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

Stephen Lim, Theo Vos, Abraham Flaxman, Goodarz Danaei, Kenji Shibuya, Heather Adair-Rohani, Mohammad Almazroa, Markus Amann, H Anderson, Kathryn Andrews, Martin Aryee, Charles Atkinson, Loraine Bacchus, Adil Meng, Kalpana Balakrishnan, John Balmes, Suzanne Barker-Collo, Amanda Baxter, Michelle Bell, Jed Blore & 189 others Fiona Blyth, Carissa Bonner, Gilherme Borges, Rupert Bourne, Michel Boussinesq, Michael Brauer, peter brooks, Nigel Brude, Bert Brunekreef, Claire Bryan-Hancock, C bucello, Rachelle Buchbinder, F Bull, Richard Burnett, TIme Byers, Bianca Calabria, Johathan Carapetis, Emily Carnahan, Z Chafe, Fiona Charlson, Honglei Chen, Jian Shen Chen, Andre Cheng, Jennifer Child, Aaron Cohen, K Colson, Benjamin Cowie, Sarah C. Darby, Susan Darling, Adrian Davis, Louisa Degenhardt, Frank Dentener, Don Jarlais, Karen Devries, Mukesh Dharani, Eric Ding, E Dorsey, Tim Driscoll, Karen Edmond, Suad Ali, Rebecca Engell, Patricia Erwin, Saman Fahimi, Gail Falder, Farshad Farzadfar, alize Ferrari, Mariel Finucane, Seth Flaxman, Francis Fowkes, Greg Freedman, Michael Freeman, Emmanuela Gakidou, Santu Ghosh, Edward Giovannucci, Gerhard Gmel, Kathryn Graham, Rebecca Grainger, Bridget Grant, David Gunnell, Hialy Gutierrez, Wayne Hall, Hans Hoek, Anthony Hogan, H hosgood, Damian Hoy, Howard Hu, Bryan Hubbell, Sally Hutchings, Sydney Ibeanusi, Gemma Jacklyn, Rashmi JAsrasaria, Jost Jonas, Haidong Kan, John Kanis, Nicholas Kassebaum, Norito kawakami, Young-Ho Khang, Khatibzadeh shahab, Jon-Paul Khoo, Cindy Kok, Francine Laden, Ratilal Lalloo, Qing Lan, Tim Lathlean, Janet Leasher, James Leigh, Yang Li, John Lin, Steven Lipshultz, Stephine London, Rafael Lozano, Yuan Lu, joelle Mak, Reza Malekzadeh, Leslie Mallinger, wagner MArcenes, Lyn March, Robin Marks, Randall Martin, Paul McGale, John McGrath, Sumi metha, Ziad memish, George Mensah, Tony Merriman, Renata Micha, Catherine Michaud, Vinod Mishra, Khayriyyah Hanafiah, Ali Mokdad, Lidia Morawska, Dariush Mozaffarian, Tasha Murphy, Mohsen Naghavi, Bruce Neal, Paul Nelson, Joan Nolla, Rosana Norman, Casey Olives, Saad Omer, Jessica Orchard, Richard Osborne, Bart Ostro, Andrew Page, Kiran Pandey, Charles Parry, Erin Passmore, Jayadeep Patra, Neil Pearce, Pamela Pelizzari, Max Petzold, Michael Phillips, Dan Pope, C Pope, John Powles, Mayuree Rao, Homie Razavi, Eva Rehfuess, Jurgen Rehm, Beate Ritz, Frederick Rivara, Thomas Roberts, Carolyn Robinson, Jose Rodriguez-Portales, Isabelle Romieu, Robin Room, Lisa Rosenfeld, Ananya Roy, Lesley Rushton, Joshua Salomon, Uchechukwu Sampson, Lidia Sanchez-Riera, Ella Sanman, Amir Sapkota, Soraya Seedat, Peilin Shi, Kevin Shield, Pupak Shivakoti, Gitanjali Singh, David Sleet, Emma Smith, kirk Smith, Nicholas Stapelberg, Kyle Steenland, Heidi Stockl, Lars Stovner, Kurt Straif, Lahn Straney, GEorge Thurston, Jimmy Tran, Rita Van Dingenen, Aaron Van Donkelaar, J Veerman, Lakshmi Vijayakumar, Robert Weintraub, Myrna Weissman, Richard White, Harvey Whiteford, Steven Wiersma, James Wilkison, Hywel Williams, Warwick Williams, Nicholas Wilson, Anthony Woolf, Paul Yip, Jan Zielinski, Alan lopez, Christopher Murray, Majid Ezzati

