Files and links (1)
Published, Version of Record (VoR)CC BY V4.0, Open
Journal article
Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021
The Lancet (British edition), v 403(10440), pp 2162-2203
18 May 2024
PMID: 38762324
Featured in Collection : Incites' Hot Drexel Articles
Abstract
Background Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021.
Methods The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2.5th and 97.5th percentile values across the draws.
Findings Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8.0% (95% UI 6.7-9.4) of total DALYs, followed by high systolic blood pressure (SBP; 7.8% [6.4-9.2]), smoking (5.7% [4.7-6.8]), low birthweight and short gestation (5.6% [4.8-6.3]), and high fasting plasma glucose (FPG; 5.4% [4.8-6.0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20.7% [13.9-27.7]) and environmental and occupational risks (decrease of 22.0% [15.5-28.8]), coupled with a 49.4% (42.3-56.9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15.7% [9.9-21.7] for high BMI and 7.9% [3.3-12.9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1.8% (1.6-1.9) for high BMI and 1.3% (1.1-1.5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71.5% (64.4-78.8) for child growth failure and 66.3% (60.2-72.0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP).
Interpretation Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.
Metrics
Details
- Title
- Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021
- Creators
- Michael Brauer - University of WashingtonGregory A. Roth - Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USAAleksandr Y. Aravkin - Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USAPeng Zheng - Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USAKalkidan Hassen Abate - Jimma Univ, Dept Nutr & Dietet, Jimma, EthiopiaYohannes Habtegiorgis Abate - Aleta Wondo Hosp, Dept Clin Governance & Qual Improvement, Aleta Wondo, EthiopiaCristiana Abbafati - Univ Roma La Sapienza, Dept Jurid & Econ Studies, Rome, ItalyRouzbeh Abbasgholizadeh - Univ Calif Los Angeles, Doheny Eye Inst, Los Angeles, CA USAMadineh Akram Abbasi - Tabriz Univ Med Sci, Infect & Trop Res Ctr, Tabriz, IranMohammadreza Abbasian - Harvard Univ, Dept Orthoped Surg, Boston, MA USAMitra Abbasifard - Rafsanjan Univ Med Sci, Dept Internal Med, Rafsanjan, IranMohsen Abbasi-Kangevari - Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, IranSamar Abd ElHafeez - Alexandria UniversitySherief Abd-Elsalam - Tanta Univ, Dept Trop Med & Infect Dis, Tanta, EgyptParsa Abdi - Mem Univ, Dept Med, St John, NF, CanadaMohammad Abdollahi - Univ Tehran Med Sci, Inst Pharmaceut Sci TIPS, Tehran, IranMeriem Abdoun - Univ Setif Algeria, Dept Med, Setif, AlgeriaDeldar Morad Abdulah - Univ Duhok, Community & Matern Nursing Unit, Duhok, IraqAuwal Abdullahi - Bayero Univ Kano, Dept Physiotherapy, Kano, NigeriaMesfin Abebe - Dilla Univ, Dept Midwifery, Dilla, EthiopiaAidin Abedi - Univ Southern Calif, Dept Neurosurg, Los Angeles, CA USAArmita Abedi - Zanjan Univ Med Sci, Dept Emergency Med, Zanjan, IranTadesse M. Abegaz - Univ Gondar, Dept Clin Pharm, Gondar, EthiopiaRoberto Ariel Abeldano Zuniga - Univ Sierra