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  • A Clinical Comparison of Intravenous and Epidural Local Anesthetic for Major Abdominal Surgery. Regional anesthesia and pain medicine Terkawi, A. S., Tsang, S., Kazemi, A., Morton, S., Luo, R., Sanders, D. T., Regali, L. A., Columbano, H., Kurtzeborn, N. Y., Durieux, M. E. ; 41 (1): 28?36

    Abstract

    Epidural analgesia provides good pain control after many postoperative procedures, but it can lead to complications, has some contraindications, and occasionally fails. Intravenous lidocaine infusion has been suggested as an alternative. We assessed, in our clinical practice, the effects of perioperative intravenous lidocaine infusion compared with epidural analgesia for major abdominal surgery.We conducted a retrospective review of patients who had received intravenous lidocaine (1 mg/kg per hour) perioperatively after a major abdominal surgery. We matched them with patients who had received epidural analgesia. We tested a joint hypothesis of noninferiority of lidocaine infusion to epidural analgesia in postoperative pain scores and opioid consumption. We assigned a noninferiority margin of 1 point (on an 11-point numerical rating scale) difference in pain and a ratio [mean (lidocaine) / mean (epidural)] of 1.2 in opioid consumption, respectively.Two hundred sixteen patients (108 in each group) were analyzed. Intravenous lidocaine was not inferior to epidural analgesia with respect to pain scores. Lidocaine infusion was inferior to epidural analgesia with respect to opioid consumption. Patients in the lidocaine group had fewer episodes of hypotension and less postoperative nausea and vomiting, pruritus, and urinary retention. Patients receiving lidocaine also had earlier urinary catheter removal and earlier first gastrointestinal function. Daily mental status assessment was similar between the 2 groups.Patients who received systemic lidocaine infusions with the addition of PRN (as needed) opioids administered for breakthrough pain did not have clinically significant differences in pain scores on postoperative day 2 and beyond. Intravenous lidocaine infusion in major abdominal surgery was inferior to epidural analgesia with respect to opioid consumption. However, lidocaine was associated with improvements in several important aspects of recovery.

    View details for DOI 10.1097/AAP.0000000000000332

    View details for PubMedID 26650426

    View details for PubMedCentralID PMC5467154

  • Effect of intravenous lidocaine on postoperative recovery of patients undergoing mastectomy: a double-blind, placebo-controlled randomized trial. Regional anesthesia and pain medicine Terkawi, A. S., Durieux, M. E., Gottschalk, A., Brenin, D., Tiouririne, M. ; 39 (6): 472?77

    Abstract

    One of the modalities of treatment for breast cancer surgery pain is opioids, and opioids are associated with adverse effects such as itching and postoperative nausea and vomiting (PONV). Intravenous (IV) lidocaine has been shown to reduce opioid consumption and to improve overall postoperative outcomes in abdominal surgery. In this study, we tested the effect of intraoperative IV lidocaine infusion on the quality of postoperative recovery after breast cancer surgery.Seventy-one patients undergoing breast cancer surgery were randomly assigned to receive either placebo (group P; n = 34) or IV lidocaine (group L; n = 37, bolus 1.5 mg/kg at induction, then infusion at 2 mg/kg/h, stopped 2 hours after the end of surgery) in a prospective double-blind design. Intraoperative and postoperative morphine consumption was calculated. Postoperative pain scores, PONV, and fatigue were assessed at 2, 24, and 48 hours after surgery. Duration of postoperative hospital stay was recorded.Demographics were the same between the groups. There was no statistically significant difference in intraoperative or postoperative morphine consumption (P = 0.188 and P = 0.758) between groups. Overall pain scores either at rest or activity (P = 0.348 and P = 0.810, respectively), PONV (P = 0.350), fatigue (P = 0.758), or duration of postoperative hospital stay (P = 0.218) were not statistically different.Our findings did not show a significant effect of IV lidocaine during breast cancer surgery on opioid consumption, pain score, PONV, or fatigue, indicating that the benefit of this approach does not generalize across all types of surgery.

    View details for DOI 10.1097/AAP.0000000000000140

    View details for PubMedID 25275577

  • Perioperative lidocaine infusion reduces the incidence of post-mastectomy chronic pain: a double-blind, placebo-controlled randomized trial. Pain physician Terkawi, A. S., Sharma, S., Durieux, M. E., Thammishetti, S., Brenin, D., Tiouririne, M. ; 18 (2): E139?46

    Abstract

    Chronic post-surgical pain (CPSP) is a not uncommon complication after mastectomy, with a reported incidence between 20% and 68%. Careful dissection, the use of minimally invasive surgical techniques, and attempts to reduce the associated inflammatory and hyperalgesic responses are suggested methods to prevent CPSP.To determine if the use of perioperative lidocaine infusion is associated with decreased incidence of CPSP after mastectomy.Double-blind, placebo-controlled randomized trial.This is a secondary analysis of data from 61 out of 71 patients who underwent mastectomy for breast cancer. Patients were randomized to either placebo (Group P; n = 27) or intravenous lidocaine (Group L; n = 34, bolus 1.5 mg/kg at induction, then infusion at 2 mg/kg/hr, up to 2 hours after the end of surgery) in a prospective double-blind design. CPSP was assessed at 6 months after surgery. Stepwise logistic regression analysis was performed to assess the efficacy of lidocaine.Overall 12 (20%) patients developed CPSP, 8 (30%) in the placebo group and 4 (12%) in the lidocaine group. Predictive factors for CPSP that remained significant after multivariate analysis included lidocaine (associated with a 20-fold decrease in CPSP, P = 0.013), breast implant placement (associated with a 16-fold increase in CPSP, P = 0.034), and radiotherapy (associated with a 29-fold increase in CPSP, P = 0.008).Small sample size.Perioperative lidocaine administration was associated with a decreased incidence of CPSP, while breast implant placement and radiotherapy were associated with an increased incidence. These findings suggest a protective effect of lidocaine on CPSP development in mastectomy patients.

    View details for PubMedID 25794212

  • Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial. Regional anesthesia and pain medicine Terkawi, A. S., Tiouririne, M., Mehta, S. H., Hackworth, J. M., Tsang, S., Durieux, M. E. ; 40 (4): 344?48

    Abstract

    Hypotension is the most common complication after subarachnoid anesthesia for cesarean delivery. Several therapeutic and preventive measures are used to attenuate this side effect. Serotonin receptor-blocking drugs have been suggested as one such approach. We sought to determine whether prophylactically administered intravenous ondansetron could attenuate hypotension in patients undergoing elective cesarean delivery performed under subarachnoid anesthesia.Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (group O; n = 44) or placebo (group P; n = 42) in a prospective double-blind design. Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), and heart rate (HR) were measured at baseline and at 3-minute intervals from the time of initiation of subarachnoid anesthesia until delivery. Ondansetron effect on hemodynamics (SBP, DBP, MAP, and HR) was quantified and analyzed using a linear mixed effect model.We did not find differences in SBP (P = 0.78), MAP (P = 0.89), DBP (P = 0.82), or HR (P = 0.18) between the 2 groups during the study period. Phenylephrine requirements to treat hypotension were 350 ?g (175-700 ?g) in group O and 450 ?g (300-700 ?g) in group P (P = 0.30). The incidence of pruritus was 63% (n = 28 of 44) in group O and 56% (n = 23 of 42) in group P (difference, 0.08 [95% confidence interval, -0.23 to 0.41], P = 0.59). No difference in the incidence of nausea and vomiting or sensory level was found.Ondansetron premedication does not attenuate hemodynamic changes after subarachnoid anesthesia nor does it reduce the amount of vasopressor use, pruritus, or nausea and vomiting.

    View details for DOI 10.1097/AAP.0000000000000274

    View details for PubMedID 26066384

  • Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient. Saudi journal of anaesthesia Anwari, J. S., Khalil, L., Terkawi, A. S. ; 9 (4): 370?75

    Abstract

    Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox?) analgesia as bridging analgesia for epidural placement.Sixty-four laboring women who requested epidural analgesia with pain score of ?7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction) cycle, pain, Richmond Agitation Sedation Scale (RASS), nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded.The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001), and continued to decrease significantly over the study period (P < 0.0001). The RASS scores continuously improved after each cycle (P < 0.0001). Only 1 parturient from the cohort became lightly sedated (RASS = -1). Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment.Penthrox? provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.

    View details for DOI 10.4103/1658-354X.159457

    View details for PubMedID 26543451

    View details for PubMedCentralID PMC4610078

  • Improving Analgesic Efficacy and Safety of Thoracic Paravertebral Block for Breast Surgery: A Mixed-Effects Meta-Analysis. Pain physician Terkawi, A. S., Tsang, S., Sessler, D. I., Terkawi, R. S., Nunemaker, M. S., Durieux, M. E., Shilling, A. ; 18 (5): E757?80

    Abstract

    While most trials of thoracic paravertebral nerve blocks (TPVB) for breast surgery show benefit, their effect on postoperative pain intensity, opioid consumption, and prevention of chronic postsurgical pain varies substantially across studies. Variability may result from use of different drugs and techniques.To examine the use of TPVB in breast surgery, and to determine which method(s) provide optimal efficacy and safety.Mixed-Effects Meta-Analysis.We conducted a systematic review of randomized trials comparing TPVB to no intervention using random-effects models. To evaluate the contributions of various techniques, clinical approaches were included as moderators in mixed-effects models.A total of 24 randomized controlled trials (RCTs) with 1,822 patients were included. Use of TPVB decreased postoperative pain scores at rest and movement at the first 2, 24, 48, and 72 hours. TPVB modestly decreased intraoperative and postoperative opioid consumption, reduced nausea and vomiting, and shortened hospitalization, but to a probably clinically irrelevant degree. Blocks also appeared to reduce the incidence of chronic postsurgical pain at 6 months. Adding fentanyl to the TPVB improved pain at rest (at 24, 48, and 72 hours) and movement (at 24 and 72 hours). Multilevel blocks provided better postoperative pain control, but only during movement (at 2, 48, and 72 hours). Fewer procedural complications (especially hypotension, epidural spread, and Horner's syndrome) occurred when anatomical landmarks were supplemented with ultrasound guidance.The number of studies available was limited in the meta-analytic model of incidence of chronic post-surgical pain.TPVB reduces postoperative pain and opioid consumption, and has a limited beneficial effect on the quality of recovery. From all the techniques that were evaluated, only the addition of fentanyl, and performing multilevel blocks were associated with improved acute analgesia. TPVB may reduce chronic postsurgical pain at 6 months.

    View details for PubMedID 26431130

  • In response to perioperative use of systemic lidocaine. Pain physician Tiouririne, M., Terkawi, A. S., Durieux, M. E. ; 18 (3): E443?4

    View details for PubMedID 26000698

  • Child and adolescent health in northwestern Syria: findings from Healthy-Syria 2017 study. Avicenna journal of medicine Terkawi, A. S., Bakri, B., Alsadek, A. S., Al-Hasan, A. H., Alrahhal, M. S., Alsaleh, F. M., Alsatouf, F. A., Arab, M. A., Jnaid, H., Hadid, A. A., Terkawi, R. S., Zahran, M. M., Alghannam, N. A., Altirkawi, K. A. ; 9 (2): 61?74

    Abstract

    Since the uprising in 2011, there has been limited health-care data from inside Syria in the academic literature. This study aims to provide an updated account of pediatric health needs in the northwestern part of Syria; this should help inform the management and delivery of health-care services in this population.This is a prospective study, using a data registry, of all pediatric patients seen in a single center in northwestern Syria, between February and December 2017. We used international classification of diseases (ICD-10) codes to define cases, and tested several covariates, including age, sex, season of the year, and conditions of living for possible correlations with major illness categories.We included 11,819 patients, of whom 5,288 (45%) were male and 6,531 (55%) were female. Collectively, these patients had 23,427 encounters. Respiratory diseases were the most encountered illnesses among all age groups (6320 [27%]), except late teen females, among whom gynecological/obstetric complaints dominated. Infectious diseases caused the greatest disease burden across all age groups, with upper respiratory tract infections (URTIs), infectious diarrhea, and otitis media representing almost half (47%) of all cases in this category. Nutritional deficiencies were diagnosed in 978 patients (8%), mostly in infants and toddlers (92%). We identified 1192 (17%) cases of acute diarrhea among all age groups, making it the second most common condition after URTIs. As compared to town residents, patients living in camps for internally displaced people accounted for more cases of infectious diarrhea (58%), chronic anemia (60%), and malnutrition (66%), especially severe acute malnutrition (76% of malnutrition cases). Vaccine-preventable illnesses represented a sizable category; we reported 69 cases of hepatitis A, 2 of poliomyelitis, 9 of pertussis, 37 of varicella, 11 of mumps, 8 of rubella, and 1 case of measles.We have identified urgent health-care issues in this population, including extreme malnutrition, high rates of infectious diseases, and high rates of teenage pregnancy. Also, we observed a relapse of some vaccine-preventable illnesses, such as mumps and rubella, which are likely associated with the decline in vaccination rates.

    View details for DOI 10.4103/ajm.AJM_184_18

    View details for PubMedID 31143699

    View details for PubMedCentralID PMC6530271

  • The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery. Regional anesthesia and pain medicine Greer, K. C., Terkawi, A. S., Tsang, S., Singla, P., Durieux, M. E., Tiouririne, M. ; 42 (5): 669?73

    Abstract

    Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia.Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 ?g of fentanyl, and 100 ?g of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups.No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68).In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study.

    View details for DOI 10.1097/AAP.0000000000000642

    View details for PubMedID 28806217

    View details for PubMedCentralID PMC5654584

  • Women's health in Northwestern Syria: Findings from Healthy-Syria 2017 study. Avicenna journal of medicine Terkawi, A. S., Bakri, B., Alsadek, A. S., Alsibaee, R. H., Alasfar, E. M., Albakour, A. H., Aljouja, A. Y., Alshaikhwais, N. A., Fares, F. A., Flood, P. D., Jnaid, H., Najib, A. A., Saloom, D. A., Zahra, N. A., Altirkawi, K. A. 2019; 9 (3): 94?106

    Abstract

    Objectives: Since the uprising in 2011, there have been limited health-care data from inside Syria regarding women's health. This study aimed to provide an updated account of women's health, including pregnancy, perinatal care, childbirth, and other conditions to identify obstacles and challenges to health-care delivery in Northwestern Syria.Methods: This is a prospective data registry study, using a medical electronic records system that builds on the International Classification of Diseases, Tenth Revision (ICD-10) codes. We collected data from one medical center in Northwestern Syria during 2017. We conducted a survey to understand patients' knowledge of and barriers limiting antenatal care (ANC).Results: We studied 7213 patients' health status and surveyed 134 regarding ANC. Prenatal care, delivery, and miscarriage treatment represented the most common (70%) reasons for women's health-care visits, followed by menstrual disorders (17%). From 2057 delivery records, 70% delivered vaginally and 30% required cesarean delivery. Our findings showed that 1169 (24%) of the pregnant women (4936) in 2017 were adolescents, of them 22 (0.44%) were 14 years old. Regarding ANC visits, 85% of respondents did not have a single ANC visit in the first trimester, 82% had no visits in the second trimester, and 44% had no visits in the third trimester. Thirty-one percent had no ANC visit throughout the entire pregnancy. Only 13% had postnatal care (PNC) visits. Women who live in the refugee camp are 2.7 times less likely to meet the World Health Organization (WHO) criteria for focused ANC (FANC = 4 visits) compared to those who reside in town (P < 0.001), with only 14% having met the FANC. The major barrier to ANC is related to transportation (34%), followed by factors related to the study center (29%) and knowledge and education (19%). We estimated the number of obstetrics-gynecology doctors per 1000 populations to be 0.02.Conclusions: We found a huge deficiency in ANC and PNC visits, a high adolescent birth rate, and a higher cesarean-to-vaginal delivery ratio than what is recommended by the WHO. We also found a severe shortage in the number of obstetrician-gynecologists serving this population.

    View details for DOI 10.4103/ajm.AJM_190_18

    View details for PubMedID 31404201

  • Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA pediatrics Reiner, R. C., Olsen, H. E., Ikeda, C. T., Echko, M. M., Ballestreros, K. E., Manguerra, H., Martopullo, I., Millear, A., Shields, C., Smith, A., Strub, B., Abebe, M., Abebe, Z., Adhena, B. M., Adhikari, T. B., Akibu, M., Al-Raddadi, R. M., Alvis-Guzman, N., Antonio, C. A., Aremu, O., Asgedom, S. W., Asseffa, N. A., Avila-Burgos, L., Barac, A., Bärnighausen, T. W., Bassat, Q., Bensenor, I. M., Bhutta, Z. A., Bijani, A., Bililign, N., Cahuana-Hurtado, L., Malta, D. C., Chang, J. C., Charlson, F. J., Dharmaratne, S. D., Doku, D. T., Edessa, D., El-Khatib, Z., Erskine, H. E., Ferrari, A. J., Fullman, N., Gupta, R., Hassen, H. Y., Hay, S. I., Ilesanmi, O. S., Jacobsen, K. H., Kahsay, A., Kasaeian, A., Kassa, T. D., Kebede, S., Khader, Y. S., Khan, E. A., Khan, M. N., Khang, Y. H., Khubchandani, J., Kinfu, Y., Kochhar, S., Kokubo, Y., Koyanagi, A., Defo, B. K., Lal, D. K., Kumsa, F. A., Larson, H. J., Leung, J., Mamun, A. A., Mehata, S., Melku, M., Mendoza, W., Mezgebe, H. B., Miller, T. R., Moges, N. A., Mohammed, S., Mokdad, A. H., Monasta, L., Neupane, S., Nguyen, H. L., Ningrum, D. N., Nirayo, Y. L., Nong, V. M., Ogbo, F. A., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Patton, G. C., Pereira, D. M., Pourmalek, F., Qorbani, M., Rafay, A., Rai, R. K., Ram, U., Ranabhat, C. L., Renzaho, A. M., Rezai, M. S., Ronfani, L., Roth, G. A., Safiri, S., Sartorius, B., Scott, J. G., Shackelford, K. A., Sliwa, K., Sreeramareddy, C., Sufiyan, M. B., Terkawi, A. S., Topor-Madry, R., Tran, B. X., Ukwaja, K. N., Uthman, O. A., Vollset, S. E., Weldegwergs, K. G., Werdecker, A., Whiteford, H. A., Wijeratne, T., Yonemoto, N., Yotebieng, M., Zuhlke, L. J., Kyu, H. H., Naghavi, M., Vos, T., Murray, C. J., Kassebaum, N. J. 2019; 173 (6): e190337

    Abstract

    Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies.To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories.This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018.Being under the age of 20 years between 1990 and 2017.Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability.Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile.Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

