Risk assessment of burden of disease

Lancet, the world's leading general medical journal and specialty journals in Oncology, Neurology and Infectious Diseases, estimated deaths and disability-adjusted life years attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. The following are the main risk factors for disease burden:

Risk factor for disease burden	Ranking in 2010	Ranking in 1990
High blood pressure	1	4
Smoking	2	3
Alcohol use	3	6
Household air pollution	4	2
Low fruit consumption	5	8
High body mass index (BMI)	6	10
High fasting plasma glucose	7	9
Childhood underweight	8	1
Ambient particulate matter pollution	9	7
Physical inactivity	10	-
High sodium diets	11	12
Low nut and seed consumption	12	13
Iron deficiency	13	11
Suboptimal breastfeeding	14	5
High total cholesterol	15	14

The contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. Thus in 2010, the three leading risk factors for global disease burden were:

• High blood pressure
• Smoking
• Alcohol use

But ten years earlier, in 1990, the leading risks were childhood underweight,household air pollution from solid fuels, tobacco smoking, unimproved water and sanitation and childhood micronutrient deficiencies.
 

In addition, these risk factors varied depending on the location.

In most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia.

The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use. In most of Asia, North Africa and Middle East, and central Europe it was high blood pressure.

Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High BMI has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East and Oceania.