Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Issue 10159 (10th November 2018)

• Record Type: Journal Article
• Authors: Stanaway, Jeffrey D; Afshin, Ashkan; Gakidou, Emmanuela; Lim, Stephen S; Abate, Degu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbasi, Nooshin; Abbastabar, Hedayat; Abd-Allah, Foad; Abdela, Jemal; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abebe, Molla; Abebe, Zegeye; Abera, Semaw F; Abil, Olifan Zewdie; Abraha, Haftom Niguse; Abrham, Aklilu Roba; Abu-Raddad, Laith Jamal; Abu-Rmeileh, Niveen ME; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Acharya, Pawan; Adamu, Abdu A; Adane, Akilew Awoke; Adebayo, Oladimeji M; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Ademi, Zanfina; Adetokunboh, Olatunji O; Adib, Mina G; Admasie, Amha; Adsuar, Jose C; Afanvi, Kossivi Agbelenko; Afarideh, Mohsen; Agarwal, Gina; Aggarwal, Anju; Aghayan, Sargis Aghasi; Agrawal, Anurag; Agrawal, Sutapa; Ahmadi, Alireza; Ahmadi, Mehdi; Ahmadieh, Hamid; Ahmed, Muktar Beshir; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Akbari, Mohammad Esmaeil; Akinyemiju, Tomi; Akseer, Nadia; Al-Aly, Ziyad; Al-Eyadhy, Ayman; Al-Mekhlafi, Hesham M; Alahdab, Fares; Alam, Khurshid; Alam, Samiah; Alam, Tahiya; Alashi, Alaa; Alavian, Seyed Moayed; Alene, Kefyalew Addis; Ali, Komal; Ali, Syed Mustafa; Alijanzadeh, Mehran; Alizadeh-Navaei, Reza; Aljunid, Syed Mohamed; Alkerwi, Ala'a; Alla, François; Alsharif, Ubai; Altirkawi, Khalid; Alvis-Guzman, Nelson; Amare, Azmeraw T; Ammar, Walid; Anber, Nahla Hamed; Anderson, Jason A; Andrei, Catalina Liliana; Androudi, Sofia; Animut, Megbaru Debalkie; Anjomshoa, Mina; Ansha, Mustafa Geleto; Antó, Josep M; Antonio, Carl Abelardo T; Anwari, Palwasha; Appiah, Lambert Tetteh; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Aremu, Olatunde; Ärnlöv, Johan; Artaman, Al; Aryal, Krishna K; Asayesh, Hamid; Ataro, Zerihun; Ausloos, Marcel; Avokpaho, Euripide F G A; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Ayer, Rakesh; Ayuk, Tambe B; Azzopardi, Peter S; Babazadeh, Arefeh; Badali, Hamid; Badawi, Alaa; Balakrishnan, Kalpana; Bali, Ayele Geleto; Ball, Kylie; Ballew, Shoshana H; Banach, Maciej; Banoub, Joseph Adel Mattar; Barac, Aleksandra; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Barrero, Lope H; Basu, Sanjay; Baune, Bernhard T; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Meysam; Béjot, Yannick; Bekele, Bayu Begashaw; Bekru, Eyasu Tamru; Belay, Ezra; Belay, Yihalem Abebe; Bell, Michelle L; Bello, Aminu K; Bennett, Derrick A; Bensenor, Isabela M; Bergeron, Gilles; Berhane, Adugnaw; Bernabe, Eduardo; Bernstein, Robert S; Beuran, Mircea; Beyranvand, Tina; Bhala, Neeraj; Bhalla, Ashish; Bhattarai, Suraj; Bhutta, Zulfiqar A; Biadgo, Belete; Bijani, Ali; Bikbov, Boris; Bilano, Ver; Bililign, Nigus; Bin