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

M. H. Forouzanfar, A. Afshin, L. T. Alexander, S. Biryukov, M. Brauer, K. Cercy, F. J. Charlson, A. J. Cohen, L. Dandona, K. Estep, A. J. Ferrari, J. J. Frostad, N. Fullman, W. W. Godwin, M. Griswold, S. I. Hay, H. H. Kyu, H. J. Larson, S. S. Lim, P. Y. LiuA. D. Lopez, R. Lozano, L. Marczak, A. H. Mokdad, M. Moradi-Lakeh, M. Naghavi, M. B. Reitsma, G. A. Roth, P. J. Sur, T. Vos, J. A. Wagner, H. Wang, Y. Zhao, M. Zhou, R. M. Barber, B. Bell, J. D. Blore, D. C. Casey, M. M. Coates, K. Cooperrider, L. Cornaby, D. Dicker, H. E. Erskine, T. Fleming, K. Foreman, E. Gakidou, J. A. Haagsma, C. O. Johnson, L. Kemmer, T. Ku, J. Leung, F. Masiye, A. Millear, M. Mirarefin, A. Misganaw, E. Mullany, J. E. Mumford, M. Ng, H. Olsen, P. Rao, N. Reinig, Y. Roman, L. Sandar, D. F. Santomauro, E. L. Slepak, R. J.D. Sorensen, B. A. Thomas, S. E. Vollset, H. A. Whiteford, B. Zipkin, C. J.L. Murray, C. N. Mock, B. O. Anderson, N. D. Futran, H. R. Anderson, Z. A. Bhutta, M. I. Nisar, N. Akseer, H. Krueger, C. C. Gotay, N. Kissoon, J. A. Kopec, F. Pourmalek, R. Burnett, A. A. Abajobir, L. D. Knibbs, J. L. Veerman, R. Lalloo, J. G. Scott, N. K.M. Alam, H. N. Gouda, Y. Guo, J. J. McGrath, P. Jeemon, R. Dandona, S. Goenka, G. A. Kumar, P. W. Gething, D. Bisanzio, A. Deribew, S. C. Darby, R. Ali, D. A. Bennett, V. Jha, Y. Kinfu, M. McKee, G. V.S. Murthy, N. Pearce, H. Stöckl, L. Duan, Y. Jin, Y. Li, S. Liu, L. Wang, P. Ye, X. Liang, P. Azzopardi, G. C. Patton, A. Meretoja, K. Alam, R. Borschmann, S. M. Colquhoun, R. G. Weintraub, C. E.I. Szoeke, Z. Ademi, H. R. Taylor, T. Wijeratne, C. Batis, S. Barquera, I. R. Campos-Nonato, A. G. Contreras, L. Cuevas-Nasu, V. De, H. Gomez-Dantes, I. B. Heredia-Pi, C. Medina, F. Mejia-Rodriguez, J. C. Montañez Hernandez, C. A. Razo-García, J. A. Rivera, S. Rodríguez-Ramírez, T. G. Sánchez-Pimienta, E. E. Servan-Mori, T. Shamah, G. A. Mensah, H. J. Hoff, B. Neal, T. R. Driscoll, A. H. Kemp, J. Leigh, A. B. Mekonnen, S. Bhatt, T. Fürst, F. B. Piel, A. Rodriguez, S. J. Hutchings, A. Majeed, M. Soljak, J. A. Salomon, A. L. Thorne-Lyman, O. N. Ajala, T. Bärnighausen, L. E. Cahill, E. L. Ding, M. S. Farvid, S. Khatibzadeh, G. R. Wagner, M. G. Shrime, J. R.A. Fitchett, G. M. Aasvang, M. Savic, K. H. Abate, T. T. Gebrehiwot, A. T. Gebremedhin, C. Abbafati, K. M. Abbas, F. Abd-Allah, A. M. Abdulle, S. F. Abera, Y. A. Melaku, G. Y. Abyu, B. D. Betsu, G. B. Hailu, D. Y. Tekle, A. Z. Yalew, B. Abraham, L. J. Abu-Raddad, A. O. Adebiyi, I. A. Adedeji, A. K. Adou, J. C. Adsuar, E. E. Agardh, J. Rehm, A. Badawi, S. Popova, A. Agarwal, A. Ahmad, T. F. Akinyemiju, D. C. Schwebel, J. A. Singh, Z. Al-Aly, S. F. Aldhahri, K. A. Altirkawi, A. S. Terkawi, R. W. Aldridge, T. Tillmann, Z. A. Alemu, T. K. Tegegne, A. Alkerwi, F. Alla, F. Guillemin, P. Allebeck, R. H.S. Rabiee, S. M. Fereshtehnejad, M. Kivipelto, J. J. Carrero, E. Weiderpass, R. Havmoeller, S. Sindi, U. Alsharif, E. Alvarez, N. Alvis-Guzman, A. T. Amare, L. G. Ciobanu, B. W. Taye, A. Amberbir, A. K. Amegah, H. Amini, C. K. Karema, W. Ammar, H. L. Harb, S. M. Amrock, H. H. Andersen, C. A.T. Antonio, E. J.A. Faraon, P. Anwari, J. Ärnlöv, A. Larsson, A. Artaman, H. Asayesh, R. J. Asghar, R. Assadi, S. Atique, E. F.G.A. Avokpaho, A. Awasthi, B. P. Ayala, U. Bacha, M. C. Bahit, K. Balakrishnan, A. Barac, S. L. Barker-Collo, B. del Pozo-Cruz, S. Mohammed, L. Barregard, M. Petzold, L. H. Barrero, S. Basu, L. C. Del, S. Bazargan-Hejazi, J. Beardsley, N. Bedi, E. Beghi, K. N. Sheth, M. L. Bell, J. J. Huang, A. K. Bello, I. S. Santos, I. M. Bensenor, P. A. Lotufo, A. Berhane, C. D. Wolfe, E. Bernabé, H. S. Roba, A. S. Beyene, T. A. Hassen, Y. M. Mesfin, N. Bhala, A. Bhansali, S. Biadgilign, B. Bikbov, E. Bjertness, A. S. Htet, S. Boufous, L. Degenhardt, S. Resnikoff, B. Calabria, R. R.A. Bourne, M. Brainin, A. Brazinova, M. Majdan, J. Shen, Nicholas Jk Breitborde, H. Brenner, B. Schöttker, D. M. Broday, T. S. Brugha, B. Brunekreef, H. Kromhout, Z. A. Butt, A. van Donkelaar, R. V. Martin, R. Cárdenas, D. O. Carpenter, C. A. Castañeda-Orjuela, J. Castillo, R. E. Castro, F. Catalá-López, J. Chang, P. P. Chiang, M. Chibalabala, O. Chimed-Ochir, Y. Jiang, K. Takahashi, V. H. Chisumpa, C. C. Mapoma, A. A. Chitheer, J. J. Choi, H. Christensen, D. J. Christopher, L. T. Cooper, J. A. Crump, R. G. Poulton, A. Damasceno, P. I. Dargan, J. das Neves, A. C. Davis, J. N. Newton, N. Steel, K. Davletov, E. F. de Castro, D. De, R. P. Dellavalle, D. C. Des, S. D. Dharmaratne, P. K. Dhillon, D. K. Lal, S. Zodpey, C. Diaz-Torné, E. R. Dorsey, K. E. Doyle, M. Dubey, M. H.U. Rahman, U. Ram, A. Singh, A. K. Yadav, B. B. Duncan, C. Kieling, M. I. Schmidt, I. Elyazar, A. Y. Endries, S. P. Ermakov, B. Eshrati, F. Farzadfar, A. Kasaeian, M. Parsaeian, A. Esteghamati, N. Hafezi-Nejad, S. Sheikhbahaei, S. Fahimi, R. Malekzadeh, G. Roshandel, S. G. Sepanlou, M. S. Hassanvand, P. Heydarpour, V. Rahimi-Movaghar, M. Yaseri, T. A. Farid, A. R. Khan, C. S.E.S. Farinha, A. Faro, V. L. Feigin, J. G. Fernandes, F. Fischer, N. Foigt, I. Shiue, F. G.R. Fowkes, R. C. Franklin, A. L. Garcia-Basteiro, J. M. Geleijnse, T. Jibat, B. D. Gessner, W. Tefera, A. Z. Giref, D. Haile, W. A.A. Manamo, M. Giroud, M. D. Gishu, J. Martinez-Raga, M. C. Gomez-Cabrera, P. Gona, A. Goodridge, S. V. Gopalani, A. Goto, M. Inoue, H. C. Gugnani, R. Gupta, R. A. Gutiérrez, R. Orozco, Y. A. Halasa, E. A. Undurraga, R. R. Hamadeh, S. Hamidi, A. J. Handal, G. J. Hankey, Y. Hao, S. Harikrishnan, J. M. Haro, N. F. Hernández-Llanes, H. W. Hoek, A. K. Tura, M. Horino, N. Horita, H. D. Hosgood, D. G. Hoy, M. Hsairi, G. Hu, A. Husseini, I. Huybrechts, K. M. Iburg, B. T. Idrisov, G. F. Kwan, B. V. Ileanu, A. Pana, N. Kawakami, K. Shibuya, T. A. Jacobs, K. H. Jacobsen, N. Jahanmehr, M. B. Jakovljevic, H. A.F. Jansen, S. K. Jassal, M. B. Stein, M. Javanbakht, S. P. Jayaraman, A. U. Jayatilleke, S. H. Jee, J. B. Jonas, Z. Kabir, Y. Kalkonde, R. Kamal, J. She, H. Kan, A. Karch, C. Karimkhani, A. Kaul, D. S. Kazi, P. N. Keiyoro, C. D. Parry, A. P. Kengne, R. Matzopoulos, C. S. Wiysonge, D. J. Stein, B. M. Mayosi, A. Keren, Y. S. Khader, E. A. Khan, G. Khan, Y. H. Khang, S. Won, S. Khera, M. Tavakkoli, T. A.M. Khoja, J. Khubchandani, C. Kim, D. Kim, R. W. Kimokoti, Y. Kokubo, P. A. Koul, A. Koyanagi, M. Kravchenko, Y. Y. Varakin, B. Kuate, R. S. Kuchenbecker, B. Kucuk, E. J. Kuipers, T. Lallukka, R. Shiri, T. J. Meretoja, Q. Lan, A. A. Latif, A. E.B. Lawrynowicz, J. L. Leasher, M. Levi, X. Li, J. Liang, B. K. Lloyd, G. Logroscino, R. Lunevicius, D. Pope, M. Mahdavi, D. C. Malta, W. Marcenes, K. Matsushita, J. B. Nachega, B. X. Tran, P. A. Meaney, A. Mehari, B. A. Tedla, Z. A. Memish, W. Mendoza, G. B.M. Mensink, F. A. Mhimbira, T. R. Miller, E. J. Mills, A. Mohammadi, G. L.D. Mola, L. Monasta, L. Morawska, R. E. Norman, R. Mori, D. Mozaff, P. Shi, A. Werdecker, U. O. Mueller, A. J. Paternina, R. Westerman, S. Seedat, A. Naheed, V. Nangia, N. Nassiri, Q. L. Nguyen, P. M. Nkamedjie, O. F. Norheim, B. Norrving, L. Nyakarahuka, C. M. Obermeyer, F. A. Ogbo, I. Oh, O. Oladimeji, B. Sartorius, B. O. Olusanya, P. R. Olivares, J. O. Olusanya, J. N. Opio, Eyal - Oren, A. Ortiz, E. Ota, P. A. Mahesh, E. Park, T. Patel, S. T. Patil, S. B. Patten, J. Wang, D. M. Pereira, M. Cortinovis, G. Giussani, N. Perico, G. Remuzzi, K. Pesudovs, M. R. Phillips, J. D. Pillay, D. Plass, M. Tobollik, S. Polinder, C. D. Pond, C. A. Pope, N. M. Prasad, M. Qorbani, A. Radfar, A. Rafay, S. M. Rana, M. Rahman, S. U. Rahman, S. Rajsic, R. K. Rai, M. Raju, K. Ranganathan, A. H. Refaat, C. D. Rehm, A. L. Ribeiro, D. Rojas-Rueda, A. Roy, M. Satpathy, N. Tandon, D. Rothenbacher, M. M. Saleh, J. R. Sanabria, L. Sanchez-Riera, M. D. Sanchez-Niño, R. Sarmiento-Suarez, M. Sawhney, J. Schmidhuber, I. J.C. Schneider, A. E. Schutte, D. A.S. Silva, S. Shahraz, M. Shin, A. Shaheen, M. A. Shaikh, R. Sharma, M. Shigematsu, S. Yoon, K. Shishani, I. D. Sigfusdottir, P. K. Singh, D. G.A. Silveira, J. I. Silverberg, Y. Yano, S. Soneji, L. A. Sposato, N. Steckling, C. T. Sreeramareddy, V. Stathopoulou, K. Stroumpoulis, B. F. Sunguya, S. Swaminathan, B. L. Sykes, R. Tabarés-Seisdedos, R. T. Talongwa, D. Tanne, E. M. Tuzcu, J. Thakur, G. Shaddick, M. L. Thomas, A. G. Thrift, G. D. Thurston, A. J. Thomson, R. Topor-Madry, F. Topouzis, J. A. Towbin, O. A. Uthman, R. Tobe-Gai, N. Tsilimparis, Z. Tsala, S. Tyrovolas, K. N. Ukwaja, J. van Os, T. Vasankari, N. Venketasubramanian, F. S. Violante, S. G. Waller, C. J. Uneke, Y. Wang, S. Weichenthal, A. D. Woolf, D. Xavier, G. Xu, B. Yakob, P. Yip, C. N. Kesavachandran, M. Montico, L. Ronfani, C. Yu, Z. Zaidi, N. Yonemoto, M. Z. Younis, M. Wubshet, L. J. Zuhlke, M. E. Zaki, J. Zhu

