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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

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Gakidou, Emmanuela*;Afshin, Ashkan;Abajobir, Amanuel Alemu;Abate, Kalkidan Hassen;Abbafati, Cristiana;Abbas, Kaja M.;Abd-Allah, Foad;Abdulle, Abdishakur M.;Abera, Semaw Ferede;Aboyans, Victor;Abu-Raddad, Laith J.;Abu-Rmeileh, Niveen M. E.;Abyu, Gebre Yitayih;Adedeji, Isaac Akinkunmi;Adetokunboh, Olatunji;Afarideh, Mohsen;Agrawal, Anurag;Agrawal, Sutapa;Kiadaliri, Aliasghar Ahmad;Ahmadieh, Hamid;Ahmed, Muktar Beshir;Aichour, Amani Nidhal;Aichour, Ibtihel;Aichour, Miloud Taki Eddine;Akinyemi, Rufus Olusola;Akseer, Nadia;Alahdab, Fares;Al-Aly, Ziyad;Alam, Khurshid;Alam, Noore;Alam, Tahiya;Alasfoor, Deena;Alene, Kefyalew Addis;Ali, Komal;Alizadeh-Navaei, Reza;Alkerwi, Ala'a;Alla, Francois;Allebeck, Peter;Al-Raddadi, Rajaa;Alsharif, Ubai;Altirkawi, Khalid A.;Alvis-Guzman, Nelson;Amare, Azmeraw T.;Amini, Erfan;Ammar, Walid;Amoako, Yaw Ampem;Ansari, Hossein;Anto, Josep M.;Antonio, Carl Abelardo T.;Anwari, Palwasha;Arian, Nicholas;Arnlov, Johan;Artaman, A.;Aryal, Krishna Kumar;Asayesh, Hamid;Asgedom, Solomon Weldegebreal;Atey, Tesfay Mehari;Avila-Burgos, Leticia;Avokpaho, Euripide Frinel G. Arthur;Awasthi, Ashish;Azzopardi, Peter;Bacha, Umar;Badawi, Alaa;Balakrishnan, Kalpana;Ballew, Shoshana H.;Barac, Aleksandra;Barber, Ryan M.;Barker-Collo, Suzanne L.;Barnighausen, Till;Barquera, Simon;Barregard, Lars;Barrero, Lope H.;Batis, Carolina;Battle, Katherine E.;Baune, Bernhard T.;Beardsley, Justin;Bedi, Neeraj;Beghi, Ettore;Bell, Michelle L.;Bennett, Derrick A.;Bennett, James R.;Bensenor, Isabela M.;Berhane, Adugnaw;Berhe, Derbew Fikadu;Bernabe, Eduardo;Betsu, Balem Demtsu;Beuran, Mircea;Beyene, Addisu Shunu;Bhansali, Anil;Bhutta, Zulfiqar A.;Bikbov, Boris;Birungi, Charles;Biryukov, Stan;Blosser, Christopher D.;Boneya, Dube Jara;Bou-Orm, Ibrahim R.;Brauer, Michael;Breitborde, Nicholas J. K.;Brenner, Hermann;Brugha, Traolach S.;Bulto, Lemma Negesa Bulto;Baumgarner, Blair R.;Butt, Zahid A.;Cahuana-Hurtado, Lucero;Cardenas, Rosario;Carrero, Juan Jesus;Castaneda-Orjuela, Carlos A.;Catala-Lopez, Ferran;Cercy, Kelly;Chang, Hsing-Yi;Charlson, Fiona J.;Chimed-Ochir, Odgerel;Chisumpa, Vesper Hichilombwe;Chitheer, Abdulaal A.;Christensen, Hanne;Christopher, Devasahayam Jesudas;Cirillo, Massimo;Cohen, Aaron