Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 28;7(1):E140-E148.
doi: 10.9778/cmajo.20180137. Print 2019 Jan-Mar.

Assessment of the burden of diseases and injuries attributable to risk factors in Canada from 1990 to 2016: an analysis of the Global Burden of Disease Study

Samiah Alam  1 , Justin J Lang  1 , Aaron M Drucker  1 , Carolyn Gotay  1 , Nicole Kozloff  1 , Kedar Mate  1 , Scott B Patten  1 , Heather M Orpana  1 , Ashkan Afshin  1 , Leah E Cahill  2
Affiliations

Assessment of the burden of diseases and injuries attributable to risk factors in Canada from 1990 to 2016: an analysis of the Global Burden of Disease Study

Samiah Alam et al. CMAJ Open. .

Abstract

Background: An understanding of the risk factors contributing to disease burden is critical for determining research priorities and informing national health policy. We aimed to identify the risk factor trends in Canada.

Methods: As part of the Global Burden of Disease (GBD) study (1990-2016), we conducted an analysis of country-level estimates for Canada to assess the burden of diseases and injuries attributable to risk factors. For both 1990 and 2016, metabolic, environmental and behavioural risk factors were ranked according to their contribution to disability-adjusted life years (healthy years of life lost), total deaths and years lived with disability.

Results: In 2016, the risk factors accounting for the largest percentage of disability-adjusted life years in Canada were (1) tobacco, (2) diet, (3) high body mass index, (4) high fasting plasma glucose, (5) high systolic blood pressure, (6) alcohol and drug use, (7) occupational risks, (8) high total cholesterol, (9) impaired kidney function and (10) air pollution. Risk factor rankings remained similar from 1990 to 2016 despite some substantial declines in burden, including a 47% (± 3%) decline in the age-standardized disability-adjusted life years rate attributable to tobacco since 1990. Risk factors with an increasing contribution to disability-adjusted life years rates from 1990 to 2016 included high body mass index, high fasting plasma glucose and alcohol and drug use.

Interpretation: Metabolic and behavioural risk factors, including modifiable factors such as tobacco use and diet, remain the leading risk factors contributing to the burden of diseases and injuries in Canada. This work identifies priorities and targets for reducing premature death and disability burden in Canada.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Aaron Drucker reports grants and personal fees from Sanofi and Regeneron for activities outside the work reported here. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Simplified analytical flowchart outlining the 7 steps of the comparative risk assessment for the estimation of population attributable fractions by geography, age, sex and year. Note: DALYs = disability-adjusted life years, PAFs = population attributable fractions, TMREL = theoretical minimum risk exposure level, YLDs = years lived with disability, YLLs = years of life lost.
Figure 2:
Figure 2:
Burden of disease attributable to leading risk factors for all Canadians in 2016 expressed as a percentage of (A) disability-adjusted life years (DALYs), (B) deaths and C) years lived with disability (YLDs). One DALY is equivalent to 1 year of healthy life (free of disease, injury or disability) that has been lost. The negative percentage for alcohol is the protective effect of mild alcohol use on risk of cardiometabolic disease.
Figure 3:
Figure 3:
(A) Rank changes in disability-adjusted life years (DALYs) attributable to leading risk factors and percentage change in all-age and age-standardized DALY rates in Canada from 1990 to 2016; 1 DALY is equivalent to 1 year of healthy life (free of disease, injury or disability) that has been lost. (B) Rank changes in total deaths attributable to leading risk factors and percentage change in all-age and age-standardized death rates in Canada between 1990 and 2016. (C) Rank changes in years lived with disability (YLDs) attributable to leading risk factors and percentage change in all-age and age-standardized years lived with disability rates in Canada between 1990 and 2016.
Figure 4:
Figure 4:
Drivers of percentage changes in Canada’s risk-attributable disease and injury burden from 2006 to 2016 due to population growth, population aging, risk-deleted mortality and exposure to risk factors expressed as (A) disability-adjusted life years (DALYs) for all ages, (B) deaths for all ages and (C) DALYs by age group. One DALY is equivalent to 1 year of healthy life (free of disease, injury or disability) that has been lost.
See this image and copyright information in PMC