    View details for DOI 10.1001/jamapediatrics.2019.0337

    View details for PubMedID 31034019

    View details for PubMedCentralID PMC6547084

  • Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Kyu, H., Abate, D., Abate, K., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R., Abebe, M., Abebe, Z., Abil, O., Aboyans, V., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, D., Acharya, P., Ackerman, I. N., Adamu, A. A., Adebayo, O. M., Adekanmbi, V., Ademi, Z., Adetokunboh, O. O., Adib, M. G., Adsuar, J. C., Afanvi, K., Afarideh, M., Afshin, A., Agarwal, G., Agesa, K. M., Aggarwal, R., Aghayan, S., Agrawal, A., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmed, M., Ahmed, S., Aichour, A., Aichour, I., Aichour, M., Akinyemiju, T., Akseer, N., Ayman, Z., Al-Eyadhy, A., Al-Mekhlafi, H. M., Al-Raddadi, R. M., Alahdab, F., Alam, K., Alam, T., Alashi, A., Alavian, S., Alene, K., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S., Alkerwi, A., Alla, F., Allebeck, P., Alonso, J., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Aminde, L. N., Amini, E., Amiresmaili, M., Ammar, W., Amoako, Y., Anber, N., Andrei, C., Androudi, S., Animut, M., Anjomshoa, M., Ansha, M., Antonio, C. T., Anwari, P., Arabloo, J., Aremu, O., Arnlov, J., Arora, A., Arora, M., Artaman, A., Aryal, K. K., Asayesh, H., Ataro, Z., Ausloos, M., Avila-Burgos, L., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayer, R., Azzopardi, P. S., Babazadeh, A., Badali, H., Balakrishnan, K., Bali, A., Banach, M., Banoub, J., Barac, A., Barboza, M. A., Barker-Collo, S., Bamighausen, T., Barquera, S., Barrero, L. H., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Bekele, B., Bekru, E., Belachew, A., Belay, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Bernstein, R. S., Beuran, M., Beyranvand, '., Bhala, N., Bhatt, S., Bhaumik, S., Bhutta, Z. A., Biadgo, B., Biehl, M. H., Bijani, A., Bikbov, B., Bilano, V., Bililign, N., Bin Sayeed, M., Bisanzio, D., Bjorge, T., Bleyer, A., Bobasa, E., Bou-Orm, I. R., Boufous, S., Bourne, R., Brady, O. J., Brant, L. C., Brayne, C., Brazinova, A., Breitborde, N. K., Brenner, H., Briant, P., Briko, A., Britton, G., Brugha, T., Buchbinder, R., Busse, R., Butt, Z. A., Cahuana-Hurtado, L., Rincon, J., Cano, J., Cardenas, R., Carrero, J. J., Carter, A., Carvalho, F., Castaneda-Orjuela, C. A., Rivas, J., Castro, F., Catala-Lopez, F., Cercy, K. M., Cerin, E., Chaiah, Y., Chang, J., Charlson, F. J., Chattu, V., Chiang, P., Chitheer, A., Choi, J. J., Christensen, H., Christopher, D. J., Chung, S., Cicuttini, F. M., Cirillo, M., Collado-Mateo, D., Cooper, C., Cortesi, P., Cortinovis, M., Cousin, E., Criqui, M. H., Cromwell, E. A., Cross, M., Crump, J. A., Daba, A., Dachew, B., Dadi, A., Dandona, L., Dandona, R., Dargan, P. I., Daryani, A., Das Gupta, R., Das Neves, J., Dasa, T., Davitoiu, D., De la Hoz, F., De Leo, D., De Neve, J., De Steur, H., Degefa, M., Degenhardt, L., Deiparine, S., Demoz, G., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Jarlais, D., Dey, S., Dharmaratne, S. D., Dhimal, M., Dinberu, M., Dirac, M., Djalalinia, S., Doan, L., Dokova, K., Doku, D., Dorsey, E., Doyle, K. E., Driscoll, T., Dubey, M., Dubljanin, E., Duken, E., Duncan, B. B., Duraes, A. R., Ebrahimi, H., Ebrahimpour, S., Echko, M. M., Edessa, D., Edvardsson, D., Effiong, A., Eggen, A., Ehrlich, J. R., El Bcheraoui, C., El-Khatib, Z., Elyazar, I. F., Enayati, A., Endalifer, M., Endries, A., Er, B., Erskine, H. E., Eskandarieh, S., Esteghamati, A., Esteghamati, S., Fakhim, H., Faramarzi, M., Fareed, M., Farhadi, F., Farid, T. A., Farinha, C., Farioli, A., Faro, A., Farzadfar, F., Fazaeli, A., Feigin, V. L., Fentahun, N., Fereshtehnejad, S., Fernandes, E., Fernandes, J. C., Ferrari, A. J., Ferreira, M. 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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

  • 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. 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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
  • In Reply. Anesthesiology Terkawi, A. S., Nemergut, E. C., Sessler, D. I. 2018; 128 (2): 421?22

    View details for DOI 10.1097/ALN.0000000000001993

    View details for PubMedID 29337752

  • Danger ahead: the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region, 1990-2015. International journal of public health 2018; 63 (Suppl 1): 11?23

    Abstract

    The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change.We used the Global Burden of Disease 2015 study to present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015.Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernutrition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure.Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.

    View details for DOI 10.1007/s00038-017-1017-y

    View details for PubMedID 28776238

    View details for PubMedCentralID PMC5973982

  • Burden of diarrhea in the Eastern Mediterranean Region, 1990-2015: Findings from the Global Burden of Disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 109?21

    Abstract

    Diarrheal diseases (DD) are an important cause of disease burden, especially in children in low-income settings. DD can also impact children's potential livelihood through growth faltering, cognitive impairment, and other sequelae.As part of the Global Burden of Disease study, we estimated DD burden, and the burden attributable to specific risk factors and etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2015. We calculated disability-adjusted life-years (DALYs)-the sum of years of life lost and years lived with disability-for both sexes and all ages.We estimate that over 103,692 diarrhea deaths occurred in the EMR in 2015 (95% uncertainty interval: 87,018-124,692), and the mortality rate was 16.0 deaths per 100,000 persons (95% UI: 13.4-19.2). The majority of these deaths occurred in children under 5 (63.3%) (65,670 deaths, 95% UI: 53,640-79,486). DALYs per 100,000 ranged from 304 (95% UI 228-400) in Kuwait to 38,900 (95% UI 25,900-54,300) in Somalia.Our findings will guide evidence-based health policy decisions for interventions to achieve the ultimate goal of reducing the DD burden.

    View details for DOI 10.1007/s00038-017-1008-z

    View details for PubMedID 28776239

    View details for PubMedCentralID PMC5973974

  • Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 165?76

    Abstract

    We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR).We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (?20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach.The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages.This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.

    View details for DOI 10.1007/s00038-017-1002-5

    View details for PubMedID 28776243

    View details for PubMedCentralID PMC5973977

  • The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 25?37

    Abstract

    Mental disorders are among the leading causes of nonfatal burden of disease globally.We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases.Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values.The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

    View details for DOI 10.1007/s00038-017-1006-1

    View details for PubMedID 28776247

    View details for PubMedCentralID PMC5973970

  • Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 47?61

    Abstract

    Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015.We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries.The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region.Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.

    View details for DOI 10.1007/s00038-017-1004-3

    View details for PubMedID 28776252

    View details for PubMedCentralID PMC5973988

  • 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

  • Intentional injuries in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 39?46

    Abstract

    We used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015.The Global Burden of Disease (GBD) study defines intentional injuries as a combination of self-harm (including suicide), interpersonal violence, collective violence (war), and legal intervention. We estimated number of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for each type of intentional injuries.In 2015, 28,695 individuals (95% UI: 25,474-37,832) died from self-harm, 35,626 (95% UI: 20,947-41,857) from interpersonal violence, and 143,858 (95% UI: 63,554-223,092) from collective violence and legal interventions. In 2015, collective violence and legal intervention was the fifth-leading cause of DALYs in the EMR and the leading cause in Syria, Yemen, Iraq, Afghanistan, and Libya; they account for 49.7% of total DALYs in Syria.Our findings call for increased efforts to stabilize the region and assist in rebuilding the health systems, as well as increasing transparency and employing preventive strategies to reduce self-harm and interpersonal injuries.

    View details for DOI 10.1007/s00038-017-1005-2

    View details for PubMedID 28776251

    View details for PubMedCentralID PMC5973968

  • Adolescent health in the Eastern Mediterranean Region: findings from the global burden of disease 2015 study. International journal of public health 2018; 63 (Suppl 1): 79?96

    Abstract

    The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs.Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants.Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception.Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

    View details for DOI 10.1007/s00038-017-1003-4

    View details for PubMedID 28776253

    View details for PubMedCentralID PMC5701730

  • Transport injuries and deaths in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 Study. International journal of public health 2018; 63 (Suppl 1): 187?98

    Abstract

    Transport injuries (TI) are ranked as one of the leading causes of death, disability, and property loss worldwide. This paper provides an overview of the burden of TI in the Eastern Mediterranean Region (EMR) by age and sex from 1990 to 2015.Transport injuries mortality in the EMR was estimated using the Global Burden of Disease mortality database, with corrections for ill-defined causes of death, using the cause of death ensemble modeling tool. Morbidity estimation was based on inpatient and outpatient datasets, 26 cause-of-injury and 47 nature-of-injury categories.In 2015, 152,855 (95% uncertainty interval: 137,900-168,100) people died from TI in the EMR countries. Between 1990 and 2015, the years of life lost (YLL) rate per 100,000 due to TI decreased by 15.5%, while the years lived with disability (YLD) rate decreased by 10%, and the age-standardized disability-adjusted life years (DALYs) rate decreased by 16%.Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions.

    View details for DOI 10.1007/s00038-017-0987-0

    View details for PubMedID 28776255

    View details for PubMedCentralID PMC5973983

  • Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Gakidou, E., Afshin, A., Abajobir, A., Abate, K., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S., Aboyans, V., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Abyu, G., Adedeji, I., Adetokunboh, O., Afarideh, M., Agrawal, A., Agrawal, S., Kiadaliri, A., Ahmadieh, H., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Akinyemi, R., Akseer, N., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, T., Alasfoor, D., Alene, K., Ali, K., Alizadeh-Navaei, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amini, E., Ammar, W., Amoako, Y., Ansari, H., Anto, J. M., Antonio, C. T., Anwari, P., Arian, N., Arnlov, J., Artaman, A., Aryal, K., Asayesh, H., Asgedom, S., Atey, T., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Ballew, S. H., Barac, A., Barber, R. M., Barker-Collo, S. L., Barnighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Batis, C., Battle, K. E., Baune, B. T., Beardsley, J., Bedi, N., Beghi, E., Bell, M. L., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Berhane, A., Berhe, D., Bernabe, E., Betsu, B., Beuran, M., Beyene, A., Bhansali, A., Bhutta, Z. A., Bikbov, B., Birungi, C., Biryukov, S., Blosser, C. D., Boneya, D., Bou-Orm, I. R., Brauer, M., Breitborde, N. K., Brenner, H., Brugha, T. S., Bulto, L., Baumgarner, B. R., Butt, Z. A., Cahuana-Hurtado, L., Cardenas, R., Carrero, J., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cercy, K., Chang, H., Charlson, F. J., Chimed-Ochir, O., Chisumpa, V., Chitheer, A. A., Christensen, H., Christopher, D., Cirillo, M., Cohen, A. J., Comfort, H., Cooper, C., Coresh, J., Cornaby, L., Cortesi, P., Criqui, M. H., Crump, J. A., Dandona, L., Dandona, R., das Neves, J., Davey, G., Davitoiu, D. V., Davletov, K., de Courten, B., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deshpande, A., Dharmaratne, S. D., Ding, E. L., Djalalinia, S., Huyen Phuc Do, Dokova, K., Doku, D., Dorsey, E., Driscoll, T. R., Dubey, M., Duncan, B., Duncan, S., Ebert, N., Ebrahimi, H., El-Khatib, Z., Enayati, A., Endries, A., Ermakov, S., Erskine, H. E., Eshrati, B., Eskandarieh, S., Esteghamati, A., Estep, K., Faraon, E., E Sa Farinha, C., Faro, A., Farzadfar, F., Fay, K., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. C., Ferrari, A. J., Feyissa, T., Filip, I., Fischer, F., Fitzmaurice, C., Flaxman, A. D., Foigt, N., Foreman, K. J., Frostad, J. J., Fullman, N., Furst, T., Furtado, J. M., Ganji, M., Garcia-Basteiro, A. L., Gebrehiwot, T., Geleijnse, J. M., Geleto, A., Gemechu, B., Gesesew, H., Gething, P. W., Ghajar, A., Gibney, K. B., Gill, P., Gillum, R. F., Giref, A., Gishu, M., Giussani, G., Godwin, W. W., Gona, P. N., Goodridge, A., Gopalani, S., Goryakin, Y., Goulart, A., Graetz, N., Gugnani, H., Guo, J., Gupta, R., Gupta, T., Gupta, V., Gutierrez, R. A., Hachinski, V., Hafezi-Nejad, N., Hailu, G., Hamadeh, R., Hamidi, S., Hammami, M., Handal, A. J., Hankey, G. J., Harb, H. L., Hareri, H., Hassanvand, M., Havmoeller, R., Hawley, C., Hay, S. I., Hedayati, M. T., Hendrie, D., Beatriz Heredia-Pi, I., Hoek, H. W., Horita, N., Hosgood, H., Hostiuc, S., Hoy, D. G., Hsairi, M., Hu, G., Huang, H., Huang, J. J., Iburg, K., Ikeda, C., Inoue, M., Irvine, C., Jackson, M., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Jauregui, A., Javanbakht, M., Jeemon, P., Johansson, L. K., Johnson, C. O., Jonas, J. B., Jurisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kamal, R., Karch, A., Karema, C., Kasaeian, A., Kassebaum, N. J., Kastor, A., Katikireddi, S., Kawakami, N., Keiyoro, P., Kelbore, S., Kemmer, L., Kengne, A., Kesavachandran, C., Khader, Y., Khalil, I. A., Khan, E., Khang, Y., Khosravi, A., Khubchandani, J., Kieling, C., Kim, D., Kim, J. Y., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K. A., Kivimaki, M., Knibbs, L. D., Knudsen, A., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M., Krohn, K. J., Kromhout, H., Defo, B., Bicer, B., Kumar, G., Kutz, M., Kyu, H. H., Lal, D., Lalloo, R., Lallukka, T., Lan, Q., Lansingh, V. C., Larsson, A., Lee, A., Lee, P. H., Leigh, J., Leung, J., Levi, M., Li, Y., Li, Y., Liang, X., Liben, M., Linn, S., Liu, P., Lodha, R., Logroscino, G., Looker, K. J., Lopez, A. D., Lorkowski, S., Lotufo, P. A., Lozano, R., Lunevicius, R., Macarayan, E., Abd el Razek, H., Abd el Razek, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Mamun, A. A., Manguerra, H., Mantovani, L. G., Mapoma, C. C., Martin, R. V., Martinez-Raga, J., Martins-Melo, F., Mathur, M., Matsushita, K., Matzopoulos, R., Mazidi, M., McAlinden, C., McGrath, J. J., Mehata, S., Mehndiratta, M., Meier, T., Melaku, Y., Memiah, P., Memish, Z. A., Mendoza, W., Mengesha, M., Mensah, G. A., Mensink, G. M., Mereta, S., Meretoja, A., Meretoja, T. J., Mezgebe, H., Micha, R., Millear, A., Miller, T. R., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammed, K., Mohammed, S., Ibrahim, N., Mohan, M. V., Mokdad, A. H., Monasta, L., Montanez Hernandez, J., Montico, M., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S. D., Mountjoy-Venning, C., Mueller, U. O., Mullany, E. C., Muller, K., Murthy, G., Musa, K., Naghavi, M., Naheed, A., Nangia, V., Natarajan, G., Negoi, I., Negoi, R., Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Nichols, E., Ningrum, D., Nomura, M., Vuong Minh Nong, Norheim, O. F., Norrving, B., Noubiap, J. N., Obermeyer, C., Ogbo, F., Oh, H., Oladimeji, O., Olagunju, A., Olagunju, T., Olivares, P. R., Olsen, H. E., Olusanya, B., Olusanya, J., Opio, J., Oren, E., Ortiz, A., Ota, E., Owolabi, M. O., Pa, M., Pacella, R. E., Pana, A., Panda, B., Panda-Jonas, S., Pandian, J. D., Papachristou, C., Park, E., Parry, C. D., Patten, S. B., Patton, G. C., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M., Pillay, J., Piradov, M. A., Pishgar, F., Plass, D., Pletcher, M. A., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N., Purcell, C., Qorbani, M., Radfar, A., Rafay, A., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, M., Rai, R., Rajsic, S., Ram, U., Rawaf, S., Rehm, C. D., Rehm, J., Reiner, R. C., Reitsma, M. B., Myriam Reynales-Shigematsu, L., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Rezaei, S., Ribeiro, A. L., Rivera, J. A., Roba, K., Rojas-Rueda, D., Roman, Y., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rushton, L., Sadat, N., Safdarian, M., Safi, S., Safiri, S., Sahathevan, R., Salama, J., Salomon, J. A., Samy, A. M., Sanabria, J., Dolores Sanchez-Nino, M., Sanchez-Pimienta, T. G., Santomauro, D., Santos, I. S., Milicevic, M., Sartorius, B., Satpathy, M., Sawhney, M., Saxena, S., Schaeffner, E., Schmidt, M., Schneider, I. C., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shaddick, G., Shaheen, A., Shahraz, S., Shaikh, M., Levy, T., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Shen, J., Shi, P., Shibuya, K., Shields, C., Shiferaw, M., Shigematsu, M., Shin, M., Shiri, R., Shirkoohi, R., Shishani, K., Shoman, H., Shrime, M. G., Sigfusdottir, I., Santos Silva, D., Silva, J., Alves Silveira, D., Singh, J. A., Singh, V., Sinha, D., Skiadaresi, E., Slepak, E., Smith, D. L., Smith, M., Sobaih, B. A., Sobngwi, E., Soneji, S., Sorensen, R. D., Sposato, L. A., Sreeramareddy, C. T., Srinivasan, V., Steel, N., Stein, D. J., Steiner, C., Steinke, S., Stokes, M., Strub, B., Subart, M., Sufiyan, M., Strub, B., Subart, M., Sufiyan, M., Suliankatchi, R., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tadakamadla, S., Takahashi, K., Takala, J. S., Tandon, N., Tanner, M., Tarekegn, Y. L., Tavakkoli, M., Tegegne, T., Tehrani-Banihashemi, A., Terkawi, A., Tesssema, B., Thakur, J. S., Thamsuwan, O., Thankappan, K., Theis, A. M., Thomas, M., Thomson, A. J., Thrift, A. G., Tillmann, T., Tobe-Gai, R., Tobollik, M., Tollanes, M. C., Tonelli, M., Topor-Madry, R., Torre, A., Tortajada, M., Touvier, M., Tran, B., Truelsen, T., Tuem, K., Tuzcu, E., Tyrovolas, S., Ukwaja, K., Uneke, C., Updike, R., Uthman, O. A., van Boven, J. M., van Donkelaar, A., Varughese, S., Vasankari, T., Veerman, L. J., Venkateswaran, V., Venketasubramanian, N., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollset, S., Vos, T., Wadilo, F., Wakayo, T., Wallin, M. T., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Whiteford, H. A., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Woodbrook, R., Workicho, A., Hanson, S., Xavier, D., Xu, G., Yadgir, S., Yakob, B., Yan, L. L., Yaseri, M., Yimam, H., Yip, P., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zavala-Arciniega, L., Zhang, X., Zimsen, S. M., Zipkin, B., Zodpey, S., Lim, S. S., Murray, C. L., GBD Risk Factors Collaborators 2017; 390 (10100): 1345?1422

    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22?717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.

