High blood pressure, smoking, and alcohol present largest risks to health worldwide

December 13, 2012

The researchers identified a range of major risk factors for disease and estimated overall exposure to these risk factors for 1990, 2005, and 2010, in 21 different world regions, and for both men and women in different age groups. The data were gathered via systematic review and synthesis of published and unpublished data, and the burden of disease due to the risk factors and their combinations was calculated using estimates of cause-specific deaths and disability adjusted life years (DALYs) from GBD 2010 (see Papers 3 and 4). The researchers calculated each risk factor's contribution to the global burden of disease via the number of deaths caused and contribution to global DALYs. Data are presented for both 1990 and 2010, allowing changes over time to be meaningfully understood for the first time.

In 2010, the two most important risk factors were high blood pressure, estimated to be responsible for 9.4 million deaths (7.0% of global DALYs), and tobacco smoking, including second hand smoke, (responsible for 6.3 million deaths, 6.3% of global DALYs). Alcohol use was the third most important risk factor, thought to be responsible for 5.0 million deaths (5.5% of global DALYs). In Eastern Europe, alcohol use accounted for almost a quarter of the total regional disease burden in 2010, and was also an important cause of disease burden in most of Latin America. Collectively, dietary factors and physical inactivity were responsible for 12.5 million deaths (10.0% of global DALYs), with the most prominent dietary risks found to be diets low in fruit and diets high in sodium).

Strikingly, childhood underweight - which was ranked as the most important contributor to global disease burden in 1990, and responsible for 2.3 million deaths in that year - dropped to eighth place in 2010, and was estimated to have caused 860000 deaths that year. In 1990, the second ranked risk factor was household air pollution from solid fuel use (responsible for 4.4 million deaths in 1990, or 6.8% of global DALYs), and although this had dropped to fourth place in 2010, it was still responsible for 3.5 million deaths (4.3% of global DALYs) that year.

While a number of the risk factors have undergone dramatic changes since 1990 in their contribution to the global burden of disease, the contribution of smoking as a risk factor has barely changed, underlining the urgent need for effective and large-scale strategies to address the tobacco epidemic.

According to study authors Professor Majid Ezzati, of Imperial College London, and Associate Professor Stephen Lim of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, "Our analysis shows that, while some risk factors - such as tobacco use and poor diet - cause substantial health problems worldwide, there are huge regional variations which need to be taken into account. For instance, in sub-Saharan Africa, risks such as childhood underweight, household air pollution from solid fuels, and suboptimal breastfeeding continue to cause a disproportionate amount of health burden in 2010, despite decreasing impacts. It is also important to stress that the size of the risk factor burden does not necessarily equal priority for action, since prioritisation also depends on availability, cost, and effectiveness of intervention strategies to reduce exposures to these risks."
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Lancet

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