@article{ref1,
title="A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010",
journal="Lancet",
year="2013",
author="Lim, Stephen S. and Vos, Theo and Flaxman, Abraham D. and Danaei, Goodarz and Shibuya, Kenji and Adair-Rohani, Heather and Amann, Markus and Anderson, H. Ross and Andrews, Kathryn G. and Aryee, Martin and Atkinson, Charles and Bacchus, Loraine J. and Bahalim, Adil N. and Balakrishnan, Kalpana and Balmes, John and Barker-Collo, Suzanne and Baxter, Amanda and Bell, Michelle L. and Blore, Jed D. and Blyth, Fiona and Bonner, Carissa and Borges, Guilherme L. G. and Bourne, Rupert and Boussinesq, Michel and Brauer, Michael and Brooks, Peter and Bruce, Nigel G. and Brunekreef, Bert and Bryan-Hancock, Claire and Bucello, Chiara and Buchbinder, Rachelle and Bull, Fiona and Burnett, Richard T. and Byers, Tim E. and Calabria, Bianca and Carapetis, Jonathan and Carnahan, Emily and Chafe, Zoe and Charlson, Fiona J. and Chen, Honglei and Chen, Jian Shen and Cheng, Andrew Tai-Ann and Child, Jennifer Christine and Cohen, Aaron and Colson, K. Ellicott and Cowie, Benjamin C. and Darby, Sarah and Darling, Susan and Davis, Adrian and Degenhardt, Louisa and Dentener, Frank and Des Jarlais, Don C. and Devries, Karen and Dherani, Mukesh and Ding, Eric L. and Dorsey, E. Ray and Driscoll, Tim and Edmond, Karen and Ali, Suad Eltahir and Engell, Rebecca E. and Erwin, Patricia J. and Fahimi, Saman and Falder, Gail and Farzadfar, Farshad and Ferrari, Alize and Finucane, Mariel M. and Flaxman, Seth and Fowkes, Francis Gerry R. and Freedman, Greg and Freeman, Michael K. and Gakidou, Emmanuela and Ghosh, Santu and Giovannucci, Edward and Gmel, Gerhard and Graham, Kathryn and Grainger, Rebecca and Grant, Bridget and Gunnell, David and Gutierrez, Hialy R. and Hall, Wayne and Hoek, Hans W. and Hogan, Anthony and Hosgood, H. Dean and Hoy, Damian G. and Hu, Howard and Hubbell, Bryan J. and Hutchings, Sally J. and Ibeanusi, Sydney E. and Jacklyn, Gemma L. and Jasrasaria, Rashmi and Jonas, Jost B. and Kan, Haidong and Kanis, John A. and Kassebaum, Nicholas and Kawakami, Norito and Khang, Young-Ho and Khatibzadeh, Shahab and Khoo, Jon-Paul and Kok, Cindy and Laden, Francine and Lalloo, Ratilal and Lan, Qing and Lathlean, Tim and Leasher, Janet L. and Leigh, James and Li, Yang and Lin, John Kent and Lipshultz, Steven E. and London, Stephanie and Lozano, Rafael and Lu, Yuan and Mak, Joelle and Malekzadeh, Reza and Mallinger, Leslie and Marcenes, Wagner and March, Lyn and Marks, Robin and Martin, Randall and McGale, Paul and McGrath, John and Mehta, Sumi and Mensah, George A. and Merriman, Tony R. and Micha, Renata and Michaud, Catherine and Mishra, Vinod and Hanafiah, Khayriyyah Mohd and Mokdad, Ali A. and Morawska, Lidia and Mozaffarian, Dariush and Murphy, Tasha and Naghavi, Mohsen and Neal, Bruce and Nelson, Paul K. and Nolla, Joan Miquel and Norman, Rosana and Olives, Casey and Omer, Saad B. and Orchard, Jessica and Osborne, Richard and Ostro, Bart and Page, Andrew and Pandey, Kiran D. and Parry, Charles Dh and Passmore, Erin and Patra, Jayadeep and Pearce, Neil and Pelizzari, Pamela M. and Petzold, Max and Phillips, Michael R. and Pope, Dan and Pope, C. Arden and Powles, John and Rao, Mayuree and Razavi, Homie and Rehfuess, Eva A. and Rehm, Jürgen T. and Ritz, Beate and Rivara, Frederick P. and Roberts, Thomas and Robinson, Carolyn and Rodriguez-Portales, Jose A. and Romieu, Isabelle and Room, Robin G. W. and Rosenfeld, Lisa C. and Roy, Ananya and Rushton, Lesley and Salomon, Joshua A. and Sampson, Uchechukwu and Sanchez-Riera, Lidia and Sanman, Ella and Sapkota, Amir and Seedat, Soraya and Shi, Peilin and Shield, Kevin and Shivakoti, Rupak and Singh, Gitanjali M. and Sleet, David A. and Smith, Emma and Smith, Kirk R. and Stapelberg, Nicolas Jc and Steenland, Kyle and Stöckl, Heidi and Stovner, Lars Jacob and Straif, Kurt and Straney, Lahn and Thurston, George D. and Tran, Jimmy H. and Van Dingenen, Rita and van Donkelaar, Aaron and Veerman, J. Lennert and Vijayakumar, Lakshmi and Weintraub, Robert and Weissman, Myrna M. and White, Richard A. and Whiteford, Harvey and Wiersma, Steven T. and Wilkinson, James D. and Williams, Hywel C. and Williams, Warwick and Wilson, Nicholas and Woolf, Anthony D. and Yip, Paul and Zielinski, Jan M. and Lopez, Alan D. and Murray, Christopher Jl and Ezzati, Majid",
volume="380",
number="9859",
pages="2224-2260",
abstract="BACKGROUND: Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS: We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS: In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION: Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING: Bill & Melinda Gates Foundation.<p /> <p>Language: en</p>",
language="en",
issn="0140-6736",
doi="10.1016/S0140-6736(12)61766-8",
url="http://dx.doi.org/10.1016/S0140-6736(12)61766-8"
}