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Title: | Global, 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 2016. | Authors: | Soneji S.;Alahdab F.;Tehrani-Banihashemi A.;Terkawi A.S.;Tesssema B.;Thakur J.S.;Thamsuwan O.;Thankappan K.R.;Theis A.M.;Thomas M.L.;Thomson A.J.;Thrift A.G. ;Tillmann T.;Tobe-Gai R.;Tobollik M.;Tollanes M.C.;Tonelli M.;Topor-Madry R.;Torre A.;Tortajada M.;Touvier M.;Tran B.X.;Truelsen T.;Tuem K.B.;Tuzcu E.M.;Tyrovolas S.;Ukwaja K.N.;Uneke C.J.;Updike R.;Uthman O.A.;Van Boven J.F.M.;Van Donkelaar A.;Varughese S.;Vasankari T.;Veerman L.J.;Venkateswaran V.;Venketasubramanian N.;Violante F.S.;Vladimirov S.K.;Vlassov V.V.;Vollset S.E.;Vos T.;Wadilo F.;Wakayo T.;Wallin M.T.;Wang Y.-P.;Weichenthal S.;Weiderpass E.;Weintraub R.G.;Weiss D.J.;Werdecker A.;Westerman R.;Whiteford H.A.;Wiysonge C.S.;Woldeyes B.G.;Wolfe C.D.A.;Woodbrook R.;Workicho A.;Wulf Hanson S.;Xavier D.;Xu G.;Yadgir S.;Yakob B.;Yan L.L.;Yaseri M.;Yimam H.H.;Yip P.;Yonemoto N.;Yoon S.-J.;Yotebieng M.;Younis M.Z.;Zaidi Z.;El Sayed Zaki M.;Zavala-Arciniega L.;Zhang X.;Zimsen S.R.M.;Zipkin B.;Zodpey S.;Lim S.S.;Murray C.J.L.;Gakidou E.;Afshin A.;Abajobir A.A.;Abate K.H.;Abbafati C.;Abbas K.M.;Abd-Allah F.;Abdulle A.M.;Abera S.F.;Aboyans V.;Abu-Raddad L.J.;Abu-Rmeileh N.M.E.;Abyu G.Y.;Adedeji I.A.;Adetokunboh O.;Afarideh M.;Agrawal A.;Agrawal S.;Ahmad Kiadaliri A.;Ahmadieh H.;Ahmed M.B.;Aichour A.N.;Aichour I.;Aichour M.T.E.;Akinyemi R.O.;Akseer N.;Al-Aly Z.;Alam K.;Alam N.;Alam T.;Alasfoor D.;Alene K.A.;Ali K.;Alizadeh-Navaei R.;Alkerwi A.;Alla F.;Allebeck P.;Al-Raddadi R.;Alsharif U.;Altirkawi K.A.;Alvis-Guzman N.;Amare A.T.;Amini E.;Ammar W.;Amoako Y.A.;Ansari H.;Anto J.M.;Antonio C.A.T.;Anwari P.;Arian N.;Arnlov J.;Artaman A.;Aryal K.K.;Asayesh H.;Asgedom S.W.;Atey T.M.;Avila-Burgos L.;Avokpaho E.F.G.A.;Awasthi A.;Azzopardi P.;Bacha U.;Badawi A.;Balakrishnan K.;Ballew S.H.;Barac A.;Barber R.M.;Barker-Collo S.L.;Barnighausen T.;Barquera S.;Barregard L.;Barrero L.H.;Batis C.;Battle K.E.;Baune B.T.;Beardsley J.;Bedi N.;Beghi E.;Bell M.L.;Bennett D.A.;Bennett J.R.;Bensenor I.M.;Berhane A.;Berhe D.F.;Bernabe E.;Betsu B.D.;Beuran M.;Beyene A.S.;Bhansali A.;Bhutta Z.A.;Bikbov B.;Birungi C.;Biryukov S.;Blosser C.D.;Boneya D.J.;Bou-Orm I.R.;Brauer M.;Breitborde N.J.K.;Brenner H.;Brugha T.S.;Bulto L.N.B.;Baumgarner B.R.;Butt Z.A.;Cahuana-Hurtado L.;Cardenas R.;Carrero J.J.;Castaneda-Orjuela C.A.;Catala-Lopez F.;Cercy K.;Chang H.-Y.;Charlson F.J.;Chimed-Ochir O.;Chisumpa V.H.;Chitheer A.A.;Christensen H.;Christopher D.J.;Cirillo M.;Cohen A.J.;Comfort H.;Cooper C.;Coresh J.;Cornaby L.;Cortesi P.A.;Criqui M.H.;Crump J.A.;Dandona L.;Dandona R.;Das Neves J.;Davey G.;Davitoiu D.V.;Davletov K.;De Courten B. ;Degenhardt L.;Deiparine S.;Dellavalle R.P.;Deribe K.;Deshpande A.;Dharmaratne S.D.;Ding E.L.;Djalalinia S.;Do H.P.;Dokova K.;Doku D.T.;Dorsey E.R.;Driscoll T.R.;Dubey M.;Duncan B.B.;Duncan S.;Ebert N.;Ebrahimi H.;El-Khatib Z.Z.;Enayati A.;Endries A.Y.;Ermakov S.P.;Erskine H.E.;Eshrati B.;Eskandarieh S.;Esteghamati A.;Estep K.;Faraon E.J.A.;Farinha C.S.E.S.;Faro A.;Farzadfar F.;Fay K.;Feigin V.L.;Fereshtehnejad S.