Háskólinn í ReykjavíkReykjavik UniversityGakidou, EmmanuelaAfshin, AshkanAbajobir, Amanuel AlemuAbate, Kalkidan HassenAbbafati, CristianaAbbas, Kaja MAbd-Allah, FoadAbdulle, Abdishakur MAbera, Semaw FeredeAboyans, VictorAbu-Raddad, Laith JAbu-Rmeileh, Niveen M EAbyu, Gebre YitayihAdedeji, Isaac AkinkunmiAdetokunboh, OlatunjiAfarideh, MohsenAgrawal, AnuragAgrawal, SutapaAhmadieh, HamidAhmed, Muktar BeshirAichour, Miloud Taki EddineAichour, Amani NidhalAichour, IbtihelAkinyemi, Rufus OlusolaAkseer, NadiaAlahdab, FaresAl-Aly, ZiyadAlam, KhurshidAlam, NooreAlam, TahiyaAlasfoor, DeenaAlene, Kefyalew AddisAli, KomalAlizadeh-Navaei, RezaAlkerwi, Ala'aAlla, FrançoisAllebeck, PeterAl-Raddadi, RajaaAlsharif, UbaiAltirkawi, Khalid AAlvis-Guzman, NelsonAmare, Azmeraw TAmini, ErfanAmmar, WalidAmoako, Yaw AmpemAnsari, HosseinAntó, Josep MAntonio, Carl Abelardo TAnwari, PalwashaArian, NicholasÄrnlöv, JohanArtaman, AlAryal, Krishna KumarAsayesh, HamidAsgedom, Solomon WeldegebrealAtey, Tesfay MehariAvila-Burgos, LeticiaAvokpaho, Euripide Frinel G ArthurAwasthi, AshishAzzopardi, PeterBacha, UmarBadawi, AlaaBalakrishnan, KalpanaBallew, Shoshana HBarac, AleksandraBarber, Ryan MBarker-Collo, Suzanne LBärnighausen, TillBarquera, SimonBarregard, LarsBarrero, Lope HBatis, CarolinaBattle, Katherine EBaumgarner, Blair RBaune, Bernhard TBeardsley, JustinBedi, NeerajBeghi, EttoreBell, Michelle LBennett, Derrick ABennett, James RBensenor, Isabela MBerhane, AdugnawBerhe, Derbew FikaduBernabé, EduardoBetsu, Balem DemtsuBeuran, MirceaBeyene, Addisu ShunuBhansali, AnilBhutta, Zulfiqar ABicer, Burcu KucukBikbov, BorisBirungi, CharlesBiryukov, StanBlosser, Christopher DBoneya, Dube JaraBou-Orm, Ibrahim RBrauer, MichaelBreitborde, Nicholas J KBrenner, HermannBrugha, Traolach SBulto, Lemma Negesa BultoButt, Zahid ACahuana-Hurtado, LuceroCárdenas, RosarioCarrero, Juan JesusCastañeda-Orjuela, Carlos ACatalá-López, FerránCercy, KellyChang, Hsing-YiCharlson, Fiona JChimed-Ochir, OdgerelChisumpa, Vesper HichilombweChitheer, Abdulaal AChristensen, HanneChristopher, Devasahayam JesudasCirillo, MassimoCohen, Aaron JComfort, HaleyCooper, CyrusCoresh, JosefCornaby, LeslieCortesi, Paolo AngeloCriqui, Michael HCrump, John ADandona, LalitDandona, Rakhidas Neves, JoséDavey, GailDavitoiu, Dragos VDavletov, Kairatde Courten, BarboraDefo, Barthelemy KuateDegenhardt, LouisaDeiparine, SelinaDellavalle, Robert PDeribe, KebedeDeshpande, AniruddhaDharmaratne, Samath DDing, Eric LDjalalinia, ShirinDo, Huyen PhucDokova, KlaraDoku, David TeyeDonkelaar, Aaron vanDorsey, E RayDriscoll, Tim RDubey, ManishaDuncan, Bruce BartholowDuncan, SarahEbrahimi, HedyehEl-Khatib, Ziad ZiadEnayati, AhmadaliEndries, Aman YesufErmakov, Sergey PetrovichErskine, Holly EEshrati, BabakEskandarieh, ShararehEsteghamati, AlirezaEstep, KaraFaraon, Emerito Jose AquinoFarinha, Carla Sofia e SaFaro, AndréFarzadfar, FarshadFay, KairstenFeigin, Valery LFereshtehnejad, Seyed-MohammadFernandes, João CFerrari, Alize JFeyissa, Tesfaye RegassaFilip, IrinaFischer, FlorianFitzmaurice, ChristinaFlaxman, Abraham DFoigt, NataliyaForeman, Kyle JFrostad, Joseph JFullman, NancyFürst, ThomasFurtado, Joao MGanji, MorsalehGarcia-Basteiro, Alberto LGebrehiwot, Tsegaye TeweldeGeleijnse, Johanna MGeleto, AyeleGemechu, Bikila LenchaGesesew, Hailay AbrhaGething, Peter WGhajar, AlirezaGibney, Katherine BGill, Paramjit SinghGillum, Richard FGiref, Ababi ZergawGishu, Melkamu DedefoGiussani, GiorgiaGodwin, William WGona, Philimon