Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

GBD 2013 Risk Factors Collaborators*, and Forouzanfar, Mohammad H and Alexander, Lily and Anderson, H Ross and Bachman, Victoria F and Biryukov, Stan and Brauer, Michael and Burnett, Richard and Casey, Daniel and Coates, Matthew M and Cohen, Aaron and Delwiche, Kristen and Estep, Kara and Frostad, Joseph J and Astha, KC and Kyu, Hmwe H and Moradi-Lakeh, Maziar and Ng, Marie and Slepak, Erica Leigh and Thomas, Bernadette A and Wagner, Joseph and Rodriguez*, Alina (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386 (10010). pp. 2287-2323. ISSN 0140-6736

Full content URL: http://doi.org/10.1016/S0140-6736(15)00128-2

Documents
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Published PDF

Request a copy
GBD 2013 Risk Factor Collaborators*
[img]
[Download]
[img] PDF
GBD_79 risk factors_Lancet_2015.pdf - Whole Document
Restricted to Repository staff only

10MB
[img] Microsoft Word
GBD 2013 Risk Factors Collaborators.docx

19kB
Item Type:Article
Item Status:Live Archive

Abstract

Summary
Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the fi rst of a series of
annual updates of the GBD. Risk factor quantifi cation, particularly of modifi able risk factors, can help to identify
emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity
to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate
counterfactual risk distribution.
Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs)
have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting
explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs:
risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a
hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the fi rst level of the
hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more
detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added:
handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe
sex, and low glomerular fi ltration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression
method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on
meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks
combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through
other risks such as high systolic blood pressure and high cholesterol.
Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6%
(40·1–43·0) of DALYs. Risks quantifi ed account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging
to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in
2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million
deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs,
child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million
deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for
4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time.
In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water,
sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle
East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood
pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic
blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the
Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to
South Africa.
Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality
and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the
attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk
factors, behavioural and social science research on interventions for these risks should be strengthened. Many
prevention and primary care policy options are available now to act on key risk

Keywords:Global Burden of Disease, behavioural risk factors, prevention, environmental risk, occupational risk, body mass index (BMI)
Subjects:C Biological Sciences > C841 Health Psychology
A Medicine and Dentistry > A990 Medicine and Dentistry not elsewhere classified
C Biological Sciences > C890 Psychology not elsewhere classified
C Biological Sciences > C170 Population Biology
C Biological Sciences > C120 Behavioural Biology
Divisions:College of Social Science > School of Psychology
ID Code:25411
Deposited On:25 Jun 2019 09:18

Repository Staff Only: item control page