Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Abstrak
Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding Bill & Melinda Gates Foundation.
Topik & Kata Kunci
Penulis (500)
Christopher J L Aleksandr Y Peng Cristiana Kaja M Mohsen Foad Murray Aravkin Zheng Abbafati Abbas Abbasi-Kangeva
C. Murray
A. Aravkin
P. Zheng
C. Abbafati
K. Abbas
M. Abbasi-Kangevari
F. Abd-Allah
A. Abdelalim
M. Abdollahi
Ibrahim Abdollahpour
Kedir Hussein Abegaz
Hassan Abolhassani
Victor Aboyans
Lucas Guimarães Abreu
M. R. Abrigo
Ahmed Abualhasan
L. Abu-Raddad
A. Abushouk
M. Adabi
Victor Adekanmbi
A. Adeoye
O. Adetokunboh
Davoud Adham
S. Advani
Gina Agarwal
S. K. Aghamir
Anurag Agrawal
Tauseef Ahmad
K. Ahmadi
Mehdi Ahmadi
H. Ahmadieh
M. Ahmed
T. Akalu
R. Akinyemi
T. Akinyemiju
B. Akombi
C. Akunna
Fares Alahdab
Z. Al-Aly
K. Alam
Samiah Alam
Tahiya Alam
F. Alanezi
Turki M. Alanzi
B. Alemu
K. Alhabib
Muhammad Ali
Saqib Ali
G. Alicandro
C. Alinia
V. Alipour
H. Alizade
S. Aljunid
François Alla
Peter Allebeck
A. Almasi-Hashiani
Hesham M Al-Mekhlafi
Jordi Alonso
K. Altirkawi
Mostafa Amini-Rarani
Fatemeh Amiri
D. Amugsi
R. Ancuceanu
D. Anderlini
Jason A Anderson
C. Andrei
Tudorel Andrei
Colin Angus
Mina Anjomshoa
F. Ansari
A. Ansari-Moghaddam
I. Antonazzo
C. Antonio
C. Antony
E. Antriyandarti
Davood Anvari
R. Anwer
Seth Christopher Yaw Appiah
J. Arabloo
M. Arab-Zozani
F. Ariani
Bahram Armoon
J. Ärnlöv
A. Arzani
Mehran Asadi-Aliabadi
A. Asadi-Pooya
Charlie Ashbaugh
Michael Assmus
Z. Atafar
Desta Debalkie Atnafu
M. Atout
F. Ausloos
M. Ausloos
B. A. Ayala Quintanilla
Getinet Ayano
M. Ayanore
S. Azari
G. Azarian
Z. N. Azene
A. Badawi
A. Badiye
M. Bahrami
M. Bakhshaei
A. Bakhtiari
Shankar M. Bakkannavar
Alberto Baldasseroni
Kylie Ball
S. Ballew
Daniela Balzi
Maciej Banach
Srikanta K Banerjee
Agegnehu Bante
A. G. Baraki
S. Barker-Collo
T. Bärnighausen
L. Barrero
Celine M Barthelemy
Lingkan Barua
S. Basu
B. Baune
M. Bayati
Jacob S. Becker
Neeraj Bedi
Ettore Beghi
Y. Béjot
M. L. Bell
F. Bennitt
I. Benseñor
Kidanemaryam Berhe
Adam E. Berman
A. Bhagavathula
R. Bhageerathy
N. Bhala
Dinesh Bhandari
Krittika Bhattacharyya
Z. Bhutta
A. Bijani
B. Bikbov
M. B. Bin Sayeed
A. Biondi
Binyam Minuye Birihane
C. Bisignano
R. Biswas
Helen Bitew
S. Bohlouli
Mehdi Bohluli
Alexandra S. Boon-Dooley
G. Borges
A. Borzì
S. Borzouei
C. Bosetti
S. Boufous
D. Braithwaite
N. Breitborde
S. Breitner
