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

Mohammad H. Forouzanfar, Ashkan Afshin, Lily Alexander, H. Ross Anderson, Zulfiqar Bhutta, Stan Biryukov, Michael Brauer, Richard Burnett, Kelly Cercy, Fiona J. Charlson, Aaron Cohen, Lalit Dandona, Kara Estep, Alize J. Ferrari, Joseph J. Frostad, Nancy Fullman, Peter Gething, William W. Godwin, Max Griswold, Yohannes Kinfu & 624 others Hmwe Kyu, Heidi Larson, Xiaofeng Liang, Stephen S. Lim, Patrick Y. Liu, Alan D. Lopez, Rafael Lozano, Laurie Marczak, George Mensah, Ali H. Mokdad, Maziar Moradi-Lakeh, Mohsen Naghavi, Bruce C. Neal, Marissa B. Reitsma, Gregory A. Roth, Joshua A. Salomon, Patrick Sur, Theo Vos, Joseph Wagner, Haidong Wang, Yi Zhao, Maigeng Zhou, Gunn Marit Aasvang, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M. Abbas, Foad Abd-Allah, Abdishakur M. Abdulle, Semaw F. Abera, Biju Abraham, Laith J. Abu-Raddad, Gebre Yitayih Abyu, Akindele Olupelumi Adebiyi, Isaac Akinkunmi Adedeji, Zanfina Ademi, Arsène K. Adou, Josef C. Adsuar, Emilie E. Agardh, Arnav Agarwal, Anurag Agrawal, Aliasghar Ahmad Kiadaliri, Oluremi N. Ajala, Tomi F. Akinyemiju, Ziyad Al-Aly, Khurshid Alam, Noore K M Alam, Saleh Fahed S Aldhahri, Robert William Aldridge, Zewdie Aderaw Alemu, Raghib Ali, Ala'a Alkerwi, François Alla, Peter Allebeck, Ubai Alsharif, Khalid A. Altirkawi, Elena Alvarez Martin, Nelson Alvis-Guzman, Azmeraw T. Amare, Alemayehu Amberbir, Adeladza Kofi Amegah, Heresh Amini, Walid Ammar, Stephen Marc Amrock, Hjalte H. Andersen, Benjamin O. Anderson, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Al Artaman, Hamid Asayesh, Rana J. Asghar, Reza Assadi, Suleman Atique, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Peter Azzopardi, Umar Bacha, Alaa Badawi, Maria C. Bahit, Kalpana Balakrishnan, Aleksandra Barac, Ryan M. Barber, Suzanne L. Barker-Collo, Till Bärnighausen, Simon Barquera, Lars Barregard, Lope H. Barrero, Sanjay Basu, Carolina Batis, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Michelle L. Bell, Aminu K. Bello, Derrick A. Bennett, Isabela M. Bensenor, Adugnaw Berhane, Eduardo Bernabe, Balem Demtsu Betsu, Addisu Shunu Beyene, Neeraj Bhala, Anil Bhansali, Samir Bhatt, Sibhatu Biadgilign, Boris Bikbov, Donal Bisanzio, Espen Bjertness, Jed D. Blore, Rohan Borschmann, Soufiane Boufous, Rupert R. Bourne, Michael Brainin, Alexandra Bražinová, Nicholas J K Breitborde, Hermann Brenner, David M. Broday, Traolach S. Brugha, Bert Brunekreef, Zahid A. Butt, Leah E. Cahill, Bianca Calabria, Ismael R. Campos-Nonato, Rosario Cardenas, David O. Carpenter, Daniel Casey, Carlos A. Castaneda-Orjuela, Jacqueline Castillo Rivas, Ruben Estanislao Castro, Ferran Catala-Lopez, Jung Chen Chang, Peggy P. Chiang, Mirriam Chibalabala, Odgerel Chimed-Ochir, Vesper Hichilombwe Chisumpa, Abdulaal A. Chitheer, Jee Young Jasmine Choi, Hanne Christensen, Devasahayam Jesudas Christopher, Liliana G. Ciobanu, Matthew M. Coates, Samantha M. Colquhoun, Leslie T. Cooper, Kimberly Cooperrider, Leslie Cornaby, Monica Cortinovis, John A. Crump, Lucia Cuevas-Nasu, Albertino Damasceno, Rakhi Dandona, Sarah C. Darby, Paul I. Dargan, José das Neves, Adrian C. Davis, Kairat Davletov, E. Filipa De Castro, Vanessa De La Cruz-Gongora, Diego De Leo, Louisa Degenhardt, Liana C. Del Gobbo, Borja del Pozo-Cruz, Robert P. Dellavalle, Amare Deribew, Don C Des Jarlais, Samath D. Dharmaratne, Preet K. Dhillon, Cesar Diaz-Torne, Daniel J. Dicker, Eric L. Ding, E. Ray Dorsey, Kerrie E. Doyle, Tim R. Driscoll, Leilei Duan, Manisha Dubey, Bruce Bartholow Duncan, Iqbal Elyazar, Aman Yesuf Endries, Sergey P. Ermakov, Holly Erskine, Babak Eshrati, Alireza Esteghamati, Saman Fahimi, Emerito Jose A Faraon, Talha A. Farid, Carla Sofia e Sa Farinha, Andre Faro, Maryam S. Farvid, Farshad Farzadfar, Valery L. Feigin, Seyed Mohammad Fereshtehnejad, Jefferson G. Fernandes, Florian Fischer, Joseph Robert Ander Fitchett, Thomas Fleming, Nataliya Foigt, Kyle J. Foreman, F. Gerry R Fowkes, Richard C. Franklin, Thomas Fürst, Neal D. Futran, Emmanuela Gakidou, Alberto L. García-Basteiro, Tsegaye Tsewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Johanna M. Geleijnse, Bradford D. Gessner, Ababi Zergaw Giref, Maurice Giroud, Melkamu Dedefo Gishu, Shifalika Goenka, Mari Carmen Gomez-Cabrera, Hector Gomez Dantes, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Carolyn C. Gotay, Atsushi Goto, Hebe N. Gouda, Harish C. Gugnani, Francis Guillemin, Yuming Guo, Rahul Gupta, Rajeev Gupta, Reyna A. Gutierrez, Juanita A. Haagsma, Nima Hafezi-Nejad, Demewoz Haile, Gessessew Bugssa Hailu, Yara Halasa, Randah R. Hamadeh, Samer Hamidi, Alexis J. Handal, G. J. Hankey, Yuantao Hao, Hilda L. Harb, Sivadasanpillai Harikrishnan, J. M. Haro, Mohammad Sadegh Hassanvand, Tahir Ahmed Hassen, Rasmus Havmoeller, Ileana B. Heredia Pi, Norberto Francisco Hernández-Llanes, Pouria Heydarpour, Hans W. Hoek, H. J. Hoffman, Masako Horino, Nobuyuki Horita, H. Dean Hosgood, Damian G. Hoy, Mohamed Hsairi, Aung Soe Htet, Guoqing Hu, John J. Huang, Abdullatif Husseini, S. Hutchings, Inge Huybrechts, Kim M. Iburg, Bulat T. Idrisov, Bogdan Vasile Ileanu, Manami Inoue, Troy A. Jacobs, Kathryn H. Jacobsen, Nader Jahanmehr, Mihajlo B. Jakovljevic, Henrica A. Jansen, Simerjot K. Jassal, Mehdi Javanbakht, Achala Upendra Jayatilleke, Sun Ha Jee, Panniyammakal Jeemon, Vivekanand Jha, Ying Jiang, Tariku Jibat, Ye Jin, Catherine O. Johnson, Jost B. Jonas, Zubair Kabir, Yogeshwar Kalkonde, Ritul Kamal, Haidong Kan, Andre Karch, Corine Kakizi Karema, Chante Karimkhani, Amir Kasaeian, Anil Kaul, Norito Kawakami, Dhruv S. Kazi, Peter Njenga Keiyoro, Andrew H. Kemp, Andrew Pascal Kengne, A. Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Abdur Rahman Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Young Ho Khang, Shahab Khatibzadeh, Sahil Khera, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Christian Kieling, Cho il Kim, Daniel Kim, Ruth W. Kimokoti, Niranjan Kissoon, M. Kivipelto, Luke Knibbs, Yoshihiro Kokubo, Jacek A. Kopec, Parvaiz A. Koul, Ai Koyanagi, Michael Kravchenko, Hans Kromhout, Hans Krueger, Tiffany Ku, Barthelemy Kuate Defo, Ricardo S. Kuchenbecker, Burcu Kucuk Bicer, Ernst J. Kuipers, G. Anil Kumar, Gene F. Kwan, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Qing Lan, Anders Larsson, Asma Abdul Latif, Alicia E B Lawrynowicz, Janet L. Leasher, James Leigh, Janni Leung, Miriam Levi, Xiaohong Li, Yichong Li, Juan Liang, Shiwei Liu, Belinda K. Lloyd, Giancarlo Logroscino, Paulo A. Lotufo, Raimundas Lunevicius, Michael F. MacIntyre, Mahdi Mahdavi, Marek Majdan, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Wondimu Ayele Ayele Manamo, Christopher C. Mapoma, Wagner Marcenes, Randall V. Martin, Jose Martinez-Raga, Felix Masiye, Kunihiro Matsushita, Richard G. Matzopoulos, Bongani M. Mayosi, John J. McGrath, Martin McKee, Peter A. Meaney, Catalina Medina, Alem Mehari, Fabiola Mejia-Rodriguez, Alemayehu B. Mekonnen, Yohannes A. Melaku, Ziad Memish, Walter Mendoza, Gert B M Mensink, Atte Meretoja, Tuomo J. Meretoja, Yonatan Moges Mesfin, Francis Apolinary Mhimbira, Ted R. Miller, Edward J. Mills, Mojde Mirarefin, Awoke Misganaw, Charles N. Mock, Alireza Mohammadi, Shafiu Mohammed, Glen Liddell D Mola, Lorenzo Monasta, Julio C Montanêz Hernandez, Marcella Montico, Lidia Morawska, Rintaro Mori, Dariush Mozaffarian, Ulrich O. Mueller, Erin C. Mullany, John Everett Mumford, Gudlavalleti Venkata Satyanarayana Murthy, Jean Nachega, Aliya Naheed, Vinay Nangia, Nariman Nassiri, J. Newton, Marie Ng, Quyen Le Nguyen, Muhammad Imran Nisar, Patrick Martial Nkamedjie Pete, Ole F. Norheim, Rosana E. Norman, Bo Norrving, Luke Nyakarahuka, Carla Makhlouf Obermeyer, Felix Akpojene Ogbo, In Hwan Oh, Olanrewaju Oladimeji, Pedro R. Olivares, Helen Olsen, Bolajoko O. Olusanya, Jacob Olusegun Olusanya, John Nelson Opio, Eyal Oren, Ricardo Orozco, Alberto Ortiz, Erika Ota, Mahesh PA, Adrian Pana, Eun Kee Park, Charles D. Parry, Mahboubeh Parsaeian, Tejas Patel, Angel J Paternina Caicedo, Snehal T. Patil, Scott B. Patten, George C. Patton, Neil Pearce, David M. Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael R. Phillips, Frederic B. Piel, Julian David Pillay, Dietrich Plass, Suzanne Polinder, Constance D. Pond, C. A. Pope, D. Pope, Svetlana Popova, Richie G. Poulton, Farshad Pourmalek, Noela M. Prasad, Mostafa Qorbani, Rynaz H S Rabiee, Amir Radfar, Anwar Rafay, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Sajjad U R Rahman, Rajesh Kumar Rai, Sasa Rajsic, Murugesan Raju, Usha Ram, Saleem M. Rana, Kavitha Ranganathan, Puja Rao, Christian Aspacia Razo García, Amany H. Refaat, Colin D. Rehm, Juergen Rehm, Nikolas Reinig, Giuseppe Remuzzi, Serge Resnikoff, Antonio L. Ribeiro, Juan A. Rivera, Hirbo Shore Roba, Alina Rodriguez, Sonia Rodriguez-Ramirez, David Rojas-Rueda, Yesenia Roman, Luca Ronfani, Gholamreza Roshandel, Dietrich Rothenbacher, Ambuj Roy, Muhammad Muhammad Saleh, Juan R. Sanabria, Maria Dolores Sanchez-Niño, Tania G. Sánchez-Pimienta, Logan Sandar, Damian F. Santomauro, Itamar S. Santos, Rodrigo Sarmiento-Suarez, Benn Sartorius, Maheswar Satpathy, Miloje Savic, Monika Sawhney, Josef Schmidhuber, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, David C. Schwebel, James G. Scott, S. Seedat, Sadaf G. Sepanlou, Edson E. Servan-Mori, Amira Shaheen, Saeid Shahraz, Masood Ali Shaikh, Teresa Shamah Levy, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Kevin N. Sheth, Peilin Shi, Kenji Shibuya, Mika Shigematsu, Min Jeong Shin, Rahman Shiri, Kawkab Shishani, Ivy Shiue, Mark G. Shrime, Inga D. Sigfusdottir, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Jonathan I. Silverberg, Edgar P. Simard, Shireen Sindi, Abhishek Singh, Jasvinder A. Singh, Prashant Kumar Singh, Erica Leigh Slepak, Michael Soljak, Samir Soneji, Reed J D Sorensen, Luciano A. Sposato, Chandrashekhar T. Sreeramareddy, Vasiliki Stathopoulou, Nadine Steckling, Nicholas Steel, Dan J. Stein, Murray B. Stein, Heidi Stöckl, Saverio Stranges, Konstantinos Stroumpoulis, Bruno F. Sunguya, Soumya Swaminathan, Bryan L. Sykes, Cassandra E I Szoeke, Rafael Tabares-Seisdedos, Ken Takahashi, Roberto Tchio Talongwa, Nikhil Tandon, David Tanne, Mohammad Tavakkoli, Bineyam Taye, Hugh R. Taylor, Bemnet Amare Tedla, Worku Mekonnen Tefera, Teketo Kassaw Tegegne, Dejen Yemane Tekle, Abdullah Sulieman Terkawi, J. S. Thakur, Bernadette A. Thomas, Matthew Lloyd Thomas, Alan J. Thomson, Andrew L. Thorne-Lyman, Amanda G. Thrift, George D. Thurston, Taavi Tillmann, Ruoyan Tobe-Gai, Myriam Tobollik, Roman Topor-Madry, Fotis Topouzis, Jeffrey A. Towbin, Bach X. Tran, Zacharie Tsala Dimbuene, Nikolaos Tsilimparis, Abera Kenay Tura, Emin M. Tuzcu, Stefanos Tyrovolas, Kingsley N. Ukwaja, Eduardo A. Undurraga, Chigozie Jesse Uneke, Olalekan A. Uthman, Aaron van Donkelaar, Jim Van Os, Yuri Y. Varakin, Tommi Vasankari, J. Lennert Veerman, Narayanaswamy Venketasubramanian, F. S. Violante, Stein Emil Vollset, Gregory R. Wagner, Stephen Waller, Jianli Wang, Linhong Wang, Yanping Wang, Scott Weichenthal, Elisabete Weiderpass, Robert G. Weintraub, Andrea Werdecker, Ronny Westerman, Harvey Whiteford, Tissa Wijeratne, Charles Shey Wiysonge, Charles D A Wolfe, Sungho Won, A. D. Woolf, Mamo Wubshet, Denis Xavier, Gelin Xu, Ajit Kumar Yadav, Bereket Yakob, Ayalnesh Zemene Yalew, Yuichiro Yano, Mehdi Yaseri, Pengpeng Ye, Paul Yip, Naohiro Yonemoto, Seok Jun Yoon, Mustafa Younis, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Jun Zhu, Ben Zipkin, Sanjay Zodpey, Liesl Joanna Zuhlke, Christopher J L Murray

