Abstract
Original language | English |
---|---|
Pages (from-to) | 2287-2323 |
Journal | Lancet (London, England) |
Volume | 386 |
Issue number | 10010 |
DOIs | |
Publication status | Published - 11 Dec 2015 |
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In: Lancet (London, England), Vol. 386, No. 10010, 11.12.2015, p. 2287-2323.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - 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.
AU - Forouzanfar, Mohammad
AU - Alexander, Lily
AU - Anderson, H. Ross
AU - Bachman, Victoria
AU - Biryukov, Stanley
AU - Brauer, Michael
AU - Burnett, Richard
AU - Casey, Daniel
AU - Coates, Matthew
AU - Cohen, Aaron
AU - Delwiche, Kristen
AU - Estep, Kara
AU - Frostad, Joseph
AU - Kc, Astha
AU - Kyu, Hmwe
AU - Moradi-Lakeh, Maziar
AU - Ng, Marie
AU - Slepak, Erica Leigh
AU - Thomas, Bernadette
AU - Wagner, Joseph
AU - Aasvang, Gunn Marit
AU - Abbafati, Cristiana
AU - Ozgoren, Ayse Abbasoglu
AU - Abd-Allah, Foad
AU - Abera, Semaw
AU - Aboyans, Victor
AU - Abraham, Biju
AU - Abraham, Jerry
AU - Abubakar, Ibrahim
AU - Abu-Rmeileh, Niveen
AU - Aburto, Tania
AU - Achoki, Tom
AU - Adelekan, Ademola
AU - Adofo, Koranteng
AU - Adou, Arsène
AU - Adsuar, José
AU - Afshin, Ashkan
AU - Agardh, Emilie
AU - Al Khabouri, Mazin
AU - Al Lami, Faris
AU - Alam, Sayed Saidul
AU - Alasfoor, Deena
AU - Albittar, Mohammed
AU - Alegretti, Miguel
AU - Aleman, Alicia
AU - Alemu, Zewdie
AU - Alfonso-Cristancho, Rafael
AU - Alhabib, Samia
AU - Ali, Raghib
AU - Ali, Mohammed
AU - Alla, François
AU - Allebeck, Peter
AU - Allen, Peter
AU - Alsharif, Ubai
AU - Alvarez, Elena
AU - Alvis-Guzman, Nelson
AU - Amankwaa, Adansi
AU - Amare, Azmeraw
AU - Ameh, Emmanuel
AU - Ameli, Omid
AU - Amini, Heresh
AU - Ammar, Walid
AU - Anderson, Benjamin
AU - Antonio, Carl Abelardo
AU - Anwari, Palwasha
AU - Cunningham, Solveig Argeseanu
AU - Arnlöv, Johan
AU - Arsenijevic, Valentina
AU - Artaman, Al
AU - Asghar, Rana
AU - Assadi, Reza
AU - Atkins, Lydia
AU - Atkinson, Charles
AU - Avila, Marco
AU - Awuah, Baffour
AU - Badawi, Alaa
AU - Bahit, Maria
AU - Bakfalouni, Talal
AU - Balakrishnan, Kalpana
AU - Balalla, Shivanthi
AU - Balu, Ravi Kumar
AU - Banerjee, Amitava
AU - Barber, Ryan
AU - Barker-Collo, Suzanne
AU - Barquera, Simon
AU - Barregard, Lars
AU - Barrero, Lope
AU - Barrientos-Gutierrez, Tonatiuh
AU - Basto-Abreu, Ana
AU - Basu, Arindam
AU - Basu, Sanjay
AU - Basulaiman, Mohammed
AU - Ruvalcaba, Carolina
AU - Beardsley, Justin
AU - Bedi, Neeraj
AU - Bekele, Tolesa
AU - Bell, Michelle
AU - Benjet, Corina
AU - Bennett, Derrick
AU - Benzian, Habib
AU - Bernabé, Eduardo
AU - Beyene, Tariku
AU - Bhala, Neeraj
AU - Bhalla, Ashish
AU - Bhutta, Zulfiqar
AU - Bikbov, Boris
AU - Abdulhak, Aref A. Bin
AU - Blore, Jed
AU - Blyth, Fiona
AU - Bohensky, Megan
AU - Başara, Berrak Bora
AU - Borges, Guilherme
AU - Bornstein, Natan
AU - Bose, Dipan
AU - Boufous, Soufiane
AU - Bourne, Rupert
AU - Brainin, Michael
AU - Brazinova, Alexandra
AU - Breitborde, Nicholas
AU - Brenner, Hermann
AU - Briggs, Adam
