Distribution of major health risks: Findings from the global burden of disease study

Comparative Risk Assessment Collaborating Group

Research output: Contribution to journalArticle

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 languageEnglish (US)
Article numbere27
Pages (from-to)44-55
Number of pages12
JournalPLoS Medicine
Volume1
Issue number1
DOIs
StatePublished - Jan 1 2004

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Health
Population
Thinness
Tobacco Use
Vegetables
Cost-Benefit Analysis
Global Burden of Disease
Fruit
Body Mass Index
Age Groups
Obesity
Cholesterol
Alcohols
Databases
Blood Pressure
Hypertension
Mortality

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 journalArticle

Comparative Risk Assessment Collaborating Group. / Distribution of major health risks : Findings from the global burden of disease study. In: PLoS Medicine. 2004 ; Vol. 1, No. 1. pp. 44-55.
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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.",
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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.

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