Table 1.
GBD 2017 risk factor hierarchy and accompanying exposure definitions, theoretical minimum risk exposure level, and data representativeness index for each risk factor, pre-2007, 2007–17, and total (across all years)
| Risk factors | Exposure definition | Theoretical minimum risk exposure level |
Data representativeness index |
|||||
|---|---|---|---|---|---|---|---|---|
| Before 2007 | 2007–17 | Total | ||||||
| 0 | All | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 1 | Environmental and occupational risks | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 2 | Unsafe water, sanitation, and handwashing | .. | .. | 80·3% | 63·7% | 82·4% | ||
| 3 | Unsafe water source | Proportion of individuals with access to different water sources (unimproved, improved except piped, or piped water supply) and reported use of household water treatment methods (boiling or filtering, chlorinating or solar filtering, or no treatment) | All individuals have access to water from a piped water supply that is also boiled or filtered before drinking | 78·2% | 61·1% | 79·8% | ||
| 3 | Unsafe sanitation | Proportion of individuals with access to different sanitation facilities (unimproved, improved except sewer, or sewer connection) | All individuals have access to toilets with sewer connection | 75·7% | 54·9% | 78·8% | ||
| 3 | No access to handwashing facility | Proportion of individuals with access to handwashing facility with soap, water, and wash station | All individuals have access to handwashing facility with soap, water, and wash station | 13·5% | 34·7% | 39·4% | ||
| 2 | Air pollution | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 3 | Particulate matter pollution | .. | .. | 82·9% | 88·6% | 96·4% | ||
| 4 | Ambient particulate matter pollution | Annual average daily exposure to outdoor air concentrations of particulate matter with an aerodynamic diameter of ≤2·5 μm (PM2·5), measured in μg/m3 | Joint theoretical minimum risk exposure level for both household and ambient particulate matter pollution is a uniform distribution between 2·4 and 5·9 μg/m3, with burden attributed proportionally between household and particulate matter pollution on the basis of source of PM2·5 exposure in excess of theoretical minimum risk exposure level | 17·1% | 57·0% | 58·0% | ||
| 4 | Household air pollution from solid fuels | Individual exposure to PM2·5 due to use of solid cooking fuel | See ambient particulate matter pollution | 82·9% | 63·4% | 85·5% | ||
| 3 | Ambient ozone pollution | Seasonal (6-month period with highest ozone) 8-h daily maximum ozone concentrations, measured in ppb | Uniform distribution between 29·1 and 35·7 ppb | 100·0% | 100·0% | 100·0% | ||
| 2 | Other environmental risks | .. | .. | 47·2% | 30·1% | 48·7% | ||
| 3 | Residential radon | Average daily exposure to indoor air radon levels measured in becquerels (radon disintegrations per second) per cubic metre (Bq/m3) | 10 Bq/m3, corresponding to the outdoor concentration of radon | 36·8% | 8·8% | 36·8% | ||
| 3 | Lead exposure | Blood lead levels in μg/dL of blood, bone lead levels in μg/g of bone | 2 μg/dL, corresponding to lead levels in pre-industrial humans as natural sources of lead prevent the feasibility of zero exposure | 35·8% | 26·9% | 40·9% | ||
| 2 | Occupational risks | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 3 | Occupational carcinogens | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to asbestos | Proportion of the population with cumulative lifetime exposure to occupational asbestos | No occupational exposure to asbestos | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to arsenic | Proportion of the population ever exposed to arsenic at work or through their occupation | No occupational exposure to arsenic | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to benzene | Proportion of the population ever exposed to benzene at work or through their occupation | No occupational exposure to benzene | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to beryllium | Proportion of the population ever exposed to beryllium at work or through their occupation | No occupational exposure to beryllium | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to cadmium | Proportion of the population ever exposed to cadmium at work or through their occupation | No occupational exposure to cadmium | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to