NGoodridge, AmadorGopalani, Sameer ValiGoryakin, YevgeniyGoulart, Alessandra CarvalhoGraetz, NicholasGugnani, Harish ChanderGuo, JingwenGupta, RajeevGupta, TanushGupta, VipinGutiérrez, Reyna AHachinski, VladimirHafezi-Nejad, NimaHailu, Gessessew BugssaHamadeh, Randah RibhiHamidi, SamerHammami, MouhanadHandal, Alexis JHankey, Graeme JHanson, Sarah WulfHarb, Hilda LHareri, Habtamu AberaHassanvand, Mohammad SadeghHavmoeller, RasmusHawley, CaitlinHay, Simon IHedayati, Mohammad THendrie, DeliaHeredia-Pi, 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AdnanKissimova-Skarbek, Katarzyna AKivimaki, MikaKnibbs, Luke DKnudsen, Ann KristinKopec, Jacek AKosen, SoewartaKoul, Parvaiz AKoyanagi, AiKravchenko, MichaelKrohn, Kristopher JKromhout, HansKumar, G AnilKutz, MichaelKyu, Hmwe HLal, Dharmesh KumarLalloo, RatilalLallukka, TeaLan, QingLansingh, Van CLarsson, AndersLee, Paul HLee, AlexanderLeigh, JamesLeung, JanniLevi, MiriamLevy, Teresa ShamahLi, YichongLi, YongmeiLiang, XiaofengLiben, Misgan LegesseLinn, ShaiLiu, PatrickLodha, RakeshLogroscino, GiancarloLooker, Katherine JLopez, Alan DLorkowski, StefanLotufo, Paulo ALozano, RafaelLunevicius, RaimundasMacarayan, Erlyn Rachelle KingMagdy Abd El Razek, HassanMagdy Abd El Razek, MohammedMajdan, MarekMajdzadeh, RezaMajeed, AzeemMalekzadeh, RezaMalhotra, RajeshMalta, Deborah CarvalhoMamun, Abdullah AManguerra, HelenaMantovani, Lorenzo GMapoma, Chabila CMartin, Randall VMartinez-Raga, JoseMartins-Melo, Francisco RogerlândioMathur, Manu RajMatsushita, KunihiroMatzopoulos, RichardMazidi, 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Jean Jacques NObermeyer, Carla MakhloufOgbo, Felix AkpojeneOh, In-HwanOladimeji, OlanrewajuOlagunju, Andrew ToyinOlagunju, Tinuke OluwasefunmiOlivares, Pedro ROlsen, Helen EOlusanya, Bolajoko OlubukunolaOlusanya, Jacob OlusegunOpio, John NelsonOren, EyalOrtiz, AlbertoOta, ErikaOwolabi, Mayowa OPA, MaheshPacella, Rosana EPana, AdrianPanda, Basant KumarPanda-Jonas, SonghomitraPandian, Jeyaraj DPapachristou, ChristinaPark, Eun-KeeParry, Charles DPatten, Scott BPatton, George CPereira, David MPerico, NorbertoPesudovs, KonradPetzold, MaxPhillips, Michael RobertPillay, Julian DavidPiradov, Michael APishgar, FarhadPlass, DietrichPletcher, Martin APolinder, SuzannePopova, SvetlanaPoulton, Richie GPourmalek, FarshadPrasad, NarayanPurcell, CarrieQorbani, MostafaRadfar, AmirRafay, AnwarRahimi-Movaghar, AfarinRahimi-Movaghar, VafaRahman, Mohammad Hifz UrRahman, Muhammad AzizRahman, MahfuzarRai, Rajesh KumarRajsic, SasaRam, UshaRawaf, SalmanRehm, Colin DRehm, JürgenReiner, Robert CReitsma, Marissa BRemuzzi, GiuseppeRenzaho, Andre M NResnikoff, SergeReynales-Shigematsu, Luz MyriamRezaei, SatarRibeiro, Antonio LRivera, Juan ARoba, Kedir TejiRojas-Rueda, DavidRoman, YeseniaRoom, RobinRoshandel, GholamrezaRoth, Gregory ARothenbacher, DietrichRubagotti, EnricoRushton, LesleySadat, NafisSafdarian, MahdiSafi, SareSafiri, SaeidSahathevan, RameshSalama, JosephSalomon, Joshua ASamy, Abdallah MSanabria, Juan RamonSanchez-Niño, Maria DoloresSánchez-Pimienta, Tania GSantomauro, DamianSantos, Itamar SSantric Milicevic, Milena MSartorius, BennSatpathy, MaheswarSawhney, MonikaSaxena, SoniaSchmidt, Maria InêsSchneider, Ione J CSchutte, Aletta ESchwebel, David CSchwendicke, FalkSeedat, SorayaSepanlou, Sadaf GSerdar, BerrinServan-Mori, Edson EShaddick, GavinShaheen, AmiraShahraz, SaeidShaikh, Masood AliShamsipour, MansourShamsizadeh, MortezaShariful Islam, Sheikh