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Powers RJ, Mokdad AA, Pezzin LE, Nattinger AB, Oldham KT, Van Arendonk KJ. Disparities in utilization of outpatient surgical care among children. Surgery 2021; 170:1815-1821. [PMID: 34167822 DOI: 10.1016/j.surg.2021.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to quantify disparities in the utilization of outpatient pediatric surgical care and to examine the extent to which neighborhood-level socioeconomic disadvantage is associated with access to care among children. METHODS Clinic "no-shows" were examined among children scheduled from 2017 to 2019 at seven pediatric surgery clinics associated with a tertiary care children's hospital. The association between Area Deprivation Index, a neighborhood-level measure of socioeconomic disadvantage, and other patient factors with clinic no-shows was examined using multivariable logistic regression models. Difficulties in accessing postoperative care in particular were explored in a subgroup analysis of postoperative (within 90 days) clinic visits after appendectomy or inguinal/umbilical hernia repairs. RESULTS Among 10,162 patients, 16% had at least 1 no-show for a clinic appointment. Area Deprivation Index (most deprived decile adjusted odds ratio 3.17, 95% confidence interval 2.20-4.58, P < .001), Black race (adjusted odds ratio 3.30, 95% confidence interval 2.70-4.00, P < .001), and public insurance (adjusted odds ratio 2.75, 95% confidence interval 2.38-3.31, P < .001) were associated with having at least 1 no-show. Similar associations were identified among 2,399 children scheduled for postoperative clinic visits after undergoing appendectomy or inguinal/umbilical hernia repair, among whom 20% were a no-show. CONCLUSION Race, insurance type, and neighborhood-level socioeconomic disadvantage are associated with disparities in utilization of outpatient pediatric surgical care. Challenges accessing routine outpatient care among disadvantaged children may be one mechanism through which disparate outcomes result among children requiring surgical care.
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Affiliation(s)
- Ryan J Powers
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Ali A Mokdad
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/amokdad12
| | - Liliana E Pezzin
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Keith T Oldham
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Dogeas E, Mokdad AA, Bhattatiry M, Porembka MR, Polanco PM, Mansour JC, Choti MA, Augustine MM. Tumor Biology Impacts Survival in Surgically Managed Primary Hepatic Vascular Malignancies. J Surg Res 2021; 264:481-489. [PMID: 33857792 DOI: 10.1016/j.jss.2021.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/29/2021] [Accepted: 02/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatic angiosarcoma (AS) and hepatic epithelioid hemangioendothelioma (HEHE) are rare primary hepatic vascular malignancies (PHVM) that remain poorly understood. To guide management, we sought to identify factors and trends predicting survival after surgical intervention using a national database. MATERIALS AND METHODS In a retrospective analysis of the National Cancer Database patients with a diagnosis of PHVM were identified. Clinicopathologic factors were extracted and compared. Overall survival (OS) was estimated and predictors of survival were identified. RESULTS Three hundred ninty patients with AS and 216 with HEHE were identified. Only 16% of AS and 36% of HEHE patients underwent surgery. The median OS for patients who underwent surgical intervention was 97 months, with 5-year OS of 30% for AS versus 69% for HEHE patients (P< 0.001). Tumor biology strongly impacted OS, with AS histology (Hazard Ratio [HR] of 3.61 [1.55-8.42]), moderate/poor tumor differentiation (HR = 3.86 [1.03-14.46]) and tumor size (HR = 1.01 [1.00-1.01]) conferring worse prognosis. The presence of metastatic disease in the surgically managed cohort (HR = 5.22 [2.01-13.57]) and involved surgical margins (HR = 3.87 [1.59-9.42]), were independently associated with worse survival. CONCLUSIONS In this national cohort of PHVM, tumor biology, in the form of angiosarcoma histology, tumor differentiation and tumor size, was strongly associated with worse survival after surgery. Additionally, residual tumor burden after resection, in the form of positive surgical margins or the presence of metastasis, was also negatively associated with survival. Long-term clinical outcomes remain poor for patients with the above high-risk features, emphasizing the need to develop effective forms of adjuvant systemic therapies for this group of malignancies.
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Affiliation(s)
- Epameinondas Dogeas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mitu Bhattatiry
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Choti
- Department of Surgery, Banner MD Anderson Cancer Center, Phoenix, Arizona
| | - Mathew M Augustine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; North Texas Veterans Affairs Medical Center, Dallas, Texas.
