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

• Main Author: Mohammad Hforouzanfar
• Publication Date: 2016
• Other Authors: Fiona j Charlson, Umar Bacha, Alaa Badawi, Maria c Bahit, Kalpana Balakrishnan, Aleksandra Barac, Ryan m Barber, Suzanne l Barker-collo, Till Bärnighausen, Simon Barquera, Tawfik Ahmed Muthafer Khoja, Mohsen Naghavi, Jagdish Khubchandani, Christian Kieling, Cho-il Kim, Adugnaw Berhane, Daniel Kim, Ruth w Kimokoti, Niranjan Kissoon, Tim r Driscoll, Sivadasanpillai Harikrishnan, Miia Kivipelto, Luke d Knibbs, Yoshihiro Kokubo, Jacek a Kopec, Bruce Neal, Parvaiz a Koul, ai Koyanagi, Eduardo Bernabé, Michael Kravchenko, Hans Kromhout, Josep Maria Haro, Leilei Duan, Hans Krueger, Tiffany ku, Barthelemy Kuate Defo, Ricardo s Kuchenbecker, Burcu Kucuk Bicer, Ernst j Kuipers, Marissa b Reitsma, g Anil Kumar, Balem Demtsu Betsu, Mohammad Sadegh Hassanvand, Gene f Kwan, Lars Barregard, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Qing Lan, Anders Larsson, Asma Abdul Latif, Alicia Elena Beatriz Lawrynowicz, Janet l Leasher, Tahir Ahmed Hassen, Gregory a Roth, Addisu Shunu Beyene, Ashkan Afshin, James Leigh, Janni Leung, Miriam Levi, Xiaohong li, Yichong li, Juan Liang, Shiwei Liu, Rasmus Havmoeller, Belinda k Lloyd, Giancarlo Logroscino, Paulo a Lotufo, Simon i Hay, Neeraj Bhala, Joshua a Salomon, Raimundas Lunevicius, Michael Macintyre, Mahdi Mahdavi, Marek Majdan, Ileana Beatriz Heredia-pi, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Wondimu Ayele Ayele Manamo, Manisha Dubey, Chabila c Mapoma, Anil Bhansali, Wagner Marcenes, Patrick j Sur, Randall v Martin, Norberto Francisco Hernández-llanes, Jose Martinez-raga, Felix Masiye, Kunihiro Matsushita, Richard Matzopoulos, Bongani m Mayosi, Bruce Bartholow Duncan, John j Mcgrath, Martin Mckee, Samir Bhatt, Peter a Meaney, Alan d Lopez, Catalina Medina, Theo Vos, Alem Mehari, Fabiola Mejia-rodriguez, Alemayehu b Mekonnen, Yohannes Adama Melaku, Iqbal Elyazar, Ziad a Memish, Walter Mendoza, Gert b m Mensink, Pouria Heydarpour, Sibhatu Biadgilign, Atte Meretoja, Tuomo j Meretoja, Yonatan Moges Mesfin, h Ross Anderson, Joseph a Wagner, Francis Apolinary Mhimbira, Aman Yesuf Endries, Anoushka Millear, Ted r Miller, Ettore Beghi, Edward j Mills, Mojde Mirarefin, Kara Estep, Awoke Misganaw, Charles n Mock, Alireza Mohammadi, Shafiu Mohammed, Glen Liddell d Mola, Sergey Petrovich Ermakov, Haidong Wang, Max Griswold, Lorenzo Monasta, Julio Cesar Montañez Hernandez, Marcella Montico, Lidia Morawska, Boris Bikbov, Rintaro Mori, Dariush Mozaffarian, Ulrich o Mueller, Erin Mullany, Holly e Erskine, Hans w Hoek, John Everett Mumford, Gudlavalleti Venkata Satyanarayana Murthy, yi Zhao, Jean b Nachega, Aliya Naheed, Vinay Nangia, Donal Bisanzio, Nariman Nassiri, John n Newton, Marie ng, Howard j Hoffman, Babak Eshrati, Quyen le Nguyen, Muhammad Imran Nisar, Patrick Martial Nkamedjie Pete, Ole f Norheim, Maigeng Zhou, Rosana e Norman, bo Norrving, Espen Bjertness, Luke Nyakarahuka, Masako Horino, Carla Makhlouf Obermeyer, Alireza Esteghamati, Felix Akpojene Ogbo, In-hwan oh, Olanrewaju Oladimeji, Pedro