J.;Comfort, Haley;Cooper, Cyrus;Coresh, Josef;Cornaby, Leslie;Cortesi, Paolo Angelo;Criqui, Michael H.;Crump, John A.;Dandona, Lalit;Dandona, Rakhi;das Neves, Jose;Davey, Gail;Davitoiu, Dragos V.;Davletov, Kairat;de Courten, Barbora;Degenhardt, Louisa;Deiparine, Selina;Dellavalle, Robert P.;Deribe, Kebede;Deshpande, Aniruddha;Dharmaratne, Samath D.;Ding, Eric L.;Djalalinia, Shirin;Huyen Phuc Do;Dokova, Klara;Doku, David Teye;Dorsey, E. Ray;Driscoll, Tim R.;Dubey, Manisha;Duncan, Bruce Bartholow;Duncan, Sarah;Ebert, Natalie;Ebrahimi, Hedyeh;El-Khatib, Ziad Ziad;Enayati, Ahmadali;Endries, Aman Yesuf;Ermakov, Sergey Petrovich;Erskine, Holly E.;Eshrati, Babak;Eskandarieh, Sharareh;Esteghamati, Alireza;Estep, Kara;Faraon, Emerito Jose Aquino;E Sa Farinha, Carla Sofia;Faro, Andre;Farzadfar, Farshad;Fay, Kairsten;Feigin, Valery L.;Fereshtehnejad, Seyed-Mohammad;Fernandes, Joao C.;Ferrari, Alize J.;Feyissa, Tesfaye Regassa;Filip, Irina;Fischer, Florian;Fitzmaurice, Christina;Flaxman, Abraham D.;Foigt, Nataliya;Foreman, Kyle J.;Frostad, Joseph J.;Fullman, Nancy;Furst, Thomas;Furtado, Joao M.;Ganji, Morsaleh;Garcia-Basteiro, Alberto L.;Gebrehiwot, Tsegaye Tewelde;Geleijnse, Johanna M.;Geleto, Ayele;Gemechu, Bikila Lencha;Gesesew, Hailay Abrha;Gething, Peter W.;Ghajar, Alireza;Gibney, Katherine B.;Gill, Paramjit Singh;Gillum, Richard F.;Giref, Ababi Zergaw;Gishu, Melkamu Dedefo;Giussani, Giorgia;Godwin, William W.;Gona, Philimon N.;Goodridge, Amador;Gopalani, Sameer Vali;Goryakin, Yevgeniy;Goulart, Alessandra Carvalho;Graetz, Nicholas;Gugnani, Harish Chander;Guo, Jingwen;Gupta, Rajeev;Gupta, Tanush;Gupta, Vipin;Gutierrez, Reyna A.;Hachinski, Vladimir;Hafezi-Nejad, Nima;Hailu, Gessessew Bugssa;Hamadeh, Randah Ribhi;Hamidi, Samer;Hammami, Mouhanad;Handal, Alexis J.;Hankey, Graeme J.;Harb, Hilda L.;Hareri, Habtamu Abera;Hassanvand, Mohammad Sadegh;Havmoeller, Rasmus;Hawley, Caitlin;Hay, Simon I.;Hedayati, Mohammad T.;Hendrie, Delia;Beatriz Heredia-Pi, Ileana;Hoek, Hans W.;Horita, Nobuyuki;Hosgood, H. Dean;Hostiuc, Sorin;Hoy, Damian G.;Hsairi, Mohamed;Hu, Guoqing;Huang, Hsiang;Huang, John J.;Iburg, Kim Moesgaard;Ikeda, Chad;Inoue, Manami;Irvine, Caleb Mackay Salpeter;Jackson, Maria Delores;Jacobsen, Kathryn H.;Jahanmehr, Nader;Jakovljevic, Mihajlo (Michael) B.;Jauregui, Alejandra;Javanbakht, Mehdi;Jeemon, Panniyammakal;Johansson, Lars R. K.;Johnson, Catherine O.;Jonas, Jost