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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

Stanaway, Jeffrey D; Afshin, Ashkan; Gakidou, Emmanuela; Lim, Stephen S; Abate, Degu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbasi, Nooshin; Abbastabar, Hedayat; Abd-Allah, Foad; Abdela, Jemal; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abebe, Molla; Abebe, Zegeye; Abera, Semaw F; Abil, Olifan Zewdie; Abraha, Haftom Niguse; Abrham, Aklilu Roba; Abu-Raddad, Laith Jamal; Abu-Rmeileh, Niveen ME; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Acharya, Pawan; Adamu, Abdu A; Adane, Akilew Awoke; Adebayo, Oladimeji M; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Ademi, Zanfina; Adetokunboh, Olatunji O; Adib, Mina G; Admasie, Amha; Adsuar, Jose C; Afanvi, Kossivi Agbelenko; Afarideh, Mohsen; Agarwal, Gina; Aggarwal, Anju; Aghayan, Sargis Aghasi; Agrawal, Anurag; Agrawal, Sutapa; Ahmadi, Alireza; Ahmadi, Mehdi; Ahmadieh, Hamid; Ahmed, Muktar Beshir; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Akbari, Mohammad Esmaeil; Akinyemij...

Authors

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 Abrham

Laith Jamal Abu-Raddad

Niveen ME 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 Feigin

Andrea B Feigl

Seyed-Mohammad Fereshtehnejad

Eduarda Fernandes

Joao C Fernandes

Giannina Ferrara

Alize J Ferrari

Manuela L Ferreira

Irina Filip

Jonas David Finger

Florian Fischer

Nataliya A Foigt

Kyle J Foreman

Takeshi Fukumoto

Nancy Fullman

Thomas Fürst

João M Furtado

Neal D Futran

Seana Gall

Silvano Gallus

Amiran Gamkrelidze

Morsaleh Ganji

Alberto L Garcia-Basteiro

William M Gardner

Abadi Kahsu Gebre

Amanuel Tesfay Gebremedhin

Teklu Gebrehiwo Gebremichael

Tilayie Feto Gelano

Johanna M Geleijnse

Yilma Chisha Dea Geramo

Peter W Gething

Kebede Embaye Gezae

Reza Ghadimi

Keyghobad Ghadiri

Khalil Ghasemi Falavarjani

Maryam Ghasemi-Kasman

Mamata Ghimire

Rakesh Ghosh

Aloke Gopal Ghoshal

Simona Giampaoli

Paramjit Singh Gill

Tiffany K Gill

Richard F Gillum

Ibrahim Abdelmageed Ginawi

Giorgia Giussani

Elena V Gnedovskaya

William W Godwin

Srinivas Goli

Hector Gómez-Dantés

Philimon N Gona

Sameer Vali Gopalani

Alessandra C Goulart

Ayman Grada

Morgan E Grams

Giuseppe Grosso

Harish Chander Gugnani

Yuming Guo

Rahul Gupta

Rajeev Gupta

Tanush Gupta

Reyna Alma Gutiérrez

Daniela S Gutiérrez-Torres

Juanita A Haagsma

Tesfa Dejenie Habtewold

Vladimir Hachinski

Nima Hafezi-Nejad

Tekleberhan B Hagos

Tewodros Tesfa Hailegiyorgis

Gessessew Bugssa Hailu

Arvin Haj-Mirzaian

Arya Haj-Mirzaian

Randah R Hamadeh

Samer Hamidi

Alexis J Handal

Graeme J Hankey

Yuantao Hao

Hilda L Harb

Sivadasanpillai Harikrishnan

Josep Maria Haro

Hadi Hassankhani

Hamid Yimam Hassen

Rasmus Havmoeller

Caitlin N Hawley

Simon I Hay

Akbar Hedayatizadeh-Omran

Behzad Heibati

Behnam Heidari

Mohsen Heidari

Delia Hendrie

Andualem Henok

Ileana Heredia-Pi

Claudiu Herteliu

Fatemeh Heydarpour

Sousan Heydarpour

Desalegn T Hibstu

Tarig B Higazi

Esayas Haregot Hilawe

Hans W Hoek