Sayeed, Muhammad Shahdaat; Bisanzio, Donal; Biswas, Tuhin; Bjørge, Tone; Blacker, Brigette F; Bleyer, Archie; Borschmann, Rohan; Bou-Orm, Ibrahim R; Boufous, Soufiane; Bourne, Rupert; Brady, Oliver J; Brauer, Michael; Brazinova, Alexandra; Breitborde, Nicholas J K; Brenner, Hermann; Briko, Andrey Nikolaevich; Britton, Gabrielle; Brugha, Traolach; Buchbinder, Rachelle; Burnett, Richard T; Busse, Reinhard; Butt, Zahid A; Cahill, Leah E; Cahuana-Hurtado, Lucero; Campos-Nonato, Ismael R; Cárdenas, Rosario; Carreras, Giulia; Carrero, Juan J; Carvalho, Félix; Castañeda-Orjuela, Carlos A; Castillo Rivas, Jacqueline; Castro, Franz; Catalá-López, Ferrán; Causey, Kate; Cercy, Kelly M; Cerin, Ester; Chaiah, Yazan; Chang, Hsing-Yi; Chang, Jung-Chen; Chang, Kai-Lan; Charlson, Fiona J; Chattopadhyay, Aparajita; Chattu, Vijay Kumar; Chee, Miao Li; Cheng, Ching-Yu; Chew, Adrienne; Chiang, Peggy Pei-Chia; Chimed-Ochir, Odgerel; Chin, Ken Lee; Chitheer, Abdulaal; Choi, Jee-Young J; Chowdhury, Rajiv; Christensen, Hanne; Christopher, Devasahayam J; Chung, Sheng-Chia; Cicuttini, Flavia M; Cirillo, Massimo; Cohen, Aaron J; Collado-Mateo, Daniel; Cooper, Cyrus; Cooper, Owen R; Coresh, Josef; Cornaby, Leslie; Cortesi, Paolo Angelo; Cortinovis, Monica; Costa, Megan; Cousin, Ewerton; Criqui, Michael H; Cromwell, Elizabeth A; Cundiff, David K; Daba, Alemneh Kabeta; Dachew, Berihun Assefa; Dadi, Abel Fekadu; Damasceno, Albertino Antonio Moura; Dandona, Lalit; Dandona, Rakhi; Darby, Sarah C; Dargan, Paul I; Daryani, Ahmad; Das Gupta, Rajat; Das Neves, José; Dasa, Tamirat Tesfaye; Dash, Aditya Prasad; Davitoiu, Dragos Virgil; Davletov, Kairat; De la Cruz-Góngora, Vanessa; De La Hoz, Fernando Pio; De Leo, Diego; De Neve, Jan-Walter; Degenhardt, Louisa; Deiparine, Selina; Dellavalle, Robert P; Demoz, Gebre Teklemariam; Denova-Gutiérrez, Edgar; Deribe, Kebede; Dervenis, Nikolaos; Deshpande, Aniruddha; Des Jarlais, Don C; Dessie, Getenet Ayalew; Deveber, Gabrielle Aline; Dey, Subhojit; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Dinberu, Mesfin Tadese; Ding, Eric L; Diro, Helen Derara; Djalalinia, Shirin; Do, Huyen Phuc; Dokova, Klara; Doku, David Teye; Doyle, Kerrie E; Driscoll, Tim R; Dubey, Manisha; Dubljanin, Eleonora; Duken, Eyasu Ejeta; Duncan, Bruce B; Duraes, Andre R; Ebert, Natalie; Ebrahimi, Hedyeh; Ebrahimpour, Soheil; Edvardsson, David; Effiong, Andem; Eggen, Anne Elise; El Bcheraoui, Charbel; El-Khatib, Ziad; Elyazar, Iqbal Rf; Enayati, Ahmadali; Endries, Aman Yesuf; Er, Benjamin; Erskine, Holly E; Eskandarieh, Sharareh; Esteghamati, Alireza; Estep, Kara; Fakhim, Hamed; Faramarzi, Mahbobeh; Fareed, Mohammad; Farid, Talha A; Farinha, Carla Sofia E sá; Farioli, Andrea; Faro, Andre; Farvid, Maryam S; Farzaei, Mohammad Hosein; Fatima, Batool; Fay, Kairsten