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sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data.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

From family medical practices 15775 men and women of men). Aortic surgery was offered to the screened group aged 65-80 years were identified and randomized into two if certain criteria were met and no patient died from groups: one group was invited for ultrasonographic rupture who was fit for operation and accepted elective screening for abdominal aortic aneurysm (AAA), and the treatment. The incidence of rupture was reduced by 55 other acted as age-and sex-matched controls. Of the 7887 per cent in men in the group invited for screening, invited for screening 5394 (68.4 per cent) accepted. AAA compared with controls. The incidence of rupture in was detected in 218 (4.0 per cent overall and 7-6 per cent women was low in both groups. Patients and methodsMen and women aged 65-80 years were identified for each general practice in this district from a combination of the practice register and Family Health Service lists. The patients in each practice were then randomized by computer to 'control' and 'screening' groups. Patients randomized to screening were invited for abdominal ultrasonographic scanning by letter from their family practice; one reminder was sent if there was no reply. Maximum aortic diameter in the anteroposterior and transverse planes was measured as previously described". A diameter of 3 cm or more was considered aneurysmal. Patients with an aneurysm of 3.0-4.4 cm diameter were rescanned annually and those with an aneurysm of 45-59 cm diameter were rescanned at intervals of 3 months. This protocol was continued for the duration of the study to February 1994 or until the patient either died, underwent surgical intervention or declined further followup. The criteria for considering surgical repair were applied prospectively: an aortic diameter of 6 cm or more, an increase of diameter of 1 cm or more per year, or the development of symptoms attributable to the aneurysm. Abnormal scans and batches of normal scans were reviewed by a consultant radiologist for quality control. Patients were assessed in outpatient clinics at their third scan or if an abnormality was detected; a further confirmatory scan was Paper accepted 3 March 1995 1066 performed by the consultant vascular surgeon at this visit. Patients who fulfilled the criteria for surgery were assessed and elective aneurysm repair planned if they were deemed fit and consented to operation. If patients were unfit or declined surgery, ultrasonographic surveillance was continued. Criteria for fitness for surgery were based on those of Bernstein and Chan".Mortality data were obtained weekly from the Registrar of Births and Deaths in Chichester district before coding was undertaken, and those labelled as aortic aneurysm were checked by a clinician. The causes of death for the study population were noted, including ruptured AAA. Details of those dying outside the district but who lived locally were included. Details of operative mortality and morbidity were obtained from a prospective study started in 19814. Results Population screened and acceptance rate...

DBI is significantly and independently associated with falls in older people living in RACFs. Interventional studies designed for this population are needed to determine whether reducing DBI, through dose reduction or cessation of anticholinergic and sedative drugs, can prevent falls.