H. Brenner
P. Briant
A. Briko
N. Briko
Gabrielle Britton
Dana Bryazka
Blair R Bumgarner
K. Burkart
R. Burnett
Sharath Burugina Nagaraja
Z. Butt
F. L. Caetano dos Santos
Leah E Cahill
L. Cámera
Ismael Campos-Nonato
Rosario Cárdenas
G. Carreras
J. Carrero
F. Carvalho
J. Castaldelli-Maia
C. Castañeda-Orjuela
G. Castelpietra
Franz Castro
K. Causey
Christopher R. Cederroth
Kelly M. Cercy
Ester Cerin
J. Chandan
Kai-Lan Chang
F. Charlson
Vijay Kumar Chattu
S. Chaturvedi
N. Cherbuin
Odgerel Chimed-Ochir
Daniel Cho
J. Choi
H. Christensen
D. Chu
Michael T. Chung
S. Chung
F. Cicuttini
Liliana G. Ciobanu
Massimo Cirillo
T. Classen
Aaron J. Cohen
K. Compton
Owen R. Cooper
V. M. Costa
Ewerton Cousin
R. Cowden
Di H. Cross
Jessica A Cruz
Saad M A Dahlawi
Albertino Damasceno
G. Damiani
L. Dandona
R. Dandona
W. J. Dangel
A. Danielsson
P. Dargan
A. Darwesh
A. Daryani
Jai K Das
R. Das Gupta
J. D. das Neves
C. Dávila-Cervantes
D. Davițoiu
Diego De Leo
L. Degenhardt
Marissa N Delang
R. Dellavalle
F. M. Demeke
Gebre Teklemariam Demoz
D. Demsie
E. Denova-Gutiérrez
Nikolaos Dervenis
G. Dhungana
M. Dianatinasab
D. Dias da Silva
Daniel Diaz
Z. S. Dibaji Forooshani
S. Djalalinia
H. Do
K. Dokova
Fariba Dorostkar
L. Doshmangir
T. Driscoll
B. B. Duncan
A. Durães
Arielle Eagan
D. Edvardsson
Nevine M. El Nahas
Iman El Sayed
M. El Tantawi
I. Elbarazi
I. Elgendy
S. El-Jaafary
I. Elyazar
Sophia Emmons-Bell
H. Erskine
S. Eskandarieh
S. Esmaeilnejad
Alireza Esteghamati
Kara Estep
A. Etemadi
Atkilt Esaiyas Etisso
J. Fanzo
Mohammad Farahmand
Mohammad Fareed
R. Faridnia
Andrea Farioli
Andre Faro
M. Faruque
F. Farzadfar
N. Fattahi
Mehdi Fazlzadeh
Valery L. Feigin
Rachel Feldman
S. Fereshtehnejad
Eduarda Fernandes
Giannina Ferrara
A. Ferrari
Manuela L Ferreira
I. Filip
Florian Fischer
James L. Fisher
L. Flor
N. Foigt
M. Foláyan
A. Fomenkov
Lisa M. Force
M. Foroutan
R. Franklin
Marisa Freitas
Weijia Fu
T. Fukumoto
João M. Furtado
M. Gad
E. Gakidou
S. Gallus
A. García-Basteiro
W. M. Gardner
Biniyam Sahiledengle Geberemariyam
Assefa Ayalew Ayalew Gebreslassie
A. Geremew
Anna Gershberg Hayoon
P. Gething
Maryam Ghadimi
K. Ghadiri
F. Ghaffarifar
M. Ghafourifard
F. Ghamari
A. Ghashghaee
H. Ghiasvand
N. Ghith
A. Gholamian
Rakesh Ghosh
P. Gill
T. Ginindza
G. Giussani
E. Gnedovskaya
Salime Goharinezhad
S. Gopalani
G. Gorini
H. Goudarzi
A. Goulart
Felix Greaves
Michale Grivna
Giuseppe Grosso
