Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
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DOI：
10.1016/s0140-6736(15)00128-2
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发表时间：
2015-12-05
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影响因子：
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通讯作者：
Murray CJ
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作者：
GBD 2013 Risk Factors Collaborators;Forouzanfar MH;Alexander L;Anderson HR;Bachman VF;Biryukov S;Brauer M;Burnett R;Casey D;Coates MM;Cohen A;Delwiche K;Estep K;Frostad JJ;Astha KC;Kyu HH;Moradi-Lakeh M;Ng M;Slepak EL;Thomas BA;Wagner J;Aasvang GM;Abbafati C;Abbasoglu Ozgoren A;Abd-Allah F;Abera SF;Aboyans V;Abraham B;Abraham JP;Abubakar I;Abu-Rmeileh NM;Aburto TC;Achoki T;Adelekan A;Adofo K;Adou AK;Adsuar JC;Afshin A;Agardh EE;Al Khabouri MJ;Al Lami FH;Alam SS;Alasfoor D;Albittar MI;Alegretti MA;Aleman AV;Alemu ZA;Alfonso-Cristancho R;Alhabib S;Ali R;Ali MK;Alla F;Allebeck P;Allen PJ;Alsharif U;Alvarez E;Alvis-Guzman N;Amankwaa AA;Amare AT;Ameh EA;Ameli O;Amini H;Ammar W;Anderson BO;Antonio CA;Anwari P;Argeseanu Cunningham S;Arnlöv J;Arsenijevic VS;Artaman A;Asghar RJ;Assadi R;Atkins LS;Atkinson C;Avila MA;Awuah B;Badawi A;Bahit MC;Bakfalouni T;Balakrishnan K;Balalla S;Balu RK;Banerjee A;Barber RM;Barker-Collo SL;Barquera S;Barregard L;Barrero LH;Barrientos-Gutierrez T;Basto-Abreu AC;Basu A;Basu S;Basulaiman MO;Batis Ruvalcaba C;Beardsley J;Bedi N;Bekele T;Bell ML;Benjet C;Bennett DA;Benzian H;Bernabé E;Beyene TJ;Bhala N;Bhalla A;Bhutta ZA;Bikbov B;Bin Abdulhak AA;Blore JD;Blyth FM;Bohensky MA;Bora Başara B;Borges G;Bornstein NM;Bose D;Boufous S;Bourne RR;Brainin M;Brazinova A;Breitborde NJ;Brenner H;Briggs AD;Broday DM;Brooks PM;Bruce NG;Brugha TS;Brunekreef B;Buchbinder R;Bui LN;Bukhman G;Bulloch AG;Burch M;Burney PG;Campos-Nonato IR;Campuzano JC;Cantoral AJ;Caravanos J;Cárdenas R;Cardis E;Carpenter DO;Caso V;Castañeda-Orjuela CA;Castro RE;Catalá-López F;Cavalleri F;Çavlin A;Chadha VK;Chang JC;Charlson FJ;Chen H;Chen W;Chen Z;Chiang PP;Chimed-Ochir O;Chowdhury R;Christophi CA;Chuang TW;Chugh SS;Cirillo M;Claßen TK;Colistro V;Colomar M;Colquhoun SM;Contreras AG;Cooper C;Cooperrider K;Cooper LT;Coresh J;Courville KJ;Criqui MH;Cuevas-Nasu L;Damsere-Derry J;Danawi H;Dandona L;Dandona R;Dargan PI;Davis A;Davitoiu DV;Dayama