Erratum: 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 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

Jeffrey D. Stanaway, Ashkan Afshin, Emmanuela Gakidou, Stephen S. Lim, Degu Abate, Kalkidan Hassen Abate, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Molla Abebe, Zegeye Abebe, Semaw F. Abera, Olifan Zewdie Abil, Haftom Niguse Abraha, Aklilu Roba AbrhamLaith Jamal Abu-Raddad, Niveen M.E. Abu-Rmeileh, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Pawan Acharya, Abdu A. Adamu, Akilew Awoke Adane, Oladimeji M. Adebayo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Zanfina Ademi, Olatunji O. Adetokunboh, Mina G. Adib, Amha Admasie, Jose C. Adsuar, Kossivi Agbelenko Afanvi, Mohsen Afarideh, Gina Agarwal, Anju Aggarwal, Sargis Aghasi Aghayan, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Mohammad Esmaeil Akbari, Tomi Akinyemiju, Nadia Akseer, Ziyad Al-Aly, Ayman Al-Eyadhy, Hesham M. Al-Mekhlafi, Fares Alahdab, Khurshid Alam, Samiah Alam, Tahiya Alam, Alaa Alashi, Seyed Moayed Alavian, Kefyalew Addis Alene, Komal Ali, Syed Mustafa Ali, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Syed Mohamed Aljunid, Ala’a Alkerwi, François Alla, Ubai Alsharif, Khalid Altirkawi, Nelson Alvis-Guzman, Azmeraw T. Amare, Walid Ammar, Nahla Hamed Anber, Jason A. Anderson, Catalina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Mustafa Geleto Ansha, Josep M. Antó, Carl Abelardo T. Antonio, Palwasha Anwari, Lambert Tetteh Appiah, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Johan Ärnlöv, Al Artaman, Krishna K. Aryal, Hamid Asayesh, Zerihun Ataro, Marcel Ausloos, Euripide F.G.A. Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Rakesh Ayer, Tambe B. Ayuk, Peter S. Azzopardi, Arefeh Babazadeh, Hamid Badali, Alaa Badawi, Kalpana Balakrishnan, Ayele Geleto Bali, Kylie Ball, Shoshana H. Ballew, Maciej Banach, Joseph Adel Mattar Banoub, Aleksandra Barac, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Lope H. Barrero, Sanjay Basu, Bernhard T. Baune, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Eyasu Tamru Bekru, Ezra Belay, Yihalem Abebe Belay, Michelle L. Bell, Aminu K. Bello, Derrick A. Bennett, Isabela M. Bensenor, Gilles Bergeron, Adugnaw Berhane, Eduardo Bernabe, Robert S. Bernstein, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Ashish Bhalla, Suraj Bhattarai, Zulfiqar A. Bhutta, Belete Biadgo, Ali Bijani, Boris Bikbov, Ver Bilano, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Donal Bisanzio, Tuhin Biswas, Tone Bjørge, Brigette F. Blacker, Archie Bleyer, Rohan Borschmann, Ibrahim R. Bou-Orm, Soufiane Boufous, Rupert Bourne, Oliver J. Brady, Michael Brauer, Alexandra Brazinova, Nicholas J.K. Breitborde, Hermann Brenner, Andrey Nikolaevich Briko, Gabrielle Britton, Traolach Brugha, Rachelle Buchbinder, Richard T. Burnett, Reinhard Busse, Zahid A. Butt, Leah E. Cahill, Lucero Cahuana-Hurtado, Ismael R. Campos-Nonato, Rosario Cárdenas, Giulia Carreras, Juan J. Carrero, Félix Carvalho, Carlos A. Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz Castro, Ferrán Catalá-López, Kate Causey, Kelly M. Cercy, Ester Cerin, Yazan Chaiah, Hsing Yi Chang, Jung Chen Chang, Kai Lan Chang, Fiona J. Charlson, Aparajita Chattopadhyay, Vijay Kumar Chattu, Miao Li Chee, Ching Yu Cheng, Adrienne Chew, Peggy Pei Chia Chiang, Odgerel Chimed-Ochir, Ken Lee Chin, Abdulaal Chitheer, Jee Young J. Choi, Rajiv Chowdhury, Hanne Christensen, Devasahayam J. Christopher, Sheng Chia Chung, Flavia M. Cicuttini, Massimo Cirillo, Aaron J. Cohen, Daniel Collado-Mateo, Cyrus Cooper, Owen R. Cooper, Josef Coresh, Leslie Cornaby, Paolo Angelo Cortesi, Monica Cortinovis, Megan Costa, Ewerton Cousin, Michael H. Criqui, Elizabeth A. Cromwell, David K. Cundiff, Alemneh Kabeta Daba, Berihun Assefa Dachew, Abel Fekadu Dadi, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Sarah C. Darby, Paul I. Dargan, Ahmad Daryani, Rajat Das Gupta, José Das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Dragos Virgil Davitoiu, Kairat Davletov, Vanessa De la Cruz-Góngora, Fernando Pio De La Hoz, Diego De Leo, Jan Walter De Neve, Louisa Degenhardt, Selina Deiparine, Robert P. Dellavalle, Gebre Teklemariam Demoz, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Aniruddha Deshpande, Don C. Des Jarlais, Getenet Ayalew Dessie, Gabrielle Aline Deveber, Subhojit Dey, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mesfin Tadese Dinberu, Eric L. Ding, Helen Derara Diro, Shirin Djalalinia, Huyen Phuc Do, Klara Dokova, David Teye Doku, Kerrie E. Doyle, Tim R. Driscoll, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce B. Duncan, Andre R. Duraes, Natalie Ebert, Hedyeh Ebrahimi, Soheil Ebrahimpour, David Edvardsson, Andem Effiong, Anne Elise Eggen, Charbel El Bcheraoui, Ziad El-Khatib, Iqbal Rf Elyazar, Ahmadali Enayati, Aman Yesuf Endries, Benjamin Er, Holly E. Erskine, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Hamed Fakhim, Mahbobeh Faramarzi, Mohammad Fareed, Talha A. Farid, Carla Sofia E. Sá Farinha, Andrea Farioli, Andre Faro, Maryam S. Farvid, Mohammad Hosein Farzaei, Batool Fatima, Kairsten A. Fay, Ali Akbar Fazaeli, Valery L. 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Kravchenko, Kewal Krishan, Kristopher J. Krohn, Hans Kromhout, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G. Anil Kumar, Manasi Kumar, Igor Kuzin, Hmwe Hmwe Kyu, Carl Lachat, Deepesh P. Lad, Sheetal D. Lad, Alessandra Lafranconi, Ratilal Lalloo, Tea Lallukka, Faris Hasan Lami, Justin J. Lang, Van C. Lansingh, Samantha Leigh Larson, Arman Latifi, Jeffrey V. Lazarus, Paul H. Lee, James Leigh, Mostafa Leili, Cheru Tesema Leshargie, Janni Leung, Miriam Levi, Sonia Lewycka, Shanshan Li, Yichong Li, Juan Liang, Xiaofeng Liang, Yu Liao, Misgan Legesse Liben, Lee Ling Lim, Shai Linn, Shiwei Liu, Rakesh Lodha, Giancarlo Logroscino, Alan D. Lopez, Stefan Lorkowski, Paulo A. Lotufo, Rafael Lozano, Tim C.D. Lucas, Raimundas Lunevicius, Stefan Ma, Erlyn Rachelle King Macarayan, Ísis Eloah Machado, Fabiana Madotto, Hue Thi Mai, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Abdullah A. 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Research output: Contribution to journalArticlepeer-review

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Abstract

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.
Original languageEnglish (US)
JournalThe Lancet
Volume393
Issue number10190
DOIs
StatePublished - Jun 22 2019
Externally publishedYes

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ASJC Scopus subject areas

  • General Medicine

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Dive into the research topics of 'Erratum: 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 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))'. Together they form a unique fingerprint.

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