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@ARTICLE{Collaborators:142139,
author = {J. D. Stanaway and A. Afshin and E. Gakidou and S. S. Lim
and D. Abate and K. H. Abate and C. Abbafati and N. Abbasi
and H. Abbastabar and F. Abd-Allah and J. Abdela and A.
Abdelalim and I. Abdollahpour and R. S. Abdulkader and M.
Abebe and Z. Abebe and S. F. Abera and O. Z. Abil and H. N.
Abraha and A. R. Abrham and L. J. Abu-Raddad and N. M.
Abu-Rmeileh and M. M. K. Accrombessi and D. Acharya and P.
Acharya and A. A. Adamu and A. A. Adane and O. M. Adebayo
and R. A. Adedoyin and V. Adekanmbi and Z. Ademi and O. O.
Adetokunboh and M. G. Adib and A. Admasie and J. C. Adsuar
and K. A. Afanvi and M. Afarideh and G. Agarwal and A.
Aggarwal and S. A. Aghayan and A. Agrawal and S. Agrawal and
A. Ahmadi and M. Ahmadi and H. Ahmadieh and M. B. Ahmed and
A. N. Aichour and I. Aichour and M. T. E. Aichour and M. E.
Akbari and T. Akinyemiju and N. Akseer and Z. Al-Aly and A.
Al-Eyadhy and H. M. Al-Mekhlafi and F. Alahdab and K. Alam
and S. Alam and T. Alam and A. Alashi and S. M. Alavian and
K. A. Alene and K. Ali and S. M. Ali and M. Alijanzadeh and
R. Alizadeh-Navaei and S. M. Aljunid and A. Alkerwi and F.
Alla and U. Alsharif and K. Altirkawi and N. Alvis-Guzman
and A. T. Amare and W. Ammar and N. H. Anber and J. A.
Anderson and C. L. Andrei and S. Androudi and M. D. Animut
and M. Anjomshoa and M. G. Ansha and J. M. Antó and C. A.
T. Antonio and P. Anwari and L. T. Appiah and S. C. Y.
Appiah and J. Arabloo and O. Aremu and J. Ärnlöv and A.
Artaman and K. K. Aryal and H. Asayesh and Z. Ataro and M.
Ausloos and E. F. G. A. Avokpaho and A. Awasthi and B. P.
Ayala Quintanilla and R. Ayer and T. B. Ayuk and P. S.
Azzopardi and A. Babazadeh and H. Badali and A. Badawi and
K. Balakrishnan and A. G. Bali and K. Ball and S. H. Ballew
and M. Banach and J. A. M. Banoub and A. Barac and S. L.
Barker-Collo and T. W. Bärnighausen and L. H. Barrero and
S. Basu and B. T. Baune and S. Bazargan-Hejazi and N. Bedi
and E. Beghi and M. Behzadifar and M. Behzadifar and Y.
Béjot and B. B. Bekele and E. T. Bekru and E. Belay and Y.
A. Belay and M. L. Bell and A. K. Bello and D. A. Bennett
and I. M. Bensenor and G. Bergeron and A. Berhane and E.
Bernabe and R. S. Bernstein and M. Beuran and T. Beyranvand
and N. Bhala and A. Bhalla and S. Bhattarai and Z. A. Bhutta
and B. Biadgo and A. Bijani and B. Bikbov and V. Bilano and
N. Bililign and M. S. Bin Sayeed and D. Bisanzio and T.
Biswas and T. Bjørge and B. F. Blacker and A. Bleyer and R.
Borschmann and I. R. Bou-Orm and S. Boufous and R. Bourne
and O. J. Brady and M. Brauer and A. Brazinova and N. J. K.
Breitborde and H. Brenner$^*$ and A. N. Briko and G. Britton
and T. Brugha and R. Buchbinder and R. T. Burnett and R.
Busse and Z. A. Butt and L. E. Cahill and L. Cahuana-Hurtado
and I. R. Campos-Nonato and R. Cárdenas and G. Carreras and
J. J. Carrero and F. Carvalho and C. A. Castañeda-Orjuela
and J. Castillo Rivas and F. Castro and F. Catalá-López
and K. Causey and K. M. Cercy and E. Cerin and Y. Chaiah and
H.-Y. Chang and J.-C. Chang and K.-L. Chang and F. J.