Research output: Contribution to journalArticle

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
Pages (from-to)1659-1724
Number of pages66
JournalThe Lancet
Volume388
Issue number10053
DOIs
Publication statusPublished - 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, Mohammad H.; Afshin, Ashkan; Alexander, Lily; Anderson, H. Ross; Bhutta, Zulfiqar; Biryukov, Stan; Brauer, Michael; Burnett, Richard; Cercy, Kelly; Charlson, Fiona J.; Cohen, Aaron; Dandona, Lalit; Estep, Kara; Ferrari, Alize J.; Frostad, Joseph J.; Fullman, Nancy; Gething, Peter; Godwin, William W.; Griswold, Max; Kinfu, Yohannes; Kyu, Hmwe; Larson, Heidi; Liang, Xiaofeng; Lim, Stephen S.; Liu, Patrick Y.; Lopez, Alan D.; Lozano, Rafael; Marczak, Laurie; Mensah, George; Mokdad, Ali H.; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Neal, Bruce C.; Reitsma, Marissa B.; Roth, Gregory A.; Salomon, Joshua A.; Sur, Patrick; Vos, Theo; Wagner, Joseph; Wang, Haidong; Zhao, Yi; Zhou, Maigeng; Aasvang, Gunn Marit; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abera, Semaw F.; Abraham, Biju; Abu-Raddad, Laith J.; Abyu, Gebre Yitayih; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Ademi, Zanfina; Adou, Arsène K.; Adsuar, Josef C.; Agardh, Emilie E.; Agarwal, Arnav; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ajala, Oluremi N.; Akinyemiju, Tomi F.; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore K M; Aldhahri, Saleh Fahed S; Aldridge, Robert William; Alemu, Zewdie Aderaw; Ali, Raghib; Alkerwi, Ala'a; Alla, François; Allebeck, Peter; Alsharif, Ubai; Altirkawi, Khalid A.; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Amberbir, Alemayehu; Amegah, Adeladza Kofi; Amini, Heresh; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H.; Anderson, Benjamin O.; Antonio, Carl Abelardo T; Anwari, Palwasha; Ärnlöv, Johan; Artaman, Al; Asayesh, Hamid; Asghar, Rana J.; Assadi, Reza; Atique, Suleman; Avokpaho, Euripide Frinel G Arthur; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Bahit, Maria C.; Balakrishnan, Kalpana; Barac, Aleksandra; Barber, Ryan M.; Barker-Collo, Suzanne L.; Bärnighausen, Till; Barquera, Simon; Barregard, Lars; Barrero, Lope H.; Basu, Sanjay; Batis, Carolina; Bazargan-Hejazi, Shahrzad; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Bell, Michelle L.; Bello, Aminu K.; Bennett, Derrick A.; Bensenor, Isabela M.; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Bhala, Neeraj; Bhansali, Anil; Bhatt, Samir; Biadgilign, Sibhatu; Bikbov, Boris; Bisanzio, Donal; Bjertness, Espen; Blore, Jed D.; Borschmann, Rohan; Boufous, Soufiane; Bourne, Rupert R.; Brainin, Michael; Bražinová, Alexandra; Breitborde, Nicholas J K; Brenner, Hermann; Broday, David M.; Brugha, Traolach S.; Brunekreef, Bert; Butt, Zahid A.; Cahill, Leah E.; Calabria, Bianca; Campos-Nonato, Ismael R.; Cardenas, Rosario; Carpenter, David O.; Casey, Daniel; Castaneda-Orjuela, Carlos A.; Rivas, Jacqueline Castillo; Castro, Ruben Estanislao; Catala-Lopez, Ferran; Chang, Jung Chen; Chiang, Peggy P.; Chibalabala, Mirriam; Chimed-Ochir, Odgerel; Chisumpa, Vesper Hichilombwe; Chitheer, Abdulaal A.; Choi, Jee Young Jasmine; Christensen, Hanne; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G.; Coates, Matthew M.; Colquhoun, Samantha M.; Cooper, Leslie T.; Cooperrider, Kimberly; Cornaby, Leslie; Cortinovis, Monica; Crump, John A.; Cuevas-Nasu, Lucia; Damasceno, Albertino; Dandona, Rakhi; Darby, Sarah C.; Dargan, Paul I.; das Neves, José; Davis, Adrian C.; Davletov, Kairat; De Castro, E. Filipa; De La Cruz-Gongora, Vanessa; De Leo, Diego; Degenhardt, Louisa; Del Gobbo, Liana C.; del Pozo-Cruz, Borja; Dellavalle, Robert P.; Deribew, Amare; Jarlais, Don C Des; Dharmaratne, Samath D.; Dhillon, Preet K.; Diaz-Torne, Cesar; Dicker, Daniel J.; Ding, Eric L.; Dorsey, E. Ray; Doyle, Kerrie E.; Driscoll, Tim R.; Duan, Leilei; Dubey, Manisha; Duncan, Bruce Bartholow; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey P.; Erskine, Holly; Eshrati, Babak; Esteghamati, Alireza; Fahimi, Saman; Faraon, Emerito Jose A; Farid, Talha A.; Farinha, Carla Sofia e Sa; Faro, Andre; Farvid, Maryam S.; Farzadfar, Farshad; Feigin, Valery L.; Fereshtehnejad, Seyed Mohammad; Fernandes, Jefferson G.; Fischer, Florian; Fitchett, Joseph Robert Ander; Fleming, Thomas; Foigt, Nataliya; Foreman, Kyle J.; Fowkes, F. Gerry R; Franklin, Richard C.; Fürst, Thomas; Futran, Neal D.; Gakidou, Emmanuela; García-Basteiro, Alberto L.; Gebrehiwot, Tsegaye Tsewelde; Gebremedhin, Amanuel Tesfay; Geleijnse, Johanna M.; Gessner, Bradford D.; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Goenka, Shifalika; Gomez-Cabrera, Mari Carmen; Gomez Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Gotay, Carolyn C.; Goto, Atsushi; Gouda, Hebe N.; Gugnani, Harish C.; Guillemin, Francis; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gutierrez, Reyna A.; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haile, Demewoz; Hailu, Gessessew Bugssa; Halasa, Yara; Hamadeh, Randah R.; Hamidi, Samer; Handal, Alexis J.; Hankey, G. J.; Hao, Yuantao; Harb, Hilda L.; Harikrishnan, Sivadasanpillai; Haro, J. M.; Hassanvand, Mohammad Sadegh; Hassen, Tahir Ahmed; Havmoeller, Rasmus; Heredia Pi, Ileana B.; Hernández-Llanes, Norberto Francisco; Heydarpour, Pouria; Hoek, Hans W.; Hoffman, H. J.; Horino, Masako; Horita, Nobuyuki; Hosgood, H. Dean; Hoy, Damian G.; Hsairi, Mohamed; Htet, Aung Soe; Hu, Guoqing; Huang, John J.; Husseini, Abdullatif; Hutchings, S.; Huybrechts, Inge; Iburg, Kim M.; Idrisov, Bulat T.; Ileanu, Bogdan Vasile; Inoue, Manami; Jacobs, Troy A.; Jacobsen, Kathryn H.; Jahanmehr, Nader; Jakovljevic, Mihajlo B.; Jansen, Henrica A.; Jassal, Simerjot K.; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jee, Sun Ha; Jeemon, Panniyammakal; Jha, Vivekanand; Jiang, Ying; Jibat, Tariku; Jin, Ye; Johnson, Catherine O.; Jonas, Jost B.; Kabir, Zubair; Kalkonde, Yogeshwar; Kamal, Ritul; Kan, Haidong; Karch, Andre; Karema, Corine Kakizi; Karimkhani, Chante; Kasaeian, Amir; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S.; Keiyoro, Peter Njenga; Kemp, Andrew H.; Kengne, Andrew Pascal; Keren, A.; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khang, Young Ho; Khatibzadeh, Shahab; Khera, Sahil; Khoja, Tawfik Ahmed Muthafer; Khubchandani, Jagdish; Kieling, Christian; Kim, Cho il; Kim, Daniel; Kimokoti, Ruth W.; Kissoon, Niranjan; Kivipelto, M.; Knibbs, Luke; Kokubo, Yoshihiro; Kopec, Jacek A.; Koul, Parvaiz A.; Koyanagi, Ai; Kravchenko, Michael; Kromhout, Hans; Krueger, Hans; Ku, Tiffany; Defo, Barthelemy Kuate; Kuchenbecker, Ricardo S.; Bicer, Burcu Kucuk; Kuipers, Ernst J.; Kumar, G. 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A.; Pope, D.; Popova, Svetlana; Poulton, Richie G.; Pourmalek, Farshad; Prasad, Noela M.; Qorbani, Mostafa; Rabiee, Rynaz H S; Radfar, Amir; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad U R; Rai, Rajesh Kumar; Rajsic, Sasa; Raju, Murugesan; Ram, Usha; Rana, Saleem M.; Ranganathan, Kavitha; Rao, Puja; García, Christian Aspacia Razo; Refaat, Amany H.; Rehm, Colin D.; Rehm, Juergen; Reinig, Nikolas; Remuzzi, Giuseppe; Resnikoff, Serge; Ribeiro, Antonio L.; Rivera, Juan A.; Roba, Hirbo Shore; Rodriguez, Alina; Rodriguez-Ramirez, Sonia; Rojas-Rueda, David; Roman, Yesenia; Ronfani, Luca; Roshandel, Gholamreza; Rothenbacher, Dietrich; Roy, Ambuj; Saleh, Muhammad Muhammad; Sanabria, Juan R.; Sanchez-Niño, Maria Dolores; Sánchez-Pimienta, Tania G.; Sandar, Logan; Santomauro, Damian F.; Santos, Itamar S.; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schmidhuber, Josef; Schmidt, Maria Inês; Schneider, Ione J C; Schöttker, Ben; Schutte, Aletta Elisabeth; Schwebel, David C.; Scott, James G.; Seedat, S.; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Shaheen, Amira; Shahraz, Saeid; Shaikh, Masood Ali; Levy, Teresa Shamah; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Sheth, Kevin N.; Shi, Peilin; Shibuya, Kenji; Shigematsu, Mika; Shin, Min Jeong; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Shrime, Mark G.; Sigfusdottir, Inga D.; Silva, Diego Augusto Santos; Silveira, Dayane Gabriele Alves; Silverberg, Jonathan I.; Simard, Edgar P.; Sindi, Shireen; Singh, Abhishek; Singh, Jasvinder A.; Singh, Prashant Kumar; Slepak, Erica Leigh; Soljak, Michael; Soneji, Samir; Sorensen, Reed J D; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stathopoulou, Vasiliki; Steckling, Nadine; Steel, Nicholas; Stein, Dan J.; Stein, Murray B.; Stöckl, Heidi; Stranges, Saverio; Stroumpoulis, Konstantinos; Sunguya, Bruno F.; Swaminathan, Soumya; Sykes, Bryan L.; Szoeke, Cassandra E I; Tabares-Seisdedos, Rafael; Takahashi, Ken; Talongwa, Roberto Tchio; Tandon, Nikhil; Tanne, David; Tavakkoli, Mohammad; Taye, Bineyam; Taylor, Hugh R.; Tedla, Bemnet Amare; Tefera, Worku Mekonnen; Tegegne, Teketo Kassaw; Tekle, Dejen Yemane; Terkawi, Abdullah Sulieman; Thakur, J. 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In: The Lancet, Vol. 388, No. 10053, 08.10.2016, p. 1659-1724.