    View details for DOI 10.1016/S0140-6736(17)32366-8

    View details for Web of Science ID 000410630000006

    View details for PubMedID 28919119

    View details for PubMedCentralID PMC5614451

  • Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Naghavi, M., Abajobir, A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S., Aboyans, V., Adetokunboh, O., Arnlov, J., Afshin, A., Agrawal, A., Kiadaliri, A., Ahmadi, A., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Aiyar, S., Al-Eyadhy, A., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, T., Alene, K., Ali, S., Alizadeh-Navaei, R., Alkaabi, J. M., Alkerwi, A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amini, E., Ammar, W., Amoako, Y., Anber, N., Andersen, H. H., Andrei, C., Androudi, S., Ansari, H., Antonio, C. T., Anwari, P., Arora, M., Artaman, A., Aryal, K., Asayesh, H., Asgedom, S. W., Atey, T., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Paulina, B., Quintanilla, A., Bejot, Y., Babalola, T., Bacha, U., Balakrishnan, K., Barac, A., Barboza, M. A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Baune, B. T., Bedi, N., Beghi, E., Bekele, B., Bell, M. L., Bennett, J. R., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B., Beuran, M., Bhatt, S., Biadgilign, S., Bienhoff, K., Bikbov, B., Bisanzio, D., Bourne, R. A., Breitborde, N. K., Negesa, L., Bulto, B., Bumgarner, B. R., Butt, Z. A., Cardenas, R., Cahuana-Hurtado, L., Cameron, E., Cesar Campuzano, J., Car, J., Jesus Carrero, J., Carter, A., Casey, D. C., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charlson, F. J., Chibueze, C., Chimed-Ochir, O., Chisumpa, V., Chitheer, A. A., Christopher, D., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colombara, D., Cooper, C., Cowie, B. C., Criqui, M. H., Dandona, L., Dandona, R., Dargan, P. I., das Neves, J., Davitoiu, D. V., Davletov, K., de Courten, B., Degenhardt, L., Deiparine, S., Deribe, K., Deribew, A., Dey, S., Dicker, D., Ding, E. L., Djalalinia, S., Huyen Phuc Do, Doku, D., Douwes-Schultz, D., Driscoll, T. R., Dubey, M., Duncan, B., Echko, M., El-Khatib, Z., Ellingsen, C., Enayati, A., Erskine, H. E., Eskandarieh, S., Esteghamati, A., Ermakov, S. P., Estep, K., E Sa Farinha, C., Faro, A., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. C., Ferrari, A. J., Feyissa, T., Filip, I., Finegold, S., Fischer, F., Fitzmaurice, C., Flaxman, A. D., Foigt, N., Frank, T., Fraser, M., Fullman, N., Furst, T., Furtado, J. M., Gakidou, E., Garcia-Basteiro, A. L., Gebre, T., Gebregergs, G., Gebrehiwot, T., Gebremichael, D., Geleijnse, J. M., Genova-Maleras, R., Gesesew, H., Gething, P. W., Gillum, R. F., Ginawi, I., Giref, A., Giroud, M., Giussani, G., Godwin, W. W., Gold, A. L., Goldberg, E. M., Gona, P. N., Gopalani, S., Gouda, H. N., Goulart, A., Griswold, M., Gupta, P. C., Gupta, R., Gupta, T., Gupta, V., Haagsma, J. A., Hafezi-Nejad, N., Hailu, A., Hailu, G., Hamadeh, R., Hambisa, M., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Hareri, H., Hassanvand, M., Havmoeller, R., Hay, S. I., He, F., Hedayati, M. T., Henry, N. J., Beatriz Heredia-Pi, I., Herteliu, C., Hoek, H. W., Horino, M., Horita, N., Hosgood, H., Hostiuc, S., Hotez, P. J., Hoy, D. G., Huynh, C., Iburg, K., Ikeda, C., Ileanu, B., Irenso, A., Irvine, C., Irenso, A., Irvine, C., Jurisson, M., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayaraman, S. P., Jeemon, P., Jha, V., John, D., Johnson, C. O., Johnson, S., Jonas, J. B., Kabir, Z., Kadel, R., Kahsay, A., Kamal, R., Karch, A., Karimi, S. M., Karimkhani, C., Kasaeian, A., Kassaw, N., Kassebaum, N. J., Katikireddi, S., Kawakami, N., Keiyoro, P., Kemmer, L., Kesavachandran, C., Khader, Y., Khan, E., Khang, Y., Khoja, A., Khosravi, A., Khosravi, M., Khubchandani, J., Kieling, C., Kievlan, D., Kim, D., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kissoon, N., Kivimaki, M., Knudsen, A., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B., Kulikoff, X., Kumar, G., Kumar, P., Kutz, M., Kyu, H. H., Lal, D., Lalloo, R., Lallukka, T., Lambert, N., Lan, Q., Lansingh, V. C., Larsson, A., Lee, P. H., Leigh, J., Leung, J., Levi, M., Li, Y., Kappe, D., Liang, X., Liben, M., Lim, S. S., Liu, A., Liu, P. Y., Liu, Y., Lodha, R., Logroscino, G., Lorkowski, S., Lotufo, P. A., Lozano, R., Lucas, T. D., Ma, S., Macarayan, E., Maddison, E. R., Abd el Razek, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Manguerra, H., Manyazewal, T., Mapoma, C. C., Marczak, L. B., Markos, D., Martinez-Raga, J., Martins-Melo, F., Martopullo, I., McAlinden, C., McGaughey, M., McGrath, J. J., Mehata, S., Meier, T., Meles, K., Memiah, P., Memish, Z. A., Mengesha, M., Mengistu, D., Menota, B., Mensah, G. A., Meretoja, A., Meretoja, T. J., Millear, A., Miller, T. R., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammadi, A., Mohammed, S., Mokdad, A. H., Mola, G. D., Mollenkopf, S. K., Molokhia, M., Monasta, L., Montanez Hernandez, J. C., Montico, M., Mooney, M. D., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S. D., Morozoff, C., Mountjoy-Venning, C., Mruts, K., Muller, K., Murthy, G., Musa, K., Nachega, J. B., Naheed, A., Naldi, L., Nangia, V., Nascimento, B., Nasher, J. T., Natarajan, G., Negoi, I., Ngunjiri, J., Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Nichols, E., Ningrum, D., Vuong Minh Nong, Noubiap, J. N., Ogbo, F., Oh, I., Okoro, A., Olagunju, A., Olsen, H. E., Olusanya, B., Olusanya, J., Ong, K., Opio, J., Oren, E., Ortiz, A., Osman, M., Ota, E., Pa, M., Pacella, R. E., Pakhale, S., Pana, A., Panda, B., Panda-Jonas, S., Papachristou, C., Park, E., Patten, S. B., Patton, G. C., Paudel, D., Paulson, K., Pereira, D. M., Perez-Ruiz, F., Perico, N., Pervaiz, A., Petzold, M., Phillips, M., Pigott, D. M., Pinho, C., Plass, D., Pletcher, M. A., Polinder, S., Postma, M. J., Pourmalek, F., Purcell, C., Qorbani, M., Radfar, A., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rai, R., Ranabhat, C., Rankin, Z., Rao, P. C., Rath, G., Rawaf, S., Ray, S. E., Rehm, J., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Rezaei, S., Rezai, M., Rokni, M., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Ruhago, G., Saadat, R., Sachdev, P. S., Sadat, N., Safdarian, M., Safi, S., Safiri, S., Sagar, R., Sahathevan, R., Salama, J., Salamati, P., Salomon, J. A., Samy, A. M., Sanabria, J., Dolores Sanchez-Nino, M., Santomauro, D., Santos, I. S., Milicevic, M., Sartorius, B., Satpathy, M., Shahraz, S., Schmidt, M., Schneider, I. C., Schulhofer-Wohl, S., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaikh, M., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Sheikhbahaei, S., Shey, M., Shi, P., Shields, C., Shields, C., Shigematsu, M., Shiri, R., Shirude, S., Shiue, I., Shoman, H., Shrime, M. G., Sigfusdottir, I., Silpakit, N., Silva, J., Singh, A., Singh, J. A., Skiadaresi, E., Sligar, A., Smith, A., Smith, D. L., Smith, M., Sobaih, B. A., Soneji, S., Sorensen, R. D., Soriano, J. B., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stathopoulou, V., Steel, N., Stein, D. J., Steiner, C., Steinke, S., Stokes, M., Strong, M., Strub, B., Subart, M., Sufiyan, M., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Tabares-Seisdedos, R., Tadakamadla, S., Takahashi, K., Takala, J. S., Talongwa, R., Tarawneh, M., Tavakkoli, M., Taveira, N., Tegegne, T., Tehrani-Banihashemi, A., Temsah, M., Terkawi, A., Thakur, J. S., Thamsuwan, O., Thankappan, K., Thomas, K. E., Thompson, A. H., Thomson, A. J., Thrift, A. G., Tobe-Gai, R., Topor-Madry, R., Torre, A., Tortajada, M., Towbin, J., Bach Xuan Tran, Troeger, C., Truelsen, T., Tsoi, D., Tuzcu, E., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Updike, R., Uthman, O. A., Uzochukwu, B., van Boven, J. M., Vasankari, T., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S., Vos, T., Wakayo, T., Wallin, M. T., Wang, Y., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Whetter, B., Whiteford, H. A., Wijeratne, T., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Woodbrook, R., Workicho, A., Xavier, D., Xiao, Q., Xu, G., Yaghoubi, M., Yakob, B., Yano, Y., Yaseri, M., Yimam, H., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zegeye, E., Zenebe, Z., Zerfu, T., Zhang, A., Zhang, X., Zipkin, B., Zodpey, S., Lopez, A. D., Murray, C. L., GBD 2016 Causes Death Collaborato 2017; 390 (10100): 1151?1210

    Abstract

    Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32152-9

    View details for Web of Science ID 000410630000003

    View details for PubMedID 28919116

    View details for PubMedCentralID PMC5605883

  • Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Wang, H., Abajobir, A., Abate, K., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S., Abraha, H., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Adedeji, I., Adedoyin, R., Adetifa, I. O., Adetokunboh, O., Afshin, A., Aggarwal, R., Agrawal, A., Agrawal, S., Kiadaliri, A., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Aiyar, S., Akanda, S., Akinyemiju, T. F., Akseer, N., Al-Eyadhy, A., Al Lami, F., Alabed, S., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alasfoor, D., Aldridge, R., Alene, K., Alhabib, S., Ali, R., Alizadeh-Navaei, R., Aljunid, S. M., Alkaabi, J. M., Alkerwi, A., Alla, F., Allam, S. D., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, E., Ammar, W., Amoako, Y., Anber, N., Andrei, C., Androudi, S., Ansari, H., Ansha, M., Antonio, C. T., Anwari, P., Arnlov, J., Arora, M., Al Artaman, Aryal, K., Asayesh, H., Asgedom, S., Asghar, R., Assadi, R., Atey, T., Atre, S. R., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Quintanilla, B., Babalola, T., Bacha, U., Badawi, A., Balakrishnan, K., Balalla, S., Barac, A., Barber, R. M., Barboza, M. A., Barker-Collo, S. L., Barnighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Bejot, Y., Bekele, B., Bell, M. L., Bello, A. K., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Benson, J., Berhane, A., Berhe, D., Bernabe, E., Beuran, M., Beyene, A., Bhala, N., Bhansali, A., Bhaumik, S., Bhutta, Z. A., Bikbov, B., Birungi, C., Biryukov, S., Bisanzio, D., Bizuayehu, H., Bjerregaard, P., Blosser, C. D., Boneya, D., Boufous, S., Bourne, R. A., Brazinova, A., Breitborde, N. K., Brenner, H., Brugha, T. S., Bukhman, G., Negesa, L., Bulto, B., Bumgarner, B., Burch, M., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I., Car, J., Car, M., Crdenas, R., Carpenter, D. O., Carrero, J., Carter, A., Castaneda-Orjuela, C. A., Rivas, J., Castro, F. F., Castro, R., Catala-Lopez, F., Chen, H., Chiang, P., Chibalabala, M., Chisumpa, V., Chitheer, A. A., Choi, J., Christensen, H., Christopher, D., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colquhoun, S. M., Coresh, J., Criqui, M. H., Cromwell, E. A., Crump, J. A., Dandona, L., Dandona, R., Dargan, P. I., das Neves, J., Davey, G., Davitoiu, D. V., Davletov, K., de Courten, B., De Leo, D., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deribew, A., Des Jarlais, D. C., Dey, S., Dharmaratne, S. D., Dherani, M. K., Diaz-Torne, C., Ding, E. L., Dixit, P., Djalalinia, S., Huyen Phuc Do, Doku, D., Donnelly, C., Priscila, K., dos Santos, B., Douwes-Schultz, D., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B., Dwivedi, L., Ebrahimi, H., El Bcheraoui, C., Ellingsen, C., Enayati, A., Endries, A., Ermakov, S., Eshetie, S., Eshrati, B., Eskandarieh, S., Esteghamati, A., Estep, K., Fanuel, B., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Feyissa, T., Filip, I., Fischer, F., Foigt, N., Foreman, K. J., Frank, T., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J. J., Fullman, N., Furst, T., Furtado, J. M., Futran, N. D., Gakidou, E., Gambashidze, K., Gamkrelidze, A., Gankpe, F., Garcia-Basteiro, A. L., Gebregergs, G., Gebrehiwot, T., Gebrekidan, K., Gebremichael, M., Gelaye, A., Geleijnse, J. M., Gemechu, B., Gemechu, K., Genova-Maleras, R., Gesesew, H., Gething, P. W., Gibney, K. B., Gill, P., Gillum, R. F., Giref, A., Girma, B., Giussani, G., Goenka, S., Gomez, B., Gona, P. N., Gopalani, S., Goulart, A., Graetz, N., Gugnani, H., Gupta, P. C., Gupta, R., Gupta, R., Gupta, T., Gupta, V., Haagsma, J. A., Hafezi-Nejad, N., Bidgoli, H., Hakuzimana, A., Halasa, Y. A., Hamadeh, R., Hambisa, M., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Hareri, H., Harikrishnan, S., Haro, J., Hassanvand, M., Havmoeller, R., Hay, R. J., Hay, S. I., He, F., Heredia-Pi, I., Herteliu, C., Hilawe, E., Hoek, H. W., Horita, N., Hosgood, H., Hostiuc, S., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A., Hu, G., Huang, H., Huang, J. J., Iburg, K., Igumbor, E., Ileanu, B., Inoue, M., Irenso, A., Irvine, C. S., Islam, N., Jacobsen, K. H., Jaenisch, T., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A., Jeemon, P., Jensen, P. N., Jha, V., Jin, Y., John, D., John, O., Johnson, S., Jonas, J. B., Jurisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C., Karimi, S. M., Karthikeyan, G., Kasaeian, A., Kassaw, N., Kassebaum, N. J., Kastor, A., Katikireddi, S., Kaul, A., Kawakami, N., Kazanjan, K., Keiyoro, P., Kelbore, S., Kemp, A., Kengne, A., Keren, A., Kereselidze, M., Kesavachandran, C., Ketema, E., Khader, Y., Khalil, I. A., Khan, E., Khan, G., Khang, Y., Khera, S., Khoja, A., Khosravi, M., Kibret, G., Kieling, C., Kim, C., Kim, D., Kim, P., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kishawi, S., Kissimova-Skarbek, K. A., Kissoon, N., Kivimaki, M., Knudsen, A., Kokubo, Y., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M., Krohn, K. J., Defo, B., Bicer, B., Kuipers, E. J., Kulikoff, X., Kulkarni, V. S., Kumar, G., Kumar, P., Kumsa, F., Kutz, M., Lachat, C., Lagat, A. K., Lager, A., Lal, D., Lalloo, R., Lambert, N., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D., Lavados, P. M., Laxmaiah, A., Lee, P. H., Leigh, J., Leung, J., Leung, R., Levi, M., Li, Y., Liao, Y., Liben, M., Lim, S. S., Linn, S., Lipshultz, S. E., Liu, S., Lodha, R., Logroscino, G., Lorch, S. A., Lorkowski, S., Lotufo, P. A., Lozano, R., Lunevicius, R., Lyons, R. A., Ma, S., Macarayan, E., Machado, I., Mackay, M. T., Abd el Razek, M., Magis-Rodriguez, C., Mahdavi, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Mantovani, L. G., Manyazewal, T., Mapoma, C. C., Marczak, L. B., Marks, G. B., Martinez-Raga, J., Martins-Melo, F., Massano, J., Maulik, P. K., Mayosi, B. M., Mazidi, M., McAlinden, C., McGarvey, S., McGrath, J. J., Mckee, M., Mehata, S., Mehndiratta, M., Mehta, K. M., Meier, T., Mekonnen, T., Meles, K., Memiah, P., Memish, Z. A., Mendoza, W., Mengesha, M., Mengistie, M., Tadese, D., Menon, M. R., Menota, B., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mezgebe, H., Micha, R., Mikesell, J., Miller, T. R., Mills, E. J., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammadi, A., Mohammed, K., Mohan, M. V., Mohanty, S. K., Mokdad, A. H., Assaye, A., Mollenkopf, S. K., Molokhia, M., Monasta, L., Hernandez, J., Montico, M., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moraga, P., Morawska, L., Velasquez, I., Mori, R., Morrison, S. D., Mruts, K., Mueller, U. O., Mullany, E., Muller, K., Venkata, G., Murthy, S., Murthy, S., Musa, K., Nachega, J. B., Nagata, C., Nagel, G., Naghavi, M., Naidoo, K. S., Nanda, L., Nangia, V., Nascimento, B., Natarajan, G., Negoi, I., Cuong Tat Nguyen, Ningrum, D., Nisar, M., Nomura, M., Vuong Minh Nong, Norheim, O. F., Norrving, B., Noubiap, J. N., Nyakarahuka, L., Obermeyer, C., O'Donnell, M. J., Ogbo, F., Oh, I., Okoro, A., Oladimeji, O., Olagunju, A., Olusanya, B., Olusanya, J., Oren, E., Ortiz, A., Osgood-Zimmerman, A., Ota, E., Owolabi, M. O., Oyekale, A., Pa, M., Pacella, R. E., Pakhale, S., Pana, A., Panda, B., Panda-Jonas, S., Park, E., Parsaeian, M., Patel, T., Patten, S. B., Patton, G. C., Paudel, D., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C., Petri, W., Petzold, M., Phillips, M., Piel, F. B., Pigott, D. M., Pishgar, F., Plass, D., Polinder, S., Popova, S., Postma, M. J., Poulton, R. G., Pourmalek, F., Prasad, N., Purwar, M., Qorbani, M., Rabiee, R. S., Radfar, A., Rafay, A., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, S., Rai, R., Rajsic, S., Ram, U., Rana, S. M., Ranabhat, C., Rao, P., Rawaf, S., Ray, S. E., Rego, M., Rehm, J., Reiner, R. C., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Rezaei, S., Rezai, M., Ribeiro, A. L., Rokni, M., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Roy, A., Rubagotti, E., Ruhago, G., Saadat, S., Sabde, Y., Sachdev, P. S., Sadat, N., Safdarian, M., Safiri, S., Sagar, R., Sahathevan, R., Sahebkar, A., Sahraian, M., Salama, J., Salamati, P., Salomon, J. A., Salvi, S., Samy, A. M., Sanabria, J., Sanchez-Nino, M., Santos, I. S., Milicevic, M., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Sawhney, M., Saxena, S., Saylan, M. I., Schmidt, M., Schneider, I. C., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Seid, A., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Shaikh, M., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Shen, J., Shetty, B. P., Shi, P., Shibuya, K., Shigematsu, M., Shiri, R., Shiue, I., Shrime, M. G., Sigfusdottir, I., Silberberg, D. H., Silpakit, N., Silva, D., Silva, J., Silveira, D., Sindi, S., Singh, A., Singh, J. A., Singh, P., Singh, V., Sinha, D., Skiadaresi, E., Sligar, A., Smith, D. L., Sobaih, B. A., Sobngwi, E., Soneji, S., Soriano, J. B., Sreeramareddy, C. T., Srinivasan, V., Stathopoulou, V., Steel, N., Stein, D. J., Steiner, C., Stockl, H., Stokes, M., Strong, M., Sufiyan, M., Suliankatchi, R., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tadakamadla, S., Tadese, F., Tandon, N., Tanne, D., Tarajia, M., Tavakkoli, M., Taveira, N., Tehrani-Banihashemi, A., Tekelab, T., Tekle, D., Shifa, G., Temsah, M., Terkawi, A., Tesema, C., Tesssema, B., Theis, A., Thomas, N., Thompson, A. H., Thomson, A. J., Thrift, A. G., Tiruye, T., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tortajada, M., Tran, B., Trujillo, T., Tsilimparis, N., Tuem, K., Tuzcu, E., Tyrovolas, S., Ukwaja, K., Undurraga, E. A., Uthman, O. A., Uzochukwu, B., van Boven, J. M., Varakin, Y. Y., Varughese, S., Vasankari, T., Vasconcelos, A., Venketasubramanian, N., Vidavalur, R., Violante, F. S., Vishnu, A., Vladimirov, S. K., Vlassov, V., Vollset, S., Vos, T., Waid, J. L., Wakayo, T., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wesana, J., Wijeratne, T., Wilkinson, J. D., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Workicho, A., Workie, S., Xavier, D., Xu, G., Yaghoubi, M., Yakob, B., Yalew, A., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yimam, H., Yip, P., Yirsaw, B., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zeeb, H., Zenebe, Z., Zerfu, T., Zhang, A., Zhang, X., Zodpey, S., Zuhlke, L., Lopez, A. D., Murray, C. L., GBD 2016 Mortality Collaborators 2017; 390 (10100): 1084?1150

