Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
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DOI：
10.1016/s0140-6736(20)30752-2
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发表时间：
2020-10-17
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影响因子：
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通讯作者：
GBD 2019 Risk Factors Collaborators
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作者：
GBD 2019 Risk Factors Collaborators
严格分析主要风险因素的暴露水平和趋势，并量化其对人类健康的影响，对于确定公共卫生在哪些方面取得进展，以及在哪些情况下目前的努力不够，都是非常重要的。2019年全球疾病、伤害和风险因素负担研究（GBD）对风险因素暴露的程度、相对风险和可归因的疾病负担进行了标准化和全面的评估。GBD 2019针对87个风险因素和风险因素组合，在全球、区域以及204个国家和地区估计了归因死亡率、寿命损失年数（YLL）、残疾寿命年数（YLD）和残疾调整寿命年数（DLDs）。GBD使用风险因素的分层列表，以便对特定风险因素（例如，钠摄入量）和相关聚集体（例如，饮食质量）进行评估。该方法有六个分析步骤。(1)我们纳入了560个风险-结果对，这些对符合基于研究的令人信服或可能证据的标准。GBD 2017中包含的12个风险-结局对不再符合入选标准，基于新证据，增加了GBD 2017中已包含风险的47个风险-结局对。(2)根据已发表的系统性综述、为GBD 2019完成的81项系统性综述和荟萃回归，估计相对风险作为暴露的函数。(3)使用时空高斯过程回归、DisMod-MR 2.1、贝叶斯元回归方法或替代方法，基于所有可用数据源估计研究中包括的每个年龄-性别-地点-年的暴露水平。(4)我们从已发表的试验或队列研究中确定了与最低风险相关的暴露水平，称为理论最低风险暴露水平。(5)通过将人口归因分数（PAF）乘以每个年龄-性别-地点-年的相关结局数量，计算归因死亡、YLL、YLD和DADs。(6)考虑到不同风险因素通过其他风险因素的中介作用，估计了PAF和风险因素组合的可归因负担。在所有六个分析步骤中，分析中使用了30 652个不同的数据源。 分析的每一步的不确定性都被传播到可归因负担的最终估计中。使用汇总暴露值总结二分、多分和连续风险因素的暴露水平，以便于随时间、地点和风险进行比较。由于1990年至2019年的整个时间序列已使用一致的数据和方法重新估计，因此这些结果取代了先前公布的GBD可归因负担估计值。从2010年到2019年，风险暴露下降幅度最大的是与社会和经济发展密切相关的一系列风险，包括家庭空气污染;不安全的水、卫生设施和洗手;以及儿童发育不良。吸烟和铅暴露也在全球范围内下降。暴露风险增加最多的是环境颗粒物污染、药物使用、高空腹血糖和高体重指数。2019年，全球可归因死亡的主要二级风险因素是高收缩压，占1080万（95%不确定区间[UI] 9·51-12·1）死亡（占2019年所有死亡人数的19.2%[16.9 - 21.3]），其次是烟草（吸烟，二手和咀嚼），占871万（8.12 - 9.31）例死亡（占2019年所有死亡人数的15.4%[14.6 - 16.2]）。2019年全球可归因糖尿病的主要二级风险因素是儿童和孕产妇营养不良，这在很大程度上影响了最年轻年龄组的健康，占2.95亿（253-350）糖尿病患者（占当年全球所有糖尿病患者的11.6%[10.3 - 13.1]）。2019年，不同年龄组和地区的风险因素负担差异很大。在0-9岁的儿童中，三个主要的详细危险因素可归因于糖尿病都与营养不良有关。缺铁是10-24岁人群的主要危险因素，25-49岁人群的主要危险因素是饮酒，50-74岁和75岁及以上人群的主要危险因素是高收缩压。总体而言，过去30年来减少有害风险的记录很差。通过监管政策成功减少吸烟和铅接触，可能为公共政策在其他风险方面发挥更大作用指明了方向，此外，还应继续努力向公众提供有关风险因素危害的信息。比尔和梅林达·盖茨基金会。
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. 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. 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. 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. Bill & Melinda Gates Foundation.