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sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data.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 language | English (US) |
|---|---|
| Pages (from-to) | 2224-2260 |
| Number of pages | 37 |
| Journal | The Lancet |
| Volume | 380 |
| Issue number | 9859 |
| DOIs | |
| State | Published - Dec 2012 |
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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 C.; 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, Howard D.; 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, 12.2012, p. 2224-2260.Research output: Contribution to journal › Article
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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 C.
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, Howard D.
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 - 2012/12
Y1 - 2012/12
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
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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 -