Contribution of Six Risk Factors to Achieving the 25×25 Non-Communicable Disease Mortality Reduction Target: A Modelling Study

Study Questions:

What is the contribution of achieving six risk factor targets towards meeting the 25×25 mortality target, that is, 25% reduction in premature mortality from four main noncommunicable diseases (NCDs) by 2025?

Methods:

Countries have agreed to reduce premature mortality (defined as the probability of dying between the ages of 30 and 70 years) from four main NCDs—cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes—by 25% from 2010 levels by 2025 (referred to as 25×25 target). The investigators estimated the impact of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Their methods accounted for multicausality of NCDs and for the fact that when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from re-analyses and meta-analyses of epidemiological studies.

Results:

If risk factor targets are achieved, the probability of dying from the four main NCDs between the ages of 30 and 70 years will decrease by 22% in men and by 19% in women between 2010 and 2025, compared with a decrease of 11% in men and 10% in women under the so-called business-as-usual trends (i.e., projections based on current trends with no additional action). Achieving the risk factor targets will delay or prevent more than 37 million deaths (16 million in people ages 30–69 years and 21 million in people ages 70 years or older) from the main NCDs over these 15 years compared with a situation of rising or stagnating risk factor trends. Most of the benefits of achieving the risk factor targets, including 31 million of the delayed or prevented deaths, will be in low- and middle-income countries, and will help to reduce the global inequality in premature NCD mortality. A more ambitious target on tobacco use (a 50% reduction) will almost reach the target in men (>24% reduction in the probability of death), and enhance the benefits to a 20% reduction in women.

Conclusions:

The authors concluded that if the agreed risk factor targets are met, premature mortality from the four main NCDs will decrease to levels that are close to the 25×25 target, with most of these benefits seen in low- and middle-income countries.

Perspective:

This study suggests that achieving just six risk factor targets will contribute substantially to reducing NCD mortality by 2025, closing 77% of the gap between a situation of rising or stagnating risk factor trends and the 25×25 mortality target. Most of the benefits of achieving the risk factor targets will be in low- and middle-income countries, and contribute to a global convergence in health. There is an opportunity here to take an integrated approach to policy formulation and monitoring progress towards targets in the global effort to prevent and control NCDs. Such integration is essential to make NCD reduction a part of the post-2015 development agenda and to achieve a grand convergence in health across the world by 2035. The World Health Assembly, the United Nations, and other global health organizations have an opportunity to drive for coordinated global action and establish global and national accountability mechanisms to tackle NCDs.

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Neoplasms, Global Health, Blood Pressure, Risk Factors, Metabolic Syndrome X, Mortality, Premature, Communicable Diseases, Epidemiologic Studies, Cardiovascular Diseases, Obesity, Tobacco Use Disorder, United Nations, Diabetes Mellitus


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