AU - Omer, Saad B.

AU - Orchard, Jessica

AU - Osborne, Richard

AU - Ostro, Bart

AU - Page, Andrew

AU - Pandey, Kiran D.

AU - Parry, Charles D.H.

AU - Passmore, Erin

AU - Patra, Jayadeep

AU - Pearce, Neil

AU - Pelizzari, Pamela M.

AU - Petzold, Max

AU - Phillips, Michael R.

AU - Pope, Dan

AU - Pope, C. Arden

AU - Powles, John

AU - Rao, Mayuree

AU - Razavi, Homie

AU - Rehfuess, Eva A.

AU - Rehm, Jürgen T.

AU - Ritz, Beate

AU - Rivara, Frederick P.

AU - Roberts, Thomas

AU - Robinson, Carolyn

AU - Rodriguez-Portales, Jose A.

AU - Romieu, Isabelle

AU - Room, Robin

AU - Rosenfeld, Lisa C.

AU - Roy, Ananya

AU - Rushton, Lesley

AU - Salomon, Joshua A.

AU - Sampson, Uchechukwu

AU - Sanchez-Riera, Lidia

AU - Sanman, Ella

AU - Sapkota, Amir

AU - Seedat, Soraya

AU - Shi, Peilin

AU - Shield, Kevin

AU - Shivakoti, Rupak

AU - Singh, Gitanjali M.

AU - Sleet, David A.

AU - Smith, Emma

AU - Smith, Kirk R.

AU - Stapelberg, Nicolas J.C.

AU - Steenland, Kyle

AU - Stöckl, Heidi

AU - Stovner, Lars Jacob

AU - Straif, Kurt

AU - Straney, Lahn

AU - Thurston, George D.

AU - Tran, Jimmy H.

AU - Van Dingenen, Rita

AU - Van Donkelaar, Aaron

AU - Veerman, J. Lennert

AU - Vijayakumar, Lakshmi

AU - Weintraub, Robert

AU - Weissman, Myrna M.

AU - White, Richard A.

AU - Whiteford, Harvey

AU - Wiersma, Steven T.

AU - Wilkinson, James D.

AU - Williams, Hywel C.

AU - Williams, Warwick

AU - Wilson, Nicholas

AU - Woolf, Anthony D.

AU - Yip, Paul

AU - Zielinski, Jan M.

AU - Lopez, Alan D.

AU - Murray, Christopher J.L.

AU - Ezzati, Majid

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years; DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7 0% [95% uncertainty interval 6 2-7 7] of global DALYs); tobacco smoking including second-hand smoke (6 3% [5 5-7 0]), and alcohol use (5 5% [5 0-5 9]). In 1990, the leading risks were childhood underweight (7 9% [6 8-9 4]), household air pollution from solid fuels; (HAP; 7 0% [5 6-8 3]), and tobacco smoking including second-hand smoke (6 1% [5 4-6 8]). Dietary risk factors and physical inactivity collectively accounted for 10 0% (95% UI 9 2-10 8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water ' and sanitation accounting for 0 9% (0 4-1 6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

AB - Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years; DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7 0% [95% uncertainty interval 6 2-7 7] of global DALYs); tobacco smoking including second-hand smoke (6 3% [5 5-7 0]), and alcohol use (5 5% [5 0-5 9]). In 1990, the leading risks were childhood underweight (7 9% [6 8-9 4]), household air pollution from solid fuels; (HAP; 7 0% [5 6-8 3]), and tobacco smoking including second-hand smoke (6 1% [5 4-6 8]). Dietary risk factors and physical inactivity collectively accounted for 10 0% (95% UI 9 2-10 8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water ' and sanitation accounting for 0 9% (0 4-1 6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.

UR - http://www.scopus.com/inward/record.url?scp=84871055775&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871055775&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(12)61766-8

DO - 10.1016/S0140-6736(12)61766-8

M3 - Article

VL - 380

SP - 2224

EP - 2260

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9859

ER -