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; Justin J Lang; Aaron M Drucker; Carolyn Gotay; Nicole Kozloff; Kedar Mate; Scott B Patten; Heather M Orpana; Ashkan Afshin; Leah E Cahill

doi:10.9778/cmajo.20180137

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

CMAJ Open. 2019 Feb 28;7(1):E140-E148. doi: 10.9778/cmajo.20180137. Print 2019 Jan-Mar.

Authors

Affiliations

¹ Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass.
² Departments of Medicine (Alam, Cahill) and of Community Health and Epidemiology (Alam, Cahill), Dalhousie University, Halifax, NS; Healthy Active Living and Obesity Research Group (Lang), CHEO Research Institute, Ottawa, Ont.; Centre for Surveillance and Applied Research (Lang, Orpana), Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ont.; Division of Dermatology (Drucker), Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Ont.; Division of Dermatology (Drucker), Department of Medicine, University of Toronto, Toronto, Ont.; Centre of Excellence in Cancer Prevention (Gotay), School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC; Centre for Addiction and Mental Health (Kozloff), Toronto, Ont.; Department of Psychiatry (Kozloff), University of Toronto, Toronto, Ont.; School of Physical and Occupational Therapy (Mate), McGill University, Montréal, Que.; Departments of Community Health Sciences and Psychiatry (Patten), University of Calgary, Calgary, Alta.; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Institute for Health Metrics and Evaluation (Afshin), Seattle, Wash.; Department of Nutrition (Cahill), Harvard T.H. Chan School of Public Health, Boston, Mass leah.cahill@dal.ca.

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.