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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

Gakidou, E. and Afshin, A. and Abajobir, A.A. and Abate, K.H. and Abbafati, C. and Abbas, K.M. and Abd-Allah, F. and Abdulle, A.M. and Abera, S.F. and Aboyans, V. and Abu-Raddad, L.J. and Abu-Rmeileh, N.M.E. and Abyu, G.Y. and Adedeji, I.A. and Adetokunboh, O. and Afarideh, M. and Agrawal, A. and Agrawal, S. and Ahmad Kiadaliri, A. and Ahmadieh, H. and Ahmed, M.B. and Aichour, A.N. and Aichour, I. and Aichour, M.T.E. and Akinyemi, R.O. and Akseer, N. and Alahdab, F. and Al-Aly, Z. and Alam, K. and Alam, N. and Alam, T. and Alasfoor, D. and Alene, K.A. and Ali, K. and Alizadeh-Navaei, R. and Alkerwi, A. and Alla, F. and Allebeck, P. and Al-Raddadi, R. and Alsharif, U. and Altirkawi, K.A. and Alvis-Guzman, N. and Amare, A.T. and Amini, E. and Ammar, W. and Amoako, Y.A. and Ansari, H. and Antó, J.M. and Antonio, C.A.T. and Anwari, P. and Arian, N. and Ärnlöv, J. and Artaman, A. and Aryal, K.K. and Asayesh, H. and Asgedom, S.W. and Atey, T.M. and Avila-Burgos, L. and Avokpaho, E.F.G.A. and 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D.J. and Cirillo, M. and Cohen, A.J. and Comfort, H. and Cooper, C. and Coresh, J. and Cornaby, L. and Cortesi, P.A. and Criqui, M.H. and Crump, J.A. and Dandona, L. and Dandona, R. and Das Neves, J. and Davey, G. and Davitoiu, D.V. and Davletov, K. and De Courten, B. and Degenhardt, L. and Deiparine, S. and Dellavalle, R.P. and Deribe, K. and Deshpande, A. and Dharmaratne, S.D. and Ding, E.L. and Djalalinia, S. and Do, H.P. and Dokova, K. and Doku, D.T. and Dorsey, E.R. and Driscoll, T.R. and Dubey, M. and Duncan, B.B. and Duncan, S. and Ebert, N. and Ebrahimi, H. and El-Khatib, Z.Z. and Enayati, A. and Endries, A.Y. and Ermakov, S.P. and Erskine, H.E. and Eshrati, B. and Eskandarieh, S. and Esteghamati, A. and Estep, K. and Faraon, E.J.A. and Farinha, C.S.E.S. and Faro, A. and Farzadfar, F. and Fay, K. and Feigin, V.L. and Fereshtehnejad, S.-M. and Fernandes, J.C. and Ferrari, A.J. and Feyissa, T.R. and Filip, I. and Fischer, F. and Fitzmaurice, C. and Flaxman, A.D. and Foigt, N. and Foreman, K.J. and Frostad, J.J. and Fullman, N. and Fürst, T. and Furtado, J.M. and Ganji, M. and Garcia-Basteiro, A.L. and Gebrehiwot, T.T. and Geleijnse, J.M. and Geleto, A. and Gemechu, B.L. and Gesesew, H.A. and Gething, P.W. and Ghajar, A. and Gibney, K.B. and Gill, P.S. and Gillum, R.F. and Giref, A.Z. and Gishu, M.D. and Giussani, G. and Godwin, W.W. and Gona, P.N. and Goodridge, A. and Gopalani, S.V. and Goryakin, Y. and Goulart, A.C. and Graetz, N. and Gugnani, H.C. and Guo, J. and Gupta, R. and Gupta, T. and Gupta, V. and Gutiérrez, R.A. and Hachinski, V. and Hafezi-Nejad, N. and Hailu, G.B. and Hamadeh, R.R. and Hamidi, S. and Hammami, M. and Handal, A.J. and Hankey, G.J. and Harb, H.L. and Hareri, H.A. and Hassanvand, M.S. and Havmoeller, R. and Hawley, C. and Hay, S.I. and Hedayati, M.T. and Hendrie, D. and Heredia-Pi, I.B. and Hoek, H.W. and Horita, N. and Hosgood, H.D. and Hostiuc, S. and Hoy, D.G. and Hsairi, M. and