Research output: Contribution to journalArticle

1043 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1659-1724
Number of pages66
JournalThe Lancet
Volume388
Issue number10053
DOIs
StatePublished - Oct 8 2016

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Quality-Adjusted Life Years
Body Mass Index
Fasting
Air Pollution
Glucose
Global Burden of Disease
Smoking
Demography
Malnutrition
Sanitation
Thinness
Occupational Exposure
Pharmaceutical Preparations
Growth Disorders
Unsafe Sex
Geography
Particulate Matter
Africa South of the Sahara
Micronutrients
Information Storage and Retrieval

ASJC Scopus subject areas

  • Medicine(all)

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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. / Forouzanfar, M. H.; Afshin, A.; Alexander, L. T.; Biryukov, S.; Brauer, M.; Cercy, K.; Charlson, F. J.; Cohen, A. J.; Dandona, L.; Estep, K.; Ferrari, A. J.; Frostad, J. J.; Fullman, N.; Godwin, W. W.; Griswold, M.; Hay, S. I.; Kyu, H. H.; Larson, H. J.; Lim, S. S.; Liu, P. Y.; Lopez, A. D.; Lozano, R.; Marczak, L.; Mokdad, A. H.; Moradi-Lakeh, M.; Naghavi, M.; Reitsma, M. B.; Roth, G. A.; Sur, P. J.; Vos, T.; Wagner, J. A.; Wang, H.; Zhao, Y.; Zhou, M.; Barber, R. M.; Bell, B.; Blore, J. D.; Casey, D. C.; Coates, M. M.; Cooperrider, K.; Cornaby, L.; Dicker, D.; Erskine, H. E.; Fleming, T.; Foreman, K.; Gakidou, E.; Haagsma, J. A.; Johnson, C. O.; Kemmer, L.; Ku, T.; Leung, J.; Masiye, F.; Millear, A.; Mirarefin, M.; Misganaw, A.; Mullany, E.; Mumford, J. E.; Ng, M.; Olsen, H.; Rao, P.; Reinig, N.; Roman, Y.; Sandar, L.; Santomauro, D. F.; Slepak, E. L.; Sorensen, R. J.D.; Thomas, B. A.; Vollset, S. E.; Whiteford, H. A.; Zipkin, B.; Murray, C. J.L.; Mock, C. N.; Anderson, B. O.; Futran, N. D.; Anderson, H. R.; Bhutta, Z. A.; Nisar, M. I.; Akseer, N.; Krueger, H.; Gotay, C. C.; Kissoon, N.; Kopec, J. A.; Pourmalek, F.; Burnett, R.; Abajobir, A. A.; Knibbs, L. D.; Veerman, J. L.; Lalloo, R.; Scott, J. G.; Alam, N. K.M.; Gouda, H. N.; Guo, Y.; McGrath, J. J.; Jeemon, P.; Dandona, R.; Goenka, S.; Kumar, G. A.; Gething, P. W.; Bisanzio, D.; Deribew, A.; Darby, S. C.; Ali, R.; Bennett, D. A.; Jha, V.; Kinfu, Y.; McKee, M.; Murthy, G. V.S.; Pearce, N.; Stöckl, H.; Duan, L.; Jin, Y.; Li, Y.; Liu, S.; Wang, L.; Ye, P.; Liang, X.; Azzopardi, P.; Patton, G. C.; Meretoja, A.; Alam, K.; Borschmann, R.; Colquhoun, S. M.; Weintraub, R. G.; Szoeke, C. E.I.; Ademi, Z.; Taylor, H. R.; Wijeratne, T.; Batis, C.; Barquera, S.; Campos-Nonato, I. R.; Contreras, A. G.; Cuevas-Nasu, L.; De, V.; Gomez-Dantes, H.; Heredia-Pi, I. B.; Medina, C.; Mejia-Rodriguez, F.; Montañez Hernandez, J. C.; Razo-García, C. A.; Rivera, J. A.; Rodríguez-Ramírez, S.; Sánchez-Pimienta, T. G.; Servan-Mori, E. E.; Shamah, T.; Mensah, G. A.; Hoff, H. J.; Neal, B.; Driscoll, T. R.; Kemp, A. H.; Leigh, J.; Mekonnen, A. B.; Bhatt, S.; Fürst, T.; Piel, F. B.; Rodriguez, A.; Hutchings, S. J.; Majeed, A.; Soljak, M.; Salomon, J. A.; Thorne-Lyman, A. L.; Ajala, O. N.; Bärnighausen, T.; Cahill, L. E.; Ding, E. L.; Farvid, M. S.; Khatibzadeh, S.; Wagner, G. R.; Shrime, M. G.; Fitchett, J. R.A.; Aasvang, G. M.; Savic, M.; Abate, K. H.; Gebrehiwot, T. T.; Gebremedhin, A. T.; Abbafati, C.; Abbas, K. M.; Abd-Allah, F.; Abdulle, A. M.; Abera, S. F.; Melaku, Y. A.; Abyu, G. Y.; Betsu, B. D.; Hailu, G. B.; Tekle, D. Y.; Yalew, A. Z.; Abraham, B.; Abu-Raddad, L. J.; Adebiyi, A. O.; Adedeji, I. A.; Adou, A. K.; Adsuar, J. C.; Agardh, E. E.; Rehm, J.; Badawi, A.; Popova, S.; Agarwal, A.; Ahmad, A.; Akinyemiju, T. F.; Schwebel, D. C.; Singh, J. A.; Al-Aly, Z.; Aldhahri, S. F.; Altirkawi, K. A.; Terkawi, A. S.; Aldridge, R. W.; Tillmann, T.; Alemu, Z. A.; Tegegne, T. K.; Alkerwi, A.; Alla, F.; Guillemin, F.; Allebeck, P.; Rabiee, R. H.S.; Fereshtehnejad, S. M.; Kivipelto, M.; Carrero, J. J.; Weiderpass, E.; Havmoeller, R.; Sindi, S.; Alsharif, U.; Alvarez, E.; Alvis-Guzman, N.; Amare, A. T.; Ciobanu, L. G.; Taye, B. W.; Amberbir, A.; Amegah, A. K.; Amini, H.; Karema, C. K.; Ammar, W.; Harb, H. L.; Amrock, S. M.; Andersen, H. H.; Antonio, C. A.T.; Faraon, E. J.A.; Anwari, P.; Ärnlöv, J.; Larsson, A.; Artaman, A.; Asayesh, H.; Asghar, R. J.; Assadi, R.; Atique, S.; Avokpaho, E. F.G.A.; Awasthi, A.; Ayala, B. P.; Bacha, U.; Bahit, M. C.; Balakrishnan, K.; Barac, A.; Barker-Collo, S. L.; del Pozo-Cruz, B.; Mohammed, S.; Barregard, L.; Petzold, M.; Barrero, L. H.; Basu, S.; Del, L. C.; Bazargan-Hejazi, S.; Beardsley, J.; Bedi, N.; Beghi, E.; Sheth, K. N.; Bell, M. L.; Huang, J. J.; Bello, A. K.; Santos, I. S.; Bensenor, I. M.; Lotufo, P. A.; Berhane, A.; Wolfe, C. D.; Bernabé, E.; Roba, H. S.; Beyene, A. S.; Hassen, T. A.; Mesfin, Y. M.; Bhala, N.; Bhansali, A.; Biadgilign, S.; Bikbov, B.; Bjertness, E.; Htet, A. S.; Boufous, S.; Degenhardt, L.; Resnikoff, S.; Calabria, B.; Bourne, R. R.A.; Brainin, M.; Brazinova, A.; Majdan, M.; Shen, J.; Breitborde, Nicholas Jk; Brenner, H.; Schöttker, B.; Broday, D. M.; Brugha, T. S.; Brunekreef, B.; Kromhout, H.; Butt, Z. A.; van