Sur, Postgrad Dept, Miahuatlan De Porfirio D, MexicoOlumide Abiodun - Babcock Univ, Dept Community Med, Ilishan Remo, NigeriaTemesgen Lera Abiso - Wolaita Sodo Univ, Sch Publ Hlth, Wolaita Sodo, EthiopiaRichard Gyan Aboagye - Univ Hlth & Allied Sci, Dept Family & Community Hlth, Ho, GhanaHassan Abolhassani - Univ Tehran Med Sci, Res Ctr Immunodeficiencies, Tehran, IranMohamed Abouzid - Poznan Univ Med Sci, Dept Phys Pharm & Pharmacokinet, Poznan, PolandGirma Beressa Aboye - Madda Walabu Univ, Dept Publ Hlth, Addis Ababa, EthiopiaLucas Guimaraes Abreu - Univ Fed Minas Gerais, Dept Pediat Dent, Belo Horizonte, MG, BrazilHasan Abualruz - Al Zaytoonah Univ Jordan, Dept Nursing, Amman, JordanBilyaminu Abubakar - Usmanu Danfodiyo Univ, Dept Pharmacol & Toxicol, Sokoto, NigeriaEman Abu-Gharbieh - Univ Sharjah, Clin Sci Dept, Sharjah, U Arab EmiratesHana Jihad Jihad Abukhadijah - Hamad Med Corp, Res Dept, Doha, QatarSalahdein Aburuz - United Arab Emirates Univ, Dept Therapeut, Al Ain, U Arab EmiratesAhmed Abu-Zaid - Alfaisal Univ, Dept Surg, Riyadh, Saudi ArabiaMesafint Molla Adane - Bahir Dar Univ, Coll Med & Hlth Sci, Bahir Dar, EthiopiaIsaac Yeboah Addo - Univ New South Wales, Ctr Social Res Hlth, Sydney, NSW, AustraliaGiovanni Addolorato - Fdn Policlin Univ A Gemelli IRCCS, Agostino Gemelli Univ Polyclin IRCCS, Internal Med & Alcohol Related Dis Unit, Rome, ItalyRufus Adesoji Adedoyin - Obafemi Awolowo Univ, Dept Med Rehabil, IleIfe, NigeriaVictor Adekanmbi - College Station Medical CenterBashir Aden - Khalifa Univ, Abu Dhabi, U Arab EmiratesJuliana Bunmi Adetunji - Osun State Univ, Dept Biochem, Osogbo, NigeriaTemitayo Esther Adeyeoluwa - Univ Med Sci, Dept Biosci & Biotechnol, Ondo, NigeriaRishan Adha - Muhammadiyah Univ Mataram, Dept Business Adm, Mataram, IndonesiaAmin Adibi - Univ British Columbia, Dept Pharmaceut Sci, Vancouver, BC, CanadaQorinah EstiningtyasSakilah Adnani - College Station Medical CenterLeticia Akua Adzigbli - Univ Hlth & Allied Sci, Dept Epidemiol & Biostat, Ho, GhanaAanuoluwapo Adeyimika Afolabi - Univ Ibadan, Dept Community Med, Ibadan, NigeriaRotimi Felix Afolabi - Univ Ibadan, Dept Epidemiol & Med Stat, Ibadan, NigeriaAshkan Afshin - Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USAShadi Afyouni - Johns Hopkins Univ, Dept Radiol, Baltimore, MD USAMuhammad Sohail Afzal - Univ Management & Technol, Dept Life Sci, Lahore, PakistanSaira Afzal - King Edward Mem Hosp, Dept Community Med, Lahore, PakistanSuneth Buddhika Agampodi - Rajarata Univ Sri Lanka, Dept Community Med, Anuradhapura, Sri LankaFaith Agbozo - Univ Hlth & Allied Sci, Dept Family & Community Hlth, Ho, GhanaShahin Aghamiri - Shahid Beheshti Univ Med Sci, Dept Biotechnol, Tehran, IranAntonella Agodi - Univ Catania, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, ItalyAnurag Agrawal - Ashoka Univ, Trivedi Sch Biosci, Sonipat, IndiaWilliams Agyemang-Duah - Queens Univ, Dept Geog & Planning, Kingston, ON, CanadaBright Opoku Ahinkorah - Univ Technol Sydney, Sch Publ Hlth, Sydney, NSW, AustraliaAqeel Ahmad - Shaqra Univ, Dept Med Biochem, Shaqra, Saudi ArabiaDanish Ahmad - Drexel UniversityFirdos Ahmad - Univ Sharjah, Coll