Journal
LANCET
Volume 396, Issue 10258, Pages 1223-1249Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(20)30752-2
Keywords
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Categories
Funding
- Bill AMP
- Melinda Gates Foundation
- Bloomberg Philanthropies
- University of Melbourne
- Queensland Department of Health, Australia
- National Health and Medical Research Council, Australia
- Public Health England
- Norwegian Institute of Public Health
- Cardiovascular Medical Research and Education Fund
- National Institute on Ageing of the National Institutes of Health (NIH) [P30AG047845]
- National Institute of Mental Health of the NIH [R01MH110163]
- United States Agency for International Development (USAID)
- 985 Program of Peking University
- Wellcome Trust [072406, 205039/Z/16/Z]
- US National Institute on Aging [U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C, R01AG031716]
- European Commission [QLK6-CT-2001-00360, SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812, 211909, 227822, 261982, 676536, 654221]
- EGC
- DG Employment, Social Affairs Inclusion
- German Ministry of Education and Research
- Max Planck Society for the Advancement of Science
- WHO
- National Institute of Aging [NIA U01AG009740]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [P01-HD31921]
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior, Brazil [001]
- Conselho Nacional de Desenvolvimento Cientifico e Tecnologico
- Qatar National Research Fund [NPRP 9-040-3-008]
- National Institute on Aging, a division of the NIH [R21AG032572, R03AG043052, R01 AG030153]
- Wellcome Trust DBT India Alliance Senior Fellowship
- NIH as part of the H3Africa Consortium [U01HG010273]
- FLAIR fellowship - UK Royal Society
- African Academy of Sciences
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University
- National University of Malaysia
- Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award - German Federal Ministry of Education and Research
- Public Health Agency of Canada
- Sistema Nacional de Investigacion of SENACYT, Panama
- Swedish Research Council [2019-01059]
- FCT/MCTES [UID/MULTI/04378/2019, UID/QUI/50006/2019]
- Health Effects Institute, Boston
- Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitoria [DL57/2016/CP1334/CT0006, SFRH/BHD/110001/2015]
- NASA [NNX16AQ30G]
- NIOSH [T42-OH008673]
- Australian National Health and Medical Research Council Early Career Fellowship [APP1137969]
- National Health and Medical Research Council Early Career Fellowship Grant [APP1121516]
- International Centre for Casemix and Clinical Coding, Faculty of Medicine
- Queensland Health
- FCT/MCTES through national funds [UID/MULTI/04378/2019, UID/QUI/50006/2019]
- Queensland Centre for Mental Health Research from the Queensland Department of Health
- National Health and Medical Council of Australia fellowship
- EU (FEDER funds through COMPETE) [POCI-01-0145-FEDER-029248]
- National Funds (FCT, Fundacao para a Ciencia e Tecnologia) [PTDC/NAN-MAT/29248/2017]
- Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI [PN-III-P4-ID-PCCF-2016-0084]
- European Fund for Regional Development through Operational Program for Competitiveness [P_40_382]
- China Medical University, Taichung, Taiwan [107-Z-04]
- Japan Society for the Promotion of Science [15K08762, 18H03063]
- National Heart Foundation of Australia
- Deakin University
- Ministry of Education Science and Technological Development of the Republic of Serbia [OI175014]
- Clinical and Public Health intermediate fellowship from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20) [IA/CPHI/14/1/501497]
- UIPA scholarship from UNSW, Sydney
- NRS Senior Clinical Fellowship [SCAF/15/02]
- Medical Research Council [MC_UU_12017/13, MC_UU_12017/15]
- Scottish Government Chief Scientist Office [SPHSU13, SPHSU15]
- Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (a Brazilian public funding agency)
- Research Management Centre, Xiamen University Malaysia [XMUMRF/2018-C2/ITCM/0001]
- UGC Centre of Advanced Study (CAS II)
- NIHR Oxford Biomedical Research Centre
- BHF Centre of Research Excellence, Oxford
- Academy of Finland [319200]
- Secretaria Nacional de Ciencia, Tecnologia e Innovacion, Panama
- Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, EU) [CP18/00074]
- German Federal Ministry of Education and Research (nutriCARD) [01EA1808A]
- Department of Health, Queensland Government
- Washington University
- Danish National Research Foundation (Niels Bohr Professorship)
- Queensland Health Department (via West Moreton HHS)
- German National Cohort Study BMBF grant [01ER1801D]
- Ministry of Education, Culture, Sports, Science, and Technology of Japan [18K10082]
- ISCIII [PI19/00815, DTS18/00032]
- ISCIII-RETIC REDinREN Fondos FEDER [RD016/0009]
- FRIAT
- Comunidad de Madrid [B2017/BMD-3686 CIFRA2-CM]
- Cuthbertson and Fischer Chair in Pediatric Mental Health at the University of Calgary
- National Health AMP
- Medical Research Council Fellowship
- National Natural Science Foundation of China [81371502, 81761128031]
- Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche)
- EU (FEDER funds through the Operational Competitiveness Program [COMPETE]) [POCI-01-0145-FEDER-029253]
- The Sir Charles Hercus Health Research Fellowship Health Research Council of New Zealand [18/111]
- National Health and Medical Research Council of Australia Program Grant
- Egyptian Fulbright Mission Program
- Department of Health
- Ministry of Education, Science and Technological Development of the Republic of Serbia [175087]
- Applied and Environmental Sciences University in Bogota, Colombia
- Carlos III Institute of Health Madrid Spain
- South African National Research Foundation SARChI Chair initiative [GUN 86895]
- South African Medical Research Council
- NASA
- Region Zealand (Exercise First)
- European Research Council under the EU's Horizon 2020 research and innovation programme [801790]
- Centro de Investigacion en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- ISCIII-FEDER [PI17/00719]
- European AMP
- Developing Countries Clinical Trials Partnership, EU (LIFE project) [RIA2016MC-1615]
- David Freeze chair in health services research, University of Calgary
- Foundation for Education and European Culture
- Sara Borrell postdoctoral program from the Instituto de Salud Carlos III [CD15/00019]
- Fondos Europeo de Desarrollo Regional
- National Institute on Aging at the NIH [K23AG056638]
- Grants-in-Aid for Scientific Research [18H03063, 15K08762, 18K10082] Funding Source: KAKEN
- Fundação para a Ciência e a Tecnologia [PTDC/NAN-MAT/29248/2017] Funding Source: FCT
- MRC [MC_UU_12017/15, MC_UU_12017/13, MR/R024227/1, MC_UU_00022/2, MR/M015084/1, MR/S011676/1] Funding Source: UKRI
Ask authors/readers for more resources
Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
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