Howard J Hoffman

Michael K Hole

Enayatollah Homaie Rad

Praveen Hoogar

H Dean Hosgood

Seyed Mostafa Hosseini

Mehdi Hosseinzadeh

Mihaela Hostiuc

Sorin Hostiuc

Damian G Hoy

Mohamed Hsairi

Thomas Hsiao

Guoqing Hu

Howard Hu

John J Huang

Mamusha Aman Hussen

Chantal K Huynh

Kim Moesgaard Iburg

Nayu Ikeda

Olayinka Stephen Ilesanmi

Usman Iqbal

Seyed Sina Naghibi Irvani

Caleb Mackay Salpeter Irvine

Sheikh Mohammed Shariful Islam

Farhad Islami

Maria D Jackson

Kathryn H Jacobsen

Leila Jahangiry

Nader Jahanmehr

Sudhir Kumar Jain

Mihajlo Jakovljevic

Spencer L James

Simerjot K Jassal

Achala Upendra Jayatilleke

Panniyammakal Jeemon

Ravi Prakash Jha

Vivekanand Jha

John S Ji

Jost B Jonas

Jitendra Jonnagaddala

Zahra Jorjoran Shushtari

Ankur Joshi

Jacek Jerzy Jozwiak

Mikk Jürisson

Zubair Kabir

Amaha Kahsay

Rizwan Kalani

Tanuj Kanchan

Surya Kant

Chittaranjan Kar

Manoochehr Karami

Behzad Karami Matin

André Karch

Corine Karema

Narges Karimi

Seyed M Karimi

Amir Kasaeian

Dessalegn H Kassa

Getachew Mullu Kassa

Tesfaye Dessale Kassa

Nicholas J Kassebaum

Srinivasa Vittal Katikireddi

Anil Kaul

Norito Kawakami

Zhila Kazemi

Ali Kazemi Karyani

Adane Teshome Kefale

Peter Njenga Keiyoro

Grant Rodgers Kemp

Andre Pascal Kengne

Andre Keren

Chandrasekharan Nair Kesavachandran

Yousef Saleh Khader

Behzad Khafaei

Morteza Abdullatif Khafaie

Alireza Khajavi

Nauman Khalid

Ibrahim A Khalil

Gulfaraz Khan

Muhammad Shahzeb Khan

Muhammad Ali Khan

Young-Ho Khang

Mona M Khater

Mohammad Khazaei

Habibolah Khazaie

Abdullah T Khoja

Ardeshir Khosravi

Mohammad Hossein Khosravi

Aliasghar A Kiadaliri

Daniel N Kiirithio

Cho-Il Kim

Daniel Kim

Young-Eun Kim

Yun Jin Kim

Ruth W Kimokoti

Yohannes Kinfu

Adnan Kisa

Katarzyna Kissimova-Skarbek

Mika Kivimäki

Luke D Knibbs

Ann Kristin Skrindo Knudsen

Sonali Kochhar

Yoshihiro Kokubo

Tufa Kolola

Jacek A Kopec

Soewarta Kosen

Parvaiz A Koul

Ai Koyanagi

Michael A 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 Mamun

Ana-Laura Manda

Helena Manguerra

Mohammad Ali Mansournia

Lorenzo Giovanni Mantovani

Joemer C Maravilla

Wagner Marcenes

Ashley Marks

Randall V Martin

Sheila C O Martins

Francisco Rogerlândio Martins-Melo

Winfried März

Melvin B Marzan

Benjamin Ballard Massenburg

Manu Raj Mathur

Prashant Mathur

Kunihiro Matsushita

Pallab K Maulik

Mohsen Mazidi

Colm McAlinden

John J McGrath

Martin McKee

Ravi Mehrotra

Kala M Mehta

Varshil Mehta

Toni Meier

Fantahun Ayenew Mekonnen

Yohannes A Melaku

Addisu Melese

Mulugeta Melku

Peter T N Memiah

Ziad A Memish

Walter Mendoza

Desalegn Tadese Mengistu

George A Mensah

Gert B M Mensink

Seid Tiku Mereta

Atte Meretoja

Tuomo J Meretoja

Tomislav Mestrovic

Haftay Berhane Mezgebe

Bartosz Miazgowski

Tomasz Miazgowski

Anoushka I Millear

Ted R Miller

Molly Katherine Miller-Petrie

G K Mini

Mojde Mirarefin

Andreea Mirica

Erkin M Mirrakhimov

Awoke Temesgen Misganaw

Habtamu Mitiku

Babak Moazen

Bahram Mohajer

Karzan Abdulmuhsin Mohammad

Moslem Mohammadi

