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  • Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R., Abebe, M., Abebe, Z., Abera, S. F., Abil, O., Abraha, H., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, D., Acharya, P., Adamu, A. A., Adane, A., Adebayo, O. M., Adedoyin, R., Adekanmbi, V., Ademi, Z., Adetokunboh, O., Adib, M. G., Admasie, A., Adsuar, J. C., Afanvi, K., Afarideh, M., Agarwal, G., Aggarwal, A., Aghayan, S., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Akbari, M., Akinyemiju, T., Akseer, N., Al-Aly, Z., Al-Eyadhy, A., Al-Mekhlafi, H. M., Alandab, F., Alam, K., Alam, S., Alam, T., Alashi, A., Alavian, S., Alene, K., Ali, K., Ali, S., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S., Alkerwi, A., Alla, F., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Ammar, W., Anber, N., Anderson, J. A., Andrei, C., Androudi, S., Animut, M., Anjomshoa, M., Ansha, M., Anto, J. M., Antonio, C. T., Anwari, P., Appiah, L., Appiah, S., Arabloo, J., Aremu, O., Amlov, J., Artaman, A., Aryal, K. K., Asayesh, H., Ataro, Z., Ausloos, M., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayer, R., Ayuk, T. B., Azzopardi, P. S., Babazadeff, A., Badali, H., Badawi, A., Balakrishnan, K., Bali, A., Ball, K., Bellew, S. H., Banach, M., Banoub, J., Barac, A., Barker-Collo, S., Bamighausen, T., Barrero, L. H., Basu, S., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Bejoy, Y., Bekele, B., Bekru, F., Belay, E., Belay, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Bergeron, G., Berhane, A., Bemabe, E., Bemstein, R. S., Beuran, M., Beyranvand, T., Bhala, N., Bhalla, A., Bhattarai, S., Bhutta, Z. A., Biadgo, B., Bijani, A., Bikbov, B., Bilano, V., Bililign, N., Bin Sayeed, M., Bisanzio, D., Biswas, T., Bjorge, T., Blacker, B. F., Bleyer, A., Borschmann, R., Bou-Orm, I. R., Boufous, S., Bourne, R., Brady, O. J., Brauer, M., Brazinova, A., Breitborde, N. K., Brenner, H., Briko, A., Britton, G., Brugha, T., Buchbindet, R., Burnett, R. T., Busse, R., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. A., Rivas, J., Castro, F., Catala-Lopez, F., Causey, K., Cercy, K. M., Cerin, E., Chaiah, Y., Chang, H., Chang, J., Chang, K., Charlson, F. J., Chattopadhyay, A., Chattu, V., Chee, M., Cheng, C., Chew, A., Chiang, P., Chimed-Ochir, O., Chin, K., Chitheer, A., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Chung, S., Cicuttini, F. M., Grillo, M., Cohen, A. J., Collado-Mateo, D., Cooper, C., Cooper, O. R., Coresh, J., Cornaby, L., Cortesi, P., Cortinovis, M., Costa, M., Cousin, E., Criqui, M. H., Cromwell, E. A., Cundiff, D. K., Daba, A., Dachew, B., Dadi, A., Damasceno, A., Dandona, L., Dandona, R., Darby, S. C., Dargan, P. I., Daryani, A., Das Gupta, R., Das Neves, J., Dasa, T., Dash, A., Davitoiu, D., Davletov, K., De la Cruz-Gongora, V., De la Hoz, F., De Leo, D., De Neve, J., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Demoz, G., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Deshpande, A., Jarlais, D., Dessie, G., Deveber, G., Dey, S., Dharmaratne, S., Dhimal, M., Dinberu, M., Ding, E. L., Diro, H., Djalalinia, S., Huyen Phoc Do, Dokova, K., Doku, D., La Doyle, K., Driscoll, T. R., Dubey, M., Dubljanin, E., Duken, E., Duncan, B. B., Duraes, A. R., Ebert, N., Ebrahimi, H., Ebrahimpour, S., Edvardsson, D., Elfiong, A., Eggen, A., El Bcheraoui, C., El-Khatib, I., Elyazar, I., Enayati, A., Endries, A., Er, B., Erskine, H. E., Eskandarieh, S., Esteghamati, A., Estep, K., Fakhim, H., Faramarzi, M., Fareed, M., Farid, T. A., Farinha, C., Farioli, A., Faro, A., Farvid, M. S., Farzaei, M., Fatima, B., Fay, K. A., Fazaeli, A., Feigin, V. L., Feigl, A. B., Fereshtehnejad, S., Fernandes, E., Fernandes, J. C., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Finger, J., Fischer, F., Foigt, N. A., Foreman, K. J., Fukumoto, T., Fullman, N., Furst, T., Furtado, J. M., Futran, N. D., Gall, S., Gallus, S., Gamkrelidze, A., Ganji, M., Garcia-Basteiro, A. L., Gardner, W., Gebre, A., Gebremedhin, A., Gebremichael, T., Gelano, T., Geleijnse, J. M., Geramo, Y., Gething, P. W., Geese, K., Ghadimi, R., Ghadiri, K., Falavarjani, K., Ghasemi-Kasman, M., Ghimire, M., Ghosh, R., Ghoshal, A., Giampaoli, S., Gill, P., Gill, T. K., Gillum, R. F., Ginawi, I., Giussani, G., Gnedovskaya, E. V., Godwin, W. W., Goli, S., Gomez-Dantes, H., Gona, P. N., Gopalani, S., Goulart, A. C., Grada, A., Grams, M. E., Grosso, G., Gugnani, H., Guo, Y., Gupta, R., Gupta, R., Gupta, T., Gutierrez, R., Gutierrez-Torres, D. S., Haagsma, J. A., Habtewold, T., Hachinski, V., Hafezi-Nejad, N., Hagos, T. B., Hailegiyorgis, T., Hailu, G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamadeh, R. R., Hamidi, S., Handal, A. J., Hankey, G. J., Liao, Y., Harb, H. L., Harikrishnan, S., Haro, J., Hassankhani, H., Hassen, H., Havmoeller, R., Hawley, C. N., Hay, S. I., Hedayatizadeh-Omran, A., Heibati, B., Heidari, B., Heidari, M., Hendrie, D., Henok, A., Heredia-Pi, I., Herteliu, C., Heydarpour, F., Heydarpour, S., Hibstu, D. T., Higazi, T. B., Hilawe, E., Hoek, H. W., Hoffiman, H. J., Hole, M. K., Rad, E., Hoogar, P., Hosgood, H., Hosseini, S., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Hoy, D. G., Hsairi, M., Hsiao, T., Hu, G., Ha, H., Huang, J. J., Hussen, M., Huynh, C. K., Iburg, K., Ikeda, N., Ilesanmi, O., Iqbal, U., Irvani, S., Irvine, C., Islam, S., Islami, F., Jackson, M. D., Jacobsen, K. H., Jahangiry, L., Jahanmehr, N., Jain, S., Jakovljevic, M., James, S. L., Jassal, S. K., Jayatilleke, A., Jeemon, P., Jha, R., Jha, V., Ji, J. S., Jonas, J. B., Jonnagaddala, J., Shushtari, Z., Joshi, A., Jozwiak, J., Jurisson, M., Kabir, Z., Kahsay, A., Kalani, R., Kanchan, T., Kant, S., Kar, C., Karami, M., Matin, B., Karch, A., Karema, C., Karimi, N., Karimi, S. M., Kasaeian, A., Kassa, D. H., Kassa, G., Kassa, T., Kassebaum, N. J., Katikireddi, S., Kaul, A., Kawakami, N., Kazemi, Z., Karyani, A., Kefale, A., Keiyoro, P., Kemp, G., Kengne, A., Keren, A., Kesavachandran, C., Khader, Y., Khafaei, B., Khafaie, M., Khajavi, A., Khalid, N., Khalil, I. A., Khan, G., Khan, M., Khan, M., Khang, Y., Khater, M. M., Khazaei, M., Khazaie, H., Khoja, A. T., Khosravi, A., Khosravi, M., Kiadaliri, A. A., Kiirithio, D. N., Kim, C., Kim, D., Kim, Y., Kim, Y., Kimokoti, R. W., Kinfh, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Knibbs, L. D., Knudsen, A., Kochhar, S., Kokubo, Y., Kolola, T., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M. A., Krishan, K., Krohn, K. J., Kromhout, H., Defo, B., Bicer, B., Kumar, G., Kumar, M., Kuzin, I., Kyu, H., Lachat, C., Lad, D. P., Lad, S. D., Lafranconi, A., Lalloo, R., Lallukka, T., Lami, F., Lang, J. J., Lansingh, V. C., Larson, S., Latifi, A., Lazarus, J. V., Lee, P. H., Leigh, J., Leili, M., Leshargie, C., Leung, J., Levi, M., Lewycka, S., Li, S., Li, Y., Liang, J., Liang, X., Lian, Y., Liben, M., Lim, L., Linn, S., Liu, S., Lodha, R., Logroscino, G., Lopez, A. D., Lorkowski, S., Lotufo, P. A., Lozano, R., Lucas, T. D., Lunevicius, R., Ma, S., Macarayan, E., Machado, I., Madotto, F., Mai, H., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malta, D., Mamum, A. A., Manda, A., Manguerra, H., Mansournia, M., Mantovani, L., Maravilla, J. C., Marcenes, W., Marks, A., Martin, R. V., Martins, S. C., Martins-Melo, F., Marz, W., Marzan, M. B., Massenburg, B., Mathur, M., Mathur, P., Matsushita, K., Maulik, P. K., Mazidi, M., McAlinden, C., McGrath, J. J., McKee, M., Mehrotra, R., Mehta, K. M., Mehta, V., Meier, T., Mekonnen, F., Melaku, Y. A., Melese, A., Melku, M., Memiah, P. N., Memish, Z. A., Mendoza, W., Mengistu, D., Mensah, G. A., Mensink, G. M., Mereta, S., Meretola, A., Meretoja, T. J., Mestrovic, T., Mezgebe, H., Miazgowski, B., Miazgowski, T., Millear, A. I., Miller, T. R., Miller-Petrie, M., Mini, G. K., Mirarefin, M., Mirica, A., Mirrakhimov, E. M., Misganaw, A., Mitiku, H., Moazen, B., Mohajer, B., Mohammad, K., Mohammadi, M., Mohammadifard, N., Mohammadnia-Afrouzi, M., Mohammed, S., Mohebi, F., Mokdad, A. H., Molokhia, M., Momeniha, F., Monasta, L., Moodley, Y., Moradi, G., Moradi-Lakeh, M., Moradinazar, M., Moraga, P., Morawska, L., Morgado-Da-Costa, J., Morrison, S., Moschos, M. M., Mouodi, S., Mousavi, S., Mozaffarian, D., Mruts, K., Muche, A., Muchie, K., Mueller, U., Muhammed, O., Mukhopadhyay, S., Muller, K., Musa, K., Mustafa, G., Nabhan, A. F., Naghavi, M., Naheed, A., Nahvijou, A., Naik, G., Naik, N., Najafi, L., Nangia, V., Nansseu, J., Nascimento, B., Neal, B., Neamati, N., Negoi, I. T., Negoi, R., Neupane, S., Newton, C., Ngunjiri, J. V., Anh Quynh Nguyen, Nguyen, G., Ha Thu Nguyen, Huong Lan Thi Nguyen, Huong Thanh Nguyen, Minh Nguyen, Nam Ba