Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

Abstract

BackgroundMost 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 FindingsFor 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.ConclusionsMany 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.

Burden of disease attributable to obesity and overweight in Korea

“…Rose's work led to one of the most fundamental axioms in disease prevention across risk factors: 'A large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk.' 9 Other studies have proven that the incidence of complications was higher in the population with moderate hypertension than in that with high-level hypertension. 50,51 These findings demonstrate that health interventions aimed at influencing the whole population and shifting the whole distribution of a risk factor would be more effective than high-risk group-focused strategies to reduce the impact of the risk factor.…”

“…Extrapolation of hazard from limited number of studies to other population which was used in WHO report is another source of potential error. 9 Therefore, with the increasing public health impact of obesity, accurate measurement of the burden of disease attributable to overweight and obesity is an essential step in establishing public health interventions designed to prevent obesity-induced diseases in Korea. With above background.…”

Implications of the exposome for exposure science

“…The simple answer is that we have only a sketchy understanding of the culprits because information about exposures is gleaned almost exclusively from indirect and uncertain questionnaire data. Using such data, the estimated proportion of all human diseases attributable to environmental pollutants (the sum of outdoor air pollution; indoor air pollution from solid fuel use, lead; water, sanitation and hygiene) plus occupational exposures is about 7-10% (Rodgers et al, 2004;Saracci and Vineis, 2007), roughly the same as attributable to genetic factors. Thus, traditional environmental pollutants appear to explain a small, but significant, part of the 90% of disease risks attributable to non-genetic factors.…”

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

“…Whereas over-nutrition (manifested as overweight and obesity) is gaining much attention in the current complex epidemiological transition within most African countries, a substantial amount of under-nutrition (manifested as underweight) still persists in poorer communities across the continent [1]. Excess weight gain has been linked to type 2 diabetes, ischaemic heart disease, stroke, hypertensive heart disease, osteoarthritis, and cancers of the breast, colon, endometrium and kidney [9]. Evidence from verbal autopsy reports from the Navrongo Health and Demographic Surveillance System (NHDSS) point to the fact that cardiovascular and ischaemic heart diseases are among the top 10 causes of mortality in the Kassena-Nankana districts [10].…”