Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Relationship between SEVs and SDI for the three metabolic, behavioural, and environmental or occupational risk factors that are responsible for the largest number of attributable DALYs globallyEach point corresponds to a country in either 1990 (red) or 2016 (blue). Pearson correlation coefficients have been estimated to summarise the relationship between SEVs and SDI in 1990 and in 2016. SEVs=summary exposure values. SDI=Socio-demographic Index. DALYs=disability-adjusted life-years.

DALYs attributable to all Level 2 risk factors apportioned by Level 2 cause for each risk, both sexes combined, 2016, at the global level (A); for low SDI countries (B); for low-middle SDI countries (C); for middle SDI countries (D); for middle-high SDI countries (E); and for high SDI countries (F)DALYs from causes attributable to each risk factor are shown in different colours. Cutoffs on the SDI scale for the quintiles were selected based on examining the entire distribution of locations between 1980 and 2016. DALYs=disability-adjusted life-years. SDI=Socio-demographic Index.

Leading 30 Level 3 risk factors by attributable DALYs at the global level, 1990, 2006, and 2016, for males (A) and females (B)Risks are connected by lines between time periods. Behavioural risk factors are shown in red, environmental risks in blue, and metabolic risks in green. For the time period of 1990 to 2006 and for 2006–16, three measures of change are shown: percent change in the number of DALYs, percent change in the all-age DALY rate, and percent change in the age-standardised DALY rate. Statistically significant increases or decreases are shown in bold (p<0·05). DALYs=disability-adjusted life-years.

Relationship between attributable DALYs in 2016 for Level 3 risk factors and annualised rate of change in SEV, at the global level, both sexes combined, 1990–2016DALYs are represented on a logarithmic scale. Risks shown exhibited a statistically significant change in SEV between 1990 and 2016. The following six risks, each of which is responsible for fewer than 100 thousand DALYs, are not shown: occupational exposure to benzene, beryllium, cadmium, chromium, formaldehyde, and trichloroethylene. DALYs=disability-adjusted life-years. SEV=summary exposure value. Ambient PM=ambient particulate matter pollution. Alcohol=alcohol use. Arsenic=occupational exposure to arsenic. Asbestos=occupational exposure to asbestos. Asthmagens=occupational asthmagens. BMD=low bone mineral density. BMI=high body-mass index. Calcium=diet low in calcium. Cholesterol=high total cholesterol. Diesel=occupational exposure to diesel engine exhaust. Disc breast=discontinued breastfeeding. Drugs=drug use. Ergonomics=occupational ergonomic factors. Fibre=diet low in fibre. FPG=high fasting plasma glucose. Fruits=diet low in fruits. Handwashing=no access to handwashing facility. Household air=household air pollution from solid fuels. Impaired kidney=impaired kidney function. IPV=intimate partner violence. Iron=iron deficiency. Lead=lead exposure. Legumes=diet low in legumes. Milk=diet low in milk. Nickel=occupational exposure to nickel. Noise=occupational noise. Nuts and seeds=diet low in nuts and seeds. Occupational SHS=occupational exposure to second-hand smoke. Omega 3=diet low in seafood omega 3 fatty acids. Ozone=ambient ozone pollution. PAH=occupational exposure to polycyclic aromatic hydrocarbons. Part breastfeeding=non-exclusive breastfeeding. Physical activity=low physical activity. PM, gases, and fumes=occupational particulate matter, gases, and fumes. Processed meat=diet high in processed meat. PUFA=diet low in polyunsaturated fatty acids. Radon=residential radon. Red meat=diet high in red meat. Sanitation=unsafe sanitation. SBP=high systolic blood pressure. Sexual abuse=childhood sexual abuse. SHS=second-hand smoke. Silica=occupational exposure to silica. Smokeless=smokeless tobacco. Sodium=diet high in sodium. Stunting=child stunting. Sugar-sweetened beverages=diet high in sugar-sweetened beverages. Sulfuric acid=occupational exposure to sulfuric acid. Transfatty acids=diet high in transfatty acids. Underweight=child underweight. Vegetables=diet low in vegetables. Vitamin A=vitamin A deficiency. Wasting=child wasting. Water=unsafe water source. Whole grains=diet low in whole grains. Zinc=zinc deficiency.

Percent change in deaths (A) and DALYs (B) at the global level, 2006–16, due to population growth, population ageing, trends in exposure to all risks included in GBD 2016, and and all other (risk-deleted or residual) factorsResults are shown for all causes combined; communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries. DALYs=disability-adjusted life-years.

Percent change in all-cause DALYs, by age, at the global level, 2006-2016, due to the following drivers: population growth, population ageing, trends in exposure to all risks included in GBD 2016, and all other factorsDALYs=disability-adjusted life-years.