-M.;Fernandes J.C.;Ferrari A.J.;Feyissa T.R.;Filip I.;Fischer F.;Fitzmaurice C.;Flaxman A.D.;Foigt N.;Foreman K.J.;Frostad J.J.;Fullman N.;Furst T.;Furtado J.M.;Ganji M.;Garcia-Basteiro A.L.;Gebrehiwot T.T.;Geleijnse J.M.;Geleto A.;Gemechu B.L.;Gesesew H.A.;Gething P.W.;Ghajar A.;Gibney K.B.;Gill P.S.;Gillum R.F.;Giref A.Z.;Gishu M.D.;Giussani G.;Godwin W.W.;Gona P.N.;Goodridge A.;Gopalani S.V.;Goryakin Y.;Goulart A.C.;Graetz N.;Gugnani H.C.;Guo J.;Gupta R.;Gupta T.;Gupta V.;Gutierrez R.A.;Hachinski V.;Hafezi-Nejad N.;Hailu G.B.;Hamadeh R.R.;Hamidi S.;Hammami M.;Handal A.J.;Hankey G.J.;Harb H.L.;Hareri H.A.;Hassanvand M.S.;Havmoeller R.;Hawley C.;Hay S.I.;Hedayati M.T.;Hendrie D.;Heredia-Pi I.B.;Hoek H.W.;Horita N.;Hosgood H.D.;Hostiuc S.;Hoy D.G.;Hsairi M.;Hu G.;Huang H.;Huang J.J.;Iburg K.M.;Ikeda C.;Inoue M.;Irvine C.M.S.;Jackson M.D.;Jacobsen K.H.;Jahanmehr N.;Jakovljevic M.B.;Jauregui A.;Javanbakht M.;Jeemon P.;Johansson L.R.K.;Johnson C.O.;Jonas J.B.;Jurisson M.;Kabir Z.;Kadel R.;Kahsay A.;Kamal R.;Karch A.;Karema C.K.;Kasaeian A.;Kassebaum N.J.;Kastor A.;Katikireddi S.V.;Kawakami N.;Keiyoro P.N.;Kelbore S.G.;Kemmer L.;Kengne A.P.;Kesavachandran C.N.;Khader Y.S.;Khalil I.A.;Khan E.A.;Khang Y.-H.;Khosravi A.;Khubchandani J.;Kieling C.;Kim D.;Kim J.Y.;Kim Y.J.;Kimokoti R.W.;Kinfu Y.;Kisa A.;Kissimova-Skarbek K.A.;Kivimaki M.;Knibbs L.D.;Knudsen A.K.;Kopec J.A.;Kosen S.;Koul P.A.;Koyanagi A.;Kravchenko M.;Krohn K.J.;Kromhout H.;Kuate Defo B.;Kucuk Bicer B.;Kumar G.A.;Kutz M.;Kyu H.H.;Lal D.K.;Lalloo R.;Lallukka T.;Lan Q.;Lansingh V.C.;Larsson A.;Lee A. ;Lee P.H.;Leigh J.;Leung J.;Levi M.;Li Y.;Liang X.;Liben M.L.;Linn S.;Liu P.;Lodha R.;Logroscino G.;Looker K.J.;Lopez A.D.;Lorkowski S.;Lotufo P.A.;Lozano R.;Lunevicius R.;Macarayan E.R.K.;Magdy Abd El Razek H.;Magdy Abd El Razek M.;Majdan M.;Majdzadeh R.;Majeed A.;Malekzadeh R.;Malhotra R.;Malta D.C.;Mamun A.A.;Manguerra H.;Mantovani L.G.;Mapoma C.C.;Martin R.V.;Martinez-Raga J.;Martins-Melo F.R.;Mathur M.R.;Matsushita K.;Matzopoulos R.;Mazidi M.;McAlinden C.;McGrath J.J.;Mehata S.;Mehndiratta M.M.;Meier T.;Melaku Y.A.;Memiah P.;Memish Z.A.;Mendoza W.;Mengesha M.M.;Mensah G.A.;Mensink G.B.M.;Mereta S.T.;Meretoja A.;Meretoja T.J.;Mezgebe H.B.;Micha R.;Millear A.;Miller T.R.;Minnig S.;Mirarefin M.;Mirrakhimov E.M.;Misganaw A.;Mishra S.R.;Mohammad K.A.;Mohammed K.E.;Mohammed S.;Mohamed Ibrahim N.;Mohan M.B.V.;Mokdad A.H.;Monasta L.;Montanez Hernandez J.C.;Montico M.;Moradi-Lakeh M.;Moraga P.;Morawska L.;Morrison S.D.;Mountjoy-Venning C.;Mueller U.O.;Mullany E.C.;Muller K.;Murthy G.V.S.;Musa K.I.;Naghavi M.;Naheed A.;Nangia V.;Natarajan G.;Negoi I.;Negoi R.I.;Nguyen C.T.;Nguyen G.;Nguyen M.;Nguyen Q.L.;Nguyen T.H.;Nichols E.;Ningrum D.N.A.;Nomura M.;Nong V.M.;Norheim O.F.;Norrving B.;Noubiap J.J.N.;Obermeyer C.M.;Ogbo F.A.;Oh I.-H.;Oladimeji O.;Olagunju A.T.;Olagunju T.O.;Olivares P.R.;Olsen H.E.;Olusanya B.O.;Olusanya J.O.;Opio J.N.;Oren E.;Ortiz A.;Ota E.;Owolabi M.O.;Pa M.;Pacella R.E.;Pana A.;Panda B.K.;Panda-Jonas S.;Pandian J.D.;Papachristou C.;Park E.