TY  - JOUR
PY  - 2013//
TI  - 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
JO  - Lancet
A1  - Lim, Stephen S.
A1  - Vos, Theo
A1  - Flaxman, Abraham D.
A1  - Danaei, Goodarz
A1  - Shibuya, Kenji
A1  - Adair-Rohani, Heather
A1  - Amann, Markus
A1  - Anderson, H. Ross
A1  - Andrews, Kathryn G.
A1  - Aryee, Martin
A1  - Atkinson, Charles
A1  - Bacchus, Loraine J.
A1  - Bahalim, Adil N.
A1  - Balakrishnan, Kalpana
A1  - Balmes, John
A1  - Barker-Collo, Suzanne
A1  - Baxter, Amanda
A1  - Bell, Michelle L.
A1  - Blore, Jed D.
A1  - Blyth, Fiona
A1  - Bonner, Carissa
A1  - Borges, Guilherme L. G.
A1  - Bourne, Rupert
A1  - Boussinesq, Michel
A1  - Brauer, Michael
A1  - Brooks, Peter
A1  - Bruce, Nigel G.
A1  - Brunekreef, Bert
A1  - Bryan-Hancock, Claire
A1  - Bucello, Chiara
A1  - Buchbinder, Rachelle
A1  - Bull, Fiona
A1  - Burnett, Richard T.
A1  - Byers, Tim E.
A1  - Calabria, Bianca
A1  - Carapetis, Jonathan
A1  - Carnahan, Emily
A1  - Chafe, Zoe
A1  - Charlson, Fiona J.
A1  - Chen, Honglei
A1  - Chen, Jian Shen
A1  - Cheng, Andrew Tai-Ann
A1  - Child, Jennifer Christine
A1  - Cohen, Aaron
A1  - Colson, K. Ellicott
A1  - Cowie, Benjamin C.
A1  - Darby, Sarah
A1  - Darling, Susan
A1  - Davis, Adrian
A1  - Degenhardt, Louisa
A1  - Dentener, Frank
A1  - Des Jarlais, Don C.
A1  - Devries, Karen
A1  - Dherani, Mukesh
A1  - Ding, Eric L.
A1  - Dorsey, E. Ray
A1  - Driscoll, Tim
A1  - Edmond, Karen
A1  - Ali, Suad Eltahir
A1  - Engell, Rebecca E.
A1  - Erwin, Patricia J.
A1  - Fahimi, Saman
A1  - Falder, Gail
A1  - Farzadfar, Farshad
A1  - Ferrari, Alize
A1  - Finucane, Mariel M.
A1  - Flaxman, Seth
A1  - Fowkes, Francis Gerry R.
A1  - Freedman, Greg
A1  - Freeman, Michael K.
A1  - Gakidou, Emmanuela
A1  - Ghosh, Santu
A1  - Giovannucci, Edward
A1  - Gmel, Gerhard
A1  - Graham, Kathryn
A1  - Grainger, Rebecca
A1  - Grant, Bridget
A1  - Gunnell, David
A1  - Gutierrez, Hialy R.
A1  - Hall, Wayne
A1  - Hoek, Hans W.
A1  - Hogan, Anthony
A1  - Hosgood, H. Dean
A1  - Hoy, Damian G.
A1  - Hu, Howard
A1  - Hubbell, Bryan J.
A1  - Hutchings, Sally J.
A1  - Ibeanusi, Sydney E.
A1  - Jacklyn, Gemma L.
A1  - Jasrasaria, Rashmi
A1  - Jonas, Jost B.
A1  - Kan, Haidong
A1  - Kanis, John A.
A1  - Kassebaum, Nicholas
A1  - Kawakami, Norito
A1  - Khang, Young-Ho
A1  - Khatibzadeh, Shahab
A1  - Khoo, Jon-Paul
A1  - Kok, Cindy
A1  - Laden, Francine
A1  - Lalloo, Ratilal
A1  - Lan, Qing
A1  - Lathlean, Tim
A1  - Leasher, Janet L.