Charlson and A. Chattopadhyay and V. K. Chattu and M. L.
Chee and C.-Y. Cheng and A. Chew and P. P. Chiang and O.
Chimed-Ochir and K. L. Chin and A. Chitheer and J. J. Choi
and R. Chowdhury and H. Christensen and D. J. Christopher
and S.-C. Chung and F. M. Cicuttini and M. Cirillo and A. J.
Cohen and D. Collado-Mateo and C. Cooper and O. R. Cooper
and J. Coresh and L. Cornaby and P. A. Cortesi and M.
Cortinovis and M. Costa and E. Cousin and M. H. Criqui and
E. A. Cromwell and D. K. Cundiff and A. K. Daba and B. A.
Dachew and A. F. Dadi and A. A. M. Damasceno and L. Dandona
and R. Dandona and S. C. Darby and P. I. Dargan and A.
Daryani and R. Das Gupta and J. Das Neves and T. T. Dasa and
A. P. Dash and D. V. Davitoiu and K. Davletov and V. De la
Cruz-Góngora and F. P. De La Hoz and D. De Leo and J.-W. De
Neve and L. Degenhardt and S. Deiparine and R. P. Dellavalle
and G. T. Demoz and E. Denova-Gutiérrez and K. Deribe and
N. Dervenis and A. Deshpande and D. C. Des Jarlais and G. A.
Dessie and G. A. Deveber and S. Dey and S. D. Dharmaratne
and M. Dhimal and M. T. Dinberu and E. L. Ding and H. D.
Diro and S. Djalalinia and H. P. Do and K. Dokova and D. T.
Doku and K. E. Doyle and T. R. Driscoll and M. Dubey and E.
Dubljanin and E. E. Duken and B. B. Duncan and A. R. Duraes
and N. Ebert and H. Ebrahimi and S. Ebrahimpour and D.
Edvardsson and A. Effiong and A. E. Eggen and C. El
Bcheraoui and Z. El-Khatib and I. R. Elyazar and A. Enayati
and A. Y. Endries and B. Er and H. E. Erskine and S.
Eskandarieh and A. Esteghamati and K. Estep and H. Fakhim
and M. Faramarzi and M. Fareed and T. A. Farid and C. S. E.
S. Farinha and A. Farioli and A. Faro and M. S. Farvid and
M. H. Farzaei and B. Fatima and K. A. Fay and A. A. Fazaeli
and V. L. Feigin and A. B. Feigl and S.-M. Fereshtehnejad
and E. Fernandes and J. C. Fernandes and G. Ferrara and A.
J. Ferrari and M. L. Ferreira and I. Filip and J. D. Finger
and F. Fischer and N. A. Foigt and K. J. Foreman and T.
Fukumoto and N. Fullman and T. Fürst and J. M. Furtado and
N. D. Futran and S. Gall and S. Gallus and A. Gamkrelidze
and M. Ganji and A. L. Garcia-Basteiro and W. M. Gardner and
A. K. Gebre and A. T. Gebremedhin and T. G. Gebremichael and
T. F. Gelano and J. M. Geleijnse and Y. C. D. Geramo and P.
W. Gething and K. E. Gezae and R. Ghadimi and K. Ghadiri and
K. Ghasemi Falavarjani and M. Ghasemi-Kasman and M. Ghimire
and R. Ghosh and A. G. Ghoshal and S. Giampaoli and P. S.
Gill and T. K. Gill and R. F. Gillum and I. A. Ginawi and G.
Giussani and E. V. Gnedovskaya and W. W. Godwin and S. Goli
and H. Gómez-Dantés and P. N. Gona and S. V. Gopalani and
A. C. Goulart and A. Grada and M. E. Grams and G. Grosso and
H. C. Gugnani and Y. Guo and R. Gupta and R. Gupta and T.
Gupta and R. A. Gutiérrez and D. S. Gutiérrez-Torres and
J. A. Haagsma and T. D. Habtewold and V. Hachinski and N.
Hafezi-Nejad and T. B. Hagos and T. T. Hailegiyorgis and G.