Research output: Contribution to journalArticle

6165 Citations (Scopus)

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
Pages (from-to)2224-2260
Number of pages37
JournalLancet
Volume380
DOIs
Publication statusPublished - 2012
Externally publishedYes

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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

Cite this

Lim, Stephen ; Vos, Theo ; Flaxman, Abraham ; Danaei, Goodarz ; Shibuya, Kenji ; Adair-Rohani, Heather ; Almazroa, Mohammad ; Amann, Markus ; Anderson, H ; Andrews, Kathryn ; Aryee, Martin ; Atkinson, Charles ; Bacchus, Loraine ; Meng, Adil ; Balakrishnan, Kalpana ; Balmes, John ; Barker-Collo, Suzanne ; Baxter, Amanda ; Bell, Michelle ; Blore, Jed ; Blyth, Fiona ; Bonner, Carissa ; Borges, Gilherme ; Bourne, Rupert ; Boussinesq, Michel ; Brauer, Michael ; brooks, peter ; Brude, Nigel ; Brunekreef, Bert ; Bryan-Hancock, Claire ; bucello, C ; Buchbinder, Rachelle ; Bull, F ; Burnett, Richard ; Byers, TIme ; Calabria, Bianca ; Carapetis, Johathan ; Carnahan, Emily ; Chafe, Z ; Charlson, Fiona ; Chen, Honglei ; Chen, Jian Shen ; Cheng, Andre ; Child, Jennifer ; Cohen, Aaron ; Colson, K ; Cowie, Benjamin ; Darby, Sarah C. ; Darling, Susan ; Davis, Adrian ; Degenhardt, Louisa ; Dentener, Frank ; Jarlais, Don ; Devries, Karen ; Dharani, Mukesh ; Ding, Eric ; Dorsey, E ; Driscoll, Tim ; Edmond, Karen ; Ali, Suad ; Engell, Rebecca ; Erwin, Patricia ; Fahimi, Saman ; Falder, Gail ; Farzadfar, Farshad ; Ferrari, alize ; Finucane, Mariel ; Flaxman, Seth ; Fowkes, Francis ; Freedman, Greg ; Freeman, Michael ; Gakidou, Emmanuela ; Ghosh, Santu ; Giovannucci, Edward ; Gmel, Gerhard ; Graham, Kathryn ; Grainger, Rebecca ; Grant, Bridget ; Gunnell, David ; Gutierrez, Hialy ; Hall, Wayne ; Hoek, Hans ; Hogan, Anthony ; hosgood, H ; Hoy, Damian ; Hu, Howard ; Hubbell, Bryan ; Hutchings, Sally ; Ibeanusi, Sydney ; Jacklyn, Gemma ; JAsrasaria, Rashmi ; Jonas, Jost ; Kan, Haidong ; Kanis, John ; Kassebaum, Nicholas ; kawakami, Norito ; Khang, Young-Ho ; shahab, Khatibzadeh ; Khoo, Jon-Paul ; Kok, Cindy ; Laden, Francine ; Lalloo, Ratilal ; Lan, Qing ; Lathlean, Tim ; Leasher, Janet ; Leigh, James ; Li, Yang ; Lin, John ; Lipshultz, Steven ; London, Stephine ; Lozano, Rafael ; Lu, Yuan ; Mak, joelle ; Malekzadeh, Reza ; Mallinger, Leslie ; MArcenes, wagner ; March, Lyn ; Marks, Robin ; Martin, Randall ; McGale, Paul ; McGrath, John ; metha, Sumi ; memish, Ziad ; Mensah, George ; Merriman, Tony ; Micha, Renata ; Michaud, Catherine ; Mishra, Vinod ; Hanafiah, Khayriyyah ; Mokdad, Ali ; Morawska, Lidia ; Mozaffarian, Dariush ; Murphy, Tasha ; Naghavi, Mohsen ; Neal, Bruce ; Nelson, Paul ; Nolla, Joan ; Norman, Rosana ; Olives, Casey ; Omer, Saad ; Orchard, Jessica ; Osborne, Richard ; Ostro, Bart ; Page, Andrew ; Pandey, Kiran ; Parry, Charles ; Passmore, Erin ; Patra, Jayadeep ; Pearce, Neil ; Pelizzari, Pamela ; Petzold, Max ; Phillips, Michael ; Pope, Dan ; Pope, C ; Powles, John ; Rao, Mayuree ; Razavi, Homie ; Rehfuess, Eva ; Rehm, Jurgen ; Ritz, Beate ; Rivara, Frederick ; Roberts, Thomas ; Robinson, Carolyn ; Rodriguez-Portales, Jose ; Romieu, Isabelle ; Room, Robin ; Rosenfeld, Lisa ; Roy, Ananya ; Rushton, Lesley ; Salomon, Joshua ; Sampson, Uchechukwu ; Sanchez-Riera, Lidia ; Sanman, Ella ; Sapkota, Amir ; Seedat, Soraya ; Shi, Peilin ; Shield, Kevin ; Shivakoti, Pupak ; Singh, Gitanjali ; Sleet, David ; Smith, Emma ; Smith, kirk ; Stapelberg, Nicholas ; Steenland, Kyle ; Stockl, Heidi ; Stovner, Lars ; Straif, Kurt ; Straney, Lahn ; Thurston, GEorge ; Tran, Jimmy ; Van Dingenen, Rita ; Van Donkelaar, Aaron ; Veerman, J ; Vijayakumar, Lakshmi ; Weintraub, Robert ; Weissman, Myrna ; White, Richard ; Whiteford, Harvey ; Wiersma, Steven ; Wilkison, James ; Williams, Hywel ; Williams, Warwick ; Wilson, Nicholas ; Woolf, Anthony ; Yip, Paul ; Zielinski, Jan ; lopez, Alan ; Murray, Christopher ; 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. In: Lancet. 2012 ; Vol. 380. pp. 2224-2260.