chromium | Proportion of the population ever exposed to chromium at work or through their occupation | No occupational exposure to chromium | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to diesel engine exhaust | Proportion of the population ever exposed to diesel engine exhaust at work or through their occupation | No occupational exposure to diesel engine exhaust | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to formaldehyde | Proportion of the population ever exposed to formaldehyde at work or through their occupation | No occupational exposure to formaldehyde | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to nickel | Proportion of the population ever exposed to nickel at work or through their occupation | No occupational exposure to nickel | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to polycyclic aromatic hydrocarbons | Proportion of the population ever exposed to polycyclic aromatic hydrocarbons at work or through their occupation | No occupational exposure to polycyclic aromatic hydrocarbons | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to silica | Proportion of the population ever exposed to silica at work or through their occupation | No occupational exposure to silica | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to sulphuric acid | Proportion of the population ever exposed to sulphuric acid at work or through their occupation | No occupational exposure to sulphuric acid | 100·0% | 100·0% | 100·0% | ||
| 4 | Occupational exposure to trichloroethylene | Proportion of the population ever exposed to trichloroethylene at work or through their occupation | No occupational exposure to trichloroethylene | 100·0% | 100·0% | 100·0% | ||
| 3 | Occupational asthmagens | Proportion of the population currently exposed to asthmagens at work or through their occupation | Background asthmagen exposures | 88·1% | 82·9% | 91·2% | ||
| 3 | Occupational particulate matter, gases, and fumes | Proportion of the population ever exposed to particulates, gases, or fumes at work or through their occupation | No occupational exposure to particulates, gases, or fumes | 86·5% | 81·9% | 89·6% | ||
| 3 | Occupational noise | Proportion of the population ever exposed to noise greater than 85 decibels at work or through their occupation | Background noise exposure | 86·5% | 81·0% | 89·6% | ||
| 3 | Occupational injuries | Proportion of the population at risk to injuries related to work or through their occupation | The rate of injury deaths per 100 000 person-years is zero | 88·1% | 82·9% | 92·2% | ||
| 3 | Occupational ergonomic factors | Proportion of the population who are exposed to ergonomic risk factors for low back pain at work or through their occupation | All individuals have the ergonomic factors of clerical and related workers | 84·5% | 81·9% | 89·6% | ||
| 1 | Behavioural risks | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 2 | Child and maternal malnutrition | .. | .. | 98·5% | 97·4% | 98·5% | ||
| 3 | Suboptimal breastfeeding | .. | .. | 75·1% | 60·6% | 83·4% | ||
| 4 | Non-exclusive breastfeeding | Proportion of children younger than 6 months who receive predominant, partial, or no breastfeeding | All children are exclusively breastfed for first 6 months of life | 75·1% | 60·6% | 83·4% | ||
| 4 | Discontinued breastfeeding | Proportion of children aged 6–23 months who do not receive any breast milk | All children continue to receive breast milk until 2 years of age | 75·1% | 60·6% | 83·4% | ||
| 3 | Child growth failure | .. | .. | 76·2% | 65·3% | 77·2% | ||
| 4 | Child underweight | Proportion of children ≥3 SDs, 2–3 SDs, and 1–2 SDs lower than the WHO 2006 standard weight-for-age curve | All children are <1 SD below the WHO 2006 standard weight-for-age curve | 75·1% | 63·7% | 76·7% | ||
| 4 | Child wasting | Proportion of children ≥3 SDs, 2–3 SDs, and 1–2 SDs lower than the WHO 2006 standard weight-for-length curve | All children are <1 SD below the WHO 2006 standard weight-for-height curve | 75·1% | 65·3% | 77·2% | ||
| 4 | Child stunting | Proportion of children ≥3 SDs, 2–3 SDs, and 1–2 SDs lower than the WHO 2006 standard height-for-age curve | All children are <1 SD below the WHO 2006 standard height-for-age curve | 75·1% | 64·8% | 77·2% | ||
| 3 | Low birthweight and short gestation | .. | .. | 75·7% | 78·2% | 86·0% | ||