B.;Jurisson, Mikk;Kabir, Zubair;Kadel, Rajendra;Kahsay, Amaha;Kamal, Ritul;Karch, Andre;Karema, Corine Kakizi;Kasaeian, Amir;Kassebaum, Nicholas J.;Kastor, Anshul;Katikireddi, Srinivasa Vittal;Kawakami, Norito;Keiyoro, Peter Njenga;Kelbore, Sefonias Getachew;Kemmer, Laura;Kengne, Andre Pascal;Kesavachandran, Chandrasekharan Nair;Khader, Yousef Saleh;Khalil, Ibrahim A.;Khan, Ejaz Ahmad;Khang, Young-Ho;Khosravi, Ardeshir;Khubchandani, Jagdish;Kieling, Christian;Kim, Daniel;Kim, Jun Y.;Kim, Yun Jin;Kimokoti, Ruth W.;Kinfu, Yohannes;Kisa, Adnan;Kissimova-Skarbek, Katarzyna A.;Kivimaki, Mika;Knibbs, Luke D.;Knudsen, Ann Kristin;Kopec, Jacek A.;Kosen, Soewarta;Koul, Parvaiz A.;Koyanagi, Ai;Kravchenko, Michael;Krohn, Kristopher J.;Kromhout, Hans;Defo, Barthelemy Kuate;Bicer, Burcu Kucuk;Kumar, G. Anil;Kutz, Michael;Kyu, Hmwe H.;Lal, Dharmesh Kumar;Lalloo, Ratilal;Lallukka, Tea;Lan, Qing;Lansingh, Van C.;Larsson, Anders;Lee, Alexander;Lee, Paul H.;Leigh, James;Leung, Janni;Levi, Miriam;Li, Yichong;Li, Yongmei;Liang, Xiaofeng;Liben, Misgan Legesse;Linn, Shai;Liu, Patrick;Lodha, Rakesh;Logroscino, Giancarlo;Looker, Katherine J.;Lopez, Alan D.;Lorkowski, Stefan;Lotufo, Paulo A.;Lozano, Rafael;Lunevicius, Raimundas;Macarayan, Erlyn Rachelle King;Abd el Razek, Hassan Magdy;Abd el Razek, Mohammed Magdy;Majdan, Marek;Majdzadeh, Reza;Majeed, Azeem;Malekzadeh, Reza;Malhotra, Rajesh;Malta, Deborah Carvalho;Mamun, Abdullah A.;Manguerra, Helena;Mantovani, Lorenzo G.;Mapoma, Chabila C.;Martin, Randall V.;Martinez-Raga, Jose;Martins-Melo, Francisco Rogerlandio;Mathur, Manu Raj;Matsushita, Kunihiro;Matzopoulos, Richard;Mazidi, Mohsen;McAlinden, Colm;McGrath, John J.;Mehata, Suresh;Mehndiratta, Man Mohan;Meier, Toni;Melaku, Yohannes Adama;Memiah, Peter;Memish, Ziad A.;Mendoza, Walter;Mengesha, Melkamu Merid;Mensah, George A.;Mensink, Gert B. M.;Mereta, Seid Tiku;Meretoja, Atte;Meretoja, Tuomo J.;Mezgebe, Haftay Berhane;Micha, Renata;Millear, Anoushka;Miller, Ted R.;Minnig, Shawn;Mirarefin, Mojde;Mirrakhimov, Erkin M.;Misganaw, Awoke;Mishra, Shiva Raj;Mohammad, Karzan Abdulmuhsin;Mohammed, Kedir Endris;Mohammed, Shafiu;Ibrahim, Norlinah Mohamed;Mohan, Murali B. V.;Mokdad, Ali H.;Monasta, Lorenzo;Montanez Hernandez, Julio Cesar;Montico, Marcella;Moradi-Lakeh, Maziar;Moraga, Paula;Morawska, Lidia;Morrison, Shane D.;Mountjoy-Venning, Cliff;Mueller, Ulrich O.;Mullany, Erin C.;Muller, Kate;Murthy, Gudlavalleti Venkata Satyanarayana;Musa, Kamarul