As part of future iterations of GBD, we plan to quantify the burden attributable to some distal social risks. We have embarked on this work, but it proves to have challenges that are qualitatively different than many of the risks included here. For nearly all risk-outcome pairs, we assume in the absence of other evidence that the RRs by age and sex are generalisable across populations (the exception is for BMI in Asian and non-Asian populations for breast cancer). In principle, if there is evidence of statistically significant RRs for different population groups, we would incorporate these into the CRA. For distal social risks, the pathways to outcomes can be modified in many ways by other risks or by health-system interventions. We expect that the RR due to low education for 40-year-old men would be different in Norway than in Kenya. Given the greater potential for variation in RRs for distal risks, inclusion in GBD will require more local quantification of RRs and then a further modelling step to estimate RRs for these determinants for all locations. Our first planned target for this quantification is educational attainment.