Nguyen, Nichols, E., Nie, J., Ningrum, D., Nirayo, Y., Nishi, N., Nixon, M. R., Nojomi, M., Nomura, S., Norheim, O. F., Noroozi, M., Norrving, B., Noubiap, J., Nouri, H., Shiadeh, M., Nowroozi, M., Nsoesie, E. O., Nyasulu, P. S., Obermeyer, C. M., Odell, C. M., Ofori-Asenso, R., Ogbo, F., Oh, I., Oladimeji, O., Olagunju, A. T., Olagunju, T. O., Olivares, P. R., Olsen, H., Olusanya, B., Olusanya, J., Ong, K. L., Ong, S., Oren, E., Orpana, H. M., Ortiz, A., Ota, E., Otstavnov, S. S., Overland, S., Owolabi, M., Pacella, M., Pakhare, A. P., Pakpour, A. H., Pana, A., Panda-Jonas, S., Park, E., Parry, C. H., Parisian, H., Patel, S., Pati, S., Patil, S. T., Patle, A., Patton, G. C., Paudel, D., Paulson, K. R., Ballesteros, W., Pearce, N., Pereira, A., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Hai Quang Pham, Phillips, M. R., Pillay, J., Piradov, M. A., Pirsaheb, M., Pischon, T., Pishgar, F., Plana-Ripoll, O., Plass, D., Polinder, S., Polkinghorne, K. R., Postma, M. J., Poulton, R., Pourshams, A., Poustchi, H., Prabhakaran, D., Prakash, S., Prasad, N., Purcell, C. A., Purwar, M. B., Qorbani, M., Radfar, A., Rafay, A., Rafiei, A., Rahim, F., Rahimi, Z., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, M., Rai, R., Rajati, F., Rajsic, S., Raju, S., Ram, U., Ranabhat, C., Ranjan, P., Rath, G., Rawaf, D., Rawaf, S., Reddy, K., Rehm, C. D., Rehm, J., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Reynales-Shigematsu, L., Rezaei, S., Ribeiro, A. P., Rivera, J. A., Roba, K., Rodrigues-Ramirez, S., Roever, L., Roman, Y., Ronfani, L., Roshandel, G., Rostami, A., Roth, G. A., Rothenbacher, D., Roy, A., Rubagotti, E., Rushton, L., Sabanayagam, C., Sachdev, P. S., Saddik, B., Sadeghi, E., Moghaddam, S., Safari, H., Safari, Y., Safari-Faramani, R., Safdarian, M., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sahraian, M., Sajadi, H., Salam, N., Salamati, P., Saleem, Z., Salimi, Y., Salimeadeh, H., Salomon, J. A., Salvi, D., Satz, I., Samy, A. M., Sanabria, J., Sanchez-Nino, M., Sanchez-Pimienta, T. G., Sanders, T., Sang, Y., Santomauro, D., Santos, I. S., Santos, J., Milicevic, M., Jose, B., Sardana, M., Sacker, A., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarvi, S., Sathian, B., Satpathy, M., Sawant, A. R., Sawhney, M., Saylan, M., Sayyah, M., Schaeffner, E., Schmidt, M., Schneider, I. C., Schottker, B., Schutte, A., Schwehel, D. C., Schwendicke, F., Scott, J. G., Seedat, S., Sekerija, M., Sepanlou, S. G., Serre, M. L., Servan-Mori, E., Seyedmousavi, S., Shabaninejad, H., Shaddick, G., Shafieesabet, A., Shahbazi, M., Shaheen, A. A., Shaikh, M., Levy, T., Shams-Beyranvand, M., Shamsi, M., Sharafi, H., Sharafi, K., Sharif, M., Sharif-Alhoseini, M., Sharifi, H., Sharma, J., Sharma, M., Sharma, R., She, J., Sheikh, A., Shi, P., Shibuya, K., Shiferaw, M., Shigematsu, M., Shin, M., Shirt, R., Shirkoohi, R., Shiue, I., Shokraneh, F., Shoman, H., Shrime, M. G., Shupler, M. S., Si, S., Siabani, S., Sibai, A., Siddiqi, T. J., Sigfusdottir, I., Sigurvinsdottir, R., Silva, D., Silva, J., Silveira, D., Singh, J. A., Singh, N., Singh, V., Sinha, D., Skiadaresi, E., Skirbekk, V., Smith, D. L., Smith, M., Sobaih, B., Sobhani, S., Somayaji, R., Soofi, M., Sorensen, R. D., Soriano, J. B., Soyiri, I. N., Spinelli, A., Sposato, L. A., Sreeramareddy, C. T., Srinivasan, V., Starodubow, V. I., Steckling, N., Stein, D. J., Stein, M. B., Stevanovic, G., Stockfelt, L., Stokes, M. A., Sturua, L., Subart, M. L., Sudaryanto, A., Sufiyan, M., Sulo, G., Sunguya, B. F., Sur, P., Sykes, B. I., Szoeke, C. I., Tabares-Seisdedos, R., Tabuchi, T., Tadakamadla, S., Takahashi, K., Tandon, N., Tassew, S., Tavakkoli, M., Taveira, N., Tehrani-Banihashemi, A., Tekalign, T., Tekelemedhin, S., Tekle, M., Temesgen, H., Temsah, M., Temsah, O., Terkawi, A., Tessema, B., Teweldemedhin, M., Thankappan, K., Theis, A., Thirunavukkarasu, S., Thomas, H. J., Thomas, M., Thomas, N., Thurston, G. D., Tilahun, B., Tillmana, T., To, Q. G., Tobollik, M., Tonelli, M., Topor-Madry, R., Torre, A. E., Tortajada-Girbes, M., Touvier, M., Tovani-Palone, M., Towbin, J. A., Tran, B., Tran, K., Truelsen, T., Nu Thi Truong, Tsadik, A., Car, L., Tuzcu, E., Tymeson, H. D., Tyrovolas, S., Ukwaja, K. N., Ullah, I., Updike, R. L., Usman, M., Uthman, O. A., Vaduganathan, M., Vaezi, A., Valdez, P. R., Van Donkelaar, A., Varavikova, E., Varughese, S., Vasankari, T., Venkateswaran, V., Venketasubramanian, N., Villafaina, S., Violante, F. S., Vladimirov, S., Vlassov, V., Vollset, S., Vos, T., Vbsoughi, K., Vu, G., Vujcic, I. S., Wagnew, F., Waheed, Y., Waller, S. G., Walson, J. L., Wang, Y., Wang, Y., Wang, Y., Weiderpass, E., Weintraub, R. G., Weldegebreal, F., Werdecker, A., Weiknah, A., West, J., Westerman, R., Whiteford, H. A., Widecka, J., Wijeratne, T., Winkler, A., Wiyeh, A. B., Wiysonge, C., Wolfe, C. A., Wong, T., Wu, S., Xavier, D., Xu, G., Yadgir, S., Yadollahpour, A., Jabbari, S., Yamada, T., Yan, L. L., Yano, Y., Yaseri, M., Yasin, J., Yeshanely, A., Yimer, E. M., Yip, P., Yisma, E., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Yousefifard, M., Yu, C., Zaidi, Z., Bin Zaman, S., Zamani, M., Zavala-Arciniega, L., Zhang, A., Zhang, H., Zhang, K., Thou, M., Zimsen, S. M., Zodpey, S., Murray, C. L. 2018; 392 (10159): 1923–94
  • Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Murray, C. L., Callender, C. H., Kulikoff, X., Srinivasan, V., Abate, D., Abate, K., Abay, S. M., Abbasi, N., Abbastabar, H., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdoli, N., Abdollahpour, I., Abdulkader, R., Abebe, H., Abebe, M., Abebe, Z., Abebo, T., Abejie, A., Aboyans, V., Abraha, H., Abreu, D., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adekanmbi, V., Adetokunboh, O. O., Adhena, B., Adhikari, T., Adib, M. C., Adou, A., Adsuar, J. C., Afarideh, M., Afshin, A., Agarwal, G., Agesa, K. M., Aghayan, S., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmed, M., Ahmed, S., Aichour, A., Aichour, I., Aichour, M., Akanda, A. S., Akbari, M., Akibu, M., Akinyemi, R., Akinyemiju, T., Akseer, N., Alahdab, F., Al-Aly, Z., Alam, K., Alebel, A., Aleman, A. V., Alene, K., Al-Eyadhy, A., Ali, R., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S., Alkerwi, A., Alla, F., Allebeck, P., Almasi, A., Alonso, J., Al-Raddadi, R. M., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Ammar, W., Anber, N., Andrei, C., Androudi, S., Animut, M., Ansari, H., Ansha, M., Antonio, C. T., Appiah, S., Aremu, O., Areri, H., Arian, N., Arnlov, J., Artaman, A., Aryal, K. K., Asayesh, H., Asfaw, E., Asgedom, S., Assadi, R., Atey, T., Afique, S., Atteraya, M., Ausloos, M., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayele, Y., Ayer, R., Ayuk, T. B., Azzopardi, P. S., Babalola, T., Babazadeh, A., Radali, H., Badawi, A., Bali, A., Ranach, M., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Basaleem, H., Bassat, Q., Basu, A., Baune, B. T., Baynes, H., Beghi, E., Behzadifar, M., Belazadifar, M., Bekele, B., Belachew, A., Belay, A., Belay, E., Belay, S., Belay, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Bergeron, G., Berhane, A., Berman, A. E., Bernabe, E., Bernstein, R. S., Bertolacci, G. J., Beuran, M., Bhattarai, S., Bhaumik, S., Bhutia, Z. A., Biadgo, B., Bijani, A., Rikbov, B., Bililign, N., Bin Sayeed, M., Birlik, S., Birungi, C., Diswas, T., Bizuneh, H., Bleyer, A., Basara, B., Bosetti, C., Boufous, S., Brady, O. J., Bragazzi, N., Brainin, M., Brazinova, A., Breitborde, N. K., Brenner, H., Brewer, J. D., Briant, P., Britton, G., Burstein, R., Busse, R., Riff, Z. A., Cahuana-Hurtado, L., Campos-Nonato, I. R., Rincon, J., Cano, J., Car, M., Cardenas, R., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. A., Rivas, J., Castro, F., Catala-Lopez, F., Cavin, A., Cerin, E., Chalek, J., Chang, H., Chang, J., Chattopadhyay, A., Chaturvedi, P., Chiang, P., Chin, K., Chisumpa, V., Chitheer, A., Choi, J. J., Chowdhury, R., Christopher, D. J., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Claro, R. M., Collado-Mateo, D., Constantin, M., Conti, S., Cooper, C., Cooper, L., Cornaby, L., Cortesi, P., Cortinovis, M., Costa, M., Cromwell, E. A., Crowe, C., Cukelj, P., Cunningham, M., Daba, A., Dachew, B., Dandona, L., Dandona, R., Dargan, P. I., Daryani, A., Das Gupta, R. T., Das Neves, J., Dasa, T., Dash, A., Weaver, N., Davitoiu, D., Daffetov, K., De Leo, D., De Neve, J., Degefa, M., Degenhardt, L., Degfie, T., Deiparine, S., Demoz, G., Demtsu, E., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Des Jarlais, D. C., Dessie, G., Dharniaratne, S. D., Dhimal, M., Dicker, D., Ding, E. L., Dinsa, G., Djalalinia, S., Huyen Phuc Do, Dokova, K., Doku, D., Dolan, K. A., Doyle, K. E., Driscoll, T. 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    Abstract

