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
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Résumé
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-defined 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-specific 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 deficiencies, 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 five 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. FUNDING: Bill & Melinda Gates Foundation.
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La notice
- Revue
- The Lancet
- Thématique
- Health, Environment, Cognitive Aging
- Domaine
- Environmental Science
- Établissements canadiens
- Western UniversityHeart and Stroke FoundationUniversité de MontréalUniversity of British ColumbiaUniversity of TorontoUniversity of OttawaUniversity of CalgaryPublic Health Agency of CanadaHealth CanadaUniversity of Manitoba
- Organismes subventionnaires
- National Institute of Environmental Health SciencesNational Institute on AgingSistema Nacional de InvestigadoresNational Health and Medical Research CouncilMedical Research CouncilSchool of Public Health and Family Medicine, University of Cape TownUniversity of California, San DiegoCarolina Population Center, University of North Carolina at Chapel HillUniversity of North Carolina at Chapel HillGillings School of Public HealthUniversidad de Ciencias Aplicadas y AmbientalesWestern Sydney UniversityMinistry of Health of the Russian FederationUniversidade Federal de SergipeINCLIVA Instituto de Investigación SanitariaFakultet Medicinskih Nauka, Univerziteta U KragujevcuEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentRegione ToscanaThe Wellcome Trust DBT India AllianceAddis Ababa UniversityAlfaisal UniversityUniversity of GondarUniversidade Federal de Minas GeraisCentro de Investigación Biomédica en Red de Salud MentalSimmons CollegeUniversitetet i BergenHaramaya UniversityUniversity of TokyoTehran University of Medical Sciences and Health ServicesNational Cerebral and Cardiovascular CenterJordan University of Science and TechnologyNova Southeastern UniversityHospital de Clínicas de Porto AlegreAXA Research FundKyung Hee UniversityBirzeit UniversityYonsei UniversityNational Cancer InstituteEuropean Regional Development FundUniversity of Massachusetts BostonLahore College for Women UniversitySeoul National UniversitySun Yat-sen UniversityUniversitat de ValènciaErasmus Universiteit RotterdamQueensland University of TechnologyFoundation for Education and European CultureNational Institute of Child Health and Human DevelopmentJames Cook UniversityInternational Centre for Diarrhoeal Disease Research, BangladeshMonash UniversityRijksuniversiteit GroningenMailman School of Public Health, Columbia UniversityNational Institute on Minority Health and Health DisparitiesUniversität HeidelbergUniversität BielefeldUniversiteit StellenboschPublic Health EnglandWageningen University and ResearchPublic Health Foundation of IndiaSwansea UniversityUniversitat de BarcelonaAcademy of FinlandSree Chitra Tirunal Institute for Medical Sciences and TechnologyKing's College LondonFundação para a Ciência e a TecnologiaAcademy of Medical SciencesUniversitair Medisch Centrum GroningenSouth Dakota Governor's Office of Economic DevelopmentAhmadu Bello UniversityUniversity of GhanaAarhus UniversitetKoch Institute for Integrative Cancer Research, Massachusetts Institute of TechnologyUnited Arab Emirates UniversityLa Trobe UniversityUniversidade Federal do Rio Grande do SulCentral South UniversityArabian Gulf UniversityPerelman School of Medicine, University of PennsylvaniaCancer Research UKTrường Đại học Duy TânJohns Hopkins UniversityWellcome TrustInternational Society of NephrologyBall State UniversityDepartment of Biotechnology, Ministry of Science and Technology, IndiaVirginia Commonwealth UniversityUniversity of Cape TownUniversity of OttawaAuckland University of Technology, New ZealandSichuan UniversityInyuvesi Yakwazulu-NataliRussian Academy of SciencesJohns Hopkins Bloomberg School of Public HealthUniversity of RochesterBaqiyatallah University of Medical SciencesUniversity of LouisvilleBrandeis UniversityRMIT UniversityNational Center for Child Health and DevelopmentNational Research FoundationAmerican University of BeirutHacettepe ÜniversitesiMedical Center, University of RochesterUniversity of PittsburghMinistry of Health and Medical EducationSchool of Medicine, Wayne State UniversityUniversity of MichiganRobert Koch InstitutIran University of Medical SciencesNational Science FoundationMassachusetts General HospitalOklahoma State UniversityUniversity of PennsylvaniaNational Institute for Health and Care ResearchWayne State UniversityKorea Health Industry Development InstituteUnited States Agency for International DevelopmentGeorge Mason UniversityCurtin University of TechnologyUniversiteit GentBill and Melinda Gates FoundationNational Research University Higher School of EconomicsHelsingin YliopistoInstituto de Salud Carlos IIIArak University of Medical SciencesYale UniversityUnited Nations Population FundShahid Beheshti University of Medical SciencesU.S. Department of Health and Human ServicesInstitute for Health Metrics and EvaluationChildren's Hospital of PhiladelphiaUniversity of AberdeenAstraZeneca
- Mots-clés
- Environmental healthRisk assessmentMedicineBurden of diseaseRisk analysis (engineering)EconomicsPopulation
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