Abstract
ABSTRACTBackgroundMost analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness.Methods and FindingsFor 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median.ConclusionsMany major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.
Highlights
Reliable and comparable analysis of risks to health is an important component of evidencebased policies and programs for disease prevention [1,2]
Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden
Using the data from a global and regional assessment of multiple major risk factors, this paper reports the distribution by exposure levels, age, and sex of disease burden attributable to several major risk factors
Summary
Reliable and comparable analysis of risks to health is an important component of evidencebased policies and programs for disease prevention [1,2]. An important feature of risk assessment, with implications for specific interventions as well as broad prevention policies, is the distribution of disease burden among population subgroups These subgroups may be defined by demographic factors, such as age and sex, or by socioeconomic status. The Global Burden of Disease database, maintained by the World Health Organization, collects information from around the world on risk factors such as malnutrition, childbirth, tobacco use, and cholesterol levels, as well as on diseases such as depression, blindness, and diarrhea. This information can be used to target health interventions. For most risk factors, exposure to moderate risks (which is usually more common than exposure to severe risk) is responsible for causing most disease
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