B. Hailu and A. Haj-Mirzaian and A. Haj-Mirzaian and R. R.
Hamadeh and S. Hamidi and A. J. Handal and G. J. Hankey and
Y. Hao and H. L. Harb and S. Harikrishnan and J. M. Haro and
H. Hassankhani and H. Y. Hassen and R. Havmoeller and C. N.
Hawley and S. I. Hay and A. Hedayatizadeh-Omran and B.
Heibati and B. Heidari and M. Heidari and D. Hendrie and A.
Henok and I. Heredia-Pi and C. Herteliu and F. Heydarpour
and S. Heydarpour and D. T. Hibstu and T. B. Higazi and E.
H. Hilawe and H. W. Hoek and H. J. Hoffman and M. K. Hole
and E. Homaie Rad and P. Hoogar and H. D. Hosgood and S. M.
Hosseini and M. Hosseinzadeh and M. Hostiuc and S. Hostiuc
and D. G. Hoy and M. Hsairi and T. Hsiao and G. Hu and H. Hu
and J. J. Huang and M. A. Hussen and C. K. Huynh and K. M.
Iburg and N. Ikeda and O. S. Ilesanmi and U. Iqbal and S. S.
N. Irvani and C. M. S. Irvine and S. M. S. Islam and F.
Islami and M. D. Jackson and K. H. Jacobsen and L. Jahangiry
and N. Jahanmehr and S. K. Jain and M. Jakovljevic and S. L.
James and S. K. Jassal and A. U. Jayatilleke and P. Jeemon
and R. P. Jha and V. Jha and J. S. Ji and J. B. Jonas and J.
Jonnagaddala and Z. Jorjoran Shushtari and A. Joshi and J.
J. Jozwiak and M. Jürisson and Z. Kabir and A. Kahsay and
R. Kalani and T. Kanchan and S. Kant and C. Kar and M.
Karami and B. Karami Matin and A. Karch and C. Karema and N.
Karimi and S. M. Karimi and A. Kasaeian and D. H. Kassa and
G. M. Kassa and T. D. Kassa and N. J. Kassebaum and S. V.
Katikireddi and A. Kaul and N. Kawakami and Z. Kazemi and A.
K. Karyani and A. T. Kefale and P. N. Keiyoro and G. R. Kemp
and A. P. Kengne and A. Keren and C. N. Kesavachandran and
Y. S. Khader and B. Khafaei and M. A. Khafaie and A. Khajavi
and N. Khalid and I. A. Khalil and G. Khan and M. S. Khan
and M. A. Khan and Y.-H. Khang and M. M. Khater and M.
Khazaei and H. Khazaie and A. T. Khoja and A. Khosravi and
M. H. Khosravi and A. A. Kiadaliri and D. N. Kiirithio and
C.-I. Kim and D. Kim and Y.-E. Kim and Y. J. Kim and R. W.
Kimokoti and Y. Kinfu and A. Kisa and K. Kissimova-Skarbek
and M. Kivimäki and L. D. Knibbs and A. K. S. Knudsen and
S. Kochhar and Y. Kokubo and T. Kolola and J. A. Kopec and
S. Kosen and P. A. Koul and A. Koyanagi and M. A. Kravchenko
and K. Krishan and K. J. Krohn and H. Kromhout and B. Kuate
Defo and B. Kucuk Bicer and G. A. Kumar and M. Kumar and I.
Kuzin and H. H. Kyu and C. Lachat and D. P. Lad and S. D.
Lad and A. Lafranconi and R. Lalloo and T. Lallukka and F.
H. Lami and J. J. Lang and V. C. Lansingh and S. L. Larson
and A. Latifi and J. V. Lazarus and P. H. Lee and J. Leigh
and M. Leili and C. T. Leshargie and J. Leung and M. Levi
and S. Lewycka and S. Li and Y. Li and J. Liang and X. Liang
and Y. Liao and M. L. Liben and L.-L. Lim and S. Linn and S.