Noushin Mohammadifard

Mousa Mohammadnia-Afrouzi

Shafiu Mohammed

Farnam Mohebi

Ali H Mokdad

Mariam Molokhia

Fatemeh Momeniha

Lorenzo Monasta

Yoshan Moodley

Ghobad Moradi

Maziar Moradi-Lakeh

Mehdi Moradinazar

Paula Moraga

Lidia Morawska

Joana Morgado-Da-Costa

Shane Douglas Morrison

Marilita M Moschos

Simin Mouodi

Seyyed Meysam Mousavi

Dariush Mozaffarian

Kalayu Brhane Mruts

Achenef Asmamaw Muche

Kindie Fentahun Muchie

Ulrich Otto Mueller

Oumer Sada Muhammed

Satinath Mukhopadhyay

Kate Muller

Kamarul Imran Musa

Ghulam Mustafa

Ashraf F Nabhan

Mohsen Naghavi

Aliya Naheed

Azin Nahvijou

Gurudatta Naik

Nitish Naik

Farid Najafi

Vinay Nangia

Jobert Richie Nansseu

Bruno Ramos Nascimento

Bruce Neal

Nahid Neamati

Ionut Negoi

Ruxandra Irina Negoi

Subas Neupane

Charles Richard James Newton

Josephine W Ngunjiri

Anh Quynh Nguyen

Grant Nguyen

Ha Thu Nguyen

Huong Lan Thi Nguyen

Huong Thanh Nguyen

Minh Nguyen

Nam Ba Nguyen

Emma Nichols

Jing Nie

Dina Nur Anggraini Ningrum

Yirga Legesse Nirayo

Nobuo Nishi

Molly R Nixon

Marzieh Nojomi

Shuhei Nomura

Ole F Norheim

Mehdi Noroozi

Bo Norrving

Jean Jacques Noubiap

Hamid Reza Nouri

Malihe Nourollahpour Shiadeh

Mohammad Reza Nowroozi

Elaine O Nsoesie

Peter S Nyasulu

Carla M Obermeyer

Christopher M Odell

Richard Ofori-Asenso

Felix Akpojene Ogbo

In-Hwan Oh

Olanrewaju Oladimeji

Andrew T Olagunju

Tinuke O Olagunju

Pedro R Olivares

Helen Elizabeth Olsen

Bolajoko Olubukunola Olusanya

Jacob Olusegun Olusanya

Kanyin L Ong

Sok King Ong

Eyal Oren

Heather M Orpana

Alberto Ortiz

Erika Ota

Stanislav S Otstavnov

Simon Øverland

Mayowa Ojo Owolabi

Mahesh P A

Rosana Pacella

Abhijit P Pakhare

Amir H Pakpour

Adrian Pana

Songhomitra Panda-Jonas

Eun-Kee Park

Charles D H Parry

Hadi Parsian

Shanti Patel

Sanghamitra Pati

Snehal T Patil

Ajay Patle

George C Patton

Deepak Paudel

Katherine R Paulson

Wayra Citlali Paz Ballesteros

Neil Pearce

Alexandre Pereira

David M Pereira

Norberto Perico

Konrad Pesudovs

Max Petzold

Hai Quang Pham

Michael R Phillips

Julian David Pillay

Michael A Piradov

Meghdad Pirsaheb

Tobias Pischon

Farhad Pishgar

Oleguer Plana-Ripoll

Dietrich Plass

Suzanne Polinder

Kevan R Polkinghorne

Maarten J Postma

Richie Poulton

Akram Pourshams

Hossein Poustchi

Dorairaj Prabhakaran

Swayam Prakash

Narayan Prasad

Caroline A Purcell

Manorama B Purwar

Mostafa Qorbani

Amir Radfar

Anwar Rafay

Alireza Rafiei

Fakher Rahim

Zohreh Rahimi

Afarin Rahimi-Movaghar

Vafa Rahimi-Movaghar

Mahfuzar Rahman

Mohammad Hifz ur Rahman

Muhammad Aziz Rahman

Rajesh Kumar Rai

Fatemeh Rajati

Sasa Rajsic

Sree Bhushan Raju

Usha Ram

Chhabi Lal Ranabhat

Prabhat Ranjan

Goura Kishor Rath

David Laith Rawaf

Salman Rawaf

K Srinath Reddy

Colin D Rehm

Jürgen Rehm

Robert C Reiner

Marissa B Reitsma

Giuseppe Remuzzi

Andre M N Renzaho

Serge Resnikoff

Luz Myriam Reynales-Shigematsu

Satar Rezaei

Antonio Luiz P Ribeiro

Juan A Rivera

Kedir Teji Roba

Sonia Rodríguez-Ramírez

Leonardo Roever

Yesenia Román

Luca Ronfani