A; Fazaeli, Ali Akbar; Feigin, Valery L; Feigl, Andrea B; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Fernandes, Joao C; Ferrara, Giannina; Ferrari, Alize J; Ferreira, Manuela L; Filip, Irina; Finger, Jonas David; Fischer, Florian; Foigt, Nataliya A; Foreman, Kyle J; Fukumoto, Takeshi; Fullman, Nancy; Fürst, Thomas; Furtado, João M; Futran, Neal D; Gall, Seana; Gallus, Silvano; Gamkrelidze, Amiran; Ganji, Morsaleh; Garcia-Basteiro, Alberto L; Gardner, William M; Gebre, Abadi Kahsu; Gebremedhin, Amanuel Tesfay; Gebremichael, Teklu Gebrehiwo; Gelano, Tilayie Feto; Geleijnse, Johanna M; Geramo, Yilma Chisha Dea; Gething, Peter W; Gezae, Kebede Embaye; Ghadimi, Reza; Ghadiri, Keyghobad; Ghasemi Falavarjani, Khalil; Ghasemi-Kasman, Maryam; Ghimire, Mamata; Ghosh, Rakesh; Ghoshal, Aloke Gopal; Giampaoli, Simona; Gill, Paramjit Singh; Gill, Tiffany K; Gillum, Richard F; Ginawi, Ibrahim Abdelmageed; Giussani, Giorgia; Gnedovskaya, Elena V; Godwin, William W; Goli, Srinivas; Gómez-Dantés, Hector; Gona, Philimon N; Gopalani, Sameer Vali; Goulart, Alessandra C; Grada, Ayman; Grams, Morgan E; Grosso, Giuseppe; Gugnani, Harish Chander; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Tanush; Gutiérrez, Reyna Alma; Gutiérrez-Torres, Daniela S; Haagsma, Juanita A; Habtewold, Tesfa Dejenie; Hachinski, Vladimir; Hafezi-Nejad, Nima; Hagos, Tekleberhan B; Hailegiyorgis, Tewodros Tesfa; Hailu, Gessessew Bugssa; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randah R; Hamidi, Samer; Handal, Alexis J; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hawley, Caitlin N; Hay, Simon I; Hedayatizadeh-Omran, Akbar; Heibati, Behzad; Heidari, Behnam; Heidari, Mohsen; Hendrie, Delia; Henok, Andualem; Heredia-Pi, Ileana; Herteliu, Claudiu; Heydarpour, Fatemeh; Heydarpour, Sousan; Hibstu, Desalegn T; Higazi, Tarig B; Hilawe, Esayas Haregot; Hoek, Hans W; Hoffman, Howard J; Hole, Michael K; Homaie Rad, Enayatollah; Hoogar, Praveen; Hosgood, H Dean; Hosseini, Seyed Mostafa; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Hoy, Damian G; Hsairi, Mohamed; Hsiao, Thomas; Hu, Guoqing; Hu, Howard; Huang, John J; Hussen, Mamusha Aman; Huynh, Chantal K; Iburg, Kim Moesgaard; Ikeda, Nayu; Ilesanmi, Olayinka Stephen; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Irvine, Caleb Mackay Salpeter; Islam, Sheikh Mohammed Shariful; Islami, Farhad; Jackson, Maria D; Jacobsen, Kathryn H; Jahangiry, Leila; Jahanmehr, Nader; Jain, Sudhir Kumar; Jakovljevic, Mihajlo; James, Spencer L; Jassal, Simerjot K; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S; Jonas, Jost B; Jonnagaddala, Jitendra; Jorjoran Shushtari, Zahra; Joshi, Ankur; Jozwiak, Jacek Jerzy; Jürisson, Mikk; Kabir, Zubair; Kahsay, Amaha; Kalani, Rizwan; Kanchan, Tanuj; Kant, Surya; Kar, Chittaranjan; Karami, Manoochehr; Karami