-K.;Parry C.D.;Patten S.B.;Patton G.C.;Pereira D.M.;Perico N.;Pesudovs K.;Petzold M.;Phillips M.R.;Pillay J.D.;Piradov M.A.;Pishgar F.;Plass D.;Pletcher M.A.;Polinder S.;Popova S.;Poulton R.G.;Pourmalek F.;Prasad N.;Purcell C.;Qorbani M.;Radfar A.;Rafay A.;Rahimi-Movaghar A.;Rahimi-Movaghar V.;Rahman M.;Rahman M.H.U.;Rahman M.A.;Rai R.K.;Rajsic S.;Ram U.;Rawaf S.;Rehm C.D.;Rehm J.;Reiner R.C.;Reitsma M.B.;Reynales-Shigematsu L.M.;Remuzzi G.;Renzaho A.M.N.;Resnikoff S.;Rezaei S.;Ribeiro A.L.;Rivera J.A.;Roba K.T.;Rojas-Rueda D.;Roman Y.;Room R.;Roshandel G.;Roth G.A.;Rothenbacher D.;Rubagotti E.;Rushton L.;Sadat N.;Safdarian M.;Safi S.;Safiri S.;Sahathevan R.;Salama J.;Salomon J.A.;Samy A.M.;Sanabria J.R.;Sanchez-Nino M.D.;Sanchez-Pimienta T.G.;Santomauro D.;Santos I.S.;Santric Milicevic M.M.;Sartorius B.;Satpathy M.;Sawhney M.;Saxena S.;Schaeffner E.;Schmidt M.I.;Schneider I.J.C.;Schutte A.E.;Schwebel D.C.;Schwendicke F.;Seedat S.;Sepanlou S.G.;Serdar B.;Servan-Mori E.E.;Shaddick G.;Shaheen A.;Shahraz S.;Shaikh M.A.;Shamah Levy T.;Shamsipour M.;Shamsizadeh M.;Shariful Islam S.M.;Sharma J.;Sharma R.;She J.;Shen J.;Shi P.;Shibuya K.;Shields C.;Shiferaw M.S.;Shigematsu M.;Shin M.-J.;Shiri R.;Shirkoohi R.;Shishani K.;Shoman H.;Shrime M.G.;Sigfusdottir I.D.;Silva D.A.S.;Silva J.P.;Silveira D.G.A.;Singh J.A.;Singh V.;Sinha D.N.;Skiadaresi E.;Slepak E.L.;Smith D.L.;Smith M.;Sobaih B.H.A.;Sobngwi E.;Sorensen R.J.D.;Sposato L.A.;Sreeramareddy C.T.;Srinivasan V.;Steel N.;Stein D.J.;Steiner C.;Steinke S.;Stokes M.A.;Strub B.;Subart M.;Sufiyan M.B.;Suliankatchi R.A.;Sur P.J.;Swaminathan S.;Sykes B.L.;Szoeke C.E.I.;Tabares-Seisdedos R.;Tadakamadla S.K.;Takahashi K.;Takala J.S.;Tandon N.;Tanner M.;Tarekegn Y.L.;Tavakkoli M.;Tegegne T.K. | Institution: | (Gakidou, Afshin, Alam, Ali, Arian, Barber, Bennett, Biryukov, Brauer, Baumgarner, Cercy, Charlson, Cohen, Comfort, Cornaby, Dandona, Dandona, Degenhardt, Deiparine, Deshpande, Duncan, Erskine, Estep, Fay, Ferrari, Fitzmaurice, Flaxman, Foreman, Frostad, Fullman, Godwin, Graetz, Guo, Hawley, Hay, Ikeda, Irvine, Johnson, Kassebaum, Kemmer, Khalil, Kim, Krohn, Kutz, Kyu, Lee, Leung, Liu, Manguerra, Millear, Minnig, Mirarefin, Misganaw, Mokdad, Mountjoy-Venning, Mullany, Muller, Naghavi, Nguyen, Nguyen, Nichols, Olsen, Pletcher, Purcell, Reiner, Reitsma, Roman, Roth, Sadat, Salama, Santomauro, Shields, Slepak, Smith, Smith, Sorensen, Srinivasan, Steiner, Strub, Subart, Sur, Thamsuwan, Theis, Torre, Updike, Venkateswaran, Vollset, Vos, Whiteford, Woodbrook, Wulf Hanson, Yadgir, Zimsen, Zipkin, Lim, Murray) Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, United States (Fitzmaurice) Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, United States (Blosser, Jakovljevic, Morrison) Center for Health Trends and Forecasts, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States (Abajobir, Charlson, Erskine, Ferrari, Knibbs, Leung, Santomauro, Veerman, Whiteford) School of Public Health, University of Queensland, Brisbane, QLD, Australia (Lalloo, Mishra) School of Dentistry, University of Queensland, Brisbane, QLD, Australia (Abate, Ahmed, Gebrehiwot, Gesesew, Mereta, Wakayo, Workicho) Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia (Abbafati) La Sapienza University, Rome, Italy (Abbas) Virginia Tech., Blacksburg, VA, United States (Abd-Allah) Department of Neurology, Cairo University, Cairo, Egypt (Abdulle) New York University Abu Dhabi, Abu Dhabi, United Arab Emirates (Abera, Melaku) School of Public Health, Mekelle University, Mekelle, Ethiopia (Abera, Mohammed) College of Health Sciences, Mekelle University, Mekelle, Ethiopia (Abyu, Asgedom, Atey, Berhe, Betsu, Hailu, Kahsay, Mezgebe, Tuem) School of