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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
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
Comparative Risk Assessment (CRA) 2000
                 Study
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
Leading risk factors for disease burden in North
        Africa and Middle East in 1990




                 Percent regional DALYs
Leading risk factors for disease burden in North
        Africa and Middle East in 2010




                 Percent regional DALYs
Leading risk factors for disease burden in North
     Africa and Middle East in 2010, men




                 Percent regional DALYs
Leading risk factors for disease burden in North
   Africa and Middle East in 2010, women




                 Percent regional DALYs
Trends in age-standardized mean body mass
         index (BMI) in Middle East / North Africa

                              Women     Men




Finucane et al. Lancet 2011
Change in BMI in 199 countries (women)




Finucane et al. Lancet 2011
Data and situation in example countries, women
   Egypt                     Oman




                              Saudi Arabia




   Qatar                   Saudi Arabia
Data and situation in example countries, men
 Egypt                    Oman




 Qatar                    Saudi Arabia
Trends in age-standardized fasting plasma
           glucose (FPG) in Middle East / North Africa

                              Women          Men




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

                              Women        Men




Finucane et al. Lancet 2011
Data and situation in example countries
Egypt men                   Egypt women




Iran men                    Iran women
Trends in age-standardized total cholesterol
              (TC) in Middle East / North Africa

                              Women        Men




Finucane et al. Lancet 2011
SBP trends in high-income regions (men)


                                North America (M)      Australasia (M)




                            Asia-Pacific            Western Europe




Danaei et al. Lancet 2011
TC trends in high-income regions (men)




                               North America         Australasia




                               Asia-Pacific      Western Europe


Farzadfar et al. Lancet 2011
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
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

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

  • 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