Med, Sharjah, U Arab EmiratesNoah Ahmad - Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USAShahzaib Ahmad - Miami Canc Inst, Dept Med Oncol, Miami, FL USATauseef Ahmad - Southeast Univ, Dept Epidemiol & Hlth Stat, Nanjing, Peoples R ChinaAli Ahmed - Birmingham VA Medical CenterAnisuddin Ahmed - Int Ctr Diarrhoeal Dis Res, Maternal & Child Hlth Div, Dhaka, BangladeshAyman Ahmed - University of KhartoumLuai A. Ahmed - United Arab Emirates Univ, Inst Publ Hlth, Al Ain, U Arab EmiratesMuktar Beshir Ahmed - Jimma Univ, Dept Epidemiol, Jimma, EthiopiaSafoora Ahmed - Jamia Hamdard, Dept Biochem, Delhi, IndiaSyed Anees AhmedMarjan Ajami - Shahid Beheshti Univ Med Sci, Natl Nutr & Food Technol Res Inst, Tehran, IranGizachew Taddesse Akalu - Millennium Med Coll, St Pauls Hosp, Dept Microbiol Immunol & Parasitol, Addis Ababa, EthiopiaEssona Matatom Akara - Minist Hlth, Moyen Mono Hlth Dist, Tohoun, TogoHossein Akbarialiabad - Univ New South Wales, St George & Sutherland Clin Sch, Sydney, NSW, AustraliaShiva Akhlaghi - Ahvaz Jundishapur Univ Med Sci, Toxicol Res Ctr, Ahvaz, IranKarolina Akinosoglou - Univ Patras, Dept Internal Med, Patras, GreeceTomi Akinyemiju - Duke Univ, Dept Populat Hlth Sci, Durham, NC USAMohammed Ahmed Akkaif - Fudan Univ, Dept Cardiol, Shanghai, Peoples R ChinaSreelatha Akkala - Univ Texas, Dept Management Policy & Community Hlth, Houston, TX USABlessing Akombi-Inyang - Univ New South Wales, Sch Publ Hlth & Community Med, Sydney, NSW, AustraliaSalah Al Awaidy - Minist Hlth, Dept Communicable Dis, Muscat, OmanSyed Mahfuz Al Hasan - Washington Univ, Div Publ Hlth Sci, Sch Med, St Louis, MO USAFares Alahdab - UTHealth, McWilliams Sch Biomed Informat, Houston, TX USATareq Mohammed Ali AL-Ahdal - Heidelberg Univ, HIGH, Heidelberg, GermanySamer O. Alalalmeh - Ajman Univ, Dept Clin Sci, Ajman, U Arab EmiratesTariq A. Alalwan - Univ Bahrain, Dept Biol, Zallaq, BahrainZiyad Al-Aly - Washington Univ, John T Milliken Dept Internal Med, St Louis, MO USAKhurshid Alam - Murdoch Univ, Murdoch Business Sch, Perth, WA, AustraliaNazmul Alam - Asian Univ Women, Dept Publ Hlth, Chittagong, BangladeshFahad Mashhour Alanezi - Imam Abdulrahman Bin Faisal Univ, Dammam, Saudi ArabiaTurki M. Alanzi - Imam Abdulrahman Bin Faisal Univ, Dept Hlth Informat Management & Technol, Dammam, Saudi ArabiaAlmaza Albakri - Royal Jordanian Med Serv, Dept Med, Amman, JordanMohammad T. AlBataineh - Yarmouk Univ, Fac Med, Irbid, JordanWafa A. Aldhaleei - Mayo Clin, Div Gastroenterol & Hepatol, Jacksonville, FL USAGBD 2021 Risk Factors Collaborators
- Publication Details
- The Lancet (British edition), v 403(10440), pp 2162-2203
- Publisher
- Elsevier
- Number of pages
- 42
- Grant note
- Bill AMP; Melinda Gates Foundation; CGIAR
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Biochemistry and Molecular Biology; Urban Health Collaborative; Health Management and Policy
- Web of Science ID
- WOS:001270483200001
- Scopus ID
- 2-s2.0-85192940010
- Other Identifier
- 991021879788904721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
Highly Cited Paper
Hot Paper
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Medicine, General & Internal