    How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2).With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(18)32335-3

    View details for Web of Science ID 000449710900006

    View details for PubMedID 30415748

    View details for PubMedCentralID PMC6252083

  • Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Lozano, R., Fullman, N., Abate, D., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdollahpour, I., Abdulkader, R., Abebe, N., Abebe, Z., Abejie, A., Abera, S. P., Abil, O., Aboyans, V., Abraha, H., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N., Abyu, G. Y., Accrombessi, M., Acharya, D., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adedoyin, R., Adekanmbi, V., Adetokunboh, O., Adhena, B., Adhikari, T., Adib, M. G., Adou, A., Adsuar, J. C., Afarideh, M., Afshari, M., Afshin, A., Agarwal, G., Aghayan, S., Agius, D., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, F., Ahmed, M., Ahmed, S., Akalu, T., Akanda, A. 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E., Eshrati, B., Eskandarieh, S., Esteghamati, A., Esteghamati, S., Fakhim, H., Omrani, V., Faramarzi, M., Fareed, M., Farhadi, F., Farid, T. A., Farinha, C., Farioli, A., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fentahun, N., Fereshtehnejad, S., Fernandes, E., Fernandes, J. C., Ferrari, A. J., Feyissa, G., Filip, I., Fischer, F., Fitzmaurice, C., Foigt, N. A., Foreman, K. J., Fox, J., Frank, T. D., Fukumoto, T., Fullman, N., Furst, T., Furtado, J. M., Futran, N. D., Gall, S., Ganji, M., Gankpe, F., Garcia-Basteiro, A. L., Gardner, W. M., Gebre, A., Gebremedhin, A., Gebremichael, T., Gelano, T., Geleijnse, J. M., Genova-Maleras, R., Geramo, Y., Gething, P. W., Gezae, K., Ghadiri, K., Falavarjani, K., Ghasemi-Kasman, M., Ghimire, M., Ghosh, R., Ghoshal, A., Giampaoli, S., Gill, P., Gill, T. K., Ginawi, I., Giussani, G., Gnedovskaya, E. V., Goldberg, E. M., Goli, S., Gomez-Dantes, H., Gona, P. N., Gopalani, S., Gorman, T. M., Goulart, A. C., Goulart, B., Grada, A., Grams, M. E., Grosso, G., Gugnani, H., Guo, Y., Gupta, P. C., Gupta, R., Gupta, R., Gupta, T., Gyawali, B., Haagsma, J. A., Hachinski, V., Hafezi-Nejad, N., Bidgoli, H., Hagos, T. B., Hailu, G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamadeh, R. R., Hamidi, S., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J., Hasan, M., Hassankhani, H., Hassen, H., Havmoeller, R., Hawley, C. N., Hay, R. J., Hay, S. I., Hedayatizadeh-Omran, A., Heibati, B., Hendrie, D., Henok, A., Herteliu, C., Heydarpour, S., Hibstu, D., Huong Thanh Hoang, Hoek, H. W., Hoffman, H. J., Hole, M. K., Rad, E., Hoogar, P., Hosgood, H., Hosseini, S., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A., Hu, G., Huang, J. J., Humh, C. K., Iburg, K., Ikeda, C., Ileanu, B., Ilesanmi, O., Iqbal, U., Irvani, S., Irvine, C., Islam, S., Islami, F., Jacobsen, K. H., Jahangiry, L., Jahanmehr, N., Jain, S., Jalkovnevic, M., Javanbakht, M., Jayatilleke, A., Jeemon, P., Jha, R., Jha, V., Ji, J. S., Johnson, C. O., Jonas, J. B., Jozwiak, J., Jungari, S., Jurisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kalani, R., Kanchan, T., Karami, M., Matin, B., Karch, A., Karema, C., Karimi, N., Karimi, S. M., Kasaeian, A., Kassa, D. H., Kassa, G., Kassa, T., Kassebaum, N. J., Katikireddi, S., Kawakami, N., Karyani, A., Keighobadi, M., Keiyoro, P., Kemmer, L., Kemp, G., Kengne, A., Keren, A., Khader, Y., Khafaei, B., Khafaie, M., Khajavi, A., Khalil, I. A., Khan, E., Khan, M., Khan, M., Khang, Y., Khazaei, M., Khoja, A. T., Khosravi, A., Khosravi, M., Kiadaliri, A. A., Kiirithio, D. N., Kim, C., Kim, D., Kim, P., Kim, Y., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Knudsen, A., Kocarnik, J. M., Kochhar, S., Kokubo, Y., Kolola, T., Kopec, J. A., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Kravchenko, M. A., Krishan, K., Krohn, K. J., Defo, B., Bicer, B., Kumar, G., Kumar, M., Kyu, H., Lad, D. P., Lad, S. D., Iofranconi, A., Lalloo, R., Lallukka, T., Lami, F., Lansingh, V. C., Latifi, A., Lau, K., Lazarus, J. V., Leasher, J. L., Ledesma, J. R., Lee, P. H., Leigh, J., Leung, J., Levi, M., Lewycka, S., Li, S., Li, Y., Liao, Y., Liben, M., Lim, L., Lim, S. S., Liu, S., Lodha, R., Looker, K. J., Lopez, A. D., Lorkowski, S., Lotufo, P. A., Low, N., Lozano, R., Lucas, T. D., Lucchesi, L. R., Lunevicius, R., Lyons, R. A., Ma, S., Macarayan, E., Mackay, M. T., Madotto, F., Abd El Razelk, H., Abd El Razek, M., Maghavani, D. P., Malootra, N., Mai, H., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malta, D., Mamun, A. A., Manda, A., Manguerra, H., Manhertz, T., Mansournia, M., Mantovani, L., Mapoma, C., Maravilla, J. C., Marcenes, W., Marks, A., Martins-Melo, F., Martopullo, I., Maerz, W., Marzan, M. B., Mashamba-Thompson, T., Massenburg, B., Mathur, M., Matsushita, K., Maulik, P. K., Mazidi, M., McAlinden, C., McGrath, J. J., McKee, M., Mehndiratta, M., Mehrotra, R., Mehta, K., Mehta, V., Mejia-Rodriguez, F., Mekonen, T., Melese, A., Melku, M., Meltzer, M., Memiah, P. N., Memish, Z. A., Mendoza, W., Mengistu, D., Mengistu, G., Mensah, G. A., Mereta, S., Meretoja, A., Meretoja, T. J., Mestrovic, T., Mezerji, N., Miazgowski, B., Miazgowski, T., Millear, A. I., Miller, T. R., Miltz, B., Mini, G. K., Mirarefin, M., Minakhimov, E. M., Misganaw, A., Mitchell, P. B., Mitiku, H., Moazen, B., Mohajer, B., Mohammad, K., Mohammadifard, N., Mohammadnia-Afrouzi, M., Mohammed, M. A., Mohammed, S., Mohebi, F., Moitra, M., Mokdad, A. H., Molokhia, M., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, G., Moradi-Lakeh, M., Moradinazar, M., Moraga, P., Morawska, L., Velasquez, I., Morgado-Da-Costa, J., Morrison, S., Moschos, M. M., Mousavi, S., Mruts, K., Muche, A., Muchie, K., Mueller, U., Mohammed, O., Mukhopadhyay, S., Muller, K., Mumford, J., Murhekar, M., Musa, J., Musa, K., Mustafa, G., Nabhan, A. F., Nagata, C., Naghavi, M., Naheed, A., Nahvijou, A., Naik, G., Naik, N., Najah, F., Naldi, L., Nam, H., Nangia, V., Nansseu, J., Nascimento, B., Natarajan, G., Neamati, N., Negoi, I., Negoi, R., Neupane, S., Newton, C., Ngunjiri, J. W., Anh Quynh Nguyen, Ha Thu Nguyen, Huong Lan Thi Nguyen, Huong Thanh Nguyen, Long Hoang, N., Minh Nguyen, Nam Ba Nguyen, Son Hoang Nguyen, Nichols, E., Ningrum, D., Nixon, M. R., Nolutshungu, N., Nomura, S., Norheim, O. F., Noroozi, M., Norrving, B., Noubiap, J., Nouri, H., Shiadeh, M., Nowroozi, M., Nsoesie, E., Nyasulu, P. S., Odell, C. M., Ofori-Asenso, R., Ogbo, F., Oh, I., Oladimeji, O., Olagunju, A. T., Olagunju, T. O., Olivares, P. R., Olsen, H., Olusanya, B., Ong, K. L., Ong, S., Oren, E., Ortiz, A., Ota, E., Otstavnov, S. S., Overland, S., Owolabi, M., Mahesh, P. A., Pacella, R., Pakpour, A. H., Pana, A., Panda-Jonas, S., Parisi, A., Park, E., Parry, C. H., Patel, S., Pati, S., Paint, S. T., Patle, A., Patton, G. C., Paturi, V., Paulson, K. R., Pearce, N., Pereira, D. M., Perico, N., Pesudovs, K., Pham, H., Phillips, M. R., Pigott, D. M., Pilly, J., Piradov, M. A., Pirsaheb, M., Pishgar, F., Plana-Ripoll, O., Plass, D., Polinder, S., Popova, S., Postma, M. J., Pourshams, A., Poustchi, H., Prabhakaran, D., Prakash, S., Prakash, V., Purcell, C. A., Purwar, M. B., Qorbani, M., Quistberg, D., Radfar, A., Rafay, A., Rafiei, A., Rahim, F., Rahimi, K., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, M., Rahman, S., Rai, R., Rajati, F., Ram, U., Ranjan, P., Ranta, A., Rao, P. C., Rawaf, D., Rawaf, S., Reddy, K., Reiner, R. C., Reinig, N., Reitsma, M., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Rezaei, S., Rezai, M., Ribeiro, A. P., Robinson, S. R., Roever, L., Ronfani, L., Roshandel, G., Rostami, A., Roth, G. A., Roy, A., Rubagotti, E., Sachdev, P. S., Sadat, N., Saddik, B., Sadeghi, E., Moghaddam, S., Safari, H., Safari, Y., Safari-Faramani, R., Safdarian, M., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sahraian, M., Sajadi, H., Salam, N., Salama, J. S., Salamati, P., Saleem, K., Saleem, Z., Salimi, Y., Salomon, J. A., Salvi, S., Sale, I., Samy, A. M., Sanabria, J., Sang, Y., Santomauro, D., Santos, I. S., Santos, J., Milicevic, M., Jose, B., Sardana, M., Sarker, A., Sarrafzadegan, N., Sartorius, B., Sarvi, S., Sathian, B., Satpathy, M., Sawant, A. R., Sawhney, M., Saxena, S., Saylan, M., Schaeffner, E., Schmidt, M., Schneider, I. C., Schoettker, B., Schwebel, D. C., Schwendicke, F., Scott, J. G., Sekerija, M., Sepanlou, S. G., Servan-Mori, E., Seyedmousavi, S., Shabaninejad, H., Shafieesabet, A., Shahbazi, M., Shaheen, A. 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  • Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet (London, England) 2018; 391 (10136): 2236–71

    Abstract

    A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(18)30994-2

    View details for PubMedID 29893224

  • Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet (London, England) 2017

    Abstract

    National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)30818-8

    View details for PubMedID 28528753

    View details for PubMedCentralID PMC5528124

  • Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1423–59

    Abstract

    The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment.Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past.GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32336-X

    View details for PubMedID 28916366

    View details for PubMedCentralID PMC5603800

  • Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1260–1344

    Abstract

    Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32130-X

    View details for PubMedID 28919118

    View details for PubMedCentralID PMC5605707

  • Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1211–59

    Abstract

    As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

    View details for DOI 10.1016/S0140-6736(17)32154-2

    View details for PubMedID 28919117

    View details for PubMedCentralID PMC5605509

  • Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Dilegge, T., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Johnson, C. O., Kassebaum, N. J., Kawashima, T., Kemmer, L., Khalil, I. A., Kinfu, Y., Kyu, H. H., Leung, J., Liang, X., Lim, S. S., Lopez, A. D., Lozano, R., Marczak, L., Mensah, G. A., Mokdad, A. H., Naghavi, M., Nguyen, G., Nsoesie, E., Olsen, H., Pigott, D. M., Pinho, C., Rankin, Z., Reinig, N., Salomon, J. A., Sandar, L., Smith, A., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., Wagner, J. A., Wang, H., Wanga, V., Whiteford, H. A., Zoeckler, L., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Ackerman, I. N., Adebiyi, A. O., Ademi, Z., Adou, A. K., Afanvi, K. A., Agardh, E. E., Agarwal, A., Kiadaliri, A. A., Ahmadieh, H., Ajala, O. N., Akinyemi, R. O., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Alegretti, M. A., Alemu, Z. A., Alexander, L. T., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, G. M., Anderson, B., Antonio, C. A., Aregay, A. F., Arnlov, J., Al Artaman, Asayesh, H., Assadi, R., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Barregard, L., Barrero, L. H., Basu, A., Bazargan-Hejazi, S., Bell, B., Bell, M. L., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhofff, K., Bikbov, B., Biryukov, S., Bisanzio, D., Bjertness, E., Blore, J., Borschmann, R., Boufous, S., Brainin, M., Brazinova, A., Breitborde, N. J., Brown, J., Buchbinder, R., Buckle, G. C., Butt, Z. A., Calabria, B., Ricardo Campos-Nonato, I., Cesar Campuzano, J., Carabin, H., Cardenas, R., Carpenter, D. O., Carrero, J. J., Castaneda-Orjuela, C. A., Castillo Rivas, J., Catala-Lopez, F., Chang, J., Chiang, P. P., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Coates, M. M., Colquhoun, S. M., Cooper, C., Cortinovis, M., Crump, J. A., Damtew, S. A., Dandona, R., Daoud, F., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Dellavalle, R. P., Deribe, K., Deribew, A., Derrett, S., Des Jarlais, D. C., Dharmaratne, S. D., Dhillon, P. K., Diaz-Torne, C., Ding, E. L., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Ellenbogen, R. G., Elyazar, I., Endres, M., Endries, A. Y., Ermakov, S. P., Eshrati, B., Estep, K., Farid, T. A., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foreman, K., Fowkes, G. R., Fox, J., Franklin, R. C., Friedman, J., Frostad, J., Furst, T., Futran, N. D., Gabbe, B., Ganguly, P., Gankpe, F. G., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Glaser, E., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Grainger, R., Greaves, F., Guillemin, F., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Maria Haro, J., Havmoeller, R., Hay, R. J., Beatriz Heredia-Pi, I., Heydarpour, P., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Huang, H., Huang, J. J., Huynh, C., Iannarone, M., Iburg, K. M., Innos, K., Inoue, M., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jensen, P. N., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Keiyoro, P. N., Kemp, A. H., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khaiff, A. R., Khaiff, E. A., Khang, Y., Khera, S., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, P., Kim, C., Kim, D., Kim, Y. J., Kissoon, N., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Defo, B. K., Bicer, B. K., Kudom, A. A., Kuipers, E. J., Kumar, G. A., Kutz, M., Kwan, G. F., Lal, A., Lalloo, R., Lallukka, T., Lam, H., Lam, J. O., Langan, S. M., Larsson, A., Lavados, P. M., Leasher, J. L., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liu, S., Liu, Y., Lloyd, B. K., Lo, W. D., Logroscino, G., Looker, K. J., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Mackay, M. T., Abd El Razek, M. M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Marcenes, W., Margolis, D. J., Martinez-Raga, J., Masiye, F., Massano, J., McGarvey, S. T., McGrath, J. J., McKee, M., McMahon, B. J., Meaney, P. A., Mehari, A., Meija-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Mitchell, P. B., Mock, C. N., Mohammadi, A., Mohammed, S., Monasta, L., Montanez Hernandez, J. C., Montico, M., Mooney, M. D., Moradi-Lakeh, M., Morawska, L., Mueller, U. O., Mullany, E., Mumford, J. E., Murdoch, M. E., Nachega, J. B., Nagel, G., Naheed, A., Naldi, L., Nangia, V., Newton, J. N., Ng, M., Ngalesoni, F. N., Quyen Le Nguyen, Q., Nisar, M. I., Nkamedjie Pete, P. M., Nona, J. M., Norheim, O. F., Norman, R. E., Norrving, B., Nunes, B. P., Ogbo, F. A., Oh, I., Ohkubo, T., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Ortiz, A., Osman, M., Ota, E., Mahesh, P. A., Park, E., Parsaeian, M., de Azeredo Passos, V. M., Paternina Caicedo, A. J., Patten, S. B., Patton, G. C., Pereira, D. M., Perez-Padilla, R., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Pishgar, F., Plass, D., Platts-Mills, J. A., Polinder, S., Pond, C. D., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Qorbani, M., Rabiee, R. H., Radfar, A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Ram, U., Rao, P., Refaat, A. H., Reitsma, M. B., Remuzzi, G., Resnikofff, S., Reynolds, A., Ribeiro, A. L., Rios Blancas, M. J., Rolm, H. S., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Roy, A., Sagar, R., Sahathevan, R., Sanabria, J. R., Dolores Sanchez-Nino, M., Santos, I. S., Santos, J. V., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schaub, M. P., Schmidt, M. I., Schneider, I. J., Schottker, B., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K. A., Shaheen, A., Shaikh, M. A., Sharma, R., Sharma, U., Shen, J., Shepard, D. S., Sheth, K. N., Shibuya, K., Shin, M., Shiri, R., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silva, D. A., Alves Silveira, D. G., Singh, A., Singh, J. A., Singh, O. P., Singh, P. K., Sivonda, A., Skirbekk, V., Skogen, J. C., Sligar, A., Silwa, K., Soljak, M., Soreide, K., Soriano, J. B., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Stein, D. J., Steiner, T. J., Steinke, S., Stovner, L., Stroumpoulis, K., Sunguya, B. F., Sur, P., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Takala, J. S., Landon, N., Tanne, D., Tavakkoli, M., Taye, B., Taylor, H. R., Te Ao, B. J., Tedla, B. A., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Gool, C. H., Varakin, Y. Y., Vasankari, T., Venketasubramanian, N., Verma, R. K., Violante, F. S., Vladimirov, S. K., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Waller, S. G., Wang, L., Watkins, D. A., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., White, R. A., Williams, H. C., Wiysonge, C. S., Wolfe, C. D., Won, S., Woodbrook, R., Wubshet, M., Xavier, D., Xu, G., Yadav, A. K., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yebyo, H. G., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zeeb, H., Zhou, M., Zodpey, S., Zuhlke, L. J., Murray, C. J. 2016; 388 (10053): 1545-1602