Matin, Behzad; Karch, André; Karema, Corine; Karimi, Narges; Karimi, Seyed M; Kasaeian, Amir; Kassa, Dessalegn H; Kassa, Getachew Mullu; Kassa, Tesfaye Dessale; Kassebaum, Nicholas J; Katikireddi, Srinivasa Vittal; Kaul, Anil; Kawakami, Norito; Kazemi, Zhila; Karyani, Ali Kazemi; Kefale, Adane Teshome; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Kengne, Andre Pascal; Keren, Andre; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khafaei, Behzad; Khafaie, Morteza Abdullatif; Khajavi, Alireza; Khalid, Nauman; Khalil, Ibrahim A; Khan, Gulfaraz; Khan, Muhammad Shahzeb; Khan, Muhammad Ali; Khang, Young-Ho; Khater, Mona M; Khazaei, Mohammad; Khazaie, Habibolah; Khoja, Abdullah T; Khosravi, Ardeshir; Khosravi, Mohammad Hossein; Kiadaliri, Aliasghar A; Kiirithio, Daniel N; Kim, Cho-Il; Kim, Daniel; Kim, Young-Eun; Kim, Yun Jin; Kimokoti, Ruth W; Kinfu, Yohannes; Kisa, Adnan; Kissimova-Skarbek, Katarzyna; Kivimäki, Mika; Knibbs, Luke D; Knudsen, Ann Kristin Skrindo; Kochhar, Sonali; Kokubo, Yoshihiro; Kolola, Tufa; Kopec, Jacek A; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Kravchenko, Michael A; Krishan, Kewal; Krohn, Kristopher J; Kromhout, Hans; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kumar, G Anil; Kumar, Manasi; Kuzin, Igor; Kyu, Hmwe Hmwe; Lachat, Carl; Lad, Deepesh P; Lad, Sheetal D; Lafranconi, Alessandra; Lalloo, Ratilal; Lallukka, Tea; Lami, Faris Hasan; Lang, Justin J; Lansingh, Van C; Larson, Samantha Leigh; Latifi, Arman; Lazarus, Jeffrey V; Lee, Paul H; Leigh, James; Leili, Mostafa; Leshargie, Cheru Tesema; Leung, Janni; Levi, Miriam; Lewycka, Sonia; Li, Shanshan; Li, Yichong; Liang, Juan; Liang, Xiaofeng; Liao, Yu; Liben, Misgan Legesse; Lim, Lee-Ling; Linn, Shai; Liu, Shiwei; Lodha, Rakesh; Logroscino, Giancarlo; Lopez, Alan D; Lorkowski, Stefan; Lotufo, Paulo A; Lozano, Rafael; Lucas, Tim C D; Lunevicius, Raimundas; Ma, Stefan; Macarayan, Erlyn Rachelle King; Machado, Ísis Eloah; Madotto, Fabiana; Mai, Hue Thi; Majdan, Marek; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A; Manda, Ana-Laura; Manguerra, Helena; Mansournia, Mohammad Ali; Mantovani, Lorenzo Giovanni; Maravilla, Joemer C; Marcenes, Wagner; Marks, Ashley; Martin, Randall V; Martins, Sheila C O; Martins-Melo, Francisco Rogerlândio; März, Winfried; Marzan, Melvin B; Massenburg, Benjamin Ballard; Mathur, Manu Raj; Mathur, Prashant; Matsushita, Kunihiro; Maulik, Pallab K; Mazidi, Mohsen; McAlinden, Colm; McGrath, John J; McKee, Martin; Mehrotra, Ravi; Mehta, Kala M; Mehta, Varshil; Meier, Toni; Mekonnen, Fantahun Ayenew; Melaku, Yohannes A; Melese, Addisu; Melku, Mulugeta; Memiah, Peter T N; Memish, Ziad A; Mendoza, Walter; Mengistu, Desalegn Tadese; Mensah, George A; Mensink, Gert B M; Mereta, Seid Tiku; Meretoja, Atte; Meretoja, Tuomo