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

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

Comparative Risk Assessment (CRA) 2000 Study

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

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

Finucane et al. Lancet 2011

Women Men

Change in BMI in 199 countries (women)

Finucane et al. Lancet 2011

Data and situation in example countries, women

Saudi Arabia

Egypt Oman

Qatar Saudi Arabia

Data and situation in example countries, menEgypt Oman

Qatar Saudi Arabia

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

Finucane et al. Lancet 2011

Women Men

Trends in age-standardized systolic blood pressure (SBP) in Middle East / North Africa

Finucane et al. Lancet 2011

Women Men

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

Finucane et al. Lancet 2011

Women Men

SBP trends in high-income regions (men)

Western Europe

Danaei et al. Lancet 2011

Australasia (M)North America (M)

Asia-Pacific

TC trends in high-income regions (men)

AustralasiaNorth America

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