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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

(2018) LANCET. 392(10159). p.1923-1994
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Abstract
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. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) 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. Interpretation: 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.
Keywords
CARDIOVASCULAR-DISEASES, TOBACCO CONTROL, BLOOD-PRESSURE, METAANALYSIS, CHOLESTEROL, ILLNESS, TRENDS, TRIAL

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MLA
Stanaway, Jeffrey D, Ashkan Afshin, Emmanuela Gakidou, et al. “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.” LANCET 392.10159 (2018): 1923–1994. Print.
APA
Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K. H., Abbafati, C., et al. (2018). 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. LANCET, 392(10159), 1923–1994.
Chicago author-date
Stanaway, Jeffrey D, Ashkan Afshin, Emmanuela Gakidou, Stephen S Lim, Degu Abate, Kalkidan Hassen Abate, Cristiana Abbafati, et al. 2018. “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.” Lancet 392 (10159): 1923–1994.
Chicago author-date (all authors)
Stanaway, Jeffrey D, Ashkan Afshin, Emmanuela Gakidou, Stephen S Lim, Degu Abate, Kalkidan Hassen Abate, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Molla Abebe, Zegeye Abebe, Semaw F Abera, Olifan Zewdie Abil, Haftom Niguse Abraha, Aklilu Roba Abrham, Laith Jamal Abu-Raddad, Niveen ME Abu-Rmeileh, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Pawan Acharya, Abdu A Adamu, Akilew Awoke Adane, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Zanfina Ademi, Olatunji O Adetokunboh, Mina G Adib, Amha Admasie, Jose C Adsuar, Kossivi Agbelenko Afanvi, Mohsen Afarideh, Gina Agarwal, Anju Aggarwal, Sargis Aghasi Aghayan, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Mohammad Esmaeil Akbari, Tomi Akinyemiju, Nadia Akseer, Ziyad Al-Aly, Ayman Al-Eyadhy, Hesham M Al-Mekhlafi, Fares Alahdab, Khurshid Alam, Samiah Alam, Tahiya Alam, Alaa Alashi, Seyed Moayed Alavian, Kefyalew Addis Alene, Komal Ali, Syed Mustafa Ali, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Syed Mohamed Aljunid, Ala’a Alkerwi, François Alla, Ubai Alsharif, Khalid Altirkawi, Nelson Alvis-Guzman, Azmeraw T Amare, Walid Ammar, Nahla Hamed Anber, Jason A Anderson, Catalina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Mustafa Geleto Ansha, Josep M Antó, Carl Abelardo T Antonio, Palwasha Anwari, Lambert Tetteh Appiah, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Johan Ärnlöv, Al Artaman, Krishna K Aryal, Hamid Asayesh, Zerihun Ataro, Marcel Ausloos, Euripide F G A Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Rakesh Ayer, Tambe B Ayuk, Peter S Azzopardi, Arefeh Babazadeh, Hamid Badali, Alaa Badawi, Kalpana Balakrishnan, Ayele Geleto Bali, Kylie Ball, Shoshana H Ballew, Maciej Banach, Joseph Adel Mattar Banoub, Aleksandra Barac, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Lope H Barrero, Sanjay Basu, Bernhard T Baune, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Eyasu Tamru Bekru, Ezra Belay, Yihalem Abebe Belay, Michelle L Bell, Aminu K Bello, Derrick A Bennett, Isabela M Bensenor, Gilles Bergeron, Adugnaw Berhane, Eduardo Bernabe, Robert S Bernstein, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Ashish Bhalla, Suraj Bhattarai, Zulfiqar A Bhutta, Belete Biadgo, Ali Bijani, Boris Bikbov, Ver Bilano, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Donal Bisanzio, Tuhin Biswas, Tone Bjørge, Brigette F Blacker, Archie Bleyer, Rohan Borschmann, Ibrahim R Bou-Orm, Soufiane Boufous, Rupert Bourne, Oliver J Brady, Michael Brauer, Alexandra Brazinova, Nicholas J K Breitborde, Hermann Brenner, Andrey Nikolaevich Briko, Gabrielle Britton, Traolach Brugha, Rachelle Buchbinder, Richard T Burnett, Reinhard Busse, Zahid A Butt, Leah E Cahill, Lucero Cahuana-Hurtado, Ismael R Campos-Nonato, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz Castro, Ferrán Catalá-López, Kate Causey, Kelly M Cercy, Ester Cerin, Yazan Chaiah, Hsing-Yi Chang, Jung-Chen Chang, Kai-Lan Chang, Fiona J Charlson, Aparajita Chattopadhyay, Vijay Kumar Chattu, Miao Li Chee, Ching-Yu Cheng, Adrienne Chew, Peggy Pei-Chia Chiang, Odgerel Chimed-Ochir, Ken Lee Chin, Abdulaal Chitheer, Jee-Young J Choi, Rajiv Chowdhury, Hanne Christensen, Devasahayam J Christopher, Sheng-Chia Chung, Flavia M Cicuttini, Massimo Cirillo, Aaron J Cohen, Daniel Collado-Mateo, Cyrus Cooper, Owen R Cooper, Josef Coresh, Leslie Cornaby, Paolo Angelo Cortesi, Monica Cortinovis, Megan Costa, Ewerton Cousin, Michael H Criqui, Elizabeth A Cromwell, David K Cundiff, Alemneh Kabeta Daba, Berihun Assefa Dachew, Abel Fekadu Dadi, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Sarah C Darby, Paul I Dargan, Ahmad Daryani, Rajat Das Gupta, José Das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Dragos Virgil Davitoiu, Kairat Davletov, Vanessa De la Cruz-Góngora, Fernando Pio De La Hoz, Diego De Leo, Jan-Walter De Neve, Louisa Degenhardt, Selina Deiparine, Robert P Dellavalle, Gebre Teklemariam Demoz, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Aniruddha Deshpande, Don C Des Jarlais, Getenet Ayalew Dessie, Gabrielle Aline Deveber, Subhojit Dey, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mesfin Tadese Dinberu, Eric L Ding, Helen Derara Diro, Shirin Djalalinia, Huyen Phuc Do, Klara Dokova, David Teye Doku, Kerrie E Doyle, Tim R Driscoll, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce B Duncan, Andre R Duraes, Natalie Ebert, Hedyeh Ebrahimi, Soheil Ebrahimpour, David Edvardsson, Andem Effiong, Anne Elise Eggen, Charbel El Bcheraoui, Ziad El-Khatib, Iqbal Rf Elyazar, Ahmadali Enayati, Aman Yesuf Endries, Benjamin Er, Holly E Erskine, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Hamed Fakhim, Mahbobeh Faramarzi, Mohammad Fareed, Talha A Farid, Carla Sofia E sá Farinha, Andrea Farioli, Andre Faro, Maryam S Farvid, Mohammad Hosein Farzaei, Batool Fatima, Kairsten A Fay, Ali Akbar Fazaeli, Valery