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

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.

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.

Copyright 2019, Joule Inc. or its licensors.

Figures

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:

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:

(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:

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.