AU - Broday, David
AU - Brooks, Peter
AU - Bruce, Nigel
AU - Brugha, Traolach
AU - Brunekreef, Bert
AU - Buchbinder, Rachelle
AU - Bui, Linh
AU - Bukhman, Gene
AU - Bulloch, Andrew
AU - Burch, Michael
AU - Burney, Peter
AU - Campos-Nonato, Ismael
AU - Campuzano, Julio
AU - Cantoral, Alejandra
AU - Caravanos, Jack
AU - Cárdenas, Rosario
AU - Cardis, Elisabeth
AU - Carpenter, David
AU - Caso, Valeria
AU - Castañeda-Orjuela, Carlos
AU - Castro, Ruben
AU - Catalá-López, Ferrán
AU - Cavalleri, Fiorella
AU - Çavlin, Alanur
AU - Chadha, Vineet
AU - Chang, Jung-Chen
AU - Charlson, Fiona
AU - Chen, Honglei
AU - Chen, Wanqing
AU - Chen, Zhengming
AU - Chiang, Peggy
AU - Chimed-Ochir, Odgerel
AU - Chowdhury, Rajiv
AU - Christophi, Costas
AU - Chuang, Ting-Wu
AU - Chugh, Sumeet
AU - Cirillo, Massimo
AU - Claßen, Thomas
AU - Colistro, Valentina
AU - Colomar, Mercedes
AU - Colquhoun, Samantha
AU - Contreras, Alejandra
AU - Cooper, Cyrus
AU - Cooperrider, Kimberly
AU - Cooper, Leslie
AU - Coresh, Josef
AU - Courville, Karen
AU - Criqui, Michael
AU - Cuevas-Nasu, Lucia
AU - Damsere-Derry, James
AU - Danawi, Hadi
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dargan, Paul
AU - Davis, Adrian
AU - Davitoiu, Dragos
AU - Dayama, Anand
AU - de Castro, E. Filipa
AU - De la Cruz-Góngora, Vanessa
AU - De Leo, Diego
AU - de Lima, Graça
AU - Degenhardt, Louisa
AU - Del Pozo-Cruz, Borja
AU - Dellavalle, Robert
AU - Deribe, Kebede
AU - Derrett, Sarah
AU - Jarlais, Don
AU - Dessalegn, Muluken
AU - deVeber, Gabrielle
AU - Devries, Karen
AU - Dharmaratne, Samath
AU - Dherani, Mukesh
AU - Dicker, Daniel
AU - Ding, Eric
AU - Dokova, Klara
AU - Dorsey, E. Ray
AU - Driscoll, Tim
AU - Duan, Leilei
AU - Durrani, Adnan
AU - Ebel, Beth
AU - Ellenbogen, Richard
AU - Elshrek, Yousef
AU - Endres, Matthias
AU - Ermakov, Sergey
AU - Erskine, Holly
AU - Eshrati, Babak
AU - Esteghamati, Alireza
AU - Fahimi, Saman
AU - Faraon, Emerito Jose
AU - Farzadfar, Farshad
AU - Fay, Derek
AU - Feigin, Valery
AU - Feigl, Andrea
AU - Fereshtehnejad, Seyed-Mohammad
AU - Ferrari, Alize
AU - Ferri, Cleusa
AU - Flaxman, Abraham
AU - Fleming, Thomas
AU - Foigt, Nataliya
AU - Foreman, Kyle
AU - Paleo, Urbano Fra
AU - Franklin, Richard
AU - Gabbe, Belinda
AU - Gaffikin, Lynne
AU - Gakidou, Emmanuela
AU - Gamkrelidze, Amiran
AU - Gankpé, Fortuné
AU - Gansevoort, Ron
AU - García-Guerra, Francisco
AU - Gasana, Evariste
AU - Geleijnse, Johanna
AU - Gessner, Bradford
AU - Gething, Pete
AU - Gibney, Katherine
AU - Gillum, Richard
AU - Ginawi, Ibrahim
AU - Giroud, Maurice
AU - Giussani, Giorgia
AU - Goenka, Shifalika
AU - Goginashvili, Ketevan
AU - Dantes, Hector Gomez
AU - Gona, Philimon
AU - de Cosio, Teresita Gonzalez
AU - González-Castell, Dinorah
AU - Gotay, Carolyn
AU - Goto, Atsushi
AU - Gouda, Hebe
AU - Guerrant, Richard
AU - Gugnani, Harish
AU - Guillemin, Francis
AU - Gunnell, David
AU - Gupta, Rahul
AU - Gupta, Rajeev
AU - Gutiérrez, Reyna
AU - Hafezi-Nejad, Nima
AU - Hagan, Holly
AU - Hagstromer, Maria
AU - Halasa, Yara
AU - Hamadeh, Randah
AU - Hammami, Mouhanad
