the global and regional burden of major risk factors, and lessons for ncd prevention priorities
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MRC-HPA Centre for Environment and Health
Imperial CollegeLondon
The global and regional burden of major risk factors, and lessons for NCD prevention priorities
Majid EzzatiMRC-HPA Centre for Environment and HealthDepartment of Epidemiology and Biostatistics
School of Public HealthImperial College London
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Diseases and risk factors
• Mortality and disease burden can be attributed to– disease or injury outcomes
– risk factors
SmokingAir pollution
~1.5 million lung cancer deaths
Occupational exposures
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Comparative Risk Assessment (CRA) 2000 Study
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Drug use
Diet low in vegetables
Occupational risk factors for injuries
Iron deficiency
Diet low in seafood omega-3
Diet high in sodium
High total cholesterol
Diet low in whole grains
Sub-optimal breastfeeding
Diet low in nuts/seeds
Physical inactivity and low physical activity
Ambient particulate matter (PM) pollution
Childhood underweight
High fasting plasma glucose
High body mass index (BMI)
Household air pollution from solid fuels
Diet low in fruits
Alcohol use
Tobacco smoking, including SHS
High blood pressure
0 2 4 6 8
Neoplasm
Cardio & Circ
Chronic Resp
Cirrhosis
Digestive
Neuro
Mental
DUBE
MSK
Oth NCD
HIV+TB
Diarr+LRI+Oth
NTD+Malaria
Maternal
Neonatal Cond
Nutr Def
Oth Comm
Transport
Unintent Inj
Intent Inj
War+Disaster
Leading risk factors for disease burden in the world in 2010
Percent global DALYs
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Leading risk factors for disease burden in North Africa and Middle East in 1990
Percent regional DALYs
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Leading risk factors for disease burden in North Africa and Middle East in 2010
Percent regional DALYs
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Leading risk factors for disease burden in North Africa and Middle East in 2010, men
Percent regional DALYs
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Leading risk factors for disease burden in North Africa and Middle East in 2010, women
Percent regional DALYs
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Trends in age-standardized mean body mass index (BMI) in Middle East / North Africa
Finucane et al. Lancet 2011
Women Men
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Change in BMI in 199 countries (women)
Finucane et al. Lancet 2011
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Data and situation in example countries, women
Saudi Arabia
Egypt Oman
Qatar Saudi Arabia
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Data and situation in example countries, menEgypt Oman
Qatar Saudi Arabia
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Trends in age-standardized fasting plasma glucose (FPG) in Middle East / North Africa
Finucane et al. Lancet 2011
Women Men
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Trends in age-standardized systolic blood pressure (SBP) in Middle East / North Africa
Finucane et al. Lancet 2011
Women Men
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Data and situation in example countries
Egypt men Egypt women
Iran men Iran women
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Trends in age-standardized total cholesterol (TC) in Middle East / North Africa
Finucane et al. Lancet 2011
Women Men
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SBP trends in high-income regions (men)
Western Europe
Danaei et al. Lancet 2011
Australasia (M)North America (M)
Asia-Pacific
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TC trends in high-income regions (men)
AustralasiaNorth America
Asia-Pacific Western Europe
Farzadfar et al. Lancet 2011
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Summary
• EMRO region has been very successful in reducing risk factors for childhood infectious diseases
• The region has experienced one of the largest rises in overweight/obesity and glycaemia/diabetes in the world
• The region has not replicated the experiences of other high- and upper-middle-income regions in reducing blood pressure and cholesterol
• Metabolic risks and their diet/inactivity determinants, together with smoking for men, are leading causes of disease burden in the region
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Acknowledgements and credits
• Risk factor analysis: Stephen Lim; Christopher Murray; Alan Lopez; Theo Vos; Goodarz Danaei; Abraham Flaxman; Kenji Shibuya; and risk factor expert groups
• Metabolic Risk Factors for Chronic Diseases– BMI: MM Finucane*, GA Stevens*, MJ Cowan, G Danaei, JK Lin, CJ
Paciorek, GM Singh, HR Gutierrez, Y Lu, AN Bahalim, F Farzadfar, LM Riley, M Ezzati
– FPG: G Danaei*, MM Finucane*, Y Lu, GM Singh, MJ Cowan, CJ Paciorek, JK Lin, F Farzadfar, YH Khang, GA Stevens, M Rao, MK Ali, LM Riley, CA Robinson, M Ezzati
– SBP: G Danaei*, MM Finucane*, JK Lin*, GM Singh*, CJ Paciorek, MJ Cowan, F Farzadfar, GA Stevens, SS Lim, LM Riley, M Ezzati
– TC: F Farzadfar*, MM Finucane*, G Danaei, PM Pelizzari, MJ Cowan, CJ Paciorek, GM Singh, JK Lin, GA Stevens, LM Riley, M Ezzati
– Country data group: 321 researchers and analysts who reanalyzed health examination surveys and epidemiologic studies