r Olivares, Helen Olsen, Bolajoko Olubukunola Olusanya, Gunn Marit Aasvang, Jacob Olusegun Olusanya, Nobuyuki Horita, Jed d Blore, John Nelson Opio, Aaron j Cohen, Eyal Oren, Ricardo Orozco, Alberto Ortiz, Erika Ota, Mahesh pa, Adrian Pana, Eun-kee Park, h Dean Hosgood, Charles d Parry, Amanuel Alemu Abajobir, Rohan Borschmann, Saman Fahimi, Mahboubeh Parsaeian, Tejas Patel, Angel j Paternina Caicedo, Snehal t Patil, Scott b Patten, George c Patton, Damian g Hoy, Neil Pearce, David m Pereira, Norberto Perico, Konrad Pesudovs, Emerito Jose Aquino Faraon, Soufiane Boufous, Kalkidan Hassen Abate, Max Petzold, Michael Robert Phillips, Frédéric b Piel, Mohamed Hsairi, Julian David Pillay, Dietrich Plass, Suzanne Polinder, Constance d Pond, c Arden Pope, Yohannes Kinfu, Daniel Pope, Rupert r a Bourne, Svetlana Popova, Cristiana Abbafati, Aung Soe Htet, Richie g Poulton, Farshad Pourmalek, Noela m Prasad, Mostafa Qorbani, Rynaz h s Rabiee, Amir Radfar, Talha a Farid, Anwar Rafay, Vafa Rahimi-movaghar, Michael Brainin, Guoqing hu, Mahfuzar Rahman, Mohammad Hifz ur Rahman, Kaja m Abbas, Sajjad ur Rahman, Rajesh Kumar Rai, Sasa Rajsic, Murugesan Raju, Carla Sofia e sa Farinha, Usha Ram, Saleem m Rana, Rafael Lozano, Kavitha Ranganathan, Alexandra Brazinova, Puja Rao, Christian Aspacia Razo García, Amany h Refaat, Foad Abd-allah, Colin d Rehm, Jürgen Rehm, André Faro, Nikolas Reinig, Don c Des Jarlais, Giuseppe Remuzzi, Serge Resnikoff, Antonio Luiz Pinho Ribeiro, Nicholas j k Breitborde, Juan a Rivera, Hirbo Shore Roba, Alina Rodriguez, Sonia Rodriguez-ramirez, Zulfiqar a Bhutta, Maryam s Farvid, Brent Bell, Abdishakur m Abdulle, David Rojas-rueda, Yesenia Roman, Luca Ronfani, Gholamreza Roshandel, Alize j Ferrari, Dietrich Rothenbacher, Ambuj Roy, Muhammad Muhammad Saleh, Juan r Sanabria, John j Huang, Farshad Farzadfar, Lidia Sanchez-riera, Maria Dolores Sanchez-niño, Semaw Ferede Abera, Tania g Sánchez-pimienta, Logan Sandar, Damian f Santomauro, Hermann Brenner, Itamar s Santos, Rodrigo Sarmiento-suarez, Abdullatif Husseini, Benn Sartorius, Valery l Feigin, Maheswar Satpathy, Miloje Savic, Monika Sawhney, Josef Schmidhuber, Biju Abraham, Maria Inês Schmidt, Ione j c Schneider, David m Broday, Sally j Hutchings, Ben Schöttker, Aletta e Schutte, Seyed-mohammad Fereshtehnejad, David c Schwebel, James g Scott, Soraya Seedat, Sadaf g Sepanlou, Edson e Servan-mori, Gavin Shaddick, Laith j Abu-raddad, Inge Huybrechts, Amira Shaheen, Traolach s Brugha, Saeid Shahraz, Lope h Barrero, Masood Ali Shaikh, Teresa Shamah Levy, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Kim Moesgaard Iburg, Kevin n Sheth, Peilin Shi, Gebre Yitayih Abyu, Bert Brunekreef, Jefferson g Fernandes, Kenji Shibuya, Mika Shigematsu, Min-jeong Shin, Rahman Shiri, Kawkab Shishani, Bulat t Idrisov, Ivy Shiue, Mark g Shrime, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Florian Fischer, Zahid a Butt, Akindele Olupelumi Adebiyi, Jonathan i Silverberg, Edgar p Simard, Bogdan Vasile Ileanu, Shireen Sindi, Abhishek Singh, Jasvinder a Singh, Prashant Kumar Singh, Erica Leigh Slepak, Michael Soljak, Joseph