    Abstract

    Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone.Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016.Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.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)31833-0

    View details for Web of Science ID 000410630000002

    View details for PubMedID 28919115

    View details for PubMedCentralID PMC5605514

  • Health Effects of Overweight and Obesity in 195 Countries over 25 Years NEW ENGLAND JOURNAL OF MEDICINE Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., Marczak, L., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Salama, J. S., Vos, T., Abate, K. H., Abbafati, C., Ahmed, M. B., Al-Aly, Z., Alkerwi, A., Al-Raddadi, R., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, E., Amrock, S. M., Anjana, R. M., Arnlov, J., Asayesh, H., Banerjee, A., Barac, A., Baye, E., Bennett, D. A., Beyene, A. S., Biadgilign, S., Biryukov, S., Bjertness, E., Boneya, D. J., Campos-Nonato, I., Carrero, J. J., Cecilio, P., Cercy, K., Ciobanu, L. G., Cornaby, L., Damtew, S. A., Dandona, L., Dandona, R., Dharmaratne, S. D., Duncan, B. B., Eshrati, B., Esteghamati, A., Feigin, V. L., Fernandes, J. C., Furst, T., Gebrehiwot, T. T., Gold, A., Gona, P. N., Goto, A., Habtewold, T. D., Hadush, K. T., Hafezi-Nejad, N., Hay, S. I., Horino, M., Islami, F., Kamal, R., Kasaeian, A., Katikireddi, S. V., Kengne, A. P., Kesavachandran, C. N., Khader, Y. S., Khang, Y., Khubchandani, J., Kim, D., Kim, Y. J., Kinfu, Y., Kosen, S., Ku, T., Defo, B., Kumar, G., Larson, H. J., Leinsalu, M., Liang, X., Lim, S. S., Liu, P., Lopez, A. D., Lozano, R., Majeed, A., Malekzadeh, R., Malta, D. C., Mazidi, M., McAlinden, C., McGarvey, S. T., Mengistu, D. T., Mensah, G. A., Mensink, G. M., Mezgebe, H. B., Mirrakhimov, E. M., Mueller, U. O., Noubiap, J. J., Obermeyer, C. M., Ogbo, F. A., Owolabi, M. O., Patton, G. C., Pourmalek, F., Qorbani, M., Rafay, A., Rai, R. K., Ranabhat, C. L., Reinig, N., Safiri, S., Salomon, J. A., Sanabria, J. R., Santos, I. S., Sartorius, B., Sawhney, M., Schmidhuber, J., Schutte, A. E., Schmidt, M. I., Sepanlou, S. G., Shamsizadeh, M., Sheikhbahaei, S., Shin, M., Shiri, R., Shiue, I., Roba, H. S., Silva, D. S., Silverberg, J. I., Singh, J. A., Stranges, S., Swaminathan, S., Tabares-Seisdedos, R., Tadese, F., Tedla, B. A., Tegegne, B. S., Terkawi, A. S., Thakur, J. S., Tonelli, M., Topor-Madry, R., Tyrovolas, S., Ukwaja, K. N., Uthman, O. A., Vaezghasemi, M., Vasankari, T., Vlassov, V. V., Vollset, S. E., Weiderpass, E., Werdecker, A., Wesana, J., Westerman, R., Yano, Y., Yonemoto, N., Yonga, G., Zaidi, Z., Zenebe, Z. M., Zipkin, B., Murray, C. L., GBD 2015 Obesity Collaborators 2017; 377 (1): 13?27

    Abstract

    Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain.We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015.In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease.The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

    View details for DOI 10.1056/NEJMoa1614362

    View details for Web of Science ID 000404730000005

    View details for PubMedID 28604169

    View details for PubMedCentralID PMC5477817

  • Child and Adolescent Health From 1990 to 2015 Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study JAMA PEDIATRICS Kassebaum, N., Hmwe Kyu, H., Zoeckler, L., Elizabeth Olsen, H., Thomas, K., Pinho, C., Bhutta, Z. A., Dandona, L., Ferrari, A., Ghiwot, T., Hay, S. I., Kinfu, Y., Liang, X., Lopez, A., Carvalho Malta, D., Mokdad, A. H., Naghavi, M., Patton, G. C., Salomon, J., Sartorius, B., Topor-Madry, R., Vollset, S., Werdecker, A., Whiteford, H. A., Abate, K., Abbas, K., Damtew, S., Ahmed, M., Akseer, N., Al-Raddadi, R., Alemayohu, M., Altirkawi, K., Abajobir, A., Amare, A. T., Antonio, C. T., Amlov, J., Al Artaman, Asayesh, H., Avokpaho, E., Awasthi, A., Quintanilla, B., Bacha, U., Betsu, B., Barac, A., Bamighausen, T., Baye, E., Bedi, N., Bensenor, I. M., Berhane, A., Bernabe, E., Alberto Bernal, O., Beyene, A., Biadgilign, S., Bikbov, B., Anne Boyce, C., Brazinova, A., Hailu, G., Carter, A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charlson, F. J., Chitheer, A. A., Choi, J., Ciobanu, L. G., Crump, J., Dandona, R., Dellavalle, R. P., Deribew, A., deveber, G., Dicker, D., Ding, E. L., Dubey, M., Endries, A., Erskine, H. E., Faraon, E., Faro, A., Farzadfar, F., Fernandes, J. C., Obadare Fijabi, D., Fitzmaurice, C., Fleming, T. D., Sorio Flor, L., Foreman, K. J., Franklin, R. C., Fraser, M. S., Frostad, J. J., Fullman, N., Gebregergs, G., Gebru, A., Geleijnse, J. M., Gibney, K. B., Yihdego, M., Ginawi, I., Gishu, M., Gizachew, T., Glaser, E., Gold, A. L., Goldberg, E., Gona, P., Goto, A., Gugnani, H., Jiang, G., Gupta, R., Tesfay, F., Hankey, G. J., Havmoeller, R., Hijar, M., Horino, M., Hosgood, H., Hu, G., Jacobsen, K. H., Jakovljevic, M. B., Jayaraman, S. P., Jha, V., Jibat, T., Johnson, C. O., Jonas, J., Kasaeian, A., Kawakami, N., Keiyoro, P. N., Khalil, I., Khang, Y., Khubchandani, J., Ahmad Kiadaliri, A. A., Kieling, C., Kim, D., Kissoon, N., Knibbs, L. D., Koyanagi, A., Krohn, K. J., Defo, B., Bicer, B., Kulikoff, R., Kumar, A., Lal, D., Lam, H. Y., Larson, H. J., Larsson, A., Laryea, D., Leung, J., Lim, S. S., Lo, L., Lo, W. D., Looker, K. J., Lotufo, P. A., El Razek, H., Malekzadeh, R., Shifti, D., Mazidi, M., Meaney, P. A., Meles, K., Memiah, P., Mendoza, W., Mengistie, M., Mengistu, G., Mensah, G. A., Miller, T. R., Mock, C., Mohammadi, A., Mohammed, S., Monasta, L., Mueller, U., Nagata, C., Naheed, A., Nguyen, G., Le Nguyen, Q., Nsoesie, E., Oh, I., Okoro, A., Olusanya, J., Olusanya, B. O., Ortiz, A., Paudel, D., Pereira, D. M., Perico, N., Petzold, M., Phillips, M., Polanczyk, G. V., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rai, R., Ram, U., Rankin, Z., Remuzzi, G., Renzaho, A. N., Roba, H., Rojas-Rueda, D., Ronfani, L., Sagar, R., Sanabria, J., Mohammed, M., Santos, I. S., Satpathy, M., Sawhney, M., Ben Schottker, Schwebel, D. C., Scott, J. G., Sepanlou, S. G., Shaheen, A., Shaikh, M., She, J., Shiri, R., Shiue, I., Sigfusdottir, I., Singh, J., Silpakit, N., Smith, A., Sreeramareddy, C., Stanaway, J. D., Stein, D. J., Steiner, C., Sufiyan, M., Swaminathan, S., Tabares-Seisdedos, R., Tabb, K. M., Tadese, F., Tavakkoli, M., Taye, B., Teeple, S., Tegegne, T., Shifa, G., Terkawi, A., Thomas, B., Thomson, A. J., Tobe-Gai, R., Tonelli, M., Tran, B., Troeger, C., Ukwaja, K. N., Uthman, O., Vasankari, T., Venketasubramanian, N., Vlassov, V., Weiderpass, E., Weintraub, R., Gebrehiwot, S., Westerman, R., Williams, H. C., Wolfe, C. A., Woodbrook, R., Yano, Y., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaki, M., Zegeye, E., Zuhlke, L., Murray, C. L., Vos, T. 2017; 171 (6): 573?92

    Abstract

    Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

    View details for PubMedID 28384795

    View details for PubMedCentralID PMC5540012

  • 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

  • Development and validation of Arabic version of the Neuropathic Pain Questionnaire-Short Form. Saudi journal of anaesthesia Terkawi, A. S., Backonja, M. M., Abolkhair, A., Almaharbi, S., Joy, J., Foula, F., Alswiti, M., Terkawi, Y. S., Al-Zhahrani, T., Alghamdi, F. S., Tsang, S. 2017; 11 (Suppl 1): S53?S62

    Abstract

    The Neuropathic Pain Questionnaire-Short Form (NPQ-SF) is the shortest diagnostic tool for the assessment of neuropathic pain, designed with the goal to differentiate between neuropathic and nonneuropathic pain. The aim of this study was to translate, culturally adapt, and validate the NPQ-SF questionnaire in Arabic.A systematic translation process was used to translate the original English NPQ-SF into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. Reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficient (ICC). We examined the validity of the Arabic NPQ-SF via construct validity, concurrent validity (associations with the numeric pain scale, Brief Pain Inventory, and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated NPQ-SF questionnaire was administered twice among the same group of patients.A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's ? were 0.45 (95% CI: 0.29, 0.61) and 0.48 (95% CI: 0.33, 0.63), and the ICC was 0.78 (95% CI: 0.72, 0.85). The NPQ-SF was moderately to strongly associated with the S-LANSS questionnaire. Results showed our Arabic NPQ-SF to have good diagnostic accuracy, with area under the curve of 0.76 (95% CI: 0.67, 0.84). Results from the receiver operating characteristic analysis identified a cut-off score of ?0.52 as the best score to distinguish between patients with or without neuropathic pain, which was higher than the recommended cut-off score (?0) in the original study. With both sensitivity and specificity of 71%. Most patients found the NPQ-SF questionnaire to be clear and easy to understand.Our translated version of NPQ-SF is reliable and valid for use, thus providing physicians a new tool with which to evaluate and diagnose neuropathic pain among Arabic-speaking patients.

    View details for DOI 10.4103/sja.SJA_86_17

    View details for PubMedID 28616004

    View details for PubMedCentralID PMC5463567

  • Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013. Annals of the rheumatic diseases Moradi-Lakeh, M., Forouzanfar, M. H., Vollset, S. E., El Bcheraoui, C., Daoud, F., Afshin, A., Charara, R., Khalil, I., Higashi, H., Abd El Razek, M. M., Kiadaliri, A. A., Alam, K., Akseer, N., Al-Hamad, N., Ali, R., AlMazroa, M. A., Alomari, M. A., Al-Rabeeah, A. A., Alsharif, U., Altirkawi, K. A., Atique, S., Badawi, A., Barrero, L. H., Basulaiman, M., Bazargan-Hejazi, S., Bedi, N., Bensenor, I. M., Buchbinder, R., Danawi, H., Dharmaratne, S. D., Zannad, F., Farvid, M. S., Fereshtehnejad, S. M., Farzadfar, F., Fischer, F., Gupta, R., Hamadeh, R. R., Hamidi, S., Horino, M., Hoy, D. G., Hsairi, M., Husseini, A., Javanbakht, M., Jonas, J. B., Kasaeian, A., Khan, E. A., Khubchandani, J., Knudsen, A. K., Kopec, J. A., Lunevicius, R., Abd El Razek, H. M., Majeed, A., Malekzadeh, R., Mate, K., Mehari, A., Meltzer, M., Memish, Z. A., Mirarefin, M., Mohammed, S., Naheed, A., Obermeyer, C. M., Oh, I. H., Park, E. K., Peprah, E. K., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Shiri, R., Rahman, S. U., Rai, R. K., Rana, S. M., Sepanlou, S. G., Shaikh, M. A., Shiue, I., Sibai, A. M., Silva, D. A., Singh, J. A., Skogen, J. C., Terkawi, A. S., Ukwaja, K. N., Westerman, R., Yonemoto, N., Yoon, S. J., Younis, M. Z., Zaidi, Z., Zaki, M. E., Lim, S. S., Wang, H., Vos, T., Naghavi, M., Lopez, A. D., Murray, C. J., Mokdad, A. H. 2017; 76 (8): 1365?73

    Abstract

    We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).For musculoskeletal disorders, the crude DALYs rate per 100?000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

    View details for DOI 10.1136/annrheumdis-2016-210146

    View details for PubMedID 28209629

    View details for PubMedCentralID PMC5738600

  • Development and validation of Arabic version of the Short-Form McGill Pain Questionnaire. Saudi journal of anaesthesia Terkawi, A. S., Tsang, S., Abolkhair, A., Alsharif, M., Alswiti, M., Alsadoun, A., AlZoraigi, U. S., Aldhahri, S. F., Al-Zhahrani, T., Altirkawi, K. A. 2017; 11 (Suppl 1): S2?S10

    Abstract

    The Short-Form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for qualitative and quantitative pain assessment. Our aim was to translate, culturally adapt, and validate the SF-MPQ in Arabic.A systematic translation process was used to translate the original English SF-MPQ into Arabic. After the pilot study, we validated our version in patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations between SF-MPQ, Brief Pain Inventory [BPI], and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), and face validity. The questionnaire was administered twice to examine responsiveness.A total of 142 participants (68 men and 74 women) were included in this study. Cronbach's ? was 0.85 (95% confidence interval: 0.81 - 0.89), and interclass correlation coefficients were 0.71 (0.62-0.79) for the whole scale. SF-MPQ was moderately associated with patients' present pain (r = 0.55, P < 0.001) and the numerical rating scale (r = 0.42, P < 0.001). The total pain score was moderately correlated with pain severity and interference assessed with the BPI (rs = 0.39 to 0.49, all Ps < 0.001). SF-MPQ total pain score was weakly associated with neuropathic pain assessed with S-LANSS (r = 0.26, P < 0.01). Most patients found the SF-MPQ questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their pain.Our translated version of SF-MPQ was reliable and valid for use among Arabic-speaking patients. The SF-MPQ is a good qualitative and quantitative assessment tool for pain but is only weakly associated with neuropathic pain.

    View details for DOI 10.4103/sja.SJA_42_17

    View details for PubMedID 28615999

    View details for PubMedCentralID PMC5463564

  • Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi journal of anaesthesia Terkawi, A. S., Tsang, S., AlKahtani, G. J., Al-Mousa, S. H., Al Musaed, S., AlZoraigi, U. S., Alasfar, E. M., Doais, K. S., Abdulrahman, A., Altirkawi, K. A. 2017; 11 (Suppl 1): S11?S18

    Abstract

    The Hospital Anxiety and Depression Scale (HADS) is widely used to predict and diagnose hospital anxiety and depression. It has been translated and validated in many languages, but the existing Arabic version was not validated in hospitalized patients. The aim was to translate, culturally adapt, and validate the HADS Questionnaire into Arabic language for in-patient use, especially for surgical wards.A systematic translation process was used to translate the original English HADS into Arabic. After the pilot study, we validated our version in surgical patients at two tertiary care centers. We tested the reliability of our version using internal consistency. We examined the validity by assessing construct validity, concurrent validity (by testing the associations between HADS, Generalized Anxiety Disorder 7-item scale [GAD-7], and Major Depression Inventory [MDI]), and face validity. The questionnaire was administered before and after surgery to examine responsiveness.A total of 110 patients (22 men, 88 women) were included in the study. Cronbach's ?s for the HADS anxiety subscale were 0.83 (95% confidence interval: 0.79- 0.88) and for the HADS depression subscale were 0.77 (0.7-0.83). Nearly 36% of the patients reported symptoms indicative of borderline or case anxiety before surgery, which decreased to 25% 1 week after surgery. HADS anxiety score was strongly correlated with GAD-7, and HADS depression score was strongly associated with MDI. Patients with higher American Society of Anesthesiologists Physical Status and those who remained hospitalized for more than 5 days were more likely to report depression symptoms. Most patients found the HADS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their hospital anxiety and depression.Our Arabic version of HADS is a reliable and valid tool to assess the mood states in hospitalized patients.

