Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
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.
1223-1249
Abbafati, Cristiana
521168a7-4836-42f0-b082-7b21c8093724
Abbas, Kaja M.
43cf5abc-77b4-4aea-809d-b9b4f0e48b17
Abbasi-Kangevari, Mohsen
6605d315-6856-461b-a501-4a38e4ab9918
Abd-Allah, Foad
67ee336c-84ba-4ff1-9324-28a02b45412e
Abdelalim, Ahmed
705987b2-ce4d-4573-b722-e0b4d145670a
Abdollahi, Mohammad
96ec68db-6302-4216-9aaf-9951a44be8b8
Abdollahpour, Ibrahim
8a1b3f3c-497f-4297-adc2-03055e798176
Abegaz, Kedir Hussein
6eb2ac98-d880-4cb3-843f-8e6b7cac1d5b
Abolhassani, Hassan
f02011b5-df85-4627-94c7-1365a4241b95
Aboyans, Victor
49a8cbaa-c577-4047-90af-3cdae75aa1f5
Abreu, Lucas Guimarães
23690a30-3320-46af-bd14-7c17c06a40ea
Abrigo, Michael R.M.
11213002-2bb2-420c-9087-c251164bf353
Abualhasan, Ahmed
0d2e772b-b31f-4304-8022-ebe47d78dd1d
Abu-Raddad, Laith Jamal
645c0199-ac7e-4e0d-97b6-829eb7f2f388
Abushouk, Abdelrahman I.
75af6533-bad5-4233-8403-c8383b39c51b
Adabi, Maryam
ad7550fc-d5d5-4fe4-8968-48665f2ebfb9
Adekanmbi, Victor
46d212c3-bfe7-468e-8f11-0574bbbb90bd
Adeoye, Abiodun Moshood
ec5e4a2d-86a4-4541-a16a-1d9366e88d96
Adetokunboh, Olatunji O.
f80bd9b5-5b52-4f3e-9a3d-2cfb4ee24ab1
Adham, Davoud
bf7a0903-f574-4200-a47d-4f7ed2a5bba5
Advani, Shailesh M.
7c0591f3-1783-4779-86a3-8532038f3bc3
Afshin, Ashkan
0cdfa673-855e-484f-9d48-4dcfe0d1a59c
Agarwal, Gina
857b681f-eb3d-44a7-8f21-1ade6a01a9cc
Aghamir, Seyed Mohammad Kazem
dce0a3f7-1671-4884-8cab-fb55d050d8a8
Agrawal, Anurag
f7d3c8c9-b6ff-4260-b8b1-2aad8fa116b0
Ahmad, Tauseef
655b560c-a5b7-4562-ace0-54e62f14685c
Ahmadi, Keivan
64f3fe5b-fdd6-42ea-9c11-75cdd1cc7775
Ahmadi, Mehdi
c974cd4d-bd6e-45c9-aec9-1b8f168cdde4
Ahmadieh, Hamid
f828ae31-8e90-4368-8405-dbb30f9c21f6
Ahmed, Muktar Beshir
e1af2a0d-079f-4e56-b325-714bc9b1e318
Akalu, Temesgen Yihunie
cfc98983-56d3-4ab3-8964-d5e86338134e
Akinyemi, Rufus Olusola
1f73524a-e377-4df4-acc9-69b5cefe408d
Akinyemiju, Tomi
c70b01a9-1434-4611-9dd5-be253673431e
Akombi, Blessing
17335f9c-e6fa-4775-8faf-8f7562ed2b92
Akunna, Chisom Joyqueenet
500e01fc-7e84-4f49-bc2e-645e0a3800df
Alahdab, Fares
f446c0b7-f9d5-48f7-9053-40243513997a
Al-Aly, Ziyad
99c680ae-f71e-475f-90b8-736dc2333782
Alam, Khurshid
3d76f8f9-aa4b-43e5-883a-a34d532a29f3
Alam, Samiah
882e6c25-d0eb-4e59-b3e2-c258b7b3ea1d
Alam, Tahiya
a2c07547-9702-4a83-b1f5-1a0409c5a97c
Alanezi, Fahad Mashhour
dc0f1b9d-f0e9-44f1-bd12-46477958435a
Alanzi, Turki M.
9b26c002-86dc-4847-8051-404c5e577ebd
Alemu, Biresaw Wassihun
ee62d13b-9268-4172-96d9-e2cc3fb112e3
Gething, Peter W.
2cacb985-6234-4d1f-9aa1-1dc7bee7da14
Hasan, Md Mehedi
878d2875-98f0-49aa-835b-9297e66c16bf
Liu, Yang
511575d6-8bac-4803-b678-530e216077d1
Roberts, Nicholas L.S.
7c1dffbe-b5ee-4b30-983a-865c00324f0f
Salomon, Joshua A.
f9a8fa54-4a27-4589-95e5-8e2b0b5b0756
Wang, Yuan Pang
332ff320-0449-4df8-a3db-2ac6020cff7f
Lim, Stephen S.
99ad2619-c72c-4c23-a352-33f473f1a30f
Lee, Paul
02620eab-ae7f-4a1c-bad1-8a50e7e48951
17 October 2020
Abbafati, Cristiana
521168a7-4836-42f0-b082-7b21c8093724
Abbas, Kaja M.