r a Fitchett, Samir Soneji, Leah e Cahill, Reed j d Sorensen, Manami Inoue, Isaac Akinkunmi Adedeji, Luciano a Sposato, Chandrashekhar t Sreeramareddy, Vasiliki Stathopoulou, Nadine Steckling, Nicholas Steel, Dan j Stein, Hmwe h Kyu, Murray b Stein, Heidi Stöckl, Troy a Jacobs, Bianca Calabria, Saverio Stranges, Konstantinos Stroumpoulis, Zanfina Ademi, Bruno f Sunguya, Soumya Swaminathan, Bryan l Sykes, Cassandra e i Szoeke, Tom Fleming, Rafael Tabarés-seisdedos, Samath d Dharmaratne, Ken Takahashi, Roberto Tchio Talongwa, Ismael Ricardo Campos-nonato, Nikhil Tandon, David Tanne, Mohammad Tavakkoli, Arsène Kouablan Adou, Belaynew Wasie Taye, Hugh r Taylor, Nataliya Foigt, Kathryn h Jacobsen, Bemnet Amare Tedla, Worku Mekonnen Tefera, Teketo Kassaw Tegegne, Dejen Yemane Tekle, Rosario Cárdenas, Abdullah Sulieman Terkawi, j s Thakur, Bernadette a Thomas, Matthew Lloyd Thomas, José c Adsuar, Michelle l Bell, Kyle Foreman, Alan j Thomson, Andrew l Thorne-lyman, Amanda g Thrift, George d Thurston, Taavi Tillmann, David o Carpenter, Ruoyan Tobe-gai, Myriam Tobollik, Roman Topor-madry, Laurie Marczak, Fotis Topouzis, f Gerry r Fowkes, Jeffrey Allen Towbin, Stan Biryukov, Emilie Elisabet Agardh, Bach Xuan Tran, Zacharie Tsala Dimbuene, Nikolaos Tsilimparis, Joseph j Frostad, Abera Kenay Tura, Nader Jahanmehr, Emin Murat Tuzcu, Stefanos Tyrovolas, Richard c Franklin, Kingsley n Ukwaja, Eduardo a Undurraga, Chigozie Jesse Uneke, Olalekan a Uthman, Arnav Agarwal, Aaron Van Donkelaar, Jim Van os, Mihajlo b Jakovljevic, Juan Jesus Carrero, Yuri y Varakin, Tommi Vasankari, Thomas Fürst, j Lennert Veerman, Narayanaswamy Venketasubramanian, Francesco s Violante, Stein Emil Vollset, Gregory r Wagner, Stephen g Waller, Henrica a f m Jansen, Anurag Agrawal, Jian li Wang, Daniel c Casey, Linhong Wang, Sanjay Basu, Yanping Wang, Scott Weichenthal, Elisabete Weiderpass, Robert g Weintraub, Andrea Werdecker, Simerjot k Jassal, Ronny Westerman, Harvey a Whiteford, Tissa Wijeratne, Aliasghar Ahmad Kiadaliri, Carlos a Castañeda-orjuela, Neal d Futran, Charles Shey Wiysonge, Charles d a Wolfe, Sungho Won, Anthony d Woolf, Mehdi Javanbakht, Mamo Wubshet, Denis Xavier, Gelin xu, Ajit Kumar Yadav, Bereket Yakob, Ayalnesh Zemene Yalew, Emmanuela Gakidou, Jacqueline Castillo Rivas, Oluremi n Ajala, Yuichiro Yano, Sudha p Jayaraman, Mehdi Yaseri, Pengpeng ye, Paul Yip, Naohiro Yonemoto, Seok-jun Yoon, Mustafa z Younis, Chuanhua yu, Alberto l Garcia-basteiro, Zoubida Zaidi, Ruben Estanislao Castro, Achala Upendra Jayatilleke, Maysaa el Sayed Zaki, Tomi f Akinyemiju, Jun Zhu, Ben Zipkin, Sanjay Zodpey, Liesl Joanna Zuhlke, Christopher j l Murray, Ziyad Al-aly, Tsegaye Tewelde Gebrehiwot, Khurshid Alam, Preet k Dhillon, Noore k m Alam, Ferrán Catalá-lópez, Saleh Fahed Aldhahri, Michael Brauer, Robert William Aldridge, Zewdie Aderaw Alemu, Raghib Ali, Ala'a Alkerwi, François Alla, Heidi j Larson, Sun ha Jee, Peter Allebeck, Ubai Alsharif, Khalid a Altirkawi, Jung-chen Chang, Elena Alvarez Martin, Nelson Alvis-guzman, Richard Burnett, Alemayehu Amberbir, Adeladza Kofi Amegah, Heresh Amini, Panniyammakal