    View details for DOI 10.4103/sja.SJA_43_17

    View details for PubMedID 28616000

    View details for PubMedCentralID PMC5463562

  • Development and validation of Arabic version of the douleur neuropathique 4 questionnaire. Saudi journal of anaesthesia Terkawi, A. S., Abolkhair, A., Didier, B., Alzhahrani, T., Alsohaibani, M., Terkawi, Y. S., Almoqbali, Y., Tolba, Y. Y., Pangililan, E., Foula, F., Tsang, S. 2017; 11 (Suppl 1): S31?S39

    Abstract

    The douleur neuropathique 4 (DN4) questionnaire is a widely used tool for diagnosis of neuropathic pain (NP). The aim was to translate, culturally adapt, and validate the DN4 questionnaire in Arabic.A systematic translation process was used to translate the original English DN4 into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. The reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficients. We examined the validity of the Arabic DN4 via construct validity, concurrent validity (associations with the numeric rating scale, brief pain inventory, and Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated DN4 was administered twice among the same group of patients.A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's ? was 0.67 (95% confidence interval [CI]: 0.59-0.75), and interclass correlation coefficients was 0.81 (95% CI: 0.76-0.87). The DN4 was moderately associated with the S-LANSS questionnaire. Results showed our Arabic DN4 to have good diagnostic accuracy, with area under the curve of 0.88 (95% CI: 0.82-0.94). As with the original version, a score of ?4 was found to be the best cut-off for the diagnosis of NP, with a sensitivity of 88.31%, specificity of 74.47%, a positive predictive value of 85%, and a negative predictive value of 80%. Most patients found the DN4 questionnaire to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain.Our Arabic version of the DN4 is a reliable and valid screening tool that can be easily administered among patients to differentiate between NP and non-NP.

    View details for DOI 10.4103/sja.SJA_97_17

    View details for PubMedID 28616002

    View details for PubMedCentralID PMC5463565

  • Development and validation of Arabic version of the pain catastrophizing scale. Saudi journal of anaesthesia Terkawi, A. S., Sullivan, M., Abolkhair, A., Al-Zhahrani, T., Terkawi, R. S., Alasfar, E. M., Khait, S. S., Elkabbani, A., Kabbani, N., Altirkawi, K. A., Tsang, S. 2017; 11 (Suppl 1): S63?S70

    Abstract

    The pain catastrophizing scale (PCS) is the most widely used tool to assess pain catastrophizing. The aim of this study was to translate, culturally adapt, and validate the PCS questionnaire in Arabic.A systematic translation process was used to translate the original English PCS into Arabic. After the pilot study, we validated our version among patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations with Brief Pain Inventory [BPI]), and face validity.A total of 113 subjects (50 men, 63 women) were included in the study. Cronbach's ? was 0.94 (95% confidence interval [CI]: 0.92-0.96), and interclass correlation coefficients was 0.83 (95% CI: 0.77-0.89) for the total scale. There was no statistically significant difference in the total PCS scores between patients who reported experiencing current pain and those who did not. Among patients who reported having current pain, pain severity was weakly associated with the total PCS scores (r = 0.22, P = 0.03). PCS and its subscales were not statistically significantly associated with any of the BPI items. Nonetheless, patients who were diagnosed with neuropathic pain had statistically significantly higher scores on the total PCS, rumination, and helplessness subscales. Most patients found the PCS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain catastrophizing.Our translated version of PCS is reliable and valid for use among Arabic-speaking patients.

    View details for DOI 10.4103/sja.SJA_130_17

    View details for PubMedID 28616005

    View details for PubMedCentralID PMC5463568

  • Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi journal of anaesthesia Tsang, S., Royse, C. F., Terkawi, A. S. 2017; 11 (Suppl 1): S80?S89

    Abstract

    The task of developing a new questionnaire or translating an existing questionnaire into a different language might be overwhelming. The greatest challenge perhaps is to come up with a questionnaire that is psychometrically sound, and is efficient and effective for use in research and clinical settings. This article provides guidelines for the development and translation of questionnaires for application in medical fields, with a special emphasis on perioperative and pain medicine. We provide a framework to guide researchers through the various stages of questionnaire development and translation. To ensure that the questionnaires are psychometrically sound, we present a number of statistical methods to assess the reliability and validity of the questionnaires.

    View details for DOI 10.4103/sja.SJA_203_17

    View details for PubMedID 28616007

    View details for PubMedCentralID PMC5463570

  • 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

  • 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

  • Development and validation of Arabic version of the postoperative quality of recovery-40 questionnaire. Saudi journal of anaesthesia Terkawi, A. S., Myles, P. S., Riad, W., Nassar, S. N., Mahmoud, M., AlKahtani, G. J., Sala, F. J., Abdulrahman, A., Doais, K. S., Terkawi, R. S., Tsang, S. 2017; 11 (Suppl 1): S40?S52

    Abstract

    The postoperative quality of recovery-40 (QoR-40) is one of the most frequently used tools to assess the quality of recovery after surgery. The aim of the current study was to translate, culturally adapt, and validate the QoR-40 questionnaire in Arabic.A systematic translation process was used to translate the original English QoR-40 into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. The reliability (using internal consistency) and validity of our translated Arabic version was examined. To investigate the responsiveness of the translated QoR-40, the questionnaire was administered five times among the same group of patients (once before surgery as baseline measure, and four times after surgery, up to 1 week after surgery).A total of 182 participants (7 men, 175 women) were included in the study. The QoR-40 total scale and all subscales showed excellent internal consistencies over time, with the exception of the QoR-40 pain subscale at postoperative day 1. The QoR-40 total and subscale scores were inversely associated with patients' self-report pain scores but positively correlated with patients' self-report recovery scores. Patients' QoR-40 total, comfort, emotions, and physical subscale scores increased over time after surgery, indicating a general trend of recovery over time. Patients' scores in the QoR-40 pain and support subscales remained stable over time, suggesting no substantial changes were reported in these two domains. Quality of recovery was also found to be related to patients' ages, American Society of Anesthesiologists Physical Status, and the extent of surgery (major vs. minor). Most patients found the Arabic QoR-40 questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery.Our translated version of QoR-40 was reliable and valid for use among Arabic-speaking patients. In addition, the QoR-40 was able to assess the quality of recovery in several domains among patients who underwent surgical procedures.

    View details for DOI 10.4103/sja.SJA_77_17

    View details for PubMedID 28616003

    View details for PubMedCentralID PMC5463566

  • Development and validation of Arabic version of the postoperative quality of recovery scale. Saudi journal of anaesthesia Terkawi, A. S., Tsang, S., Riad, W., Nassar, S. N., Mahmoud, M., AlKahtani, G. J., Alsharif, H. H., Doais, K. S., Sala, F. J., Abdulrahman, A., Royse, C. F. 2017; 11 (Suppl 1): S19?S30

    Abstract

    The postoperative quality of recovery scale (PostopQRS) is a widely used tool to assess the postoperative quality of recovery. Our aim was to translate, culturally adapt, and validate the PostopQRS questionnaire in Arabic.A systematic translation process was used to translate the original English PostopQRS into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. We examined the reliability (using internal consistency) and validity of the translated version. To examine the responsiveness of the translated PostopQRS, the questionnaire was administered 6 times among the same group of patients (once before surgery as baseline measure, and 5 times after surgery, up to 1 week after surgery).A total of 190 patients (10 men, 180 women) were included. Internal consistencies vary across each domain and overtime, with mostly good to excellent reliability. Most patients found the PostopQRS questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery. In general, patients showed recovery across all five domains starting from postoperative day 1 (POD1). Patients showed the fastest recovery in the emotional domain, and the proportion of recovered patients remained stable over time. Most patients were recovered in the cognitive domain by POD1. Although only a small proportion of patients were recovered in the physiological and activities of daily living domains in POD1, most patients were recovered by POD3. The proportion of patients recovered in the nociceptive domain declined initially, but more patients showed recovery by POD3 and most were recovered by POD7. Furthermore, quality of recovery was related to the extent of surgery (major vs. minor).Our translated version of PostopQRS was reliable and valid for use among Arabic-speaking patients. In addition, we showed that the PostopQRS was able to track the changes in recovery among patients in our study.

    View details for DOI 10.4103/sja.SJA_68_17

    View details for PubMedID 28616001

    View details for PubMedCentralID PMC5463563

  • Pain Management Modalities after Total Knee Arthroplasty: A Network Meta-analysis of 170 Randomized Controlled Trials. Anesthesiology Terkawi, A. S., Mavridis, D., Sessler, D. I., Nunemaker, M. S., Doais, K. S., Terkawi, R. S., Terkawi, Y. S., Petropoulou, M., Nemergut, E. C. 2017; 126 (5): 923?37

    Abstract

    Optimal analgesia for total knee arthroplasty remains challenging. Many modalities have been used, including peripheral nerve block, periarticular infiltration, and epidural analgesia. However, the relative efficacy of various modalities remains unknown. The authors aimed to quantify and rank order the efficacy of available analgesic modalities for various clinically important outcomes.The authors searched multiple databases, each from inception until July 15, 2016. The authors used random-effects network meta-analysis. For measurements repeated over time, such as pain, the authors considered all time points to enhance reliability of the overall effect estimate. Outcomes considered included pain scores, opioid consumption, rehabilitation profile, quality of recovery, and complications. The authors defined the optimal modality as the one that best balanced pain scores, opioid consumption, and range of motion in the initial 72 postoperative hours.The authors identified 170 trials (12,530 patients) assessing 17 treatment modalities. Overall inconsistency and heterogeneity were acceptable. Based on the surface under the cumulative ranking curve, the best five for pain at rest were femoral/obturator, femoral/sciatic/obturator, lumbar plexus/sciatic, femoral/sciatic, and fascia iliaca compartment blocks. For reducing opioid consumption, the best five were femoral/sciatic/obturator, femoral/obturator, lumbar plexus/sciatic, lumbar plexus, and femoral/sciatic blocks. The best modality for range of motion was femoral/sciatic blocks. Femoral/sciatic and femoral/obturator blocks best met our criteria for optimal performance. Considering only high-quality studies, femoral/sciatic seemed best.Blocking multiple nerves was preferable to blocking any single nerve, periarticular infiltration, or epidural analgesia. The combination of femoral and sciatic nerve block appears to be the overall best approach. Rehabilitation parameters remain markedly understudied.

    View details for DOI 10.1097/ALN.0000000000001607

    View details for PubMedID 28288050

  • The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PloS one Charara, R., Forouzanfar, M., Naghavi, M., Moradi-Lakeh, M., Afshin, A., Vos, T., Daoud, F., Wang, H., El Bcheraoui, C., Khalil, I., Hamadeh, R. R., Khosravi, A., Rahimi-Movaghar, V., Khader, Y., Al-Hamad, N., Makhlouf Obermeyer, C., Rafay, A., Asghar, R., Rana, S. M., Shaheen, A., Abu-Rmeileh, N. M., Husseini, A., Abu-Raddad, L. J., Khoja, T., Al Rayess, Z. A., AlBuhairan, F. S., Hsairi, M., Alomari, M. A., Ali, R., Roshandel, G., Terkawi, A. S., Hamidi, S., Refaat, A. H., Westerman, R., Kiadaliri, A. A., Akanda, A. S., Ali, S. D., Bacha, U., Badawi, A., Bazargan-Hejazi, S., Faghmous, I. A., Fereshtehnejad, S. M., Fischer, F., Jonas, J. B., Kuate Defo, B., Mehari, A., Omer, S. B., Pourmalek, F., Uthman, O. A., Mokdad, A. A., Maalouf, F. T., Abd-Allah, F., Akseer, N., Arya, D., Borschmann, R., Brazinova, A., Brugha, T. S., Catalá-López, F., Degenhardt, L., Ferrari, A., Haro, J. M., Horino, M., Hornberger, J. C., Huang, H., Kieling, C., Kim, D., Kim, Y., Knudsen, A. K., Mitchell, P. B., Patton, G., Sagar, R., Satpathy, M., Savuon, K., Seedat, S., Shiue, I., Skogen, J. C., Stein, D. J., Tabb, K. M., Whiteford, H. A., Yip, P., Yonemoto, N., Murray, C. J., Mokdad, A. H. 2017; 12 (1): e0169575

    Abstract

    The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

    View details for DOI 10.1371/journal.pone.0169575

    View details for PubMedID 28095477

    View details for PubMedCentralID PMC5240956

  • Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Wang, H., Bhutta, Z. A., Coates, M. M., Coggeshall, M., Dandona, L., Diallo, K., Franca, E., Fraser, M., Fullman, N., Gething, P. W., Hay, S. I., Kinfu, Y., Kita, M., Kulikoff, X., Larson, H. J., Liang, J., Liang, X., Lim, S. S., Lind, M., Lopez, A. D., Lozano, R., Mensah, G. A., Mikesell, J. B., Mokdad, A. H., Mooney, M. D., Naghavi, M., Nguyen, G., Rakovac, I., Salomon, J. A., Silpakit, N., Sligar, A., Sorensen, R. D., Vos, T., Zhu, J., Abajobir, A., Abate, K., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S., Aboyans, V., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Abyu, G., Achoki, T., Adebiyi, A., Adedeji, I., Adelekan, A., Adou, A., Agarwal, A., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Alam, K., Alam, N. M., Alasfoor, D., Aldridge, R., Alegretti, M., Alemu, Z., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A., Ameh, E. A., Ammar, W., Amrock, S., Andersen, H. H., Anderson, G. M., Antonio, C. T., Arlov, J., Artaman, A., Asayesh, H., Asghar, R., Assadi, R., Atique, S., Avokpaho, E., Awasthi, A., Quintanilla, B., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Banigbe, B. F., Barac, A., Barber, R. M., Barker-Collo, S. L., Barnighausen, T., Barrero, L. H., Bayou, T., Bayou, Y., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B., Beyene, A., Bhatt, S., Biadgilign, S., Bikbov, B., Birlik, S., Bisanzio, D., Bjertness, E., Blore, J. D., Bourne, R. A., Brainin, M., Brazinova, A., Breitborde, N. K., Brown, A., Colin Buckle, G., Burch, M., Butt, Z. A., Ricardo Campos-Nonato, I., Cesar Campuzano, J., Cardenas, R., Carpenter, D. O., Jesus Carrero, J., Carter, A., Casey, D. C., Castaneda-Orjuela, C. A., Rivas, J., Castro, R., Catala-Lopez, F., Cercy, K., Chang, H., Chang, J., Chibueze, C., Chisumpa, V., Choi, J., Chowdhury, R., Christopher, D., Ciobanu, L. G., Colquhoun, S. M., Cooper, C., Cornaby, L., Damtew, S., Danawi, H., Dandona, R., das Neves, J., Davis, A. C., de Jager, P., De Leo, D., Degenhardt, L., Deribe, K., Deribew, A., Jarlais, D., deVeber, G. A., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Doshi, P., Doyle, K. E., Duan, L., Dubey, M., Ebrahimi, H., Ellingsen, C., Elyazar, I., Endries, A., Ermakov, S., Eshrati, B., Esteghamati, A., Faraon, E., Farid, T. A., Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. A., Foigt, N., Franklin, R. C., Friedman, J., Furst, T., Gambashidze, K., Gamkrelidze, A., Ganguly, P., Gebre, T., Gebrehiwot, T., Gebremedhin, A., Gebru, A., Geleijnse, J. M., Gessner, B. D., Ginawi, I., Giref, A., Gishu, M., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S., Goto, A., Gouda, H. N., Gugnani, H., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gyawali, B., Haagsma, J. A., Hafezi-Nejad, N., Haile, D., Hailu, A., Hailu, G., Hamadeh, R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Harun, K. M., Havmoeller, R., Hay, R. J., Heredia-Pi, I., Hoek, H. W., Horino, M., Horita, N., Hosgood, H., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, C., Huang, J. J., Huang, H., Huiart, L., Huynh, C., Iburg, K., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jahanmehr, N., Javanbakht, M., Jayatilleke, A., Jee, S., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Kang, G., Karch, A., Karema, C., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J., Kazanjan, K., Keiyoro, P., Kemp, A., Kengne, A., Keren, A., Kereselidze, M., Kesavachandran, C., Khader, Y., Khalil, I. A., Khan, A., Khan, E., Khang, Y., Khonelidze, I., Khubchandani, J., Kim, C., Kim, D., Kim, Y., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B., Bicer, B., Kudom, A. A., Kumar, G., Kutz, M. J., Kyu, H. H., Lal, D., Lalloo, R., Lam, H., Lam, J. O., Lansingh, V. C., Larsson, A., Leigh, J., Leung, R., Li, Y., Li, Y., Lindsay, M., Liu, P. Y., Liu, S., Lloyd, B. K., Lo, W. D., Logroscino, G., Low, N., Lunevicius, R., Lyons, R. A., Ma, S., Abd El Razek, H., Abd El Razek, M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Martinez-Raga, J., Marzan, M., Masiye, F., McGrath, J. J., Meaney, P. A., Mehari, A., Mehndiratta, M., Mekonnen, A. B., Melaku, Y., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mock, C. N., Mohammad, K., Mohammadi, A., Mohammed, S. U., Monasta, L., Hernandez, J., Montico, M., Moore, A. R., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U. O., Murphy, G. V., Murthy, S., Nachega, J. B., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Neupane, S., Newton, C. R., Newton, J. N., Ng, M., Ngalesoni, F., Nguhiu, P., Quyen Le Nguyen, Nisar, M., Pete, P., Norheim, O. F., Norman, R. E., Ogbo, F., Oh, I., Ojelabi, F., Olivares, P. R., Olusanya, B., Olusanya, J., Oren, E., Ota, E., Mahesh, P. A., Park, E., Park, H., Parsaeian, M., Caicedo, A., Patten, S. B., Pedro, J., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M., Pillay, J., Pishgar, F., Polinder, S., Pope, D., Popova, S., Pourmalek, F., Qorbani, M., Rabiee, R. S., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, S., Rai, R., Raju, M., Ram, U., Rana, S. M., Ranabhat, C., Rao, P., Refaat, A. H., Remuzzi, G., Resnikoff, S., Reynolds, A., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Roy, A., Ruhago, G., Sagar, R., Saleh, M., Sanabria, J. R., Sanchez-Nino, M., Santos, I. S., Santos, J., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schneider, I. C., Schottker, B., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Setegn, T., Shahraz, S., Shaikh, M., Shakh-Nazarova, M., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shibuya, K., Shin, H., Shin, M., Shiri, R., Shuie, I., Sigfusdottir, I., Silva, D., Silverberg, J., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, O., Singh, P., Singh, V., Soriano, J. B., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tavakkoli, M., Taye, B., Tedla, B., Tefera, W., Tekle, T., Shifa, G., Terkawi, A., Tesfay, F., Tessema, G., Thapa, K., Thomson, A. J., Thorne-Lyman, A. L., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B., Troeger, C., Truelsen, T., Dimbuene, Z., Tura, A., Tyrovolas, S., Ukwaja, K. N., Uneke, C., Uthman, O. A., Vaezghasemi, M., Vasankari, T., Vasconcelos, A., Venketasubramanian, N., Verma, R., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollset, S., Wang, L., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Widdowson, M., Wijeratne, T., Williams, T., Wiysonge, C., Wolfe, C. A., Wolfe, I., Won, S., Wubshet, M., Xiao, Q., Xu, G., Yadav, A., Yakob, B., Yano, Y., Yaseri, M., Ye, P., Yebyo, H., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M., Zeeb, H., Zhang, H., Zhao, Y., Zheng, Y., Zhou, M., Zodpey, S., Murray, C. L., GBD 2015 Child Mortality Collabora 2016; 388 (10053): 1725?74