Liu and R. Lodha and G. Logroscino and A. D. Lopez and S.
Lorkowski and P. A. Lotufo and R. Lozano and T. C. D. Lucas
and R. Lunevicius and S. Ma and E. R. K. Macarayan and Í.
E. Machado and F. Madotto and H. T. Mai and M. Majdan and R.
Majdzadeh and A. Majeed and R. Malekzadeh and D. C. Malta
and A. A. Mamun and A.-L. Manda and H. Manguerra and M. A.
Mansournia and L. G. Mantovani and J. C. Maravilla and W.
Marcenes and A. Marks and R. V. Martin and S. C. O. Martins
and F. R. Martins-Melo and W. März and M. B. Marzan and B.
B. Massenburg and M. R. Mathur and P. Mathur and K.
Matsushita and P. K. Maulik and M. Mazidi and C. McAlinden
and J. J. McGrath and M. McKee and R. Mehrotra and K. M.
Mehta and V. Mehta and T. Meier and F. A. Mekonnen and Y. A.
Melaku and A. Melese and M. Melku and P. T. N. Memiah and Z.
A. Memish and W. Mendoza and D. T. Mengistu and G. A. Mensah
and G. B. M. Mensink and S. T. Mereta and A. Meretoja and T.
J. Meretoja and T. Mestrovic and H. B. Mezgebe and B.
Miazgowski and T. Miazgowski and A. I. Millear and T. R.
Miller and M. K. Miller-Petrie and G. K. Mini and M.
Mirarefin and A. Mirica and E. M. Mirrakhimov and A. T.
Misganaw and H. Mitiku and B. Moazen and B. Mohajer and K.
A. Mohammad and M. Mohammadi and N. Mohammadifard and M.
Mohammadnia-Afrouzi and S. Mohammed and F. Mohebi and A. H.
Mokdad and M. Molokhia and F. Momeniha and L. Monasta and Y.
Moodley and G. Moradi and M. Moradi-Lakeh and M. Moradinazar
and P. Moraga and L. Morawska and J. Morgado-Da-Costa and S.
D. Morrison and M. M. Moschos and S. Mouodi and S. M.
Mousavi and D. Mozaffarian and K. B. Mruts and A. A. Muche
and K. F. Muchie and U. O. Mueller and O. S. Muhammed and S.
Mukhopadhyay and K. Muller and K. I. Musa and G. Mustafa and
A. F. Nabhan and M. Naghavi and A. Naheed and A. Nahvijou
and G. Naik and N. Naik and F. Najafi and V. Nangia and J.
R. Nansseu and B. R. Nascimento and B. Neal and N. Neamati
and I. Negoi and R. I. Negoi and S. Neupane and C. R. J.
Newton and J. W. Ngunjiri and A. Q. Nguyen and G. Nguyen and
H. T. Nguyen and H. L. T. Nguyen and H. T. Nguyen and M.
Nguyen and N. B. Nguyen and E. Nichols and J. Nie and D. N.
A. Ningrum and Y. L. Nirayo and N. Nishi and M. R. Nixon and
M. Nojomi and S. Nomura and O. F. Norheim and M. Noroozi and
B. Norrving and J. J. Noubiap and H. R. Nouri and M.
Nourollahpour Shiadeh and M. R. Nowroozi and E. O. Nsoesie
and P. S. Nyasulu and C. M. Obermeyer and C. M. Odell and R.
Ofori-Asenso and F. A. Ogbo and I.-H. Oh and O. Oladimeji
and A. T. Olagunju and T. O. Olagunju and P. R. Olivares and
H. E. Olsen and B. O. Olusanya and J. O. Olusanya and K. L.
Ong and S. K. Ong and E. Oren and H. M. Orpana and A. Ortiz
and E. Ota and S. S. Otstavnov and S. Øverland and M. O.
Owolabi and M. P A and R. Pacella and A. P. Pakhare and A.
