1. The global and regional burden of major risk
factors, 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 exposures
Smoking
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 NCD
Physical 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 Men
Finucane 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 Men
Finucane et al. Lancet 2011

14. Trends in age-standardized systolic blood
pressure (SBP) in Middle East / North Africa
Women Men
Finucane et al. Lancet 2011

15. Data and situation in example countries
Egypt men Egypt women
Iran men Iran women

16. Trends in age-standardized total cholesterol
(TC) in Middle East / North Africa
Women Men
Finucane et al. Lancet 2011

17. SBP trends in high-income regions (men)
North America (M) Australasia (M)
Asia-Pacific Western Europe
Danaei et al. Lancet 2011

18. TC trends in high-income regions (men)
North America Australasia
Asia-Pacific Western Europe
Farzadfar 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