A;de Castro EF;De la Cruz-Góngora V;De Leo D;de Lima G;Degenhardt L;del Pozo-Cruz B;Dellavalle RP;Deribe K;Derrett S;Des Jarlais DC;Dessalegn M;deVeber GA;Devries KM;Dharmaratne SD;Dherani MK;Dicker D;Ding EL;Dokova K;Dorsey ER;Driscoll TR;Duan L;Durrani AM;Ebel BE;Ellenbogen RG;Elshrek YM;Endres M;Ermakov SP;Erskine HE;Eshrati B;Esteghamati A;Fahimi S;Faraon EJ;Farzadfar F;Fay DF;Feigin VL;Feigl AB;Fereshtehnejad SM;Ferrari AJ;Ferri CP;Flaxman AD;Fleming TD;Foigt N;Foreman KJ;Paleo UF;Franklin RC;Gabbe B;Gaffikin L;Gakidou E;Gamkrelidze A;Gankpé FG;Gansevoort RT;García-Guerra FA;Gasana E;Geleijnse JM;Gessner BD;Gething P;Gibney KB;Gillum RF;Ginawi IA;Giroud M;Giussani G;Goenka S;Goginashvili K;Gomez Dantes H;Gona P;Gonzalez de Cosio T;González-Castell D;Gotay CC;Goto A;Gouda HN;Guerrant RL;Gugnani HC;Guillemin F;Gunnell D;Gupta R;Gupta R;Gutiérrez RA;Hafezi-Nejad N;Hagan H;Hagstromer M;Halasa YA;Hamadeh RR;Hammami M;Hankey GJ;Hao Y;Harb HL;Haregu TN;Haro JM;Havmoeller R;Hay SI;Hedayati MT;Heredia-Pi IB;Hernandez L;Heuton KR;Heydarpour P;Hijar M;Hoek HW;Hoffman HJ;Hornberger JC;Hosgood HD;Hoy DG;Hsairi M;Hu G;Hu H;Huang C;Huang JJ;Hubbell BJ;Huiart L;Husseini A;Iannarone ML;Iburg KM;Idrisov BT;Ikeda N;Innos K;Inoue M;Islami F;Ismayilova S;Jacobsen KH;Jansen HA;Jarvis DL;Jassal SK;Jauregui A;Jayaraman S;Jeemon P;Jensen PN;Jha V;Jiang F;Jiang G;Jiang Y;Jonas JB;Juel K;Kan H;Kany Roseline SS;Karam NE;Karch A;Karema CK;Karthikeyan G;Kaul A;Kawakami N;Kazi DS;Kemp AH;Kengne AP;Keren A;Khader YS;Khalifa SE;Khan EA;Khang YH;Khatibzadeh S;Khonelidze I;Kieling C;Kim D;Kim S;Kim Y;Kimokoti RW;Kinfu Y;Kinge JM;Kissela BM;Kivipelto M;Knibbs LD;Knudsen AK;Kokubo Y;Kose MR;Kosen S;Kraemer A;Kravchenko M;Krishnaswami S;Kromhout H;Ku T;Kuate Defo B;Kucuk Bicer B;Kuipers EJ;Kulkarni C;Kulkarni VS;Kumar GA;Kwan GF;Lai T;Lakshmana Balaji A;Lalloo R;Lallukka T;Lam H;Lan Q;Lansingh VC;Larson HJ;Larsson A;Laryea DO;Lavados PM;Lawrynowicz AE;Leasher JL;Lee JT;Leigh J;Leung R;Levi M;Li Y;Li Y;Liang J;Liang X;Lim SS;Lindsay MP;Lipshultz SE;Liu S;Liu Y;Lloyd BK;Logroscino G;London SJ;Lopez N;Lortet-Tieulent J;Lotufo PA;Lozano R;Lunevicius R;Ma J;Ma S;Machado VM;MacIntyre MF;Magis-Rodriguez C;Mahdi AA;Majdan M;Malekzadeh R;Mangalam S;Mapoma CC;Marape M;Marcenes W;Margolis DJ;Margono C;Marks GB;Martin RV;Marzan MB;Mashal MT;Masiye