Summary 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sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data.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 we 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 s...

Background: To determine the relationship between country level prevalence of interpersonal violence (IPV) and the prevalence of early childhood caries (ECC) in children aged 3-5-year-olds. Method: This was an ecological study using extracted IPV (physical, sexual and emotional) and ECC data for 3-5-year-olds in 20 low-and middle-income countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-old children with ECC (outcome variable) and the four IPV indicators (physical, sexual, emotional and a combination of the three). The model was adjusted for the country's Gross National Income GNI. Partial eta squared (as measure of effect size), regression coefficients, confidence intervals and p values were calculated. Results: The strongest association was between ECC prevalence and exposure to physical violence (partial eta squared= 0.01), followed by exposure to sexual violence (partial eta squared= 0.005), and exposure to all types of IPV combined (partial eta squared= 0.001). Exposure to emotional violence had the weakest association with ECC (partial eta squared < 0.0001). For 1% higher percentage of women reporting exposure to physical violence and percentage of women reporting all types of IPV combined, there was a 0.18% higher prevalence of ECC. For 1% higher prevalence of sexual violence, there was 0.22% higher ECC prevalence. For 1% higher prevalence of emotional violence, there was 0.04% higher ECC prevalence. Conclusions: Countries with high prevalence of IPV will likely also have high prevalence of ECC. This needs further studies.

Karen Devries and colleagues conduct a systematic review of longitudinal studies to evaluate the direction of association between symptoms of depression and intimate partner violence. Please see later in the article for the Editors' Summary

There is a clear positive association between alcohol use and intimate partner physical or sexual violence victimization among women, suggesting a need for programming and research that addresses this link. However, the temporal direction of the association remains unclear. Longitudinal studies with multiple waves of data collection are needed.

BACKGROUND AND OBJECTIVE: Self-inflicted injuries are one of the major causes of disease burden and death globally. Understanding the extent to which this is associated with childhood sexual abuse (CSA) exposure can help inform prevention strategies. We aimed to quantify to what extent CSA was associated with incident suicide attempts in men and women. Longitudinal studies and cotwin analyses from twin studies in any population from any year were eligible for inclusion. Of 22 235 abstracts screened as part of a series of reviews, 9 studies met the inclusion criteria for this review. Characteristics, effect estimates, and quality data were extracted. Randomeffects meta-analysis was used to generate pooled odds ratios (ORs).RESULTS: Seven longitudinal and 2 twin studies with 8733 participants met the inclusion criteria. The overall pooled estimate for longitudinal studies was OR = 2.43 (95% confidence interval: 1.94-3.05), I 2 = 87.5%, P , .0001. The pooled OR from cotwin analysis was 2.65 (95% confidence interval: 0.82-4.49, I 2 = 0%, P = .867). Studies adjusted for a range of confounders, but baseline suicidal behavior was not wellcontrolled. Too few studies met the inclusion criteria to quantitatively examine sources of heterogeneity.CONCLUSIONS: CSA exposure is associated with suicide attempts when a range of different confounders are controlled for, but the temporality of the association is not well established, and the association is highly heterogeneous. Pediatrics 2014;133:e1331-e1344