Similar articles

  • Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
    Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, Cahuana-Hurtado L, Darney B, Avila-Burgos L, Correa-Rotter R, Rivera JA, Barquera S, González-Pier E, Aburto-Soto T, de Castro EF, Barrientos-Gutiérrez T, Basto-Abreu AC, Batis C, Borges G, Campos-Nonato I, Campuzano-Rincón JC, de Jesús Cantoral-Preciado A, Contreras-Manzano AG, Cuevas-Nasu L, de la Cruz-Gongora VV, Diaz-Ortega JL, de Lourdes García-García M, Garcia-Guerra A, de Cossío TG, González-Castell LD, Heredia-Pi I, Hijar-Medina MC, Jauregui A, Jimenez-Corona A, Lopez-Olmedo N, Magis-Rodríguez C, Medina-Garcia C, Medina-Mora ME, Mejia-Rodriguez F, Montañez JC, Montero P, Montoya A, Moreno-Banda GL, Pedroza-Tobías A, Pérez-Padilla R, Quezada AD, Richardson-López-Collada VL, Riojas-Rodríguez H, Ríos Blancas MJ, Razo-Garcia C, Mendoza MP, Sánchez-Pimienta TG, Sánchez-Romero LM, Schilmann A, Servan-Mori E, Shamah-Levy T, Téllez-Rojo MM, Texcalac-Sangrador JL, Wang H, Vos T, Forouzanfar MH, Naghavi M, Lopez AD, Murray CJ, Lozano R. Gómez-Dantés H, et al. Lancet. 2016 Nov 12;388(10058):2386-2402. doi: 10.1016/S0140-6736(16)31773-1. Epub 2016 Oct 5. Lancet. 2016. PMID: 27720260
  • Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.
    India State-Level Disease Burden Initiative Collaborators. India State-Level Disease Burden Initiative Collaborators. Lancet. 2017 Dec 2;390(10111):2437-2460. doi: 10.1016/S0140-6736(17)32804-0. Epub 2017 Nov 14. Lancet. 2017. PMID: 29150201 Free PMC article.
  • The burden of disease in Spain: Results from the Global Burden of Disease 2016.
    Soriano JB, Rojas-Rueda D, Alonso J, Antó JM, Cardona PJ, Fernández E, Garcia-Basteiro AL, Benavides FG, Glenn SD, Krish V, Lazarus JV, Martínez-Raga J, Masana MF, Nieuwenhuijsen MJ, Ortiz A, Sánchez-Niño MD, Serrano-Blanco A, Tortajada-Girbés M, Tyrovolas S, Haro JM, Naghavi M, Murray CJL; Colaboradores de GBD en España; Lista de colaboradores de GBD en España:. Soriano JB, et al. Med Clin (Barc). 2018 Sep 14;151(5):171-190. doi: 10.1016/j.medcli.2018.05.011. Epub 2018 Jul 20. Med Clin (Barc). 2018. PMID: 30037695 English, Spanish.
  • Overview.
    Bradshaw D, Pillay van-Wyk V, Neethling I, Roomaney RA, Cois A, Joubert JD, Nannan N, Abdelatief N, Awotiwon OF, Turawa EB, Nojilana B, Groenewald P, Matzopoulos R, Prinsloo M, Cairncross E, Wright CY, Peer N, Pacella R; The Sacra Collaborative Group. Bradshaw D, et al. S Afr Med J. 2022 Sep 30;112(8b):556-570. doi: 10.7196/SAMJ.2022.v112i8b.16648. S Afr Med J. 2022. PMID: 36458357
  • The global burden of ischemic stroke: findings of the GBD 2010 study.
    Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, Connor M, Lawes CM, Moran AE, Anderson LM, Roth GA, Mensah GA, Ezzati M, Murray CJ, Feigin VL; Global Burden of Diseases, Injuries, and Risk Factors 2010 Study Stroke Expert Group. Bennett DA, et al. Glob Heart. 2014 Mar;9(1):107-12. doi: 10.1016/j.gheart.2014.01.001. Glob Heart. 2014. PMID: 25432120 Review.
See all similar articles

Cited by

See all "Cited by" articles

References

    1. Manuel DG, Perez R, Sanmartin C, et al. Measuring burden of unhealthy behaviours using a multivariable predictive approach: life expectancy lost in Canada attributable to smoking, alcohol, physical inactivity, and diet. PLoS Med. 2016;13:e1002082. - PMC - PubMed
    1. Global Burden of Disease Study Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71. - PMC - PubMed
    1. Smith JN. Epic measures: One doctor Seven billion patients. 1st ed. New York: HarperCollins; 2015.
    1. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608. - PMC - PubMed
    1. Mokdad AH, Forouzanfar MH, Daoud F, et al. Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387:2383–401. - PubMed