Donkelaar, A.; Martin, R. V.; Cárdenas, R.; Carpenter, D. O.; Castañeda-Orjuela, C. A.; Castillo, J.; Castro, R. E.; Catalá-López, F.; Chang, J.; Chiang, P. P.; Chibalabala, M.; Chimed-Ochir, O.; Jiang, Y.; Takahashi, K.; Chisumpa, V. H.; Mapoma, C. C.; Chitheer, A. A.; Choi, J. J.; Christensen, H.; Christopher, D. J.; Cooper, L. T.; Crump, J. A.; Poulton, R. G.; Damasceno, A.; Dargan, P. I.; das Neves, J.; Davis, A. C.; Newton, J. N.; Steel, N.; Davletov, K.; de Castro, E. F.; De, D.; Dellavalle, R. P.; Des, D. C.; Dharmaratne, S. D.; Dhillon, P. K.; Lal, D. K.; Zodpey, S.; Diaz-Torné, C.; Dorsey, E. R.; Doyle, K. E.; Dubey, M.; Rahman, M. H.U.; Ram, U.; Singh, A.; Yadav, A. K.; Duncan, B. B.; Kieling, C.; Schmidt, M. I.; Elyazar, I.; Endries, A. Y.; Ermakov, S. P.; Eshrati, B.; Farzadfar, F.; Kasaeian, A.; Parsaeian, M.; Esteghamati, A.; Hafezi-Nejad, N.; Sheikhbahaei, S.; Fahimi, S.; Malekzadeh, R.; Roshandel, G.; Sepanlou, S. G.; Hassanvand, M. S.; Heydarpour, P.; Rahimi-Movaghar, V.; Yaseri, M.; Farid, T. A.; Khan, A. R.; Farinha, C. S.E.S.; Faro, A.; Feigin, V. L.; Fernandes, J. G.; Fischer, F.; Foigt, N.; Shiue, I.; Fowkes, F. G.R.; Franklin, R. C.; Garcia-Basteiro, A. L.; Geleijnse, J. M.; Jibat, T.; Gessner, B. D.; Tefera, W.; Giref, A. Z.; Haile, D.; Manamo, W. A.A.; Giroud, M.; Gishu, M. D.; Martinez-Raga, J.; Gomez-Cabrera, M. C.; Gona, P.; Goodridge, A.; Gopalani, S. V.; Goto, A.; Inoue, M.; Gugnani, H. C.; Gupta, R.; Gutiérrez, R. A.; Orozco, R.; Halasa, Y. A.; Undurraga, E. A.; Hamadeh, R. R.; Hamidi, S.; Handal, A. J.; Hankey, G. J.; Hao, Y.; Harikrishnan, S.; Haro, J. M.; Hernández-Llanes, N. F.; Hoek, H. W.; Tura, A. K.; Horino, M.; Horita, N.; Hosgood, H. D.; Hoy, D. G.; Hsairi, M.; Hu, G.; Husseini, A.; Huybrechts, I.; Iburg, K. M.; Idrisov, B. T.; Kwan, G. F.; Ileanu, B. V.; Pana, A.; Kawakami, N.; Shibuya, K.; Jacobs, T. A.; Jacobsen, K. H.; Jahanmehr, N.; Jakovljevic, M. B.; Jansen, H. A.F.; Jassal, S. K.; Stein, M. B.; Javanbakht, M.; Jayaraman, S. P.; Jayatilleke, A. U.; Jee, S. H.; Jonas, J. B.; Kabir, Z.; Kalkonde, Y.; Kamal, R.; She, J.; Kan, H.; Karch, A.; Karimkhani, C.; Kaul, A.; Kazi, D. S.; Keiyoro, P. N.; Parry, C. D.; Kengne, A. P.; Matzopoulos, R.; Wiysonge, C. S.; Stein, D. J.; Mayosi, B. M.; Keren, A.; Khader, Y. S.; Khan, E. A.; Khan, G.; Khang, Y. H.; Won, S.; Khera, S.; Tavakkoli, M.; Khoja, T. A.M.; Khubchandani, J.; Kim, C.; Kim, D.; Kimokoti, R. W.; Kokubo, Y.; Koul, P. A.; Koyanagi, A.; Kravchenko, M.; Varakin, Y. Y.; Kuate, B.; Kuchenbecker, R. S.; Kucuk, B.; Kuipers, E. J.; Lallukka, T.; Shiri, R.; Meretoja, T. J.; Lan, Q.; Latif, A. A.; Lawrynowicz, A. E.B.; Leasher, J. L.; Levi, M.; Li, X.; Liang, J.; Lloyd, B. K.; Logroscino, G.; Lunevicius, R.; Pope, D.; Mahdavi, M.; Malta, D. C.; Marcenes, W.; Matsushita, K.; Nachega, J. B.; Tran, B. X.; Meaney, P. A.; Mehari, A.; Tedla, B. A.; Memish, Z. A.; Mendoza, W.; Mensink, G. B.M.; Mhimbira, F. A.; Miller, T. R.; Mills, E. J.; Mohammadi, A.; Mola, G. L.D.; Monasta, L.; Morawska, L.; Norman, R. E.; Mori, R.; Mozaff, D.; Shi, P.; Werdecker, A.; Mueller, U. O.; Paternina, A. J.; Westerman, R.; Seedat, S.; Naheed, A.; Nangia, V.; Nassiri, N.; Nguyen, Q. L.; Nkamedjie, P. M.; Norheim, O. F.; Norrving, B.; Nyakarahuka, L.; Obermeyer, C. M.; Ogbo, F. A.; Oh, I.; Oladimeji, O.; Sartorius, B.; Olusanya, B. O.; Olivares, P. R.; Olusanya, J. O.; Opio, J. N.; Oren, Eyal -; Ortiz, A.; Ota, E.; Mahesh, P. A.; Park, E.; Patel, T.; Patil, S. T.; Patten, S. B.; Wang, J.; Pereira, D. M.; Cortinovis, M.; Giussani, G.; Perico, N.; Remuzzi, G.; Pesudovs, K.; Phillips, M. R.; Pillay, J. D.; Plass, D.; Tobollik, M.; Polinder, S.; Pond, C. D.; Pope, C. A.; Prasad, N. M.; Qorbani, M.; Radfar, A.; Rafay, A.; Rana, S. M.; Rahman, M.; Rahman, S. U.; Rajsic, S.; Rai, R. K.; Raju, M.; Ranganathan, K.; Refaat, A. H.; Rehm, C. D.; Ribeiro, A. L.; Rojas-Rueda, D.; Roy, A.; Satpathy, M.; Tandon, N.; Rothenbacher, D.; Saleh, M. M.; Sanabria, J. R.; Sanchez-Riera, L.; Sanchez-Niño, M. D.; Sarmiento-Suarez, R.; Sawhney, M.; Schmidhuber, J.; Schneider, I. J.C.; Schutte, A. E.; Silva, D. A.S.; Shahraz, S.; Shin, M.; Shaheen, A.; Shaikh, M. A.; Sharma, R.; Shigematsu, M.; Yoon, S.; Shishani, K.; Sigfusdottir, I. D.; Singh, P. K.; Silveira, D. G.A.; Silverberg, J. I.; Yano, Y.; Soneji, S.; Sposato, L. A.; Steckling, N.; Sreeramareddy, C. T.; Stathopoulou, V.; Stroumpoulis, K.; Sunguya, B. F.; Swaminathan, S.; Sykes, B. L.; Tabarés-Seisdedos, R.; Talongwa, R. T.; Tanne, D.; Tuzcu, E. M.; Thakur, J.; Shaddick, G.; Thomas, M. L.; Thrift, A. G.; Thurston, G. D.; Thomson, A. J.; Topor-Madry, R.; Topouzis, F.; Towbin, J. A.; Uthman, O. A.; Tobe-Gai, R.; Tsilimparis, N.; Tsala, Z.; Tyrovolas, S.; Ukwaja, K. N.; van Os, J.; Vasankari, T.; Venketasubramanian, N.; Violante, F. S.; Waller, S. G.; Uneke, C. J.; Wang, Y.; Weichenthal, S.; Woolf, A. D.; Xavier, D.; Xu, G.; Yakob, B.; Yip, P.; Kesavachandran, C. N.; Montico, M.; Ronfani, L.; Yu, C.; Zaidi, Z.; Yonemoto, N.; Younis, M. Z.; Wubshet, M.; Zuhlke, L. J.; Zaki, M. E.; Zhu, J.