H. Pakpour and A. Pana and S. Panda-Jonas and E.-K. Park and
C. D. H. Parry and H. Parsian and S. Patel and S. Pati and
S. T. Patil and A. Patle and G. C. Patton and D. Paudel and
K. R. Paulson and W. C. Paz Ballesteros and N. Pearce and A.
Pereira and D. M. Pereira and N. Perico and K. Pesudovs and
M. Petzold and H. Q. Pham and M. R. Phillips and J. D.
Pillay and M. A. Piradov and M. Pirsaheb and T. Pischon and
F. Pishgar and O. Plana-Ripoll and D. Plass and S. Polinder
and K. R. Polkinghorne and M. J. Postma and R. Poulton and
A. Pourshams and H. Poustchi and D. Prabhakaran and S.
Prakash and N. Prasad and C. A. Purcell and M. B. Purwar and
M. Qorbani and A. Radfar and A. Rafay and A. Rafiei and F.
Rahim and Z. Rahimi and A. Rahimi-Movaghar and V.
Rahimi-Movaghar and M. Rahman and M. H. U. Rahman and M. A.
Rahman and R. K. Rai and F. Rajati and S. Rajsic and S. B.
Raju and U. Ram and C. L. Ranabhat and P. Ranjan and G. K.
Rath and D. L. Rawaf and S. Rawaf and K. S. Reddy and C. D.
Rehm and J. Rehm and R. C. Reiner and M. B. Reitsma and G.
Remuzzi and A. M. N. Renzaho and S. Resnikoff and L. M.
Reynales-Shigematsu and S. Rezaei and A. L. P. Ribeiro and
J. A. Rivera and K. T. Roba and S. Rodríguez-Ramírez and
L. Roever and Y. Román and L. Ronfani and G. Roshandel and
A. Rostami and G. A. Roth and D. Rothenbacher and A. Roy and
E. Rubagotti and L. Rushton and C. Sabanayagam and P. S.
Sachdev and B. Saddik and E. Sadeghi and S. Saeedi Moghaddam
and H. Safari and Y. Safari and R. Safari-Faramani and M.
Safdarian and S. Safi and S. Safiri and R. Sagar and A.
Sahebkar and M. A. Sahraian and H. S. Sajadi and N. Salam
and P. Salamati and Z. Saleem and Y. Salimi and H.
Salimzadeh and J. A. Salomon and D. D. Salvi and I. Salz and
A. M. Samy and J. Sanabria and M. D. Sanchez-Niño and T. G.
Sánchez-Pimienta and T. Sanders and Y. Sang and D. F.
Santomauro and I. S. Santos and J. V. Santos and M. M.
Santric Milicevic and B. P. Sao Jose and M. Sardana and A.
R. Sarker and R. Sarmiento-Suárez and N. Sarrafzadegan and
B. Sartorius and S. Sarvi and B. Sathian and M. Satpathy and
A. R. Sawant and M. Sawhney and M. Saylan and M. Sayyah and
E. Schaeffner and M. I. Schmidt and I. J. C. Schneider and
B. Schöttker and A. E. Schutte and D. C. Schwebel and F.
Schwendicke and J. G. Scott and S. Seedat and M. Sekerija
and S. G. Sepanlou and M. L. Serre and E. Serván-Mori and
S. Seyedmousavi and H. Shabaninejad and G. Shaddick and A.
Shafieesabet and M. Shahbazi and A. A. Shaheen and M. A.
Shaikh and T. Shamah Levy and M. Shams-Beyranvand and M.
Shamsi and H. Sharafi and K. Sharafi and M. Sharif and M.
Sharif-Alhoseini and H. Sharifi and J. Sharma and M. Sharma
and R. Sharma and J. She and A. Sheikh and P. Shi and K.
Shibuya and M. S. Shiferaw and M. Shigematsu and M.-J. Shin
and R. Shiri and R. Shirkoohi and I. Shiue and F. Shokraneh
and H. Shoman and M. G. Shrime and M. S. Shupler and S. Si
and S. Siabani and A. M. Sibai and T. J. Siddiqi and I. D.