    Abstract

    Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4-19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30-2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35-2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000008

    View details for PubMedCentralID PMC5055577

  • Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., Cohen, A. J., Dandona, L., Estep, K., Ferrari, A. J., Frostad, J. J., Fullman, N., Gething, P. W., Godwin, W. W., Griswold, M., Kinfu, Y., Kyu, H. H., Larson, H. J., Liang, X., Lim, S. S., Liu, P. Y., Lopez, A. D., Lozano, R., Marczak, L., Mensah, G. A., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Neal, B., Reitsma, M. B., Roth, G. A., Salomon, J. A., Sur, P. J., Vos, T., Wagner, J. A., Wang, H., Zhao, Y., Zhou, M., Aasvang, G. M., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Abraham, B., Abu-Raddad, L. J., Abyu, G. Y., Adebiyi, A. O., Adedeji, I. A., Ademi, Z., Adou, A. K., Adsuar, J. C., Agardh, E. E., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ajala, O. N., Akinyemiju, T. F., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Aldridge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Alsharif, U., Altirkawi, K. A., Alvarez Martin, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Antonio, C. A., Anwar, P., Arnlov, J., Al Artaman, Asayesh, H., Asghar, R. J., Assadi, R., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Barac, A., Barber, R. M., Barker-Collo, S. L., Baernighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Basu, S., Bans, C., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhansali, A., Bhatt, S., Biadgilign, S., Bikbov, B., Bisanzio, D., Bjertness, E., Blore, J. D., Borschmann, R., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. J., Brenner, H., Broday, D. M., Brugha, T. S., Brunekreef, B., Butt, Z. A., Cahill, L. E., Calabria, B., Ricardo Campos-Nonato, I., Cardenas, R., Carpenter, D., Casey, D. C., Castaneda-Oquela, C. A., Castillo Rivas, J., Estanislao Castro, R., Catala-Lopez, F., Chang, J., Chiang, P. P., Chibalabala, M., Chimed-Ochir, O., Chisumpa, V. H., Chitheer, A. A., Choi, J. J., Christensen, H., Christopher, D. J., Ciobanu, L. G., Coates, M. M., Colquhoun, S. M., Cooper, L. T., Cooperrider, K., Cornaby, L., Cortinovis, M., Crump, J. A., Cuevas-Nasu, L., Damasceno, A., Dandona, R., Darby, S. C., Dargan, P. I., das Neves, J., Davis, A. C., Davletov, K., Filipa de Castro, E., De la Cruz-Gongora, V., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Del Pozo-Cruz, B., Dellavalle, R. P., Deribew, A., Des Jarlais, D. C., Dharmaratne, S. D., Dhillon, P. K., Diaz-Tome, C., Dicker, D., Ding, E. L., Dorsey, E. R., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Elyazar, I., Endries, A. Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Aquino Faraon, E. J., Farid, T. A., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fischer, F., Fitchett, J. R., Fleming, T., Foigt, N., Foreman, K., Fowkes, F. G., Franklin, R. C., Fuerst, T., Futran, N. D., Gakidou, E., Garcia-Basteiro, A. L., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gessner, B. D., Giref, A. Z., Giroud, M., Gishu, M. D., Goenka, S., Carmen Gomez-Cabrera, M., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Gugnani, H. C., Guillemin, F., Guo, Y., Gupta, R., Gupta, R., Gutierrez, R. A., Haagsma, J. A., Hafezi-Nejad, N., Haile, D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Maria Haro, J., Hassanvand, M. S., Hassen, T. A., Havmoeller, R., Beatriz Heredia-Pi, I., Francisco Hernandez-Llanes, N., Heydarpour, P., Hoek, H. W., Hoffman, H. J., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Htet, A. S., Hu, G., Huang, J. J., Husseini, A., Hutchings, S. J., Huybrechts, I., Iburg, K. M., Idrisov, B. T., Ileanu, B. V., Inoue, M., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Jansen, H. A., Jassal, S. K., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, Y., Jibat, T., Jin, Y., Johnson, C. O., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Kazi, D. S., Keiyoro, P. N., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khang, Y., Khatibzadeh, S., Khera, S., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kimokoti, R. W., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kopec, J. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Kromhout, H., Krueger, H., Ku, T., Defo, B. K., Kuchenbecker, R. S., Bicer, B. K., Kuipers, E. J., Kumar, G. A., Kwan, G. F., Lal, D. K., Lalloo, R., Lallukka, T., Lan, Q., Larsson, A., Latif, A. A., Beatriz Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, J., Levi, M., Li, X., Li, Y., Liang, J., Liu, S., Lloyd, B. K., Logroscino, G., Lotufo, P. A., Lunevicius, R., Maclntyre, M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Manamo, W. A., Mapoma, C. C., Marcenes, W., Martin, R. V., Martinez-Raga, J., Masiye, F., Matsushita, K., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Medina, C., Mehari, A., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Mensink, G. B., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mock, C. N., Mohammadi, A., Mohammed, S., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montico, M., Morawska, L., Mori, R., Mozaffarian, D., Mueller, U. O., Mullany, E., Mumford, J. E., Murthy, G. V., Nachega, J. B., Naheed, A., Nangia, V., Nassiri, N., Newton, J. N., Ng, M., Quyen Le Nguyen, Q., Nisar, M. I., Pete, P. M., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olsen, H., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Orozco, R., Ortiz, A., Ota, E., Mahesh, P. A., Pana, A., Park, E., Parry, C. D., Parsaeian, M., Patel, T., Caicedo, A. J., Patil, S. T., Patten, S. B., Patton, G. C., Pearce, N., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Plass, D., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N. M., Qorbani, M., Rabiee, R. H., Radfar, A., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Rana, S. M., Ranganathan, K., Rao, P., Razo Garcia, C. A., Refaat, A. H., Rehm, C. D., Rehm, J., Reinig, N., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Rivera, J. A., Rolm, H. S., Rodriguez, A., Rodriguez-Ramirez, S., Rojas-Rueda, D., Roman, Y., Ronfani, L., Roshandel, G., Rothenbacher, D., Roy, A., Saleh, M. M., Sanabria, J. R., Dolores Sanchez-Nino, M., Sanchez-Pimienta, T. G., Sandar, L., Santomauro, D. F., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schmidhuber, J., Schmidt, M. I., Schneider, I. J., Schoettker, B., Schutte, A. E., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shaheen, A., Shahraz, S., Shaikh, M. A., Levy, T. 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    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000010

    View details for PubMedCentralID PMC5388856

  • Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Kassebaum, N. J., Arora, M., Barber, R. M., Bhutta, Z. A., Carter, A., Casey, D. C., Charlson, F. J., Coates, M. M., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Foreman, K., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Johnson, C., Kemmer, L., Khalil, I. A., Kinfu, Y., Kutz, M. J., Kyu, H. H., Leung, J., Liang, X., Lim, S. S., Lim, S. S., Lozano, R., Mensah, G. A., Mikesell, J., Mokdad, A. H., Mooney, M. D., Naghavi, M., Nguyen, G., Nsoesie, E., Pigott, D. M., Pinho, C., Rankin, Z., Reinig, N., Salomon, J. A., Sandar, L., Smith, A., Sorensen, R. J., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., VanderZanden, A., Wagner, J. A., Wanga, V., Whiteford, H. A., Zhou, M., Zoeckler, L., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Ackerman, I. N., Adebiyi, A. O., Adedeji, I. A., Adsuar, J. C., Afanvi, K. A., Afshin, A., Agardh, E. E., Agarwal, A., Kumar, S., Ahmed, M. B., Kiadaliri, A. A., Ahmadieh, H., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alexander, L. T., Raghib, A., Alkerwi, A., Alla, F., Allebeck, P., Alsharif, U., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Anderson, G. M., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asayesh, H., Asghar, R. J., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Barregard, L., Barrero, L. H., Basu, S., Bayou, T. A., Beardsley, J., Bedi, N., Beghi, E., Bell, B., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhansali, A., Bhatt, S., Biadgilign, S., Bienhofff, K., Bikbov, B., Bin Abdulhak, A. A., Bisanzio, D., Bjertness, E., Blore, J. D., Borschmann, R., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. J., Brugha, T. S., Buchbinder, R., Buckle, G. C., Butt, Z. A., Calabria, B., Campos-Nonato, I. R., Campuzano, J. C., Carabin, H., Carapetis, J. R., Cardenas, R., Carrero, J. J., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Chang, J., Chiang, P. P., Chibalabala, M., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Choudhury, L., Christensen, H., Ciobanu, L. G., Colistro, V., Colomar, M., Colquhoun, S. M., Cortinovis, M., Crump, J. A., Damasceno, A., Dandona, R., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Derrett, S., Des Jarlais, D. C., deVeber, G. A., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Ellenbogen, R. G., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Fahimi, S., Farid, T. A., Sa Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foigt, N., Fowkes, F. G., Franklin, R. C., Friedman, J., Frostad, J., Furst, T., Futran, N. D., Gabbe, B., Gankpe, F. G., Garcia-Basteiro, A. L., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Hafezi-Nejad, N., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Ribhi, R., Hamadeh, Hamidi, S., Hammami, M., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Haro, J. M., Hassanvand, M. S., Hassen, T. A., Havmoeller, R., Hay, R. J., Hedayati, M. T., Heredia-Pi, I. B., Heydarpour, P., Hoek, H. W., Hoffman, D. J., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Huang, H., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Inoue, M., Jacobsen, K. H., Jauregui, A., Jayatilleke, A. U., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jin, Y., Jonas, J. B., Kabir, Z., Kajungu, D. K., Kalkonde, Y., Kamal, R., Kan, H., Kandel, A., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Katibeh, M., Kaul, A., Kawakami, N., Kazi, D. S., Keiyoro, P. N., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khang, Y., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kim, Y. J., Kissoon, N., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Koul, P. A., Koyanagi, A., Defo, B. K., Kuchenbecker, R. S., Bicer, B. K., Kuipers, E. J., Kumar, G. A., Kwan, G. F., Lalloo, R., Lallukka, T., Larsson, A., Latif, A. A., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, R., Li, Y., Li, Y., Lipshultz, S. E., Liu, P. Y., Liu, Y., Lloyd, B. K., Logroscino, G., Looker, K. J., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., El Razek, H. M., Mandavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Marcenes, W., Martinez-Raga, J., Masiye, F., Mason-Jones, A. J., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Mehari, A., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Mirrakhimov, E. M., Mitchell, P. B., Mock, C. N., Mohammad, K. A., Mohammadi, A., Mohammed, S., Monasta, L., Montanez Hernandez, J. C., Montico, M., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Mumford, J. E., Murdoch, M. E., Murthy, G. V., Nachega, J. B., Naheed, A., Naldi, L., Nangia, V., Newton, J. N., Ng, M., Ngalesoni, F. N., Le Nguyen, Q., Nisar, M. I., Pete, P. M., Nolla, J. M., Norheim, O. F., Norman, R. E., Norrving, B., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Oren, E., Ortiz, A., Ota, E., Oyekale, A. S., Pa, M., Park, E., Parsaeian, M., Patten, S. B., Patton, G. C., Pedro, J. M., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Pishgar, F., Plass, D., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N. M., Qorbani, M., Rabiee, R. H., Radfar, A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, D., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Ranganathan, K., Refaat, A. H., Reitsma, M. B., Remuzzi, G., Resnikoff, S., Reynolds, A., Ribeiro, A. L., Ricci, S., Roba, H. S., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Roy, A., Sackey, B. B., Sagar, R., Sanabria, J. R., Dolores Sanchez-Nino, M., Santos, I. S., Santos, J. V., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schmidt, M. I., Schneider, I. J., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shahraz, S., Shaikh, M. A., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shibuya, K., Shigematsu, M., Shin, M., Shin, R., Sigfusdottir, I. D., Santos Silva, D. A., Silverberg, J. I., Simard, E. P., Singh, A., Singh, J. A., Singh, P. K., Skirbekk, V., Skogen, J. C., Soljak, M., Soreide, K., Sorensen, R. J., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Stein, D. J., Stein, M. B., Steiner, T. J., Stovner, L. J., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Landon, N., Tanne, D., Tavakkoli, M., Taye, B., Taylor, H. R., Ao, B. J., Tegegne, T. K., Tekle, D. Y., Terkawi, A. S., Tessema, G. A., Thakur, J. S., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Gool, C. H., van Os, J., Vasankari, T., Vasconcelos, A. M., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Wallin, M. T., Wang, L., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., WestermaM, R., Wijeratne, T., Wilkinson, J. D., Williams, H. C., Wiysonge, C. S., Woldeyohannes, S. M., Wolfe, C. D., Won, S., Xu, G., Yadav, A. K., Yakob, B., Yan, L. L., Yan, Y., Yaseri, M., Ye, P., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zeeb, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Zeeb, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Vos, T., Lopez, A. D., Murray, C. J. 2016; 388 (10053): 1603-1658

