SummaryBackgroundThe 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.MethodsWe 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.FindingsIn 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) 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). I...

SummaryBackgroundAlcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.MethodsUsing 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.FindingsGlobally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.InterpretationAlcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.FundingBill & Meli...

SummaryBackgroundDetailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.MethodsWe have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations in...

Resumo Objetivo Descrever as mudanças nos estilos de vida, quanto ao consumo de tabaco, bebidas alcoólicas, alimentação e atividade física, no período de restrição social consequente à pandemia da COVID-19. Métodos Estudo transversal realizado com dados do inquérito ConVid sobre comportamentos em saúde. Os dados foram coletados por meio de questionário on-line autopreenchido pelos participantes. Procedimentos de pós-estratificação foram empregados para o cálculo das prevalências e intervalos de confiança de 95%. Resultados Participaram 45.161 indivíduos com 18 ou mais anos de idade. Durante o período de restrição social, foi relatada diminuição da prática de atividade física e aumento do tempo em frente a telas, da ingestão de alimentos ultraprocessados, do número de cigarros fumados e do consumo de bebidas alcóolicas. Foram observadas diferenças segundo sexo e faixa etária. Conclusão Os resultados apontam uma piora dos estilos de vida e aumento de comportamentos de risco à saúde.

SummaryBackgroundPolitical, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.MethodsWe analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.FindingsNationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.InterpretationHealth improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.FundingBill & Melinda Gates Foundation and the Brazilian Ministry of Health.

Resumo Objetivo: Analisar a frequência de tristeza, nervosismo e alterações do sono durante a pandemia de COVID-19 no Brasil, identificando os segmentos demográficos mais afetados. Métodos: Estudo transversal, com questionário aplicado via web a adultos e idosos, coletando informações sobre condições de vida, saúde e comportamento. Foram estimadas prevalências e razões de prevalências ajustadas por idade e sexo. Resultados: De 45.161 brasileiros respondentes, verificou-se que, durante a pandemia, 40,4% (IC95% 39,0;41,8) se sentiram frequentemente tristes ou deprimidos, e 52,6% (IC95% 51,2;54,1) frequentemente ansiosos ou nervosos; 43,5% (IC95% 41,8;45,3) relataram início de problemas de sono, e 48,0% (IC95% 45,6;50,5) problema de sono preexistente agravado. Tristeza, nervosismo frequentes e alterações do sono estiveram mais presentes entre adultos jovens, mulheres e pessoas com antecedente de depressão. Conclusão: As elevadas prevalências encontradas indicam a necessidade de garantir a provisão de serviços de atenção à saúde mental e à qualidade do sono, adaptados ao contexto pandêmico.

RESUMO: Objetivo: Determinar a prevalência populacional de hipertensão arterial em adultos, segundo diferentes critérios diagnósticos. Métodos: Trata-se de um estudo transversal, que analisa informações da Pesquisa Nacional de Saúde de 2013, que consistiu em entrevistas, medidas físicas e laboratoriais da população brasileira (n = 60.202). A prevalência de hipertensão arterial foi definida segundo três critérios diagnósticos: hipertensão autorreferida; medida por instrumento (pressão arterial ≥ 140/90 mmHg); medida e/ou em uso de medicamentos anti-hipertensivos. Foram estimadas as prevalências de hipertensão arterial segundo os três critérios diagnósticos e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: As prevalências de hipertensão arterial encontradas foram: 21,4% (IC95% 20,8 - 22,0) utilizando-se o critério autorreferido, 22,8% (IC95% 22,1 - 23,4) para hipertensão arterial medida e 32,3% (IC95% 31,7 - 33,0) para hipertensão arterial medida e/ou relato de uso de medicação. As mulheres apresentaram prevalências de hipertensão mais elevadas no critério autorreferido (24,2%; IC95% 23,4 - 24,9). Entre os homens, a prevalência foi maior no critério hipertensão arterial medida (25,8%; IC95% 24,8 - 26,7). Utilizando os três critérios, a hipertensão arterial aumentou com a idade, foi mais frequente na região urbana e maior nas regiões sudeste e sul, em relação à média do país e às demais regiões. Conclusão: Estes resultados são importantes para apoiar políticas que visem atingir a meta da Organização Mundial de Saúde de redução da hipertensão em 25% na próxima década.

ABSTRACT:Objective: To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. Methods: Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. Results: The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. Conclusion: Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.