Imran;Naghavi, Mohsen;Naheed, Aliya;Nangia, Vinay;Natarajan, Gopalakrishnan;Negoi, Ionut;Negoi, Ruxandra Irina;Cuong Tat Nguyen;Grant Nguyen;Minh Nguyen;Quyen Le Nguyen;Trang Huyen Nguyen;Nichols, Emma;Ningrum, Dina Nur Anggraini;Nomura, Marika;Vuong Minh Nong;Norheim, Ole F.;Norrving, Bo;Noubiap, Jean Jacques N.;Obermeyer, Carla Makhlouf;Ogbo, Felix Akpojene;Oh, Hwan;Oladimeji, Olanrewaju;Olagunju, Andrew Toyin;Olagunju, Tinuke Oluwasefunmi;Olivares, Pedro R.;Olsen, Helen E.;Olusanya, Bolajoko Olubukunola;Olusanya, Jacob Olusegun;Opio, John Nelson;Oren, Eyal;Ortiz, Alberto;Ota, Erika;Owolabi, Mayowa O.;Pa, Mahesh;Pacella, Rosana E.;Pana, Adrian;Panda, Basant Kumar;Panda-Jonas, Songhomitra;Pandian, Jeyaraj D.;Papachristou, Christina;Park, Eun-Kee;Parry, Charles D.;Patten, Scott B.;Patton, George C.;Pereira, David M.;Perico, Norberto;Pesudovs, Konrad;Petzold, Max;Phillips, Michael Robert;Pillay, Julian David;Piradov, Michael A.;Pishgar, Farhad;Plass, Dietrich;Pletcher, Martin A.;Polinder, Suzanne;Popova, Svetlana;Poulton, Richie G.;Pourmalek, Farshad;Prasad, Narayan;Purcell, Carrie;Qorbani, Mostafa;Radfar, Amir;Rafay, Anwar;Rahimi-Movaghar, Afarin;Rahimi-Movaghar, Vafa;Rahman, Mahfuzar;Rahman, Mohammad Hifz Ur;Rahman, Muhammad Aziz;Rai, Rajesh Kumar;Rajsic, Sasa;Ram, Usha;Rawaf, Salman;Rehm, Colin D.;Rehm, Jurgen;Reiner, Robert C.;Reitsma, Marissa B.;Myriam Reynales-Shigematsu, Luz;Remuzzi, Giuseppe;Renzaho, Andre M. N.;Resnikoff, Serge;Rezaei, Satar;Ribeiro, Antonio L.;Rivera, Juan A.;Roba, Kedir Teji;Rojas-Rueda, David;Roman, Yesenia;Room, Robin;Roshandel, Gholamreza;Roth, Gregory A.;Rothenbacher, Dietrich;Rubagotti, Enrico;Rushton, Lesley;Sadat, Nafis;Safdarian, Mahdi;Safi, Sare;Safiri, Saeid;Sahathevan, Ramesh;Salama, Joseph;Salomon, Joshua A.;Samy, Abdallah M.;Sanabria, Juan Ramon;Dolores Sanchez-Nino, Maria;Sanchez-Pimienta, Tania G.;Santomauro, Damian;Santos, Itamar S.;Milicevic, Milena M. Santric;Sartorius, Benn;Satpathy, Maheswar;Sawhney, Monika;Saxena, Sonia;Schaeffner, Elke;Schmidt, Maria Ines;Schneider, Ione J. C.;Schutte, Aletta E.;Schwebel, David C.;Schwendicke, Falk;Seedat, Soraya;Sepanlou, Sadaf G.;Serdar, Berrin;Servan-Mori, Edson E.;Shaddick, Gavin;Shaheen, Amira;Shahraz, Saeid;Shaikh, Masood Ali;Levy, Teresa Shamah;Shamsipour, Mansour;Shamsizadeh, Morteza;Islam, Sheikh Mohammed Shariful;Sharma, Jayendra;Sharma, Rajesh;She, Jun;Shen, Jiabin;Shi, Peilin;Shibuya, Kenji;Shields, Chloe;Shiferaw, Mekonnen