Imperial College London

Dr Frédéric B. Piel

Faculty of MedicineSchool of Public Health

Senior Lecturer



+44 (0)20 7594 3346f.piel




Praed StreetSt Mary's Campus






BibTex format

author = {Forouzanfar, MH and Afshin, A and Alexander, LT and Anderson, HR and Bhutta, ZA and Biryukov, S and Brauer, M and Burnett, R and Cercy, K and Charlson, FJ and Cohen, AJ and Dandona, L and Estep, K and Ferrari, AJ and Frostad, JJ and Fullman, N and Gething, PW and Godwin, WW and Griswold, M and Kinfu, Y and Kyu, HH and Larson, HJ and Liang, X and Lim, SS and Liu, PY and Lopez, AD and Lozano, R and Marczak, L and Mensah, GA and Mokdad, AH and Moradi-Lakeh, M and Naghavi, M and Neal, B and Reitsma, MB and Roth, GA and Salomon, JA and Sur, PJ and Vos, T and Wagner, JA and Wang, H and Zhao, Y and Zhou, M and Aasvang, GM and Abajobir, AA and Abate, KH and Abbafati, C and Abbas, KM and Abd-Allah, F and Abdulle, AM and Abera, SF and Abraham, B and Abu-Raddad, LJ and Abyu, GY and Adebiyi, AO and Adedeji, IA and Ademi, Z and Adou, AK and Adsuar, JC and Agardh, EE and Agarwal, A and Agrawal, A and Kiadaliri, AA and Ajala, ON and Akinyemiju, TF and Al-Aly, Z and Alam, K and Alam, NKM and Aldhahri,},
doi = {10.1016/S0140-6736(16)31679-8},
journal = {The Lancet},
pages = {1659--1724},
title = {Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015},
url = {},
volume = {388},
year = {2016}

RIS format (EndNote, RefMan)

AB - SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated
AU - Forouzanfar,MH
AU - Afshin,A
AU - Alexander,LT
AU - Anderson,HR
AU - Bhutta,ZA
AU - Biryukov,S
AU - Brauer,M
AU - Burnett,R
AU - Cercy,K
AU - Charlson,FJ
AU - Cohen,AJ
AU - Dandona,L
AU - Estep,K
AU - Ferrari,AJ
AU - Frostad,JJ
AU - Fullman,N
AU - Gething,PW
AU - Godwin,WW
AU - Griswold,M
AU - Kinfu,Y
AU - Kyu,HH
AU - Larson,HJ
AU - Liang,X
AU - Lim,SS
AU - Liu,PY
AU - Lopez,AD
AU - Lozano,R
AU - Marczak,L
AU - Mensah,GA
AU - Mokdad,AH
AU - Moradi-Lakeh,M
AU - Naghavi,M
AU - Neal,B
AU - Reitsma,MB
AU - Roth,GA
AU - Salomon,JA
AU - Sur,PJ
AU - Vos,T
AU - Wagner,JA
AU - Wang,H
AU - Zhao,Y
AU - Zhou,M
AU - Aasvang,GM
AU - Abajobir,AA
AU - Abate,KH
AU - Abbafati,C
AU - Abbas,KM
AU - Abd-Allah,F
AU - Abdulle,AM
AU - Abera,SF
AU - Abraham,B
AU - Abu-Raddad,LJ
AU - Abyu,GY
AU - Adebiyi,AO
AU - Adedeji,IA
AU - Ademi,Z
AU - Adou,AK
AU - Adsuar,JC
AU - Agardh,EE
AU - Agarwal,A
AU - Agrawal,A
AU - Kiadaliri,AA
AU - Ajala,ON
AU - Akinyemiju,TF
AU - Al-Aly,Z
AU - Alam,K
AU - Alam,NKM
AU - Aldhahri,SF
AU - Aldridge,RW
AU - Alemu,ZA
AU - Ali,R
AU - Alkerwi,A
AU - Alla,F
AU - Allebeck,P
AU - Alsharif,U
AU - Altirkawi,KA
AU - Martin,EA
AU - Alvis-Guzman,N
AU - Amare,AT
AU - Amberbir,A
AU - Amegah,AK
AU - Amini,H
AU - Ammar,W
AU - Amrock,SM
AU - Andersen,HH
AU - Anderson,BO
AU - Antonio,CAT
AU - Anwari,P
AU - Ärnlöv,J
AU - Artaman,A
AU - Asayesh,H
AU - Asghar,RJ
AU - Assadi,R
AU - Atique,S
AU - Avokpaho,EFGA
AU - Awasthi,A
AU - Quintanilla,BPA
AU - Azzopardi,P
AU - Bacha,U
AU - Badawi,A
AU - Bahit,MC
AU - Balakrishnan,K
AU - Barac,A
AU - Barber,RM
AU - Barker-Collo,SL
AU - Bärnighausen,T
AU - Barquera,S
AU - Barregard,L
AU - Barrero,LH
AU - Basu,S
AU - Batis,C
AU - Bazargan-Hejazi,S
AU - Beardsley,J
AU - Bedi,N
AU - Beghi,E
AU - Bell,ML
AU - Bello,AK
AU - Bennett,DA
AU - Bensenor,IM
AU - Berhane,A
AU - Bernabé,E
AU - Betsu,BD
AU - Beyene,AS
AU - Bhala,N
AU - Bhansali,A
AU - Bhatt,S
AU - Biadgilign,S
AU - Bikbov,B
AU - Bisanzio,D
AU - Bjertness,E
AU - Blore,JD
AU - Borschmann,R
AU - Boufous,S
AU - Bourne,RRA
AU - Brainin,M
AU - Brazinova,A
AU - Breitborde,NJK
AU - Brenner,H
AU - Broday,DM
AU - Brugha,TS
AU - Brunekreef,B
AU - Butt,ZA
AU - Cahill,LE
AU - Calabria,B
AU - Campos-Nonato,IR
AU - Cárdenas,R
AU - Carpenter,DO
AU - Casey,DC
AU - Castañeda-Orjuela,CA
AU - Rivas,JC
AU - Castro,RE
AU - Catalá-López,F
AU - Chang,J
AU - Chiang,PP
AU - Chibalabala,M
AU - Chimed-Ochir,O
AU - Chisumpa,VH
AU - Chitheer,AA
AU - Choi,JJ
AU - Christensen,H
AU - Christopher,DJ
AU - Ciobanu,LG
AU - Coates,MM
AU - Colquhoun,SM
AU - Cooper,LT
AU - Cooperrider,K
AU - Cornaby,L
AU - Cortinovis,M
AU - Crump,JA
AU - Cuevas-Nasu,L
AU - Damasceno,A
AU - Dandona,R
AU - Darby,SC
AU - Dargan,PI
DO - 10.1016/S0140-6736(16)31679-8
EP - 1724
PY - 2016///
SN - 0140-6736
SP - 1659
TI - Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
T2 - The Lancet
UR -
UR -
VL - 388
ER -