J; Mestrovic, Tomislav; Mezgebe, Haftay Berhane; Miazgowski, Bartosz; Miazgowski, Tomasz; Millear, Anoushka I; Miller, Ted R; Miller-Petrie, Molly Katherine; Mini, G K; Mirarefin, Mojde; Mirica, Andreea; Mirrakhimov, Erkin M; Misganaw, Awoke Temesgen; Mitiku, Habtamu; Moazen, Babak; Mohajer, Bahram; Mohammad, Karzan Abdulmuhsin; Mohammadi, Moslem; Mohammadifard, Noushin; Mohammadnia-Afrouzi, Mousa; Mohammed, Shafiu; Mohebi, Farnam; Mokdad, Ali H; Molokhia, Mariam; Momeniha, Fatemeh; Monasta, Lorenzo; Moodley, Yoshan; Moradi, Ghobad; Moradi-Lakeh, Maziar; Moradinazar, Mehdi; Moraga, Paula; Morawska, Lidia; Morgado-Da-Costa, Joana; Morrison, Shane Douglas; Moschos, Marilita M; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffarian, Dariush; Mruts, Kalayu Brhane; Muche, Achenef Asmamaw; Muchie, Kindie Fentahun; Mueller, Ulrich Otto; Muhammed, Oumer Sada; Mukhopadhyay, Satinath; Muller, Kate; Musa, Kamarul Imran; Mustafa, Ghulam; Nabhan, Ashraf F; Naghavi, Mohsen; Naheed, Aliya; Nahvijou, Azin; Naik, Gurudatta; Naik, Nitish; Najafi, Farid; Nangia, Vinay; Nansseu, Jobert Richie; Nascimento, Bruno Ramos; Neal, Bruce; Neamati, Nahid; Negoi, Ionut; Negoi, Ruxandra Irina; Neupane, Subas; Newton, Charles Richard James; Ngunjiri, Josephine W; Nguyen, Anh Quynh; Nguyen, Grant; Nguyen, Ha Thu; Nguyen, Huong Lan Thi; Nguyen, Huong Thanh; Nguyen, Minh; Nguyen, Nam Ba; Nichols, Emma; Nie, Jing; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Nishi, Nobuo; Nixon, Molly R; Nojomi, Marzieh; Nomura, Shuhei; Norheim, Ole F; Noroozi, Mehdi; Norrving, Bo; Noubiap, Jean Jacques; Nouri, Hamid Reza; Nourollahpour Shiadeh, Malihe; Nowroozi, Mohammad Reza; Nsoesie, Elaine O; Nyasulu, Peter S; Obermeyer, Carla M; Odell, Christopher M; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew T; Olagunju, Tinuke O; Olivares, Pedro R; Olsen, Helen Elizabeth; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Ong, Kanyin L; Ong, Sok King; Oren, Eyal; Orpana, Heather M; Ortiz, Alberto; Ota, Erika; Otstavnov, Stanislav S; Øverland, Simon; Owolabi, Mayowa Ojo; P A, Mahesh; Pacella, Rosana; Pakhare, Abhijit P; Pakpour, Amir H; Pana, Adrian; Panda-Jonas, Songhomitra; Park, Eun-Kee; Parry, Charles D H; Parsian, Hadi; Patel, Shanti; Pati, Sanghamitra; Patil, Snehal T; Patle, Ajay; Patton, George C; Paudel, Deepak; Paulson, Katherine R; Paz Ballesteros, Wayra Citlali; Pearce, Neil; Pereira, Alexandre; Pereira, David M; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Pham, Hai Quang; Phillips, Michael R; Pillay, Julian David; Piradov, Michael A; Pirsaheb, Meghdad; Pischon, Tobias; Pishgar, Farhad; Plana-Ripoll, Oleguer; Plass, Dietrich; Polinder, Suzanne; Polkinghorne, Kevan R; Postma, Maarten J; Poulton, Richie; Pourshams, Akram; Poustchi, Hossein; Prabhakaran, Dorairaj; Prakash, Swayam; Prasad, Narayan; Purcell, Caroline