Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Abstract

SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).FindingsBetween 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DA...

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

“…Some studies in Ghana have alluded to the fact that socioculturally, a large body size among females is perceived as a sign of affluence [27], and women with higher education are likely to be affluent and have more exposure to energy-dense foods. The observed association of sedentary lifestyle with higher BMI among men and women is largely consistent with other studies both outside [1] and within Africa [39,45] and Ghana [41,42]. …”

“…Cardiometabolic diseases have become a major global health concern and are specifically increasing in sub-Saharan Africa (SSA) [1,2]. Countries in SSA are at different stages of the transition, with the majority moving from under- to over-nutrition [3–5].…”

“…Whereas over-nutrition (manifested as overweight and obesity) is gaining much attention in the current complex epidemiological transition within most African countries, a substantial amount of under-nutrition (manifested as underweight) still persists in poorer communities across the continent [1]. Excess weight gain has been linked to type 2 diabetes, ischaemic heart disease, stroke, hypertensive heart disease, osteoarthritis, and cancers of the breast, colon, endometrium and kidney [9].…”

“…The Non-communicable Disease Risk Factor Collaboration gave a global estimate of the trends in underweight recently. This study observed that underweight was still high in West, East and Central Africa and was associated with a slow decline over the past decade [1]. …”

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

“…Hypertension (raised blood pressure [BP], >140 mm Hg systolic BP, and/or >90 mm Hg diastolic BP) ranks as the third‐most important risk factor for global burden of disease,1 responsible for considerable and increasing noncommunicable diseases burden and mortality 1, 2. This condition affects more than 1 billion people worldwide with a global prevalence of close to 20%.…”