Jeemon, Amanuel Tesfay Gebremedhin, Walid Ammar, Stephen Marc Amrock, Hjalte h Andersen, Benjamin o Anderson, Peggy Pei-chia Chiang, Carl Abelardo t Antonio, Palwasha Anwari, Kelly Cercy, Johan Ärnlöv, Aminu k Bello, al Artaman, Johanna m Geleijnse, Hamid Asayesh, Rana Jawad Asghar, Reza Assadi, Suleman Atique, Euripide Frinel g Arthur Avokpaho, Mirriam Chibalabala, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Vivekanand Jha, Peter Azzopardi, Azmeraw t Amare, Bradford d Gessner, Odgerel Chimed-ochir, Nancy Fullman, Vesper Hichilombwe Chisumpa, Abdulaal a Chitheer, Jee-young Jasmine Choi, Hanne Christensen, Devasahayam Jesudas Christopher, Lily t Alexander, Liliana g Ciobanu, Matthew m Coates, Samantha m Colquhoun, Ababi Zergaw Giref, Alejandra g Contreras Manzano, Leslie Trumbull Cooper, Peter w Gething, Kimberly Cooperrider, Leslie Cornaby, Monica Cortinovis, George a Mensah, John a Crump, Lucia Cuevas-nasu, Albertino Damasceno, Rakhi Dandona, Maurice Giroud, Sarah c Darby, Paul i Dargan, José Das Neves, William w Godwin, Adrian c Davis, Ying Jiang, Kairat Davletov, e Filipa de Castro, Vanessa de la Cruz-góngora, Diego de Leo, Louisa Degenhardt, Carolina Batis, Liana c Del Gobbo, Borja Del Pozo-cruz, Robert p Dellavalle, Amare Deribew, Tariku Jibat, Melkamu Dedefo Gishu, Giorgia Giussani, Shifalika Goenka, Mari Carmen Gomez-cabrera, Hector Gomez-dantes, Xiaofeng Liang, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Carolyn c Gotay, ye Jin, Shahrzad Bazargan-hejazi, Atsushi Goto, Hebe n Gouda, Harish Chander Gugnani, Francis Guillemin, Yuming Guo, Rahul Gupta, Stephen s Lim, Rajeev Gupta, Reyna a Gutiérrez, Catherine o Johnson, Juanita a Haagsma, Justin Beardsley, Nima Hafezi-nejad, Demewoz Haile, Gessessew Bugssa Hailu, Yara a Halasa, Randah Ribhi Hamadeh, Samer Hamidi, Alexis j Handal, Patrick y Liu, Cesar Diaz-torné, Graeme j Hankey, Yuantao Hao, Neeraj Bedi, Hilda l Harb, Jost b Jonas, Zubair Kabir, Yogeshwar Kalkonde, Lalit Dandona, Ritul Kamal, Haidong Kan, André Karch, Ali h Mokdad, Corine Kakizi Karema, Chante Karimkhani, Eric l Ding, Amir Kasaeian, Daniel Dicker, Anil Kaul, Norito Kawakami, Derrick a Bennett, Dhruv s Kazi, Peter Njenga Keiyoro, Laura Kemmer, Andrew Haddon Kemp, Andre Pascal Kengne, e Ray Dorsey, Maziar Moradi-lakeh, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Abdur Rahman Khan, Isabela m Bensenor, Ejaz Ahmad Khan, Gulfaraz Khan, Young-ho Khang, Shahab Khatibzadeh, Kerrie e Doyle, Sahil Khera
• Format: Article
• Language: eng
• Source: Repositório Institucional da UFMG
• Download full: http://hdl.handle.net/1843/52489; https://orcid.org/0000-0002-8214-5734
• topic: Saúde global; Carga Global da Doença; Saúde Coletiva; Carga Global da Doença

Background 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-defi ned 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 specifi c 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 same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient defi ciencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading fi ve risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.