Global burden of 87 risk factors in 204 countries

Opening Statement
This critical assessment is based on the peer-reviewed article “Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019” written by GBD 2019 Risk Factor Collaborators that Boseley cites in “Thirty-year failure to tackle preventable disease fuelling global Covid pandemic”. As The Lancet is a weekly peer-reviewed general medical journal, it can be stated that the scientific study has also been examined using peer-review method.
Critical Appraisal
Introduction and question/aim of research
The peer-reviewed article has aimed to offer new and updated data for the quantification of 560 risk-outcome pairs related to health expectancy. The article has identified the research gap evident in the literature from the introduction section. Many previous studies have been published each year on the burden of specific health risks. However, this study has presented updated results for the quantification of 560 risk-outcome pairs including new and updated data for relative risks, updated data for exposure etc. The article has used significant references to provide evidence to the statements used in this study. For example, the authors have used evidence from “Changes in diet and lifestyle and long-term weight gain in women and men” by Mozaffarian et al., (2011) when discussing the reasons behind increased BMI.
It can be stated that the authors have accounted for recent developments in this field as they have also included the impact of climate change on human health. The article has stated that the burden due to low temperature was cited as 2.2 times greater than the burden attributable to high temperature in 2019. The article has opposed the imbalances in the 2019 study as the authors have concluded that the burden varies depending on location (Murray et al., 2020).
The research question is not stated clearly rather it is engraved in the introduction. The authors have aimed to provide updated results regarding the quantification of 560 risk-outcome pairs, including two new risk factors – low and high non-optima temperatures.
The authors have added significant details in the method section that includes geographical units, age groups, time periods, estimating relative risk because of exposure for each risk-outcome pair etc. Moreover, the authors have included appendices for related data like relative risks for people of different sex and age who use alcohol globally. The appendixes are not given on the webpage. However, the authors have linked these appendixes to the webpage.
The study design has been successful in answering the research question as the accumulated data have shown substantial changes from data gathered in 2017. The study aimed to offer new and updated data regarding the field accomplished. For example, the GBD 2019 data regarding the burden attributable to diet quality is 29.7 % lower than the 2017 report. The authors excluded 12 diet risk-outcome pairs (that were considered in GBD 2017) from GBD 2019 as the re-analysis have suggested that the effects of these pairs are no longer significant. The authors have included some risk-outcome pairs like omega-3 and ischaemic heart disease. The new meta-regression of 27 cohort studies and 21 trials has suggested that these criteria are still important (Murray et al., 2020). However, the authors have also suggested that future studies may exclude these criteria as per outcome. The authors have suggested that quantifying and reporting attributable burden and exposure are significant as exposure may increase while the attributable burden diminishes if other drivers of the outcomes are decreasing at a fast rate. As the study has unravelled the changes in the burden attributable and the outcome pairs, the study is successful in answering the research question.
The study has collected data from the Child National Health Survey 2003 and 2009- 10. Data has been accumulated from China Family Panel Studies funded by 985 program of Perking University (Murray et al., 2020). The mentioned survey was carried out by the Institute of Social Science Survey of Peking University. Data has been collected from Eurostat and WHO-published articles (Murray et al., 2020). The authors have provided links from where the accumulated data have been collected. The data have been presented in tabular form and maps and the figures have also been analyzed. The amount of data is huge so it is not offered in its entirety. However, the authors have provided links to appendixes from which detailed data can be accessed.
The authors have used a hierarchical list of risk factors useful as it has allowed the authors to assess specific risk factors like sodium-intake and related aggregates like diet quality. The GBD location hierarchy has allowed the authors to include estimates for 990 locations, which has significantly helped the authors (Murray et al., 2020). Data regarding risk-attributable burden has its own limitations as the quality of the primary data may vary. The authors have argued that data regarding risk relationships such as childhood sexual abuse, bullying victimisation, occupational risks, ambient ozone pollution etc. are sparse. There is no mention of the study being approved by ethics board.
Results and Discussion
The findings are linked to the figure through which data is presented. However, the results have not been linked to the procedures at all levels. The planned analysis have produced sound results as the study claims that combined global exposure to risks identified have remained constant over past 30 years. The study has reported a decline in exposure to lead and tobacco at nearly 1 % per year. The authors have found a correlation between high-income country and increased age-standardised cardiovascular disease mortality. Each claim is linked to a finding presented in the results. Each claim is supported by either citation or results. The findings are direct and only the current trends have been supported by citations. Hence, the authors have not gone beyond the data. The limitations have been discussed in detail.
Concluding Insights
I think that the research question is not explicitly presented. The authors could have linked the data with the procedures. Citing relevant literature, accumulating data from a range of publications, aiming for recent developments in the fields can be considered as strengths of the study. The authors have not been able to provide additional details from where data has been taken. However, I think this weakness can be rolled out as they have hyperlinked the related data from where it can be read.
Boseley (2020) has used the peer-reviewed article published in Lancet to create a link between preventable diseases and COVID-infused risk. The figure published in the media article regarding “High systolic blood pressure was associated with 10.8m deaths worldwide in 2019” is not identical to the source article. The figures published in the Lancet article are divided between males and females. However, the media article has not provided different figures for the two sexes which may have resulted in alterations. The media article perfectly shows that elderly people with non-communicable metabolic diseases are more vulnerable to COVID-19. However, I think that Boseley (2020) has failed to consider other risk factors like temperature, dietary risks, tobacco etc.

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