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Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

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dc.contributor.author Abbafati, C.
dc.contributor.author Machado, D.B.
dc.contributor.author Cislaghi, B.
dc.contributor.author Salman, O.M.
dc.contributor.author Karanikolos, M.
dc.contributor.author McKee, M.
dc.contributor.author Abbas, K.M.
dc.contributor.author Brady, O.J.
dc.contributor.author Larson, H.J.
dc.contributor.author Trias-Llimós, S.
dc.contributor.author Cummins, S.
dc.contributor.author Langan, S.M.
dc.contributor.author Sartorius, B.
dc.contributor.author Hafiz, A.
dc.contributor.author Jenabi, E.
dc.contributor.author Mohammad Gholi Mezerji, N.
dc.contributor.author Borzouei, S.
dc.contributor.author Azarian, G.
dc.contributor.author Khazaei, S.
dc.contributor.author Abbasi, M.
dc.contributor.author Asghari, B.
dc.contributor.author Masoumi, S.
dc.contributor.author Komaki, H.
dc.contributor.author Taherkhani, A.
dc.contributor.author Adabi, M.
dc.contributor.author Abbasifard, M.
dc.contributor.author Bazmandegan, G.
dc.contributor.author Kamiab, Z.
dc.contributor.author Vakilian, A.
dc.contributor.author Anjomshoa, M.
dc.contributor.author Mokari, A.
dc.contributor.author Sabour, S.
dc.contributor.author Shahbaz, M.
dc.contributor.author Saeedi, R.
dc.contributor.author Ahmadieh, H.
dc.contributor.author Yousefinezhadi, T.
dc.contributor.author Haj-Mirzaian, A.
dc.contributor.author Nikbakhsh, R.
dc.contributor.author Safi, S.
dc.contributor.author Asgari, S.
dc.contributor.author Irvani, S.N.
dc.contributor.author Jahanmehr, N.
dc.contributor.author Ramezanzadeh, K.
dc.contributor.author Abbasi-Kangevari, M.
dc.contributor.author Khayamzadeh, M.
dc.contributor.author Abbastabar, H.
dc.contributor.author Shirkoohi, R.
dc.contributor.author Fazlzadeh, M.
dc.contributor.author Janjani, H.
dc.contributor.author Hosseini, M.
dc.contributor.author Mansournia, M.
dc.contributor.author Tohidinik, H.
dc.contributor.author Bakhtiari, A.
dc.contributor.author Fazaeli, A.
dc.contributor.author Mousavi, S.
dc.contributor.author Hasanzadeh, A.
dc.contributor.author Nabavizadeh, B.
dc.contributor.author Malekzadeh, R.
dc.contributor.author Hashemian, M.
dc.contributor.author Pourshams, A.
dc.contributor.author Salimzadeh, H.
dc.contributor.author Sepanlou, S.G.
dc.contributor.author Afarideh, M.
dc.contributor.author Esteghamati, A.
dc.contributor.author Esteghamati, S.
dc.contributor.author Ghajar, A.
dc.contributor.author Heidari, B.
dc.contributor.author Rezaei, N.
dc.contributor.author Mohamadi, E.
dc.contributor.author Rahimi-Movaghar, A.
dc.contributor.author Rahim, F.
dc.contributor.author Eskandarieh, S.
dc.contributor.author Sahraian, M.
dc.contributor.author Mohebi, F.
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dc.contributor.author Ebrahimi, H.
dc.contributor.author Farzadfar, F.
dc.contributor.author Mohajer, B.
dc.contributor.author Pishgar, F.
dc.contributor.author Saeedi Moghaddam, S.
dc.contributor.author Shabani, M.
dc.contributor.author Zarafshan, H.
dc.contributor.author Abolhassani, H.
dc.contributor.author Hafezi-Nejad, N.
dc.contributor.author Heidari-Soureshjani, R.
dc.contributor.author Abdollahi, M.
dc.contributor.author Farahmand, M.
dc.contributor.author Salamati, P.
dc.contributor.author Mehrabi Nasab, E.
dc.contributor.author Tajdini, M.
dc.contributor.author Aghamir, S.
dc.contributor.author Mirzaei, R.
dc.contributor.author Dibaji Forooshani, Z.
dc.contributor.author Khater, M.M.
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dc.contributor.author Abdelalim, A.
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dc.contributor.author Khater, A.M.
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dc.contributor.author Salem, M.R.R.
dc.contributor.author Salem, H.
dc.contributor.author Sadeghi, M.
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dc.contributor.author Tehrani-Banihashemi, A.
dc.contributor.author Yoosefi Lebni, J.
dc.contributor.author Manafi, N.
dc.contributor.author Pazoki Toroudi, H.
dc.contributor.author Dorostkar, F.
dc.contributor.author Alipour, V.
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dc.contributor.author Arabloo, J.
dc.contributor.author Azari, S.
dc.contributor.author Ghashghaee, A.
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dc.contributor.author Babaee, E.
dc.contributor.author Eshrati, B.
dc.contributor.author Goharinezhad, S.
dc.contributor.author Moradi-Lakeh, M.
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dc.contributor.author Rashedi, V.
dc.contributor.author Kumar, V.
dc.contributor.author Elgendy, I.Y.
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dc.contributor.author Park, J.
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dc.contributor.author Norheim, O.F.
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dc.contributor.author Cahill, L.E.
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dc.contributor.author Gomez, R.S.
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dc.contributor.author Abrigo, M.R.M.
dc.contributor.author Almulhim, A.M.
dc.contributor.author Dahlawi, S.M.A.
dc.contributor.author Pottoo, F.H.
dc.contributor.author Menezes, R.G.
dc.contributor.author Alanzi, T.M.
dc.contributor.author Alumran, A.K.
dc.contributor.author Abu Haimed, A.K.
dc.contributor.author Madadin, M.
dc.contributor.author Alanezi, F.M.
dc.contributor.author Abu-Gharbieh, E.
dc.contributor.author Saddik, B.
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dc.contributor.author Samy, A.M.
dc.contributor.author El Nahas, N.
dc.contributor.author Shalash, A.S.
dc.contributor.author Nabhan, A.F.
dc.contributor.author Kamath, A.M.
dc.contributor.author Kassebaum, N.J.
dc.contributor.author Aravkin, A.Y.
dc.contributor.author Kochhar, S.
dc.contributor.author Sorensen, R.J.D.
dc.contributor.author Afshin, A.
dc.contributor.author Burkart, K.
dc.contributor.author Cromwell, E.A.
dc.contributor.author Dandona, L.
dc.contributor.author Dharmaratne, S.D.
dc.contributor.author Gakidou, E.
dc.contributor.author Hay, S.I.
dc.contributor.author Kyu, H.H.
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dc.contributor.author Lozano, R.
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dc.contributor.author Mokdad, A.H.
dc.contributor.author Naghavi, M.
dc.contributor.author Pigott, D.M.
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dc.contributor.author Roth, G.A.
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dc.contributor.author Causey, K.
dc.contributor.author Cercy, K.M.
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dc.contributor.author Comfort, H.
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dc.contributor.author Dirac, M.A.
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dc.contributor.author GBD 2019 Risk Factors Collaborators
dc.date.accessioned 2020-12-14T16:05:50Z
dc.date.available 2020-12-14T16:05:50Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8644
dc.description.abstract 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. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1474-547X
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject UNAVAILABLE en_US
dc.title Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(20)30752-2
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00

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