Gholamreza Roshandel

Ali Rostami

Gregory A Roth

Dietrich Rothenbacher

Ambuj Roy

Enrico Rubagotti

Lesley Rushton

Charumathi Sabanayagam

Perminder S Sachdev

Basema Saddik

Ehsan Sadeghi

Sahar Saeedi Moghaddam

Hosein Safari

Yahya Safari

Roya Safari-Faramani

Mahdi Safdarian

Sare Safi

Saeid Safiri

Rajesh Sagar

Amirhossein Sahebkar

Mohammad Ali Sahraian

Haniye Sadat Sajadi

Nasir Salam

Payman Salamati

Zikria Saleem

Yahya Salimi

Hamideh Salimzadeh

Joshua A Salomon

Devashri Digvijay Salvi

Inbal Salz

Abdallah M Samy

Juan Sanabria

Maria Dolores Sanchez-Niño

Tania G Sánchez-Pimienta

Taren Sanders

Yingying Sang

Damian Francesco Santomauro

Itamar S Santos

João Vasco Santos

Milena M Santric Milicevic

Bruno Piassi Sao Jose

Mayank Sardana

Abdur Razzaque Sarker

Rodrigo Sarmiento-Suárez

Nizal Sarrafzadegan

Benn Sartorius

Shahabeddin Sarvi

Brijesh Sathian

Maheswar Satpathy

Arundhati R Sawant

Monika Sawhney

Mete Saylan

Mehdi Sayyah

Elke Schaeffner

Maria Inês Schmidt

Ione J C Schneider

Ben Schöttker

Aletta Elisabeth Schutte

David C Schwebel

Falk Schwendicke

James G Scott

Soraya Seedat

Mario Sekerija

Sadaf G Sepanlou

Marc L Serre

Edson Serván-Mori

Seyedmojtaba Seyedmousavi

Hosein Shabaninejad

Gavin Shaddick

Azadeh Shafieesabet

Mehdi Shahbazi

Amira A Shaheen

Masood Ali Shaikh

Teresa Shamah Levy

Mehran Shams-Beyranvand

Mohammadbagher Shamsi

Heidar Sharafi

Kiomars Sharafi

Mehdi Sharif

Mahdi Sharif-Alhoseini

Hamid Sharifi

Jayendra Sharma

Meenakshi Sharma

Rajesh Sharma

Jun She

Aziz Sheikh

Peilin Shi

Kenji Shibuya

Mekonnen Sisay Shiferaw

Mika Shigematsu

Min-Jeong Shin

Rahman Shiri

Reza Shirkoohi

Ivy Shiue

Farhad Shokraneh

Haitham Shoman

Mark G Shrime

Matthew S Shupler

Si Si

Soraya Siabani

Abla Mehio Sibai

Tariq J Siddiqi

Inga Dora Sigfusdottir

Rannveig Sigurvinsdottir

Diego Augusto Santos Silva

João Pedro Silva

Dayane Gabriele Alves Silveira

Jasvinder A Singh

Narinder Pal Singh

Virendra Singh

Dhirendra Narain Sinha

Eirini Skiadaresi

Vegard Skirbekk

David L Smith

Mari Smith

Badr Hasan Sobaih

Soheila Sobhani

Ranjani Somayaji

Moslem Soofi

Reed J D Sorensen

Joan B Soriano

Angela Spinelli

Luciano A Sposato

Chandrashekhar T Sreeramareddy

Vinay Srinivasan

Vladimir I Starodubov

Nadine Steckling

Dan J Stein

Murray B Stein

Goran Stevanovic

Leo Stockfelt

Mark A Stokes

Lela Sturua

Michelle L Subart

Agus Sudaryanto

Mu'awiyyah Babale Sufiyan

Gerhard Sulo

Bruno F Sunguya

Patrick John Sur

Bryan L Sykes

Cassandra E I Szoeke

Rafael Tabarés-Seisdedos

Takahiro Tabuchi

Santosh Kumar Tadakamadla

Ken Takahashi

Nikhil Tandon

Segen Gebremeskel Tassew

Mohammad Tavakkoli

Nuno Taveira

Arash Tehrani-Banihashemi

Tigist Gashaw Tekalign

Shishay Wahdey Tekelemedhin

Merhawi Gebremedhin Tekle

Habtamu Temesgen

Mohamad-Hani Temsah

Omar Temsah

Abdullah Sulieman Terkawi

Belay Tessema

Mebrahtu Teweldemedhin

Kavumpurathu Raman Thankappan

Andrew Theis

Sathish Thirunavukkarasu

Hannah J Thomas

Matthew Lloyd Thomas

Nihal Thomas