M. I. Gubari
H. Gugnani
R. Guimarães
Rashid Abdi Guled
Gaorui Guo
Yuming Guo
R. Gupta
Tarun Gupta
Beatrix Haddock
N. Hafezi-Nejad
Abdul Hafiz
A. Haj-Mirzaian
A. Haj-Mirzaian
Brian J. Hall
Iman Halvaei
R. Hamadeh
S. Hamidi
M. Hammer
G. Hankey
H. Haririan
J. Haro
Ahmed I Hasaballah
M. Hasan
E. Hasanpoor
Abdiwahab Hashi
S. Hassanipour
H. Hassankhani
Rasmus J. Havmoeller
Simon Iain Hay
Khezar Hayat
G. Heidari
R. Heidari-Soureshjani
Hannah Henrikson
Molly E Herbert
C. Herteliu
F. Heydarpour
T. Hird
Hans W. Hoek
R. Holla
Praveen Hoogar
H. Hosgood
Naznin Hossain
M. Hosseini
M. Hosseinzadeh
M. Hostiuc
S. Hostiuc
Mowafa J Househ
M. Hsairi
V. Hsieh
G. Hu
K. Hu
Tanvir M. Huda
A. Humayun
Chantal K Huynh
Bing-Fang Hwang
Vincent C Iannucci
S. E. Ibitoye
Nayu Ikeda
K. Ikuta
O S Ilesanmi
Irena Ilic
Milena Ilic
L. Inbaraj
Helen Ippolito
Usman Iqbal
S. Irvani
C. Irvine
M. M. Islam
Sheikh Mohammed Shariful Islam
Hiroyasu Iso
Rebecca Q Ivers
C. C. Iwu
C. Iwu
I. Iyamu
J. Jaafari
K. Jacobsen
Hussain Jafari
M. Jafarinia
M. Jahani
M. Jakovljevic
F. Jalilian
S. James
H. Janjani
Tahereh Javaheri
Javad Javidnia
P. Jeemon
E. Jenabi
R. Jha
Vivekanand Jha
John S. Ji
Lars Johansson
Oommen John
Y. John-Akinola
C. Johnson
J. Jonas
F. Joukar
J. Jozwiak
M. Jürisson
Alia Kabir
Zubair Kabir
H. Kalani
Rizwan Kalani
L. Kalankesh
R. Kalhor
T. Kanchan
Neeti Kapoor
B. Karami Matin
André Karch
M. Karim
G. Kassa
S. Katikireddi
G. Kayode
Ali Kazemi Karyani
P. Keiyoro
Cathleen Keller
L. Kemmer
Parkes Kendrick
Nauman Khalid
M. Khammarnia
E. Khan
Maseer Khan
Khaled Khatab
M. Khater
M. Khatib
M. Khayamzadeh
Salman Khazaei
C. Kieling
Y. Kim
R. Kimokoti
A. Kisa
S. Kisa
Mika Kivimäki
Luke D. Knibbs
A. Knudsen
Jonathan M Kocarnik
S. Kochhar
Jacek A. Kopec
V. A. Korshunov
P. Koul
A. Koyanagi
Moritz U. G. Kraemer
K. Krishan
Kristopher J. Krohn
H. Kromhout
Barthelemy Kuate Defo
G. Kumar
Vivek Kumar
O. Kurmi
Dian Kusuma
C. La Vecchia
Ben Lacey
D. Lal
R. Lalloo
T. Lallukka
F. Lami
I. Landires
Justin J. Lang
S. Langan
Anders O. Larsson
Savita Lasrado
P. Lauriola
J. Lazarus
P. Lee
Shaun Wen Huey Lee
K. LeGrand
J. Leigh
Matilde Leonardi
H. Lescinsky
Janni Leung
Miriam Levi
Shanshan Li
Lee-Ling Lim
S. Linn
Shiwei Liu
Simin Liu
Format Sitasi
Akses Cepat
- Tahun Terbit
- 2020
- Bahasa
- en
- Total Sitasi
- 5613×
- Sumber Database
- Semantic Scholar
- DOI
- 10.1016/S0140-6736(20)30752-2
- Akses
- Open Access ✓