@article{2a2e8cec04a248dba3e2c779598d6f2c,
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",
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 = "Stephen Lim and Theo Vos and Abraham Flaxman and Goodarz Danaei and Kenji Shibuya and Heather Adair-Rohani and Mohammad Almazroa and Markus Amann and H Anderson and Kathryn Andrews and Martin Aryee and Charles Atkinson and Loraine Bacchus and Adil Meng and Kalpana Balakrishnan and John Balmes and Suzanne Barker-Collo and Amanda Baxter and Michelle Bell and Jed Blore and Fiona Blyth and Carissa Bonner and Gilherme Borges and Rupert Bourne and Michel Boussinesq and Michael Brauer and peter brooks and Nigel Brude and Bert Brunekreef and Claire Bryan-Hancock and C bucello and Rachelle Buchbinder and F Bull and Richard Burnett and TIme Byers and Bianca Calabria and Johathan Carapetis and Emily Carnahan and Z Chafe and Fiona Charlson and Honglei Chen and Chen, {Jian Shen} and Andre Cheng and Jennifer Child and Aaron Cohen and K Colson and Benjamin Cowie and Darby, {Sarah C.} and Susan Darling and Adrian Davis and Louisa Degenhardt and Frank Dentener and Don Jarlais and Karen Devries and Mukesh Dharani and Eric Ding and E Dorsey and Tim Driscoll and Karen Edmond and Suad Ali and Rebecca Engell and Patricia Erwin and Saman Fahimi and Gail Falder and Farshad Farzadfar and alize Ferrari and Mariel Finucane and Seth Flaxman and Francis Fowkes and Greg Freedman and Michael Freeman 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 Hialy Gutierrez and Wayne Hall and Hans Hoek and Anthony Hogan and H hosgood and Damian Hoy and Howard Hu and Bryan Hubbell and Sally Hutchings and Sydney Ibeanusi and Gemma Jacklyn and Rashmi JAsrasaria and Jost Jonas and Haidong Kan and John Kanis and Nicholas Kassebaum and Norito kawakami and Young-Ho Khang and Khatibzadeh shahab and Jon-Paul Khoo and Cindy Kok and Francine Laden and Ratilal Lalloo and Qing Lan and Tim Lathlean and Janet Leasher and James Leigh and Yang Li and John Lin and Steven Lipshultz and Stephine 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 metha and Ziad memish and George Mensah and Tony Merriman and Renata Micha and Catherine Michaud and Vinod Mishra and Khayriyyah Hanafiah and Ali Mokdad and Lidia Morawska and Dariush Mozaffarian and Tasha Murphy and Mohsen Naghavi and Bruce Neal and Paul Nelson and Joan Nolla and Rosana Norman and Casey Olives and Saad Omer and Jessica Orchard and Richard Osborne and Bart Ostro and Andrew Page and Kiran Pandey and Charles Parry and Erin Passmore and Jayadeep Patra and Neil Pearce and Pamela Pelizzari and Max Petzold and Michael Phillips and Dan Pope and C Pope and John Powles and Mayuree Rao and Homie Razavi and Eva Rehfuess and Jurgen Rehm and Beate Ritz and Frederick Rivara and Thomas Roberts and Carolyn Robinson and Jose Rodriguez-Portales and Isabelle Romieu and Robin Room and Lisa Rosenfeld and Ananya Roy and Lesley Rushton and Joshua Salomon and Uchechukwu Sampson and Lidia Sanchez-Riera and Ella Sanman and Amir Sapkota and Soraya Seedat and Peilin Shi and Kevin Shield and Pupak Shivakoti and Gitanjali Singh and David Sleet and Emma Smith and kirk Smith and Nicholas Stapelberg and Kyle Steenland and Heidi Stockl and Lars Stovner and Kurt Straif and Lahn Straney and GEorge Thurston and Jimmy Tran and {Van Dingenen}, Rita and {Van Donkelaar}, Aaron and J Veerman and Lakshmi Vijayakumar and Robert Weintraub and Myrna Weissman and Richard White and Harvey Whiteford and Steven Wiersma and James Wilkison and Hywel Williams and Warwick Williams and Nicholas Wilson and Anthony Woolf and Paul Yip and Jan Zielinski and Alan lopez and Christopher Murray and Majid Ezzati",
year = "2012",
doi = "10.1016/S0140-6736(12)61766-8",
language = "English",
volume = "380",
pages = "2224--2260",
journal = "Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",