| 4 | Low birthweight for gestation | Proportion of births occurring in 2-week gestational age categories from [0–24) weeks to [40–42) weeks, for each 500-g birthweight category starting from [0–500) g to [4000–4500) g* | 500-g birthweight category with lowest risk within each gestational age category | 75·7% | 78·2% | 86·0% | ||
| 4 | Short gestation for birthweight | Proportion of births occurring in 500-g birthweight categories from [0–500) g to [4000–4500) g, for each 2-week gestational age category starting from [0–24) weeks to [40–42) weeks* | 2-week gestational age category with lowest risk within each birthweight category | 75·7% | 78·2% | 86·0% | ||
| 3 | Iron deficiency | Peripheral blood haemoglobin concentration in g/L for all iron-responsive causes | Counterfactual haemoglobin concentration in the absence of iron deficiency in g/L for all iron-responsive causes | 75·1% | 78·2% | 86·0% | ||
| 3 | Vitamin A deficiency | Proportion of children aged 0–5 years with serum retinol concentration <0·7 μmol/L | No childhood vitamin A deficiency | 63·7% | 43·5% | 64·8% | ||
| 3 | Zinc deficiency | Proportion of the population with inadequate zinc intake versus loss | No inadequate zinc intake | 92·2% | 92·2% | 92·2% | ||
| 2 | Tobacco | .. | .. | 99·0% | 99·0% | 100·0% | ||
| 3 | Smoking | Prevalence of current use of any smoked tobacco product and prevalence of former use of any smoked tobacco product; among current smokers, cigarette equivalents smoked per smoker per day and cumulative pack-years of exposure; among former smokers, number of years since quitting | All individuals are lifelong non-smokers | 98·5% | 98·5% | 99·5% | ||
| 3 | Chewing tobacco | Current use of any chewing tobacco product | All individuals are lifelong non-users of chewing tobacco products | 33·2% | 70·5% | 73·6% | ||
| 3 | Second-hand smoke | Average daily exposure to air particulate matter from second-hand smoke with an aerodynamic diameter smaller than 2·5 μg, measured in μg/m3, among non-smokers | No second-hand smoke exposure | 80·3% | 73·1% | 88·1% | ||
| 2 | Alcohol use | Average daily alcohol consumption of pure alcohol (measured in g per day) in current drinkers who had consumed alcohol during the past 12 months | Estimated distribution 0–10 g per day | 52·3% | 33·2% | 59·6% | ||
| 2 | Drug use | Proportion of the population dependent upon opioids, cannabis, cocaine, or amphetamines; proportion of the population who have ever injected drugs | No drug use | 17·6% | 30·1% | 39·4% | ||
| 2 | Dietary risks | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in fruits | Average daily consumption of fruits (fresh, frozen, cooked, canned, or dried, excluding fruit juices and salted or pickled fruits) | Consumption of fruit 200–300 g per day | 68·9% | 38·3% | 78·8% | ||
| 3 | Diet low in vegetables | Average daily consumption of vegetables (fresh, frozen, cooked, canned, or dried, excluding legumes and salted or pickled vegetables, juices, nuts and seeds, and starchy vegetables such as potatoes or corn) | Consumption of vegetables 290–430 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in legumes | Average daily consumption of legumes (fresh, frozen, cooked, canned, or dried legumes) | Consumption of legumes 50–70 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in whole grains | Average daily consumption of whole grains (bran, germ, and endosperm in their natural proportion) from breakfast cereals, bread, rice, pasta, biscuits, muffins, tortillas, pancakes, and other sources | Consumption of whole grains 100–150 g per day | 58·6% | 28·0% | 68·9% | ||
| 3 | Diet low in nuts and seeds | Average daily consumption of nut and seed foods | Consumption of nuts and seeds 16–25 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in milk | Average daily consumption of milk, including non-fat, low-fat, and full-fat milk, excluding soy milk and other plant derivatives | Consumption of milk 350–520 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet high in red meat | Average daily consumption of red meat (beef, pork, lamb, and goat but excluding poultry, fish, eggs, and all processed meats) | Consumption of red meat 18–27 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet high in processed meat | Average daily consumption of meat preserved by smoking, curing, salting, or addition of chemical preservatives | Consumption of processed meat 0–4 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet high in sugar-sweetened beverages | Average daily consumption of beverages with ≥50 kcal per 226·8 g serving, including carbonated beverages, sodas, energy drinks, fruit drinks, but excluding 100% fruit and vegetable juices | Consumption of sugar-sweetened beverages 0–5 g per day | 13·0% | 16·1% | 26·9% | ||
