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 Article
Author(s): Blyth F.,Ding E.L.,Sleet D.A.,Fowkes F.G.R.,Robinson C.,Dentener F.,Driscoll T.,March L.,Yip P.,Straif K.,Khoo J.-P.,Orchard J.,Li Y.,Murray C.J.L.,Giovannucci E.,Patra J.,Dorsey E.R.,Ritz B.,Tran J.H.,Rivara F.P.,Leasher J.L.,Finucane M.M.,Bryan-Hancock C.,Burnett R.T.,Aryee M.,Razavi H.,Thurston G.D.,Darby S.,Roy A.,Davis A.,Khang Y.-H.,Rushton L.,Lathlean T.,London S.,Borges G.,Baxter A.,Morawska L.,Stöckl H.,Pelizzari P.M.,Powles J.,Blore J.D.,Sanman E.,Hanafiah K.M.,Micha R.,McGale P.,Devries K.,Calabria B.,Kassebaum N.,Wiersma S.T.,Bull F.,Dherani M.,Atkinson C.,Flaxman A.D.,Wilkinson J.D.,Norman R.,Petzold M.,Nelson P.K.,Mishra V.,Marks R.,Ostro B.,Engell R.E.,Vijayakumar L.,Stapelberg N.J.C.,McGrath J.,Amann M.,Rehfuess E.A.,Jonas J.B.,Jasrasaria R.,Chen J.S.,Shi P.,Hoek H.W.,Hogan A.,Fahimi S.,Rosenfeld L.C.,Freeman M.K.,Boussinesq M.,Hoy D.,Kok C.,Lipshultz S.E.,Cheng A.T.-A.,Vos T.,Kawakami N.,Williams W.,Sanchez-Riera L.,Martin R.,Grant B.,Farzadfar F.,Naghavi M.,Ferrari A.,Nolla J.M.,Rehm J.T.,Romieu I.,Hu H.,Singh G.M.,Jacklyn G.L.,Bacchus L.J.,Mozaffarian D.,Brauer M.,Olives C.,Brooks P.,Williams H.C.,Lim S.S.,Ibeanusi S.E.,Hutchings S.J.,Malekzadeh R.,Gmel G.,Lozano R.,Shield K.,Danaei G.,Adair-Rohani H.,Bucello C.,Murphy T.,Hubbell B.J.,Osborne R.,Bonner C.,Bahalim A.N.,Hosgood III H.D.,Smith E.,Sapkota A.,Bell M.L.,Van Donkelaar A.,Merriman T.R.,Seedat S.,Balakrishnan K.,Gunnell D.,Ali S.E.,Van Dingenen R.,Barker-Collo S.,Carapetis J.,Wilson N.,Lopez A.D.,Shibuya K.,Ghosh S.,Andrews K.G.,Cohen A.,Hall W.,Laden F.,Colson K.E.,Mehta S.,Salomon J.A.,Whiteford H.,Passmore E.,Parry C.D.H.,Lu Y.,Bourne R.,Balmes J.,Lan Q.,Stovner L.J.,Graham K.,Weintraub R.,Room R.,Marcenes W.,Straney L.,Charlson F.,Gakidou E.,Zielinski J.M.,Gutierrez H.R.,Veerman J.L.,Shivakoti R.,Anderson H.R.,Weissman M.M.,Khatibzadeh S.,White R.A.,Des Jarlais D.C.,Pandey K.D.,Erwin P.J.,Degenhardt L.,Cowie B.C.,Byers T.E.,Neal B.,Mallinger L.,Child J.C.,Page A.,Rodriguez-Portales J.A.,Chafe Z.,Smith K.R.,Ezzati M.,Buchbinder R.,Carnahan E.,Grainger R.,Bruce N.G.,Woolf A.D.,Darling S.,Brunekreef B.,Mokdad A.A.,Mak J.,Lin J.K.,Phillips M.R.,Mensah G.A.,Pearce N.,Steenland K.,Roberts T.,Leigh J.,Freedman G.,Rao M.,Edmond K.,Flaxman S.,Lalloo R.,Kan H.,Michaud C.,Pope III C.A.,Omer S.B.,Chen H.,Falder G.,Sampson U.,Pope D.,Kanis J.A.
The Lancet Volume 380, Issue 9859, 2012 , Pages 2224-2260

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.
systolic blood pressure adult childhood disease Child, Preschool cannabis article glucose blood level low back pain Risk Assessment particulate matter bone density meat industry child general aspects of disease Infant, Newborn male Middle East very elderly groups by age treatment outcome age disability adjusted life year omega 3 fatty acid infant alcohol consumption alcohol polycyclic aromatic hydrocarbon immobilization communicable disease death Age Factors water supply beryllium Disability Adjusted Life Years North Africa Mortality South Asia methodology risk factor retinol sanitation calcium intake injury sodium intake young adult Sex Factors Aged randomized controlled trial (topic) World Health dietary intake Humans priority journal Child unindexed drug zinc deficiency breast feeding female air pollution Male benzene sodium fuel passive smoking cadmium sex difference household underweight Europe health South and Central America body mass quality adjusted life year child sexual abuse disease management trans fatty acid newborn exposure disease burden sex arsenic fruit diet Adult amphetamine cholesterol blood level water iron deficiency adolescent Pacific islands Young Adult Middle Aged Aged, 80 and over Risk Factors chromium preschool child glucose blood pressure measurement aged diesel engine opiate Adolescent smoking iron middle aged occupational exposure Africa south of the Sahara environmental factor income asbestos risk assessment cholesterol tobacco smoke nickel partner violence mortality cause of death calcium formaldehyde lead retinol deficiency Female human physical activity measurement fume beverage zinc hypertension systematic review sulfuric acid sea food vegetable Australia and New Zealand Infant silicon dioxide polyunsaturated fatty acid body weight nutritional deficiency Quality-Adjusted Life Years

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