In: The Lancet, Vol. 388, No. 10053, 08.10.2016, p. 1659-1724.

Research output: Contribution to journalArticle

Forouzanfar, MH, Afshin, A, Alexander, LT, Biryukov, S, Brauer, M, Cercy, K, Charlson, FJ, Cohen, AJ, Dandona, L, Estep, K, Ferrari, AJ, Frostad, JJ, Fullman, N, Godwin, WW, Griswold, M, Hay, SI, Kyu, HH, Larson, HJ, Lim, SS, Liu, PY, Lopez, AD, Lozano, R, Marczak, L, Mokdad, AH, Moradi-Lakeh, M, Naghavi, M, Reitsma, MB, Roth, GA, Sur, PJ, Vos, T, Wagner, JA, Wang, H, Zhao, Y, Zhou, M, Barber, RM, Bell, B, Blore, JD, Casey, DC, Coates, MM, Cooperrider, K, Cornaby, L, Dicker, D, Erskine, HE, Fleming, T, Foreman, K, Gakidou, E, Haagsma, JA, Johnson, CO, Kemmer, L, Ku, T, Leung, J, Masiye, F, Millear, A, Mirarefin, M, Misganaw, A, Mullany, E, Mumford, JE, Ng, M, Olsen, H, Rao, P, Reinig, N, Roman, Y, Sandar, L, Santomauro, DF, Slepak, EL, Sorensen, RJD, Thomas, BA, Vollset, SE, Whiteford, HA, Zipkin, B, Murray, CJL, Mock, CN, Anderson, BO, Futran, ND, Anderson, HR, Bhutta, ZA, Nisar, MI, Akseer, N, Krueger, H, Gotay, CC, Kissoon, N, Kopec, JA, Pourmalek, F, Burnett, R, Abajobir, AA, Knibbs, LD, Veerman, JL, Lalloo, R, Scott, JG, Alam, NKM, Gouda, HN, Guo, Y, McGrath, JJ, Jeemon, P, Dandona, R, Goenka, S, Kumar, GA, Gething, PW, Bisanzio, D, Deribew, A, Darby, SC, Ali, R, Bennett, DA, Jha, V, Kinfu, Y, McKee, M, Murthy, GVS, Pearce, N, Stöckl, H, Duan, L, Jin, Y, Li, Y, Liu, S, Wang, L, Ye, P, Liang, X, Azzopardi, P, Patton, GC, Meretoja, A, Alam, K, Borschmann, R, Colquhoun, SM, Weintraub, RG, Szoeke, CEI, Ademi, Z, Taylor, HR, Wijeratne, T, Batis, C, Barquera, S, Campos-Nonato, IR, Contreras, AG, Cuevas-Nasu, L, De, V, Gomez-Dantes, H, Heredia-Pi, IB, Medina, C, Mejia-Rodriguez, F, Montañez Hernandez, JC, Razo-García, CA, Rivera, JA, Rodríguez-Ramírez, S, Sánchez-Pimienta, TG, Servan-Mori, EE, Shamah, T, Mensah, GA, Hoff, HJ, Neal, B, Driscoll, TR, Kemp, AH, Leigh, J, Mekonnen, AB, Bhatt, S, Fürst, T, Piel, FB, Rodriguez, A, Hutchings, SJ, Majeed, A, Soljak, M, Salomon, JA, Thorne-Lyman, AL, Ajala, ON, Bärnighausen, T, Cahill, LE, Ding, EL, Farvid, MS, Khatibzadeh, S, Wagner, GR, Shrime, MG, Fitchett, JRA, Aasvang, GM, Savic, M, Abate, KH, Gebrehiwot, TT, Gebremedhin, AT, Abbafati, C, Abbas, KM, Abd-Allah, F, Abdulle, AM, Abera, SF, Melaku, YA, Abyu, GY, Betsu, BD, Hailu, GB, Tekle, DY, Yalew, AZ, Abraham, B, Abu-Raddad, LJ, Adebiyi, AO, Adedeji, IA, Adou, AK, Adsuar, JC, Agardh, EE, Rehm, J, Badawi, A, Popova, S, Agarwal, A, Ahmad, A, Akinyemiju, TF, Schwebel, DC, Singh, JA, Al-Aly, Z, Aldhahri, SF, Altirkawi, KA, Terkawi, AS, Aldridge, RW, Tillmann, T, Alemu, ZA, Tegegne, TK, Alkerwi, A, Alla, F, Guillemin, F, Allebeck, P, Rabiee, RHS, Fereshtehnejad, SM, Kivipelto, M, Carrero, JJ, Weiderpass, E, Havmoeller, R, Sindi, S, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, AT, Ciobanu, LG, Taye, BW, Amberbir, A, Amegah, AK, Amini, H, Karema, CK, Ammar, W, Harb, HL, Amrock, SM, Andersen, HH, Antonio, CAT, Faraon, EJA, Anwari, P, Ärnlöv, J, Larsson, A, Artaman, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Avokpaho, EFGA, Awasthi, A, Ayala, BP, Bacha, U, Bahit, MC, Balakrishnan, K, Barac, A, Barker-Collo, SL, del Pozo-Cruz, B, Mohammed, S, Barregard, L, Petzold, M, Barrero, LH, Basu, S, Del, LC, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Beghi, E, Sheth, KN, Bell, ML, Huang, JJ, Bello, AK, Santos, IS, Bensenor, IM, Lotufo, PA, Berhane, A, Wolfe, CD, Bernabé, E, Roba, HS, Beyene, AS, Hassen, TA, Mesfin, YM, Bhala, N, Bhansali, A, Biadgilign, S, Bikbov, B, Bjertness, E, Htet, AS, Boufous, S, Degenhardt, L, Resnikoff, S, Calabria, B, Bourne, RRA, Brainin, M, Brazinova, A, Majdan, M, Shen, J, Breitborde, NJ, Brenner, H, Schöttker, B, Broday, DM, Brugha, TS, Brunekreef, B, Kromhout, H, Butt, ZA, van Donkelaar, A, Martin, RV, Cárdenas, R, Carpenter, DO, Castañeda-Orjuela, CA, Castillo, J, Castro, RE, Catalá-López, F, Chang, J, Chiang, PP, Chibalabala, M, Chimed-Ochir, O, Jiang, Y, Takahashi, K, Chisumpa, VH, Mapoma, CC, Chitheer, AA, Choi, JJ, Christensen, H, Christopher, DJ, Cooper, LT, Crump, JA, Poulton, RG, Damasceno, A, Dargan, PI, das Neves, J, Davis, AC, Newton, JN, Steel, N, Davletov, K, de Castro, EF, De, D, Dellavalle, RP, Des, DC, Dharmaratne, SD, Dhillon, PK, Lal, DK, Zodpey, S, Diaz-Torné, C, Dorsey, ER, Doyle, KE, Dubey, M, Rahman, MHU, Ram, U, Singh, A, Yadav, AK, Duncan, BB, Kieling, C, Schmidt, MI, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Farzadfar, F, Kasaeian, A, Parsaeian, M, Esteghamati, A, Hafezi-Nejad, N, Sheikhbahaei, S, Fahimi, S, Malekzadeh, R, Roshandel, G, Sepanlou, SG, Hassanvand, MS, Heydarpour, P, Rahimi-Movaghar, V, Yaseri, M, Farid, TA, Khan, AR, Farinha, CSES, Faro, A, Feigin, VL, Fernandes, JG, Fischer, F, Foigt, N, Shiue, I, Fowkes, FGR, Franklin, RC, Garcia-Basteiro, AL, Geleijnse, JM, Jibat, T, Gessner, BD, Tefera, W, Giref, AZ, Haile, D, Manamo, WAA, Giroud, M, Gishu, MD, Martinez-Raga, J, Gomez-Cabrera, MC, Gona, P, Goodridge, A, Gopalani, SV, Goto, A, Inoue, M, Gugnani, HC, Gupta, R, Gutiérrez, RA, Orozco, R, Halasa, YA, Undurraga, EA, Hamadeh, RR, Hamidi, S, Handal, AJ, Hankey, GJ, Hao, Y, Harikrishnan, S, Haro, JM, Hernández-Llanes, NF, Hoek, HW, Tura, AK, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Husseini, A, Huybrechts, I, Iburg, KM, Idrisov, BT, Kwan, GF, Ileanu, BV, Pana, A, Kawakami, N, Shibuya, K, Jacobs, TA, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Jansen, HAF, Jassal, SK, Stein, MB, Javanbakht, M, Jayaraman, SP, Jayatilleke, AU, Jee, SH, Jonas, JB, Kabir, Z, Kalkonde, Y, Kamal, R, She, J, Kan, H, Karch, A, Karimkhani, C, Kaul, A, Kazi, DS, Keiyoro, PN, Parry, CD, Kengne, AP, Matzopoulos, R, Wiysonge, CS, Stein, DJ, Mayosi, BM, Keren, A, Khader, YS, Khan, EA, Khan, G, Khang, YH, Won, S, Khera, S, Tavakkoli, M, Khoja, TAM, Khubchandani, J, Kim, C, Kim, D, Kimokoti, RW, Kokubo, Y, Koul, PA, Koyanagi, A, Kravchenko, M, Varakin, YY, Kuate, B, Kuchenbecker, RS, Kucuk, B, Kuipers, EJ, Lallukka, T, Shiri, R, Meretoja, TJ, Lan, Q, Latif, AA, Lawrynowicz, AEB, Leasher, JL, Levi, M, Li, X, Liang, J, Lloyd, BK, Logroscino, G, Lunevicius, R, Pope, D, Mahdavi, M, Malta, DC, Marcenes, W, Matsushita, K, Nachega, JB, Tran, BX, Meaney, PA, Mehari, A, Tedla, BA, Memish, ZA, Mendoza, W, Mensink, GBM, Mhimbira, FA, Miller, TR, Mills, EJ, Mohammadi, A, Mola, GLD, Monasta, L, Morawska, L, Norman, RE, Mori, R, Mozaff, D, Shi, P, Werdecker, A, Mueller, UO, Paternina, AJ, Westerman, R, Seedat, S, Naheed, A, Nangia, V, Nassiri, N, Nguyen, QL, Nkamedjie, PM, Norheim, OF, Norrving, B, Nyakarahuka, L, Obermeyer, CM, Ogbo, FA, Oh, I, Oladimeji, O, Sartorius, B, Olusanya, BO, Olivares, PR, Olusanya, JO, Opio, JN, Oren, E, Ortiz, A, Ota, E, Mahesh, PA, Park, E, Patel, T, Patil, ST, Patten, SB, Wang, J, Pereira, DM, Cortinovis, M, Giussani, G, Perico, N, Remuzzi, G, Pesudovs, K, Phillips, MR, Pillay, JD, Plass, D, Tobollik, M, Polinder, S, Pond, CD, Pope, CA, Prasad, NM, Qorbani, M, Radfar, A, Rafay, A, Rana, SM, Rahman, M, Rahman, SU, Rajsic, S, Rai, RK, Raju, M, Ranganathan, K, Refaat, AH, Rehm, CD, Ribeiro, AL, Rojas-Rueda, D, Roy, A, Satpathy, M, Tandon, N, Rothenbacher, D, Saleh, MM, Sanabria, JR, Sanchez-Riera, L, Sanchez-Niño, MD, Sarmiento-Suarez, R, Sawhney, M, Schmidhuber, J, Schneider, IJC, Schutte, AE, Silva, DAS, Shahraz, S, Shin, M, Shaheen, A, Shaikh, MA, Sharma, R, Shigematsu, M, Yoon, S, Shishani, K, Sigfusdottir, ID, Singh, PK, Silveira, DGA, Silverberg, JI, Yano, Y, Soneji, S, Sposato, LA, Steckling, N, Sreeramareddy, CT, Stathopoulou, V, Stroumpoulis, K, Sunguya, BF, Swaminathan, S, Sykes, BL, Tabarés-Seisdedos, R, Talongwa, RT, Tanne, D, Tuzcu, EM, Thakur, J, Shaddick, G, Thomas, ML, Thrift, AG, Thurston, GD, Thomson, AJ, Topor-Madry, R, Topouzis, F, Towbin, JA, Uthman, OA, Tobe-Gai, R, Tsilimparis, N, Tsala, Z, Tyrovolas, S, Ukwaja, KN, van