F;Mason-Jones AJ;Matsushita K;Matzopoulos R;Mayosi BM;Mazorodze TT;McKay AC;McKee M;McLain A;Meaney PA;Medina C;Mehndiratta MM;Mejia-Rodriguez F;Mekonnen W;Melaku YA;Meltzer M;Memish ZA;Mendoza W;Mensah GA;Meretoja A;Mhimbira FA;Micha R;Miller TR;Mills EJ;Misganaw A;Mishra S;Mohamed Ibrahim N;Mohammad KA;Mokdad AH;Mola GL;Monasta L;Montañez Hernandez JC;Montico M;Moore AR;Morawska L;Mori R;Moschandreas J;Moturi WN;Mozaffarian D;Mueller UO;Mukaigawara M;Mullany EC;Murthy KS;Naghavi M;Nahas Z;Naheed A;Naidoo KS;Naldi L;Nand D;Nangia V;Narayan KM;Nash D;Neal B;Nejjari C;Neupane SP;Newton CR;Ngalesoni FN;Ngirabega Jde D;Nguyen G;Nguyen NT;Nieuwenhuijsen MJ;Nisar MI;Nogueira JR;Nolla JM;Nolte S;Norheim OF;Norman RE;Norrving B;Nyakarahuka L;Oh IH;Ohkubo T;Olusanya BO;Omer SB;Opio JN;Orozco R;Pagcatipunan RS Jr;Pain AW;Pandian JD;Panelo CI;Papachristou C;Park EK;Parry CD;Paternina Caicedo AJ;Patten SB;Paul VK;Pavlin BI;Pearce N;Pedraza LS;Pedroza A;Pejin Stokic L;Pekericli A;Pereira DM;Perez-Padilla R;Perez-Ruiz F;Perico N;Perry SA;Pervaiz A;Pesudovs K;Peterson CB;Petzold M;Phillips MR;Phua HP;Plass D;Poenaru D;Polanczyk GV;Polinder S;Pond CD;Pope CA;Pope D;Popova S;Pourmalek F;Powles J;Prabhakaran D;Prasad NM;Qato DM;Quezada AD;Quistberg DA;Racapé L;Rafay A;Rahimi K;Rahimi-Movaghar V;Rahman SU;Raju M;Rakovac I;Rana SM;Rao M;Razavi H;Reddy KS;Refaat AH;Rehm J;Remuzzi G;Ribeiro AL;Riccio PM;Richardson L;Riederer A;Robinson M;Roca A;Rodriguez A;Rojas-Rueda D;Romieu I;Ronfani L;Room R;Roy N;Ruhago GM;Rushton L;Sabin N;Sacco RL;Saha S;Sahathevan R;Sahraian MA;Salomon JA;Salvo D;Sampson UK;Sanabria JR;Sanchez LM;Sánchez-Pimienta TG;Sanchez-Riera L;Sandar L;Santos IS;Sapkota A;Satpathy M;Saunders JE;Sawhney M;Saylan MI;Scarborough P;Schmidt JC;Schneider IJ;Schöttker B;Schwebel DC;Scott JG;Seedat S;Sepanlou SG;Serdar B;Servan-Mori EE;Shaddick G;Shahraz S;Levy TS;Shangguan S;She J;Sheikhbahaei S;Shibuya K;Shin HH;Shinohara Y;Shiri R;Shishani K;Shiue I;Sigfusdottir ID;Silberberg DH;Simard EP;Sindi S;Singh A;Singh GM;Singh JA;Skirbekk V;Sliwa K;Soljak M;Soneji S;Søreide K;Soshnikov S;Sposato LA;Sreeramareddy CT;Stapelberg NJ;Stathopoulou V;Steckling N;Stein DJ;Stein MB;Stephens N;Stöckl H;Straif K;Stroumpoulis K;Sturua L;Sunguya BF;Swaminathan S;Swaroop M;Sykes BL;Tabb KM;Takahashi K;Talongwa RT;Tandon N;Tanne D;Tanner