Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

GBD 2017 Risk Factor Collaborators

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2476 Citations (Scopus)


Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA 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 groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. 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. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.

Original languageEnglish
Pages (from-to)1923-1994
Number of pages72
JournalThe Lancet
Issue number10159
Publication statusPublished - 10 Nov 2018

Bibliographical note

Funding Information:
Carl Abelardo Antonio reports personal fees from Johnson & Johnson (Philippines). Yannick Bejot reports grants and personal fees from AstraZeneca and Boehringer-Ingelheim and personal fees from Daiichi-Sankyo, Bristol-Myers Squibb (BMS), Pfizer, Medtronic, Bayer, Novex Pharma, and Merck Sharp & Dohme (MSD). Cyrus Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GlaxoSmithKline (GSK), Medtronic, Merck & Co, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. Seana Gall reports grants from the National Health and Medical Research Council and the National Heart Foundation of Australia. Panniyammakal Jeemon reports a Clinical and Public Health Intermediate Fellowship from the Wellcome Trust–DBT India Alliance (2015–20). Jacek Jóźwiak reports a grant from Valeant, personal fees from Valeant, ALAB Laboratoria and Amgen, and non-financial support from Microlife and Servier. Nicholas Kassebaum reports personal fees and other support from Vifor Pharmaceuticals. Srinivasa Vittal Katikireddi reports grants from NHS Research Scotland, the Medical Research Council, and the Scottish Government Chief Scientist Office. Jeffrey Lazarus reports personal fees from Janssen and Cepheid and grants and personal fees from AbbVie, Gilead Sciences, and MSD. Stefan Lorkowski reports personal fees from Amgen, Berlin-Chemie, MSD, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and non-financial support from Preventicus. Winfried März reports grants and personal fees from Siemens Diagnostics, Aegerion Pharmaceuticals, Amgen, AstraZeneca, Danone Research, Pfizer, BASF, Numares, and Berline-Chemie; personal fees from Hoffmann LaRoche, MSD, Sanofi, and Synageva; grants from Abbott Diagnostics; and other support from Synlab. Walter Mendoza is currently a Program Analyst for Population and Development at the Peru Country Office of the United Nations Population Fund. Dariush Mozaffarian reports grants from National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation; personal fees from Global Organization for EPA and DHA Omega-3s, DSM, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, and America's Test Kitchen; chapter royalties from UpToDate; they serve on the scientific advisory board for Omada Health, Elysium Health, and DayTwo. Maarten Postma reports grants from Mundipharma, Bayer, BMS, AstraZeneca, ARTEG, and AscA; grants and personal fees from Sigma Tau, MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, Ingress Health, AbbVie, and Sanofi; personal fees from Quintiles, Astellas, Mapi, OptumInsight, Novartis, Swedish Orphan, Innoval, Jansen, Intercept, and Pharmerit, and stock ownership in Ingress Health and Pharmacoeconomics Advice Groningen. Kenji Shibuya reports grants from the Ministry of Health, Labour, and Welfare and from the Ministry of Education, Culture, Sports, Science, and Technology. Mark Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation. Jasvinder Singh reports consulting for Horizon, Fidia, UBM, Medscape, WebMD, the NIH, and the American College of Rheumatology; they serve as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to Dinora, a 501c3 entity; they are on the steering committee of OMERACT, an international organisation that develops measures for clinical trials and receives arms-length funding from 36 pharmaceutical companies. Cassandra Szoeke reports a grant from the National Medical Health Research Council, Lundbeck, Alzheimer's Association, and the Royal Australasian College of Practitioners; she holds patent PCT/AU2008/001556. Jeffrey Stanaway reports a grant from Merck & Co. Muthiah Vaduganathan receives research support from the NIH/National Heart, Lung, and Blood Institute and serves as a consultant for Bayer and Baxter Healthcare. Denis Xavier reports grants from Cadila Pharmaceuticals, Boehringer Ingelheim, Sanofi-Aventis, Pfizer, and BMS. All other authors declare no competing interests.

Funding Information:
Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, St Jude Children's Research Hospital, the National Institute on Ageing of the National Institutes of Health (NIH; award P30AG047845) , and the National Institute of Mental Health of NIH (award R01MH110163) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. We thank the Russia Longitudinal Monitoring Survey, done by National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology RAS, for making these data available. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/Europe. The International Coordinator of the 1997–98, 2001–02, 2005–06, and 2009–10 surveys was Candace Currie and the databank managers were Bente Wold for the 1997–98 survey and Oddrun Samdal for the following surveys. A list of principal investigators in each country can be found on the HBSC website . This research uses data from Add Health, a programme project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design of Add Health. People interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W Franklin Street, Chapel Hill, NC 27516–2524 ( ). No direct support was received from grant P01-HD31921 for this analysis. Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. This research used data from the National Health Survey 2003. The authors are grateful to the Ministry of Health of Chile, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Palestinian Central Bureau of Statistics granted the researchers of GBD 2017 access to relevant data in accordance with licence no SLN2014–3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. This paper uses data from Survey of Health, Ageing and Retirement in Europe ( SHARE Waves 1, 2, 3 (SHARELIFE), 4, 5, and 6 (DOIs: 10·6103/SHARE.w1.611, 10.6103/SHARE.w2.611, 10.6103/SHARE.w3.611, 10.6103/SHARE.w4.611, 10.6103/SHARE.w5.611, 10.6103/SHARE.w6.611), see Börsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001–00360), FP6 (SHARE-I3: RII-CT-2006–062193, COMPARE: CIT5-CT-2005–028857, SHARELIFE: CIT4-CT-2006–028812) and FP7 (SHARE-PREP: No 211909, SHARE-LEAP: No 227822, SHARE M4: No 261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740–13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553–01, IAG_BSR06–11, OGHA_04–064, and HHSN271201300071C) and from various national funding sources is gratefully acknowledged. This paper uses data from the WHO Study on global AGEing and adult health.

Publisher Copyright:
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.


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