Os, J, Vasankari, T, Venketasubramanian, N, Violante, FS, Waller, SG, Uneke, CJ, Wang, Y, Weichenthal, S, Woolf, AD, Xavier, D, Xu, G, Yakob, B, Yip, P, Kesavachandran, CN, Montico, M, Ronfani, L, Yu, C, Zaidi, Z, 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Forouzanfar, M. H. ; Afshin, A. ; Alexander, L. T. ; Biryukov, S. ; Brauer, M. ; Cercy, K. ; Charlson, F. J. ; Cohen, A. J. ; Dandona, L. ; Estep, K. ; Ferrari, A. J. ; Frostad, J. J. ; Fullman, N. ; Godwin, W. W. ; Griswold, M. ; Hay, S. I. ; Kyu, H. H. ; Larson, H. J. ; Lim, S. S. ; Liu, P. Y. ; Lopez, A. D. ; Lozano, R. ; Marczak, L. ; Mokdad, A. H. ; Moradi-Lakeh, M. ; Naghavi, M. ; Reitsma, M. B. ; Roth, G. A. ; Sur, P. J. ; Vos, T. ; Wagner, J. A. ; Wang, H. ; Zhao, Y. ; Zhou, M. ; Barber, R. M. ; Bell, B. ; Blore, J. D. ; Casey, D. C. ; Coates, M. M. ; Cooperrider, K. ; Cornaby, L. ; Dicker, D. ; Erskine, H. E. ; Fleming, T. ; Foreman, K. ; Gakidou, E. ; Haagsma, J. A. ; Johnson, C. O. ; Kemmer, L. ; Ku, T. ; Leung, J. ; Masiye, F. ; Millear, A. ; Mirarefin, M. ; Misganaw, A. ; Mullany, E. ; Mumford, J. E. ; Ng, M. ; Olsen, H. ; Rao, P. ; Reinig, N. ; Roman, Y. ; Sandar, L. ; Santomauro, D. F. ; Slepak, E. L. ; Sorensen, R. J.D. ; Thomas, B. A. ; Vollset, S. E. ; Whiteford, H. A. ; Zipkin, B. ; Murray, C. J.L. ; Mock, C. N. ; Anderson, B. O. ; Futran, N. D. ; Anderson, H. R. ; Bhutta, Z. A. ; Nisar, M. I. ; Akseer, N. ; Krueger, H. ; Gotay, C. C. ; Kissoon, N. ; Kopec, J. A. ; Pourmalek, F. ; Burnett, R. ; Abajobir, A. A. ; Knibbs, L. D. ; Veerman, J. L. ; Lalloo, R. ; Scott, J. G. ; Alam, N. K.M. ; Gouda, H. N. ; Guo, Y. ; McGrath, J. J. ; Jeemon, P. ; Dandona, R. ; Goenka, S. ; Kumar, G. A. ; Gething, P. W. ; Bisanzio, D. ; Deribew, A. ; Darby, S. C. ; Ali, R. ; Bennett, D. A. ; Jha, V. ; Kinfu, Y. ; McKee, M. ; Murthy, G. V.S. ; Pearce, N. ; Stöckl, H. ; Duan, L. ; Jin, Y. ; Li, Y. ; Liu, S. ; Wang, L. ; Ye, P. ; Liang, X. ; Azzopardi, P. ; Patton, G. C. ; Meretoja, A. ; Alam, K. ; Borschmann, R. ; Colquhoun, S. M. ; Weintraub, R. G. ; Szoeke, C. E.I. ; Ademi, Z. ; Taylor, H. R. ; Wijeratne, T. ; Batis, C. ; Barquera, S. ; Campos-Nonato, I. R. ; Contreras, A. G. ; Cuevas-Nasu, L. ; De, V. ; Gomez-Dantes, H. ; Heredia-Pi, I. 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@article{f0d1dad3e30243efabe9caae7a30bc54,
title = "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",
abstract = "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.",
author = "Forouzanfar, {M. H.} and A. Afshin and Alexander, {L. T.} and S. Biryukov and M. Brauer and K. Cercy and Charlson, {F. J.} and Cohen, {A. J.} and L. Dandona and K. Estep and Ferrari, {A. J.} and Frostad, {J. J.} and N. Fullman and Godwin, {W. W.} and M. Griswold and Hay, {S. I.} and Kyu, {H. H.} and Larson, {H. J.} and Lim, {S. S.} and Liu, {P. Y.} and Lopez, {A. D.} and R. Lozano and L. Marczak and Mokdad, {A. H.} and M. Moradi-Lakeh and M. Naghavi and Reitsma, {M. B.} and Roth, {G. A.} and Sur, {P. J.} and T. Vos and Wagner, {J. A.} and H. Wang and Y. Zhao and M. Zhou and Barber, {R. M.} and B. Bell and Blore, {J. D.} and Casey, {D. C.} and Coates, {M. M.} and K. Cooperrider and L. Cornaby and D. Dicker and Erskine, {H. E.} and T. Fleming and K. Foreman and E. Gakidou and Haagsma, {J. A.} and Johnson, {C. O.} and L. Kemmer and T. Ku and J. Leung and F. Masiye and A. Millear and M. Mirarefin and A. Misganaw and E. Mullany and Mumford, {J. E.} and M. Ng and H. Olsen and P. Rao and N. Reinig and Y. Roman and L. Sandar and Santomauro, {D. F.} and Slepak, {E. L.} and Sorensen, {R. J.D.} and Thomas, {B. A.} and Vollset, {S. E.} and Whiteford, {H. A.} and B. Zipkin and Murray, {C. J.L.} and Mock, {C. N.} and Anderson, {B. O.} and Futran, {N. D.} and Anderson, {H. R.} and Bhutta, {Z. A.} and Nisar, {M. I.} and N. Akseer and H. Krueger and Gotay, {C. C.} and N. Kissoon and Kopec, {J. A.} and F. Pourmalek and R. Burnett and Abajobir, {A. A.} and Knibbs, {L. D.} and Veerman, {J. L.} and R. Lalloo and Scott, {J. G.} and Alam, {N. K.M.} and Gouda, {H. N.} and Y. Guo and McGrath, {J. J.} and P. Jeemon and R. Dandona and S. Goenka and Kumar, {G. A.} and Gething, {P. W.} and D. Bisanzio and A. Deribew and Darby, {S. C.} and R. Ali and Bennett, {D. A.} and V. Jha and Y. Kinfu and M. McKee and Murthy, {G. V.S.} and N. Pearce and H. St{\"o}ckl and L. Duan and Y. Jin and Y. Li and S. Liu and L. Wang and P. Ye and X. Liang and P. Azzopardi and Patton, {G. C.} and A. Meretoja and K. Alam and R. Borschmann and Colquhoun, {S. M.} and Weintraub, {R. G.} and Szoeke, {C. E.I.} and Z. Ademi and Taylor, {H. R.} and T. Wijeratne and C. Batis and S. Barquera and Campos-Nonato, {I. R.} and Contreras, {A. G.} and L. Cuevas-Nasu and V. De and H. Gomez-Dantes and Heredia-Pi, {I. B.} and C. Medina and F. Mejia-Rodriguez and {Monta{\~n}ez Hernandez}, {J. C.} and Razo-Garc{\'i}a, {C. A.} and Rivera, {J. A.} and S. Rodr{\'i}guez-Ram{\'i}rez and S{\'a}nchez-Pimienta, {T. G.} and Servan-Mori, {E. E.} and T. Shamah and Mensah, {G. A.} and Hoff, {H. J.} and B. Neal and Driscoll, {T. R.} and Kemp, {A. H.} and J. Leigh and Mekonnen, {A. B.} and S. Bhatt and T. F{\"u}rst and Piel, {F. B.} and A. Rodriguez and Hutchings, {S. J.} and A. Majeed and M. Soljak and Salomon, {J. A.} and Thorne-Lyman, {A. L.} and Ajala, {O. N.} and T. B{\"a}rnighausen and Cahill, {L. E.} and Ding, {E. L.} and Farvid, {M. S.} and S. Khatibzadeh and Wagner, {G. R.} and Shrime, {M. G.} and Fitchett, {J. R.A.} and Aasvang, {G. M.} and M. Savic and Abate, {K. H.} and Gebrehiwot, {T. T.} and Gebremedhin, {A. T.} and C. Abbafati and Abbas, {K. M.} and F. Abd-Allah and Abdulle, {A. M.} and Abera, {S. F.} and Melaku, {Y. A.} and Abyu, {G. Y.} and Betsu, {B. D.} and Hailu, {G. B.} and Tekle, {D. Y.} and Yalew, {A. Z.} and B. Abraham and Abu-Raddad, {L. J.} and Adebiyi, {A. O.} and Adedeji, {I. A.} and Adou, {A. K.} and Adsuar, {J. C.} and Agardh, {E. E.} and J. Rehm and A. Badawi and S. Popova and A. Agarwal and A. Ahmad and Akinyemiju, {T. F.} and Schwebel, {D. C.} and Singh, {J. A.} and Z. Al-Aly and Aldhahri, {S. F.} and Altirkawi, {K. A.} and Terkawi, {A. S.} and Aldridge, {R. W.} and T. Tillmann and Alemu, {Z. A.} and Tegegne, {T. K.} and A. Alkerwi and F. Alla and F. Guillemin and P. Allebeck and Rabiee, {R. H.S.} and Fereshtehnejad, {S. M.} and M. Kivipelto and Carrero, {J. J.} and E. Weiderpass and R. Havmoeller and S. Sindi and U. Alsharif and E. Alvarez and N. Alvis-Guzman and Amare, {A. T.} and Ciobanu, {L. G.} and Taye, {B. W.} and A. Amberbir and Amegah, {A. K.} and H. Amini and Karema, {C. K.} and W. Ammar and Harb, {H. L.} and Amrock, {S. M.} and Andersen, {H. H.} and Antonio, {C. A.T.} and Faraon, {E. J.A.} and P. Anwari and J. {\"A}rnl{\"o}v and A. Larsson and A. Artaman and H. Asayesh and Asghar, {R. J.} and R. Assadi and S. Atique and Avokpaho, {E. F.G.A.} and A. Awasthi and Ayala, {B. P.} and U. Bacha and Bahit, {M. C.} and K. Balakrishnan and A. Barac and Barker-Collo, {S. L.