Sigfusdottir and R. Sigurvinsdottir and D. A. S. Silva and
J. P. Silva and D. G. A. Silveira and J. A. Singh and N. P.
Singh and V. Singh and D. N. Sinha and E. Skiadaresi and V.
Skirbekk and D. L. Smith and M. Smith and B. H. Sobaih and
S. Sobhani and R. Somayaji and M. Soofi and R. J. D.
Sorensen and J. B. Soriano and I. N. Soyiri and A. Spinelli
and L. A. Sposato and C. T. Sreeramareddy and V. Srinivasan
and V. I. Starodubov and N. Steckling and D. J. Stein and M.
B. Stein and G. Stevanovic and L. Stockfelt and M. A. Stokes
and L. Sturua and M. L. Subart and A. Sudaryanto and M. B.
Sufiyan and G. Sulo and B. F. Sunguya and P. J. Sur and B.
L. Sykes and C. E. I. Szoeke and R. Tabarés-Seisdedos and
T. Tabuchi and S. K. Tadakamadla and K. Takahashi and N.
Tandon and S. G. Tassew and M. Tavakkoli and N. Taveira and
A. Tehrani-Banihashemi and T. G. Tekalign and S. W.
Tekelemedhin and M. G. Tekle and H. Temesgen and M.-H.
Temsah and O. Temsah and A. S. Terkawi and B. Tessema and M.
Teweldemedhin and K. R. Thankappan and A. Theis and S.
Thirunavukkarasu and H. J. Thomas and M. L. Thomas and N.
Thomas and G. D. Thurston and B. Tilahun and T. Tillmann and
Q. G. To and M. Tobollik and M. Tonelli and R. Topor-Madry
and A. E. Torre and M. Tortajada-Girbés and M. Touvier and
M. R. Tovani-Palone and J. A. Towbin and B. X. Tran and K.
B. Tran and T. C. Truelsen and N. T. Truong and A. G. Tsadik
and L. Tudor Car and E. M. Tuzcu and H. D. Tymeson and S.
Tyrovolas and K. N. Ukwaja and I. Ullah and R. L. Updike and
M. S. Usman and O. A. Uthman and M. Vaduganathan and A.
Vaezi and P. R. Valdez and A. Van Donkelaar and E.
Varavikova and S. Varughese and T. J. Vasankari and V.
Venkateswaran and N. Venketasubramanian and S. Villafaina
and F. S. Violante and S. K. Vladimirov and V. Vlassov and
S. E. Vollset and T. Vos and K. Vosoughi and G. T. Vu and I.
S. Vujcic and F. S. Wagnew and Y. Waheed and S. G. Waller
and J. L. Walson and Y. Wang and Y. Wang and Y.-P. Wang and
E. Weiderpass and R. G. Weintraub and F. Weldegebreal and A.
Werdecker and A. A. Werkneh and J. J. West and R. Westerman
and H. A. Whiteford and J. Widecka and T. Wijeratne and A.
S. Winkler and A. B. Wiyeh and C. S. Wiysonge and C. D. A.
Wolfe and T. Y. Wong and S. Wu and D. Xavier and G. Xu and
S. Yadgir and A. Yadollahpour and S. H. Yahyazadeh Jabbari
and T. Yamada and L. L. Yan and Y. Yano and M. Yaseri and Y.
J. Yasin and A. Yeshaneh and E. M. Yimer and P. Yip and E.
Yisma and N. Yonemoto and S.-J. Yoon and M. Yotebieng and M.
Z. Younis and M. Yousefifard and C. Yu and Z. Zaidi and S.
B. Zaman and M. Zamani and L. Zavala-Arciniega and A. L.
Zhang and H. Zhang and K. Zhang and M. Zhou and S. R. M.