AU - Hankey, Graeme
AU - Hao, Yuantao
AU - Harb, Hilda
AU - Haregu, Tilahun Nigatu
AU - Haro, Josep Maria
AU - Havmoeller, Rasmus
AU - Hay, Simon
AU - Hedayati, Mohammad
AU - Heredia-Pi, Ileana
AU - Hernandez, Lucia
AU - Heuton, Kyle
AU - Heydarpour, Pouria
AU - Hijar, Martha
AU - Hoek, Hans
AU - Hoffman, Howard
AU - Hornberger, John
AU - Hosgood, H. Dean
AU - Hoy, Damian
AU - Hsairi, Mohamed
AU - Hu, Guoqing
AU - Hu, Howard
AU - Huang, Cheng
AU - Huang, John
AU - Hubbell, Bryan
AU - Huiart, Laetitia
AU - Husseini, Abdullatif
AU - Iannarone, Marissa
AU - Iburg, Kim
AU - Idrisov, Bulat
AU - Ikeda, Nayu
AU - Innos, Kaire
AU - Inoue, Manami
AU - Islami, Farhad
AU - Ismayilova, Samaya
AU - Jacobsen, Kathryn
AU - Jansen, Henrica
AU - Jarvis, Deborah
AU - Jassal, Simerjot
AU - Jauregui, Alejandra
AU - Jayaraman, Sudha
AU - Jeemon, Panniyammakal
AU - Jensen, Paul
AU - Jha, Vivekanand
AU - Jiang, Fan
AU - Jiang, Guohong
AU - Jiang, Ying
AU - Jonas, Jost
AU - Juel, Knud
AU - Kan, Haidong
AU - Sidibé, Kany Roseline
AU - Karam, Nadim
AU - Karch, André
AU - Karema, Corine
AU - Karthikeyan, Ganesan
AU - Kaul, Anil
AU - Kawakami, Norito
AU - Kazi, Dhruv
AU - Kemp, Andrew
AU - Kengne, Andre
AU - Keren, Andre
AU - Khader, Yousef
AU - Khalifa, Shams Eldin Ali
AU - Khan, Ejaz
AU - Khang, Young-Ho
AU - Khatibzadeh, Shahab
AU - Khonelidze, Irma
AU - Kieling, Christian
AU - Kim, Daniel
AU - Kim, Sungroul
AU - Kim, Yunjin
AU - Kimokoti, Ruth
AU - Kinfu, Yohannes
AU - Kinge, Jonas
AU - Kissela, Brett
AU - Kivipelto, Miia
AU - Knibbs, Luke
AU - Knudsen, Ann Kristin
AU - Kokubo, Yoshihiro
AU - Kose, M. Rifat
AU - Kosen, Soewarta
AU - Kraemer, Alexander
AU - Kravchenko, Michael
AU - Krishnaswami, Sanjay
AU - Kromhout, Hans
AU - Ku, Tiffany
AU - Defo, Barthelemy Kuate
AU - Bicer, Burcu Kucuk
AU - Kuipers, Ernst
AU - Kulkarni, Chanda
AU - Kulkarni, Veena
AU - Kumar, G. Anil
AU - Kwan, Gene
AU - Lai, Taavi
AU - Balaji, Arjun Lakshmana
AU - Lalloo, Ratilal
AU - Lallukka, Tea
AU - Lam, Hilton
AU - Lan, Qing
AU - Lansingh, Van
AU - Larson, Heidi
AU - Larsson, Anders
AU - Laryea, Dennis
AU - Lavados, Pablo
AU - Lawrynowicz, Alicia
AU - Leasher, Janet
AU - Lee, Jong-Tae
AU - Leigh, James
AU - Leung, Ricky
AU - Levi, Miriam
AU - Li, Yichong
AU - Li, Yongmei
AU - Liang, Juan
AU - Liang, Xiaofeng
AU - Lim, Stephen
AU - Lindsay, M. Patrice
AU - Lipshultz, Steven
AU - Liu, Shiwei
AU - Liu, Yang
AU - Lloyd, Belinda
AU - Logroscino, Giancarlo
AU - London, Stephanie
AU - Lopez, Nancy
AU - Lortet-Tieulent, Joannie
AU - Lotufo, Paulo
AU - Lozano, Rafael
AU - Lunevicius, Raimundas
AU - Ma, Jixiang
AU - Ma, Stefan
AU - Machado, Vasco
AU - MacIntyre, Michael
AU - Magis-Rodriguez, Carlos
AU - Mahdi, Abbas
AU - Majdan, Marek
AU - Malekzadeh, Reza
AU - Mangalam, Srikanth
AU - Mapoma, Christopher
AU - Marape, Marape
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AU - Margolis, David
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AU - Marzan, Melvin
AU - Mashal, Mohammad
AU - Masiye, Felix
AU - Mason-Jones, Amanda
