Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Analysing the levels and trends in exposure to leading risk factors and quantification of their effects on human health is 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. The 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.
GBD provides a rules based approach to evidence synthesis that follows the Guidelines on Accurate and Transparent Health Estimates Reporting. Comparable quantification across risks over time and across populations facilitates identifying relative importance and how population health risks are evolving over time. GBD also provides a framework to understand both the trends in risk exposure and the trends in burden attributable to risks. Quantifying and reporting both exposure and attributable burden is important because exposure might be increasing and attributable burden decreasing if other drivers of the underlying outcomes are declining at a fast enough rate.
Global Exposure to Risk:
There were substantial declines, substantial. substantial increases and either non-significant rates of change or significant rates of change. The declining risks fall into two categories. First, a set of risks that are strongly linked to social and economic development, measured by the Sociodemographic Index (SDI). The second set of declining risks includes tobacco smoking and lead, which historically have not been negatively correlated with SDI. For a long list of risk factors, including some large risks, the annual rate of change was either statistically insignificant or the annual rate of change was between –0·5% and 0·5% per year.
Many of these stagnating risks have been or are targets of concerted public health efforts spanning public policy, targeted programmes, and primary care intervention. Concerning for both current and future health are the exposures that are increasing at more than 0·5% per year. Many of the increasing risks are metabolic risk factors; in fact, taken together, the exposure to metabolic risks increased 1·37% per year from 1990 to 2019 and 1·46% per year from 2010 to 2019.
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