The global and regional burden of major risk factors, and lessons for NCD prevention priorities

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  • 1. The global and regional burden of major riskfactors, and lessons for NCD prevention priorities Majid Ezzati MRC-HPA Centre for Environment and Health Department of Epidemiology and Biostatistics School of Public Health Imperial College London MRC-HPA Centre for Environment and Health Imperial College London
  • 2. Diseases and risk factors • Mortality and disease burden can be attributed to – disease or injury outcomes – risk factors Occupational exposuresSmoking Air pollution ~1.5 million lung cancer deaths
  • 3. Comparative Risk Assessment (CRA) 2000 Study
  • 4. Leading risk factors for disease burden in the world in 2010 High blood pressure Tobacco smoking, including SHS Neoplasm Alcohol use Cardio & Circ Chronic Resp Diet low in fruits Cirrhosis Household air pollution from solid fuels Digestive High body mass index (BMI) Neuro High fasting plasma glucose Mental DUBE Childhood underweight MSK Ambient particulate matter (PM) pollution Oth NCDPhysical inactivity and low physical activity HIV+TB Diet low in nuts/seeds Diarr+LRI+Oth Sub-optimal breastfeeding NTD+Malaria Maternal Diet low in whole grains Neonatal Cond High total cholesterol Nutr Def Diet high in sodium Oth Comm Diet low in seafood omega-3 Transport Unintent Inj Iron deficiency Intent Inj Occupational risk factors for injuries War+Disaster Diet low in vegetables Drug use 0 2 4 6 8 Percent global DALYs
  • 5. Leading risk factors for disease burden in North Africa and Middle East in 1990 Percent regional DALYs
  • 6. Leading risk factors for disease burden in North Africa and Middle East in 2010 Percent regional DALYs
  • 7. Leading risk factors for disease burden in North Africa and Middle East in 2010, men Percent regional DALYs
  • 8. Leading risk factors for disease burden in North Africa and Middle East in 2010, women Percent regional DALYs
  • 9. Trends in age-standardized mean body mass index (BMI) in Middle East / North Africa Women MenFinucane et al. Lancet 2011
  • 10. Change in BMI in 199 countries (women)Finucane et al. Lancet 2011
  • 11. Data and situation in example countries, women Egypt Oman Saudi Arabia Qatar Saudi Arabia
  • 12. Data and situation in example countries, men Egypt Oman Qatar Saudi Arabia
  • 13. Trends in age-standardized fasting plasma glucose (FPG) in Middle East / North Africa Women MenFinucane et al. Lancet 2011
  • 14. Trends in age-standardized systolic blood pressure (SBP) in Middle East / North Africa Women MenFinucane et al. Lancet 2011
  • 15. Data and situation in example countriesEgypt men Egypt womenIran men Iran women
  • 16. Trends in age-standardized total cholesterol (TC) in Middle East / North Africa Women MenFinucane et al. Lancet 2011
  • 17. SBP trends in high-income regions (men) North America (M) Australasia (M) Asia-Pacific Western EuropeDanaei et al. Lancet 2011
  • 18. TC trends in high-income regions (men) North America Australasia Asia-Pacific Western EuropeFarzadfar et al. Lancet 2011
  • 19. 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
  • 20. 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