L Feigin, Andrea B Feigl, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Joao C Fernandes, Giannina Ferrara, Alize J Ferrari, Manuela L Ferreira, Irina Filip, Jonas David Finger, Florian Fischer, Nataliya A Foigt, Kyle J Foreman, Takeshi Fukumoto, Nancy Fullman, Thomas Fürst, João M Furtado, Neal D Futran, Seana Gall, Silvano Gallus, Amiran Gamkrelidze, Morsaleh Ganji, Alberto L Garcia-Basteiro, William M Gardner, Abadi Kahsu Gebre, Amanuel Tesfay Gebremedhin, Teklu Gebrehiwo Gebremichael, Tilayie Feto Gelano, Johanna M Geleijnse, Yilma Chisha Dea Geramo, Peter W Gething, Kebede Embaye Gezae, Reza Ghadimi, Keyghobad Ghadiri, Khalil Ghasemi Falavarjani, Maryam Ghasemi-Kasman, Mamata Ghimire, Rakesh Ghosh, Aloke Gopal Ghoshal, Simona Giampaoli, Paramjit Singh Gill, Tiffany K Gill, Richard F Gillum, Ibrahim Abdelmageed Ginawi, Giorgia Giussani, Elena V Gnedovskaya, William W Godwin, Srinivas Goli, Hector Gómez-Dantés, Philimon N Gona, Sameer Vali Gopalani, Alessandra C Goulart, Ayman Grada, Morgan E Grams, Giuseppe Grosso, Harish Chander Gugnani, Yuming Guo, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Reyna Alma Gutiérrez, Daniela S Gutiérrez-Torres, Juanita A Haagsma, Tesfa Dejenie Habtewold, Vladimir Hachinski, Nima Hafezi-Nejad, Tekleberhan B Hagos, Tewodros Tesfa Hailegiyorgis, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi, Alexis J Handal, Graeme J Hankey, Yuantao Hao, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Caitlin N Hawley, Simon I Hay, Akbar Hedayatizadeh-Omran, Behzad Heibati, Behnam Heidari, Mohsen Heidari, Delia Hendrie, Andualem Henok, Ileana Heredia-Pi, Claudiu Herteliu, Fatemeh Heydarpour, Sousan Heydarpour, Desalegn T Hibstu, Tarig B Higazi, Esayas Haregot Hilawe, Hans W Hoek, Howard J Hoffman, Michael K Hole, Enayatollah Homaie Rad, Praveen Hoogar, H Dean Hosgood, Seyed Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Damian G Hoy, Mohamed Hsairi, Thomas Hsiao, Guoqing Hu, Howard Hu, John J Huang, Mamusha Aman Hussen, Chantal K Huynh, Kim Moesgaard Iburg, Nayu Ikeda, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine, Sheikh Mohammed Shariful Islam, Farhad Islami, Maria D Jackson, Kathryn H Jacobsen, Leila Jahangiry, Nader Jahanmehr, Sudhir Kumar Jain, Mihajlo Jakovljevic, Spencer L James, Simerjot K Jassal, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Jost B Jonas, Jitendra Jonnagaddala, Zahra Jorjoran Shushtari, Ankur Joshi, Jacek Jerzy Jozwiak, Mikk Jürisson, Zubair Kabir, Amaha Kahsay, Rizwan Kalani, Tanuj Kanchan, Surya Kant, Chittaranjan Kar, Manoochehr Karami, Behzad Karami Matin, André Karch, Corine Karema, Narges Karimi, Seyed M Karimi, Amir Kasaeian, Dessalegn H Kassa, Getachew Mullu Kassa, Tesfaye Dessale Kassa, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Zhila Kazemi, Ali Kazemi Karyani, Adane Teshome Kefale, Peter Njenga Keiyoro, Grant Rodgers Kemp, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Behzad Khafaei, Morteza Abdullatif Khafaie, Alireza Khajavi, Nauman Khalid, Ibrahim A Khalil, Gulfaraz Khan, Muhammad Shahzeb Khan, Muhammad Ali Khan, Young-Ho Khang, Mona M Khater, Mohammad Khazaei, Habibolah Khazaie, Abdullah T Khoja, Ardeshir Khosravi, Mohammad Hossein Khosravi, Aliasghar A Kiadaliri, Daniel N Kiirithio, Cho-Il Kim, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna Kissimova-Skarbek, Mika Kivimäki, Luke D Knibbs, Ann Kristin Skrindo Knudsen, Sonali Kochhar, Yoshihiro Kokubo, Tufa Kolola, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Kristopher J Krohn, Hans Kromhout, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G Anil Kumar, Manasi Kumar, Igor Kuzin, Hmwe Hmwe Kyu, Carl Lachat, Deepesh P Lad, Sheetal D Lad, Alessandra Lafranconi, Ratilal Lalloo, Tea Lallukka, Faris Hasan Lami, Justin J Lang, Van C Lansingh, Samantha Leigh Larson, Arman Latifi, Jeffrey V Lazarus, Paul H Lee, James Leigh, Mostafa Leili, Cheru Tesema Leshargie, Janni Leung, Miriam Levi, Sonia Lewycka, Shanshan Li, Yichong Li, Juan Liang, Xiaofeng Liang, Yu Liao, Misgan Legesse Liben, Lee-Ling Lim, Shai Linn, Shiwei Liu, Rakesh Lodha, Giancarlo Logroscino, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Tim C D Lucas, Raimundas Lunevicius, Stefan Ma, Erlyn Rachelle King Macarayan, Ísis Eloah Machado, Fabiana Madotto, Hue Thi Mai, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Abdullah A Mamun, Ana-Laura Manda, Helena Manguerra, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Joemer C Maravilla, Wagner Marcenes, Ashley Marks, Randall V Martin, Sheila C O Martins, Francisco Rogerlândio Martins-Melo, Winfried März, Melvin B Marzan, Benjamin Ballard Massenburg, Manu Raj Mathur, Prashant Mathur, Kunihiro Matsushita, Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Martin McKee, Ravi Mehrotra, Kala M Mehta, Varshil Mehta, Toni Meier, Fantahun Ayenew Mekonnen, Yohannes A Melaku, Addisu Melese, Mulugeta Melku, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Desalegn Tadese Mengistu, George A Mensah, Gert B M Mensink, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Haftay Berhane Mezgebe, Bartosz Miazgowski, Tomasz Miazgowski, Anoushka I Millear, Ted R Miller, Molly Katherine Miller-Petrie, G K Mini, Mojde Mirarefin, Andreea Mirica, Erkin M Mirrakhimov, Awoke Temesgen Misganaw, Habtamu Mitiku, Babak Moazen, Bahram Mohajer, Karzan Abdulmuhsin Mohammad, Moslem Mohammadi, Noushin Mohammadifard, Mousa Mohammadnia-Afrouzi, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Mariam Molokhia, Fatemeh Momeniha, Lorenzo Monasta, Yoshan Moodley, Ghobad Moradi, Maziar Moradi-Lakeh, Mehdi Moradinazar, Paula Moraga, Lidia Morawska, Joana Morgado-Da-Costa, Shane Douglas Morrison, Marilita M Moschos, Simin Mouodi, Seyyed Meysam Mousavi, Dariush Mozaffarian, Kalayu Brhane Mruts, Achenef Asmamaw Muche, Kindie Fentahun Muchie, Ulrich Otto Mueller, Oumer Sada Muhammed, Satinath Mukhopadhyay, Kate Muller, Kamarul Imran Musa, Ghulam Mustafa, Ashraf F Nabhan, Mohsen Naghavi, Aliya Naheed, Azin Nahvijou, Gurudatta Naik, Nitish Naik, Farid Najafi, Vinay Nangia, Jobert Richie Nansseu, Bruno Ramos Nascimento, Bruce