Hu, G. and Huang, H. and Huang, J.J. and Iburg, K.M. and Ikeda, C. and Inoue, M. and Irvine, C.M.S. and Jackson, M.D. and Jacobsen, K.H. and Jahanmehr, N. and Jakovljevic, M.B. and Jauregui, A. and Javanbakht, M. and Jeemon, P. and Johansson, L.R.K. and Johnson, C.O. and Jonas, J.B. and Jürisson, M. and Kabir, Z. and Kadel, R. and Kahsay, A. and Kamal, R. and Karch, A. and Karema, C.K. and Kasaeian, A. and Kassebaum, N.J. and Kastor, A. and Katikireddi, S.V. and Kawakami, N. and Keiyoro, P.N. and Kelbore, S.G. and Kemmer, L. and Kengne, A.P. and Kesavachandran, C.N. and Khader, Y.S. and Khalil, I.A. and Khan, E.A. and Khang, Y.-H. and Khosravi, A. and Khubchandani, J. and Kieling, C. and Kim, D. and Kim, J.Y. and Kim, Y.J. and Kimokoti, R.W. and Kinfu, Y. and Kisa, A. and Kissimova-Skarbek, K.A. and Kivimaki, M. and Knibbs, L.D. and Knudsen, A.K. and Kopec, J.A. and Kosen, S. and Koul, P.A. and Koyanagi, A. and Kravchenko, M. and Krohn, K.J. and Kromhout, H. and Kuate Defo, B. and Kucuk Bicer, B. and Kumar, G.A. and Kutz, M. and Kyu, H.H. and Lal, D.K. and Lalloo, R. and Lallukka, T. and Lan, Q. and Lansingh, V.C. and Larsson, A. and Lee, A. and Lee, P.H. and Leigh, J. and Leung, J. and Levi, M. and Li, Y. and Li, Y. and Liang, X. and Liben, M.L. and Linn, S. and Liu, P. and Lodha, R. and Logroscino, G. and Looker, K.J. and Lopez, A.D. and Lorkowski, S. and Lotufo, P.A. and Lozano, R. and Lunevicius, R. and Macarayan, E.R.K. and Magdy Abd El Razek, H. and Magdy Abd El Razek, M. and Majdan, M. and Majdzadeh, R. and Majeed, A. and Malekzadeh, R. and Malhotra, R. and Malta, D.C. and Mamun, A.A. and Manguerra, H. and Mantovani, L.G. and Mapoma, C.C. and Martin, R.V. and Martinez-Raga, J. and Martins-Melo, F.R. and Mathur, M.R. and Matsushita, K. and Matzopoulos, R. and Mazidi, M. and McAlinden, C. and McGrath, J.J. and Mehata, S. and Mehndiratta, M.M. and Meier, T. and Melaku, Y.A. and Memiah, P. and Memish, Z.A. and Mendoza, W. and Mengesha, M.M. and Mensah, G.A. and Mensink, G.B.M. and Mereta, S.T. and Meretoja, A. and Meretoja, T.J. and Mezgebe, H.B. and Micha, R. and Millear, A. and Miller, T.R. and Minnig, S. and Mirarefin, M. and Mirrakhimov, E.M. and Misganaw, A. and Mishra, S.R. and Mohammad, K.A. and Mohammed, K.E. and Mohammed, S. and Mohamed Ibrahim, N. and Mohan, M.B.V. and Mokdad, A.H. and Monasta, L. and Montañez Hernandez, J.C. and Montico, M. and Moradi-Lakeh, M. and Moraga, P. and Morawska, L. and Morrison, S.D. and Mountjoy-Venning, C. and Mueller, U.O. and Mullany, E.C. and Muller, K. and Murthy, G.V.S. and Musa, K.I. and Naghavi, M. and Naheed, A. and Nangia, V. and Natarajan, G. and Negoi, I. and Negoi, R.I. and Nguyen, C.T. and Nguyen, G. and Nguyen, M. and Nguyen, Q.L. and Nguyen, T.H. and Nichols, E. and Ningrum, D.N.A. and Nomura, M. and Nong, V.M. and Norheim, O.F. and Norrving, B. and Noubiap, J.J.N. and Obermeyer, C.M. and Ogbo, F.A. and Oh, I.-H. and Oladimeji, O. and Olagunju, A.T. and Olagunju, T.O. and Olivares, P.R. and Olsen, H.E. and Olusanya, B.O. and Olusanya, J.O. and Opio, J.N. and Oren, E. and Ortiz, A. and Ota, E. and Owolabi, M.O. and Pa, M. and Pacella, R.E. and Pana, A. and Panda, B.K. and Panda-Jonas, S. and Pandian, J.D. and Papachristou, C. and Park, E.