AU - Matsushita, Kunihiro
AU - Matzopoulos, Richard
AU - Mayosi, Bongani
AU - Mazorodze, Tasara
AU - McKay, Abigail
AU - McKee, Martin
AU - McLain, Abigail
AU - Meaney, Peter
AU - Medina, Catalina
AU - Mehndiratta, Man Mohan
AU - Mejia-Rodriguez, Fabiola
AU - Mekonnen, Wubegzier
AU - Melaku, Yohannes
AU - Meltzer, Michele
AU - Memish, Ziad
AU - Mendoza, Walter
AU - Mensah, George
AU - Meretoja, Atte
AU - Mhimbira, Francis
AU - Micha, Renata
AU - Miller, Ted
AU - Mills, Edward
AU - Misganaw, Awoke
AU - Mishra, Santosh
AU - Ibrahim, Norlinah Mohamed
AU - Mohammad, Karzan
AU - Mokdad, Ali
AU - Mola, Glen
AU - Monasta, Lorenzo
AU - Hernandez, Julio
AU - Montico, Marcella
AU - Moore, Ami
AU - Morawska, Lidia
AU - Mori, Rintaro
AU - Moschandreas, Joanna
AU - Moturi, Wilkister
AU - Mozaffarian, Dariush
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AU - Mukaigawara, Mitsuru
AU - Mullany, Erin
AU - Murthy, Kinnari
AU - Naghavi, Mohsen
AU - Nahas, Ziad
AU - Naheed, Aliya
AU - Naidoo, Kovin
AU - Naldi, Luigi
AU - Nand, Devina
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AU - Narayan, Venkat
AU - Nash, Denis
AU - Neal, Bruce
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AU - Neupane, Sudan
AU - Newton, Charles
AU - Ngalesoni, Frida
AU - de Dieu Ngirabega, Jean
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AU - Nieuwenhuijsen, Mark
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AU - Vijayakumar, Lakshmi
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AU - Violante, Francesco
AU - Vlassov, Vasiliy
AU - Vollset, Stein Emil
AU - Wagner, Gregory
AU - Waller, Stephen
AU - Wallin, Mitchell
AU - Wang, Xiaoxian
AU - Wang, Haidong
AU - Wang, JianLi
AU - Wang, Linhong
AU - Wang, Wenzhi
AU - Wang, Yanping
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AU - Weichenthal, Scott
AU - Weiderpass, Elisabete
AU - Weintraub, Robert
AU - Werdecker, Andrea
AU - Wessells, K. Ryan
AU - Westerman, Ronny
AU - Whiteford, Harvey
AU - Wilkinson, James
AU - Williams, Hywel
AU - Williams, Thomas
AU - Woldeyohannes, Solomon Meseret
AU - Wolfe, Charles
AU - Wong, John
AU - Woolf, Anthony
AU - Wright, Jonathan
AU - Wurtz, Brittany
AU - Xu, Gelin
AU - Yan, Lijing
AU - Yang, Gonghuan
AU - Yano, Yuichiro
AU - Ye, Pengpeng
AU - Yenesew, Muluken
AU - Yentür, Gökalp
AU - Yip, Paul
AU - Yonemoto, Naohiro
AU - Yoon, Seok-Jun
AU - Younis, Mustafa
AU - Younoussi, Zourkaleini
AU - Yu, Chuanhua
AU - Zaki, Maysaa
AU - Zhao, Yong
AU - Zheng, Yingfeng
AU - Zhou, Maigeng
AU - Zhu, Jun
AU - Zhu, Shankuan
AU - Zou, Xiaonong
AU - Zunt, Joseph
AU - Lopez, Alan
AU - Vos, Theo
AU - Murray, Christopher
PY - 2015/12/11
Y1 - 2015/12/11
N2 - BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Bill & Melinda Gates Foundation.
AB - BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Bill & Melinda Gates Foundation.
U2 - 10.1016/S0140-6736(15)00128-2
DO - 10.1016/S0140-6736(15)00128-2
M3 - Article
SN - 0140-6736
SN - 1474-547X
VL - 386
SP - 2287
EP - 2323
JO - Lancet (London, England)
JF - Lancet (London, England)
IS - 10010
ER -