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 KinfuHmwe 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

ASJC Scopus subject areas

  • Medicine(all)

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    Forouzanfar, M. H., Afshin, A., Alexander, L., Anderson, H. R., Bhutta, Z., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., Cohen, A., Dandona, L., Estep, K., Ferrari, A. J., Frostad, J. J., Fullman, N., Gething, P., Godwin, W. W., Griswold, M., ... Murray, C. J. L. (2016). 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. The Lancet, 388(10053), 1659-1724. https://doi.org/10.1016/S0140-6736(16)31679-8