A; Purwar, Manorama B; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rafiei, Alireza; Rahim, Fakher; Rahimi, Zohreh; Rahimi-Movaghar, Afarin; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz ur; Rahman, Muhammad Aziz; Rai, Rajesh Kumar; Rajati, Fatemeh; Rajsic, Sasa; Raju, Sree Bhushan; Ram, Usha; Ranabhat, Chhabi Lal; Ranjan, Prabhat; Rath, Goura Kishor; Rawaf, David Laith; Rawaf, Salman; Reddy, K Srinath; Rehm, Colin D; Rehm, Jürgen; Reiner, Robert C; Reitsma, Marissa B; Remuzzi, Giuseppe; Renzaho, Andre M N; Resnikoff, Serge; Reynales-Shigematsu, Luz Myriam; Rezaei, Satar; Ribeiro, Antonio Luiz P; Rivera, Juan A; Roba, Kedir Teji; Rodríguez-Ramírez, Sonia; Roever, Leonardo; Román, Yesenia; Ronfani, Luca; Roshandel, Gholamreza; Rostami, Ali; Roth, Gregory A; Rothenbacher, Dietrich; Roy, Ambuj; Rubagotti, Enrico; Rushton, Lesley; Sabanayagam, Charumathi; Sachdev, Perminder S; Saddik, Basema; Sadeghi, Ehsan; Saeedi Moghaddam, Sahar; Safari, Hosein; Safari, Yahya; Safari-Faramani, Roya; Safdarian, Mahdi; Safi, Sare; Safiri, Saeid; Sagar, Rajesh; Sahebkar, Amirhossein; Sahraian, Mohammad Ali; Sajadi, Haniye Sadat; Salam, Nasir; Salamati, Payman; Saleem, Zikria; Salimi, Yahya; Salimzadeh, Hamideh; Salomon, Joshua A; Salvi, Devashri Digvijay; Salz, Inbal; Samy, Abdallah M; Sanabria, Juan; Sanchez-Niño, Maria Dolores; Sánchez-Pimienta, Tania G; Sanders, Taren; Sang, Yingying; Santomauro, Damian Francesco; Santos, Itamar S; Santos, João Vasco; Santric Milicevic, Milena M; Sao Jose, Bruno Piassi; Sardana, Mayank; Sarker, Abdur Razzaque; Sarmiento-Suárez, Rodrigo; Sarrafzadegan, Nizal; Sartorius, Benn; Sarvi, Shahabeddin; Sathian, Brijesh; Satpathy, Maheswar; Sawant, Arundhati R; Sawhney, Monika; Saylan, Mete; Sayyah, Mehdi; Schaeffner, Elke; Schmidt, Maria Inês; Schneider, Ione J C; Schöttker, Ben; Schutte, Aletta Elisabeth; Schwebel, David C; Schwendicke, Falk; Scott, James G; Seedat, Soraya; Sekerija, Mario; Sepanlou, Sadaf G; Serre, Marc L; Serván-Mori, Edson; Seyedmousavi, Seyedmojtaba; Shabaninejad, Hosein; Shaddick, Gavin; Shafieesabet, Azadeh; Shahbazi, Mehdi; Shaheen, Amira A; Shaikh, Masood Ali; Shamah Levy, Teresa; Shams-Beyranvand, Mehran; Shamsi, Mohammadbagher; Sharafi, Heidar; Sharafi, Kiomars; Sharif, Mehdi; Sharif-Alhoseini, Mahdi; Sharifi, Hamid; Sharma, Jayendra; Sharma, Meenakshi; Sharma, Rajesh; She, Jun; Sheikh, Aziz; Shi, Peilin; Shibuya, Kenji; Shiferaw, Mekonnen Sisay; Shigematsu, Mika; Shin, Min-Jeong; Shiri, Rahman; Shirkoohi, Reza; Shiue, Ivy; Shokraneh, Farhad; Shoman, Haitham; Shrime, Mark G; Shupler, Matthew S; Si, Si; Siabani, Soraya; Sibai, Abla Mehio; Siddiqi, Tariq J; Sigfusdottir, Inga Dora; Sigurvinsdottir, Rannveig; Silva, Diego Augusto Santos; Silva, João Pedro; Silveira, Dayane Gabriele