Pharmacy, Mekelle University, Mekelle, Ethiopia (Abera) Food Security and Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany (Aboyans) Dupuytren University Hospital, Limoges, France (Abu-Raddad) Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar (Abu-Rmeileh) Institute of Community and Public Health, Birzeit University, Ramallah, Palestine (Adedeji) Olabisi Onabanjo University, Ago-Iwoye, Nigeria (Adetokunboh, Parry, Seedat, Wiysonge) Department of Psychiatry, Stellenbosch University, Cape Town, South Africa (Agrawal) CSIR - Institute of Genomics and Integrative Biology, Delhi, India (Agrawal) Department of Internal Medicine, Baylor College of Medicine, Houston, TX, United States (Jeemon) Centre for Control of Chronic Conditions, Gurugram, India (Murthy) Indian Institute of Public Health, Gurugram, India (Agrawal, Dandona, Dandona, Kumar, Lal, Mathur, Zodpey) Public Health Foundation of India, Gurugram, India (Ahmad Kiadaliri) Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden (Norrving) Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden (Ahmadieh, Safi, Yaseri) Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Jahanmehr) School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Ahmadieh) Department of Ophthalmology, Labbafinejad Medical Center, Tehran, Iran, Islamic Republic of (Aichour) University Ferhat Abbas of Setif, Setif, Algeria (Aichour) National Institute of Nursing Education, Setif, Algeria (Aichour) High National School of Veterinary Medicine, Algiers, Algeria (Akinyemi) University of Ibadan, Ibadan, Nigeria (Akinyemi) Newcastle University, Newcastle-upon-Tyne, United Kingdom (Akseer, Bhutta) Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada (Akseer, Rehm) Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Badawi) Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Popova) Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada (Alahdab) Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, United States (Alahdab) Syrian American Medical Society, Washington, DC, United States (Al-Aly) Washington University in St Louis, St. Louis, MO, United States (Alam, Azzopardi, Weintraub) Murdoch Childrens Research Institute, University of Melbourne, Melbourne, VIC, Australia (Azzopardi, Patton) Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia (Lopez) Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (Meretoja) Department of Medicine, University of Melbourne, Melbourne, VIC, Australia (Alam, Rahman, Szoeke, Weintraub) Institute of Health and Ageing, University of Melbourne, Melbourne, VIC, Australia (Alam, Driscoll, Leigh) Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia (Alam) Department of Health, Queensland, Brisbane, QLD, Australia (Alasfoor) Ministry of Health, Al Khuwair, Oman (Alene, Tesssema) Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia (Alene) Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia (Alizadeh-Navaei) Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Hedayati) Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Alkerwi) Luxembourg Institute of Health, Strassen, Luxembourg (Alla) School of Public Health, University of Lorraine, Nancy, France (Allebeck, El-Khatib) Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Arnlov) Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden (Carrero, Weiderpass) Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (Fereshtehnejad, Havmoeller) Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (Al-Raddadi) Joint Program of Family and Community Medicine, Jeddah, Saudi Arabia (Alsharif, Ebert, Schaeffner) Charite Universitatsmedizin, Berlin, Germany (Altirkawi, Sobaih) King Saud University, Riyadh, Saudi Arabia (Alvis-Guzman) Universidad de Cartagena, Cartagena de Indias, Colombia (Amare, Baune, Melaku) School of Medicine, University of Adelaide, Adelaide, SA, Australia (Olagunju) Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia (Amare) College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia (Amini, Pishgar) Uro-Oncology Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Ebrahimi, Farzadfar, Khosravi, Pishgar) Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Amini, Esteghamati, Hafezi-Nejad, Kasaeian) Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Hassanvand) Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Kasaeian) Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Majdzadeh) Knowledge Utilization Research Center, Community Based Participatory Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Ebrahimi) Liver and Pancreaticobiliary Diseases Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Malekzadeh, Roshandel, Sepanlou) Digestive Diseases Research Institute, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Rahimi-Movaghar) Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Rahimi-Movaghar, Safdarian) Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Shamsipour) Institute for Environmental Research, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Afarideh, Ganji, Ghajar, Shirkoohi, Yaseri) Cancer Research Center, Tehran University of Medical Sciences, Terhan, Iran, Islamic Republic of (Ammar, Bou-Orm, Harb) Ministry of Public Health, Beirut, Lebanon (Amoako) Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Ansari) Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of (Anto) ISGlobal Barcelona Institute for Global Health, Barcelona, Spain (Antonio, Faraon) Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines (Anwari) KabulAfghanistan (Arnlov) School of Health and Social Studies, Dalarna University, Falun, Sweden (Artaman) University of Manitoba, Winnipeg, MB, Canada (Aryal) Nepal Health Research Council, Kathmandu, Nepal (Aryal) University of Oslo, Oslo, Norway (Asayesh) Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran, Islamic Republic of (Batis) National Council for Science and Technology, Cuernavaca, Mexico (Avila-Burgos, Barquera, Cahuana-Hurtado, Heredia-Pi, Jauregui, Lozano, Montanez Hernandez, Reynales-Shigematsu, Rivera, Sanchez-Pimienta, Servan-Mori, Shamah Levy, Zavala-Arciniega) National Institute of Public Health, Cuernavaca, Mexico (Avokpaho) Institut de Recherche Clinique du Benin (IRCB), Cotonou, Benin (Avokpaho) Laboratoire d'Etudes et de Recherche-Action en Sante (LERAS Afrique), Parakou, Benin (Awasthi) Indian Institute of Public Health, Gandhinagar, India (Azzopardi) Burnet Institute, Melbourne, VIC, Australia (Azzopardi) Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia (Bacha) School of Health Sciences, University of Management and Technology, Lahore, Pakistan (Badawi) Public Health Agency of Canada, Toronto, ON, Canada (Balakrishnan) Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India (Ballew, Coresh, Matsushita, Tran) Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States (Barac) Faculty of Medicine, University of Belgrade, Belgrade, Serbia (Santric Milicevic) Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (Santric Milicevic) Centre School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (Barker-Collo) School of Psychology, University of Auckland, Auckland, New Zealand (Barnighausen, Salomon) Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States (Ding) Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States (Macarayan) Ariadne Labs, Harvard University, Boston, MA, United States (Barnighausen) Africa Health Research Institute, Mtubatuba, South Africa (Barnighausen, Mohammed) Institute of Public Health, Heidelberg University, Heidelberg, Germany (Barregard) Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Barrero) Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia (Battle) Malaria Atlas Project, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom (Hay) Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom (Bennett) Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (Gething, Weiss) Department of Zoology, University of Oxford, Oxford, United Kingdom (Beardsley) Oxford University, Ho Chi Minh City, United Kingdom (Bedi) College of Public Health and Tropical Medicine, Jazan, Saudi Arabia (Beghi, Bikbov, Giussani, Perico, Remuzzi) IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy (Bell, Huang) Yale University, New Haven, CT, United States (Goulart) Center for Clinical and Epidemiological Research Center, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil (Bensenor, Lotufo, Santos) Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil (Berhane) College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia (Berhe) University Medical Center Groningen, University of Groningen, Groningen, Netherlands (Hoek, Van Boven) Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands (Bernabe, Wolfe) Division of Health and Social Care Research, King's College London, London, United Kingdom (Beuran, Davitoiu, Hostiuc, Negoi, Negoi) Carol Davila University of 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[Ovid has truncated this field to avoid Excel character limitations] | Issue Date: | 27-Oct-2017 | Copyright year: | 2017 | Publisher: | Lancet Publishing Group (E-mail: cususerv@lancet.com) | Place of publication: | United Kingdom | Publication information: | The Lancet. 390 (10100) (pp 1345-1422), 2017. Date of Publication: 16 Sep 2017. | Journal: | The Lancet | Abstract: | Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Method(s): 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. Finding(s): 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. Interpretation(s): Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.Copyright © The Author(s). Published by Elsevier Ltd. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/S0140-6736%2817%2932366-8 | PubMed URL: | 28919119 [http://www.ncbi.nlm.nih.gov/pubmed/?term=28919119] | ISSN: | 0140-6736 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/27382 | Type: | Article | Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
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