}

Lim, S, Vos, T, Flaxman, A, Danaei, G, Shibuya, K, Adair-Rohani, H, Almazroa, M, Amann, M, Anderson, H, Andrews, K, Aryee, M, Atkinson, C, Bacchus, L, Meng, A, Balakrishnan, K, Balmes, J, Barker-Collo, S, Baxter, A, Bell, M, Blore, J, Blyth, F, Bonner, C, Borges, G, Bourne, R, Boussinesq, M, Brauer, M, brooks, P, Brude, N, Brunekreef, B, Bryan-Hancock, C, bucello, C, Buchbinder, R, Bull, F, Burnett, R, Byers, TI, Calabria, B, Carapetis, J, Carnahan, E, Chafe, Z, Charlson, F, Chen, H, Chen, JS, Cheng, A, Child, J, Cohen, A, Colson, K, Cowie, B, Darby, SC, Darling, S, Davis, A, Degenhardt, L, Dentener, F, Jarlais, D, Devries, K, Dharani, M, Ding, E, Dorsey, E, Driscoll, T, Edmond, K, Ali, S, Engell, R, Erwin, P, Fahimi, S, Falder, G, Farzadfar, F, Ferrari, A, Finucane, M, Flaxman, S, Fowkes, F, Freedman, G, Freeman, M, Gakidou, E, Ghosh, S, Giovannucci, E, Gmel, G, Graham, K, Grainger, R, Grant, B, Gunnell, D, Gutierrez, H, Hall, W, Hoek, H, Hogan, A, hosgood, H, Hoy, D, Hu, H, Hubbell, B, Hutchings, S, Ibeanusi, S, Jacklyn, G, JAsrasaria, R, Jonas, J, Kan, H, Kanis, J, Kassebaum, N, kawakami, N, Khang, Y-H, shahab, K, Khoo, J-P, Kok, C, Laden, F, Lalloo, R, Lan, Q, Lathlean, T, Leasher, J, Leigh, J, Li, Y, Lin, J, Lipshultz, S, London, S, Lozano, R, Lu, Y, Mak, J, Malekzadeh, R, Mallinger, L, MArcenes, W, March, L, Marks, R, Martin, R, McGale, P, McGrath, J, metha, S, memish, Z, Mensah, G, Merriman, T, Micha, R, Michaud, C, Mishra, V, Hanafiah, K, Mokdad, A, Morawska, L, Mozaffarian, D, Murphy, T, Naghavi, M, Neal, B, Nelson, P, Nolla, J, Norman, R, Olives, C, Omer, S, Orchard, J, Osborne, R, Ostro, B, Page, A, Pandey, K, Parry, C, Passmore, E, Patra, J, Pearce, N, Pelizzari, P, Petzold, M, Phillips, M, Pope, D, Pope, C, Powles, J, Rao, M, Razavi, H, Rehfuess, E, Rehm, J, Ritz, B, Rivara, F, Roberts, T, Robinson, C, Rodriguez-Portales, J, Romieu, I, Room, R, Rosenfeld, L, Roy, A, Rushton, L, Salomon, J, Sampson, U, Sanchez-Riera, L, Sanman, E, Sapkota, A, Seedat, S, Shi, P, Shield, K, Shivakoti, P, Singh, G, Sleet, D, Smith, E, Smith, K, Stapelberg, N, Steenland, K, Stockl, H, Stovner, L, Straif, K, Straney, L, Thurston, GE, Tran, J, Van Dingenen, R, Van Donkelaar, A, Veerman, J, Vijayakumar, L, Weintraub, R, Weissman, M, White, R, Whiteford, H, Wiersma, S, Wilkison, J, Williams, H, Williams, W, Wilson, N, Woolf, A, Yip, P, Zielinski, J, lopez, A, Murray, C & 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', Lancet, vol. 380, pp. 2224-2260. https://doi.org/10.1016/S0140-6736(12)61766-8