Neal, Nahid Neamati, Ionut Negoi, Ruxandra Irina Negoi, Subas Neupane, Charles Richard James Newton, Josephine W Ngunjiri, Anh Quynh Nguyen, Grant Nguyen, Ha Thu Nguyen, Huong Lan Thi Nguyen, Huong Thanh Nguyen, Minh Nguyen, Nam Ba Nguyen, Emma Nichols, Jing Nie, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Nobuo Nishi, Molly R Nixon, Marzieh Nojomi, Shuhei Nomura, Ole F Norheim, Mehdi Noroozi, Bo Norrving, Jean Jacques Noubiap, Hamid Reza Nouri, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi, Elaine O Nsoesie, Peter S Nyasulu, Carla M Obermeyer, Christopher M Odell, Richard Ofori-Asenso, Felix Akpojene Ogbo, In-Hwan Oh, Olanrewaju Oladimeji, Andrew T Olagunju, Tinuke O Olagunju, Pedro R Olivares, Helen Elizabeth Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin L Ong, Sok King Ong, Eyal Oren, Heather M Orpana, Alberto Ortiz, Erika Ota, Stanislav S Otstavnov, Simon Øverland, Mayowa Ojo Owolabi, Mahesh P A, Rosana Pacella, Abhijit P Pakhare, Amir H Pakpour, Adrian Pana, Songhomitra Panda-Jonas, Eun-Kee Park, Charles D H Parry, Hadi Parsian, Shanti Patel, Sanghamitra Pati, Snehal T Patil, Ajay Patle, George C Patton, Deepak Paudel, Katherine R 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Luz Myriam Reynales-Shigematsu, Satar Rezaei, Antonio Luiz P Ribeiro, Juan A Rivera, Kedir Teji Roba, Sonia Rodríguez-Ramírez, Leonardo Roever, Yesenia Román, Luca Ronfani, Gholamreza Roshandel, Ali Rostami, Gregory A Roth, Dietrich Rothenbacher, Ambuj Roy, Enrico Rubagotti, Lesley Rushton, Charumathi Sabanayagam, Perminder S Sachdev, Basema Saddik, Ehsan Sadeghi, Sahar Saeedi Moghaddam, Hosein Safari, Yahya Safari, Roya Safari-Faramani, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, Haniye Sadat Sajadi, Nasir Salam, Payman Salamati, Zikria Saleem, Yahya Salimi, Hamideh Salimzadeh, Joshua A Salomon, Devashri Digvijay Salvi, Inbal Salz, Abdallah M Samy, Juan Sanabria, Maria Dolores Sanchez-Niño, Tania G Sánchez-Pimienta, Taren Sanders, Yingying Sang, Damian Francesco Santomauro, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Mayank Sardana, Abdur Razzaque Sarker, Rodrigo Sarmiento-Suárez, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Arundhati R Sawant, Monika Sawhney, Mete Saylan, Mehdi Sayyah, Elke Schaeffner, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, David C Schwebel, Falk Schwendicke, James G Scott, Soraya Seedat, Mario Sekerija, Sadaf G Sepanlou, Marc L Serre, Edson Serván-Mori, Seyedmojtaba Seyedmousavi, Hosein Shabaninejad, Gavin Shaddick, Azadeh Shafieesabet, Mehdi Shahbazi, Amira A Shaheen, Masood Ali Shaikh, Teresa Shamah Levy, Mehran Shams-Beyranvand, Mohammadbagher Shamsi, Heidar Sharafi, Kiomars Sharafi, Mehdi Sharif, Mahdi Sharif-Alhoseini, Hamid Sharifi, Jayendra Sharma, Meenakshi Sharma, Rajesh Sharma, Jun She, Aziz Sheikh, Peilin Shi, Kenji Shibuya, Mekonnen Sisay Shiferaw, Mika Shigematsu, Min-Jeong Shin, Rahman Shiri, Reza Shirkoohi, Ivy Shiue, Farhad Shokraneh, Haitham Shoman, Mark G Shrime, Matthew S Shupler, Si Si, Soraya Siabani, Abla Mehio Sibai, Tariq J Siddiqi, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Diego Augusto Santos Silva, João Pedro Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Narinder Pal Singh, Virendra Singh, Dhirendra Narain Sinha, Eirini Skiadaresi, Vegard Skirbekk, David L Smith, Mari Smith, Badr Hasan Sobaih, Soheila Sobhani, Ranjani Somayaji, Moslem Soofi, Reed J D Sorensen, Joan B Soriano, Ireneous N Soyiri, Angela Spinelli, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Vladimir I Starodubov, Nadine Steckling, Dan J Stein, Murray B Stein, Goran Stevanovic, Leo Stockfelt, Mark A Stokes, Lela Sturua, Michelle L Subart, Agus Sudaryanto, Mu’awiyyah Babale Sufiyan, Gerhard Sulo, Bruno F Sunguya, Patrick John Sur, Bryan L Sykes, Cassandra E I Szoeke, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Santosh Kumar Tadakamadla, Ken Takahashi, Nikhil Tandon, Segen Gebremeskel Tassew, Mohammad Tavakkoli, Nuno Taveira, Arash Tehrani-Banihashemi, Tigist Gashaw Tekalign, Shishay Wahdey Tekelemedhin, Merhawi Gebremedhin Tekle, Habtamu Temesgen, Mohamad-Hani Temsah, Omar Temsah, Abdullah Sulieman Terkawi, Belay Tessema, Mebrahtu Teweldemedhin, Kavumpurathu Raman Thankappan, Andrew Theis, Sathish Thirunavukkarasu, Hannah J Thomas, Matthew Lloyd Thomas, Nihal Thomas, George D Thurston, Binyam Tilahun, Taavi Tillmann, Quyen G To, Myriam Tobollik, Marcello Tonelli, Roman Topor-Madry, Anna E Torre, Miguel Tortajada-Girbés, Mathilde Touvier, Marcos Roberto Tovani-Palone, Jeffrey A Towbin, Bach Xuan Tran, Khanh Bao Tran, Thomas Clement Truelsen, Nu Thi Truong, Afewerki Gebremeskel Tsadik, Lorainne Tudor Car, E Murat Tuzcu, Hayley D Tymeson, Stefanos Tyrovolas, Kingsley N Ukwaja, Irfan Ullah, Rachel L Updike, Muhammad Shariq Usman, Olalekan A Uthman, Muthiah Vaduganathan, Afsane Vaezi, Pascual R Valdez, Aaron Van Donkelaar, Elena Varavikova, Santosh Varughese, Tommi Juhani Vasankari, Vidhya Venkateswaran, Narayanaswamy Venketasubramanian, Santos Villafaina, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Kia Vosoughi, Giang Thu Vu, Isidora S Vujcic, Fasil Shiferaw Wagnew, Yasir Waheed, Stephen G Waller, Judd L Walson, Yafeng Wang, Yanping Wang, Yuan-Pang Wang, Elisabete Weiderpass, Robert G Weintraub, Fitsum Weldegebreal, Andrea Werdecker, Adhena Ayaliew Werkneh, J Jason West, Ronny Westerman, Harvey A Whiteford, Justyna Widecka, Tissa Wijeratne, Andrea Sylvia Winkler, Alison B Wiyeh, Charles Shey Wiysonge, Charles D A Wolfe, Tien Yin Wong, Shouling Wu, Denis Xavier, Gelin Xu, Simon Yadgir, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Yasin Jemal Yasin, Alex Yeshaneh, Ebrahim M Yimer, Paul Yip, Engida Yisma, Naohiro Yonemoto, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Mahmoud Yousefifard, Chuanhua Yu, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Luis Zavala-Arciniega, Anthony Lin Zhang, Hao Zhang, Kai Zhang, Maigeng Zhou, Stephanie R M Zimsen, Sanjay Zodpey, and Christopher J L Murray. 2018. “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.” Lancet 392 (10159): 1923–1994.
