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Percorrer por autor "Roth, Gregory A."

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  • Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
    Publication . GBD 2021 Risk Factors Collaborators; Brauer, Michael; Roth, Gregory A.; Aravkin, Aleksandr Y.; Zheng, Peng; Abate, Kalkidan Hassen; Abate, Yohannes Habtegiorgis; Abbafati, Cristiana; Abbasgholizadeh, Rouzbeh; Abbasi, Madineh Akram; Abbasian, Mohammadreza; Abbasifard, Mitra; Abbasi-Kangevari, Mohsen; ElHafeez, Samar Abd; Abd-Elsalam, Sherief; Abdi, Parsa; Abdollahi, Mohammad; Abdoun, Meriem; Abdulah, Deldar Morad; Abdullahi, Auwal; Abebe, Mesfin; Abedi, Aidin; Abedi, Armita; Abegaz, Tadesse M.; Zuñiga, Roberto Ariel Abeldaño; Abiodun, Olumide; Abiso, Temesgen Lera; Aboagye, Richard Gyan; Abolhassani, Hassan; Abouzid, Mohamed; Aboye, Girma Beressa; Abreu, Lucas Guimarães; Abualruz, Hasan; Abubakar, Bilyaminu; Abu-Gharbieh, Eman; Abukhadijah, Hana Jihad Jihad; Aburuz, Salahdein; Abu-Zaid, Ahmed; Adane, Mesafint Molla; Addo, Isaac Yeboah; Addolorato, Giovanni; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Aden, Bashir; Adetunji, Juliana Bunmi; Adeyeoluwa, Temitayo Esther; Adha, Rishan; Adibi, Amin; Adnani, Qorinah Estiningtyas Sakilah; Adzigbli, Leticia Akua; Bettencourt, Paulo J. G.
    Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation.
    2024-05-18Artigo científico Acesso aberto Ver mais
  • Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
    Publication . Afshin, Ashkan; Sur, Patrick John; Fay, Kairsten A.; Cornaby, Leslie; Ferrara, Giannina; Salama, Joseph S.; Mullany, Erin C.; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abebe, Zegeye; Afarideh, Mohsen; Goulart, Alessandra C.; Farvid, Maryam S.; Farzadfar, Farshad; Feigin, Valery L.; Fernandes, João C.; Ganji, Morsaleh; Flor, Luisa Sorio; Geleijnse, Johanna M.; Yu, Chuanhua; Grosso, Giuseppe; Kimokoti, Ruth W.; Guessous, Idris; Hamidi, Samer; Hankey, Graeme J.; Harikrishnan, Sivadasanpillai; Lotufo, Paulo A.; Hassen, Hamid Yimam; Hay, Simon I.; Hoang, Chi Linh; Malekzadeh, Reza; Horino, Masako; Kokubo, Yoshihiro; Islami, Farhad; Jackson, Maria D.; James, Spencer L.; Johansson, Lars; Jonas, Jost B.; Lozano, Rafael; Kasaeian, Amir; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khang, Young-Ho; Kumar, G. Anil; Marz, Winfried; Lallukka, Tea; Lopez, Alan D.; Yonemoto, Naohiro; Lorkowski, Stefan; Meier, Toni; Melaku, Yohannes A.; Mendoza, Walter; Rivera, Juan A.; Mensink, Gert B. M.; Micha, Renata; Mirarefin, Mojde; Mohan, Viswanathan; Schutte, Aletta Elisabeth; Mokdad, Ali H.; Sartorius, Benn; Mozaffarian, Dariush; Nagel, Gabriele; Naghavi, Mohsen; Rodriguez-Ramirez, Sonia; Cuong Tat Nguyen; Nixon, Molly R.; Ong, Kanyin L.; Pereira, David M.; Poustchi, Hossein; Sepanlou, Sadaf G.; Qorbani, Mostafa; Rai, Rajesh Kumar; Schmidhuber, Josef; Razo-Garcia, Christian; Roshandel, Gholamreza; Rehm, Colin D.; Roth, Gregory A.; Sanabria, Juan; Shin, Min-Jeong; Sanchez-Pimienta, Tania G.; Sorensen, Reed J. D.; Springmann, Marco; Szponar, Lucjan; Willett, Walter C.; Thorne-Lyman, Andrew L.; Thrift, Amanda G.; Aggarwal, Anju; Touvier, Mathilde; Bacha, Umar; Tran, Bach Xuan; Tyrovolas, Stefanos; Ukwaja, Kingsley Nnanna; Ullah, Irfan; Uthman, Olalekan A.; Wu, Jason H.; Vaezghasemi, Masoud; Vasankari, Tommi Juhani; Vollset, Stein Emil; Vos, Theo; Agrawal, Sutapa; Bachman, Victoria F.; Vu, Giang Thu; Vu, Linh Gia; Weiderpass, Elisabete; Werdecker, Andrea; Xu, Gelin; Wijeratne, Tissa; Akinyemiju, Tomi; Alahdab, Fares; Badali, Hamid; Murray, Christopher J. L.; Badawi, Alaa; Bensenor, Isabela M.; Bernabe, Eduardo; Foigt, Nataliya A.; Biryukov, Stan H.; Biadgilign, Sibhatu Kassa K.; Cahill, Leah E.; Carrero, Juan J.; Gillum, Richard F.; Cercy, Kelly M.; Dandona, Lalit; Dandona, Rakhi; Dang, Anh Kim; Degefa, Meaza Girma; Forouzanfar, Mohammad H.; Zaki, Maysaa El Sayed; Esteghamati, Alireza; Esteghamati, Sadaf; Fanzo, Jessica; Farinha, Carla Sofia E. Sá
    Background Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity. Methods By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of diseasespecific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome. Findings In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates. Interpretation This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.
    2019Artigo científico Acesso aberto Ver mais