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. / Lim, Stephen; Vos, Theo; Flaxman, Abraham; Danaei, Goodarz; Shibuya, Kenji; Adair-Rohani, Heather; Almazroa, Mohammad; Amann, Markus; Anderson, H; Andrews, Kathryn; Aryee, Martin; Atkinson, Charles; Bacchus, Loraine; Meng, Adil; Balakrishnan, Kalpana; Balmes, John; Barker-Collo, Suzanne; Baxter, Amanda; Bell, Michelle; Blore, Jed; Blyth, Fiona; Bonner, Carissa; Borges, Gilherme; Bourne, Rupert; Boussinesq, Michel; Brauer, Michael; brooks, peter; Brude, Nigel; Brunekreef, Bert; Bryan-Hancock, Claire; bucello, C; Buchbinder, Rachelle; Bull, F; Burnett, Richard; Byers, TIme; Calabria, Bianca; Carapetis, Johathan; Carnahan, Emily; Chafe, Z; Charlson, Fiona; Chen, Honglei; Chen, Jian Shen; Cheng, Andre; Child, Jennifer; Cohen, Aaron; Colson, K; Cowie, Benjamin; Darby, Sarah C.; Darling, Susan; Davis, Adrian; Degenhardt, Louisa; Dentener, Frank; Jarlais, Don; Devries, Karen; Dharani, Mukesh; Ding, Eric; Dorsey, E; Driscoll, Tim; Edmond, Karen; Ali, Suad; Engell, Rebecca; Erwin, Patricia; Fahimi, Saman; Falder, Gail; Farzadfar, Farshad; Ferrari, alize; Finucane, Mariel; Flaxman, Seth; Fowkes, Francis; Freedman, Greg; Freeman, Michael; Gakidou, Emmanuela; Ghosh, Santu; Giovannucci, Edward; Gmel, Gerhard; Graham, Kathryn; Grainger, Rebecca; Grant, Bridget; Gunnell, David; Gutierrez, Hialy; Hall, Wayne; Hoek, Hans; Hogan, Anthony; hosgood, H; Hoy, Damian; Hu, Howard; Hubbell, Bryan; Hutchings, Sally; Ibeanusi, Sydney; Jacklyn, Gemma; JAsrasaria, Rashmi; Jonas, Jost; Kan, Haidong; Kanis, John; Kassebaum, Nicholas; kawakami, Norito; Khang, Young-Ho; shahab, Khatibzadeh; Khoo, Jon-Paul; Kok, Cindy; Laden, Francine; Lalloo, Ratilal; Lan, Qing; Lathlean, Tim; Leasher, Janet; Leigh, James; Li, Yang; Lin, John; Lipshultz, Steven; London, Stephine; Lozano, Rafael; Lu, Yuan; Mak, joelle; Malekzadeh, Reza; Mallinger, Leslie; MArcenes, wagner; March, Lyn; Marks, Robin; Martin, Randall; McGale, Paul; McGrath, John; metha, Sumi; memish, Ziad; Mensah, George; Merriman, Tony; Micha, Renata; Michaud, Catherine; Mishra, Vinod; Hanafiah, Khayriyyah; Mokdad, Ali; Morawska, Lidia; Mozaffarian, Dariush; Murphy, Tasha; Naghavi, Mohsen; Neal, Bruce; Nelson, Paul; Nolla, Joan; Norman, Rosana; Olives, Casey; Omer, Saad; Orchard, Jessica; Osborne, Richard; Ostro, Bart; Page, Andrew; Pandey, Kiran; Parry, Charles; Passmore, Erin; Patra, Jayadeep; Pearce, Neil; Pelizzari, Pamela; Petzold, Max; Phillips, Michael; Pope, Dan; Pope, C; Powles, John; Rao, Mayuree; Razavi, Homie; Rehfuess, Eva; Rehm, Jurgen; Ritz, Beate; Rivara, Frederick; Roberts, Thomas; Robinson, Carolyn; Rodriguez-Portales, Jose; Romieu, Isabelle; Room, Robin; Rosenfeld, Lisa; Roy, Ananya; Rushton, Lesley; Salomon, Joshua; Sampson, Uchechukwu; Sanchez-Riera, Lidia; Sanman, Ella; Sapkota, Amir; Seedat, Soraya; Shi, Peilin; Shield, Kevin; Shivakoti, Pupak; Singh, Gitanjali; Sleet, David; Smith, Emma; Smith, kirk; Stapelberg, Nicholas; Steenland, Kyle; Stockl, Heidi; Stovner, Lars; Straif, Kurt; Straney, Lahn; Thurston, GEorge; Tran, Jimmy; Van Dingenen, Rita; Van Donkelaar, Aaron; Veerman, J; Vijayakumar, Lakshmi; Weintraub, Robert; Weissman, Myrna; White, Richard; Whiteford, Harvey; Wiersma, Steven; Wilkison, James; Williams, Hywel; Williams, Warwick; Wilson, Nicholas; Woolf, Anthony; Yip, Paul; Zielinski, Jan; lopez, Alan; Murray, Christopher; Ezzati, Majid.