Vancouver
1.
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. 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. LANCET. 2018;392(10159):1923–94.
IEEE
[1]
J. D. Stanaway et al., “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,” LANCET, vol. 392, no. 10159, pp. 1923–1994, 2018.
@article{8583589,
  abstract     = {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. 
Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) 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. 
Interpretation: 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.},
  author       = {Stanaway, Jeffrey D and Afshin, Ashkan and Gakidou, Emmanuela and Lim, Stephen S and Abate, Degu and Abate, Kalkidan Hassen and Abbafati, Cristiana and Abbasi, Nooshin and Abbastabar, Hedayat and Abd-Allah, Foad and Abdela, Jemal and Abdelalim, Ahmed and Abdollahpour, Ibrahim and Abdulkader, Rizwan Suliankatchi and Abebe, Molla and Abebe, Zegeye and Abera, Semaw F and Abil, Olifan Zewdie and Abraha, Haftom Niguse and Abrham, Aklilu Roba and Abu-Raddad, Laith Jamal and Abu-Rmeileh, Niveen ME and Accrombessi, Manfred Mario Kokou and Acharya, Dilaram and Acharya, Pawan and Adamu, Abdu A and Adane, Akilew Awoke and Adebayo, Oladimeji M and Adedoyin, Rufus Adesoji and Adekanmbi, Victor and Ademi, Zanfina and Adetokunboh, Olatunji O and Adib, Mina G and Admasie, Amha and Adsuar, Jose C and Afanvi, Kossivi Agbelenko and Afarideh, Mohsen and Agarwal, Gina and Aggarwal, Anju and Aghayan, Sargis Aghasi and Agrawal, Anurag and Agrawal, Sutapa and Ahmadi, Alireza and Ahmadi, Mehdi and Ahmadieh, Hamid and Ahmed, Muktar Beshir and Aichour, Amani Nidhal and Aichour, Ibtihel and Aichour, Miloud Taki Eddine and Akbari, Mohammad Esmaeil and Akinyemiju, Tomi and Akseer, Nadia and Al-Aly, Ziyad and Al-Eyadhy, Ayman and Al-Mekhlafi, Hesham M and Alahdab, Fares and Alam, Khurshid and Alam, Samiah and Alam, Tahiya and Alashi, Alaa and Alavian, Seyed Moayed and Alene, Kefyalew Addis and Ali, Komal and Ali, Syed Mustafa and Alijanzadeh, Mehran and Alizadeh-Navaei, Reza and Aljunid, Syed Mohamed and Alkerwi, Ala'a and Alla, François and Alsharif, Ubai and Altirkawi, Khalid and Alvis-Guzman, Nelson and Amare, Azmeraw T and Ammar, Walid and Anber, Nahla Hamed and Anderson, Jason A and Andrei, Catalina Liliana and Androudi, Sofia and Animut, Megbaru Debalkie and Anjomshoa, Mina and Ansha, Mustafa Geleto and Antó, Josep M and Antonio, Carl Abelardo T and Anwari, Palwasha and Appiah, Lambert Tetteh and Appiah, Seth Christopher Yaw and Arabloo, Jalal and Aremu, Olatunde and Ärnlöv, Johan and Artaman, Al and Aryal, Krishna K and Asayesh, Hamid and Ataro, Zerihun and Ausloos, Marcel and Avokpaho, Euripide F G A and Awasthi, Ashish and Ayala Quintanilla, Beatriz Paulina and Ayer, Rakesh and Ayuk, Tambe B and Azzopardi, Peter S and Babazadeh, Arefeh and Badali, Hamid and Badawi, Alaa and Balakrishnan, Kalpana and Bali, Ayele Geleto and Ball, Kylie and Ballew, Shoshana H and Banach, Maciej and Banoub, Joseph Adel Mattar and Barac, Aleksandra and Barker-Collo, Suzanne Lyn and Bärnighausen, Till Winfried and Barrero, Lope H and Basu, Sanjay and Baune, Bernhard T and Bazargan-Hejazi, Shahrzad and Bedi, Neeraj and Beghi, Ettore and Behzadifar, Masoud and Behzadifar, Meysam and Béjot, Yannick and Bekele, Bayu Begashaw and Bekru, Eyasu Tamru and Belay, Ezra and Belay, Yihalem Abebe and Bell, Michelle L and Bello, Aminu K and Bennett, Derrick A and Bensenor, Isabela M and Bergeron, Gilles and Berhane, Adugnaw and Bernabe, Eduardo and Bernstein, Robert S and Beuran, Mircea and Beyranvand, Tina and Bhala, Neeraj and Bhalla, Ashish and Bhattarai, Suraj and Bhutta, Zulfiqar A and Biadgo, Belete and Bijani, Ali and Bikbov, Boris and Bilano, Ver and Bililign, Nigus and Bin Sayeed, Muhammad Shahdaat and Bisanzio, Donal and Biswas, Tuhin and Bjørge, Tone and Blacker, Brigette F and Bleyer, Archie and Borschmann, Rohan and Bou-Orm, Ibrahim R and Boufous, Soufiane and Bourne, Rupert and Brady, Oliver J and Brauer, Michael and Brazinova, Alexandra and Breitborde, Nicholas J K and Brenner, Hermann and Briko, Andrey Nikolaevich and Britton, Gabrielle and Brugha, Traolach and Buchbinder, Rachelle and Burnett, Richard T and Busse, Reinhard and Butt, Zahid A and Cahill, Leah E and Cahuana-Hurtado, Lucero and Campos-Nonato, Ismael R and Cárdenas, Rosario and Carreras, Giulia and Carrero, Juan J and Carvalho, Félix and Castañeda-Orjuela, Carlos A and Castillo Rivas, Jacqueline and Castro, Franz and Catalá-López, Ferrán and Causey, Kate and Cercy, Kelly M and Cerin, Ester and Chaiah, Yazan and Chang, Hsing-Yi and Chang, Jung-Chen and Chang, Kai-Lan and Charlson, Fiona J and Chattopadhyay, Aparajita and Chattu, Vijay Kumar and Chee, Miao Li and Cheng, Ching-Yu and Chew, Adrienne and Chiang, Peggy Pei-Chia and Chimed-Ochir, Odgerel and Chin, Ken Lee