} and {del Pozo-Cruz}, B. and S. Mohammed and L. Barregard and M. Petzold and Barrero, {L. H.} and S. Basu and Del, {L. C.} and S. Bazargan-Hejazi and J. Beardsley and N. Bedi and E. Beghi and Sheth, {K. N.} and Bell, {M. L.} and Huang, {J. J.} and Bello, {A. K.} and Santos, {I. S.} and Bensenor, {I. M.} and Lotufo, {P. A.} and A. Berhane and Wolfe, {C. D.} and E. Bernab{\'e} and Roba, {H. S.} and Beyene, {A. S.} and Hassen, {T. A.} and Mesfin, {Y. M.} and N. Bhala and A. Bhansali and S. Biadgilign and B. Bikbov and E. Bjertness and Htet, {A. S.} and S. Boufous and L. Degenhardt and S. Resnikoff and B. Calabria and Bourne, {R. R.A.} and M. Brainin and A. Brazinova and M. Majdan and J. Shen and Breitborde, {Nicholas Jk} and H. Brenner and B. Sch{\"o}ttker and Broday, {D. M.} and Brugha, {T. S.} and B. Brunekreef and H. Kromhout and Butt, {Z. A.} and {van Donkelaar}, A. and Martin, {R. V.} and R. C{\'a}rdenas and Carpenter, {D. O.} and Casta{\~n}eda-Orjuela, {C. A.} and J. Castillo and Castro, {R. E.} and F. Catal{\'a}-L{\'o}pez and J. Chang and Chiang, {P. P.} and M. Chibalabala and O. Chimed-Ochir and Y. Jiang and K. Takahashi and Chisumpa, {V. H.} and Mapoma, {C. C.} and Chitheer, {A. A.} and Choi, {J. J.} and H. Christensen and Christopher, {D. J.} and Cooper, {L. T.} and Crump, {J. A.} and Poulton, {R. G.} and A. Damasceno and Dargan, {P. I.} and {das Neves}, J. and Davis, {A. C.} and Newton, {J. N.} and N. Steel and K. Davletov and {de Castro}, {E. F.} and D. De and Dellavalle, {R. P.} and Des, {D. C.} and Dharmaratne, {S. D.} and Dhillon, {P. K.} and Lal, {D. K.} and S. Zodpey and C. Diaz-Torn{\'e} and Dorsey, {E. R.} and Doyle, {K. E.} and M. Dubey and Rahman, {M. H.U.} and U. Ram and A. Singh and Yadav, {A. K.} and Duncan, {B. B.} and C. Kieling and Schmidt, {M. I.} and I. Elyazar and Endries, {A. Y.} and Ermakov, {S. P.} and B. Eshrati and F. Farzadfar and A. Kasaeian and M. Parsaeian and A. Esteghamati and N. Hafezi-Nejad and S. Sheikhbahaei and S. Fahimi and R. Malekzadeh and G. Roshandel and Sepanlou, {S. G.} and Hassanvand, {M. S.} and P. Heydarpour and V. Rahimi-Movaghar and M. Yaseri and Farid, {T. A.} and Khan, {A. R.} and Farinha, {C. S.E.S.} and A. Faro and Feigin, {V. L.} and Fernandes, {J. G.} and F. Fischer and N. Foigt and I. Shiue and Fowkes, {F. G.R.} and Franklin, {R. C.} and Garcia-Basteiro, {A. L.} and Geleijnse, {J. M.} and T. Jibat and Gessner, {B. D.} and W. Tefera and Giref, {A. Z.} and D. Haile and Manamo, {W. A.A.} and M. Giroud and Gishu, {M. D.} and J. Martinez-Raga and Gomez-Cabrera, {M. C.} and P. Gona and A. Goodridge and Gopalani, {S. V.} and A. Goto and M. Inoue and Gugnani, {H. C.} and R. Gupta and Guti{\'e}rrez, {R. A.} and R. Orozco and Halasa, {Y. A.} and Undurraga, {E. A.} and Hamadeh, {R. R.} and S. Hamidi and Handal, {A. J.} and Hankey, {G. J.} and Y. Hao and S. Harikrishnan and Haro, {J. M.} and Hern{\'a}ndez-Llanes, {N. F.} and Hoek, {H. W.} and Tura, {A. K.} and M. Horino and N. Horita and Hosgood, {H. D.} and Hoy, {D. G.} and M. Hsairi and G. Hu and A. Husseini and I. Huybrechts and Iburg, {K. M.} and Idrisov, {B. T.} and Kwan, {G. F.} and Ileanu, {B. V.} and A. Pana and N. Kawakami and K. Shibuya and Jacobs, {T. A.} and Jacobsen, {K. H.} and N. Jahanmehr and Jakovljevic, {M. B.} and Jansen, {H. A.F.} and Jassal, {S. K.} and Stein, {M. B.} and M. Javanbakht and Jayaraman, {S. P.} and Jayatilleke, {A. U.} and Jee, {S. H.} and Jonas, {J. B.} and Z. Kabir and Y. Kalkonde and R. Kamal and J. She and H. Kan and A. Karch and C. Karimkhani and A. Kaul and Kazi, {D. S.} and Keiyoro, {P. N.} and Parry, {C. D.} and Kengne, {A. P.} and R. Matzopoulos and Wiysonge, {C. S.} and Stein, {D. J.} and Mayosi, {B. M.} and A. Keren and Khader, {Y. S.} and Khan, {E. A.} and G. Khan and Khang, {Y. H.} and S. Won and S. Khera and M. Tavakkoli and Khoja, {T. A.M.} and J. Khubchandani and C. Kim and D. Kim and Kimokoti, {R. W.} and Y. Kokubo and Koul, {P. A.} and A. Koyanagi and M. Kravchenko and Varakin, {Y. Y.} and B. Kuate and Kuchenbecker, {R. S.} and B. Kucuk and Kuipers, {E. J.} and T. Lallukka and R. Shiri and Meretoja, {T. J.} and Q. Lan and Latif, {A. A.} and Lawrynowicz, {A. E.B.} and Leasher, {J. L.} and M. Levi and X. Li and J. Liang and Lloyd, {B. K.} and G. Logroscino and R. Lunevicius and D. Pope and M. Mahdavi and Malta, {D. C.} and W. Marcenes and K. Matsushita and Nachega, {J. B.} and Tran, {B. X.} and Meaney, {P. A.} and A. Mehari and Tedla, {B. A.} and Memish, {Z. A.} and W. Mendoza and Mensink, {G. B.M.} and Mhimbira, {F. A.} and Miller, {T. R.} and Mills, {E. J.} and A. Mohammadi and Mola, {G. L.D.} and L. Monasta and L. Morawska and Norman, {R. E.} and R. Mori and D. Mozaff and P. Shi and A. Werdecker and Mueller, {U. O.} and Paternina, {A. J.} and R. Westerman and S. Seedat and A. Naheed and V. Nangia and N. Nassiri and Nguyen, {Q. L.} and Nkamedjie, {P. M.} and Norheim, {O. F.} and B. Norrving and L. Nyakarahuka and Obermeyer, {C. M.} and Ogbo, {F. A.} and I. Oh and O. Oladimeji and B. Sartorius and Olusanya, {B. O.} and Olivares, {P. R.} and Olusanya, {J. O.} and Opio, {J. N.} and Oren, {Eyal -} and A. Ortiz and E. Ota and Mahesh, {P. A.} and E. Park and T. Patel and Patil, {S. T.} and Patten, {S. B.} and J. Wang and Pereira, {D. M.} and M. Cortinovis and G. Giussani and N. Perico and G. Remuzzi and K. Pesudovs and Phillips, {M. R.} and Pillay, {J. D.} and D. Plass and M. Tobollik and S. Polinder and Pond, {C. D.} and Pope, {C. A.} and Prasad, {N. M.} and M. Qorbani and A. Radfar and A. Rafay and Rana, {S. M.} and M. Rahman and Rahman, {S. U.} and S. Rajsic and Rai, {R. K.} and M. Raju and K. Ranganathan and Refaat, {A. H.} and Rehm, {C. D.} and Ribeiro, {A. L.} and D. Rojas-Rueda and A. Roy and M. Satpathy and N. Tandon and D. Rothenbacher and Saleh, {M. M.} and Sanabria, {J. R.} and L. Sanchez-Riera and Sanchez-Ni{\~n}o, {M. D.} and R. Sarmiento-Suarez and M. Sawhney and J. Schmidhuber and Schneider, {I. J.C.} and Schutte, {A. E.} and Silva, {D. A.S.} and S. Shahraz and M. Shin and A. Shaheen and Shaikh, {M. A.} and R. Sharma and M. Shigematsu and S. Yoon and K. Shishani and Sigfusdottir, {I. D.} and Singh, {P. K.} and Silveira, {D. G.A.} and Silverberg, {J. I.} and Y. Yano and S. Soneji and Sposato, {L. A.} and N. Steckling and Sreeramareddy, {C. T.} and V. Stathopoulou and K. Stroumpoulis and Sunguya, {B. F.} and S. Swaminathan and Sykes, {B. L.} and R. Tabar{\'e}s-Seisdedos and Talongwa, {R. T.} and D. Tanne and Tuzcu, {E. M.} and J. Thakur and G. Shaddick and Thomas, {M. L.} and Thrift, {A. G.} and Thurston, {G. D.} and Thomson, {A. J.} and R. Topor-Madry and F. Topouzis and Towbin, {J. A.} and Uthman, {O. A.} and R. Tobe-Gai and N. Tsilimparis and Z. Tsala and S. Tyrovolas and Ukwaja, {K. N.} and {van Os}, J. and T. Vasankari and N. Venketasubramanian and Violante, {F. S.} and Waller, {S. G.} and Uneke, {C. J.} and Y. Wang and S. Weichenthal and Woolf, {A. D.} and D. Xavier and G. Xu and B. Yakob and P. Yip and Kesavachandran, {C. N.} and M. Montico and L. Ronfani and C. Yu and Z. Zaidi and N. Yonemoto and Younis, {M. Z.} and M. Wubshet and Zuhlke, {L. J.} and Zaki, {M. E.} and J. Zhu",
year = "2016",
month = "10",
day = "8",
doi = "10.1016/S0140-6736(16)31679-8",
language = "English (US)",
volume = "388",
pages = "1659--1724",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10053",

