Prioritizing risk factors to identify preventive interventions for economic assessment
Nick Wilson, Tony Blakely, Rachel H Foster, David Hadorn & Theo Vos
Volume 90, Number 2, February 2012, 88-96
Table 1. Risk factors that contributed most to the burden of disease in 2004, as measured in disability-adjusted life years (DALYs), in high-income countries of the Western Pacific Region of the World Health Organization (WHO)
| Risk factor | DALYs (thousands) | Percentage of total DALYs | Deaths (thousands) | Percentage of total deaths | Previous New Zealand rankinga |
|---|---|---|---|---|---|
| 1. Tobacco useb | 1871 | 8.4 | 261 | 17.7 | 2nd |
| 2. Alcohol use | 1541 | 6.9 | 52 | 3.5 | 13th (with other drugs)c |
| 3. High blood pressureb | 1273 | 5.7 | 200 | 13.5 | 5th |
| 4. High blood glucoseb | 1077 | 4.8 | 86 | 5.8 | 8th (pre-diabetes) |
| 5. Overweight and obesityb | 839 | 3.8 | 56 | 3.8 | 6th |
| 6. Physical inactivityb | 806 | 3.6 | 87 | 5.9 | 7th |
| 7. High blood cholesterolb | 570 | 2.6 | 52 | 3.5 | 4th |
| 8. Occupational hazards | 462 | 2.1 | 22 | 1.5 | 19th |
| 9. Low fruit and vegetable intakeb | 299 | 1.3 | 40 | 2.7 | 10th |
| 10. Urban outdoor air pollution | 231 | 1.0 | 47 | 3.2 | 12th (all air pollution) |
| 11. Iron deficiency | 210 | 0.9 | 1 | 0.1 | Not listed |
| 12. Childhood sexual abuse | 197 | 0.9 | 3 | 0.2 | 14th (all violence) |
| 13. Illicit drug use | 155 | 0.7 | 3 | 0.2 | See alcohol use. |
| 14. Unsafe medical injections | 126 | 0.6 | 9 | 0.6 | Not listed |
| 15. Unsafe sex | 125 | 0.6 | 6 | 0.4 | 20th |
a Previous ranking by New Zealand’s Ministry of Health (but note that this ranking was based on cause of death and not DALYs, the metric used by WHO).4
b For all risk factors in this table, WHO analyses considered joint effects to avoid double counting (i.e. in cases in which multiple risk factors underlie the same disease contributing to DALYs). In addition, for all of the top 10 leading risk factors in this list (other than alcohol use and occupational hazards), DALY estimates took into account factors such as: (i) mediated effects on cardiovascular disease (CVD) (e.g. two thirds of the effect of body mass index being mediated by blood cholesterol, blood pressure and high blood glucose); (ii) effect modification of cardiovascular disease risk factors (high blood pressure and high blood cholesterol); (iii) joint effects of smoking and other risk factors (e.g. high blood cholesterol). Further details are provided in the WHO report5 and supporting material, available at: http://image.thelancet.com/extras/02art10418webtable2.pdf
c The discrepancy between rankings from our study, based on WHO data, and from previous work in New Zealand is likely to reflect improved methods.
Source: World Health Organization.5