43cf5abc-77b4-4aea-809d-b9b4f0e48b17
Abbasi-Kangevari, Mohsen
6605d315-6856-461b-a501-4a38e4ab9918
Abd-Allah, Foad
67ee336c-84ba-4ff1-9324-28a02b45412e
Abdelalim, Ahmed
705987b2-ce4d-4573-b722-e0b4d145670a
Abdollahi, Mohammad
96ec68db-6302-4216-9aaf-9951a44be8b8
Abdollahpour, Ibrahim
8a1b3f3c-497f-4297-adc2-03055e798176
Abegaz, Kedir Hussein
6eb2ac98-d880-4cb3-843f-8e6b7cac1d5b
Abolhassani, Hassan
f02011b5-df85-4627-94c7-1365a4241b95
Aboyans, Victor
49a8cbaa-c577-4047-90af-3cdae75aa1f5
Abreu, Lucas Guimarães
23690a30-3320-46af-bd14-7c17c06a40ea
Abrigo, Michael R.M.
11213002-2bb2-420c-9087-c251164bf353
Abualhasan, Ahmed
0d2e772b-b31f-4304-8022-ebe47d78dd1d
Abu-Raddad, Laith Jamal
645c0199-ac7e-4e0d-97b6-829eb7f2f388
Abushouk, Abdelrahman I.
75af6533-bad5-4233-8403-c8383b39c51b
Adabi, Maryam
ad7550fc-d5d5-4fe4-8968-48665f2ebfb9
Adekanmbi, Victor
46d212c3-bfe7-468e-8f11-0574bbbb90bd
Adeoye, Abiodun Moshood
ec5e4a2d-86a4-4541-a16a-1d9366e88d96
Adetokunboh, Olatunji O.
f80bd9b5-5b52-4f3e-9a3d-2cfb4ee24ab1
Adham, Davoud
bf7a0903-f574-4200-a47d-4f7ed2a5bba5
Advani, Shailesh M.
7c0591f3-1783-4779-86a3-8532038f3bc3
Afshin, Ashkan
0cdfa673-855e-484f-9d48-4dcfe0d1a59c
Agarwal, Gina
857b681f-eb3d-44a7-8f21-1ade6a01a9cc
Aghamir, Seyed Mohammad Kazem
dce0a3f7-1671-4884-8cab-fb55d050d8a8
Agrawal, Anurag
f7d3c8c9-b6ff-4260-b8b1-2aad8fa116b0
Ahmad, Tauseef
655b560c-a5b7-4562-ace0-54e62f14685c
Ahmadi, Keivan
64f3fe5b-fdd6-42ea-9c11-75cdd1cc7775
Ahmadi, Mehdi
c974cd4d-bd6e-45c9-aec9-1b8f168cdde4
Ahmadieh, Hamid
f828ae31-8e90-4368-8405-dbb30f9c21f6
Ahmed, Muktar Beshir
e1af2a0d-079f-4e56-b325-714bc9b1e318
Akalu, Temesgen Yihunie
cfc98983-56d3-4ab3-8964-d5e86338134e
Akinyemi, Rufus Olusola
1f73524a-e377-4df4-acc9-69b5cefe408d
Akinyemiju, Tomi
c70b01a9-1434-4611-9dd5-be253673431e
Akombi, Blessing
17335f9c-e6fa-4775-8faf-8f7562ed2b92
Akunna, Chisom Joyqueenet
500e01fc-7e84-4f49-bc2e-645e0a3800df
Alahdab, Fares
f446c0b7-f9d5-48f7-9053-40243513997a
Al-Aly, Ziyad
99c680ae-f71e-475f-90b8-736dc2333782
Alam, Khurshid
3d76f8f9-aa4b-43e5-883a-a34d532a29f3
Alam, Samiah
882e6c25-d0eb-4e59-b3e2-c258b7b3ea1d
Alam, Tahiya
a2c07547-9702-4a83-b1f5-1a0409c5a97c
Alanezi, Fahad Mashhour
dc0f1b9d-f0e9-44f1-bd12-46477958435a
Alanzi, Turki M.
9b26c002-86dc-4847-8051-404c5e577ebd
Alemu, Biresaw Wassihun
ee62d13b-9268-4172-96d9-e2cc3fb112e3
Gething, Peter W.
2cacb985-6234-4d1f-9aa1-1dc7bee7da14
Hasan, Md Mehedi
878d2875-98f0-49aa-835b-9297e66c16bf
Liu, Yang
511575d6-8bac-4803-b678-530e216077d1
Roberts, Nicholas L.S.
7c1dffbe-b5ee-4b30-983a-865c00324f0f
Salomon, Joshua A.
f9a8fa54-4a27-4589-95e5-8e2b0b5b0756
Wang, Yuan Pang
332ff320-0449-4df8-a3db-2ac6020cff7f
Lim, Stephen S.
99ad2619-c72c-4c23-a352-33f473f1a30f
Lee, Paul
02620eab-ae7f-4a1c-bad1-8a50e7e48951