A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
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DOI：
10.1016/s0140-6736(12)61766-8
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发表时间：
2012-12-15
期刊：
影响因子：
168.9
通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
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作者：
Lim, Stephen S.;Vos, Theo;Flaxman, Abraham D.;Danaei, Goodarz;Shibuya, Kenji;Adair-Rohani, Heather;Amann, Markus;Anderson, H. Ross;Andrews, Kathryn G.;Aryee, Martin;Atkinson, Charles;Bacchus, Loraine J.;Bahalim, Adil N.;Balakrishnan, Kalpana;Balmes, John;Barker-Collo, Suzanne;Baxter, Amanda;Bell, Michelle L.;Blore, Jed D.;Blyth, Fiona;Bonner, Carissa;Borges, Guilherme;Bourne, Rupert;Boussinesq, Michel;Brauer, Michael;Brooks, Peter;Bruce, Nigel G.;Brunekreef, Bert;Bryan-Hancock, Claire;Bucello, Chiara;Buchbinder, Rachelle;Bull, Fiona;Burnett, Richard T.;Byers, Tim E.;Calabria, Bianca;Carapetis, Jonathan;Carnahan, Emily;Chafe, Zoe;Charlson, Fiona;Chen, Honglei;Chen, Jian Shen;Cheng, Andrew Tai-Ann;Child, Jennifer Christine;Cohen, Aaron;Colson, K. Ellicott;Cowie, Benjamin C.;Darby, Sarah;Darling, Susan;Davis, Adrian;Degenhardt, Louisa;Dentener, Frank;Des Jarlais, Don C.;Devries, Karen;Dherani, Mukesh;Ding, Eric L.;Dorsey, E. Ray;Driscoll, Tim;Edmond, Karen;Ali, Suad Eltahir;Engell, Rebecca E.;Erwin, Patricia J.;Fahimi, Saman;Falder, Gail;Farzadfar, Farshad;Ferrari, Alize;Finucane, Mariel M.;Flaxman, Seth;Fowkes, Francis Gerry R.;Freedman, Greg;Freeman, Michael K.;Gakidou, Emmanuela;Ghosh, Santu;Giovannucci, Edward;Gmel, Gerhard;Graham, Kathryn;Grainger, Rebecca;Grant, Bridget;Gunnell, David;Gutierrez, Hialy R.;Hall, Wayne;Hoek, Hans W.;Hogan, Anthony;Hosgood, H. Dean, III;Hoy, Damian;Hu, Howard;Hubbell, Bryan J.;Hutchings, Sally J.;Ibeanusi, Sydney E.;Jacklyn, Gemma L.;Jasrasaria, Rashmi;Jonas, Jost B.;Kan, Haidong;Kanis, John A.;Kassebaum, Nicholas;Kawakami, Norito;Khang, Young-Ho;Khatibzadeh, Shahab;Khoo, Jon-Paul;Kok, Cindy;Laden, Francine;Lalloo, Ratilal;Lan, Qing;Lathlean, Tim;Leasher, Janet L.;Leigh, James;Li, Yang;Lin, John Kent;Lipshultz, Steven E.;London, Stephanie;Lozano, Rafael;Lu, Yuan;Mak, Joelle;Malekzadeh, Reza;Mallinger, Leslie;Marcenes, Wagner;March, Lyn;Marks, Robin;Martin, Randall;McGale, Paul;McGrath, John;Mehta, Sumi;Mensah, George A.;Merriman, Tony R.;Micha, Renata;Michaud, Catherine;Mishra, Vinod;Hanafiah, Khayriyyah Mohd;Mokdad, Ali A.;Morawska, Lidia;Mozaffarian, Dariush;Murphy, Tasha;Naghavi, Mohsen;Neal, Bruce;Nelson, Paul K.;Miquel Nolla, Joan;Norman, Rosana;Olives, Casey;Omer, Saad