and Chitheer, Abdulaal and Choi, Jee-Young J and Chowdhury, Rajiv and Christensen, Hanne and Christopher, Devasahayam J and Chung, Sheng-Chia and Cicuttini, Flavia M and Cirillo, Massimo and Cohen, Aaron J and Collado-Mateo, Daniel and Cooper, Cyrus and Cooper, Owen R and Coresh, Josef and Cornaby, Leslie and Cortesi, Paolo Angelo and Cortinovis, Monica and Costa, Megan and Cousin, Ewerton and Criqui, Michael H and Cromwell, Elizabeth A and Cundiff, David K and Daba, Alemneh Kabeta and Dachew, Berihun Assefa and Dadi, Abel Fekadu and Damasceno, Albertino Antonio Moura and Dandona, Lalit and Dandona, Rakhi and Darby, Sarah C and Dargan, Paul I and Daryani, Ahmad and Das Gupta, Rajat and Das Neves, José and Dasa, Tamirat Tesfaye and Dash, Aditya Prasad and Davitoiu, Dragos Virgil and Davletov, Kairat and De la Cruz-Góngora, Vanessa and De La Hoz, Fernando Pio and De Leo, Diego and De Neve, Jan-Walter and Degenhardt, Louisa and Deiparine, Selina and Dellavalle, Robert P and Demoz, Gebre Teklemariam and Denova-Gutiérrez, Edgar and Deribe, Kebede and Dervenis, Nikolaos and Deshpande, Aniruddha and Des Jarlais, Don C and Dessie, Getenet Ayalew and Deveber, Gabrielle Aline and Dey, Subhojit and Dharmaratne, Samath Dhamminda and Dhimal, Meghnath and Dinberu, Mesfin Tadese and Ding, Eric L and Diro, Helen Derara and Djalalinia, Shirin and Do, Huyen Phuc and Dokova, Klara and Doku, David Teye and Doyle, Kerrie E and Driscoll, Tim R and Dubey, Manisha and Dubljanin, Eleonora and Duken, Eyasu Ejeta and Duncan, Bruce B and Duraes, Andre R and Ebert, Natalie and Ebrahimi, Hedyeh and Ebrahimpour, Soheil and Edvardsson, David and Effiong, Andem and Eggen, Anne Elise and El Bcheraoui, Charbel and El-Khatib, Ziad and Elyazar, Iqbal Rf and Enayati, Ahmadali and Endries, Aman Yesuf and Er, Benjamin and Erskine, Holly E and Eskandarieh, Sharareh and Esteghamati, Alireza and Estep, Kara and Fakhim, Hamed and Faramarzi, Mahbobeh and Fareed, Mohammad and Farid, Talha A and Farinha, Carla Sofia E sá and Farioli, Andrea and Faro, Andre and Farvid, Maryam S and Farzaei, Mohammad Hosein and Fatima, Batool and Fay, Kairsten A and Fazaeli, Ali Akbar and Feigin, Valery L and Feigl, Andrea B and Fereshtehnejad, Seyed-Mohammad and Fernandes, Eduarda and Fernandes, Joao C and Ferrara, Giannina and Ferrari, Alize J and Ferreira, Manuela L and Filip, Irina and Finger, Jonas David and Fischer, Florian and Foigt, Nataliya A and Foreman, Kyle J and Fukumoto, Takeshi and Fullman, Nancy and Fürst, Thomas and Furtado, João M and Futran, Neal D and Gall, Seana and Gallus, Silvano and Gamkrelidze, Amiran and Ganji, Morsaleh and Garcia-Basteiro, Alberto L and Gardner, William M and Gebre, Abadi Kahsu and Gebremedhin, Amanuel Tesfay and Gebremichael, Teklu Gebrehiwo and Gelano, Tilayie Feto and Geleijnse, Johanna M and Geramo, Yilma Chisha Dea and Gething, Peter W and Gezae, Kebede Embaye and Ghadimi, Reza and Ghadiri, Keyghobad and Ghasemi Falavarjani, Khalil and Ghasemi-Kasman, Maryam and Ghimire, Mamata and Ghosh, Rakesh and Ghoshal, Aloke Gopal and Giampaoli, Simona and Gill, Paramjit Singh and Gill, Tiffany K and Gillum, Richard F and Ginawi, Ibrahim Abdelmageed and Giussani, Giorgia and Gnedovskaya, Elena V and Godwin, William W and Goli, Srinivas and Gómez-Dantés, Hector and Gona, Philimon N and Gopalani, Sameer Vali and Goulart, Alessandra C and Grada, Ayman and Grams, Morgan E and Grosso, Giuseppe and Gugnani, Harish Chander and Guo, Yuming and Gupta, Rahul and Gupta, Rajeev and Gupta, Tanush and Gutiérrez, Reyna Alma and Gutiérrez-Torres, Daniela S and Haagsma, Juanita A and Habtewold, Tesfa Dejenie and Hachinski, Vladimir and Hafezi-Nejad, Nima and Hagos, Tekleberhan B and Hailegiyorgis, Tewodros Tesfa and Hailu, Gessessew Bugssa and Haj-Mirzaian, Arvin and Haj-Mirzaian, Arya and Hamadeh, Randah R and Hamidi, Samer and Handal, Alexis J and Hankey, Graeme J and Hao, Yuantao and Harb, Hilda L and Harikrishnan, Sivadasanpillai and Haro, Josep Maria and Hassankhani, Hadi and Hassen, Hamid Yimam and Havmoeller, Rasmus and Hawley, Caitlin N and Hay, Simon I and Hedayatizadeh-Omran, Akbar and Heibati, Behzad and Heidari, Behnam and Heidari, Mohsen and Hendrie, Delia and Henok, Andualem and Heredia-Pi, Ileana and Herteliu, Claudiu and Heydarpour, Fatemeh and Heydarpour, Sousan and Hibstu, Desalegn T and Higazi, Tarig B and Hilawe, Esayas Haregot and Hoek, Hans W and Hoffman, Howard J and Hole, Michael K and Homaie Rad, Enayatollah and Hoogar, Praveen and Hosgood, H Dean and Hosseini, Seyed Mostafa and Hosseinzadeh, Mehdi and Hostiuc, Mihaela and Hostiuc, Sorin and Hoy, Damian G and Hsairi, Mohamed and Hsiao, Thomas and Hu, Guoqing and Hu, Howard and Huang, John J and Hussen, Mamusha Aman and Huynh, Chantal K and Iburg, Kim Moesgaard and Ikeda, Nayu and Ilesanmi, Olayinka Stephen and Iqbal, Usman and Irvani, Seyed