Research output: Contribution to journalArticle

Forouzanfar, MH, Afshin, A, Alexander, L, Anderson, HR, Bhutta, Z, Biryukov, S, Brauer, M, Burnett, R, Cercy, K, Charlson, FJ, Cohen, A, Dandona, L, Estep, K, Ferrari, AJ, Frostad, JJ, Fullman, N, Gething, P, Godwin, WW, Griswold, M, Kinfu, Y, Kyu, H, Larson, H, Liang, X, Lim, SS, Liu, PY, Lopez, AD, Lozano, R, Marczak, L, Mensah, G, Mokdad, AH, Moradi-Lakeh, M, Naghavi, M, Neal, BC, Reitsma, MB, Roth, GA, Salomon, JA, Sur, P, Vos, T, Wagner, J, Wang, H, Zhao, Y, Zhou, M, Aasvang, GM, Abajobir, AA, Abate, KH, Abbafati, C, Abbas, KM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abraham, B, Abu-Raddad, LJ, Abyu, GY, Adebiyi, AO, Adedeji, IA, Ademi, Z, Adou, AK, Adsuar, JC, Agardh, EE, Agarwal, A, Agrawal, A, Kiadaliri, AA, Ajala, ON, Akinyemiju, TF, Al-Aly, Z, Alam, K, Alam, NKM, Aldhahri, SFS, Aldridge, RW, Alemu, ZA, Ali, R, Alkerwi, A, Alla, F, Allebeck, P, Alsharif, U, Altirkawi, KA, Martin, EA, Alvis-Guzman, N, Amare, AT, Amberbir, A, Amegah, AK, Amini, H, Ammar, W, Amrock, SM, Andersen, HH, Anderson, BO, Antonio, CAT, Anwari, P, Ärnlöv, J, Artaman, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Avokpaho, EFGA, Awasthi, A, Quintanilla, BPA, Azzopardi, P, Bacha, U, Badawi, A, Bahit, MC, Balakrishnan, K, Barac, A, Barber, RM, Barker-Collo, SL, Bärnighausen, T, Barquera, S, Barregard, L, Barrero, LH, Basu, S, Batis, C, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Beghi, E, Bell, ML, Bello, AK, Bennett, DA, Bensenor, IM, Berhane, A, Bernabe, E, Betsu, BD, Beyene, AS, Bhala, N, Bhansali, A, Bhatt, S, Biadgilign, S, Bikbov, B, Bisanzio, D, Bjertness, E, Blore, JD, Borschmann, R, Boufous, S, Bourne, RR, Brainin, M, Bražinová, A, Breitborde, NJK, Brenner, H, Broday, DM, Brugha, TS, Brunekreef, B, Butt, ZA, Cahill, LE, Calabria, B, Campos-Nonato, IR, Cardenas, R, Carpenter, DO, Casey, D, Castaneda-Orjuela, CA, Rivas, JC, Castro, RE, Catala-Lopez, F, Chang, JC, Chiang, PP, Chibalabala, M, Chimed-Ochir, O, Chisumpa, VH, Chitheer, AA, Choi, JYJ, Christensen, H, Christopher, DJ, 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Gopalani, SV, Gotay, CC, Goto, A, Gouda, HN, Gugnani, HC, Guillemin, F, Guo, Y, Gupta, R, Gupta, R, Gutierrez, RA, Haagsma, JA, Hafezi-Nejad, N, Haile, D, Hailu, GB, Halasa, Y, Hamadeh, RR, Hamidi, S, Handal, AJ, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Hassanvand, MS, Hassen, TA, Havmoeller, R, Heredia Pi, IB, Hernández-Llanes, NF, Heydarpour, P, Hoek, HW, Hoffman, HJ, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Htet, AS, Hu, G, Huang, JJ, Husseini, A, Hutchings, S, Huybrechts, I, Iburg, KM, Idrisov, BT, Ileanu, BV, Inoue, M, Jacobs, TA, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Jansen, HA, Jassal, SK, Javanbakht, M, Jayatilleke, AU, Jee, SH, Jeemon, P, Jha, V, Jiang, Y, Jibat, T, Jin, Y, Johnson, CO, Jonas, JB, Kabir, Z, Kalkonde, Y, Kamal, R, Kan, H, Karch, A, Karema, CK, Karimkhani, C, Kasaeian, A, Kaul, A, Kawakami, N, Kazi, DS, Keiyoro, PN, Kemp, AH, Kengne, AP, Keren, A, Kesavachandran, CN, Khader, YS, Khan, AR, Khan, EA, Khan, G, Khang, YH, Khatibzadeh, S, Khera, S, Khoja, TAM, Khubchandani, J, Kieling, C, Kim, CI, Kim, D, Kimokoti, RW, Kissoon, N, Kivipelto, M, Knibbs, L, Kokubo, Y, Kopec, JA, Koul, PA, Koyanagi, A, Kravchenko, M, Kromhout, H, Krueger, H, Ku, T, Defo, BK, Kuchenbecker, RS, Bicer, BK, Kuipers, EJ, Kumar, GA, Kwan, GF, Lal, DK, Lalloo, R, Lallukka, T, Lan, Q, Larsson, A, Latif, AA, Lawrynowicz, AEB, Leasher, JL, Leigh, J, Leung, J, Levi, M, Li, X, Li, Y, Liang, J, Liu, S, Lloyd, BK, Logroscino, G, Lotufo, PA, Lunevicius, R, MacIntyre, MF, Mahdavi, M, Majdan, M, Majeed, A, Malekzadeh, R, Malta, DC, Manamo, WAA, Mapoma, CC, Marcenes, W, Martin, RV, Martinez-Raga, J, Masiye, F, Matsushita, K, Matzopoulos, RG, Mayosi, BM, McGrath, JJ, McKee, M, Meaney, PA, Medina, C, Mehari, A, Mejia-Rodriguez, F, Mekonnen, AB, Melaku, YA, Memish, Z, Mendoza, W, Mensink, GBM, Meretoja, A, Meretoja, TJ, Mesfin, YM, Mhimbira, FA, Miller, TR, Mills, EJ, Mirarefin, M, Misganaw, A, Mock, CN, Mohammadi, A, Mohammed, S, Mola, GLD, Monasta, L, Hernandez, JCM, Montico, M, Morawska, L, Mori, R, Mozaffarian, D, Mueller, UO, Mullany, EC, Mumford, JE, Murthy, GVS, Nachega, J, Naheed, A, Nangia, V, Nassiri, N, Newton, J, Ng, M, Nguyen, QL, Nisar, MI, Pete, PMN, Norheim, OF, Norman, RE, Norrving, B, Nyakarahuka, L, Obermeyer, CM, Ogbo, FA, Oh, IH, Oladimeji, O, Olivares, PR, Olsen, H, Olusanya, BO, Olusanya, JO, Opio, JN, Oren, E, Orozco, R, Ortiz, A, Ota, E, PA, M, Pana, A, Park, EK, Parry, CD, Parsaeian, M, Patel, T, Caicedo, AJP, Patil, ST, Patten, SB, Patton, GC, Pearce, N, Pereira, DM, Perico, N, Pesudovs, K, Petzold, M, Phillips, MR, Piel, FB, Pillay, JD, Plass, D, Polinder, S, Pond, CD, Pope, CA, Pope, D, Popova, S, Poulton, RG, Pourmalek, F, Prasad, NM, Qorbani, M, Rabiee, RHS, Radfar, A, Rafay, A, Rahimi-Movaghar, V, Rahman, M, Rahman, MHU, Rahman, SUR, Rai, RK, Rajsic, S, Raju, M, Ram, U, Rana, SM, Ranganathan, K, Rao, P, García, CAR, Refaat, AH, Rehm, CD, Rehm, J, Reinig, N, Remuzzi, G, Resnikoff, S, Ribeiro, AL, Rivera, JA, Roba, HS, Rodriguez, A, Rodriguez-Ramirez, S, Rojas-Rueda, D, Roman, Y, Ronfani, L, Roshandel, G, Rothenbacher, D, Roy, A, Saleh, MM, Sanabria, JR, Sanchez-Niño, MD, Sánchez-Pimienta, TG, Sandar, L, Santomauro, DF, Santos, IS, Sarmiento-Suarez, R, Sartorius, B, Satpathy, M, Savic, M, Sawhney, M, Schmidhuber, J, Schmidt, MI, Schneider, IJC, Schöttker, B, Schutte, AE, Schwebel, DC, Scott, JG, Seedat, S, Sepanlou, SG, Servan-Mori, EE, Shaheen, A, Shahraz, S, Shaikh, MA, Levy, TS, Sharma, R, She, J, Sheikhbahaei, S, Shen, J, Sheth, KN, Shi, P, Shibuya, K, Shigematsu, M, Shin, MJ, Shiri, R, Shishani, K, Shiue, I, Shrime, MG, Sigfusdottir, ID, Silva, DAS, Silveira, DGA, Silverberg, JI, Simard, EP, Sindi, S, Singh, A, Singh, JA, Singh, PK, Slepak, EL, Soljak, M, Soneji, S, Sorensen, RJD, Sposato, LA, Sreeramareddy, CT, Stathopoulou, V, Steckling, N, Steel, N, Stein, DJ, Stein, MB, Stöckl, H, Stranges, S, Stroumpoulis, K, Sunguya, BF, Swaminathan, S, Sykes, BL, Szoeke, CEI, 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Forouzanfar, Mohammad H. ; Afshin, Ashkan ; Alexander, Lily ; Anderson, H. Ross ; Bhutta, Zulfiqar ; Biryukov, Stan ; Brauer, Michael ; Burnett, Richard ; Cercy, Kelly ; Charlson, Fiona J. ; Cohen, Aaron ; Dandona, Lalit ; Estep, Kara ; Ferrari, Alize J. ; Frostad, Joseph J. ; Fullman, Nancy ; Gething, Peter ; Godwin, William W. ; Griswold, Max ; Kinfu, Yohannes ; Kyu, Hmwe ; Larson, Heidi ; Liang, Xiaofeng ; Lim, Stephen S. ; Liu, Patrick Y. ; Lopez, Alan D. ; Lozano, Rafael ; Marczak, Laurie ; Mensah, George ; Mokdad, Ali H. ; Moradi-Lakeh, Maziar ; Naghavi, Mohsen ; Neal, Bruce C. ; Reitsma, Marissa B. ; Roth, Gregory A. ; Salomon, Joshua A. ; Sur, Patrick ; Vos, Theo ; Wagner, Joseph ; Wang, Haidong ; Zhao, Yi ; Zhou, Maigeng ; Aasvang, Gunn Marit ; Abajobir, Amanuel Alemu ; Abate, Kalkidan Hassen ; Abbafati, Cristiana ; Abbas, Kaja M. ; Abd-Allah, Foad ; Abdulle, Abdishakur M. ; Abera, Semaw F. ; Abraham, Biju ; Abu-Raddad, Laith J. ; Abyu, Gebre Yitayih ; Adebiyi, Akindele Olupelumi ; Adedeji, Isaac Akinkunmi ; Ademi, Zanfina ; Adou, Arsène K. ; Adsuar, Josef C. ; Agardh, Emilie E. ; Agarwal, Arnav ; Agrawal, Anurag ; Kiadaliri, Aliasghar Ahmad ; Ajala, Oluremi N. ; Akinyemiju, Tomi F. ; Al-Aly, Ziyad ; Alam, Khurshid ; Alam, Noore K M ; Aldhahri, Saleh Fahed S ; Aldridge, Robert William ; Alemu, Zewdie Aderaw ; Ali, Raghib ; Alkerwi, Ala'a ; Alla, François ; Allebeck, Peter ; Alsharif, Ubai ; Altirkawi, Khalid A. ; Martin, Elena Alvarez ; Alvis-Guzman, Nelson ; Amare, Azmeraw T. ; Amberbir, Alemayehu ; Amegah, Adeladza Kofi ; Amini, Heresh ; Ammar, Walid ; Amrock, Stephen Marc ; Andersen, Hjalte H. ; Anderson, Benjamin O. ; Antonio, Carl Abelardo T ; Anwari, Palwasha ; Ärnlöv, Johan ; Artaman, Al ; Asayesh, Hamid ; Asghar, Rana J. ; Assadi, Reza ; Atique, Suleman ; Avokpaho, Euripide Frinel G Arthur ; Awasthi, Ashish ; Quintanilla, Beatriz Paulina Ayala ; Azzopardi, Peter ; Bacha, Umar ; Badawi, Alaa ; Bahit, Maria C. ; Balakrishnan, Kalpana ; Barac, Aleksandra ; Barber, Ryan M. ; Barker-Collo, Suzanne L. ; Bärnighausen, Till ; Barquera, Simon ; Barregard, Lars ; Barrero, Lope H. ; Basu, Sanjay ; Batis, Carolina ; Bazargan-Hejazi, Shahrzad ; Beardsley, Justin ; Bedi, Neeraj ; Beghi, Ettore ; Bell, Michelle L. ; Bello, Aminu K. ; Bennett, Derrick A. ; Bensenor, Isabela M. ; Berhane, Adugnaw ; Bernabe, Eduardo ; Betsu, Balem Demtsu ; Beyene, Addisu Shunu ; Bhala, Neeraj ; Bhansali, Anil ; Bhatt, Samir ; Biadgilign, Sibhatu ; Bikbov, Boris ; Bisanzio, Donal ; Bjertness, Espen ; Blore, Jed D. ; Borschmann, Rohan ; Boufous, Soufiane ; Bourne, Rupert R. ; Brainin, Michael ; Bražinová, Alexandra ; Breitborde, Nicholas J K ; Brenner, Hermann ; Broday, David M. ; Brugha, Traolach S. ; Brunekreef, Bert ; Butt, Zahid A. ; Cahill, Leah E. ; Calabria, Bianca ; Campos-Nonato, Ismael R. ; Cardenas, Rosario ; Carpenter, David O. ; Casey, Daniel ; Castaneda-Orjuela, Carlos A. ; Rivas, Jacqueline Castillo ; Castro, Ruben Estanislao ; Catala-Lopez, Ferran ; Chang, Jung Chen ; Chiang, Peggy P. ; Chibalabala, Mirriam ; Chimed-Ochir, Odgerel ; Chisumpa, Vesper Hichilombwe ; Chitheer, Abdulaal A. ; Choi, Jee Young Jasmine ; Christensen, Hanne ; Christopher, Devasahayam Jesudas ; Ciobanu, Liliana G. ; Coates, Matthew M. ; Colquhoun, Samantha M. ; Cooper, Leslie T. ; Cooperrider, Kimberly ; Cornaby, Leslie ; Cortinovis, Monica ; Crump, John A. ; Cuevas-Nasu, Lucia ; Damasceno, Albertino ; Dandona, Rakhi ; Darby, Sarah C. ; Dargan, Paul I. ; das Neves, José ; Davis, Adrian C. ; Davletov, Kairat ; De Castro, E. Filipa ; De La Cruz-Gongora, Vanessa ; De Leo, Diego ; Degenhardt, Louisa ; Del Gobbo, Liana C. ; del Pozo-Cruz, Borja ; Dellavalle, Robert P. ; Deribew, Amare ; Jarlais, Don C Des ; Dharmaratne, Samath D. ; Dhillon, Preet K. ; Diaz-Torne, Cesar ; Dicker, Daniel J. ; Ding, Eric L. ; Dorsey, E. Ray ; Doyle, Kerrie E. ; Driscoll, Tim R. ; Duan, Leilei ; Dubey, Manisha ; Duncan, Bruce Bartholow ; Elyazar, Iqbal ; Endries, Aman Yesuf ; Ermakov, Sergey P. ; Erskine, Holly ; Eshrati, Babak ; Esteghamati, Alireza ; Fahimi, Saman ; Faraon, Emerito Jose A ; Farid, Talha A. ; Farinha, Carla Sofia e Sa ; Faro, Andre ; Farvid, Maryam S. ; Farzadfar, Farshad ; Feigin, Valery L. ; Fereshtehnejad, Seyed Mohammad ; Fernandes, Jefferson G. ; Fischer, Florian ; Fitchett, Joseph Robert Ander ; Fleming, Thomas ; Foigt, Nataliya ; Foreman, Kyle J. ; Fowkes, F. Gerry R ; Franklin, Richard C. ; Fürst, Thomas ; Futran, Neal D. ; Gakidou, Emmanuela ; García-Basteiro, Alberto L. ; Gebrehiwot, Tsegaye Tsewelde ; Gebremedhin, Amanuel Tesfay ; Geleijnse, Johanna M. ; Gessner, Bradford D. ; Giref, Ababi Zergaw ; Giroud, Maurice ; Gishu, Melkamu Dedefo ; Goenka, Shifalika ; Gomez-Cabrera, Mari Carmen ; Gomez Dantes, Hector ; Gona, Philimon ; Goodridge, Amador ; Gopalani, Sameer Vali ; Gotay, Carolyn C. ; Goto, Atsushi ; Gouda, Hebe N. ; Gugnani, Harish C. ; Guillemin, Francis ; Guo, Yuming ; Gupta, Rahul ; Gupta, Rajeev ; Gutierrez, Reyna A. ; Haagsma, Juanita A. ; Hafezi-Nejad, Nima ; Haile, Demewoz ; Hailu, Gessessew Bugssa ; Halasa, Yara ; Hamadeh, Randah R. ; Hamidi, Samer ; Handal, Alexis J. ; Hankey, G. J. ; Hao, Yuantao ; Harb, Hilda L. ; Harikrishnan, Sivadasanpillai ; Haro, J. M. ; Hassanvand, Mohammad Sadegh ; Hassen, Tahir Ahmed ; Havmoeller, Rasmus ; Heredia Pi, Ileana B. ; Hernández-Llanes, Norberto Francisco ; Heydarpour, Pouria ; Hoek, Hans W. ; Hoffman, H. J. ; Horino, Masako ; Horita, Nobuyuki ; Hosgood, H. Dean ; Hoy, Damian G. ; Hsairi, Mohamed ; Htet, Aung Soe ; Hu, Guoqing ; Huang, John J. ; Husseini, Abdullatif ; Hutchings, S. ; Huybrechts, Inge ; Iburg, Kim M. ; Idrisov, Bulat T. ; Ileanu, Bogdan Vasile ; Inoue, Manami ; Jacobs, Troy A. ; Jacobsen, Kathryn H. ; Jahanmehr, Nader ; Jakovljevic, Mihajlo B. ; Jansen, Henrica A. ; Jassal, Simerjot K. ; Javanbakht, Mehdi ; Jayatilleke, Achala Upendra ; Jee, Sun Ha ; Jeemon, Panniyammakal ; Jha, Vivekanand ; Jiang, Ying ; Jibat, Tariku ; Jin, Ye ; Johnson, Catherine O. ; Jonas, Jost B. ; Kabir, Zubair ; Kalkonde, Yogeshwar ; Kamal, Ritul ; Kan, Haidong ; Karch, Andre ; Karema, Corine Kakizi ; Karimkhani, Chante ; Kasaeian, Amir ; Kaul, Anil ; Kawakami, Norito ; Kazi, Dhruv S. ; Keiyoro, Peter Njenga ; Kemp, Andrew H. ; Kengne, Andrew Pascal ; Keren, A. ; Kesavachandran, Chandrasekharan Nair ; Khader, Yousef Saleh ; Khan, Abdur Rahman ; Khan, Ejaz Ahmad ; Khan, Gulfaraz ; Khang, Young Ho ; Khatibzadeh, Shahab ; Khera, Sahil ; Khoja, Tawfik Ahmed Muthafer ; Khubchandani, Jagdish ; Kieling, Christian ; Kim, Cho il ; Kim, Daniel ; Kimokoti, Ruth W. ; Kissoon, Niranjan ; Kivipelto, M. ; Knibbs, Luke ; Kokubo, Yoshihiro ; Kopec, Jacek A. ; Koul, Parvaiz A. ; Koyanagi, Ai ; Kravchenko, Michael ; Kromhout, Hans ; Krueger, Hans ; Ku, Tiffany ; Defo, Barthelemy Kuate ; Kuchenbecker, Ricardo S. ; Bicer, Burcu Kucuk ; Kuipers, Ernst J. ; Kumar, G. Anil ; Kwan, Gene F. ; Lal, Dharmesh Kumar ; Lalloo, Ratilal ; Lallukka, Tea ; Lan, Qing ; Larsson, Anders ; Latif, Asma Abdul ; Lawrynowicz, Alicia E B ; Leasher, Janet L. ; Leigh, James ; Leung, Janni ; Levi, Miriam ; Li, Xiaohong ; Li, Yichong ; Liang, Juan ; Liu, Shiwei ; Lloyd, Belinda K. ; Logroscino, Giancarlo ; Lotufo, Paulo A. ; Lunevicius, Raimundas ; MacIntyre, Michael F. ; Mahdavi, Mahdi ; Majdan, Marek ; Majeed, Azeem ; Malekzadeh, Reza ; Malta, Deborah Carvalho ; Manamo, Wondimu Ayele Ayele ; Mapoma, Christopher C. ; Marcenes, Wagner ; Martin, Randall V. ; Martinez-Raga, Jose ; Masiye, Felix ; Matsushita, Kunihiro ; Matzopoulos, Richard G. ; Mayosi, Bongani M. ; McGrath, John J. ; McKee, Martin ; Meaney, Peter A. ; Medina, Catalina ; Mehari, Alem ; Mejia-Rodriguez, Fabiola ; Mekonnen, Alemayehu B. ; Melaku, Yohannes A. ; Memish, Ziad ; Mendoza, Walter ; Mensink, Gert B M ; Meretoja, Atte ; Meretoja, Tuomo J. ; Mesfin, Yonatan Moges ; Mhimbira, Francis Apolinary ; Miller, Ted R. ; Mills, Edward J. ; Mirarefin, Mojde ; Misganaw, Awoke ; Mock, Charles N. ; Mohammadi, Alireza ; Mohammed, Shafiu ; Mola, Glen Liddell D ; Monasta, Lorenzo ; Hernandez, Julio C Montanêz ; Montico, Marcella ; Morawska, Lidia ; Mori, Rintaro ; Mozaffarian, Dariush ; Mueller, Ulrich O. ; Mullany, Erin C. ; Mumford, John Everett ; Murthy, Gudlavalleti Venkata Satyanarayana ; Nachega, Jean ; Naheed, Aliya ; Nangia, Vinay ; Nassiri, Nariman ; Newton, J. ; Ng, Marie ; Nguyen, Quyen Le ; Nisar, Muhammad Imran ; Pete, Patrick Martial Nkamedjie ; Norheim, Ole F. ; Norman, Rosana E. ; Norrving, Bo ; Nyakarahuka, Luke ; Obermeyer, Carla Makhlouf ; Ogbo, Felix Akpojene ; Oh, In Hwan ; Oladimeji, Olanrewaju ; Olivares, Pedro R. ; Olsen, Helen ; Olusanya, Bolajoko O. ; Olusanya, Jacob Olusegun ; Opio, John Nelson ; Oren, Eyal ; Orozco, Ricardo ; Ortiz, Alberto ; Ota, Erika ; PA, Mahesh ; Pana, Adrian ; Park, Eun Kee ; Parry, Charles D. ; Parsaeian, Mahboubeh ; Patel, Tejas ; Caicedo, Angel J Paternina ; Patil, Snehal T. ; Patten, Scott B. ; Patton, George C. ; Pearce, Neil ; Pereira, David M. ; Perico, Norberto ; Pesudovs, Konrad ; Petzold, Max ; Phillips, Michael R. ; Piel, Frederic B. ; Pillay, Julian David ; Plass, Dietrich ; Polinder, Suzanne ; Pond, Constance D. ; Pope, C. A. ; Pope, D. ; Popova, Svetlana ; Poulton, Richie G. ; Pourmalek, Farshad ; Prasad, Noela M. ; Qorbani, Mostafa ; Rabiee, Rynaz H S ; Radfar, Amir ; Rafay, Anwar ; Rahimi-Movaghar, Vafa ; Rahman, Mahfuzar ; Rahman, Mohammad Hifz Ur ; Rahman, Sajjad U R ; Rai, Rajesh Kumar ; Rajsic, Sasa ; Raju, Murugesan ; Ram, Usha ; Rana, Saleem M. ; Ranganathan, Kavitha ; Rao, Puja ; García, Christian Aspacia Razo ; Refaat, Amany H. ; Rehm, Colin D. ; Rehm, Juergen ; Reinig, Nikolas ; Remuzzi, Giuseppe ; Resnikoff, Serge ; Ribeiro, Antonio L. ; Rivera, Juan A. ; Roba, Hirbo Shore ; Rodriguez, Alina ; Rodriguez-Ramirez, Sonia ; Rojas-Rueda, David ; Roman, Yesenia ; Ronfani, Luca ; Roshandel, Gholamreza ; Rothenbacher, Dietrich ; Roy, Ambuj ; Saleh, Muhammad Muhammad ; Sanabria, Juan R. ; Sanchez-Niño, Maria Dolores ; Sánchez-Pimienta, Tania G. ; Sandar, Logan ; Santomauro, Damian F. ; Santos, Itamar S. ; Sarmiento-Suarez, Rodrigo ; Sartorius, Benn ; Satpathy, Maheswar ; Savic, Miloje ; Sawhney, Monika ; Schmidhuber, Josef ; Schmidt, Maria Inês ; Schneider, Ione J C ; Schöttker, Ben ; Schutte, Aletta Elisabeth ; Schwebel, David C. ; Scott, James G. ; Seedat, S. ; Sepanlou, Sadaf G. ; Servan-Mori, Edson E. ; Shaheen, Amira ; Shahraz, Saeid ; Shaikh, Masood Ali ; Levy, Teresa Shamah ; Sharma, Rajesh ; She, Jun ; Sheikhbahaei, Sara ; Shen, Jiabin ; Sheth, Kevin N. ; Shi, Peilin ; Shibuya, Kenji ; Shigematsu, Mika ; Shin, Min Jeong ; Shiri, Rahman ; Shishani, Kawkab ; Shiue, Ivy ; Shrime, Mark G. ; Sigfusdottir, Inga D. ; Silva, Diego Augusto Santos ; Silveira, Dayane Gabriele Alves ; Silverberg, Jonathan I. ; Simard, Edgar P. ; Sindi, Shireen ; Singh, Abhishek ; Singh, Jasvinder A. ; Singh, Prashant Kumar ; Slepak, Erica Leigh ; Soljak, Michael ; Soneji, Samir ; Sorensen, Reed J D ; Sposato, Luciano A. ; Sreeramareddy, Chandrashekhar T. ; Stathopoulou, Vasiliki ; Steckling, Nadine ; Steel, Nicholas ; Stein, Dan J. ; Stein, Murray B. ; Stöckl, Heidi ; Stranges, Saverio ; Stroumpoulis, Konstantinos ; Sunguya, Bruno F. ; Swaminathan, Soumya ; Sykes, Bryan L. ; Szoeke, Cassandra E I ; Tabares-Seisdedos, Rafael ; Takahashi, Ken ; Talongwa, Roberto Tchio ; Tandon, Nikhil ; Tanne, David ; Tavakkoli, Mohammad ; Taye, Bineyam ; Taylor, Hugh R. ; Tedla, Bemnet Amare ; Tefera, Worku Mekonnen ; Tegegne, Teketo Kassaw ; Tekle, Dejen Yemane ; Terkawi, Abdullah Sulieman ; Thakur, J. 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D. ; Wubshet, Mamo ; Xavier, Denis ; Xu, Gelin ; Yadav, Ajit Kumar ; Yakob, Bereket ; Yalew, Ayalnesh Zemene ; Yano, Yuichiro ; Yaseri, Mehdi ; Ye, Pengpeng ; Yip, Paul ; Yonemoto, Naohiro ; Yoon, Seok Jun ; Younis, Mustafa ; Yu, Chuanhua ; Zaidi, Zoubida ; Zaki, Maysaa El Sayed ; Zhu, Jun ; Zipkin, Ben ; Zodpey, Sanjay ; Zuhlke, Liesl Joanna ; Murray, Christopher J L. / 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. In: The Lancet. 2016 ; Vol. 388, No. 10053. pp. 1659-1724.
@article{8d95d6169d5c4037895a61feee6b4fc4,
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, {Mohammad H.} and Ashkan Afshin and Lily Alexander and Anderson, {H. Ross} and Zulfiqar Bhutta and Stan Biryukov and Michael Brauer and Richard Burnett and Kelly Cercy and Charlson, {Fiona J.} and Aaron Cohen and Lalit Dandona and Kara Estep and Ferrari, {Alize J.} and Frostad, {Joseph J.} and Nancy Fullman and Peter Gething and Godwin, {William W.} and Max Griswold and Yohannes Kinfu and Hmwe Kyu and Heidi Larson and Xiaofeng Liang and Lim, {Stephen S.} and Liu, {Patrick Y.} and Lopez, {Alan D.} and Rafael Lozano and Laurie Marczak and George Mensah and Mokdad, {Ali H.} and Maziar Moradi-Lakeh and Mohsen Naghavi and Neal, {Bruce C.} and Reitsma, {Marissa B.} and Roth, {Gregory A.} and Salomon, {Joshua A.} and Patrick Sur and Theo Vos and Joseph Wagner and Haidong Wang and Yi Zhao and Maigeng Zhou and Aasvang, {Gunn Marit} and Abajobir, {Amanuel Alemu} and Abate, {Kalkidan Hassen} and Cristiana Abbafati and Abbas, {Kaja M.} and Foad Abd-Allah and Abdulle, {Abdishakur M.} and Abera, {Semaw F.} and Biju Abraham and Abu-Raddad, {Laith J.} and Abyu, {Gebre Yitayih} and Adebiyi, {Akindele Olupelumi} and Adedeji, {Isaac Akinkunmi} and Zanfina Ademi and Adou, {Ars{\`e}ne K.} and Adsuar, {Josef C.} and Agardh, {Emilie E.} and Arnav Agarwal and Anurag Agrawal and Kiadaliri, {Aliasghar Ahmad} and Ajala, {Oluremi N.} and Akinyemiju, {Tomi F.} and Ziyad Al-Aly and Khurshid Alam and Alam, {Noore K M} and Aldhahri, {Saleh Fahed S} and Aldridge, {Robert William} and Alemu, {Zewdie Aderaw} and Raghib Ali and Ala'a Alkerwi and Fran{\cc}ois Alla and Peter Allebeck and Ubai Alsharif and Altirkawi, {Khalid A.