Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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Abstract

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS: We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS: Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION: Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING: The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.

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The record

Venue

The Lancet

Topic

Health, Environment, Cognitive Aging

Field

Environmental Science

Canadian institutions

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Funders

Daiichi Sankyo EuropeInstitute of Infection and ImmunityInstitute of GeneticsMailman School of Public Health, Columbia UniversityEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentDivision of Graduate EducationFogarty International CenterNational Institute on AgingSahlgrenska AkademinInstituto de Salud Carlos IIIRussian Academy of SciencesFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilEngineering and Physical Sciences Research CouncilMedical Research CouncilWeill Cornell Medicine - QatarCollege of Medicine, Seoul National UniversitySchool of Public Health and Family Medicine, University of Cape TownQatar National Research FundJohns Hopkins Bloomberg School of Public HealthWollega UniversityNational Institutes of HealthAswan UniversityArak University of Medical SciencesRede de Química e TecnologiaMinistry of Health of the Russian FederationUniversidade Federal de SergipeUniversity of Colorado School of Medicine, Anschutz Medical CampusINCLIVA Instituto de Investigación SanitariaPublic Health Foundation of IndiaApplied Molecular Biosciences UnitWageningen University and ResearchSamara UniversityH. Lundbeck A/SServierFakultet Medicinskih Nauka, Univerziteta U KragujevcuUniversity Hospitals Bristol NHS Foundation TrustChristian Medical College, VellorePontificia Universidad JaverianaThe Wellcome Trust DBT India AllianceGeorge Institute for Global HealthUniversity of PeradeniyaAuckland University of Technology, New ZealandWeill Cornell Medical CollegeXiamen UniversityUniversity of GondarTartu ÜlikoolUniversity of the PhilippinesNational Institute of Child Health and Human DevelopmentSri Ramachandra UniversityUniversity of Massachusetts BostonFundação Instituto de Pesquisas EconômicasDamon Runyon Cancer Research FoundationAlzheimer's AssociationUniversidade Federal de Minas GeraisBurnet InstituteUniversity of DelhiCentro de Investigación Biomédica en Red de Salud MentalHospital for Sick ChildrenGATSBahir Dar UniversityShahid Beheshti University of Medical SciencesGöteborgs UniversitetDebre Markos UniversityFlinders UniversityUniversität BielefeldColorado School of Public HealthMedical Center, University of RochesterUniversity of HaifaUniversidade de São PauloUniversity of New South WalesFoundation for Education and European CultureNational Yang-Ming UniversityHacettepe ÜniversitesiUniversitetet i OsloUniversitair Medisch Centrum GroningenMinistry of Health and Medical EducationHaramaya UniversityInyuvesi Yakwazulu-NataliYork UniversityTehran University of Medical Sciences and Health ServicesFundação de Amparo à Pesquisa do Estado do Rio Grande do SulMax-Planck-GesellschaftKyowa Hakko KirinEuropean Regional Development FundKarolinska InstitutetBundesbehörden der Schweizerischen EidgenossenschaftJordan University of Science and TechnologyTampereen YliopistoHospital de Clínicas de Porto AlegreBall State UniversityAddis Ababa UniversityUniversità degli Studi di SalernoNational Research Foundation of KoreaUniversity of California, San DiegoNational Health Research InstitutesConselho Nacional de Desenvolvimento Científico e TecnológicoPublic Health EnglandHigh Blood Pressure Research Council of AustraliaImperial College LondonUniversity of TorontoNational Institute of Allergy and Infectious DiseasesUniversitat de ValènciaUniversity of CanberraSecretaría Nacional de Ciencia, Tecnología e InnovaciónCairo UniversityLunds UniversitetDalhousie UniversityYale UniversityJimma UniversityChinese Academy of SciencesBundesministerium für Bildung und ForschungCoordenação de Aperfeiçoamento de Pessoal de Nível SuperiorAXA Research FundEconomic and Social Research CouncilNational Natural Science Foundation of ChinaCurtin University of TechnologyUniversiteit UtrechtScottish GovernmentU.S. Department of Health and Human ServicesUniversity of MelbourneWashington University in St. LouisMonash UniversityAllerganSecretaría de SaludNational Institute for Health Research Health Protection Research UnitDanmarks GrundforskningsfondAteneo de Manila UniversityHögskolan DalarnaUniversity of BristolUniversity of WashingtonRijksuniversiteit GroningenEuropean CommissionUniversity of North Carolina at Chapel HillEli Lilly and CompanyPublic Health AgencySouth African Medical Research CouncilPublic Health Agency of CanadaMadda Walabu UniversityUniversity Hospital Southampton NHS Foundation TrustIstituto di Ricerche Farmacologiche Mario Negri - IRCCSNational Heart Foundation of AustraliaQueensland Brain InstituteNewcastle UniversityUniversität HohenheimUniversity of OxfordUniwersytet Jagielloński Collegium MedicumUniversity College LondonNational Human Genome Research InstitutePublic Health InstituteKing's College LondonOhio State UniversityJohns Hopkins UniversityUniversity of WarwickUniversity of LeicesterZahedan University of Medical SciencesHarvard UniversityWarwick Medical SchoolDeutsches KrebsforschungszentrumPostgraduate Institute of Medical Education and Research, ChandigarhUniversity of AberdeenNational Research FoundationCenters for Disease Control and PreventionUniversity of QueenslandNational Institute for Health and Care ResearchUniversidad Autónoma MetropolitanaDepartment of Science and Technology, Ministry of Science and Technology, IndiaNew York University Abu DhabiUniversity of Occupational and Environmental HealthBloomberg PhilanthropiesUniversity of Cape TownHorizon PharmaceuticalsUniversity of SydneyBirzeit UniversityUniversity of SouthamptonBrien Holden Vision InstituteUniversity of GlasgowNorwegian Institute of Public HealthInternational Society of NephrologyLondon School of Economics and Political ScienceUniversity College CorkUniversidade Federal do Rio Grande do SulCentral South UniversityInstitute of Genetics and Developmental Biology, Chinese Academy of SciencesArabian Gulf UniversitySeattle Children's Research InstituteQueensland HealthGeneralitat ValencianaRegeneron PharmaceuticalsSouth Australian Health and Medical Research InstituteNational Cancer InstitutePeking UniversitySeoul National UniversityCenters for Disease Control and Prevention FoundationHelsingin YliopistoKing Saud UniversityOttawa Hospital Research InstituteUniversité de LorraineUniversity of RochesterUniversità degli Studi di MilanoUniversity of OtagoWellcome TrustPfizerBill and Melinda Gates FoundationEconomic Growth Center, Yale UniversityMekelle UniversityUniversiteit StellenboschUniversity of MichiganUniversitetet i BergenMinistarstvo Prosvete, Nauke i Tehnološkog RazvojaPublic Health WalesSimmons CollegeMazandaran University of Medical SciencesWorld Health OrganizationKaiser PermanenteDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthUppsala UniversitetChinese Center for Disease Control and PreventionGeorge Mason UniversityTrường Đại học Duy TânInstitute for Health Metrics and EvaluationUniversidade do PortoAustralian GovernmentADC FoundationAlexander von Humboldt-StiftungUniversität BaselAarhus UniversitetUniversity of TokyoNational Council on DisabilityUniversidad Nacional de ColombiaNational Drug and Alcohol Research CentreFriedrich-Schiller-Universität JenaAmgenNational Rosacea Society

Keywords

Environmental healthRisk assessmentBurden of diseaseMedicineEconomicsPopulation

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