    Abstract

    Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000009

    View details for PubMedCentralID PMC5388857

  • Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Kassebaum, N. J., Barber, R. M., Bhutta, Z. A., Dandona, L., Gething, P. W., Hay, S. I., Kinfu, Y., Larson, H. J., Liang, X., Lim, S. S., Lopez, A. D., Lozano, R., Mensah, G. A., Mokdad, A. H., Naghavi, M., Pinho, C., Salomon, J. A., Steiner, C., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbas, K. M., Abd-Allah, F., Abdallat, M. A., Abdulle, A. M., Abera, S. F., Aboyans, V., Abubakar, I., Abu-Rmeileh, N. M., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Adelekan, A. L., Adou, A. K., Afanvi, K. A., Agarwal, A., Kiadaliri, A. A., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R., Alsharif, U., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, G. M., Antoine, R. M., Antonio, C. A., Aregay, A. F., Arnlov, J., Arora, M., Arsenijevic, V. S., Al Artaman, Asayesh, H., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Basu, S., Bayou, T. A., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N. W., Bekele, T., Bell, M. L., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Biadgilign, S., Bikbov, B., Bin Abdulhak, A. A., Biroscak, B. J., Biryukov, S., Bisanzio, D., Bjertness, E., Blore, J. D., Brainin, M., Brazinova, A., Breitborde, N. J., Brugha, T. S., Butt, Z. A., Campos-Nonato, I. R., Campuzano, J. C., Cardenas, R., Carrero, J. J., Carter, A., Casey, D. C., Castaneda-Oquela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Chang, H., Chang, J. -., Chavan, L., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Coates, M. M., Coggeshall, M., Colistro, V., Colquhoun, S. M., Cooper, C., Cooper, L. T., Cortinovis, M., Dahiru, T., Damasceno, A., Danawi, H., Dandona, R., das Neves, J., De Leo, D., Dellavalle, R. P., Deribe, K., Deribew, A., Jarlais, D. C., Dharmaratne, S. D., Dicker, D. J., Ding, E. L., Dossou, E., Dubey, M., Ebel, B. E., Ellingsen, C. L., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Faraon, E. J., Farid, T. A., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. R., Fleming, T., Gt, N. F., Franca, E. B., Franklin, R. C., Fraser, M. S., Friedman, J., Pullman, N., Furst, T., Futran, N. D., Gambashidze, K., Gamkrelidze, A., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebremedhin, M., Gebru, A. A., Geleijnse, J. M., Gibney, K. B., Giref, A. Z., Giroud, M., Gishu, M. D., Glaser, E., Goenka, S., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Goto, A., Graetz, N., Gugnani, H. C., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Hafezi-Nejad, N., Hailu, A. D., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Harun, K. M., Havmoeller, R., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Hu, G., Huang, H., Huang, J. J., Huybrechts, I., Huynh, C., Iannarone, M., Iburg, K. M., Idrisov, B. T., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jonas, J. B., Kabir, Z., Kamal, R., Kan, H., Karch, A., Karletsos, D., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J. F., Kazanjan, K., Kazi, D. S., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khang, Y., Khonelidze, I., Khosravi, A., Khubchandani, J., Kim, Y. J., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kudom, A. A., Kulikoff, X. R., Kulkarni, C., Kumar, G. A., Kutz, M. J., Lal, D. K., Lalloo, R., Lam, H., Lamadrid-Figueroa, H., Lan, Q., Larsson, A., Laryea, D. O., Leigh, J., Leung, R., Li, Y., Li, Y., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Lunevicius, R., Ma, S., El Razek, H. M., El Razek, M. M., Majdan, M., Majeed, A., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Margolis, D. J., Marquez, N., Masiye, F., Marzan, M. B., Mason-Jones, A. J., Mazorodze, T. T., Meaney, P. A., Mehari, A., Mehndiratta, M. M., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Ibrahim, N. M., Mohammad, K. A., Mohammadi, A., Mohammed, S., Mola, G. L., Monasta, L., Monis, J. d., Hernandez, J. C., Montero, P., Montico, M., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U., Murthy, G. V., Murthy, S., Nachega, J. B., Naheed, A., Naldi, L., Nand, D., Nangia, V., Nash, D., Neupane, S., Newton, J. N., Ng, M., Ngalesoni, F. N., Nguhiu, P., Nguyen, G., Le Nguyen, Q., Nisar, M. I., Nomura, M., Norheim, O. F., Norman, R. E., Nyakarahuka, L., Obermeyer, C. M., Ogbo, F. A., Oh, I., Ojelabi, F. A., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ota, E., Oyekale, A. S., Pa, M., Pain, A., Papantoniou, N., Park, E., Park, H., Caicedo, A. J., Patten, S. B., Paul, V. K., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Pillay, J. D., Pishgar, F., Polinder, S., Pope, D., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Ram, U., Ranabhat, C. L., Rangaswamy, T., Rao, P. V., Refaat, A. H., Remuzzi, G. 2016; 388 (10053): 1775-1812

    Abstract

    In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance.Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000012

    View details for PubMedCentralID PMC5224694

  • Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015 LANCET Lim, S. S., Allen, K., Bhutta, Z. A., Dandona, L., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Hay, S. I., Holmberg, M., Kinfu, Y., Kutz, M. J., Larson, H. J., Liang, X., Lopez, A. D., Lozano, R., McNellan, C. R., Mokdad, A. H., Mooney, M. D., Naghavi, M., Olsen, H. E., Pigott, D. M., Salomon, J. A., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Afanvi, K. A., Afshin, A., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ahmadieh, H., Ahmed, K. Y., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, U., Alasfoor, D., Albuhairan, F. S., Aldhahri, S. F., Dge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alkhateeb, M. A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Anderson, G. M., Antonio, C. A., Anwari, P., Arnlov, J., Artaman, A., Asayesh, H., Asghar, R. J., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barber, R., Barker-Collo, S. L., Barnighausen, T., Barrero, L. H., Barrientos-Gutierrez, T., Basu, S., Bayou, T. A., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabe, E., Bernal, O. A., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhoff, K. A., Bikbov, B., Binagwaho, A., Bisanzio, D., Bjertness, E., Blore, J., Bourne, R. R., Brainin, M., Brauer, M., Brazinova, A., Breitborde, N. J., Broday, D. M., Brugha, T. S., Buchbinder, R., Butt, Z. A., Cahill, L. E., Campos-Nonato, I. R., Campuzano, J. C., Carabin, H., Cardenas, R., Carrero, J. J., Carter, A., Casey, D., Caso, V., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Cecilio, P., Chang, H., Chang, J., Charlson, F. J., Che, X., Chen, A. Z., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Ciobanu, L. G., Cirillo, M., Coates, M. M., Coggeshall, M., Cohen, A. J., Cooke, G. S., Cooper, C., Cooper, L. T., Cowie, B. C., Crump, J. A., Damtew, S. A., Dandona, R., Dargan, P. I., das Neves, J., Davis, A. C., Davletov, K., de Castro, E. F., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Deribe, K., Derrett, S., Jarlais, D. C., Deshpande, A., deVeber, G. A., Dey, S., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Dorsey, E. R., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. 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    Abstract

    In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices.In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2)=0·88) and the MDG index (r(2)=0·92), whereas the non-MDG index had a weaker relation with SDI (r(2)=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened.GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000013

    View details for PubMedID 27665228

    View details for PubMedCentralID PMC5055583

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J., Meaney, P. A., Mehari, A., Mehndiratta, M. M., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Micha, R., Miller, T. R., Mirarefin, M., Misganaw, A., Mock, C. N., Abdulmuhsin Mohammad, K., Mohammadi, A., Mohammed, S., Mohan, V., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montero, P., Montico, M., Montine, T. J., Moradi-Lakeh, M., Morawska, L., Morgan, K., Mori, R., Mozaffarian, D., Mueller, U., Satyanarayana Murthy, G. V., Murthy, S., Musa, K. I., Nachega, J. B., Nagel, G., Naidoo, K. S., Naik, N., Naldi, L., Nangia, V., Nash, D., Nejjari, C., Neupane, S., Newton, C. R., Newton, J. N., Ng, M., Ngalesoni, F. N., Ngirabega, J. d., Quyen Le Nguyen, Q., Nisar, M. I., Nkamedjie Pete, P. M., Nomura, M., Norheim, O. F., Norman, P. E., Norrving, B., Nyakarahuka, L., Ogbo, F. A., Ohkubo, T., Ojelabi, F. A., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ortiz, A., Osman, M., Ota, E., Ozdemir, R., Pa, M., Pandian, J. D., Pant, P. R., Papachristou, C., Park, E., Park, J., Parry, C. D., Parsaeian, M., Caicedo, A. J., Patten, S. B., Patton, G. C., Paul, V. K., Pearce, N., Pedro, J. M., Stokic, L. P., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Plass, D., Platts-Mills, J. A., Polinder, S., Pope, C. A., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Qorbani, M., Quame-Amaglo, J., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajavi, Z., Rajsic, S., Raju, M., Rakovac, I., Rana, S. M., Ranabhat, C. L., Rangaswamy, T., Rao, P., Rao, S. R., Refaat, A. H., Rehm, J., Reitsma, M. B., Remuzzi, G., Resnikofff, S., Ribeiro, A. L., Ricci, S., Blancas, M. J., Roberts, B., Roca, A., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Rothenbacher, D., Roy, A., Roy, N. K., Ruhago, G. M., Sagar, R., Saha, S., Sahathevan, R., Saleh, M. M., Sanabria, J. R., Sanchez-Nino, M. D., Sanchez-Riera, L., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schaub, M. P., Schmidt, M. I., Schneider, I. J., Schottker, B., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K. A., Shaddick, G., Shaheen, A., Shahraz, S., Shaikh, M. A., Shakh-Nazarova, M., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Shen, Z., Shepard, D. S., Sheth, K. N., Shetty, B. P., Shi, P., Shibuya, K., Shin, M., Shiri, R., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Silva, D. A., Silveira, D. G., Silverberg, J. I., Simard, E. P., Singh, A., Singh, G. M., Singh, J. A., Singh, O. P., Singh, P. K., Singh, V., Soneji, S., Soreide, K., Soriano, J. B., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Stein, D. J., Stein, M. B., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Sur, P., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Tabb, K. M., Takahashi, K., Takala, J. S., Talongwa, R. T., Tandon, N., Tavakkoli, M., Taye, B., Taylor, H. R., Ao, B. J., Tedla, B. A., Tefera, W. M., ten Have, M., Terkawi, A. S., Tesfay, F. H., Tessema, G. A., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tirschwell, D. L., Tonelli, M., Topor-Madry, R., Topouzis, F., Nx, J. A., Traebert, J., Tran, B. X., Truelsen, T., Trujillo, U., Tura, A. K., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uthman, O. A., Van Dingenen, R., van Donkelaar, A., Vasankari, T., Vasconcelos, A. M., Venketasubramanian, N., Vidavalur, R., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Wagner, J. A., Wagner, G. R., Wallin, M. T., Wang, L., Watkins, D. A., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., White, R. A., Wijeratne, T., Wilkinson, J. D., Williams, H. C., Wiysonge, C. S., Woldeyohannes, S. M., Wolfe, C. D., Won, S., Wong, J. Q., Woolf, A. D., Xavier, D., Xiao, Q., Xu, G., Yakob, B., Yalew, A. Z., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yebyo, H. G., Yip, P., Yirsaw, B. D., Yonemoto, N., Yonga, G., Younis, M. Z., Yu, S., Zaidi, Z., Zaki, M. E., Zannad, F., Zavala, D. E., Zeeb, H., Zeleke, B. M., Zhang, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Vos, T., Lopez, A. D., Murray, C. J. 2016; 388 (10053): 1459-1544

    Abstract

    Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000007

    View details for PubMedCentralID PMC5388903

  • Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia? Meta-analysis, Meta-regression, and Trial Sequential Analysis ANESTHESIOLOGY Terkawi, A. S., Mavridis, D., Flood, P., Wetterslev, J., Terkawi, R. S., Bin Abdulhak, A. A., Nunemaker, M. S., Tiouririne, M. 2016; 124 (4): 846-869

    Abstract

    Disagreement among many underpowered studies has led to an equivocal understanding of the efficacy of the 5-HT3 antagonist ondansetron in preventing the consequences of sympathectomy after subarachnoid anesthesia. The authors assessed the efficacy of ondansetron with respect to the overall quality and statistical power of the meta-analyses.The authors used a standard and a newer method of meta-analysis, trial sequential analysis (TSA), to estimate adjusted CIs based on how much information has been accrued. They also used random-effects meta-analyses techniques, small trial bias assessment, selection models, sensitivity analyses, and the Grading of Recommendations on Assessment, Development, and Evaluation system. These results from the aforementioned techniques were compared, and importance of consideration of these factors was discussed.Fourteen randomized placebo-controlled trials (1,045 subjects) were identified and analyzed. By using conventional meta-analyses, the authors determined that ondansetron was associated with reduction in the incidence of hypotension (relative risk = 0.62 [95% CI, 0.46 to 0.83], P = 0.001; TSA-adjusted CI, 0.34 to 1.12; I = 60%, P = 0.002) and bradycardia (relative risk = 0.44 [95% CI, 0.26 to 0.73], P = 0.001; TSA-adjusted CI, 0.05 to 3.85; I = 0%, P = 0.84). However, the authors found indications of bias among these trials. TSAs demonstrated that the meta-analysis lacked adequate information size and did not achieve statistical significance when adjusted for sparse data and repetitive testing. The Grading of Recommendations on Assessment, Development, and Evaluation system showed that the results had low to very low quality of evidence.The analyses fail to confirm evidence that ondansetron reduces the incidence of hypotension and bradycardia after subarachnoid anesthesia due to the risk of bias and information sizes less than the required. As results from meta-analysis are given significant weight, it is important to carefully evaluate the quality of the evidence that is input.