Sina Naghibi and Irvine, Caleb Mackay Salpeter and Islam, Sheikh Mohammed Shariful and Islami, Farhad and Jackson, Maria D and Jacobsen, Kathryn H and Jahangiry, Leila and Jahanmehr, Nader and Jain, Sudhir Kumar and Jakovljevic, Mihajlo and James, Spencer L and Jassal, Simerjot K and Jayatilleke, Achala Upendra and Jeemon, Panniyammakal and Jha, Ravi Prakash and Jha, Vivekanand and Ji, John S and Jonas, Jost B and Jonnagaddala, Jitendra and Jorjoran Shushtari, Zahra and Joshi, Ankur and Jozwiak, Jacek Jerzy and Jürisson, Mikk and Kabir, Zubair and Kahsay, Amaha and Kalani, Rizwan and Kanchan, Tanuj and Kant, Surya and Kar, Chittaranjan and Karami, Manoochehr and Karami Matin, Behzad and Karch, André and Karema, Corine and Karimi, Narges and Karimi, Seyed M and Kasaeian, Amir and Kassa, Dessalegn H and Kassa, Getachew Mullu and Kassa, Tesfaye Dessale and Kassebaum, Nicholas J and Katikireddi, Srinivasa Vittal and Kaul, Anil and Kawakami, Norito and Kazemi, Zhila and Karyani, Ali Kazemi and Kefale, Adane Teshome and Keiyoro, Peter Njenga and Kemp, Grant Rodgers and Kengne, Andre Pascal and Keren, Andre and Kesavachandran, Chandrasekharan Nair and Khader, Yousef Saleh and Khafaei, Behzad and Khafaie, Morteza Abdullatif and Khajavi, Alireza and Khalid, Nauman and Khalil, Ibrahim A and Khan, Gulfaraz and Khan, Muhammad Shahzeb and Khan, Muhammad Ali and Khang, Young-Ho and Khater, Mona M and Khazaei, Mohammad and Khazaie, Habibolah and Khoja, Abdullah T and Khosravi, Ardeshir and Khosravi, Mohammad Hossein and Kiadaliri, Aliasghar A and Kiirithio, Daniel N and Kim, Cho-Il and Kim, Daniel and Kim, Young-Eun and Kim, Yun Jin and Kimokoti, Ruth W and Kinfu, Yohannes and Kisa, Adnan and Kissimova-Skarbek, Katarzyna and Kivimäki, Mika and Knibbs, Luke D and Knudsen, Ann Kristin Skrindo and Kochhar, Sonali and Kokubo, Yoshihiro and Kolola, Tufa and Kopec, Jacek A and Kosen, Soewarta and Koul, Parvaiz A and Koyanagi, Ai and Kravchenko, Michael A and Krishan, Kewal and Krohn, Kristopher J and Kromhout, Hans and Kuate Defo, Barthelemy and Kucuk Bicer, Burcu and Kumar, G Anil and Kumar, Manasi and Kuzin, Igor and Kyu, Hmwe Hmwe and Lachat, Carl and Lad, Deepesh P and Lad, Sheetal D and Lafranconi, Alessandra and Lalloo, Ratilal and Lallukka, Tea and Lami, Faris Hasan and Lang, Justin J and Lansingh, Van C and Larson, Samantha Leigh and Latifi, Arman and Lazarus, Jeffrey V and Lee, Paul H and Leigh, James and Leili, Mostafa and Leshargie, Cheru Tesema and Leung, Janni and Levi, Miriam and Lewycka, Sonia and Li, Shanshan and Li, Yichong and Liang, Juan and Liang, Xiaofeng and Liao, Yu and Liben, Misgan Legesse and Lim, Lee-Ling and Linn, Shai and Liu, Shiwei and Lodha, Rakesh and Logroscino, Giancarlo and Lopez, Alan D and Lorkowski, Stefan and Lotufo, Paulo A and Lozano, Rafael and Lucas, Tim C D and Lunevicius, Raimundas and Ma, Stefan and Macarayan, Erlyn Rachelle King and Machado, Ísis Eloah and Madotto, Fabiana and Mai, Hue Thi and Majdan, Marek and Majdzadeh, Reza and Majeed, Azeem and Malekzadeh, Reza and Malta, Deborah Carvalho and Mamun, Abdullah A and Manda, Ana-Laura and Manguerra, Helena and Mansournia, Mohammad Ali and Mantovani, Lorenzo Giovanni and Maravilla, Joemer C and Marcenes, Wagner and Marks, Ashley and Martin, Randall V and Martins, Sheila C O and Martins-Melo, Francisco Rogerlândio and März, Winfried and Marzan, Melvin B and Massenburg, Benjamin Ballard and Mathur, Manu Raj and Mathur, Prashant and Matsushita, Kunihiro and Maulik, Pallab K and Mazidi, Mohsen and McAlinden, Colm and McGrath, John J and McKee, Martin and Mehrotra, Ravi and Mehta, Kala M and Mehta, Varshil and Meier, Toni and Mekonnen, Fantahun Ayenew and Melaku, Yohannes A and Melese, Addisu and Melku, Mulugeta and Memiah, Peter T N and Memish, Ziad A and Mendoza, Walter and Mengistu, Desalegn Tadese and Mensah, George A and Mensink, Gert B M and Mereta, Seid Tiku and Meretoja, Atte and Meretoja, Tuomo J and Mestrovic, Tomislav and Mezgebe, Haftay Berhane and Miazgowski, Bartosz and Miazgowski, Tomasz and Millear, Anoushka I and Miller, Ted R and Miller-Petrie, Molly Katherine and Mini, G K and Mirarefin, Mojde and Mirica, Andreea and Mirrakhimov, Erkin M and Misganaw, Awoke Temesgen and Mitiku, Habtamu and Moazen, Babak and Mohajer, Bahram and Mohammad, Karzan Abdulmuhsin and Mohammadi, Moslem and Mohammadifard, Noushin and Mohammadnia-Afrouzi, Mousa and Mohammed, Shafiu and Mohebi, Farnam and Mokdad, Ali H and Molokhia, Mariam and Momeniha, Fatemeh and Monasta, Lorenzo and Moodley, Yoshan and Moradi, Ghobad and Moradi-Lakeh, Maziar and Moradinazar, Mehdi and Moraga, Paula and Morawska, Lidia and Morgado-Da-Costa, Joana and Morrison, Shane Douglas and Moschos, Marilita M and Mouodi, Simin and Mousavi, Seyyed Meysam and Mozaffarian, Dariush and Mruts, Kalayu Brhane and Muche, Achenef