Abstract
Background: Most 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 Findings: For 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. Conclusions: Many 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.
| Original language | English (US) |
|---|---|
| Article number | e27 |
| Pages (from-to) | 44-55 |
| Number of pages | 12 |
| Journal | PLoS Medicine |
| Volume | 1 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2004 |
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ASJC Scopus subject areas
- Medicine(all)
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Distribution of major health risks : Findings from the global burden of disease study. / Comparative Risk Assessment Collaborating Group.
In: PLoS Medicine, Vol. 1, No. 1, e27, 01.01.2004, p. 44-55.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Distribution of major health risks
T2 - Findings from the global burden of disease study
AU - Comparative Risk Assessment Collaborating Group
AU - Rodgers, Anthony
AU - Ezzati, Majid
AU - Vander Hoorn, Stephen
AU - Lopez, Alan D.
AU - Lin, Ruey Bin
AU - Murray, Christopher J.L.
AU - Fishman, Steven
AU - Caulfield, Laura
AU - de Onis, Mercedes
AU - Blössner, Monika
AU - Hyder, Adnan A.
AU - Mullany, Luke C
AU - Black, Robert E
AU - Stoltzfus, Rebecca J.
AU - Rice, Amy J.
AU - West, Keith
AU - Lawes, Carlene
AU - Law, Malcolm
AU - Elliott, Paul
AU - MacMahon, Stephen
AU - James, W. Philip T.
AU - Jackson-Leach, Rachel
AU - Ni Mhurchu, Cliona
AU - Kalamara, Eleni
AU - Shayeghi, Maryam
AU - Rigby, Neville J.
AU - Nishida, Chizuru
AU - Lock, Karen
AU - Pomerleau, Joceline
AU - Causer, Louise
AU - McKee, Martin
AU - Bull, Fiona C.
AU - Dixon, Tracy
AU - Ham, Sandra
AU - Neiman, Andrea
AU - Pratt, Michael
AU - Rehm, Jürgen
AU - Room, Robin
AU - Monteiro, Maristela
AU - Gmel, Gerhard
AU - Graham, Kathryn
AU - Rehn, Nina
AU - Sempos, Christopher T.
AU - Frick, Ulrich
AU - Jernigan, David
AU - Degenhardt, Louisa
AU - Hall, Wayne
AU - Warner-Smith, Matthew
AU - Lynskey, Michael
AU - Walker, Neff
PY - 2004/1/1
Y1 - 2004/1/1
N2 - Background: Most 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 Findings: For 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. Conclusions: Many 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.
AB - Background: Most 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 Findings: For 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. Conclusions: Many 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.
UR - http://www.scopus.com/inward/record.url?scp=15744400763&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=15744400763&partnerID=8YFLogxK
U2 - 10.1371/journal.pmed.0010027
DO - 10.1371/journal.pmed.0010027
M3 - Article
C2 - 15526049
AN - SCOPUS:15744400763
VL - 1
SP - 44
EP - 55
JO - PLoS Medicine
JF - PLoS Medicine
SN - 1549-1277
IS - 1
M1 - e27
ER -