    View details for DOI 10.1097/ALN.0000000000001039

    View details for Web of Science ID 000373352000018

    View details for PubMedID 26835645

  • Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013 Findings From the Global Burden of Disease 2013 Study JAMA PEDIATRICS Kyu, H. H., Pinho, C., Wagner, J. A., Brown, J. C., Bertozzi-Villa, A., Charlson, F. J., Coffeng, L. E., Dandona, L., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T. D., Forouzanfar, M. H., Graetz, N., Guinovart, C., Haagsma, J., Higashi, H., Kassebaum, N. J., Larson, H. J., Lim, S. S., Mokdad, A. H., Moradi-Lakeh, M., Odell, S. V., Roth, G. A., Serina, P. T., Stanaway, J. D., Misganaw, A., Whiteford, H. A., Wolock, T. M., Hanson, S. W., Abd-Allah, F., Abera, S. F., Abu-Raddad, L. J., Albuhairan, F. S., Amare, A. T., Antonio, C. A., Artaman, A., Barker-Collo, S. L., Barrero, L. H., Benjet, C., Bensenor, I. M., Bhutta, Z. A., Bikbov, B., Brazinova, A., Campos-Nonato, I., Castaneda-Orjuela, C. A., Catala-Lopez, F., Chowdhury, R., Cooper, C., Crump, J. A., Dandona, R., Degenhardt, L., Dellavalle, R. P., Dharmaratne, S. D., Faraon, E. J., Feigin, V. L., Fuerst, T., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Goto, A., Gunnell, D., Hankey, G. J., Hay, R. J., Hornberger, J. C., Hosgood, H. D., Hu, G., Jacobsen, K. H., Jayaraman, S. P., Jeemon, P., Jonas, J. B., Karch, A., Kim, D., Kim, S., Kokubo, Y., Defo, B. K., Bicer, B. K., Kumar, G. A., Larsson, A., Leasher, J. L., Leung, R., Li, Y., Lipshultz, S. E., Lopez, A. D., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Majdan, M., Malekzadeh, R., Mashal, T., Mason-Jones, A. J., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mock, C. N., Murray, J., Nolte, S., Oh, I., Olusanya, B. O., Ortblad, K. F., Park, E., Paternina Caicedo, A. J., Patten, S. B., Patton, G. C., Pereira, D. M., Perico, N., Piel, F. B., Polinder, S., Popova, S., Pourmalek, F., Quistberg, D. A., Remuzzi, G., Rodriguez, A., Rojas-Rueda, D., Rothenbacher, D., Rothstein, D. H., Sanabria, J., Santos, I. S., Schwebel, D. C., Sepanlou, S. G., Shaheen, A., Shiri, R., Shiue, I., Skirbekk, V., Sliwa, K., Sreeramareddy, C. T., Stein, D. J., Steiner, T. J., Stovner, L. J., Sykes, B. L., Tabb, K. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Ukwaja, K. N., Vasankari, T., Venketasubramanian, N., Vlassov, V. V., Vollset, S. E., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wilkinson, J. D., Woldeyohannes, S. M., Wolfe, C. D., Yano, Y., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaki, M. E., Naghavi, M., Murray, C. J., Vos, T. 2016; 170 (3): 267-287

    Abstract

    The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study.Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

    View details for DOI 10.1001/jamapediatrics.2015.4276

    View details for Web of Science ID 000372304700018

  • Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Forouzanfar, M. H., Alexander, L., Anderson, H. R., Bachman, V. F., Biryukov, S., Brauer, M., Burnett, R., Casey, D., Coates, M. M., Cohen, A., Delwiche, K., Estep, K., Frostad, J. J., Astha, K. C., Kyu, H. H., Moradi-Lakeh, M., Ng, M., Slepak, E. L., Thomas, B. A., Wagner, J., Aasvang, G. M., Abbafati, C., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, B., Abraham, J. P., Abubakar, I., Abu-Rmeileh, N. M., Aburto, T. C., Achoki, T., Adelekan, A., Adofo, K., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Al Khabouri, M. J., Al Lami, F. H., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Ali, M. K., Alla, F., Allebeck, P., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Ameh, E. A., Ameli, O., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Cunningham, S. A., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Avila, M. A., Awuah, B., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Balu, R. K., Banerjee, A., Barber, R. M., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Barrientos-Gutierrez, T., Basto-Abreu, A. C., Basu, A., Basu, S., Basulaiman, M. O., Ruvalcaba, C. B., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Benzian, H., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. Q., Bikbov, B., Bin Abdulhak, A. A., Blore, J. D., Blyth, F. M., Bohensky, M. A., Basara, B. B., Borges, G., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. J., Brenner, H., Briggs, A. D., Broday, D. M., Brooks, P. M., Bruce, N. G., Brugha, T. S., Brunekreef, B., Buchbinder, R., Bui, L. N., Bukhman, G., Bulloch, A. G., Burch, M., Burney, P. G., Campos-Nonato, I. R., Campuzano, J. C., Cantoral, A. J., Caravanos, J., Cardenas, R., Cardis, E., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Cavlin, A., Chadha, V. K., Chang, J., Charlson, F. J., Chen, H., Chen, W., Chen, Z., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christophi, C. A., Chuang, T., Chugh, S. S., Cirillo, M., Classen, T. K., Colistro, V., Colomar, M., Colquhoun, S. M., Contreras, A. G., Cooper, C., Cooperrider, K., Cooper, L. T., Coresh, J., Courville, K. J., Criqui, M. H., Cuevas-Nasu, L., Damsere-Derry, J., Danawi, H., Dandona, L., Dandona, R., Dargan, P. I., Davis, A., Davitoiu, D. V., Dayama, A., de Castro, E. F., De la Cruz-Gongora, V., De Leo, D., de Lima, G., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. 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    Abstract

    The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(15)00128-2

    View details for Web of Science ID 000365993200031

    View details for PubMedCentralID PMC4685753

  • Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition LANCET Murray, C. J., Barber, R. M., Foreman, K. J., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Ackerman, I. N., Ademi, Z., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allebeck, P., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, H., Ammar, W., Anderson, H. R., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Avila, M. A., Awuah, B., Bachman, V. F., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Basu, A., Basu, S., Basulaiman, M. O., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bernabe, E., Bertozzi-Villa, A., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bienhoff, K., Bikbov, B., Biryukov, S., Blore, J. D., Blosser, C. D., Blyth, F. M., Bohensky, M. A., Bolliger, I. W., Basara, B. B., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Briggs, A. D., Brooks, P. M., Brown, J. C., Brugha, T. S., Buchbinder, R., Buckle, G. C., Budke, C. M., Bulchis, A., Bulloch, A. G., Campos-Nonato, I. R., Carabin, H., Carapetis, J. R., Cardenas, R., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Cavlin, A., Chadha, V. K., Chang, J., Charlson, F. 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H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Juel, K., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Karthikeyan, G., Kassebaum, N. J., Kaul, A., Kawakami, N., Kazanjan, K., Kemp, A. H., Kengne, A. P., Keren, A., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Kieling, C., Kim, D., Kim, S., Kim, Y., Kinfu, Y., Kinge, J. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kosen, S., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kyu, H. H., Lai, T., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larsson, A., Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, R., Levitz, C. E., Li, B., Li, Y., Li, Y., Lim, S. S., Lind, M., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lofgren, K. T., Logroscino, G., Looker, K. J., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., MacIntyre, M. F., Mackay, M. T., Majdan, M., Malekzadeh, R., Marcenes, W., Margolis, D. J., Margono, C., Marzan, M. B., Masci, J. R., Mashal, M. T., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., McGill, N. W., McGrath, J. J., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mitchell, P. B., Mock, C. N., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montico, M., Montine, T. J., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moran, A. E., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M. L., Mozaffarian, D., Msemburi, W. T., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murdoch, M. E., Murray, J., Murthy, K. S., Naghavi, M., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nejjari, C., Neupane, S. P., Newton, C. R., Ng, M., Ngalesoni, F. N., Nguyen, G., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Ohno, S. L., Olusanya, B. O., Opio, J. N., Ortblad, K., Ortiz, A., Pain, A. W., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Park, J., Patten, S. B., Patton, G. C., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phillips, B. K., Phillips, D. E., Piel, F. B., Plass, D., Poenaru, D., Polinder, S., Pope, D., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Pullan, R. L., Qato, D. M., Quistberg, D. A., Rafay, A., Rahimi, K., Rahman, S. U., Raju, M., Rana, S. M., Razavi, H., Reddy, K. S., Refaat, A., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Richardson, L., Richardus, J. H., Roberts, D. A., Rojas-Rueda, D., Ronfani, L., Roth, G. A., Rothenbacher, D., Rothstein, D. H., Rowley, J. T., Roy, N., Ruhago, G. M., Saeedi, M. Y., Saha, S., Sahraian, M. A., Sampson, U. K., Sanabria, J. R., Sandar, L., Santos, I. S., Satpathy, M., Sawhney, M., Scarborough, P., Schneider, I. J., Schoettker, B., Schumacher, A. E., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serina, P. T., Servan-Mori, E. E., Shackelford, K. A., Shaheen, A., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shi, P., Shibuya, K., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, L., Skirbekk, V., Slepak, E. L., Sliwa, K., Soneji, S., Soreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stanaway, J. D., Stathopoulou, V., Stein, D. J., Stein, M. B., Steiner, C., Steiner, T. J., Stevens, A., Stewart, A., Stovner, L. J., Stroumpoulis, K., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Taylor, H. R., Te Ao, B. J., Tediosi, F., Temesgen, A. M., Templin, T., ten Have, M., Tenkorang, E. Y., Terkawi, A. S., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tonelli, M., Topouzis, F., Toyoshima, H., Traebert, J., Tran, B. X., Trillini, M., Truelsen, T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Van Brakel, W. H., van de Vijver, S., van Gool, C. H., van Os, J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Wagner, J., Waller, S. G., Wan, X., Wang, H., Wang, J., Wang, L., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Wang Wenzhi, W. Z., Werdecker, A., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, T. N., Wolfe, C. D., Wolock, T. M., Woolf, A. D., Wulf, S., Wurtz, B., Xu, G., Yan, L. L., Yano, Y., Ye, P., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zonies, D., Zou, X., Salomon, J. A., Lopez, A. D., Vos, T. 2015; 386 (10009): 2145-2191