    Abstract

    Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone.Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000423462600001

    View details for PubMedID 27733285

    View details for PubMedCentralID PMC5224696

  • 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. B., Ebrahimi, H., Endries, A. Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Farid, T. A., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felicio, M. M., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Ferrari, A. J., Fischer, F., Fitchett, J. R., Fitzmaurice, C., Foigt, N., Foreman, K., Fowkes, F. G., Franca, E. B., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J., Furst, T., Gabbe, B., Garcia-Basteiro, A. L., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebru, A. A., Gessner, B. D., Gillum, R. F., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Godwin, W., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Greenwell, K. F., Griswold, M., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Gyawali, B., Haagsma, J. A., Haakenstad, A., Hafezi-Nejad, N., Haile, D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Harb, H. L., Haro, J. M., Hassanvand, M. S., Havmoeller, R., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Hu, G., Huang, H., Iburg, K. M., Idrisov, B. T., Inoue, M., Islami, F., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., James, P., Jansen, H. A., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, Y., Jibat, T., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Kandel, A., Karch, A., Karema, C. K., KarimIchani, C., Karunapema, P., Kasaeian, A., Kassebaum, N. J., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khang, Y., Khoja, T. A., Khosravi, A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kim, S., Kim, Y. J., Kimokoti, R. W., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kolte, D., Kosen, S., Kotsakis, G. A., Koul, P. 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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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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 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. S., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shi, P., Shibuya, K., Shigematsu, M., Shin, M., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silva, D. A., Alves Silveira, D. G., Silverberg, J. I., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, P. K., Slepak, E. L., Soljak, M., Soneji, S., Sorensen, R. J., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Steckling, N., Steel, N., Stein, D. J., Stein, M. B., Stockl, H., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Takahashi, K., Talongwa, R. T., Landon, N., Tanne, D., Tavakkoli, M., Taye, B. W., Taylor, H. R., Tedla, B. A., Tefera, W. M., Tegegne, T. K., Tekle, D. Y., Terkawi, A. S., Thakur, J. S., Thomas, B. A., Thomas, M. L., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobe-Gai, R., Tobollik, M., Topor-Madry, R., Topouzis, F., Towbin, J. A., Bach Xuan Tran, B. X., Dimbuene, Z. T., Tsilimparis, N., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Donkelaar, A., van Os, J., Varakin, Y. Y., Vasankari, T., Veerman, J. L., Venketasubramanian, N., Violante, F. S., Vollset, S. E., Wagner, G. R., Waller, S. G., Wang, J., Wang, L., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., Whiteford, H. A., Wijeratne, T., Wiysonge, C. S., Wolfe, C. D., Won, S., Woolf, A. D., Wubshet, M., Xavier, D., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yano, Y., Yaseri, M., Ye, P., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zhu, J., Zipkin, B., Zodpey, S., Zuhlke, L. J., Murray, C. J. 2016; 388 (10053): 1659-1724

    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 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

  • Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Wang, H., Naghavi, M., Allen, C., Barber, R. M., Bhutta, Z. A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coates, M. M., Coggeshall, M., Dandona, L., Dicker, D. J., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Foreman, K., Forouzanfar, M. H., Fraser, M. S., Pullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Hay, S. I., Huynh, C., Johnson, C., Kassebaum, N. J., Kinfu, Y., Kulikoff, X. R., Kutz, M., Kyu, H. H., Larson, H. J., Leung, J., Liang, X., Lim, S. S., Lind, M., Lozano, R., Marquez, N., Mensah, G. A., Mikesell, J., Mokdad, A. H., Mooney, M. D., Nguyen, G., Nsoesie, E., Pigott, D. M., Pinho, C., Roth, G. A., Salomon, J. A., Sandar, L., Silpakit, N., Sligar, A., Sorensen, R. J., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., VanderZanden, A., Vollset, S. E., Wanga, V., Whiteford, H. A., Wolock, T., Zoeckler, L., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Abreu, D. M., Abu-Raddad, L. J., Abyu, G. Y., Achoki, T., Adelekan, A. L., Ademi, Z., Adou, A. K., Adsuar, J. C., Afanvi, K. A., Afshin, A., Agardh, E. E., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ajala, O. N., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al Lami, F. H., Alabed, S., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alexander, L. T., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amegah, A. K., Ameh, E. A., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B., Anderson, G. M., Antonio, C. A., Aregay, A. F., Arnlov, J., Arsenijevic, V. S., Al Artaman, Asayesh, H., Asghar, R. J., Atique, S., Arthur Avokpaho, E. F., Awasthi, A., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Barregard, L., Barrero, L. H., Basu, A., Basu, S., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Belay, H. A., Bell, B., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhalla, A., Biadgilign, S., Bikbov, B., Bin Abdulhak, A. A., Biroscak, B. J., Biryukov, S., Bjertness, E., Blore, J. D., Blosser, C. D., Bohensky, M. A., Borschmann, R., Bose, D., Bourne, R. R., Brainin, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Brewer, J. D., Brown, A., Brown, J., Brugha, T. S., Buckle, G. C., Butt, Z. A., Calabria, B., Campos-Novato, I. R., Campuzano, J. C., Carapetis, J. R., Cardenas, R., Carpenter, D., Carrero, J. J., Castaneda-Oquela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Cercy, K., Cerda, J., Chen, W., Chew, A., Chiang, P. P., Chibalabala, M., Chibueze, C. E., Chimed-Ochir, O., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colistro, V., Colomar, M., Colquhoun, S. M., Cooper, C., Cooper, L. T., Cortinovis, M., Cowie, B. C., Crump, J. A., Damsere-Derry, J., Danawi, H., Dandona, R., Daoud, F., Darby, S. C., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., Davitoiu, D. V., de Castro, E. F., de Jager, P., De Leo, D., Degenhardt, L., Dellavalle, R. P., Deribe, K., Deribew, A., Dharmaratne, S. D., Dhillon, P. K., Diaz-Torne, C., Ding, E. L., dos Santos, K. P., Dossou, E., Driscoll, T. R., Duan, L., Dubey, M., Bartholow, B., Ellenbogen, R. G., Lycke, C., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Faghmous, I. D., Fahimi, S., Jose, E., 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., Flaxman, A., Foigt, N., Fowkes, F. G., Franca, E. B., Franklin, R. C., Friedman, J., Frostad, J., Hirst, T., Futran, N. D., Gall, S. L., Gambashidze, K., Gamkrelidze, A., Ganguly, P., Gankpe, F. G., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebru, A. A., Geleijnse, J. M., Gessner, B. D., Ghoshal, A. G., Gibney, K. B., Gillum, R. F., Gilmour, S., Giref, A. Z., Giroud, M., Gishu, M. D., Giussani, G., Glaser, E., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Greaves, F., Gugnani, H. C., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Hafezi-Nejad, N., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J. M., Havmoeller, R., Heckbert, S. R., Heredia-Pi, I. B., Heydarpour, P., Hilderink, H. B., Hoek, H. W., Hogg, R. S., Horino, M., Horita, N., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A. S., Than Htike, M. M., Hu, G., Huang, C., Huang, H., Huiart, L., Husseini, A., Huybrechts, I., Huynh, G., Iburg, K. M., Innos, K., Inoue, M., Iyer, V. J., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., James, P., Javanbakht, M., Jayaraman, S. P., Jayatilleke, A. U., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jonas, J. B., Joshi, T. K., Kabir, Z., Karnak, R., Kan, H., Kant, S., Karch, A., Karema, C. K., Karimkhani, C., Karletsos, D., Karthikeyan, G., Kasaeian, A., Katibeh, M., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Kesavachandran, C. N., Khader, Y. S., Khalil, I. A., Khan, A. R., Khan, E. A., Khang, Y., Khera, S., Muthafer Khoja, T. A., Kieling, C., Kim, D., Kim, Y. J., Kissela, B. M., Kissoon, N., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Krog, N. H., Defo, B. K., Bicer, B. K., Kudom, A. A., Kuipers, E. J., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lal, A., Lal, D. K., Lalloo, R., Lam, H., Lam, J. O., Langan, S. M., Lansingh, V. C., Larsson, A., Laryea, D. O., Latif, A. A., Lawrynowicz, A. E., Leigh, J., Levi, M., Li, Y., Lindsay, M. P., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lo, L., Logroscino, G., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., Pedro Machado, V. M., Mackay, M. T., Maclachlan, J. H., Abd El Razek, H. M., Abd El Razek, M. M., Majdan, M., Majeed, A., Malekzadeh, R., Ayele Manamo, W. A., Mandisarisa, J., Mangalam, S., Mapoma, C. C., Marcenes, W., Margolis, D. J., Martin, G. R., Martinez-Raga, J., Marzan, M. B., Masiye, F., Mason-Jones, A. J., Massano, J., Matzopoulos, R., Mayosi, B. M., McGarvey, S. T., McGrath, J. J., McKee, M., McMahon, B. 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

  • 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

  • Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015 LANCET HIV Wang, H., Wolock, T. M., Carter, A., Nguyen, G., Kyu, H. H., Gakidou, E., Hay, S. I., Mills, E. J., Trickey, A., Msemburi, W., Coates, M. M., Mooney, M. D., Fraser, M. S., Sligar, A., Salomon, J., Larson, H. J., Friedman, J., Abajobir, A. A., Abate, K. H., Abbas, K. M., Abd El Razek, M. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Adebiyi, A. O., Adedeji, I. A., Adelekan, A. L., Adofo, K., Adou, A. K., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Al Lami, F. H., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R. M., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Ammar, W., Amrock, S. M., Antonio, C. A., Anwari, P., Arnlov, J., Al Artaman, Asayesh, H., Asghar, R. J., Assadi, R., Atique, S., Atkins, L. S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Bacha, U., Badawi, A., Barac, A., Barnighausen, T., Basu, A., Bayou, T. A., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Bennett, D. A., Bensenor, I. M., Betsu, B. D., Beyene, A. S., Bhatia, E., Bhutta, Z. A., Biadgilign, S., Bikbov, B., Birlik, S. M., Bisanzio, D., Brainin, M., Brazinova, A., Breitborde, N. J., Brown, A., Burch, M., Butt, Z. A., Campuzano, J. C., Cardenas, R., Carrero, J. J., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Chang, H., Chang, J., Chavan, L., Chen, W., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. J., Christopher, D. J., Ciobanu, L. G., Cooper, C., Dahiru, T., Damtew, S. A., Dandona, L., Dandona, R., das Neves, J., de Jager, P., De Leo, D., Degenhardt, L., Dellavalle, R. P., Deribe, K., Deribew, A., Jarlais, D. C., Dharmaratne, S. D., Ding, E. L., Doshi, P. P., Driscoll, T. R., Dubey, M., Elshrek, Y. M., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Faghmous, I. D., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foigt, N., Fullman, N., Furst, T., Gankpe, F. G., Gebre, T., Gebremedhin, A. T., Gebru, A. A., Geleijnse, J. M., Gessner, B. D., Gething, P. W., Ghiwot, T. T., Giroud, M., Gishu, M. D., Glaser, E., Goenka, S., Goodridge, A., Gopalani, S. V., Goto, A., Gugnani, H. C., Guimaraes, M. D., Gupta, R., Gupta, R., Gupta, V., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J. M., Harun, K. M., Havmoeller, R., Hedayati, M. T., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Hu, G., Huang, H., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jonas, J. B., Kabir, Z., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karletsos, D., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemp, A. H., Kengne, A. P., Kesavachandran, C. N., Khader, Y. S., Khalil, I., Khan, A. R., Khan, E. A., Khang, Y., Khubchandani, J., Kim, Y. J., Kinfu, Y., Kivipelto, M., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B. K., Bicer, B. K., Kulkarni, V. S., Kumar, G. A., Lal, D. K., Lam, H., Lam, J. O., Langan, S. M., Lansingh, V. C., Larsson, A., Leigh, J., Leung, R., Li, Y., Lim, S. S., Lipshultz, S. E., Liu, S., Lloyd, B. K., Logroscino, G., Lotufo, P. A., Lunevicius, R., Abd El Razek, H. M., Mahdavi, M., Majdan, M., Majeed, A., Makhlouf, C., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Martinez-Raga, J., Marzan, M. B., Masiye, F., Mason-Jones, A. J., Mayosi, B. M., McKee, M., Meaney, P. A., Mehndiratta, M. M., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Miller, T. R., Mikesell, J., Mirarefin, M., Mohammad, K. A., Mohammed, S., Mokdad, A. H., Monasta, L., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Murimira, B., Murthy, G. V., Naheed, A., Naldi, L., Nangia, V., Nash, D., Nawaz, H., Nejjari, C., Ngalesoni, F. N., Ngirabega, J. d., Quyen Le Nguyen, Q., Nisar, M. I., Norheim, O. F., Norman, R. E., Nyakarahuka, L., Ogbo, F. A., Oh, I., Ojelabi, F. A., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ota, E., Padukudru, M. A., Park, H., Park, J., Patil, S. T., Patten, S. B., Paul, V. K., Pearson, K., Peprah, E. K., Pereira, C. C., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Pillay, J. D., Plass, D., Polinder, S., Pourmalek, F., Prokop, D. M., Qorbani, M., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Ram, U., Rana, S. M., Rao, P. V., Remuzzi, G., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roy, A., Ruhago, G. M., Saeedi, M. Y., Sagar, R., Saleh, M. M., Sanabria, J. R., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Sawhney, M., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shaikh, M. A., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Shibuya, K., Shin, H. H., Sigfusdottir, I. D., Silpakit, N., Santos Silva, D. A., Alves Silveira, D. G., Simard, E. P., Sindi, S., Singh, J. A., Singh, O. P., Singh, P. K., Skirbekk, V., Sliwa, K., Soneji, S., Sorensen, R. J., Soriano, J. B., Soti, D. O., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Tabares-Seisdedos, R., Talongwa, R. T., Tavakkoli, M., Taye, B., Tedla, B. A., Tekle, T., Shifa, G. T., Temesgen, A. M., Terkawi, A. S., Tesfay, F. H., Tessema, G. A., Thapa, K., Thomson, A. J., Thorne-Lyman, A. L., Tobe-Gai, R., Topor-Madry, R., Towbin, J. A., Bach Xuan Tran, B. X., Dimbuene, Z. T., Tsilimparis, N., Tura, A. K., Ukwaja, K. N., Uneke, C. J., Uthman, O. A., Venketasubramanian, N., Vladimirov, S. K., Vlassov, V. V., Vollset, S. E., Wang, L., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., Wijeratne, T., Wilkinson, J. D., Wiysonge, C. S., Wolfe, C. D., Won, S., Wong, J. Q., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yano, Y., Yaseri, M., Yebyo, H. G., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Yu, S., Zaidi, Z., Zaki, M. E., Zeeb, H., Zhang, H., Zhao, Y., Zodpey, S., Zoeckler, L., Zuhlke, L. J., Lopez, A. D., Murray, C. J. 2016; 3 (8): E361-E387

    Abstract

    Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.

    View details for DOI 10.1016/S2352-3018(16)30087-X

    View details for Web of Science ID 000380842400010

    View details for PubMedID 27470028

    View details for PubMedCentralID PMC5056319

  • 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

  • Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. The American journal of tropical medicine and hygiene Khalil, I., Colombara, D. V., Forouzanfar, M. H., Troeger, C., Daoud, F., Moradi-Lakeh, M., Bcheraoui, C. E., Rao, P. C., Afshin, A., Charara, R., Abate, K. H., Razek, M. M., Abd-Allah, F., Abu-Elyazeed, R., Kiadaliri, A. A., Akanda, A. S., Akseer, N., Alam, K., Alasfoor, D., Ali, R., AlMazroa, M. A., Alomari, M. A., Al-Raddadi, R. M., Alsharif, U., Alsowaidi, S., Altirkawi, K. A., Alvis-Guzman, N., Ammar, W., Antonio, C. A., Asayesh, H., Asghar, R. J., Atique, S., Awasthi, A., Bacha, U., Badawi, A., Barac, A., Bedi, N., Bekele, T., Bensenor, I. M., Betsu, B. D., Bhutta, Z., Abdulhak, A. A., Butt, Z. A., Danawi, H., Dubey, M., Endries, A. Y., Faghmous, I. D., Farid, T., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S. M., Fischer, F., Fitchett, J. R., Gibney, K. B., Ginawi, I. A., Gishu, M. D., Gugnani, H. C., Gupta, R., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Harb, H. L., Hedayati, M. T., Hsairi, M., Husseini, A., Jahanmehr, N., Javanbakht, M., Jibat, T., Jonas, J. B., Kasaeian, A., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khoja, T. A., Kinfu, Y., Kissoon, N., Koyanagi, A., Lal, A., Latif, A. A., Lunevicius, R., Razek, H. M., Majeed, A., Malekzadeh, R., Mehari, A., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Misganaw, A., Mohamed, L. A., Nachega, J. B., Nguyen, Q. L., Nisar, M. I., Peprah, E. K., Platts-Mills, J. A., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Rahman, S. U., Rai, R. K., Rana, S. M., Ranabhat, C. L., Rao, S. R., Refaat, A. H., Riddle, M., Roshandel, G., Ruhago, G. M., Saleh, M. M., Sanabria, J. R., Sawhney, M., Sepanlou, S. G., Setegn, T., Sliwa, K., Sreeramareddy, C. T., Sykes, B. L., Tavakkoli, M., Tedla, B. A., Terkawi, A. S., Ukwaja, K., Uthman, O. A., Westerman, R., Wubshet, M., Yenesew, M. A., Yonemoto, N., Younis, M. Z., Zaidi, Z., Zaki, M. E., Rabeeah, A. A., Wang, H., Naghavi, M., Vos, T., Lopez, A. D., Murray, C. J., Mokdad, A. H. 2016; 95 (6): 1319?29

    Abstract

    Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

    View details for DOI 10.4269/ajtmh.16-0339

    View details for PubMedID 27928080

    View details for PubMedCentralID PMC5154365

  • Flexible bronchoscopy in children: Utility and complications. International journal of pediatrics & adolescent medicine Terkawi, R. S., Altirkawi, K. A., Terkawi, A. S., Mukhtar, G., Al-Shamrani, A. 2016; 3 (1): 18?27

    Abstract

    The flexible bronchoscope has become widely used by pediatric pulmonologists as a diagnostic and therapeutic tool. Nevertheless, there are several gaps in our knowledge to help refine its use and reduce its complications. In this study, we aimed to evaluate the utility and complications of pediatric bronchoscopy.We conducted a retrospective review of bronchoscopy cases between March 2006 and April 2015 at a tertiary care medical center (King Fahad Medical City). One-hundred forty nine patients were studied.We evaluated how bronchoscopy contributed to the patients' diagnosis, assessed the accuracy of bronchoalveolar lavage white blood cell count (BAL WBC) to differentiate between infectious and non-infectious conditions, assessed the ability of clinical factors to predict high risk of desaturation during bronchoscopy, and finally summarized the reported procedural complications.We found pediatric bronchoscopy was a crucial diagnostic (confirming, ruling out, and discovering unexpected diagnosis) and therapeutic tool. The accuracy of BAL WBC counts is poor (AUC (95% CI) = 0.609 (0.497-0.712)); however, using two cutoff values (?10 WBCs (sensitivity = 84.44% and specificity = 29.27%) to rule out, and ?400 WBCs (sensitivity = 33.33% and specificity 81.49%) to rule in infection) helped in early differentiation between infectious and non-infectious conditions. From the factors that we test, none we found predictive of desaturation. The most common procedural complication was desaturation (pooled incidence (95% CI) = 13 (8-19)%) followed by cough, mild airway bleeding, and spasm.Flexible bronchoscopy is an important and relatively safe diagnostic and therapeutic tool in pediatric medicine, and utilization of this service should be encouraged after a careful consideration of which patient needs this procedure and a rigorous estimate of its pros and cons.

