Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and R...

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Autores:: Murray, Christopher
Aravkin, Aleksandr
Zheng, Peng
ABBAFATI, Cristiana
Abbas, Kaja
Abbasi-Kangevari, Mohsen
Abd-Allah, Foad
Abdelalim, Ahmed
Abdollahi, Mohammad
Abdollahpour, Ibrahim
Abegaz, Kedir
Abolhassani, Hassan
Aboyans, Victor
Guimarães Abreu, Lucas
M Abrigo, Michael R
Abualhasan, Ahmed
Ibrahim Abushouk, Abdelrahman
adabi, maryam
Adekanmb, Victor
ADEOYE , Abiodun Eyitayo
Adetokunboh, Olatunji
adham, davoud
Advani, Shailesh
Agarwal, Gina
Aghamir, Seyed Mohammad Kazem
Agrawal, Anurag
Ahmad, Tauseef
Ahmadi, Keivan
Ahmadi, Mehdi
Ahmadieh, Hamid
Beshir Ahmed, Muktar
Yihunie Akalu, Temesgen
Akinyemi, Rufus
Akinyemiju, Tomi
Akombi-Inyang, Blessing
Akunna, Chisom
Alahdab, Fares
Al-Aly, Ziyad
Alam, Khurshid
Alam, Samiah
Alam, Tahiya
Mashhour Alanez, Fahad
Alanzi, Turki
wassihun, biresaw
Alhabib, Khalid
Ali, Muhammad
Ali, Saqib
alicandro, gianfranco
Alinia, Cyrus
Alipour, Vahid
Alizade, Hesam
Aljunid, Syed Mohamed
alla, françois
Allebeck, Peter
Almasi-Hashiani, Amir
Al-Mekhlafi, Hesham
Alonso, Jordi
Altirkawi, Khalid
Amini-Rarani, Mostafa
Amiri, Fatemeh
Amugsi, DICKSON
Ancuceanu, Robert
Anderlini, Deanna
Anderson, Jason A
Andrei, Catalina Liliana
Andrei, Tudorel
Angus, Colin
Anjomshoa, Mina
Ansari, Fereshteh
Ansari-Moghaddam, Alireza
Antonazzo, Ippazio Cosimo
Antonio, Carl Abelardo
Antony, Catherine M
Antriyandarti, Ernoiz
Anvari, Davood
Anwer, Razique
Appiah, Seth Christopher Yaw
arabloo, Jalal
Arab-Zozani, Morteza
Ariani, Filippo
Armoon, Bahram
Ärnlöv, Johan
Arzani, Afsaneh
Asadi-Aliabadi, Mehran
Asadi-Pooya, Ali
Ashbaugh, Charlie
Assmus, Michael
Atafar, Zahra
Debalkie, Desta
Wahbi Atout, Maha Moh'd
Ausloos, Floriane
ausloos, marcel
Ayala Quintanilla, Beatriz Paulina
Ayano, Getinet
Ayanore, Martin
Azari, Samad
Azarian, Ghasem
Azene, Zelalem Nigussie
Badawi, Alaa
Badiye, Ashish
Amin Bahram, Mohammad
Bakhshaei, Hossein
Bakhtiari, Ahad
Bakkannavar, Shankar M
Baldasseroni, Alberto
Ball, Kylie
Ballew, Shoshana
Balzi, Daniela
Banach, Maciej
Banerjee, Srikanta K
Bante, Agegnehu
BARAKI, ADHANOM
Barker-Collo, Suzanne
Bärnighausen, Till
Barrero, Lope
Barthelemy, Celine
Barua, Lingkan
Basu, Sanjay
Baune, Bernhard T
Bayati, Mohsen
Becker, Jacob S
Bedi, Neeraj
Beghi, Ettore
Béjot, Yannick
L Bell, Akshaya
Bhagavathula, Srikanth
Bhageerathy, Reshmi
Bhala, Neeraj
Bhandari, Dinesh
Bhattacharyya, Krittika
Bhutta, Zulfiqar
Bijani, Ali
Bikbov, Boris
Bin Sayeed, Muhammad Shahdaat
Biondi, Antonio
Minuye, Binyam
Bisignano, Catherine
Biswas, Raaj Kishore
Bitew, Helen
Bohloul, Somayeh
Bohluli, Mehdi
Boon-Dooley, Alexandra S
Borzì, Antonio Maria
Borzouei, Shiva
bosetti, cristina
Boufous, Soufiane
Braithwaite, Dejana
Breitner-Busch (née Breitner), Susanne
Brenner, Hermann
Svitil Briant, Paul
Briko, Andrey Nikolaevich
Briko, Nikolay
Bryazka, Dana
Burkart, Katrin
Burnett, Richard Thomas
Burugina Nagaraja, Sharath
Butt, Zahid A
Caetano Dos Santos, Florentino Luciano
Cámera, Luis Alberto
Campos, Ismael
Cárdenas, Rosario
Carreras, Giulia
CARRERO ESPINOSA, JULIA JOSÉ
Carvalho, Felix
Castaldelli-Maia, Joao Mauricio
Castañeda-Orjuela, Carlos
Castelpietra, Giulio
Castro, Franz
Causey, Kate
Cederroth, Christopher
Cercy, Kelly M
Cerin, Ester
Chandan, Joht
Chang, Kai-Lan
Charlson, Fiona
Chattu, Vijay Kumar
Chaturvedi, Sarika
Cherbuin, Nicolas
Chimed-Ochir, Odgerel
Youngwhan Cho, Daniel
Jasmine Cho, Jee-Young
Christensen, Hanne
Chu, Dinh-Toi
Chung, Michael T
Chung, Sheng-Chia
Cicuttini, Flavia
Ciobanu, Liliana G
Cirillo, Massimo
Thomas, Dwayne
Cohen, Aaron J
Compton, Kelly
COOPER, OWEN
Costa, Vera Marisa
Cousin, Ewerton
Cowden, Richard Gregory
Cross, Di H
Cruz, Jessica A
Dahlawi, Saad
Moura Damasceno, Albertino Antonio
Damiani, Giovanni
Dandona, Lalit
Dandona, Rakhi
Dangel, William James
Danielsson, Anna-Karin
Dargan, Paul
Das, Jai
Das Gupta, Rajat
das Neves, José
Dávila-Cervantes, Claudio Alberto
Davitoiu, Dragos
de leo, diego
Degenhardt, Louisa
DeLang, Marissa
Dellavalle, Robert
Mekonnen Demeke, Feleke
Demoz, Gebre Teklemariam
Getnet Demsie, Desalegn
Denova-Gutiérrez, Edgar
Dervenis, Nikolaos
Dhungana, Govinda Prasad
Dianatinasab, Mostafa
Dias da Silva, Diana
Diaz, Daniel
Dibaji Forooshani, Zahra Sadat
Djalalinia, Shirin
Thi Do, Hoa

Tipo de recurso:: Article of journal

Fecha de publicación:: 2020

Institución:: Corporación Universidad de la Costa

Repositorio:: REDICUC - Repositorio CUC

Idioma:: eng

Description
Summary:	Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation.

Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

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