B.;Orchard, Jessica;Osborne, Richard;Ostro, Bart;Page, Andrew;Pandey, Kiran D.;Parry, Charles D. H.;Passmore, Erin;Patra, Jayadeep;Pearce, Neil;Pelizzari, Pamela M.;Petzold, Max;Phillips, Michael R.;Pope, Dan;Pope, C. Arden, III;Powles, John;Rao, Mayuree;Razavi, Homie;Rehfuess, Eva A.;Rehm, Juergen T.;Ritz, Beate;Rivara, Frederick P.;Roberts, Thomas;Robinson, Carolyn;Rodriguez-Portales, Jose A.;Romieu, Isabelle;Room, Robin;Rosenfeld, Lisa C.;Roy, Ananya;Rushton, Lesley;Salomon, Joshua A.;Sampson, Uchechukwu;Sanchez-Riera, Lidia;Sanman, Ella;Sapkota, Amir;Seedat, Soraya;Shi, Peilin;Shield, Kevin;Shivakoti, Rupak;Singh, Gitanjali M.;Sleet, David A.;Smith, Emma;Smith, Kirk R.;Stapelberg, Nicolas J. C.;Steenland, Kyle;Stoeckl, Heidi;Stovner, Lars Jacob;Straif, Kurt;Straney, Lahn;Thurston, George D.;Tran, Jimmy H.;Van Dingenen, Rita;van Donkelaar, Aaron;Veerman, J. Lennert;Vijayakumar, Lakshmi;Weintraub, Robert;Weissman, Myrna M.;White, Richard A.;Whiteford, Harvey;Wiersma, Steven T.;Wilkinson, James D.;Williams, Hywel C.;Williams, Warwick;Wilson, Nicholas;Woolf, Anthony D.;Yip, Paul;Zielinski, Jan M.;Lopez, Alan D.;Murray, Christopher J. L.;Ezzati, Majid
对不同风险造成的疾病负担进行量化，可为预防工作提供信息，因为它提供的健康损失说明不同于逐个疾病分析所提供的说明。自2000年进行比较风险评估以来，没有对风险因素造成的全球疾病负担进行过全面修订，以前的分析也没有评估过风险因素造成的负担随时间的变化。我们估计了1990年和2010年21个地区67个风险因素和风险因素集群的独立影响导致的死亡和残疾调整生命年（DALLS;残疾生存年[YLD]和寿命损失年[YLL]之和）。我们通过系统地回顾和综合已发表和未发表的数据，估计了每年、地区、性别和年龄组的暴露分布以及每单位暴露的相对风险。我们使用这些估计值，以及2010年全球疾病负担研究中的死因特异性死亡和伤残估计值，计算与理论上的最低风险暴露相比，归因于每种风险因素暴露的负担。我们将疾病负担、相对风险和暴露的不确定性纳入我们对可归因负担的估计。2010年，全球疾病负担的三个主要风险因素是高血压（占全球DSB的7.0%[95%不确定性区间6.2 - 7.7]）、吸烟（包括二手烟）（6.3%[5.5 - 7.0]）和饮酒（5.5%[5.0 - 5.9]）。1990年，主要风险是儿童体重不足（7.9%[6.8 - 9.4]），固体燃料的家庭空气污染（HAP; 7.0%[5.6 - 8.3]）和吸烟，包括二手烟（6.1%[5.4 - 6.8]）。2010年，饮食风险因素和缺乏身体活动合计占全球糖尿病患者的10.0%（95% UI 9.2 - 10.8），其中最突出的饮食风险是水果含量低和钠含量高的饮食。1990年至2010年，主要影响儿童传染病的几个风险，包括未经改善的水和卫生设施以及儿童微量营养素缺乏症，排名下降，2010年未经改善的水和卫生设施占全球DVDs的0.9%（0.4 - 1.6）。然而，在撒哈拉以南非洲的大多数地区，儿童体重不足、HAP以及非纯母乳喂养和停止母乳喂养是2010年的主要风险，而HAP是南亚的主要风险。2010年，东欧、拉丁美洲大部分地区和撒哈拉以南非洲南部的主要风险因素是饮酒;在亚洲大部分地区、北非和中东以及中欧，主要风险因素是高血压。尽管有所下降，但包括二手烟在内的吸烟仍然是北美和西欧高收入国家的主要风险。高体重指数在全球范围内增加，是澳大拉西亚和拉丁美洲南部的主要风险，在其他高收入地区，北非和中东以及大洋洲也排名很高。在世界范围内，不同风险因素对疾病负担的影响发生了重大变化，从儿童传染性疾病风险转向成人非传染性疾病风险。这些变化与人口老龄化、5岁以下儿童死亡率下降、死亡原因构成的变化以及风险因素暴露的变化有关。新的证据导致主要风险的程度发生变化，包括未经改善的水和卫生设施、维生素A和锌缺乏以及环境颗粒物污染。流行病学发生转变的程度以及目前的主要风险在各区域之间差异很大。在撒哈拉以南非洲大部分地区，主要风险仍然是与贫穷有关的风险和影响儿童的风险。比尔和梅林达·盖茨基金会。
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. 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. 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. Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. Bill & Melinda Gates Foundation.