| 3 | Diet low in fibre | Average daily intake of fibre from all sources including fruits, vegetables, grains, legumes, and pulses | Consumption of fibre 19–28 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in calcium | Average daily intake of calcium from all sources, including milk, yogurt, and cheese | Consumption of calcium 1·0–1·5 g per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in seafood omega 3 fatty acids | Average daily intake of eicosapentaenoic acid and docosahexaenoic acid | Consumption of seafood omega 3 fatty acids 200–300 mg per day | 100·0% | 100·0% | 100·0% | ||
| 3 | Diet low in polyunsaturated fatty acids | Average daily intake of omega 6 fatty acids from all sources, mainly liquid vegetable oils, including soybean oil, corn oil, and safflower oil | Consumption of polyunsaturated fatty acids as 9–13% of total daily energy | 61·1% | 31·1% | 67·9% | ||
| 3 | Diet high in trans fatty acids | Average daily intake of trans fat from all sources, mainly partially hydrogenated vegetable oils and ruminant products | Consumption of trans fatty acids as 0–1% of total daily energy | 35·8% | 36·8% | 36·8% | ||
| 3 | Diet high in sodium | 24-h urinary sodium measured in g per day | 24-h urinary sodium 1–5 g per day | 13·5% | 17·6% | 21·8% | ||
| 2 | Intimate partner violence | Proportion of the population who have ever experienced one or more acts of physical or sexual violence by a present or former intimate partner since age 15 years | No intimate partner violence | 65·8% | 70·5% | 84·5% | ||
| 2 | Childhood maltreatment | .. | .. | 44·6% | 62·2% | 70·5% | ||
| 3 | Childhood sexual abuse | Proportion of the population ever having had the experience of intercourse or other contact abuse (ie, fondling and other sexual touching) when aged 15 years or younger, and the perpetrator or partner was more than 5 years older than the victim | No childhood sexual abuse | 31·1% | 20·7% | 38·9% | ||
| 3 | Bullying victimisation | Proportion of population attending school who have been exposed to bullying victimisation within the past year | No bullying victimisation | 26·4% | 52·3% | 58·6% | ||
| 2 | Unsafe sex | Proportion of the population with exposure to sexual encounters that convey the risk of disease | No exposure to disease-causing pathogen through sex | 18·7% | 49·2% | 50·3% | ||
| 2 | Low physical activity | Average weekly physical activity at work, home, transport-related and recreational measured by MET min per week | All adults experience 3000–4500 MET min per week | 51·3% | 32·1% | 67·4% | ||
| 1 | Metabolic risks | .. | .. | 100·0% | 100·0% | 100·0% | ||
| 2 | High fasting plasma glucose | Serum fasting plasma glucose measured in mmol/L | 4·8–5·4 mmol/L | 50·3% | 50·3% | 67·9% | ||
| 2 | High low-density lipoprotein cholesterol | Serum low-density lipoprotein, measured in mmol/L | 0·7–1·3 mmol/L | 49·7% | 48·2% | 71·5% | ||
| 2 | High systolic blood pressure | Systolic blood pressure, measured in mm Hg | 110–115 mm Hg | 61·1% | 64·8% | 81·4% | ||
| 2 | High body-mass index | Body-mass index, measured in kg/m2 | 20–25 kg/m2 | 100·0% | 100·0% | 100·0% | ||
| 2 | Low bone mineral density | Standardised mean bone mineral density values measured by dual x-ray absorptiometry at the femoral neck in g/cm2 | 99th percentile of NHANES 1988–2014 by age and sex | 23·8% | 10·4% | 25·9% | ||
| 2 | Impaired kidney function | Proportion of the population with ACR >30 mg/g or GFR <60 mL/min/1·73 m2, excluding end-stage renal disease | GFR >60 mL/min/1·73 m2 and ACR <30 mg/g | 16·1% | 28·5% | 31·1% | ||
The data representativeness index is calculated as the percentage of locations for which we have data in a given time period. ACR=albumin-to-creatine ratio. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. GFR=glomerular filtration rate. MET=metabolic equivalent. NHANES=National Health and Nutrition Examination Survey. PM2·5=particulate matter with an aerodynamic diameter smaller than 2·5 μm, measured in μm/m3. ppb=parts per billion.
*
In numbered intervals, square brackets indicate included endpoints and round brackets indicate excluded endpoints.