} and Martin, {Elena Alvarez} and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Alemayehu Amberbir and Amegah, {Adeladza Kofi} and Heresh Amini and Walid Ammar and Amrock, {Stephen Marc} and Andersen, {Hjalte H.} and Anderson, {Benjamin O.} and Antonio, {Carl Abelardo T} and Palwasha Anwari and Johan {\"A}rnl{\"o}v and Al Artaman and Hamid Asayesh and Asghar, {Rana J.} and Reza Assadi and Suleman Atique and Avokpaho, {Euripide Frinel G Arthur} and Ashish Awasthi and Quintanilla, {Beatriz Paulina Ayala} and Peter Azzopardi and Umar Bacha and Alaa Badawi and Bahit, {Maria C.} and Kalpana Balakrishnan and Aleksandra Barac and Barber, {Ryan M.} and Barker-Collo, {Suzanne L.} and Till B{\"a}rnighausen and Simon Barquera and Lars Barregard and Barrero, {Lope H.} and Sanjay Basu and Carolina Batis and Shahrzad Bazargan-Hejazi and Justin Beardsley and Neeraj Bedi and Ettore Beghi and Bell, {Michelle L.} and Bello, {Aminu K.} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Adugnaw Berhane and Eduardo Bernabe and Betsu, {Balem Demtsu} and Beyene, {Addisu Shunu} and Neeraj Bhala and Anil Bhansali and Samir Bhatt and Sibhatu Biadgilign and Boris Bikbov and Donal Bisanzio and Espen Bjertness and Blore, {Jed D.} and Rohan Borschmann and Soufiane Boufous and Bourne, {Rupert R.} and Michael Brainin and Alexandra Bražinov{\'a} and Breitborde, {Nicholas J K} and Hermann Brenner and Broday, {David M.} and Brugha, {Traolach S.} and Bert Brunekreef and Butt, {Zahid A.} and Cahill, {Leah E.} and Bianca Calabria and Campos-Nonato, {Ismael R.} and Rosario Cardenas and Carpenter, {David O.} and Daniel Casey and Castaneda-Orjuela, {Carlos A.} and Rivas, {Jacqueline Castillo} and Castro, {Ruben Estanislao} and Ferran Catala-Lopez and Chang, {Jung Chen} and Chiang, {Peggy P.} and Mirriam Chibalabala and Odgerel Chimed-Ochir and Chisumpa, {Vesper Hichilombwe} and Chitheer, {Abdulaal A.} and Choi, {Jee Young Jasmine} and Hanne Christensen and Christopher, {Devasahayam Jesudas} and Ciobanu, {Liliana G.} and Coates, {Matthew M.} and Colquhoun, {Samantha M.} and Cooper, {Leslie T.} and Kimberly Cooperrider and Leslie Cornaby and Monica Cortinovis and Crump, {John A.} and Lucia Cuevas-Nasu and Albertino Damasceno and Rakhi Dandona and Darby, {Sarah C.} and Dargan, {Paul I.} and {das Neves}, Jos{\'e} and Davis, {Adrian C.} and Kairat Davletov and {De Castro}, {E. Filipa} and {De La Cruz-Gongora}, Vanessa and {De Leo}, Diego and Louisa Degenhardt and {Del Gobbo}, {Liana C.} and {del Pozo-Cruz}, Borja and Dellavalle, {Robert P.} and Amare Deribew and Jarlais, {Don C Des} and Dharmaratne, {Samath D.} and Dhillon, {Preet K.} and Cesar Diaz-Torne and Dicker, {Daniel J.} and Ding, {Eric L.} and Dorsey, {E. Ray} and Doyle, {Kerrie E.} and Driscoll, {Tim R.} and Leilei Duan and Manisha Dubey and Duncan, {Bruce Bartholow} and Iqbal Elyazar and Endries, {Aman Yesuf} and Ermakov, {Sergey P.} and Holly Erskine and Babak Eshrati and Alireza Esteghamati and Saman Fahimi and Faraon, {Emerito Jose A} and Farid, {Talha A.} and Farinha, {Carla Sofia e Sa} and Andre Faro and Farvid, {Maryam S.} and Farshad Farzadfar and Feigin, {Valery L.} and Fereshtehnejad, {Seyed Mohammad} and Fernandes, {Jefferson G.} and Florian Fischer and Fitchett, {Joseph Robert Ander} and Thomas Fleming and Nataliya Foigt and Foreman, {Kyle J.} and Fowkes, {F. Gerry R} and Franklin, {Richard C.} and Thomas F{\"u}rst and Futran, {Neal D.} and Emmanuela Gakidou and Garc{\'i}a-Basteiro, {Alberto L.} and Gebrehiwot, {Tsegaye Tsewelde} and Gebremedhin, {Amanuel Tesfay} and Geleijnse, {Johanna M.} and Gessner, {Bradford D.} and Giref, {Ababi Zergaw} and Maurice Giroud and Gishu, {Melkamu Dedefo} and Shifalika Goenka and Gomez-Cabrera, {Mari Carmen} and {Gomez Dantes}, Hector and Philimon Gona and Amador Goodridge and Gopalani, {Sameer Vali} and Gotay, {Carolyn C.} and Atsushi Goto and Gouda, {Hebe N.} and Gugnani, {Harish C.} and Francis Guillemin and Yuming Guo and Rahul Gupta and Rajeev Gupta and Gutierrez, {Reyna A.} and Haagsma, {Juanita A.} and Nima Hafezi-Nejad and Demewoz Haile and Hailu, {Gessessew Bugssa} and Yara Halasa and Hamadeh, {Randah R.} and Samer Hamidi and Handal, {Alexis J.} and Hankey, {G. J.} and Yuantao Hao and Harb, {Hilda L.} and Sivadasanpillai Harikrishnan and Haro, {J. M.} and Hassanvand, {Mohammad Sadegh} and Hassen, {Tahir Ahmed} and Rasmus Havmoeller and {Heredia Pi}, {Ileana B.} and Hern{\'a}ndez-Llanes, {Norberto Francisco} and Pouria Heydarpour and Hoek, {Hans W.} and Hoffman, {H. J.} and Masako Horino and Nobuyuki Horita and Hosgood, {H. Dean} and Hoy, {Damian G.} and Mohamed Hsairi and Htet, {Aung Soe} and Guoqing Hu and Huang, {John J.} and Abdullatif Husseini and S. Hutchings and Inge Huybrechts and Iburg, {Kim M.} and Idrisov, {Bulat T.} and Ileanu, {Bogdan Vasile} and Manami Inoue and Jacobs, {Troy A.} and Jacobsen, {Kathryn H.} and Nader Jahanmehr and Jakovljevic, {Mihajlo B.} and Jansen, {Henrica A.} and Jassal, {Simerjot K.} and Mehdi Javanbakht and Jayatilleke, {Achala Upendra} and Jee, {Sun Ha} and Panniyammakal Jeemon and Vivekanand Jha and Ying Jiang and Tariku Jibat and Ye Jin and Johnson, {Catherine O.} and Jonas, {Jost B.} and Zubair Kabir and Yogeshwar Kalkonde and Ritul Kamal and Haidong Kan and Andre Karch and Karema, {Corine Kakizi} and Chante Karimkhani and Amir Kasaeian and Anil Kaul and Norito Kawakami and Kazi, {Dhruv S.} and Keiyoro, {Peter Njenga} and Kemp, {Andrew H.} and Kengne, {Andrew Pascal} and A. Keren and Kesavachandran, {Chandrasekharan Nair} and Khader, {Yousef Saleh} and Khan, {Abdur Rahman} and Khan, {Ejaz Ahmad} and Gulfaraz Khan and Khang, {Young Ho} and Shahab Khatibzadeh and Sahil Khera and Khoja, {Tawfik Ahmed Muthafer} and Jagdish Khubchandani and Christian Kieling and Kim, {Cho il} and Daniel Kim and Kimokoti, {Ruth W.} and Niranjan Kissoon and M. Kivipelto and Luke Knibbs and Yoshihiro Kokubo and Kopec, {Jacek A.} and Koul, {Parvaiz A.} and Ai Koyanagi and Michael Kravchenko and Hans Kromhout and Hans Krueger and Tiffany Ku and Defo, {Barthelemy Kuate} and Kuchenbecker, {Ricardo S.} and Bicer, {Burcu Kucuk} and Kuipers, {Ernst J.} and Kumar, {G. Anil} and Kwan, {Gene F.} and Lal, {Dharmesh Kumar} and Ratilal Lalloo and Tea Lallukka and Qing Lan and Anders Larsson and Latif, {Asma Abdul} and Lawrynowicz, {Alicia E B} and Leasher, {Janet L.} and James Leigh and Janni Leung and Miriam Levi and Xiaohong Li and Yichong Li and Juan Liang and Shiwei Liu and Lloyd, {Belinda K.} and Giancarlo Logroscino and Lotufo, {Paulo A.} and Raimundas Lunevicius and MacIntyre, {Michael F.