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

Background: 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 in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Multiparticle azimuthal correlations in p -Pb and Pb-Pb collisions at the CERN Large Hadron Collider

Measurements of multiparticle azimuthal correlations (cumulants) for charged particles in p-Pb at 1asNN = 5.02 TeV and Pb-Pb at 1asNN = 2.76 TeV collisions are presented. They help address the question of whether there is evidence for global, flowlike, azimuthal correlations in the p-Pb system. Comparisons are made to measurements from the larger Pb-Pb system, where such evidence is established. In particular, the second harmonic two-particle cumulants are found to decrease with multiplicity, characteristic of a dominance of few-particle correlations in p-Pb collisions. However, when a |\u394\u3b7| gap is placed to suppress such correlations, the two-particle cumulants begin to rise at high multiplicity, indicating the presence of global azimuthal correlations. The Pb-Pb values are higher than the p-Pb values at similar multiplicities. In both systems, the second harmonic four-particle cumulants exhibit a transition from positive to negative values when the multiplicity increases. The negative values allow for a measurement of v2{4} to be made, which is found to be higher in Pb-Pb collisions at similar multiplicities. The second harmonic six-particle cumulants are also found to be higher in Pb-Pb collisions. In Pb-Pb collisions, we generally find v2{4} 43 v2{6} \u338= 0 which is indicative of a Bessel-Gaussian function for the v2 distribution. For very high-multiplicity Pb-Pb collisions, we observe that the four- and six-particle cumulants become consistent with 0. Finally, third harmonic two-particle cumulants in p-Pb and Pb-Pb are measured. These are found to be similar for overlapping multiplicities, when a |\u394\u3b7| > 1.4 gap is placed

Azimuthal anisotropy of D-meson production in Pb-Pb collisions at root s(NN)=2.76 TeV

The production of the prompt charmed mesonsD(0), D+, andD(*+) relative to the reaction plane was measured in Pb-Pb collisions at a center-of-mass energy per nucleon-nucleon collision of root s(NN) = 2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. D mesons were reconstructed via their hadronic decays at central rapidity in the transverse-momentum (pT) interval 2-16 GeV/c. The azimuthal anisotropy is quantified in terms of the second coefficient v(2) in a Fourier expansion of the D-meson azimuthal distribution and in terms of the nuclear modification factor R-AA, measured in the direction of the reaction plane and orthogonal to it. The v(2) coefficient was measured with three different methods and in three centrality classes in the interval 0%-50%. A positive v(2) is observed in midcentral collisions (30%-50% centrality class), with a mean value of 0.204(-0.036)(+0.099) (tot.unc.) in the interval 2 < pT < 6 GeV/c, which decreases towards more central collisions (10%-30% and 0%-10% classes). The positive v(2) is also reflected in the nuclear modification factor, which shows a stronger suppression in the direction orthogonal to the reaction plane formidcentral collisions. The measurements are compared to theoretical calculations of charm-quark transport and energy loss in high-density strongly interacting matter at high temperature. The models that include substantial elastic interactions with an expanding medium provide a good description of the observed anisotropy. However, they are challenged to simultaneously describe the strong suppression of high-pT yield of D mesons in central collisions and their azimuthal anisotropy in noncentral collisions

Measurement of electrons from semileptonic heavy-flavor hadron decays in pp collisions at root s=2.76 TeV

The p(T)-differential production cross section of electrons from semileptonic decays of heavy-flavor hadrons has been measured at midrapidity in proton-proton collisions at root s = 2.76 TeV in the transverse momentum range 0.5 < p(T) < 12 GeV/c with the ALICE detector at the LHC. The analysis was performed using minimum bias events and events triggered by the electromagnetic calorimeter. Predictions from perturbative QCD calculations agree with the data within the theoretical and experimental uncertainties

Measurement of charged jet suppression in Pb-Pb collisions at sNN\sqrt{s_{NN}} = 2.76 TeV

A measurement of the transverse momentum spectra of jets in Pb-Pb collisions at √sNN = 2.76TeV is reported. Jets are reconstructed from charged particles using the anti-k T jet algorithm with jet resolution parameters R of 0.2 and 0.3 in pseudo-rapidity |η| < 0.5. The transverse momentum p T of charged particles is measured down to 0.15 GeV/c which gives access to the low p T fragments of the jet. Jets found in heavy-ion collisions are corrected event-by-event for average background density and on an inclusive basis (via unfolding) for residual background fluctuations and detector effects. A strong suppression of jet production in central events with respect to peripheral events is observed. The suppression is found to be similar to the suppression of charged hadrons, which suggests that substantial energy is radiated at angles larger than the jet resolution parameter R = 0.3 considered in the analysis. The fragmentation bias introduced by selecting jets with a high p T leading particle, which rejects jets with a soft fragmentation pattern, has a similar effect on the jet yield for central and peripheral events. The ratio of jet spectra with R = 0.2 and R = 0.3 is found to be similar in Pb-Pb and simulated PYTHIA pp events, indicating no strong broadening of the radial jet structure in the reconstructed jets with R < 0.3