George D Thurston

Binyam Tilahun

Taavi Tillmann

Quyen G To

Myriam Tobollik

Marcello Tonelli

Roman Topor-Madry

Anna E Torre

Miguel Tortajada-Girbés

Mathilde Touvier

Marcos Roberto Tovani-Palone

Jeffrey A Towbin

Bach Xuan Tran

Khanh Bao Tran

Thomas Clement Truelsen

Nu Thi Truong

Afewerki Gebremeskel Tsadik

Lorainne Tudor Car

E Murat Tuzcu

Hayley D Tymeson

Stefanos Tyrovolas

Kingsley N Ukwaja

Irfan Ullah

Rachel L Updike

Muhammad Shariq Usman

Olalekan A Uthman

Muthiah Vaduganathan

Afsane Vaezi

Pascual R Valdez

Aaron Van Donkelaar

Elena Varavikova

Santosh Varughese

Tommi Juhani Vasankari

Vidhya Venkateswaran

Narayanaswamy Venketasubramanian

Santos Villafaina

Francesco S Violante

Sergey Konstantinovitch Vladimirov

Vasily Vlassov

Stein Emil Vollset

Theo Vos

Kia Vosoughi

Giang Thu Vu

Isidora S Vujcic

Fasil Shiferaw Wagnew

Yasir Waheed

Stephen G Waller

Judd L Walson

Yafeng Wang

Yanping Wang

Yuan-Pang Wang

Elisabete Weiderpass

Robert G Weintraub

Fitsum Weldegebreal

Andrea Werdecker

Adhena Ayaliew Werkneh

J Jason West

Ronny Westerman

Harvey A Whiteford

Justyna Widecka

Tissa Wijeratne

Andrea Sylvia Winkler

Alison B Wiyeh

Charles Shey Wiysonge

Charles D A Wolfe

Tien Yin Wong

Shouling Wu

Denis Xavier

Gelin Xu

Simon Yadgir

Ali Yadollahpour

Seyed Hossein Yahyazadeh Jabbari

Tomohide Yamada

Lijing L Yan

Yuichiro Yano

Mehdi Yaseri

Yasin Jemal Yasin

Alex Yeshaneh

Ebrahim M Yimer

Paul Yip

Engida Yisma

Naohiro Yonemoto

Seok-Jun Yoon

Marcel Yotebieng

Mustafa Z Younis

Mahmoud Yousefifard

Chuanhua Yu

Zoubida Zaidi

Sojib Bin Zaman

Mohammad Zamani

Luis Zavala-Arciniega

Anthony Lin Zhang

Hao Zhang

Kai Zhang

Maigeng Zhou

Stephanie R M Zimsen

Sanjay Zodpey

Christopher J L Murray



Contributors

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.

Citation

Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K. H., …Murray, C. J. L. (2018). 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. Lancet, 392(10159), 1923-1994. https://doi.org/10.1016/S0140-6736%2818%2932225-6

Journal Article Type Article
Acceptance Date Nov 10, 2018
Online Publication Date Nov 10, 2018
Publication Date Nov 10, 2018
Deposit Date May 15, 2019
Publicly Available Date Mar 28, 2024
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 392
Issue 10159
Pages 1923-1994
DOI https://doi.org/10.1016/S0140-6736%2818%2932225-6
Keywords General Medicine
Public URL https://hull-repository.worktribe.com/output/1746198
Publisher URL https://www.sciencedirect.com/science/article/pii/S0140673618322256
Additional Information This article is maintained by: Elsevier; Article Title: 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; Journal Title: The Lancet; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S0140-6736(18)32225-6; Content Type: article; Copyright: © 2018 The Author(s). Published by Elsevier Ltd.

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Copyright Statement
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.





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