    Abstract

    Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(15)61340-X

    View details for Web of Science ID 000365992600030

    View details for PubMedCentralID PMC5388903

  • Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., Duan, L., Erskine, H., Feigin, V. L., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Graetz, N., Guinovart, C., Haagsma, J., Hansen, G. M., Hanson, S. W., Heuton, K. R., Higashi, H., Kassebaum, N., Kyu, H., Laurie, E., Liang, X., Lofgren, K., Lozano, R., MacIntyre, M. F., Moradi-Lakeh, M., Naghavi, M., Nguyen, G., Odell, S., Ortblad, K., Roberts, D. A., Roth, G. A., Sandar, L., Serina, P. T., Stanaway, J. D., Steiner, C., Thomas, B., Vollset, S. E., Whiteford, H., Wolock, T. M., Ye, P., Zhou, M., Avila, M. A., Aasvang, G. M., Abbafati, C., Ozgoren, A. A., Abd-Allah, F., Aziz, M. I., Abera, S. F., Aboyans, V., Abraham, J. P., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Aburto, T. C., Achoki, T., Ackerman, I. N., Adelekan, A., Ademi, Z., Adou, A. K., Adsuar, J. C., Arnlov, J., Agardh, E. E., Al Khabouri, M. J., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allebeck, P., Allen, P. J., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Ameli, O., Amini, H., Ammar, W., Anderson, B. O., Anderson, H. R., Antonio, C. A., Anwari, P., Apfel, H., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Banerjee, A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Basu, S., Basu, A., Baxter, A., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. Q., Bienhoff, K., Bikbov, B., Bin Abdulhak, A., Blore, J. D., Blyth, F. M., Bohensky, M. A., Basara, B. B., Borges, G., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brauer, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Briggs, A. D., Brooks, P. M., Brown, J., Brugha, T. S., Buchbinder, R., Buckle, G. C., Bukhman, G., Bulloch, A. G., Burch, M., Burnett, R., Cardenas, R., Cabral, N. L., Nonato, I. R., Campuzano, J. C., Carapetis, J. R., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Catala-Lopez, F., Chadha, V. K., Chang, J., Chen, H., Chen, W., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Chugh, S. S., Cirillo, M., Coggeshall, M., Cohen, A., Colistro, V., Colquhoun, S. M., Contreras, A. G., Cooper, L. T., Cooper, C., Cooperrider, K., Coresh, J., Cortinovis, M., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Dandona, R., Dandona, L., Dansereau, E., Dantes, H. G., Dargan, P. I., Davey, G., Davitoiu, D. V., Dayama, A., De la Cruz-Gongora, V., de la Vega, S. F., De Leo, D., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Derrett, S., Des Jarlais, D. C., Dessalegn, M., de Veber, G. A., Dharmaratne, S. D., Diaz-Torne, C., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duber, H., Durrani, A. M., Edmond, K. M., Ellenbogen, R. G., Endres, M., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Fahimi, S., Farzadfar, F., Fay, D. F., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Ferri, C. P., Flaxman, A., Foigt, N., Foreman, K. J., Fowkes, F. G., Franklin, R. C., Furst, T., Futran, N. D., Gabbe, B. J., Gankpe, F. G., Garcia-Guerra, F. A., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giroud, M., Giussani, G., Goenka, S., Goginashvili, K., Gona, P., de Cosio, T. G., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Guerrant, R. L., Gugnani, H. C., Gunnell, D., Gupta, R., Gupta, R., Gutierrez, R. A., Hafezi-Nejad, N., Hagan, H., Halasa, Y., Hamadeh, R. R., Hamavid, H., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Haro, J. M., Havmoeller, R., Hay, R. J., Hay, S., Hedayati, M. T., Pi, I. B., Heydarpour, P., Hijar, M., Hoek, H. W., Hoffman, H. J., Hornberger, J. C., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, H., Hu, G., Huang, J. J., Huang, C., Huiart, L., Husseini, A., Iannarone, M., Iburg, K. M., Innos, K., Inoue, M., Jacobsen, K. H., Jassal, S. K., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Joseph, J., Juel, K., Kan, H., Karch, A., Karimkhani, C., Karthikeyan, G., Katz, R., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L., Knudsen, A. K., Kokubo, Y., Kosen, S., Kramer, A., Kravchenko, M., Krishnamurthi, R. V., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, V. S., Kumar, K., Kumar, G. A., Kwan, G. F., Lai, T., Lalloo, R., Lam, H., Lan, Q., Lansingh, V. C., Larson, H., Larsson, A., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, B., Li, Y., Li, Y., Liang, J., Lim, S., Lin, H., Lind, M., Lindsay, M. P., Lipshultz, S. E., Liu, S., Lloyd, B. K., Ohno, S. L., Logroscino, G., Looker, K. J., Lopez, A. D., Lopez-Olmedo, N., Lortet-Tieulent, J., Lotufo, P. A., Low, N., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, J., Ma, S., Mackay, M. T., Majdan, M., Malekzadeh, R., Mapoma, C. C., Marcenes, W., March, L. M., Margono, C., Marks, G. B., Marzan, M. B., Masci, J. R., Mason-Jones, A. J., Matzopoulos, R. G., Mayosi, B. M., Mazorodze, T. T., McGill, N. W., McGrath, J. J., McKee, M., McLain, A., McMahon, B. J., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mensah, G., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mitchell, P. B., Mock, C. N., Moffitt, T. E., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Montine, T. J., Moore, A. R., Moran, A. E., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M., Mozaffarian, D., Mueller, U. O., Mukaigawara, M., Murdoch, M. E., Murray, J., Murthy, K. S., Naghavi, P., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Neupane, S. P., Newman, L. M., Newton, C. R., Ng, M., Ngalesoni, F. N., Nhung, N. T., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I. H., Ohkubo, T., Omer, S. B., Opio, J. N., Ortiz, A., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Parry, C. D., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pedraza, L. S., Pellegrini, C. A., Pereira, D. M., Perez-Ruiz, F. P., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phillips, D., Phillips, B., Piel, F. B., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pope, C. A., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Qato, D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Razavi, H., Refaat, A., Rehm, J., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Riccio, P. M., Richardson, L., Richardus, J. H., Riederer, A. M., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Ronfani, L., Rothenbacher, D., Roy, N., Ruhago, G. M., Sabin, N., Sacco, R. L., Ksoreide, K., Saha, S., Sahathevan, R., Sahraian, M. A., Sampson, U., Sanabria, J. R., Sanchez-Riera, L., Santos, I. S., Satpathy, M., Saunders, J. E., Sawhney, M., Saylan, M. I., Scarborough, P., Schoettker, B., Schneider, I. J., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shepard, D. S., Shi, P., Shibuya, K., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, J. A., Singh, L., Skirbekk, V., Sliwa, K., Soljak, M., Soneji, S., Soshnikov, S. S., Speyer, P., Sposato, L. A., Sreeramareddy, C. T., Stoeckl, H., Stathopoulou, V. K., Steckling, N., Stein, M. B., Stein, D. J., Steiner, T. J., Stewart, A., Stork, E., Stovner, L. J., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Tan, F., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Taylor, H. R., Ao, B. J., Temesgen, A. M., ten Have, M., Tenkorang, E. Y., Terkawi, A. S., Theadom, A. M., Thomas, E., Thorne-Lyman, A. L., Thrift, A. G., Tleyjeh, I. M., Tonelli, M., Topouzis, F., Towbin, J. A., Toyoshima, H., Traebert, J., Tran, B. X., Trasande, L., Trillini, M., Truelsen, T., Trujillo, U., Tsilimbaris, M., Tuzcu, E. M., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Van Brakel, W. H., de Vijver, S. v., Van Dingenen, R., van Gool, C. H., Varakin, Y. Y., Vasankari, T. J., Vavilala, M. S., Veerman, L. J., Velasquez-Melendez, G., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Waller, S., Wallin, M. T., Wan, X., Wang, L., Wang, J., Wang, Y., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wessells, K. R., Westerman, R., Wilkinson, J. D., Williams, H. C., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wong, J. Q., Wong, H., Woolf, A. D., Wright, J. L., Wurtz, B., Xu, G., Yang, G., Yano, Y., Yenesew, M. A., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Kim, K. Y., Zaki, M. E., Zhang, Y., Zhao, Z., Zhao, Y., Zhu, J., Zonies, D., Zunt, J. R., Salomon, J. A., Murray, C. J. 2015; 386 (9995): 743-800

    Abstract

    Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(15)60692-4

    View details for Web of Science ID 000360287900025

    View details for PubMedCentralID PMC4561509

  • Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Naghavi, M., Wang, H., Lozano, R., Davis, A., Liang, X., Zhou, M., Vollset, S. E., Ozgoren, A. A., Abdalla, S., Abd-Allah, F., Aziz, M. I., Abera, S. F., Aboyans, V., Abraham, B., Abraham, J. P., Abuabara, K. E., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adelekan, A., Ademi, Z. N., Adofo, K., Adou, A. K., Adsuar, J. C., Aernlov, J., Agardh, E. E., Akena, D., Al Khabouri, M. J., Alasfoor, D., Albittar, M., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, M. K., Ali, R., Alla, F., Al Lami, F., Allebeck, P., AlMazroa, M. A., Salman, R. A., Alsharif, U., Alvarez, E., Alviz-Guzman, N., Amankwaa, A. A., Amare, A. T., Ameli, O., Amini, H., Ammar, W., Anderson, H. R., Anderson, B. O., Antonio, C. A., Anwari, P., Apfel, H., Cunningham, S. A., Arsenijevic, V. S., Al Artaman, Asad, M. M., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Banerjee, A., Barber, R. M., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Barrientos-Gutierrez, T., Basu, A., Basu, S., Basulaiman, M. O., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bertozzi-Villa, A., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bikbov, B., Bin Abdulhak, A., Biryukov, S., Blore, J. D., Blyth, F. M., Bohensky, M. A., Borges, G., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brauer, M., Brayne, C. E., Brazinova, A., Breitborde, N., Brenner, H., Briggs, A. D., Brown, J. C., Brugha, T. S., Buckle, G. C., Bui, L. N., Bukhman, G., Burch, M., Nonato, I. R., Carabin, H., Cardenas, R., Carapetis, J., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Chang, J., Charlson, F. C., Che, X., Chen, H., Chen, Y., Chen, J. S., Chen, Z., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Chuang, T., Chugh, S. S., Cirillo, M., Coates, M. M., Coffeng, L. E., Coggeshall, M. S., Cohen, A., Colistro, V., Colquhoun, S. M., Colomar, M., Cooper, L. T., Cooper, C., Coppola, L. M., Cortinovis, M., Courville, K., Cowie, B. C., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Leite, I. d., Dabhadkar, K. C., Dandona, L., Dandona, R., Dansereau, E., Dargan, P. I., Dayama, A., De la Cruz-Gongora, V., de la Vega, S. F., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Jarlais, D. C., Dessalegn, M., deVeber, G. A., Dharmaratne, S. D., Dherani, M., Diaz-Ortega, J., Diaz-Torne, C., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Duber, H. C., Durrani, A. M., Ebel, B. E., Edmond, K. M., Ellenbogen, R. G., Elshrek, Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Estep, K., Fuerst, T., Fahimi, S., Fahrion, A. S., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigl, A. B., Feigin, V. L., Felicio, M. M., Fereshtehnejad, S., Fernandes, J. G., Ferrari, A. J., Fleming, T. D., Foigt, N., Foreman, K., Forouzanfar, M. H., Fowkes, F. G., Fra Paleo, U., Franklin, R. C., Futran, N. D., Gaffikin, L., Gambashidze, K., Gankpe, F. G., Garcia-Guerra, F. A., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Gillum, R. F., Gilmour, S., Abdelmageem, I., Ginawi, M., Giroud, M., Glaser, E. L., Goenka, S., Dantes, H. G., Gona, P., Gonzalez-Medina, D., Guinovart, C., Gupta, R., Gupta, R., Gosselin, R. A., Gotay, C. C., Goto, A., Gowda, H. N., Graetz, N., Greenwell, K. F., Gugnani, H. C., Gunnell, D., Gutierrez, R. A., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Hagstromer, M., Halasa, Y. A., Hamadeh, R. R., Hamavid, H., Hammami, M., Hancock, J., Hankey, G. J., Hansen, G. M., Harb, H. L., Harewood, H., Haro, J. M., Havmoeller, R., Hay, R. J., Hay, S. I., Hedayati, M. T., Pi, I. B., Heuton, K. R., Heydarpour, P., Higashi, H., Hijar, M., Hoek, H. W., Hoffman, H. J., Hornberger, J. C., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, J. J., Huffman, M. D., Hughes, A. J., Husseini, A., Huynh, C., Iannarone, M., Iburg, K. M., Idrisov, B. T., Ikeda, N., Innos, K., Inoue, M., Islami, F., Ismayilova, S., Jacobsen, K. H., Jassal, S., Jayaraman, S. P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Joseph, J., Juel, K., Kabagambe, E. K., Kan, H., Karch, A., Karimkhani, C., Karthikeyan, G., Kassebaum, N., Kaul, A., Kawakami, N., Kazanjan, K., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Kieling, C., Kinfu, Y., Kinge, J. M., Kim, D., Kim, S., Kivipelto, M., Knibbs, L., Knudsen, A. K., Kokubo, Y., Kosen, S., Kotagal, M., Kravchenko, M. A., Krishnaswami, S., Krueger, H., Defo, B. K., Kuipers, E. J., Bicer, B. K., Kulkarni, C., Kulkarni, V. S., Kumar, K., Kumar, R. B., Kwan, G. F., Kyu, H., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Levitz, C., Li, B., Li, Y., Li, Y., Liddell, C., Lim, S. S., de Lima, G. M., Lind, M. L., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lofgren, K. T., Logroscino, G., London, S. J., Lortet-Tieulent, J., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., Machado, V. M., MacIntyre, M. F., Mackay, M. T., Maclachlan, J. H., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margono, C., Marks, G. B., Marzan, M. B., Masci, J. R., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matzopolous, R., Mayosi, B. M., Mazorodze, T. T., McGrath, J. J., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S. K., Mock, C. N., Moffitt, T. E., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Monis, J. d., Hernandez, J. C., Montico, M., Montine, T. J., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moran, A. E., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M. L., Mozaffarian, D., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murray, J., Mustapha, A., Naghavi, P., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Nasher, J., Nejjari, C., Nelson, R. G., Neuhouser, M., Neupane, S. P., Newcomb, P. A., Newman, L., Newton, C. R., Ng, M., Ngalesoni, F. N., Nguyen, G., Nhung Thi Trang Nguyen, N. T., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Odell, S., O'Donnell, M., Ohkubo, T., Ohno, S. L., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Ortblad, K. F., Ortiz, A., Otayza, M. L., Pain, A. W., Pandian, J. D., Panelo, C. I., Panniyammakal, J., Papachristou, C., Paternina Caicedo, A. J., Patten, S. B., Patton, G. C., Paul, V. K., Pavlin, B., Pearce, N., Pellegrini, C. A., Pereira, D. M., Peresson, S. C., Perez-Padilla, R., Perez-Ruiz, F. P., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, B. K., Phillips, D. E., Phillips, M. R., Plass, D., Piel, F. B., Poenaru, D., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Qato, D., Quezada, A. D., Quistberg, D. A., Rabito, F., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Refaat, A., Remuzzi, G., Ribeiro, A. L., Ricci, S., Riccio, P. M., Richardson, L., Richardus, J. H., Roberts, B., Roberts, D. A., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Ronfani, L., Room, R., Roth, G. A., Rothenbacher, D., Rothstein, D. H., Rowley, J. T., Roy, N., Ruhago, G. M., Rushton, L., Sambandam, S., Soreide, K., Saeedi, M. Y., Saha, S., Sahathevan, R., Sahraian, M. A., Sahle, B. W., Salomon, J. A., Salvo, D., Samonte, G. M., Sampson, U., Sanabria, J. R., Sandar, L., Santos, I. S., Satpathy, M., Sawhney, M., Saylan, M., Scarborough, P., Schoettker, B., Schmidt, J. C., Schneider, I. J., Schumacher, A. E., Schwebel, D. C., Scott, J. G., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Shakh-Nazarova, M., Shangguan, S., She, J., Sheikhbahaei, S., Shepard, D. S., Shibuya, K., Shinohara, Y., Shishani, K., Shiue, I., Shivakoti, R., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Sindi, S., Singh, J. A., Singh, L., Sioson, E., Skirbekk, V., Sliwa, K., So, S., Soljak, M., Soneji, S., Soshnikov, S. S., Sposato, L. A., Sreeramareddy, C. T., Stanaway, J. R., Stathopoulou, V. K., Steenland, K., Stein, C., Steiner, C., Stevens, A., Stoeckl, H., Straif, K., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Talongwa, R. T., Tan, F., Tanne, D., Tanner, M., Tavakkoli, M., Ao, B. T., Teixeira, C. M., Templin, T., Tenkorang, E. Y., Terkawi, A. S., Thomas, B. A., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tirschwell, D. L., Tleyjeh, I. M., Tonelli, M., Topouzis, F., Towbin, J. A., Toyoshima, H., Traebert, J., Tran, B. X., Truelsen, T., Trujillo, U., Trillini, M., Dimbuene, Z. T., Tsilimbaris, M., Tuzcu, E. M., Ubeda, C., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Vallely, A. J., van de Vijver, S., van Gool, C. H., Varakin, Y. Y., Vasankari, T. J., Vasconcelos, A. M., Vavilala, M. S., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Wagner, G. R., Waller, S. G., Wang, J., Wang, L., Wang, X., Wang, Y., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Wenzhi, W., Werdecker, A., Wessells, K. R., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wolock, T. M., Woolf, A. D., Wong, J. Q., Wright, J. L., Wulf, S., Wurtz, B., Xu, G., Yang, Y. C., Yano, Y., Yatsuya, H., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zamakhshary, M. F., Zeeb, H., Zhang, Y., Zhao, Y., Zheng, Y., Zhu, J., Zhu, S., Zonies, D., Zou, X. N., Zunt, J. R., Vos, T., Lopez, A. D., Murray, C. J. 2015; 385 (9963): 117-171