    View details for DOI 10.1016/j.ijpam.2015.12.003

    View details for PubMedID 30805463

    View details for PubMedCentralID PMC6372410

  • Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis. Journal of anesthesia Terkawi, A. S., Larkin, S. K., Tsang, S., Sheeran, J. S., Tiouririne, M. 2016; 30 (5): 796?802

    Abstract

    Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use.We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group).Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intraoperative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group.Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.

    View details for DOI 10.1007/s00540-016-2208-z

    View details for PubMedID 27364518

    View details for PubMedCentralID PMC5467153

  • Comparison of SEER Sonorheometry With Rotational Thromboelastometry and Laboratory Parameters in Cardiac Surgery. Anesthesia and analgesia Huffmyer, J. L., Fernandez, L. G., Haghighian, C., Terkawi, A. S., Groves, D. S. 2016; 123 (6): 1390?99

    Abstract

    The Quantra Hemostasis Analyzer is a novel diagnostic device that uses an ultrasound-based technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to characterize the dynamic changes in viscoelastic properties of a blood sample during coagulation. Cardiac surgery utilizing cardiopulmonary bypass (CPB) is associated with a significant impact on the coagulation system and can result in perioperative coagulopathy. The aim of this study was to correlate SEER sonorheometry results to corresponding rotational thromboelastometry (ROTEM) and laboratory parameters obtained before, during, and after CPB.The Quantra uses a multiwell cartridge that performs 4 independent measurements with different combination of reagents. The output test results include Clot Time, Clot Stiffness, Fibrinogen and Platelet Contribution, Clot Time Ratio, and Heparinase Clot Time. Clot Time was compared with ROTEM INTEM clotting time and the adjusted partial thromboplastin time. Clot Stiffness was compared with ROTEM EXTEM. The Fibrinogen Contribution to the Clot Stiffness was correlated to ROTEM FIBTEM as well as fibrinogen concentration by the Clauss method. The Platelet Contribution to Clot Stiffness was compared with absolute platelet count and ROTEM-determined clot elasticity attributable to platelets.Fifty-five patients undergoing elective cardiac surgery were enrolled in this prospective observational study. Clot Time exhibited good correlation with ROTEM INTEM clotting time (pre-CPB r = 0.84, post-CPB r = 0.65) and adjusted partial thromboplastin time (pre-CPB r = 0.72, post-CPB r = 0.89); however, the majority of values were within a narrow normal range. Clot Stiffness exhibited significant correlation with ROTEM EXTEM A10 throughout the course of the study in all samples (r = 0.84). Fibrinogen Contribution correlated strongly with FIBTEM A10 (r = 0.85), and moderately with the fibrinogen concentration (r = 0.73) determined with the Clauss assay. The Platelet Contribution to Clot Stiffness showed moderate correlation to absolute platelet counts (r = 0.48). However, the correlation between Platelet Contribution and ROTEM-determined clot elasticity attributable to platelets was stronger (r = 0.78) than platelet number. All of the correlation coefficients were statistically significant with P < .001.SEER sonorheometry demonstrates significant correlation with ROTEM for determining Clot Stiffness and assessing Fibrinogen Contribution. SEER sonorheometry results can provide valuable information about the coagulation status in patients undergoing cardiac surgery using CPB.

    View details for DOI 10.1213/ANE.0000000000001507

    View details for PubMedID 27749339

  • SEER Sonorheometry Versus Rotational Thromboelastometry in Large Volume Blood Loss Spine Surgery. Anesthesia and analgesia Naik, B. I., Durieux, M. E., Knisely, A., Sharma, J., Bui-Huynh, V. C., Yalamuru, B., Terkawi, A. S., Nemergut, E. C. 2016; 123 (6): 1380?89

    Abstract

    Sonic estimation of elasticity via resonance (SEER) sonorheometry is a novel technology that uses acoustic deformation of the developing clot to measure its viscoelastic properties and extract functional measures of coagulation. Multilevel spine surgery is associated with significant perioperative blood loss, and coagulopathy occurs frequently. The aim of this study was to correlate SEER sonorheometry results with those of equivalent rotation thromboelastometry (ROTEM) and laboratory parameters obtained during deformity correction spine surgery.Four independent SEER sonorheometry hemostatic indices (clot time, clot stiffness, fibrinogen, and platelet contribution) were measured. SEER sonorheometry clot time, using kaolin as an activator, was correlated with ROTEM intrinsic temogram clotting time and the activated partial thromboplastin time. For clot stiffness, thromboplastin was the primary activator, and this was correlated against ROTEM external temogram amplitude at 10 minutes (A10). The assay for the fibrinogen contribution was similar to clot stiffness, but abciximab was added to inhibit platelet function. The fibrinogen contribution assay was correlated with the ROTEM fibrinogen temogram A10. Finally, the SEER sonorheometry platelet contribution was calculated by subtracting the fibrinogen contribution from the clot stiffness. This variable was correlated with both absolute platelet counts, and ROTEM determined clot elasticity attributable to platelets.Fifty-one patients were enrolled in this prospective observational study. SEER sonorheometry clot stiffness, fibrinogen, and platelet contribution had a very strong correlation with ROTEM external temogram A10 (rs = .92; 99% confidence interval, .85-.96), fibrinogen temogram A10 (rs = .90; 99% confidence interval, .83-.93), and ROTEM-determined clot elasticity attributable to platelets (rs = .89; 99% confidence interval, .80-.95). SEER sonorheometry clot time exhibited moderate correlation with ROTEM intrinsic temogram clotting time (rs = .62; 99% confidence interval, .44-.77) and very weak correlation with activated partial thromboplastin time (rs = .33; 99% confidence interval, .10-.51).SEER sonorheometry demonstrates very strong correlation with ROTEM for determining clot stiffness and assessing fibrinogen and platelet contribution to clot strength in major spine surgery. An advantage of SEER sonorheometry is direct measurement of clot elasticity with no need to transform amplitude oscillation to elasticity.

    View details for DOI 10.1213/ANE.0000000000001509

    View details for PubMedID 27584686

  • Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. Global health Mokdad, A. H., Forouzanfar, M. H., Daoud, F., El Bcheraoui, C., Moradi-Lakeh, M., Khalil, I., Afshin, A., Tuffaha, M., Charara, R., Barber, R. M., Wagner, J., Cercy, K., Kravitz, H., Coates, M. M., Robinson, M., Estep, K., Steiner, C., Jaber, S., Mokdad, A. A., O'Rourke, K. F., Chew, A., Kim, P., El Razek, M. M., Abdalla, S., Abd-Allah, F., Abraham, J. P., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Al-Nehmi, A. A., Akanda, A. S., Al Ahmadi, H., Al Khabouri, M. J., Al Lami, F. H., Al Rayess, Z. A., Alasfoor, D., AlBuhairan, F. S., Aldhahri, S. F., Alghnam, S., Alhabib, S., Al-Hamad, N., Ali, R., Ali, S. D., Alkhateeb, M., AlMazroa, M. A., Alomari, M. A., Al-Raddadi, R., Alsharif, U., Al-Sheyab, N., Alsowaidi, S., Al-Thani, M., Altirkawi, K. A., Amare, A. T., Amini, H., Ammar, W., Anwari, P., Asayesh, H., Asghar, R., Assabri, A. M., Assadi, R., Bacha, U., Badawi, A., Bakfalouni, T., Basulaiman, M. O., Bazargan-Hejazi, S., Bedi, N., Bhakta, A. R., Bhutta, Z. A., Bin Abdulhak, A. A., Boufous, S., Bourne, R. R., Danawi, H., Das, J., Deribew, A., Ding, E. L., Durrani, A. M., Elshrek, Y., Ibrahim, M. E., Eshrati, B., Esteghamati, A., Faghmous, I. A., Farzadfar, F., Feigl, A. B., Fereshtehnejad, S. M., Filip, I., Fischer, F., Gankpé, F. G., Ginawi, I., Gishu, M. D., Gupta, R., Habash, R. M., Hafezi-Nejad, N., Hamadeh, R. R., Hamdouni, H., Hamidi, S., Harb, H. L., Hassanvand, M. S., Hedayati, M. T., Heydarpour, P., Hsairi, M., Husseini, A., Jahanmehr, N., Jha, V., Jonas, J. B., Karam, N. E., Kasaeian, A., Kassa, N. A., Kaul, A., Khader, Y., Khalifa, S. E., Khan, E. A., Khan, G., Khoja, T., Khosravi, A., Kinfu, Y., Defo, B. K., Balaji, A. L., Lunevicius, R., Obermeyer, C. M., Malekzadeh, R., Mansourian, M., Marcenes, W., Farid, H. M., Mehari, A., Mehio-Sibai, A., Memish, Z. A., Mensah, G. A., Mohammad, K. A., Nahas, Z., Nasher, J. T., Nawaz, H., Nejjari, C., Nisar, M. I., Omer, S. B., Parsaeian, M., Peprah, E. K., Pervaiz, A., Pourmalek, F., Qato, D. M., Qorbani, M., Radfar, A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. U., Rai, R. K., Rana, S. M., Rao, S. R., Refaat, A. H., Resnikoff, S., Roshandel, G., Saade, G., Saeedi, M. Y., Sahraian, M. A., Saleh, S., Sanchez-Riera, L., Satpathy, M., Sepanlou, S. G., Setegn, T., Shaheen, A., Shahraz, S., Sheikhbahaei, S., Shishani, K., Sliwa, K., Tavakkoli, M., Terkawi, A. S., Uthman, O. A., Westerman, R., Younis, M. Z., El Sayed Zaki, M., Zannad, F., Roth, G. A., Wang, H., Naghavi, M., Vos, T., Al Rabeeah, A. A., Lopez, A. D., Murray, C. J. 2016; 4 (10): e704?13

    Abstract

    The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100?000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100?000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.Bill & Melinda Gates Foundation.

    View details for PubMedID 27568068

  • 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. P., Deribe, K., Derrett, S., Jarlais, D. C., Dessalegn, M., deVeber, G. A., Devries, K. M., Dharmaratne, S. D., Dherani, M. K., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Durrani, A. M., Ebel, B. E., Ellenbogen, R. G., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigin, V. L., Feigl, A. B., Fereshtehnejad, S., Ferrari, A. J., Ferri, C. P., Flaxman, A. D., Fleming, T. D., Foigt, N., Foreman, K. J., Paleo, U. F., Franklin, R. C., Gabbe, B., Gaffikin, L., Gakidou, E., Gamkrelidze, A., Gankpe, F. G., Gansevoort, R. T., Garcia-Guerra, F. A., Gasana, E., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giroud, M., Giussani, G., Goenka, S., Goginashvili, K., Dantes, H. G., Gona, P., de Cosio, T. G., Gonzalez-Castell, D., Gotay, C. C., Goto, A., Gouda, H. N., Guerrant, R. L., Gugnani, H. C., Guillemin, F., Gunnell, D., Gupta, R., Gupta, R., Gutierrez, R. A., Hafezi-Nejad, N., Hagan, H., Hagstromer, M., Halasa, Y. A., Hamadeh, R. R., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Haregu, T. N., Haro, J. M., Havmoeller, R., Hay, S. I., Hedayati, M. T., Heredia-Pi, I. B., Hernandez, L., Heuton, K. R., Heydarpour, P., Hijar, M., Hoek, H. W., Man, H. J., Hornberger, J. C., Hosgood, H. D., Hoy, D. G., Hsairi, M., Hu, G., Hu, H., Huang, C., Huang, J. J., Hubbell, B. J., Huiart, L., Husseini, A., Iannarone, M. L., Iburg, K. M., Idrisov, B. T., Ikeda, N., Innos, K., Inoue, M., Islami, F., Ismayilova, S., Jacobsen, K. H., Jansen, H. A., Jarvis, D. L., Jassal, S. K., Jauregui, A., Jayaraman, S., Jeemon, P., Jensen, P. N., Jha, V., Jiang, F., Jiang, G., Jiang, Y., Jonas, J. B., Juel, K., Kan, H., Roseline, S. S., Karam, N. E., Karch, A., Karema, C. K., Karthikeyan, G., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khatibzadeh, S., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kose, M. R., Kosen, S., Kraemer, A., Kravchenko, M., Krishnaswami, S., Kromhout, H., Ku, T., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D. O., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lindsay, M. P., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Logroscino, G., London, S. J., Lopez, N., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lunevicius, R., Ma, J., Ma, S., Machado, V. M., MacIntyre, M. F., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margolis, D. J., Margono, C., Marks, G. B., Martin, R. V., Marzan, M. B., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matsushita, K., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Hernandez, J. C., Montico, M., Moore, A. R., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Arian, D. M., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murthy, K. S., Naghavi, M., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Neal, B., Nejjari, C., Neupane, S. P., Newton, C. R., Ngalesoni, F. N., Ngirabega, J. d., Nguyen, G., Nguyen, N. T., Nieuwenhuijsen, M. J., Nisar, M. I., Nogueira, J. R., Nolla, J. M., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orozco, R., Pagcatipunan, R. S., Pain, A. W., 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., Pedroza, A., Stokic, L. P., Pekericli, A., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Perry, S. A., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phua, H. P., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Pourmalek, F., Powles, J., Prabhakaran, D., Prasad, N. M., Qato, D. M., Quezada, A. D., Quistberg, D. A., Racape, L., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Rao, M., Razavi, H., Reddy, K. S., Refaat, A. H., Rehm, J., Remuzzi, G., Ribeiro, A. L., Riccio, P. M., Richardson, L., Riederer, A., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Romieu, I., Ronfani, L., Room, R., Roy, N., Ruhago, G. M., Rushton, L., Sabin, N., Sacco, R. L., Saha, S., Sahathevan, R., Sahraian, M. A., Salomon, J. A., Salvo, D., Sampson, U. K., Sanabria, J. R., Sanchez, L. M., Sanchez-Pimienta, T. G., Sanchez-Riera, L., Sandar, L., Santos, I. S., Sapkota, A., Satpathy, M., Saunders, J. E., Sawhney, M., Saylan, M. I., Scarborough, P., Schmidt, J. C., Schneider, I. J., Schoettker, B., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shaddick, G., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, G. M., Singh, J. A., Skirbekk, V., Sliwa, K., Soljak, M., Soneji, S., Soreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stapelberg, N. J., Stathopoulou, V., Steckling, N., Stein, D. J., Stein, M. B., Stephens, N., 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., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Ao, B. J., Teixeira, C. M., Rojo, M. M., Terkawi, A. S., Texcalac-Sangrador, J. L., Thackway, S. V., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobollik, M., Tonelli, M., Topouzis, F., Towbin, J. R., Toyoshima, H., Traebert, J. E., Tran, B. X., Trasande, L., Trillini, M., Trujillo, U., Dimbuene, Z. T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., van de Vijver, S., Van Dingenen, R., van Gool, C. H., van Os, J., Varakin, Y. Y., Vasankari, T. J., Vasconcelos, A. M., Vavilala, M. S., Veerman, L. J., Velasquez-Melendez, G., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Waller, S. G., Wallin, M. T., Wan, X., Wang, H., Wang, J., Wang, L., Wang, W., Wang, Y., Warouw, T. S., Watts, C. H., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wessells, K. R., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, H. C., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wong, J. Q., Woolf, A. D., Wright, J. L., Wurtz, B., Xu, G., Yan, L. L., Yang, G., Yano, Y., Ye, P., Yenesew, M., Yentuer, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Younoussi, Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zhu, S., Zou, X., Zunt, J. R., Lopez, A. D., Vos, T., Murray, C. J. 2015; 386 (10010): 2287-2323

    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. J., Chen, H., Chen, W., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Cirillo, M., Coates, M. M., Coffeng, L. E., Coggeshall, M. S., Colistro, V., Colquhoun, S. M., Cooke, G. S., Cooper, C., Cooper, L. T., Coppola, L. M., Cortinovis, M., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Danawi, H., Dandona, L., Dandona, R., Dansereau, E., Dargan, P. I., Davey, G., Davis, A., Davitoiu, D. V., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Derrett, S., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dherani, M. K., Diaz-Torne, C., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Duber, H. C., Ebel, B. E., Edmond, K. M., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Estep, K., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigin, V. L., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Ferrari, A. J., Fitzmaurice, C., Flaxman, A. D., Fleming, T. D., Foigt, N., Forouzanfar, M. H., Fowkes, F. G., Paleo, U. F., Franklin, R. C., Fuerst, T., Gabbe, B., Gaffikin, L., Gankpe, F. G., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Giroud, M., Giussani, G., Gomez Dantes, H., Gona, P., Gonzalez-Medina, D., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Gugnani, H. C., Gupta, R., Gupta, R., Gutierrez, R. A., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Halasa, Y. A., Hamadeh, R. R., Hamavid, H., Hammami, M., Hancock, J., Hankey, G. J., Hansen, G. M., Hao, Y., Harb, H. L., Maria Haro, J., Havmoeller, R., Hay, S. I., Hay, R. J., Heredia-Pi, I. B., Heuton, K. R., Heydarpour, P., Higashi, H., Hijar, M., Hoek, H. W., Hoffman, H. J., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, C., Huang, J. J., Husseini, A., Huynh, C., Iannarone, M. L., Iburg, K. M., Innos, K., Inoue, M., Islami, F., Jacobsen, K. H., Jarvis, D. L., Jassal, S. K., Jee, S. 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. 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    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. 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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