}

TY - JOUR

T1 - Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015

T2 - a systematic analysis for the Global Burden of Disease Study 2015

AU - Forouzanfar, M. H.

AU - Afshin, A.

AU - Alexander, L. T.

AU - Biryukov, S.

AU - Brauer, M.

AU - Cercy, K.

AU - Charlson, F. J.

AU - Cohen, A. J.

AU - Dandona, L.

AU - Estep, K.

AU - Ferrari, A. J.

AU - Frostad, J. J.

AU - Fullman, N.

AU - Godwin, W. W.

AU - Griswold, M.

AU - Hay, S. I.

AU - Kyu, H. H.

AU - Larson, H. J.

AU - Lim, S. S.

AU - Liu, P. Y.

AU - Lopez, A. D.

AU - Lozano, R.

AU - Marczak, L.

AU - Mokdad, A. H.

AU - Moradi-Lakeh, M.

AU - Naghavi, M.

AU - Reitsma, M. B.

AU - Roth, G. A.

AU - Sur, P. J.

AU - Vos, T.

AU - Wagner, J. A.

AU - Wang, H.

AU - Zhao, Y.

AU - Zhou, M.

AU - Barber, R. M.

AU - Bell, B.

AU - Blore, J. D.

AU - Casey, D. C.

AU - Coates, M. M.

AU - Cooperrider, K.

AU - Cornaby, L.

AU - Dicker, D.

AU - Erskine, H. E.

AU - Fleming, T.

AU - Foreman, K.

AU - Gakidou, E.

AU - Haagsma, J. A.

AU - Johnson, C. O.

AU - Kemmer, L.

AU - Ku, T.

AU - Leung, J.

AU - Masiye, F.

AU - Millear, A.

AU - Mirarefin, M.

AU - Misganaw, A.

AU - Mullany, E.

AU - Mumford, J. E.

AU - Ng, M.

AU - Olsen, H.

AU - Rao, P.

AU - Reinig, N.

AU - Roman, Y.

AU - Sandar, L.

AU - Santomauro, D. F.

AU - Slepak, E. L.

AU - Sorensen, R. J.D.

AU - Thomas, B. A.