    Abstract

    Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries.We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)61682-2

    View details for Web of Science ID 000347715900024

    View details for PubMedCentralID PMC4340604

  • Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., Apfel, H., Iannarone, M., Phillips, B., Lofgren, K. T., Sandar, L., Dorrington, R. E., Rakovac, I., Jacobs, T. A., Liang, X., Zhou, M., Zhu, J., Yang, G., Wang, Y., Liu, S., Li, Y., Ozgoren, A. A., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Alemu, Z. A., Allen, P. J., AlMazroa, M. A., Alvarez, E., Amankwaa, A. A., Amare, A. T., Ammar, W., Anwari, P., Cunningham, S. A., Asad, M. M., Assadi, R., Banerjee, A., Basu, S., Bedi, N., Bekele, T., Bell, M. L., Bhutta, Z. Q., Blore, J. D., Basara, B. B., Boufous, S., Breitborde, N., Bruce, N. G., Linh Ngoc Bui, L. N., Carapetis, J. R., Cardenas, R., Carpenter, D. O., Caso, V., Estanislao Castro, R., Catala-Lopez, F., Cavlin, A., Che, X., Chiang, P. P., Chowdhury, R., Christophi, C. A., Chuang, T., Cirillo, M., Leite, I. d., Courville, K. J., Dandona, L., Dandona, R., Davis, A., Dayama, A., Deribe, K., Dharmaratne, S. D., Dherani, M. K., Dilmen, U., Ding, E. L., Edmond, K. M., Ermakov, S. P., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Foigt, N., Forouzanfar, M. H., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Goginashvili, K., Gona, P., Goto, A., Gouda, H. N., Green, M. A., Greenwell, K. F., Gugnani, H. C., Gupta, R., Hamadeh, R. R., Hammami, M., Harb, H. L., Hay, S., Hedayati, M. T., Hosgood, H. D., Hoy, D. G., Idrisov, B. T., Islami, F., Ismayilova, S., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kazi, D. S., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khang, Y., Kim, D., Kinfu, Y., Kinge, J. M., Kokubo, Y., Kosen, S., Defo, B. K., Kumar, G. A., Kumar, K., Kumar, R. B., Lai, T., Lan, Q., Larsson, A., Lee, J., Leinsalu, M., Lim, S. S., Lipshultz, S. E., Logroscino, G., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Ma, S., Mahdi, A. A., Marzan, M. B., Mashal, M. T., Mazorodze, T. T., McGrath, J. J., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Monasta, L., Montico, M., Moore, A. R., Moschandreas, J., Msemburi, W. T., Mueller, U. O., Muszynska, M. M., Naghavi, M., Naidoo, K. S., Narayan, K. M., Nejjari, C., Ng, M., de Dieu Ngirabega, J., Nieuwenhuijsen, M. J., Nyakarahuka, L., Ohkubo, T., Omer, S. B., Paternina Caicedo, A. J., Pillay-Van Wyk, V., Pope, D., Pourmalek, F., Prabhakaran, D., Rahman, S. u., Rana, S. M., Reilly, R. Q., Rojas-Rueda, D., Ronfani, L., Rushton, L., Saeedi, M. Y., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Schmidt, J. C., Shakh-Nazarova, M., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shishani, K., Shiue, I., Sigfusdottir, I. D., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Stathopoulou, V. K., Stroumpoulis, K., Tabb, K. M., Talongwa, R. T., Teixeira, C. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Toyoshima, H., Dimbuene, Z. T., Uwaliraye, P., Uzun, S. B., Vasankari, T. J., Nogales Vasconcelos, A. M., Vlassov, V. V., Vollset, S. E., Waller, S., Wan, X., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Williams, H. C., Yang, Y. C., Yentur, G. K., Yip, P., Yonemoto, N., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zhu, S., Vos, T., Lopez, A. D., Murray, C. J. 2014; 384 (9947): 957-979

    Abstract

    Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.

    View details for DOI 10.1016/S0140-6736(14)60497-9

    View details for Web of Science ID 000341679700030

    View details for PubMedCentralID PMC4165626

  • Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Murray, C. J., Ortblad, K. F., Guinovart, C., Lim, S. S., Wolock, T. M., Roberts, D. A., Dansereau, E. A., Graetz, N., Barber, R. M., Brown, J. C., Wang, H., Duber, H. C., Naghavi, M., Dicker, D., Dandona, L., Salomon, J. A., Heuton, K. R., Foreman, K., Phillips, D. E., Fleming, T. D., Flaxman, A. D., Phillips, B. K., Johnson, E. K., Coggeshall, M. S., Abd-Allah, F., Abera, S. F., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adeyemo, A. O., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Al Kahbouri, M. J., Alasfoor, D., Albittar, M. I., Alcala-Cerra, G., Angel Alegretti, M., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Banerjee, A., Basu, S., Beardsley, J., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bin Abdulhak, A., Binagwaho, A., Blore, J. D., Basara, B. B., Bose, D., Brainin, M., Breitborde, N., Castaneda-Orjuela, C. A., Catala-Lopez, F., Chadha, V. K., Chang, J., Chiang, P. P., Chuang, T., Colomar, M., Cooper, L. T., Cooper, C., Courville, K. J., Cowie, B. C., Criqui, M. H., Dandona, R., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Deribe, K., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Driscoll, T. R., Durrani, A. M., Ellenbogen, R. G., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Forouzanfar, M. H., Paleo, U. F., Gaffikin, L., Gamkrelidze, A., Gankpe, F. G., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Glaser, E. L., Gona, P., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Maria Haro, J., Havmoeller, R., Hay, S. I., Hedayati, M. T., Heredia Pi, I. B., Hoek, H. W., Hornberger, J. C., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kan, H., Kankindi, I., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khonelidze, I., Kinfu, Y., Kinge, J. M., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, V. S., Kulkarni, C., Kumar, K., Kumar, R. B., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, Y., Li, Y., Ferreira De Lima, G. M., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Pedro Machado, V. M., Maclachlan, J. H., Magis-Rodriguez, C., Majdan, M., Mapoma, C. C., Marcenes, W., Barrieotos Marzan, M., Masci, J. R., Mashal, M. T., Mason-Jones, A. J., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Moore, A. R., Mori, R., Moturi, W. N., Mukaigawara, M., Murthy, K. S., Naheed, A., Naidoo, K. S., Naldi, L., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nisar, M. I., Nolte, S., Norheim, O. F., Nowaseb, V., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Paternina Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pervaiz, A., Pesudovs, K., Petzold, M., Pourmalek, F., Qato, D., Quezada, A. D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rana, S. M., Razavi, H., Reilly, R. Q., Remuzzi, G., Richardus, J. H., Ronfani, L., Roy, N., Sabin, N., Saeedi, M. Y., Sahraian, M. A., Samonte, G. M., Sawhney, M., Schneider, I. J., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Shivakoti, R., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soneji, S., Soshnikov, S. S., Sreeramareddy, C. T., Stathopoulou, V. K., Stroumpoulis, K., Swaminathan, S., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tenkorang, E. Y., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Traebert, J., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., Vallely, A. J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Waller, S., Wallin, M. T., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., White, R. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wong, J. Q., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Vos, T. 2014; 384 (9947): 1005-1070

    Abstract

    The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60844-8

    View details for Web of Science ID 000341679700032

    View details for PubMedCentralID PMC4202387

  • Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., Templin, T., Wolock, T. M., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Alasfoor, D., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Al Kahbouri, M. J., Alla, F., Allen, P. J., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Antonio, C. A., Anwari, P., Arnlov, J., Arsic Arsenijevic, V. S., Artaman, A., Asad, M. M., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Basu, A., Basu, S., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhutta, Z., Bin Abdulhak, A., Blore, J. D., Basara, B. B., Bose, D., Breitborde, N., Cardenas, R., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavlin, A., Chang, J., Che, X., Christophi, C. A., Chugh, S. S., Cirillo, M., Colquhoun, S. M., Cooper, L. T., Cooper, C., Leite, I. d., Dandona, L., Dandona, R., Davis, A., Dayama, A., Degenhardt, L., De Leo, D., Del Pozo-Cruz, B., Deribe, K., Dessalegn, M., deVeber, G. A., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Dorrington, R. E., Driscoll, T. R., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Felicio, M. M., Fereshtehnejad, S., Ferreira De Lima, G. M., Forouzanfar, M. H., Franca, E. B., Gaffikin, L., Gambashidze, K., Gankpe, F. G., Garcia, A. C., Geleijnse, J. M., Gibney, K. B., Giroud, M., Glaser, E. L., Goginashvili, K., Gona, P., Gonzalez-Castell, D., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Havmoeller, R., Hay, S. I., Heredia Pi, I. B., Hoek, H. W., Hosgood, H. D., Hoy, D. G., Husseini, A., Idrisov, B. T., Innos, K., Inoue, M., Jacobsen, K. H., Jahangir, E., Jee, S. H., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kan, H., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazanjan, K., Kazi, D. S., Kemp, A. H., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kumar, K., Kumar, R. B., Kwan, G., Lai, T., Lalloo, R., Lam, H., Lansingh, V. C., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, X., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., London, S. J., Lotufo, P. A., Ma, J., Ma, S., Pedro Machado, V. M., Mainoo, N. K., Majdan, M., Mapoma, C. C., Marcenes, W., Barrientos Marzan, M., Mason-Jones, A. J., Mehndiratta, M. M., Mejia-Rodriguez, F., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mokdad, A. H., Mola, G. L., Monasta, L., de la Cruz Monis, J., Montanez Hernandez, J. C., Moore, A. R., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Mukaigawara, M., Naheed, A., Naidoo, K. S., Nand, D., Nangia, V., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nieuwenhuijsen, M. J., Nisar, M. I., Nolte, S., Norheim, O. F., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Park, J., Paternina Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pesudovs, K., Petzold, M., Poenaru, D., Polanczyk, G. V., Polinder, S., Pope, D., Pourmalek, F., Qato, D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., ur Rahman, S., Raju, M., Rana, S. M., Refaat, A., Ronfani, L., Roy, N., Sanchez Pimienta, T. G., Sahraian, M. A., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Sayinzoga, F., Schneider, I. J., Schumacher, A., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shakh-Nazarova, M., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Sreeramareddy, C. T., Stroumpoulis, K., Sturua, L., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tan, F., Teixeira, C. M., Tenkorang, E. Y., Terkawi, A. S., Thorne-Lyman, A. L., Tirschwell, D. L., Towbin, J. A., Tran, B. X., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Vallely, A. J., van Gool, C. H., Vasankari, T. J., Vavilala, M. S., Venketasubramanian, N., Villalpando, S., Violante, F. S., Vlassov, V. V., Vos, T., Waller, S., Wang, H., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Woldeyohannes, S. M., Wong, J. Q., Wordofa, M. A., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Jin, K. Y., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Naghavi, M., Murray, C. J., Lozano, R. 2014; 384 (9947): 980-1004

    Abstract

    The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60696-6

    View details for Web of Science ID 000341679700031

  • Polymorphism in the ADRB2 Gene Explains a Small Portion of Intersubject Variability in Pain Relative to Cervical Dilation in the First Stage of Labor ANESTHESIOLOGY Terkawi, A. S., Jackson, W. M., Hansoti, S., Tabassum, R., Flood, P. 2014; 121 (1): 140-148

    Abstract

    Variability in labor pain has been associated with demographic, clinical, and psychological factors. Polymorphisms of the β2-adrenergic receptor gene (ADRB2) influence sensitivity to experimental pain in humans and are a risk factor for chronic pain. The authors hypothesized that polymorphisms in ADRB2 may influence labor pain.After Institutional Review Board approval and written informed consent, the authors prospectively obtained hourly pain reports from 233 nulliparous parturients during the first stage of labor, of which 199 were included in the current analysis. DNA from blood samples was genotyped at polymorphisms in the genes for the β2-adrenergic receptor, the μ opioid receptor subtype 1, catechol-O-methyltransferase, fatty acid amide hydrolase, and the oxytocin receptor. Labor pain as a function of cervical dilation was modeled with previously described methods. Patient covariates, ADRB2 genotype, and obstetrical and anesthesia treatment were evaluated as covariates in the model.Labor pain more rapidly became severe in parturients heterozygous or homozygous for the G allele at rs1042714 in the ADRB2 gene. Labor pain increased more rapidly after artificial rupture of membranes, augmentation with oxytocin, and in younger women. Inclusion of covariates explained approximately 10% of the variability between subjects. ADRB2 genotype explained less than 1% of the intersubject variability.ADRB2 genotype correlates with labor pain but explained less than 1% of the intersubject variance in the model.

    View details for DOI 10.1097/ALN.0000000000000258

    View details for Web of Science ID 000337758500018