} and Mahdi Mahdavi and Marek Majdan and Azeem Majeed and Reza Malekzadeh and Malta, {Deborah Carvalho} and Manamo, {Wondimu Ayele Ayele} and Mapoma, {Christopher C.} and Wagner Marcenes and Martin, {Randall V.} and Jose Martinez-Raga and Felix Masiye and Kunihiro Matsushita and Matzopoulos, {Richard G.} and Mayosi, {Bongani M.} and McGrath, {John J.} and Martin McKee and Meaney, {Peter A.} and Catalina Medina and Alem Mehari and Fabiola Mejia-Rodriguez and Mekonnen, {Alemayehu B.} and Melaku, {Yohannes A.} and Ziad Memish and Walter Mendoza and Mensink, {Gert B M} and Atte Meretoja and Meretoja, {Tuomo J.} and Mesfin, {Yonatan Moges} and Mhimbira, {Francis Apolinary} and Miller, {Ted R.} and Mills, {Edward J.} and Mojde Mirarefin and Awoke Misganaw and Mock, {Charles N.} and Alireza Mohammadi and Shafiu Mohammed and Mola, {Glen Liddell D} and Lorenzo Monasta and Hernandez, {Julio C Montan{\^e}z} and Marcella Montico and Lidia Morawska and Rintaro Mori and Dariush Mozaffarian and Mueller, {Ulrich O.} and Mullany, {Erin C.} and Mumford, {John Everett} and Murthy, {Gudlavalleti Venkata Satyanarayana} and Jean Nachega and Aliya Naheed and Vinay Nangia and Nariman Nassiri and J. Newton and Marie Ng and Nguyen, {Quyen Le} and Nisar, {Muhammad Imran} and Pete, {Patrick Martial Nkamedjie} and Norheim, {Ole F.} and Norman, {Rosana E.} and Bo Norrving and Luke Nyakarahuka and Obermeyer, {Carla Makhlouf} and Ogbo, {Felix Akpojene} and Oh, {In Hwan} and Olanrewaju Oladimeji and Olivares, {Pedro R.} and Helen Olsen and Olusanya, {Bolajoko O.} and Olusanya, {Jacob Olusegun} and Opio, {John Nelson} and Eyal Oren and Ricardo Orozco and Alberto Ortiz and Erika Ota and Mahesh PA and Adrian Pana and Park, {Eun Kee} and Parry, {Charles D.} and Mahboubeh Parsaeian and Tejas Patel and Caicedo, {Angel J Paternina} and Patil, {Snehal T.} and Patten, {Scott B.} and Patton, {George C.} and Neil Pearce and Pereira, {David M.} and Norberto Perico and Konrad Pesudovs and Max Petzold and Phillips, {Michael R.} and Piel, {Frederic B.} and Pillay, {Julian David} and Dietrich Plass and Suzanne Polinder and Pond, {Constance D.} and Pope, {C. A.} and D. Pope and Svetlana Popova and Poulton, {Richie G.} and Farshad Pourmalek and Prasad, {Noela M.} and Mostafa Qorbani and Rabiee, {Rynaz H S} and Amir Radfar and Anwar Rafay and Vafa Rahimi-Movaghar and Mahfuzar Rahman and Rahman, {Mohammad Hifz Ur} and Rahman, {Sajjad U R} and Rai, {Rajesh Kumar} and Sasa Rajsic and Murugesan Raju and Usha Ram and Rana, {Saleem M.} and Kavitha Ranganathan and Puja Rao and Garc{\'i}a, {Christian Aspacia Razo} and Refaat, {Amany H.} and Rehm, {Colin D.} and Juergen Rehm and Nikolas Reinig and Giuseppe Remuzzi and Serge Resnikoff and Ribeiro, {Antonio L.} and Rivera, {Juan A.} and Roba, {Hirbo Shore} and Alina Rodriguez and Sonia Rodriguez-Ramirez and David Rojas-Rueda and Yesenia Roman and Luca Ronfani and Gholamreza Roshandel and Dietrich Rothenbacher and Ambuj Roy and Saleh, {Muhammad Muhammad} and Sanabria, {Juan R.} and Sanchez-Ni{\~n}o, {Maria Dolores} and S{\'a}nchez-Pimienta, {Tania G.} and Logan Sandar and Santomauro, {Damian F.} and Santos, {Itamar S.} and Rodrigo Sarmiento-Suarez and Benn Sartorius and Maheswar Satpathy and Miloje Savic and Monika Sawhney and Josef Schmidhuber and Schmidt, {Maria In{\^e}s} and Schneider, {Ione J C} and Ben Sch{\"o}ttker and Schutte, {Aletta Elisabeth} and Schwebel, {David C.} and Scott, {James G.} and S. Seedat and Sepanlou, {Sadaf G.} and Servan-Mori, {Edson E.} and Amira Shaheen and Saeid Shahraz and Shaikh, {Masood Ali} and Levy, {Teresa Shamah} and Rajesh Sharma and Jun She and Sara Sheikhbahaei and Jiabin Shen and Sheth, {Kevin N.} and Peilin Shi and Kenji Shibuya and Mika Shigematsu and Shin, {Min Jeong} and Rahman Shiri and Kawkab Shishani and Ivy Shiue and Shrime, {Mark G.} and Sigfusdottir, {Inga D.} and Silva, {Diego Augusto Santos} and Silveira, {Dayane Gabriele Alves} and Silverberg, {Jonathan I.} and Simard, {Edgar P.} and Shireen Sindi and Abhishek Singh and Singh, {Jasvinder A.} and Singh, {Prashant Kumar} and Slepak, {Erica Leigh} and Michael Soljak and Samir Soneji and Sorensen, {Reed J D} and Sposato, {Luciano A.} and Sreeramareddy, {Chandrashekhar T.} and Vasiliki Stathopoulou and Nadine Steckling and Nicholas Steel and Stein, {Dan J.} and Stein, {Murray B.} and Heidi St{\"o}ckl and Saverio Stranges and Konstantinos Stroumpoulis and Sunguya, {Bruno F.} and Soumya Swaminathan and Sykes, {Bryan L.} and Szoeke, {Cassandra E I} and Rafael Tabares-Seisdedos and Ken Takahashi and Talongwa, {Roberto Tchio} and Nikhil Tandon and David Tanne and Mohammad Tavakkoli and Bineyam Taye and Taylor, {Hugh R.} and Tedla, {Bemnet Amare} and Tefera, {Worku Mekonnen} and Tegegne, {Teketo Kassaw} and Tekle, {Dejen Yemane} and Terkawi, {Abdullah Sulieman} and Thakur, {J. S.} and Thomas, {Bernadette A.} and Thomas, {Matthew Lloyd} and Thomson, {Alan J.} and Thorne-Lyman, {Andrew L.} and Thrift, {Amanda G.} and Thurston, {George D.} and Taavi Tillmann and Ruoyan Tobe-Gai and Myriam Tobollik and Roman Topor-Madry and Fotis Topouzis and Towbin, {Jeffrey A.} and Tran, {Bach X.} and Dimbuene, {Zacharie Tsala} and Nikolaos Tsilimparis and Tura, {Abera Kenay} and Tuzcu, {Emin M.} and Stefanos Tyrovolas and Ukwaja, {Kingsley N.} and Undurraga, {Eduardo A.} and Uneke, {Chigozie Jesse} and Uthman, {Olalekan A.} and {van Donkelaar}, Aaron and {Van Os}, Jim and Varakin, {Yuri Y.} and Tommi Vasankari and Veerman, {J. Lennert} and Narayanaswamy Venketasubramanian and Violante, {F. S.} and Vollset, {Stein Emil} and Wagner, {Gregory R.} and Stephen Waller and Jianli Wang and Linhong Wang and Yanping Wang and Scott Weichenthal and Elisabete Weiderpass and Weintraub, {Robert G.} and Andrea Werdecker and Ronny Westerman and Harvey Whiteford and Tissa Wijeratne and Wiysonge, {Charles Shey} and Wolfe, {Charles D A} and Sungho Won and Woolf, {A. D.} and Mamo Wubshet and Denis Xavier and Gelin Xu and Yadav, {Ajit Kumar} and Bereket Yakob and Yalew, {Ayalnesh Zemene} and Yuichiro Yano and Mehdi Yaseri and Pengpeng Ye and Paul Yip and Naohiro Yonemoto and Yoon, {Seok Jun} and Mustafa Younis and Chuanhua Yu and Zoubida Zaidi and Zaki, {Maysaa El Sayed} and Jun Zhu and Ben Zipkin and Sanjay Zodpey and Zuhlke, {Liesl Joanna} and Murray, {Christopher J L}",
year = "2016",
month = "10",
day = "8",
doi = "10.1016/S0140-6736(16)31679-8",
language = "English",
volume = "388",
pages = "1659--1724",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Lancet Publishing Group",
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, Mohammad H.

