Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

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Not AvailableThis is Vol. X, No. 1 issue of 'IASRI Statistical Newsletter' and covers the activities and allied information in respect of this Institute during the quarter January-March, 1984. This Newsletter has been proving useful to the Agricultural Research Statisticians and other users.Not Availabl

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Not AvailableThe National Agricultural Research System (NARS) is playing a pivotal role in enabling food security by continuous generation of technologies in agriculture and allied sectors in the country. The Indian farming mostly characterized with diversified agro-ecologies, water scarcity, unpredicted rains due to vagaries of monsoon and high cost of technological inputs. Based on the changing scenario of agriculture year by year, it requires promotion of proper management of natural resources like soil, water and micro environment, besides wellbeing of all stakeholders involved in the food production and consumption chain. This is primarily possible by technological empowerment of farmers. As part of such a strategy, the Indian Council of Agricultural Research (ICAR) is playing a crucial role in providing technologies generated by NARS after its assessment, refinement, demonstration in the micro farming situations, in addition to updating the knowledge and skill of farmers and extension personnel by taking up innovative approaches through its network of 589 Krishi Vigyan Kendras (KVKs), which act as knowledge and resource centers for empowering all the partners in the agricultural development process. Over the years, there is a change in agrarian structure, though 80% of farmers are operating small and marginal land holdings and having a weak access to critical production resources. It is expected that India will have the largest agricultural manpower dominated by youths under 30 years of age by 2020. Majority of the Indian youth live in villages and are engaged in agricultural activities. Keeping in view such a situation, the KVKs are effectively addressing the felt needs of farming community especially rural youth by following plough to plate approach and creating an enterprising environment. In order to reach the farmers efficiently, a number of activities are carried out by the entire KVK system to bring out location specific technology modules and appropriate extension approaches. It is therefore very important to review and analyze the input, output, outcome and impact of technological interventions implemented by KVKs by documenting the success achieved and to reorient the strategies for effective functioning of KVKs for fulfilling its mandate. In this direction, the Division of Agricultural Extension of ICAR has made a critical review of success stories emerged from KVKs through a rigorous process followed by the Programme Coordinators at district level, the Zonal Project Directorates at Zonal level and by the Division at national level. Altogether 101 salient technological interventions which proved success have been chosen as a testimony of hard work put in by KVK system and are presented in the form of this document. There is no denying the fact that until the full potential of technology modules tested and demonstrated by KVKs are harvested by the millions of farmers in the country, success cannot be truly translated into production gains at the field level. It is hoped that this attempt may direct the KVKs and the farming community for up-scaling and replication of successful enterprising interventions for teaching the untaught and reaching the unreached.Not Availabl