MohammedSharma, JayendraSharma, RajeshShe, JunShen, JiabinShi, PeilinShibuya, KenjiShields, ChloeShiferaw, Mekonnen SisayShigematsu, MikaShin, Min-JeongShiri, RahmanShirkoohi, RezaShishani, KawkabShoman, HaithamShrime, Mark GSigfúsdóttir, Inga DóraSilva, Diego Augusto SantosSilva, João PedroSilveira, Dayane Gabriele AlvesSingh, Jasvinder ASingh, VirendraSinha, Dhirendra NarainSkiadaresi, EiriniSlepak, Erica LeighSmith, David LSmith, MariSobaih, Badr H ASobngwi, EugeneSoneji, SamirSorensen, Reed J DSposato, Luciano ASreeramareddy, Chandrashekhar TSrinivasan, VinaySteel, NicholasStein, Dan JSteiner, CaitlynSteinke, SabineStokes, Mark AndrewStrub, BryanSubart, MichelleSufiyan, Muawiyyah BabaleSuliankatchi, Rizwan AbdulkaderSur, Patrick JSwaminathan, SoumyaSykes, Bryan LSzoeke, Cassandra E ITabarés-Seisdedos, RafaelTadakamadla, Santosh KumarTakahashi, KenTakala, Jukka STandon, NikhilTanner, MarcelTarekegn, Yihunie LTavakkoli, MohammadTegegne, Teketo KassawTehrani-Banihashemi, ArashTerkawi, Abdullah SuliemanTesssema, BelayThakur, JSThamsuwan, OrnwipaThankappan, Kavumpurathu RamanTheis, Andrew MThomas, Matthew LloydThomson, Alan JThrift, Amanda GTillmann, TaaviTobe-Gai, RuoyanTobollik, MyriamTollanes, Mette CTonelli, MarcelloTopor-Madry, RomanTorre, AnnaTortajada, MiguelTouvier, MathildeTran, Bach XuanTruelsen, ThomasTuem, Kald BeshirTuzcu, Emin MuratTyrovolas, StefanosUkwaja, Kingsley NnannaUneke, Chigozie JesseUpdike, RachelUthman, Olalekan Avan Boven, Job F MVarughese, SantoshVasankari, TommiVeerman, Lennert JVenkateswaran, VidhyaVenketasubramanian, NarayanaswamyViolante, Francesco SVladimirov, Sergey KVlassov, Vasiliy VictorovichVollset, Stein EmilVos, TheoWadilo, FisehaWakayo, TolassaWallin, Mitchell TWang, Yuan-PangWeichenthal, ScottWeiderpass, ElisabeteWeintraub, Robert GWeiss, Daniel JWerdecker, AndreaWesterman, RonnyWhiteford, Harvey AWiysonge, Charles SheyWoldeyes, Belete GetahunWolfe, Charles D AWoodbrook, RachelWorkicho, AbdulhalikXavier, DenisXu, GelinYadgir, SimonYakob, BereketYan, Lijing LYaseri, MehdiYimam, Hassen HamidYip, PaulYonemoto, NaohiroYoon, Seok-JunYotebieng, MarcelYounis, Mustafa ZZaidi, ZoubidaZaki, Maysaa El SayedZavala-Arciniega, LuisZhang, XueyingZimsen, Stephanie Raman MZipkin, BenZodpey, SanjayLim, Stephen SMurray, Christopher J L2020-02-172020-02-172017-09-18Gakidou, 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., Ahmadieh, H., … Murray, C. J. L. (2017). 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. The Lancet, 390(10100), 1345–1422. https://doi.org/10.1016/S0140-6736(17)32366-80140-67361474-547X (eISSN)https://hdl.handle.net/20.500.11815/1540Correction in: LANCET Volume: 390 Issue: 10104 Pages: 1736-1736 Published: OCT 14 2017 ; LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017.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. Methods 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. Interpretation 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.1345-1422eninfo:eu-repo/semantics/openAccessWorld healthPublic healthHealth risk assessmentHealth policyMenWomenChildrenMalnutritionPregnancyBirthweightHypertensionBody mass indexSmokingMortalityQuality of lifeHeilbrigðisvísindiLýðheilsaHeilbrigðisstefnaÁhættugreiningHeilsufarKarlarKonurBörnNæringarskorturMeðgangaFæðingarþyngdHáþrýstingurLíkamsþyngdarstuðullReykingarDánartíðniDánarmeinLífsgæðiSálfræðiPsychologyGlobal burden of disease/statistics and numerical dataCause of death/trendsinfo:eu-repo/semantics/articleThe Lancet10.1016/S0140-6736(17)32366-8