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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

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    Author(s)
    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, H Dean
    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
    Miquel Nolla, Joan
    Norman, Rosana
    Olives, Casey
    Omer, Saad B
    Orchard, Jessica
    Osborne, Richard
    Ostro, Bart
    Page, Andrew
    Pandey, Kiran D
    Parry, Charles DH
    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, Juergen 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 JC
    Steenland, Kyle
    Stoeckl, 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 JL
    Ezzati, Majid
    Griffith University Author(s)
    Veerman, Lennert L.
    Year published
    2012
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    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 eff ects of 67 risk factors and clusters ...
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    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 eff ects 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 household air pollution from solid fuels (4·3% [3·4–5·3]). In 1990, the leading risks were childhood underweight (7·9% [6·8–9·4]), household air pollution from solid fuels (HAP; 6·8% [5·5–8·0]), 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, Andean Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, most of Latin America, 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.
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    Journal Title
    The Lancet
    Volume
    380
    Issue
    9859
    DOI
    https://doi.org/10.1016/S0140-6736(12)61766-8
    Copyright Statement
    © 2012 Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
    Subject
    Biomedical and clinical sciences
    Epidemiology not elsewhere classified
    Publication URI
    http://hdl.handle.net/10072/49807
    Collection
    • Journal articles

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