M;Tavakkoli M;Te Ao BJ;Teixeira CM;Téllez Rojo MM;Terkawi AS;Texcalac-Sangrador JL;Thackway SV;Thomson B;Thorne-Lyman AL;Thrift AG;Thurston GD;Tillmann T;Tobollik M;Tonelli M;Topouzis F;Towbin JA;Toyoshima H;Traebert J;Tran BX;Trasande L;Trillini M;Trujillo U;Dimbuene ZT;Tsilimbaris M;Tuzcu EM;Uchendu US;Ukwaja KN;Uzun SB;van de Vijver S;Van Dingenen R;van Gool CH;van Os J;Varakin YY;Vasankari TJ;Vasconcelos AM;Vavilala MS;Veerman LJ;Velasquez-Melendez G;Venketasubramanian N;Vijayakumar L;Villalpando S;Violante FS;Vlassov VV;Vollset SE;Wagner GR;Waller SG;Wallin MT;Wan X;Wang H;Wang J;Wang L;Wang W;Wang Y;Warouw TS;Watts CH;Weichenthal S;Weiderpass E;Weintraub RG;Werdecker A;Wessells KR;Westerman R;Whiteford HA;Wilkinson JD;Williams HC;Williams TN;Woldeyohannes SM;Wolfe CD;Wong JQ;Woolf AD;Wright JL;Wurtz B;Xu G;Yan LL;Yang G;Yano Y;Ye P;Yenesew M;Yentür GK;Yip P;Yonemoto N;Yoon SJ;Younis MZ;Younoussi Z;Yu C;Zaki ME;Zhao Y;Zheng Y;Zhou M;Zhu J;Zhu S;Zou X;Zunt JR;Lopez AD;Vos T;Murray CJ
《2013年全球疾病、伤害和风险因素负担研究》（GBD 2013）是GBD一系列年度更新中的第一份。风险因素量化，特别是可改变的风险因素量化，可有助于确定人口健康面临的新威胁和预防机会。GBD 2013提供了一个及时的机会，可以使用暴露、相对风险的新数据以及有关适当反事实风险分布的证据来更新比较风险评估。使用GBD 2010方法，对79种风险或风险群的归因死亡、寿命损失年、残疾生存年和残疾调整生命年（DIBs）进行了估计。1990年至2013年期间，使用三个输入：风险暴露、相对风险和理论最低风险暴露水平（TMREL），按年龄和性别对188个国家的符合明确证据标准的风险-结果对进行了评估。风险被组织成一个层次结构，行为、环境和职业以及代谢风险位于层次结构的第一级。层级中的下一级包括九组相关风险和两个单独风险，层级中的第3级和第4级提供了更多详细信息。与2010年GBD相比，增加了6个新的风险因素：洗手习惯、职业性三氯乙烯暴露、儿童消瘦、儿童发育迟缓、不安全性行为和肾小球滤过率低。对于大多数风险，使用贝叶斯元回归方法DisMod-MR 2.0或时空高斯过程回归合成暴露数据。相对风险基于已发表的队列和干预研究的荟萃回归。风险群和所有风险合并的归因负担考虑了通过高收缩压和高胆固醇等其他风险介导高体重指数等一些风险的证据。所有风险合计占死亡的57.2%（95%不确定性区间[UI] 55.8 - 58.5）和死亡的41.6%（40.1 - 43.0）。量化的风险占87.9%（86.5 - 89.3）的心血管疾病DADs，范围为新生儿疾病和被忽视的热带疾病和疟疾的0%。就2013年的全球债务危机而言，有六种风险或风险集群造成的债务危机超过5%：饮食风险导致1130万人死亡和2.414亿迪拉姆，高收缩压导致1040万人死亡和2.081亿迪拉姆，儿童和孕产妇营养不良导致170万人死亡和1.769亿迪拉姆，吸烟导致610万例死亡和1.435亿丹麦克朗，空气污染导致550万例死亡和1.415亿丹麦克朗，高BMI导致440万例死亡和1.340亿丹麦克朗。风险因素模式因区域和国家而异，并随时间而变化。在撒哈拉以南非洲，主要风险因素是儿童和孕产妇营养不良、不安全的性行为以及不安全的水、卫生设施和洗手。在美洲、北非和中东的几乎所有国家以及许多其他高收入国家，高BMI是女性的主要风险因素，而在中欧、东欧、南亚和东亚的大部分国家，高收缩压是主要风险因素。对于男性来说，高收缩压或烟草使用是几乎所有高收入国家，北非和中东，欧洲和亚洲的主要风险。对于男性和女性来说，不安全的性行为是从肯尼亚到南非的走廊的主要风险。行为、环境和职业以及代谢风险可以解释全球死亡率的一半和全球三分之一以上的疾病，这提供了许多预防机会。在较大的风险中，高BMI的负担在过去23年中有所增加。鉴于行为风险因素的突出性，应加强关于这些风险干预措施的行为和社会科学研究。现在有许多预防和初级保健政策可供选择，以应对主要风险。比尔和梅林达·盖茨基金会。
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. Bill & Melinda Gates Foundation.