Bulletin of the World Health Organization

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