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

GBD 2016 Risk Factors Collaborators

    Research output: Contribution to journalArticle

    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.

    Original languageEnglish (US)
    Pages (from-to)1345-1422
    Number of pages78
    JournalThe Lancet
    Volume390
    Issue number10100
    DOIs
    StatePublished - Sep 16 2017

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    Quality-Adjusted Life Years
    Global Burden of Disease
    Population Growth
    Health
    Fasting
    Body Mass Index
    Smoking
    Blood Pressure
    Hypertension
    Glucose
    Pregnancy
    Africa South of the Sahara
    Information Storage and Retrieval
    Air Pollution
    Censuses
    Causality

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    @article{62d3337875484376bbc4ac15b5a40493,
    title = "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",
    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.",
    author = "{GBD 2016 Risk Factors Collaborators} and Emmanuela Gakidou and Ashkan Afshin and Abajobir, {Amanuel Alemu} and Abate, {Kalkidan Hassen} and Cristiana Abbafati and Abbas, {Kaja M.} and Foad Abd-Allah and Abdishakur Abdulle and Abera, {Semaw Ferede} and Victor Aboyans and Abu-Raddad, {Laith J.} and Abu-Rmeileh, {Niveen M.E.} and Abyu, {Gebre Yitayih} and Adedeji, {Isaac Akinkunmi} and Olatunji Adetokunboh and Mohsen Afarideh and Anurag Agrawal and Sutapa Agrawal and {Ahmad Kiadaliri}, Aliasghar and Hamid Ahmadieh and Ahmed, {Muktar Beshir} and Aichour, {Amani Nidhal} and Ibtihel Aichour and Aichour, {Miloud Taki Eddine} and Akinyemi, {Rufus Olusola} and Nadia Akseer and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Noore Alam and Tahiya Alam and Deena Alasfoor and Alene, {Kefyalew Addis} and Komal Ali and Reza Alizadeh-Navaei and Ala'a Alkerwi and Fran{\cc}ois Alla and Peter Allebeck and Rajaa Al-Raddadi and Ubai Alsharif and Altirkawi, {Khalid A.} and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Erfan Amini and Walid Ammar and Amoako, {Yaw Ampem} and Hossein Ansari and Ant{\'o}, {Josep M.} and Antonio, {Carl Abelardo T.} and Palwasha Anwari",
    year = "2017",
    month = "9",
    day = "16",
    doi = "10.1016/S0140-6736(17)32366-8",
    language = "English (US)",
    volume = "390",
    pages = "1345--1422",
    journal = "The Lancet",
    issn = "0140-6736",
    publisher = "Elsevier Limited",
    number = "10100",

    }

    TY - JOUR

    T1 - Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016

    T2 - A systematic analysis for the Global Burden of Disease Study 2016

    AU - GBD 2016 Risk Factors Collaborators

    AU - Gakidou, Emmanuela

    AU - Afshin, Ashkan

    AU - Abajobir, Amanuel Alemu

    AU - Abate, Kalkidan Hassen

    AU - Abbafati, Cristiana

    AU - Abbas, Kaja M.

    AU - Abd-Allah, Foad

    AU - Abdulle, Abdishakur

    AU - Abera, Semaw Ferede

    AU - Aboyans, Victor

    AU - Abu-Raddad, Laith J.

    AU - Abu-Rmeileh, Niveen M.E.

    AU - Abyu, Gebre Yitayih

    AU - Adedeji, Isaac Akinkunmi

    AU - Adetokunboh, Olatunji

    AU - Afarideh, Mohsen

    AU - Agrawal, Anurag

    AU - Agrawal, Sutapa

    AU - Ahmad Kiadaliri, Aliasghar

    AU - Ahmadieh, Hamid

    AU - Ahmed, Muktar Beshir

    AU - Aichour, Amani Nidhal

    AU - Aichour, Ibtihel

    AU - Aichour, Miloud Taki Eddine

    AU - Akinyemi, Rufus Olusola

    AU - Akseer, Nadia

    AU - Alahdab, Fares

    AU - Al-Aly, Ziyad

    AU - Alam, Khurshid

    AU - Alam, Noore

    AU - Alam, Tahiya

    AU - Alasfoor, Deena

    AU - Alene, Kefyalew Addis

    AU - Ali, Komal

    AU - Alizadeh-Navaei, Reza

    AU - Alkerwi, Ala'a

    AU - Alla, François

    AU - Allebeck, Peter

    AU - Al-Raddadi, Rajaa

    AU - Alsharif, Ubai

    AU - Altirkawi, Khalid A.

    AU - Alvis-Guzman, Nelson

    AU - Amare, Azmeraw T.

    AU - Amini, Erfan

    AU - Ammar, Walid

    AU - Amoako, Yaw Ampem

    AU - Ansari, Hossein

    AU - Antó, Josep M.

    AU - Antonio, Carl Abelardo T.

    AU - Anwari, Palwasha

    PY - 2017/9/16

    Y1 - 2017/9/16

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=85031722400&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85031722400&partnerID=8YFLogxK

    U2 - 10.1016/S0140-6736(17)32366-8

    DO - 10.1016/S0140-6736(17)32366-8

    M3 - Article

    VL - 390

    SP - 1345

    EP - 1422

    JO - The Lancet

    JF - The Lancet

    SN - 0140-6736

    IS - 10100

    ER -