Alves; Singh, Jasvinder A; Singh, Narinder Pal; Singh, Virendra; Sinha, Dhirendra Narain; Skiadaresi, Eirini; Skirbekk, Vegard; Smith, David L; Smith, Mari; Sobaih, Badr Hasan; Sobhani, Soheila; Somayaji, Ranjani; Soofi, Moslem; Sorensen, Reed J D; Soriano, Joan B; Soyiri, Ireneous N; Spinelli, Angela; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Srinivasan, Vinay; Starodubov, Vladimir I; Steckling, Nadine; Stein, Dan J; Stein, Murray B; Stevanovic, Goran; Stockfelt, Leo; Stokes, Mark A; Sturua, Lela; Subart, Michelle L; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Sulo, Gerhard; Sunguya, Bruno F; Sur, Patrick John; Sykes, Bryan L; Szoeke, Cassandra E I; Tabarés-Seisdedos, Rafael; Tabuchi, Takahiro; Tadakamadla, Santosh Kumar; Takahashi, Ken; Tandon, Nikhil; Tassew, Segen Gebremeskel; Tavakkoli, Mohammad; Taveira, Nuno; Tehrani-Banihashemi, Arash; Tekalign, Tigist Gashaw; Tekelemedhin, Shishay Wahdey; Tekle, Merhawi Gebremedhin; Temesgen, Habtamu; Temsah, Mohamad-Hani; Temsah, Omar; Terkawi, Abdullah Sulieman; Tessema, Belay; Teweldemedhin, Mebrahtu; Thankappan, Kavumpurathu Raman; Theis, Andrew; Thirunavukkarasu, Sathish; Thomas, Hannah J; Thomas, Matthew Lloyd; Thomas, Nihal; Thurston, George D; Tilahun, Binyam; Tillmann, Taavi; To, Quyen G; Tobollik, Myriam; Tonelli, Marcello; Topor-Madry, Roman; Torre, Anna E; Tortajada-Girbés, Miguel; Touvier, Mathilde; Tovani-Palone, Marcos Roberto; Towbin, Jeffrey A; Tran, Bach Xuan; Tran, Khanh Bao; Truelsen, Thomas Clement; Truong, Nu Thi; Tsadik, Afewerki Gebremeskel; Tudor Car, Lorainne; Tuzcu, E Murat; Tymeson, Hayley D; Tyrovolas, Stefanos; Ukwaja, Kingsley N; Ullah, Irfan; Updike, Rachel L; Usman, Muhammad Shariq; Uthman, Olalekan A; Vaduganathan, Muthiah; Vaezi, Afsane; Valdez, Pascual R; Van Donkelaar, Aaron; Varavikova, Elena; Varughese, Santosh; Vasankari, Tommi Juhani; Venkateswaran, Vidhya; Venketasubramanian, Narayanaswamy; Villafaina, Santos; Violante, Francesco S; Vladimirov, Sergey Konstantinovitch; Vlassov, Vasily; Vollset, Stein Emil; Vos, Theo; Vosoughi, Kia; Vu, Giang Thu; Vujcic, Isidora S; Wagnew, Fasil Shiferaw; Waheed, Yasir; Waller, Stephen G; Walson, Judd L; Wang, Yafeng; Wang, Yanping; 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• Is Part Of: Lancet. Volume 392:Issue 10159(2018)
• Page Start: 1923
• Page End: 1994
• Publication Date: 2018-11-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(18)32225-6
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods: We used the CRA 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 groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. 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. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Funding: Bill & Melinda Gates Foundation and Bloomberg Philanthropies.