  • Rotational thromboelastometry-guided blood product management in major spine surgery. Journal of neurosurgery. Spine Naik, B. I., Pajewski, T. N., Bogdonoff, D. I., Zuo, Z., Clark, P., Terkawi, A. S., Durieux, M. E., Shaffrey, C. I., Nemergut, E. C. 2015; 23 (2): 239?49

    Abstract

    OBJECT Major spinal surgery in adult patients is often associated with significant intraoperative blood loss. Rotational thromboelastometry (ROTEM) is a functional viscoelastometric method for real-time hemostasis testing. In this study, the authors sought to characterize the coagulation abnormalities encountered in spine surgery and determine whether a ROTEM-guided, protocol-based approach to transfusion reduced blood loss and blood product use and cost. METHODS A hospital database was used to identify patients who had undergone adult deformity correction spine surgery with ROTEM-guided therapy. All patients who received ROTEM-guided therapy (ROTEM group) were matched with historical cohorts whose coagulation status had not been evaluated with ROTEM but who were treated using a conventional clinical and point-of-care laboratory approach to transfusion (Conventional group). Both groups were subdivided into 2 groups based on whether they had received intraoperative tranexamic acid (TXA), the only coagulation-modifying medication administered intraoperatively during the study period. In the ROTEM group, 26 patients received TXA (ROTEM-TXA group) and 24 did not (ROTEM-nonTXA group). Demographic, surgical, laboratory, and perioperative transfusion data were recorded. Data were analyzed by rank permutation test, adapted for the 1:2 ROTEM-to-Conventional matching structure, with p < 0.05 considered significant. RESULTS Comparison of the 2 groups in which TXA was used showed significantly less fresh-frozen plasma (FFP) use in the ROTEM-TXA group than in the Conventional-TXA group (median 0 units [range 0-4 units] vs 2.5 units [range 0-13 units], p < 0.0002) but significantly more cryoprecipitate use (median 1 unit [range 0-4 units] in the ROTEM-TXA group vs 0 units [range 0-2 units] in the Conventional-TXA group, p < 0.05), with a nonsignificant reduction in blood loss (median 2.6 L [range 0.9-5.4 L] in the ROTEM-TXA group vs 2.9 L [0.7-7.0 L] in the Conventional-TXA group, p = 0.21). In the 2 groups in which TXA was not used, the ROTEM-nonTXA group showed significantly less blood loss than the Conventional-nonTXA group (median 1 L [range 0.2-6.0 L] vs 1.5 L [range 1.0-4.5 L], p = 0.0005), with a trend toward less transfusion of packed red blood cells (pRBC) (median 0 units [range 0-4 units] vs 1 unit [range 0-9 units], p = 0.09]. Cryoprecipitate use was increased and FFP use decreased in response to ROTEM analysis identifying hypofibrinogenemia as a major contributor to ongoing coagulopathy. CONCLUSIONS In major spine surgery, ROTEM-guided transfusion allows for standardization of transfusion practices and early identification and treatment of hypofibrinogenemia. Hypofibrinogenemia is an important cause of the coagulopathy encountered during these procedures and aggressive management of this complication is associated with less intraoperative blood loss, reduced transfusion requirements, and decreased transfusion-related cost.

    View details for DOI 10.3171/2014.12.SPINE14620

    View details for PubMedID 26053893

  • Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. The Journal of arthroplasty Al-Zahrani, T., Doais, K. S., Aljassir, F., Alshaygy, I., Albishi, W., Terkawi, A. S. 2015; 30 (1): 149?54

    Abstract

    Pain control following total knee arthroplasty (TKA) is crucial to hasten rehabilitation and decrease morbidity. We evaluated whether there is a difference between epidural infusion and continuous femoral nerve block with respect to postoperative pain control and rehabilitation course. Fifty patients completed the study. There was no statistically significant difference in the pain scores (P=0.33), morphine consumption (P=0.09) mean blood pressure or heart rate (P=0.957, and P=0.716) between groups. The postoperative daily mobilization (P=0.80), knee joint range of motion (P=0.83), and straight leg test (P=0.99) were also similar between both groups. Patients were highly satisfied with their pain management in both groups without statistically significant difference (P=0.98).

    View details for DOI 10.1016/j.arth.2014.07.032

    View details for PubMedID 25149364

  • 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 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

  • 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

  • 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 ?2-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 ?2-adrenergic receptor, the ? 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

  • General anesthesia for the heaviest man in the world. Saudi journal of anaesthesia Terkawi, A. S., Rafiq, M., Algadaan, R., Ur Rehman, I., Doais, K. S., Durieux, M. E., AlSohaibani, M. 2014; 8 (Suppl 1): S101?4

    Abstract

    The prevalence of obesity has increased greatly over the last 20 years, resulting in an increase in the number of bariatric and nonbariatric surgeries in this population. We present the case of a 20-year-old male, weighing 610 kg (1345 lb), and believed to be the heaviest living man in the world. After 4 months of rigorous in-hospital weight reduction, now weighing 510 kg (1125 lb), he underwent a laparoscopic gastric sleeve procedure under general anesthesia. This report describes the management of his anesthetic and exemplifies the challenges associated with this patient population.

    View details for DOI 10.4103/1658-354X.144087

    View details for PubMedID 25538498

    View details for PubMedCentralID PMC4268505

  • Invasive and ultrasound based monitoring of the intracranial pressure in an experimental model of epidural hematoma progressing towards brain tamponade on rabbits. TheScientificWorldJournal Kasapas, K., Diamantopoulou, A., Pentilas, N., Papalois, A., Douzinas, E., Kouraklis, G., Slama, M., Terkawi, A. S., Blaivas, M., Sargsyan, A. E., Karakitsos, D. 2014; 2014: 504248

    Abstract

    An experimental epidural hematoma model was used to study the relation of ultrasound indices, namely, transcranial color-coded-Doppler (TCCD) derived pulsatility index (PI), optic nerve sheath diameter (ONSD), and pupil constriction velocity (V) which was derived from a consensual sonographic pupillary light reflex (PLR) test with invasive intracranial pressure (ICP) measurements.Twenty rabbits participated in the study. An intraparenchymal ICP catheter and a 5F Swan-Ganz catheter (SG) for the hematoma reproduction were used. We successively introduced 0.1 mL increments of autologous blood into the SG until the Cushing reaction occurred. Synchronous ICP and ultrasound measurements were performed accordingly.A constant increase of PI and ONSD and a decrease of V values were observed with increased ICP values. The relationship between the ultrasound variables and ICP was exponential; thus curved prediction equations of ICP were used. PI, ONSD, and V were significantly correlated with ICP (r˛ = 0.84 ± 0.076, r˛ = 0.62 ± 0.119, and r˛ = 0.78 ± 0.09, resp. (all P < 0.001)).Although statistically significant prediction models of ICP were derived from ultrasound indices, the exponential relationship between the parameters underpins that results should be interpreted with caution and in the current experimental context.

    View details for DOI 10.1155/2014/504248

    View details for PubMedID 24578637

    View details for PubMedCentralID PMC3918727

  • Factors predicting post-thyroidectomy hypoparathyroidism recovery. World journal of surgery Al-Dhahri, S. F., Mubasher, M., Mufarji, K., Allam, O. S., Terkawi, A. S. 2014; 38 (9): 2304?10

    Abstract

    Hypoparathyroidism is the most common complication after thyroidectomy and the main reason for frequent outpatient visits; however, there is a poor understanding of its outcomes and no clear follow-up strategies are available. We aimed to predict post-thyroidectomy hypoparathyroidism outcomes and identify relevant factors.A multicenter, standardized prospective study was conducted. The parathyroid hormone level (PTH) was measured preoperatively and at the first hour after surgery, then at each outpatient follow-up visit after 1 week, 3 weeks, and 1 month, and then every 2 months, until it either reached normal values or up to 6 months. Cox proportional hazard modeling was used to determine the factors that affect PTH recovery. A Weibull distribution model was used to predict time to recovery. Both models were evaluated by goodness of fit.A total of 186 patients were enrolled in the study; 53 (28.5 %) developed hypoparathyroidism, 47 of them (88.6 %) females. Their mean age was 41.2 years, and 11.4 % were diabetic. Of these women, 33 (62.3 %) recovered within 1 month, 10 (18.9 %) recovered after 1 month but within 6 months, 7 (13.2 %) did not recover within 6 months, and 3 (5.6 %) missed follow-up. Factors that are found to affect and predict the speed of recovery were the preoperative PTH level, perioperative percent drop in PTH level, diabetes mellitus, and gender.This study provides potentially useful information for early prediction of PTH recovery, and it highlights the factors that affect the course of hypoparathyroidism recovery, which in turn should be reflected in better patient management, improved patient satisfaction, and overall cost-effectiveness.

    View details for DOI 10.1007/s00268-014-2571-6

    View details for PubMedID 24728582

  • Ultrasound-guided pulsed radiofrequency ablation of the genital branch of the genitofemoral nerve for treatment of intractable orchalgia. Saudi journal of anaesthesia Terkawi, A. S., Romdhane, K. 2014; 8 (2): 294?98

    Abstract

    Chronic orchalgia is a frustrating clinical problem for both the patient and the physician. We present a 17-year-old boy with a bilateral idiopathic chronic intractable orchalgia with failed conservative treatment. For 2 years, he suffered from severe attacks of scrotal pain that affected his daily activities and caused frequent absence from school. Ultrasound-guided pulsed radiofrequency ablation (PRF) of the genital branches of the genitofemoral nerve performed after local anesthetic nerve block confirmed the diagnosis and yielded 6 weeks of symptom relief. Seven-month follow-up revealed complete satisfactory analgesia. The use of PRF is an effective and non-invasive approach to treat intractable chronic orchalgia.

    View details for DOI 10.4103/1658-354X.130755

    View details for PubMedID 24843352

    View details for PubMedCentralID PMC4024696

  • Early prediction of oral calcium and vitamin D requirements in post-thyroidectomy hypocalcaemia. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Al-Dhahri, S. F., Mubasher, M., Al-Muhawas, F., Alessa, M., Terkawi, R. S., Terkawi, A. S. 2014; 151 (3): 407?14

    Abstract

    To optimize and individualize post-thyroidectomy hypocalcemia management.A multicenter prospective cohort study.Two tertiary care hospitals.parathyroid hormone (PTH) was measured preoperatively, then at 1 and 6 hours after surgery. The required doses of calcium and vitamin D were defined as those maintaining the patients asymptomatic and their cCa ? 2 mmol/L. They were used as an endpoint in a generalized linear mixed effect model (GLIMMEX) aiming to identify the best predictors of these optimal required doses. Models were evaluated by goodness of fit and Receiver Operating Characteristic (ROC) curves.One hundred and sixty-eight patients were analyzed; 85.1% were female, 49.3% had BMI > 30, and 64% had vitamin D deficiency. Post-thyroidectomy hypocalcemia was found in 25.6%, of whom 18 (41.9%) were symptomatic and received intravenous calcium. First hour percentage of drop in PTH correlated positively with the severity of hypocalcemia (P < .0001). The GLIMMIX prediction model for oral calcium requirement was based on first-hour percentage change from preoperative PTH level, preoperative actual PTH, BMI, and thyroid function. The same predictors were identified for vitamin D, except that thyroid function was replaced with vitamin D status. These factors were used to build predictive equations for calcium and vitamin D doses.Our findings help to optimize management of post-thyroidectomy hypocalcemia by assisting in the early identification of those who are not at risk of hypocalcaemia and by guiding early effective management of those at risk. This may reduce complications and medical cost.

    View details for DOI 10.1177/0194599814536848

    View details for PubMedID 24903452

  • Perioperative parathyroid hormone measurements in thyroid surgery: one stone to hit three birds. Brazilian journal of otorhinolaryngology Terkawi, A. S., Al-Dhahri, S. F. 2014; 80 (6): 551?53

    View details for DOI 10.1016/j.bjorl.2014.08.015

    View details for PubMedID 25457078

  • Ultrasound for the anesthesiologists: present and future. TheScientificWorldJournal Terkawi, A. S., Karakitsos, D., Elbarbary, M., Blaivas, M., Durieux, M. E. 2013; 2013: 683685

    Abstract

    Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum.

    View details for DOI 10.1155/2013/683685

    View details for PubMedID 24348179

    View details for PubMedCentralID PMC3856172

  • Oxytocin and catechol-O-methyltransferase receptor genotype predict the length of the first stage of labor AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Terkawi, A. S., Jackson, W. M., Thiet, M., Hansoti, S., Tabassum, R., Flood, P. 2012; 207 (3)

    Abstract

    We aimed to identify genetic factors that influence the rate of the first stage of labor.We prospectively enrolled 233 laboring nulliparous parturients. Demographic, clinical, and genetic data were collected. We evaluated the influence of population and individual variability using a nonlinear mixed effects model.Parturients who were homozygous for "G" at oxytocin receptor gene rs53576 transitioned to active labor later and thus had slower labor. Catechol-O-methyltransferase rs4633 genotype TT was associated with slower latent phase labor. Labor induction with prostaglandin was associated with faster labor, and request for meperidine was associated with slower labor. Birthweight was related inversely to the rate of the active phase.There are demographic, clinical, and genetic factors that influence an individual's rate of labor progress. This information could be used in automated form to improve the prediction of the length of the first stage of labor.

    View details for DOI 10.1016/j.ajog.2012.06.079

    View details for Web of Science ID 000308583100019

    View details for PubMedID 22939719

  • Anesthetic considerations in Leigh disease: Case report and literature review. Saudi journal of anaesthesia Terkawi, A. S., Wani, T. M., Al-Shuaibi, K. M., Tobias, J. D. 2012; 6 (2): 181?85

    Abstract

    Leigh disease is an extremely rare disorder, characterized by a progressive neurodegenerative course, with subacute necrotizing encephalomyelopathy. It usually presents in infancy with developmental delay, seizures, dysarthria, and ataxia. These patients may also develop episodes of lactic acidosis that usually lead to respiratory failure and death. Due to the rarity of the condition, the most appropriate anesthetic plan remains unclear. We present a patient with Leigh disease, who required general anesthesia. The pathogenesis of the disease is discussed and previous reports of perioperative care from the literature are reviewed.

    View details for DOI 10.4103/1658-354X.97037

    View details for PubMedID 22754450

    View details for PubMedCentralID PMC3385266

  • Fibrous dysplasia and aneurysmal bone cyst of the skull base presenting with blindness: a report of a rare locally aggressive example. Head & neck oncology Terkawi, A. S., Al-Qahtani, K. H., Baksh, E., Soualmi, L., Mohamed, A. E., Sabbagh, A. J. 2011; 3: 15

    Abstract

    Fibrous dysplasia (FD) and aneurysmal bone cyst (ABC) are uncommon benign intraosseous lesions. Simultaneous occurrence of both lesions is extremely rare. We present an example of concomitant FD and ABC in a 7 year-old with left eye blindness and discharge of one month duration. Physical examination revealed a proptotic left eye and bulging of the hard palate. CT and MRI are consistent with FD and ABC that involved the sphenoid and ethmoidal bones bilaterally. Incomplete combined endonasalcranial resection was performed. The patient presented five months postoperatively with a large recurrence and subsequent follow up was lost. Concomitant FD with ABC may occur in paranasal sinuses and may develop rapidly and exhibit locally aggressive behavior.

    View details for DOI 10.1186/1758-3284-3-15

    View details for PubMedID 21396116

    View details for PubMedCentralID PMC3063217

  • Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale Fahad Al-Dhahri, S., Al-Ghonaim, Y. A., Sulieman Terkawi, A. 2010; 39 (4): 342?48

    Abstract

    To evaluate the accuracy of measurement of different parathyroid hormone (PTH) and corrected calcium (cCa) levels at different times as early predictors of postthyroidectomy hypocalcemia.A retrospective cohort study.King Fahad Medical City, Riyadh, Saudi Arabia, between January 2006 and March 2009.Patients who underwent total or completion thyroidectomy were followed until hospital discharge. Patients were observed clinically for hypocalcemia; at the same time, the postoperative PTH and cCa levels after 6, 12, and 20 hours and then twice daily were recorded.Postthyroidectomy hypocalcemia.Seventy-nine of 116 patients were enrolled in our study; 26.60% of them had hypocalcemia. PTH measurement at 6 hours postoperatively was an excellent predictor of hypocalcemia (area under the curve = 0.95, 95% CI 0.88-0.99). The mean PTH at 6 hours for hypocalcemic patients was 0.93 (+/- 0.60). A 1.7 pmol/L as a cutoff level of PTH at 6 hours has 95.2% sensitivity, 89.7% specificity, 76.9% positive predictive value (PPV), and 98.1% negative predictive value (NPV). On the other hand, a 2.1 mmol/L as a cutoff level of cCa has 81.0% sensitivity, 81.6% specificity, 65.3% PPV, and 90.9% NPV in predicting hypocalcemic patients.PTH measurement 6 hours after surgery with a cutoff level of 1.7 pmol/L is more accurate than serial calcium level measurement for early prediction of patients at risk of hypocalcemia. Thus, a single PTH measurement postoperatively will help in discharging patients safely within the first 24 hours, improving bed use and cost-effective care.

    View details for PubMedID 20642997

  • Cerebellar mass as a primary presentation of papillary thyroid carcinoma: case report and literature review. Head & neck oncology Al-Dhahri, S. F., Al-Amro, A. S., Al-Shakwer, W., Terkawi, A. S. 2009; 1: 23

    Abstract

    Papillary carcinoma is the most common differentiated malignant thyroid neoplasm. The biological course of this cancer is typically indolent with a protracted clinical course. Metastases commonly occur in regional lymph nodes, and distant metastasis is a late and rare occurrence. We report a patient who presented with cerebellar metastasis prior to the diagnosis of papillary thyroid carcinoma and review the literature of brain metastasis from papillary thyroid carcinoma.A 75-year old female presented at the emergency room with progressive dizziness, headache and vomiting, where a brain CT and MRI showed a posterior cerebellar tumor. Surgical resection revealed papillary carcinoma consistent with thyroid origin. Subsequent ultrasound and CT-scan revealed a thyroid nodule, after which the patient underwent total thyroidectomy. Pathologic evaluation was consistent with papillary thyroid carcinoma.Brain metastasis may rarely be the initial presentation of papillary thyroid carcinoma. Solitary brain metastasis can completely be resected with better prognosis.

    View details for DOI 10.1186/1758-3284-1-23

    View details for PubMedID 19558727

    View details for PubMedCentralID PMC2712461

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