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Contribution of Six Risk Factors to Achieving the 25×25 Non-Communicable Disease Mortality Reduction Target: A Modeling Study
Study Questions:
What is the contribution of achieving six risk factor targets toward reducing premature mortality from four main noncommunicable diseases (NCDs) by 25% from 2010 levels by 2025?
Methods:
NCD was defined as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes. Premature mortality was defined as the probability of dying between the ages of 30 years and 70 years. Data from systematic analyses of available country data were used to estimate risk factor and mortality trends. 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 was estimated. Methods accounted for multi-causality of NCDs and for the fact that when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. 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 years 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). This business-as-usual trend is largely due to the continuing decline in mortality from cardiovascular diseases and chronic respiratory diseases. However, due to population growth and ageing, the number of deaths from these four NCDs will rise from 28.3 million in 2010 to 38.8 million in 2025. Of the 10.5 million additional deaths, 3.1 million will occur before 70 years of age and another 7.3 million in older people. 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 aged 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-income and middle-income countries, and will help to reduce the global inequality in premature NCD mortality. The largest benefits will come from reducing blood pressure and tobacco use. 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 investigators 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% reduction target, with most of these benefits seen in low-income and middle-income countries. On the basis of mortality benefits and feasibility, a more ambitious target than currently agreed on should be adopted for tobacco use.
Perspective:
This analysis highlights the impact of reducing risk factors on global health. The largest impact appears to be related to reducing tobacco use.
Keywords: Alcohols, Neoplasms, Mortality, Premature, Global Health, Epidemiologic Studies, Population Growth, Income, Risk Factors, Blood Pressure, Obesity, Tobacco Use, Diabetes Mellitus, Glucose
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