Sisay;Shigematsu, Mika;Shin, Min-Jeong;Shiri, Rahman;Shirkoohi, Reza;Shishani, Kawkab;Shoman, Haitham;Shrime, Mark G.;Sigfusdottir, Inga Dora;Santos Silva, Diego Augusto;Silva, Joao Pedro;Alves Silveira, Dayane Gabriele;Singh, Jasvinder A.;Singh, Virendra;Sinha, Dhirendra Narain;Skiadaresi, Eirini;Slepak, Erica Leigh;Smith, David L.;Smith, Mari;Sobaih, Badr H. A.;Sobngwi, Eugene;Soneji, Samir;Sorensen, Reed J. D.;Sposato, Luciano A.;Sreeramareddy, Chandrashekhar T.;Srinivasan, Vinay;Steel, Nicholas;Stein, Dan J.;Steiner, Caitlyn;Steinke, Sabine;Stokes, Mark Andrew;Strub, Bryan;Subart, Michelle;Sufiyan, Muawiyyah Babale;Suliankatchi, Rizwan Abdulkader;Sur, Patrick J.;Swaminathan, Soumya;Sykes, Bryan L.;Szoeke, Cassandra E. I.;Tabares-Seisdedos, Rafael;Tadakamadla, Santosh Kumar;Takahashi, Ken;Takala, Jukka S.;Tandon, Nikhil;Tanner, Marcel;Tarekegn, Yihunie L.;Tavakkoli, Mohammad;Tegegne, Teketo Kassaw;Tehrani-Banihashemi, Arash;Terkawi, Abdullah Sulieman;Tesssema, Belay;Thakur, J. S.;Thamsuwan, Ornwipa;Thankappan, Kavumpurathu Raman;Theis, Andrew M.;Thomas, Matthew Lloyd;Thomson, Alan J.;Thrift, Amanda G.;Tillmann, Taavi;Tobe-Gai, Ruoyan;Tobollik, Myriam;Tollanes, Mette C.;Tonelli, Marcello;Topor-Madry, Roman;Torre, Anna;Tortajada, Miguel;Touvier, Mathilde;Tran, Bach Xuan;Truelsen, Thomas;Tuem, Kald Beshir;Tuzcu, Emin Murat;Tyrovolas, Stefanos;Ukwaja, Kingsley Nnanna;Uneke, Chigozie Jesse;Updike, Rachel;Uthman, Olalekan A.;van Boven, Job F. M.;van Donkelaar, Aaron;Varughese, Santosh;Vasankari, Tommi;Veerman, Lennert J.;Venkateswaran, Vidhya;Venketasubramanian, Narayanaswamy;Violante, Francesco S.;Vladimirov, Sergey K.;Vlassov, Vasiliy Victorovich;Vollset, Stein Emil;Vos, Theo;Wadilo, Fiseha;Wakayo, Tolassa;Wallin, Mitchell T.;Wang, Yuan-Pang;Weichenthal, Scott;Weiderpass, Elisabete;Weintraub, Robert G.;Weiss, Daniel J.;Werdecker, Andrea;Westerman, Ronny;Whiteford, Harvey A.;Wiysonge, Charles Shey;Woldeyes, Belete Getahun;Wolfe, Charles D. A.;Woodbrook, Rachel;Workicho, Abdulhalik;Hanson, Sarah Wulf;Xavier, Denis;Xu, Gelin;Yadgir, Simon;Yakob, Bereket;Yan, Lijing L.;Yaseri, Mehdi;Yimam, Hassen Hamid;Yip, Paul;Yonemoto, Naohiro;Yoon, Seok-Jun;Yotebieng, Marcel;Younis, Mustafa Z.;Zaidi, Zoubida;Zaki, Maysaa El Sayed;Zavala-Arciniega, Luis;Zhang, Xueying;Zimsen, Stephanie Raman M.;Zipkin, Ben;Zodpey, Sanjay;Lim, Stephen S.;Murray, Christopher J. L.