In: Lancet, Vol. 380, 2012, p. 2224-2260.

Research output: Contribution to journalArticle

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: a systematic analysis for the Global Burden of Disease Study

AU - Lim, Stephen

AU - Vos, Theo

AU - Flaxman, Abraham

AU - Danaei, Goodarz

AU - Shibuya, Kenji

AU - Adair-Rohani, Heather

AU - Almazroa, Mohammad

AU - Amann, Markus

AU - Anderson, H

AU - Andrews, Kathryn

AU - Aryee, Martin

AU - Atkinson, Charles

AU - Bacchus, Loraine

AU - Meng, Adil

AU - Balakrishnan, Kalpana

AU - Balmes, John

AU - Barker-Collo, Suzanne

AU - Baxter, Amanda

AU - Bell, Michelle

AU - Blore, Jed

AU - Blyth, Fiona

AU - Bonner, Carissa

AU - Borges, Gilherme

AU - Bourne, Rupert

AU - Boussinesq, Michel

AU - Brauer, Michael

AU - brooks, peter

AU - Brude, Nigel

AU - Brunekreef, Bert

AU - Bryan-Hancock, Claire

AU - bucello, C

AU - Buchbinder, Rachelle

AU - Bull, F

AU - Burnett, Richard

AU - Byers, TIme

AU - Calabria, Bianca

AU - Carapetis, Johathan

AU - Carnahan, Emily

AU - Chafe, Z

AU - Charlson, Fiona

AU - Chen, Honglei

AU - Chen, Jian Shen

AU - Cheng, Andre

AU - Child, Jennifer

AU - Cohen, Aaron

AU - Colson, K

AU - Cowie, Benjamin

AU - Darby, Sarah C.