-K. and Parry, C.D. and Patten, S.B. and Patton, G.C. and Pereira, D.M. and Perico, N. and Pesudovs, K. and Petzold, M. and Phillips, M.R. and Pillay, J.D. and Piradov, M.A. and Pishgar, F. and Plass, D. and Pletcher, M.A. and Polinder, S. and Popova, S. and Poulton, R.G. and Pourmalek, F. and Prasad, N. and Purcell, C. and Qorbani, M. and Radfar, A. and Rafay, A. and Rahimi-Movaghar, A. and Rahimi-Movaghar, V. and Rahman, M. and Rahman, M.H.U. and Rahman, M.A. and Rai, R.K. and Rajsic, S. and Ram, U. and Rawaf, S. and Rehm, C.D. and Rehm, J. and Reiner, R.C. and Reitsma, M.B. and Reynales-Shigematsu, L.M. and Remuzzi, G. and Renzaho, A.M.N. and Resnikoff, S. and Rezaei, S. and Ribeiro, A.L. and Rivera, J.A. and Roba, K.T. and Rojas-Rueda, D. and Roman, Y. and Room, R. and Roshandel, 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Zipkin, B. and Zodpey, S. and Lim, S.S. and Murray, C.J.L. (2017) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390 (10100). pp. 1345-1422.

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Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings: Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124.1 million DALYs 95% UI 111.2 million to 137.0 million), high systolic blood pressure (122.2 million DALYs 110.3 million to 133.3 million, and low birthweight and short gestation (83.0 million DALYs 78.3 million to 87.7 million), and for women, were high systolic blood pressure (89.9 million DALYs 80.9 million to 98.2 million), high body-mass index (64.8 million DALYs 44.4 million to 87.6 million), and high fasting plasma glucose (63.8 million DALYs 53.2 million to 76.3 million). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9.3% (6.9-11.6) decline in deaths and a 10.8% (8.3-13.1) decrease in DALYs at the global level, while population ageing accounts for 14.9% (12.7-17.5) of deaths and 6.2% (3.9-8.7) of DALYs, and population growth for 12.4% (10.1-14.9) of deaths and 12.4% (10.1-14.9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27.3% (24.9-29.7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation: Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. © The Author(s). Published by Elsevier Ltd.

Item Type: Article
Additional Information: cited By 12
Uncontrolled Keywords: glucose, aging; air pollution; Article; behavior assessment; body mass; cardiometabolic risk; child growth; disability-adjusted life year; environmental exposure; gestational age; global disease burden; glucose blood level; growth disorder; human; low birth weight; mortality; occupational exposure; outcome assessment; population growth; priority journal; risk assessment; risk factor; smoking; systematic review; systolic blood pressure
Subjects: مقالات نمایه شده محققین دانشگاه در سایت ,Web of Science ,Scopus
Depositing User: GOUMS
Date Deposited: 27 Dec 2017 07:55
Last Modified: 27 Dec 2017 07:55
URI: http://eprints.goums.ac.ir/id/eprint/9493

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