A1  - Leigh, James
A1  - Li, Yang
A1  - Lin, John Kent
A1  - Lipshultz, Steven E.
A1  - London, Stephanie
A1  - Lozano, Rafael
A1  - Lu, Yuan
A1  - Mak, Joelle
A1  - Malekzadeh, Reza
A1  - Mallinger, Leslie
A1  - Marcenes, Wagner
A1  - March, Lyn
A1  - Marks, Robin
A1  - Martin, Randall
A1  - McGale, Paul
A1  - McGrath, John
A1  - Mehta, Sumi
A1  - Mensah, George A.
A1  - Merriman, Tony R.
A1  - Micha, Renata
A1  - Michaud, Catherine
A1  - Mishra, Vinod
A1  - Hanafiah, Khayriyyah Mohd
A1  - Mokdad, Ali A.
A1  - Morawska, Lidia
A1  - Mozaffarian, Dariush
A1  - Murphy, Tasha
A1  - Naghavi, Mohsen
A1  - Neal, Bruce
A1  - Nelson, Paul K.
A1  - Nolla, Joan Miquel
A1  - Norman, Rosana
A1  - Olives, Casey
A1  - Omer, Saad B.
A1  - Orchard, Jessica
A1  - Osborne, Richard
A1  - Ostro, Bart
A1  - Page, Andrew
A1  - Pandey, Kiran D.
A1  - Parry, Charles Dh
A1  - Passmore, Erin
A1  - Patra, Jayadeep
A1  - Pearce, Neil
A1  - Pelizzari, Pamela M.
A1  - Petzold, Max
A1  - Phillips, Michael R.
A1  - Pope, Dan
A1  - Pope, C. Arden
A1  - Powles, John
A1  - Rao, Mayuree
A1  - Razavi, Homie
A1  - Rehfuess, Eva A.
A1  - Rehm, Jürgen T.
A1  - Ritz, Beate
A1  - Rivara, Frederick P.
A1  - Roberts, Thomas
A1  - Robinson, Carolyn
A1  - Rodriguez-Portales, Jose A.
A1  - Romieu, Isabelle
A1  - Room, Robin G. W.
A1  - Rosenfeld, Lisa C.
A1  - Roy, Ananya
A1  - Rushton, Lesley
A1  - Salomon, Joshua A.
A1  - Sampson, Uchechukwu
A1  - Sanchez-Riera, Lidia
A1  - Sanman, Ella
A1  - Sapkota, Amir
A1  - Seedat, Soraya
A1  - Shi, Peilin
A1  - Shield, Kevin
A1  - Shivakoti, Rupak
A1  - Singh, Gitanjali M.
A1  - Sleet, David A.
A1  - Smith, Emma
A1  - Smith, Kirk R.
A1  - Stapelberg, Nicolas Jc
A1  - Steenland, Kyle
A1  - Stöckl, Heidi
A1  - Stovner, Lars Jacob
A1  - Straif, Kurt
A1  - Straney, Lahn
A1  - Thurston, George D.
A1  - Tran, Jimmy H.
A1  - Van Dingenen, Rita
A1  - van Donkelaar, Aaron
A1  - Veerman, J. Lennert
A1  - Vijayakumar, Lakshmi
A1  - Weintraub, Robert
A1  - Weissman, Myrna M.
A1  - White, Richard A.
A1  - Whiteford, Harvey
A1  - Wiersma, Steven T.
A1  - Wilkinson, James D.
A1  - Williams, Hywel C.
A1  - Williams, Warwick
A1  - Wilson, Nicholas
A1  - Woolf, Anthony D.
A1  - Yip, Paul
A1  - Zielinski, Jan M.
A1  - Lopez, Alan D.
A1  - Murray, Christopher Jl
A1  - Ezzati, Majid
SP  - 2224
EP  - 2260
VL  - 380
IS  - 9859
N2  - 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>
LA  - en
SN  - 0140-6736
UR  - http://dx.doi.org/10.1016/S0140-6736(12)61766-8
ID  - ref1
ER  -