AU - Darling, Susan

AU - Davis, Adrian

AU - Degenhardt, Louisa

AU - Dentener, Frank

AU - Jarlais, Don

AU - Devries, Karen

AU - Dharani, Mukesh

AU - Ding, Eric

AU - Dorsey, E

AU - Driscoll, Tim

AU - Edmond, Karen

AU - Ali, Suad

AU - Engell, Rebecca

AU - Erwin, Patricia

AU - Fahimi, Saman

AU - Falder, Gail

AU - Farzadfar, Farshad

AU - Ferrari, alize

AU - Finucane, Mariel

AU - Flaxman, Seth

AU - Fowkes, Francis

AU - Freedman, Greg

AU - Freeman, Michael

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

AU - Hall, Wayne

AU - Hoek, Hans

AU - Hogan, Anthony

AU - hosgood, H

AU - Hoy, Damian

AU - Hu, Howard

AU - Hubbell, Bryan

AU - Hutchings, Sally

AU - Ibeanusi, Sydney

AU - Jacklyn, Gemma

AU - JAsrasaria, Rashmi

AU - Jonas, Jost

AU - Kan, Haidong

AU - Kanis, John

AU - Kassebaum, Nicholas

AU - kawakami, Norito

AU - Khang, Young-Ho

AU - shahab, Khatibzadeh

AU - Khoo, Jon-Paul

AU - Kok, Cindy

AU - Laden, Francine

AU - Lalloo, Ratilal

AU - Lan, Qing

AU - Lathlean, Tim

AU - Leasher, Janet

AU - Leigh, James

AU - Li, Yang

AU - Lin, John

AU - Lipshultz, Steven

AU - London, Stephine

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 - metha, Sumi

AU - memish, Ziad

AU - Mensah, George

AU - Merriman, Tony

AU - Micha, Renata

AU - Michaud, Catherine

AU - Mishra, Vinod

AU - Hanafiah, Khayriyyah

AU - Mokdad, Ali

AU - Morawska, Lidia

AU - Mozaffarian, Dariush

AU - Murphy, Tasha

AU - Naghavi, Mohsen

AU - Neal, Bruce

AU - Nelson, Paul

AU - Nolla, Joan

AU - Norman, Rosana

AU - Olives, Casey

AU - Omer, Saad

AU - Orchard, Jessica

AU - Osborne, Richard

AU - Ostro, Bart

AU - Page, Andrew

AU - Pandey, Kiran

AU - Parry, Charles

AU - Passmore, Erin

AU - Patra, Jayadeep

AU - Pearce, Neil

AU - Pelizzari, Pamela

AU - Petzold, Max

AU - Phillips, Michael

AU - Pope, Dan

AU - Pope, C

AU - Powles, John

AU - Rao, Mayuree

AU - Razavi, Homie

AU - Rehfuess, Eva

AU - Rehm, Jurgen

AU - Ritz, Beate

AU - Rivara, Frederick

AU - Roberts, Thomas

AU - Robinson, Carolyn

AU - Rodriguez-Portales, Jose

AU - Romieu, Isabelle

AU - Room, Robin

AU - Rosenfeld, Lisa

AU - Roy, Ananya

AU - Rushton, Lesley

AU - Salomon, Joshua

AU - Sampson, Uchechukwu

AU - Sanchez-Riera, Lidia

AU - Sanman, Ella

AU - Sapkota, Amir

AU - Seedat, Soraya

AU - Shi, Peilin

AU - Shield, Kevin

AU - Shivakoti, Pupak

AU - Singh, Gitanjali

AU - Sleet, David

AU - Smith, Emma

AU - Smith, kirk

AU - Stapelberg, Nicholas

AU - Steenland, Kyle

AU - Stockl, Heidi

AU - Stovner, Lars

AU - Straif, Kurt

AU - Straney, Lahn

AU - Thurston, GEorge

AU - Tran, Jimmy

AU - Van Dingenen, Rita

AU - Van Donkelaar, Aaron

AU - Veerman, J

AU - Vijayakumar, Lakshmi

AU - Weintraub, Robert

AU - Weissman, Myrna

AU - White, Richard

AU - Whiteford, Harvey

AU - Wiersma, Steven

AU - Wilkison, James

AU - Williams, Hywel

AU - Williams, Warwick

AU - Wilson, Nicholas

AU - Woolf, Anthony

AU - Yip, Paul

AU - Zielinski, Jan

AU - lopez, Alan

AU - Murray, Christopher

AU - Ezzati, Majid

PY - 2012

Y1 - 2012

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

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 - Lancet

JF - Lancet

SN - 0140-6736

ER -