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dc.contributor.authorGakidou, Emmanuelaen_US
dc.contributor.authorAfshin, Ashkanen_US
dc.contributor.authorAbajobir, Amanuel Alemuen_US
dc.contributor.authorAbate, Kalkidan Hassenen_US
dc.contributor.authorAbbafati, Cristianaen_US
dc.contributor.authorAbbas, Kaja M.en_US
dc.contributor.authorAbd-Allah, Foaden_US
dc.contributor.authorAbdulle, Abdishakur M.en_US
dc.contributor.authorAbera, Semaw Feredeen_US
dc.contributor.authorAboyans, Victoren_US
dc.contributor.authorAbu-Raddad, Laith J.en_US
dc.contributor.authorAbu-Rmeileh, Niveen M. E.en_US
dc.contributor.authorAbyu, Gebre Yitayihen_US
dc.contributor.authorAdedeji, Isaac Akinkunmien_US
dc.contributor.authorAdetokunboh, Olatunjien_US
dc.contributor.authorAfarideh, Mohsenen_US
dc.contributor.authorAgrawal, Anuragen_US
dc.contributor.authorAgrawal, Sutapaen_US
dc.contributor.authorKiadaliri, Aliasghar Ahmaden_US
dc.contributor.authorAhmadieh, Hamiden_US
dc.contributor.authorAhmed, Muktar Beshiren_US
dc.contributor.authorAichour, Amani Nidhalen_US
dc.contributor.authorAichour, Ibtihelen_US
dc.contributor.authorAichour, Miloud Taki Eddineen_US
dc.contributor.authorAkinyemi, Rufus Olusolaen_US
dc.contributor.authorAkseer, Nadiaen_US
dc.contributor.authorAlahdab, Faresen_US
dc.contributor.authorAl-Aly, Ziyaden_US
dc.contributor.authorAlam, Khurshiden_US
dc.contributor.authorAlam, Nooreen_US
dc.contributor.authorAlam, Tahiyaen_US
dc.contributor.authorAlasfoor, Deenaen_US
dc.contributor.authorAlene, Kefyalew Addisen_US
dc.contributor.authorAli, Komalen_US
dc.contributor.authorAlizadeh-Navaei, Rezaen_US
dc.contributor.authorAlkerwi, Ala'aen_US
dc.contributor.authorAlla, Francoisen_US
dc.contributor.authorAllebeck, Peteren_US
dc.contributor.authorAl-Raddadi, Rajaaen_US
dc.contributor.authorAlsharif, Ubaien_US
dc.contributor.authorAltirkawi, Khalid A.en_US
dc.contributor.authorAlvis-Guzman, Nelsonen_US
dc.contributor.authorAmare, Azmeraw T.en_US
dc.contributor.authorAmini, Erfanen_US
dc.contributor.authorAmmar, Waliden_US
dc.contributor.authorAmoako, Yaw Ampemen_US
dc.contributor.authorAnsari, Hosseinen_US
dc.contributor.authorAnto, Josep M.en_US
dc.contributor.authorAntonio, Carl Abelardo T.en_US
dc.contributor.authorAnwari, Palwashaen_US
dc.contributor.authorArian, Nicholasen_US
dc.contributor.authorArnlov, Johanen_US
dc.contributor.authorArtaman, A.en_US
dc.contributor.authorAryal, Krishna Kumaren_US
dc.contributor.authorKisa, Adnanen_US
dc.contributor.authorKnudsen, Ann Kristinen_US
dc.contributor.authorVollset, Stein Emilen_US
dc.contributor.authorNorheim, Ole Frithjofen_US
dc.contributor.authorTollånes, Mette Christophersenen_US
dc.contributor.authorWeiderpass, Elisabeteen_US
dc.date.accessioned2018-02-12T14:49:10Z
dc.date.available2018-02-12T14:49:10Z
dc.date.issued2017-09
dc.identifier.issn1474-547X
dc.identifier.issn0140-6736
dc.identifier.urihttps://hdl.handle.net/1956/17382
dc.description.abstractMETHODS: We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS: Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.en_US
dc.language.isoengeng
dc.publisherElseviereng
dc.relation.urihttp://www.sciencedirect.com/science/article/pii/S0140673617323668?via%3Dihub
dc.rightsAttribution CC BYeng
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/eng
dc.titleGlobal, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016en_US
dc.typePeer reviewed
dc.typeJournal article
dc.date.updated2018-02-02T15:41:25Z
dc.description.versionpublishedVersionen_US
dc.rights.holderCopyright 2017 The Author(s)
dc.identifier.doihttps://doi.org/10.1016/s0140-6736(17)32366-8
dc.identifier.cristin1530250
dc.source.journalThe Lancet
dc.source.40390
dc.source.1410100
dc.source.pagenumber1345-1422


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