AU - Afshin, Ashkan

AU - Alexander, Lily

AU - Anderson, H. Ross

AU - Bhutta, Zulfiqar

AU - Biryukov, Stan

AU - Brauer, Michael

AU - Burnett, Richard

AU - Cercy, Kelly

AU - Charlson, Fiona J.

AU - Cohen, Aaron

AU - Dandona, Lalit

AU - Estep, Kara

AU - Ferrari, Alize J.

AU - Frostad, Joseph J.

AU - Fullman, Nancy

AU - Gething, Peter

AU - Godwin, William W.

AU - Griswold, Max

AU - Kinfu, Yohannes

AU - Kyu, Hmwe

AU - Larson, Heidi

AU - Liang, Xiaofeng

AU - Lim, Stephen S.

AU - Liu, Patrick Y.

AU - Lopez, Alan D.

AU - Lozano, Rafael

AU - Marczak, Laurie

AU - Mensah, George

AU - Mokdad, Ali H.

AU - Moradi-Lakeh, Maziar

AU - Naghavi, Mohsen

AU - Neal, Bruce C.

AU - Reitsma, Marissa B.

AU - Roth, Gregory A.

AU - Salomon, Joshua A.

AU - Sur, Patrick

AU - Vos, Theo

AU - Wagner, Joseph

AU - Wang, Haidong

AU - Zhao, Yi

AU - Zhou, Maigeng

AU - Aasvang, Gunn Marit

AU - Abajobir, Amanuel Alemu

AU - Abate, Kalkidan Hassen

AU - Abbafati, Cristiana

AU - Abbas, Kaja M.

AU - Abd-Allah, Foad

AU - Abdulle, Abdishakur M.

AU - Abera, Semaw F.

AU - Abraham, Biju

AU - Abu-Raddad, Laith J.

AU - Abyu, Gebre Yitayih

AU - Adebiyi, Akindele Olupelumi

AU - Adedeji, Isaac Akinkunmi

AU - Ademi, Zanfina

AU - Adou, Arsène K.

AU - Adsuar, Josef C.

AU - Agardh, Emilie E.

AU - Agarwal, Arnav

AU - Agrawal, Anurag

AU - Kiadaliri, Aliasghar Ahmad

AU - Ajala, Oluremi N.

AU - Akinyemiju, Tomi F.

AU - Al-Aly, Ziyad

AU - Alam, Khurshid

AU - Alam, Noore K M

AU - Aldhahri, Saleh Fahed S

AU - Aldridge, Robert William

AU - Alemu, Zewdie Aderaw

AU - Ali, Raghib

AU - Alkerwi, Ala'a

AU - Alla, François

AU - Allebeck, Peter

AU - Alsharif, Ubai

AU - Altirkawi, Khalid A.

AU - Martin, Elena Alvarez

AU - Alvis-Guzman, Nelson

AU - Amare, Azmeraw T.

AU - Amberbir, Alemayehu

AU - Amegah, Adeladza Kofi

AU - Amini, Heresh

AU - Ammar, Walid

AU - Amrock, Stephen Marc

AU - Andersen, Hjalte H.

AU - Anderson, Benjamin O.

AU - Antonio, Carl Abelardo T

AU - Anwari, Palwasha

AU - Ärnlöv, Johan

AU - Artaman, Al

AU - Asayesh, Hamid

AU - Asghar, Rana J.

AU - Assadi, Reza

AU - Atique, Suleman

AU - Avokpaho, Euripide Frinel G Arthur

AU - Awasthi, Ashish

AU - Quintanilla, Beatriz Paulina Ayala

AU - Azzopardi, Peter

AU - Bacha, Umar

AU - Badawi, Alaa

AU - Bahit, Maria C.

AU - Balakrishnan, Kalpana

AU - Barac, Aleksandra

AU - Barber, Ryan M.

AU - Barker-Collo, Suzanne L.

AU - Bärnighausen, Till

AU - Barquera, Simon

AU - Barregard, Lars

AU - Barrero, Lope H.

AU - Basu, Sanjay

AU - Batis, Carolina

AU - Bazargan-Hejazi, Shahrzad

AU - Beardsley, Justin

AU - Bedi, Neeraj

AU - Beghi, Ettore

AU - Bell, Michelle L.

AU - Bello, Aminu K.

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhane, Adugnaw

AU - Bernabe, Eduardo

AU - Betsu, Balem Demtsu

AU - Beyene, Addisu Shunu

AU - Bhala, Neeraj

AU - Bhansali, Anil

AU - Bhatt, Samir

AU - Biadgilign, Sibhatu

AU - Bikbov, Boris

AU - Bisanzio, Donal

AU - Bjertness, Espen

AU - Blore, Jed D.

AU - Borschmann, Rohan

AU - Boufous, Soufiane

AU - Bourne, Rupert R.

AU - Brainin, Michael

AU - Bražinová, Alexandra

AU - Breitborde, Nicholas J K

AU - Brenner, Hermann

AU - Broday, David M.

AU - Brugha, Traolach S.

AU - Brunekreef, Bert

AU - Butt, Zahid A.

AU - Cahill, Leah E.

AU - Calabria, Bianca

AU - Campos-Nonato, Ismael R.

AU - Cardenas, Rosario

AU - Carpenter, David O.

AU - Casey, Daniel

AU - Castaneda-Orjuela, Carlos A.

AU - Rivas, Jacqueline Castillo

AU - Castro, Ruben Estanislao

AU - Catala-Lopez, Ferran

AU - Chang, Jung Chen

AU - Chiang, Peggy P.

AU - Chibalabala, Mirriam

AU - Chimed-Ochir, Odgerel

AU - Chisumpa, Vesper Hichilombwe

AU - Chitheer, Abdulaal A.

AU - Choi, Jee Young Jasmine

AU - Christensen, Hanne

AU - Christopher, Devasahayam Jesudas

AU - Ciobanu, Liliana G.

AU - Coates, Matthew M.

AU - Colquhoun, Samantha M.

AU - Cooper, Leslie T.

AU - Cooperrider, Kimberly

AU - Cornaby, Leslie

AU - Cortinovis, Monica

AU - Crump, John A.

AU - Cuevas-Nasu, Lucia

AU - Damasceno, Albertino

AU - Dandona, Rakhi

AU - Darby, Sarah C.

AU - Dargan, Paul I.

AU - das Neves, José

AU - Davis, Adrian C.

AU - Davletov, Kairat

AU - De Castro, E. Filipa

AU - De La Cruz-Gongora, Vanessa

AU - De Leo, Diego

AU - Degenhardt, Louisa

AU - Del Gobbo, Liana C.

AU - del Pozo-Cruz, Borja

AU - Dellavalle, Robert P.

AU - Deribew, Amare

AU - Jarlais, Don C Des

AU - Dharmaratne, Samath D.

AU - Dhillon, Preet K.

AU - Diaz-Torne, Cesar

AU - Dicker, Daniel J.

AU - Ding, Eric L.

AU - Dorsey, E. Ray

AU - Doyle, Kerrie E.

AU - Driscoll, Tim R.

AU - Duan, Leilei

AU - Dubey, Manisha

AU - Duncan, Bruce Bartholow

AU - Elyazar, Iqbal

AU - Endries, Aman Yesuf

AU - Ermakov, Sergey P.

AU - Erskine, Holly

AU - Eshrati, Babak

AU - Esteghamati, Alireza

AU - Fahimi, Saman

AU - Faraon, Emerito Jose A

AU - Farid, Talha A.

AU - Farinha, Carla Sofia e Sa

AU - Faro, Andre

AU - Farvid, Maryam S.

AU - Farzadfar, Farshad

AU - Feigin, Valery L.

AU - Fereshtehnejad, Seyed Mohammad

AU - Fernandes, Jefferson G.

AU - Fischer, Florian

AU - Fitchett, Joseph Robert Ander

AU - Fleming, Thomas

AU - Foigt, Nataliya

AU - Foreman, Kyle J.

AU - Fowkes, F. Gerry R

AU - Franklin, Richard C.

AU - Fürst, Thomas

AU - Futran, Neal D.

AU - Gakidou, Emmanuela

AU - García-Basteiro, Alberto L.

AU - Gebrehiwot, Tsegaye Tsewelde

AU - Gebremedhin, Amanuel Tesfay

AU - Geleijnse, Johanna M.

AU - Gessner, Bradford D.

AU - Giref, Ababi Zergaw

AU - Giroud, Maurice

AU - Gishu, Melkamu Dedefo

AU - Goenka, Shifalika

AU - Gomez-Cabrera, Mari Carmen

AU - Gomez Dantes, Hector

AU - Gona, Philimon

AU - Goodridge, Amador

AU - Gopalani, Sameer Vali

AU - Gotay, Carolyn C.

AU - Goto, Atsushi

AU - Gouda, Hebe N.

AU - Gugnani, Harish C.

AU - Guillemin, Francis

AU - Guo, Yuming

AU - Gupta, Rahul

AU - Gupta, Rajeev

AU - Gutierrez, Reyna A.

AU - Haagsma, Juanita A.

AU - Hafezi-Nejad, Nima

AU - Haile, Demewoz

AU - Hailu, Gessessew Bugssa

AU - Halasa, Yara

AU - Hamadeh, Randah R.

AU - Hamidi, Samer

AU - Handal, Alexis J.

AU - Hankey, G. J.

AU - Hao, Yuantao

AU - Harb, Hilda L.

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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.

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

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

M3 - Article

VL - 388

SP - 1659

EP - 1724

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10053

ER -