AU - Vollset, S. E.

AU - Whiteford, H. A.

AU - Zipkin, B.

AU - Murray, C. J.L.

AU - Mock, C. N.

AU - Anderson, B. O.

AU - Futran, N. D.

AU - Anderson, H. R.

AU - Bhutta, Z. A.

AU - Nisar, M. I.

AU - Akseer, N.

AU - Krueger, H.

AU - Gotay, C. C.

AU - Kissoon, N.

AU - Kopec, J. A.

AU - Pourmalek, F.

AU - Burnett, R.

AU - Abajobir, A. A.

AU - Knibbs, L. D.

AU - Veerman, J. L.

AU - Lalloo, R.

AU - Scott, J. G.

AU - Alam, N. K.M.

AU - Gouda, H. N.

AU - Guo, Y.

AU - McGrath, J. J.

AU - Jeemon, P.

AU - Dandona, R.

AU - Goenka, S.

AU - Kumar, G. A.

AU - Gething, P. W.

AU - Bisanzio, D.

AU - Deribew, A.

AU - Darby, S. C.

AU - Ali, R.

AU - Bennett, D. A.

AU - Jha, V.

AU - Kinfu, Y.

AU - McKee, M.

AU - Murthy, G. V.S.

AU - Pearce, N.

AU - Stöckl, H.

AU - Duan, L.

AU - Jin, Y.

AU - Li, Y.

AU - Liu, S.

AU - Wang, L.

AU - Ye, P.

AU - Liang, X.

AU - Azzopardi, P.

AU - Patton, G. C.

AU - Meretoja, A.

AU - Alam, K.

AU - Borschmann, R.

AU - Colquhoun, S. M.

AU - Weintraub, R. G.

AU - Szoeke, C. E.I.

AU - Ademi, Z.

AU - Taylor, H. R.

AU - Wijeratne, T.

AU - Batis, C.

AU - Barquera, S.

AU - Campos-Nonato, I. R.

AU - Contreras, A. G.

AU - Cuevas-Nasu, L.

AU - De, V.

AU - Gomez-Dantes, H.

AU - Heredia-Pi, I. B.

AU - Medina, C.

AU - Mejia-Rodriguez, F.

AU - Montañez Hernandez, J. C.

AU - Razo-García, C. A.

AU - Rivera, J. A.

AU - Rodríguez-Ramírez, S.

AU - Sánchez-Pimienta, T. G.

AU - Servan-Mori, E. E.

AU - Shamah, T.

AU - Mensah, G. A.

AU - Hoff, H. J.

AU - Neal, B.

AU - Driscoll, T. R.

AU - Kemp, A. H.

AU - Leigh, J.

AU - Mekonnen, A. B.

AU - Bhatt, S.

AU - Fürst, T.

AU - Piel, F. B.

AU - Rodriguez, A.

AU - Hutchings, S. J.

AU - Majeed, A.

AU - Soljak, M.

AU - Salomon, J. A.

AU - Thorne-Lyman, A. L.

AU - Ajala, O. N.

AU - Bärnighausen, T.

AU - Cahill, L. E.

AU - Ding, E. L.

AU - Farvid, M. S.

AU - Khatibzadeh, S.

AU - Wagner, G. R.

AU - Shrime, M. G.

AU - Fitchett, J. R.A.

AU - Aasvang, G. M.

AU - Savic, M.

AU - Abate, K. H.

AU - Gebrehiwot, T. T.

AU - Gebremedhin, A. T.

AU - Abbafati, C.

AU - Abbas, K. M.

AU - Abd-Allah, F.

AU - Abdulle, A. M.

AU - Abera, S. F.

AU - Melaku, Y. A.

AU - Abyu, G. Y.

AU - Betsu, B. D.

AU - Hailu, G. B.

AU - Tekle, D. Y.

AU - Yalew, A. Z.

AU - Abraham, B.

AU - Abu-Raddad, L. J.

AU - Adebiyi, A. O.

AU - Adedeji, I. A.

AU - Adou, A. K.

AU - Adsuar, J. C.

AU - Agardh, E. E.

AU - Rehm, J.

AU - Badawi, A.

AU - Popova, S.

AU - Agarwal, A.

AU - Ahmad, A.

AU - Akinyemiju, T. F.

AU - Schwebel, D. C.

AU - Singh, J. A.

AU - Al-Aly, Z.

AU - Aldhahri, S. F.

AU - Altirkawi, K. A.

AU - Terkawi, A. S.

AU - Aldridge, R. W.

AU - Tillmann, T.

AU - Alemu, Z. A.

AU - Tegegne, T. K.

AU - Alkerwi, A.

AU - Alla, F.

AU - Guillemin, F.

AU - Allebeck, P.

AU - Rabiee, R. H.S.

AU - Fereshtehnejad, S. M.

AU - Kivipelto, M.

AU - Carrero, J. J.

AU - Weiderpass, E.

AU - Havmoeller, R.

AU - Sindi, S.

AU - Alsharif, U.

AU - Alvarez, E.

AU - Alvis-Guzman, N.

AU - Amare, A. T.

AU - Ciobanu, L. G.

AU - Taye, B. W.

AU - Amberbir, A.

AU - Amegah, A. K.

AU - Amini, H.

AU - Karema, C. K.

AU - Ammar, W.

AU - Harb, H. L.

AU - Amrock, S. M.

AU - Andersen, H. H.

AU - Antonio, C. A.T.

AU - Faraon, E. J.A.

AU - Anwari, P.

AU - Ärnlöv, J.

AU - Larsson, A.

AU - Artaman, A.

AU - Asayesh, H.

AU - Asghar, R. J.

AU - Assadi, R.

AU - Atique, S.

AU - Avokpaho, E. F.G.A.

AU - Awasthi, A.

AU - Ayala, B. P.

AU - Bacha, U.

AU - Bahit, M. C.

AU - Balakrishnan, K.

AU - Barac, A.

AU - Barker-Collo, S. L.

AU - del Pozo-Cruz, B.

AU - Mohammed, S.

AU - Barregard, L.

AU - Petzold, M.

AU - Barrero, L. H.

AU - Basu, S.

AU - Del, L. C.

AU - Bazargan-Hejazi, S.

AU - Beardsley, J.

AU - Bedi, N.

AU - Beghi, E.

AU - Sheth, K. N.

AU - Bell, M. L.

AU - Huang, J. J.

AU - Bello, A. K.

AU - Santos, I. S.

AU - Bensenor, I. M.

AU - Lotufo, P. A.

AU - Berhane, A.

AU - Wolfe, C. D.

AU - Bernabé, E.

AU - Roba, H. S.

AU - Beyene, A. S.

AU - Hassen, T. A.

AU - Mesfin, Y. M.

AU - Bhala, N.

AU - Bhansali, A.

AU - Biadgilign, S.

AU - Bikbov, B.

AU - Bjertness, E.

AU - Htet, A. S.

AU - Boufous, S.

AU - Degenhardt, L.

AU - Resnikoff, S.

AU - Calabria, B.

AU - Bourne, R. R.A.

AU - Brainin, M.

AU - Brazinova, A.

AU - Majdan, M.

AU - Shen, J.

AU - Breitborde, Nicholas Jk

AU - Brenner, H.

AU - Schöttker, B.

AU - Broday, D. M.

AU - Brugha, T. S.

AU - Brunekreef, B.

AU - Kromhout, H.

AU - Butt, Z. A.

AU - van Donkelaar, A.

AU - Martin, R. V.

AU - Cárdenas, R.

AU - Carpenter, D. O.

AU - Castañeda-Orjuela, C. A.

AU - Castillo, J.

AU - Castro, R. E.

AU - Catalá-López, F.

AU - Chang, J.

AU - Chiang, P. P.

AU - Chibalabala, M.

AU - Chimed-Ochir, O.

AU - Jiang, Y.

AU - Takahashi, K.

AU - Chisumpa, V. H.

AU - Mapoma, C. C.

AU - Chitheer, A. A.

AU - Choi, J. J.

AU - Christensen, H.

AU - Christopher, D. J.

AU - Cooper, L. T.

AU - Crump, J. A.

AU - Poulton, R. G.

AU - Damasceno, A.

AU - Dargan, P. I.

AU - das Neves, J.

AU - Davis, A. C.

AU - Newton, J. N.

AU - Steel, N.

AU - Davletov, K.

AU - de Castro, E. F.

AU - De, D.

AU - Dellavalle, R. P.

AU - Des, D. C.

AU - Dharmaratne, S. D.

AU - Dhillon, P. K.

AU - Lal, D. K.

AU - Zodpey, S.

AU - Diaz-Torné, C.

AU - Dorsey, E. R.

AU - Doyle, K. E.

AU - Dubey, M.

AU - Rahman, M. H.U.

AU - Ram, U.

AU - Singh, A.

AU - Yadav, A. K.

AU - Duncan, B. B.

AU - Kieling, C.

AU - Schmidt, M. I.

AU - Elyazar, I.

AU - Endries, A. Y.

AU - Ermakov, S. P.

AU - Eshrati, B.

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PY - 2016/10/8

Y1 - 2016/10/8

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85060773959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060773959&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(16)31679-8

DO - 10.1016/S0140-6736(16)31679-8

M3 - Article

C2 - 27733284

AN - SCOPUS:85060773959

VL - 388

SP - 1659

EP - 1724

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10053

ER -