Asmamaw and Muchie, Kindie Fentahun and Mueller, Ulrich Otto and Muhammed, Oumer Sada and Mukhopadhyay, Satinath and Muller, Kate and Musa, Kamarul Imran and Mustafa, Ghulam and Nabhan, Ashraf F and Naghavi, Mohsen and Naheed, Aliya and Nahvijou, Azin and Naik, Gurudatta and Naik, Nitish and Najafi, Farid and Nangia, Vinay and Nansseu, Jobert Richie and Nascimento, Bruno Ramos and Neal, Bruce and Neamati, Nahid and Negoi, Ionut and Negoi, Ruxandra Irina and Neupane, Subas and Newton, Charles Richard James and Ngunjiri, Josephine W and Nguyen, Anh Quynh and Nguyen, Grant and Nguyen, Ha Thu and Nguyen, Huong Lan Thi and Nguyen, Huong Thanh and Nguyen, Minh and Nguyen, Nam Ba and Nichols, Emma and Nie, Jing and Ningrum, Dina Nur Anggraini and Nirayo, Yirga Legesse and Nishi, Nobuo and Nixon, Molly R and Nojomi, Marzieh and Nomura, Shuhei and Norheim, Ole F and Noroozi, Mehdi and Norrving, Bo and Noubiap, Jean Jacques and Nouri, Hamid Reza and Nourollahpour Shiadeh, Malihe and Nowroozi, Mohammad Reza and Nsoesie, Elaine O and Nyasulu, Peter S and Obermeyer, Carla M and Odell, Christopher M and Ofori-Asenso, Richard and Ogbo, Felix Akpojene and Oh, In-Hwan and Oladimeji, Olanrewaju and Olagunju, Andrew T and Olagunju, Tinuke O and Olivares, Pedro R and Olsen, Helen Elizabeth and Olusanya, Bolajoko Olubukunola and Olusanya, Jacob Olusegun and Ong, Kanyin L and Ong, Sok King and Oren, Eyal and Orpana, Heather M and Ortiz, Alberto and Ota, Erika and Otstavnov, Stanislav S and Øverland, Simon and Owolabi, Mayowa Ojo and P A, Mahesh and Pacella, Rosana and Pakhare, Abhijit P and Pakpour, Amir H and Pana, Adrian and Panda-Jonas, Songhomitra and Park, Eun-Kee and Parry, Charles D H and Parsian, Hadi and Patel, Shanti and Pati, Sanghamitra and Patil, Snehal T and Patle, Ajay and Patton, George C and Paudel, Deepak and Paulson, Katherine R and Paz Ballesteros, Wayra Citlali and Pearce, Neil and Pereira, Alexandre and Pereira, David M and Perico, Norberto and Pesudovs, Konrad and Petzold, Max and Pham, Hai Quang and Phillips, Michael R and Pillay, Julian David and Piradov, Michael A and Pirsaheb, Meghdad and Pischon, Tobias and Pishgar, Farhad and Plana-Ripoll, Oleguer and Plass, Dietrich and Polinder, Suzanne and Polkinghorne, Kevan R and Postma, Maarten J and Poulton, Richie and Pourshams, Akram and Poustchi, Hossein and Prabhakaran, Dorairaj and Prakash, Swayam and Prasad, Narayan and Purcell, Caroline A and Purwar, Manorama B and Qorbani, Mostafa and Radfar, Amir and Rafay, Anwar and Rafiei, Alireza and Rahim, Fakher and Rahimi, Zohreh and Rahimi-Movaghar, Afarin and Rahimi-Movaghar, Vafa and Rahman, Mahfuzar and Rahman, Mohammad Hifz ur and Rahman, Muhammad Aziz and Rai, Rajesh Kumar and Rajati, Fatemeh and Rajsic, Sasa and Raju, Sree Bhushan and Ram, Usha and Ranabhat, Chhabi Lal and Ranjan, Prabhat and Rath, Goura Kishor and Rawaf, David Laith and Rawaf, Salman and Reddy, K Srinath and Rehm, Colin D and Rehm, Jürgen and Reiner, Robert C and Reitsma, Marissa B and Remuzzi, Giuseppe and Renzaho, Andre M N and Resnikoff, Serge and Reynales-Shigematsu, Luz Myriam and Rezaei, Satar and Ribeiro, Antonio Luiz P and Rivera, Juan A and Roba, Kedir Teji and Rodríguez-Ramírez, Sonia and Roever, Leonardo and Román, Yesenia and Ronfani, Luca and Roshandel, Gholamreza and Rostami, Ali and Roth, Gregory A and Rothenbacher, Dietrich and Roy, Ambuj and Rubagotti, Enrico and Rushton, Lesley and Sabanayagam, Charumathi and Sachdev, Perminder S and Saddik, Basema and Sadeghi, Ehsan and Saeedi Moghaddam, Sahar and Safari, Hosein and Safari, Yahya and Safari-Faramani, Roya and Safdarian, Mahdi and Safi, Sare and Safiri, Saeid and Sagar, Rajesh and Sahebkar, Amirhossein and Sahraian, Mohammad Ali and Sajadi, Haniye Sadat and Salam, Nasir and Salamati, Payman and Saleem, Zikria and Salimi, Yahya and Salimzadeh, Hamideh and Salomon, Joshua A and Salvi, Devashri Digvijay and Salz, Inbal and Samy, Abdallah M and Sanabria, Juan and Sanchez-Niño, Maria Dolores and Sánchez-Pimienta, Tania G and Sanders, Taren and Sang, Yingying and Santomauro, Damian Francesco and Santos, Itamar S and Santos, João Vasco and Santric Milicevic, Milena M and Sao Jose, Bruno Piassi and Sardana, Mayank and Sarker, Abdur Razzaque and Sarmiento-Suárez, Rodrigo and Sarrafzadegan, Nizal and Sartorius, Benn and Sarvi, Shahabeddin and Sathian, Brijesh and Satpathy, Maheswar and Sawant, Arundhati R and Sawhney, Monika and Saylan, Mete and Sayyah, Mehdi and Schaeffner, Elke and Schmidt, Maria Inês and Schneider, Ione J C and Schöttker, Ben and Schutte, Aletta Elisabeth and Schwebel, David C and Schwendicke, Falk and Scott, James G and Seedat, Soraya and Sekerija, Mario and Sepanlou, Sadaf G and Serre, Marc L and Serván-Mori, Edson and Seyedmousavi, Seyedmojtaba and Shabaninejad, Hosein and Shaddick, Gavin and Shafieesabet, Azadeh and