Risk factors of burden of disease: a comparative assessment study for evidence-based health policy making in Vietnam

Abstract Background With the rising cost of health care and the population ageing, many governments, including that of Vietnam, are looking for effective strategies to prevent diseases. To inform preventive health policies, quantification of the contribution of major risk factors to the burden of disease and injury is essential. Methods Global comparative risk assessment methodology was applied to estimate the ten major risk factors attributed to the burden of disease in Vietnam in 2008, including high blood pressure, high blood cholesterol, high body-mass index, diabetes, physical inactivity, tobacco smoking, alcohol consumption, unsafe water and sanitation, air pollution, and low fruit and vegetable intake. The proportion of deaths and disease burden (measured by disability-adjusted life-years [DALYs]) was estimated by the population attributable fraction, which projects how much the disease burden would have been reduced if exposure to a risk factor in the population had been at the level of a theoretical minimum. Findings In Vietnam, the three leading risk factors for deaths and disease burden were high blood pressure (17·4% [94 314 of 541 228] of total deaths, 7·8% [958 512 of 12 268 460] of total DALYs), tobacco smoking (6·2% [33 695 of 541 228] of total deaths, 4·1% [499 396 of 12 268 460] of total DALYs), and low fruit and vegetable intake (6·3% [33 951 of 541 228] of total deaths, 4·2% [513 327 of 12 268 460] of total DALYs). Lifestyle risk factors—physical inactivity, tobacco smoking, alcohol consumption, and low fruit and vegetable intake—together accounted for 16·6% [90 064 of 541 228] of total deaths and 11·2% [1 378 115 of 12 268 460] of total DALYs, while two environmental risk factors—unsafe water and sanitation and air pollution—were responsible for 1·1% [5954 of 541 228] of total deaths and 0·7% [90 979 of 12 268 460] of total DALYs in Vietnam. Interpretation Vietnam is moving fast in the epidemiological transition whereby lifestyle risk factors play a significant role in non-communicable diseases. Our work provides the first empirical evidence of how risk factors contributed to disease burden in Vietnam, which can aid priority setting and preventive efforts. Funding The Atlantic Philanthropies.