Zimsen and S. Zodpey and C. J. L. Murray},
collaboration = {GBD 2017 Risk {Factor Collaborators}},
title = {{G}lobal, 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 {G}lobal {B}urden of {D}isease {S}tudy
2017.},
journal = {The lancet},
volume = {392},
number = {10159},
issn = {0140-6736},
address = {London [u.a.]},
publisher = {Elsevier},
reportid = {DKFZ-2018-02369},
pages = {1923 - 1994},
year = {2018},
abstract = {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.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.In 2017,
34·1 million $(95\%$ uncertainty interval [UI] 33·3-35·0)
deaths and 1·21 billion (1·14-1·28) DALYs were
attributable to GBD risk factors. Globally, $61·0\%$
(59·6-62·4) of deaths and $48·3\%$ (46·3-50·2) of DALYs
were attributed to the GBD 2017 risk factors. When ranked by
risk-attributable DALYs, high systolic blood pressure (SBP)
was the leading risk factor, accounting for 10·4 million
(9·39-11·5) deaths and 218 million (198-237) DALYs,
followed by smoking (7·10 million [6·83-7·37] deaths and
182 million [173-193] DALYs), high fasting plasma glucose
(6·53 million [5·23-8·23] deaths and 171 million
[144-201] DALYs), high body-mass index (BMI; 4·72 million
[2·99-6·70] deaths and 148 million [98·6-202] DALYs), and
short gestation for birthweight (1·43 million [1·36-1·51]
deaths and 139 million [131-147] DALYs). In total,
risk-attributable DALYs declined by $4·9\%$ (3·3-6·5)
between 2007 and 2017. In the absence of demographic changes
(ie, population growth and ageing), changes in risk exposure
and risk-deleted DALYs would have led to a $23·5\%$ decline
in DALYs during that period. Conversely, in the absence of
changes in risk exposure and risk-deleted DALYs, demographic
changes would have led to an $18·6\%$ increase in DALYs
during that period. The ratios of observed risk exposure
levels to exposure levels expected based on SDI (O/E ratios)
increased globally for unsafe drinking water and household
air pollution between 1990 and 2017. This result suggests
that development is occurring more rapidly than are changes
in the underlying risk structure in a population.
Conversely, nearly universal declines in O/E ratios for
smoking and alcohol use indicate that, for a given SDI,
exposure to these risks is declining. In 2017, the leading
Level 4 risk factor for age-standardised DALY rates was high
SBP in four super-regions: central Europe, eastern Europe,
and central Asia; north Africa and Middle East; south Asia;
and southeast Asia, east Asia, and Oceania. The leading risk
factor in the high-income super-region was smoking, in Latin
America and Caribbean was high BMI, and in sub-Saharan
Africa was unsafe sex. O/E ratios for unsafe sex in
sub-Saharan Africa were notably high, and those for alcohol
use in north Africa and the Middle East were notably low.By
quantifying levels and trends in exposures to risk factors
and the resulting disease burden, this assessment offers
insight into where past policy and programme efforts might
have been successful and highlights current priorities for
public health action. Decreases in behavioural,
environmental, and occupational risks have largely offset
the effects of population growth and ageing, in relation to
trends in absolute burden. Conversely, the combination of
increasing metabolic risks and population ageing will
probably continue to drive the increasing trends in
non-communicable diseases at the global level, which
presents both a public health challenge and opportunity. We
see considerable spatiotemporal heterogeneity in levels of
risk exposure and risk-attributable burden. Although levels
of development underlie some of this heterogeneity, O/E
ratios show risks for which countries are overperforming or
underperforming relative to their level of development. As
such, these ratios provide a benchmarking tool to help to
focus local decision making. Our findings reinforce the
importance of both risk exposure monitoring and
epidemiological research to assess causal connections
between risks and health outcomes, and they highlight the
usefulness of the GBD study in synthesising data to draw
comprehensive and robust conclusions that help to inform
good policy and strategic health planning.Bill $\&$ Melinda
Gates Foundation.},
cin = {C070 / G110},
ddc = {610},
cid = {I:(DE-He78)C070-20160331 / I:(DE-He78)G110-20160331},
pnm = {323 - Metabolic Dysfunction as Risk Factor (POF3-323)},
pid = {G:(DE-HGF)POF3-323},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:30496105},
pmc = {pmc:PMC6227755},
doi = {10.1016/S0140-6736(18)32225-6},
url = {https://inrepo02.dkfz.de/record/142139},
}
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