Shahbazi, Mehdi and Shaheen, Amira A and Shaikh, Masood Ali and Shamah Levy, Teresa and Shams-Beyranvand, Mehran and Shamsi, Mohammadbagher and Sharafi, Heidar and Sharafi, Kiomars and Sharif, Mehdi and Sharif-Alhoseini, Mahdi and Sharifi, Hamid and Sharma, Jayendra and Sharma, Meenakshi and Sharma, Rajesh and She, Jun and Sheikh, Aziz and Shi, Peilin and Shibuya, Kenji and Shiferaw, Mekonnen Sisay and Shigematsu, Mika and Shin, Min-Jeong and Shiri, Rahman and Shirkoohi, Reza and Shiue, Ivy and Shokraneh, Farhad and Shoman, Haitham and Shrime, Mark G and Shupler, Matthew S and Si, Si and Siabani, Soraya and Sibai, Abla Mehio and Siddiqi, Tariq J and Sigfusdottir, Inga Dora and Sigurvinsdottir, Rannveig and Silva, Diego Augusto Santos and Silva, João Pedro and Silveira, Dayane Gabriele Alves and Singh, Jasvinder A and Singh, Narinder Pal and Singh, Virendra and Sinha, Dhirendra Narain and Skiadaresi, Eirini and Skirbekk, Vegard and Smith, David L and Smith, Mari and Sobaih, Badr Hasan and Sobhani, Soheila and Somayaji, Ranjani and Soofi, Moslem and Sorensen, Reed J D and Soriano, Joan B and Soyiri, Ireneous N and Spinelli, Angela and Sposato, Luciano A and Sreeramareddy, Chandrashekhar T and Srinivasan, Vinay and Starodubov, Vladimir I and Steckling, Nadine and Stein, Dan J and Stein, Murray B and Stevanovic, Goran and Stockfelt, Leo and Stokes, Mark A and Sturua, Lela and Subart, Michelle L and Sudaryanto, Agus and Sufiyan, Mu'awiyyah Babale and Sulo, Gerhard and Sunguya, Bruno F and Sur, Patrick John and Sykes, Bryan L and Szoeke, Cassandra E I and Tabarés-Seisdedos, Rafael and Tabuchi, Takahiro and Tadakamadla, Santosh Kumar and Takahashi, Ken and Tandon, Nikhil and Tassew, Segen Gebremeskel and Tavakkoli, Mohammad and Taveira, Nuno and Tehrani-Banihashemi, Arash and Tekalign, Tigist Gashaw and Tekelemedhin, Shishay Wahdey and Tekle, Merhawi Gebremedhin and Temesgen, Habtamu and Temsah, Mohamad-Hani and Temsah, Omar and Terkawi, Abdullah Sulieman and Tessema, Belay and Teweldemedhin, Mebrahtu and Thankappan, Kavumpurathu Raman and Theis, Andrew and Thirunavukkarasu, Sathish and Thomas, Hannah J and Thomas, Matthew Lloyd and Thomas, Nihal and Thurston, George D and Tilahun, Binyam and Tillmann, Taavi and To, Quyen G and Tobollik, Myriam and Tonelli, Marcello and Topor-Madry, Roman and Torre, Anna E and Tortajada-Girbés, Miguel and Touvier, Mathilde and Tovani-Palone, Marcos Roberto and Towbin, Jeffrey A and Tran, Bach Xuan and Tran, Khanh Bao and Truelsen, Thomas Clement and Truong, Nu Thi and Tsadik, Afewerki Gebremeskel and Tudor Car, Lorainne and Tuzcu, E Murat and Tymeson, Hayley D and Tyrovolas, Stefanos and Ukwaja, Kingsley N and Ullah, Irfan and Updike, Rachel L and Usman, Muhammad Shariq and Uthman, Olalekan A and Vaduganathan, Muthiah and Vaezi, Afsane and Valdez, Pascual R and Van Donkelaar, Aaron and Varavikova, Elena and Varughese, Santosh and Vasankari, Tommi Juhani and Venkateswaran, Vidhya and Venketasubramanian, Narayanaswamy and Villafaina, Santos and Violante, Francesco S and Vladimirov, Sergey Konstantinovitch and Vlassov, Vasily and Vollset, Stein Emil and Vos, Theo and Vosoughi, Kia and Vu, Giang Thu and Vujcic, Isidora S and Wagnew, Fasil Shiferaw and Waheed, Yasir and Waller, Stephen G and Walson, Judd L and Wang, Yafeng and Wang, Yanping and Wang, Yuan-Pang and Weiderpass, Elisabete and Weintraub, Robert G and Weldegebreal, Fitsum and Werdecker, Andrea and Werkneh, Adhena Ayaliew and West, J Jason and Westerman, Ronny and Whiteford, Harvey A and Widecka, Justyna and Wijeratne, Tissa and Winkler, Andrea Sylvia and Wiyeh, Alison B and Wiysonge, Charles Shey and Wolfe, Charles D A and Wong, Tien Yin and Wu, Shouling and Xavier, Denis and Xu, Gelin and Yadgir, Simon and Yadollahpour, Ali and Yahyazadeh Jabbari, Seyed Hossein and Yamada, Tomohide and Yan, Lijing L and Yano, Yuichiro and Yaseri, Mehdi and Yasin, Yasin Jemal and Yeshaneh, Alex and Yimer, Ebrahim M and Yip, Paul and Yisma, Engida and Yonemoto, Naohiro and Yoon, Seok-Jun and Yotebieng, Marcel and Younis, Mustafa Z and Yousefifard, Mahmoud and Yu, Chuanhua and Zaidi, Zoubida and Zaman, Sojib Bin and Zamani, Mohammad and Zavala-Arciniega, Luis and Zhang, Anthony Lin and Zhang, Hao and Zhang, Kai and Zhou, Maigeng and Zimsen, Stephanie R M and Zodpey, Sanjay and Murray, Christopher J L},
  issn         = {0140-6736},
  journal      = {LANCET},
  keywords     = {CARDIOVASCULAR-DISEASES,TOBACCO CONTROL,BLOOD-PRESSURE,METAANALYSIS,CHOLESTEROL,ILLNESS,TRENDS,TRIAL},
  language     = {eng},
  number       = {10159},
  pages        = {1923--1994},
  title        = {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},
  url          = {http://dx.doi.org/10.1016/s0140-6736(18)32225-6},
  volume       = {392},
  year         = {2018},
}

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