通讯作者:
Gakidou, Emmanuela
作者机构:
[Naghavi, Mohsen; Woodbrook, Rachel; Fay, Kairsten; Godwin, William W.; Hanson, Sarah Wulf; Olsen, Helen E.; Ali, Komal; Foreman, Kyle J.; Liu, Patrick; Grant Nguyen; Duncan, Sarah; Strub, Bryan; Barber, Ryan M.; Mountjoy-Venning, Cliff; Afshin, Ashkan; Kyu, Hmwe H.; Santomauro, Damian; Dandona, Lalit; Whiteford, Harvey A.; Ferrari, Alize J.; Vos, Theo; Alam, Tahiya; Vollset, Stein Emil; Brauer, Michael; Subart, Michelle; Frostad, Joseph J.; Gakidou, Emmanuela; Sur, Patrick J.; Katikireddi, Srinivasa Vittal; Mokdad, Ali H.; Dandona, Rakhi; Minh Nguyen; Updike, Rachel; Nichols, Emma; Leung, Janni; Deshpande, Aniruddha; Slepak, Erica Leigh; Sadat, Nafis; Johnson, Catherine O.; Fullman, Nancy; Erskine, Holly E.; Mullany, Erin C.; Hay, Simon I.; Roth, Gregory A.; Cohen, Aaron J.; Deiparine, Selina; Thamsuwan, Ornwipa; Reiner, Robert C.; Zimsen, Stephanie Raman M.; Smith, David L.; Hawley, Caitlin; Smith, Mari; Comfort, Haley; Roman, Yesenia; Cornaby, Leslie; Minnig, Shawn; Flaxman, Abraham D.; Manguerra, Helena; Salama, Joseph; Cercy, Kelly; Muller, Kate; Sorensen, Reed J. D.; Lee, Alexander; Millear, Anoushka; Estep, Kara; Charlson, Fiona J.; Purcell, Carrie; Shields, Chloe; Biryukov, Stan; Mirarefin, Mojde; Khalil, Ibrahim A.; Graetz, Nicholas; Lim, Stephen S.; Krohn, Kristopher J.; Fitzmaurice, Christina; Ikeda, Chad; Murray, Christopher J. L.; Irvine, Caleb Mackay Salpeter; Pletcher, Martin A.; Theis, Andrew M.; Arian, Nicholas; Steiner, Caitlyn; Venkateswaran, Vidhya; Torre, Anna; Reitsma, Marissa B.; Yadgir, Simon; Degenhardt, Louisa; Kim, Jun Y.; Misganaw, Awoke; Guo, Jingwen; Zipkin, Ben; Kutz, Michael; Baumgarner, Blair R.; Bennett, James R.; Kassebaum, Nicholas J.; Kemmer, Laura] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.
[Fitzmaurice, Christina] Univ Washington, Dept Med, Div Hematol, Seattle, WA 98195 USA.
[Jakovljevic, Mihajlo (Michael) B.] Univ Washington, Ctr Hlth Trends & Forecasts, Inst Hlth Metr & Evaluat, Seattle, WA USA.
[Blosser, Christopher D.; Morrison, Shane D.] Univ Washington, Seattle, WA 98195 USA.
[Abajobir, Amanuel Alemu; Santomauro, Damian; Knibbs, Luke D.; Whiteford, Harvey A.; Ferrari, Alize J.; Leung, Janni; Erskine, Holly E.; Charlson, Fiona J.; Veerman, Lennert J.] Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.
通讯机构:
[Gakidou, Emmanuela] Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.
语种:
英文
期刊:
LANCET
ISSN:
0140-6736
年:
2017
卷:
390
期:
10100
页码:
,1422
文献类别:
WOS:Article
所属学科:
ESI学科类别:临床医学;WOS学科类别:Medicine, General & Internal
入藏号:
基金类别:
Bill AMP; Melinda Gates Foundation; Bloomberg Philanthropies
机构署名:
本校为其他机构
院系归属:
湘雅公共卫生学院
摘要:
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. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
参考文献:
Agrawal V, 2012, SEMIN FETAL NEONAT M, V17, P12, DOI 10.1016/j.siny.2011.09.001
Alvarado M, 2017, PREV MED, V105, pS23, DOI 10.1016/j.ypmed.2017.07.013
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