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Abstract
BACKGROUND AND OBJECTIVES Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. METHODS We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. RESULTS We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). CONCLUSIONS There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.
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Affiliation(s)
- Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lindsey L Wolf
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Samir Pandya
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
| | - Mark Ryan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
| | - Faisal G Qureshi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; .,Children's Medical Center Dallas, Dallas, Texas
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4
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Imran JB, Madni TD, Taveras LR, Cunningham HB, Clark AT, Cripps MW, GoldenMerry YP, Diwan W, Wolf SE, Mokdad AA, Phelan HA. Analysis of operating room efficiency between a hospital-owned ambulatory surgical center and hospital outpatient department. Am J Surg 2019; 218:809-812. [DOI: 10.1016/j.amjsurg.2019.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022]
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5
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Polanco PM, Mokdad AA, Zhu H, Choti MA, Huerta S. Association of Adjuvant Chemotherapy With Overall Survival in Patients With Rectal Cancer and Pathologic Complete Response Following Neoadjuvant Chemotherapy and Resection. JAMA Oncol 2019; 4:938-943. [PMID: 29710272 DOI: 10.1001/jamaoncol.2018.0231] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Adjuvant chemotherapy (AC) in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy (nCRT) and resection is recommended by treatment guidelines. However, its role in this setting is equivocal because data supporting benefits are lacking. Objective To compare the overall survival (OS) between AC and postoperative observation (OB) in patients with rectal cancer with pathologic complete response following nCRT and resection. Design, Setting, and Participants We identified a cohort of patients with rectal cancer and a complete pathological response (ypT0N0) after nCRT in the National Cancer Database between 2006 and 2012. Patients who received AC were compared with OB patients by propensity score matching. Overall survival was compared using the stratified log-rank test and stratified Cox regression model. The outcomes after AC vs OB were also evaluated in patient subgroups. The data analysis was completed in June 2017. Exposures Adjuvant chemotherapy and OB. Main Outcomes and Measures Overall survival. Results We identified 2764 patients (mean [SD] age, 60.0 [12.3] years; 40% female) with clinical stage II or III resected adenocarcinoma of the rectum who had received nCRT and were complete responders (ypT0N0M0). Of this cohort, 741 patients in the AC group were matched by propensity score to 741 patients who underwent OB. The AC cohort had better OS compared with the OB cohort (hazard ratio, 0.50; 95% CI, 0.32-0.79). The 1-, 3-, and 5-year OS rates were 99.7%, 97.1%, and 94.7% for the AC group and 99.2%, 93.6%, and 88.4% for the OB group (P = .005). In subgroup analysis, patients with clinical stage T3/T4 and node-positive disease benefited most from AC (hazard ratio, 0.47; 95% CI, 0.25-0.91). Conclusions and Relevance Adjuvant chemotherapy was associated with improved OS in patients with pathologic complete response after nCRT for resected locally advanced rectal cancer. This study supports the use of AC in this setting where there is currently paucity of data.
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Affiliation(s)
- Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas.,Department of Veterans Affairs North Texas Health Care System, Dallas
| | - Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Hong Zhu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Michael A Choti
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas.,Department of Veterans Affairs North Texas Health Care System, Dallas
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Mokdad AA, Yopp AC, Polanco PM, Mansour JC, Reznik SI, Heitjan DF, Choti MA, Minter RR, Wang SC, Porembka MR. Adjuvant Chemotherapy vs Postoperative Observation Following Preoperative Chemoradiotherapy and Resection in Gastroesophageal Cancer: A Propensity Score-Matched Analysis. JAMA Oncol 2019; 4:31-38. [PMID: 28975352 DOI: 10.1001/jamaoncol.2017.2805] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Distant recurrence following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma is common. Adjuvant chemotherapy may improve survival. Objective To compare adjuvant chemotherapy with postoperative observation following preoperative chemoradiotherapy and resection in patients with gastroesophageal adenocarcinoma. Design, Setting, and Participants Propensity score-matched analysis using the National Cancer Database. We included adult patients who received a diagnosis between 2006 and 2013 of clinical stage T1N1-3M0 or T2-4N0-3M0 adenocarcinoma of the distal esophagus or gastric cardia who were treated with preoperative chemoradiotherapy and curative-intent resection. Patients receiving adjuvant chemotherapy were matched by propensity score to patients undergoing postoperative observation. Exposures Adjuvant chemotherapy and postoperative observation. Main Outcomes and Measures Overall survival. Results We identified 10 086 patients (8840 [88%] male; mean [SD] age, 61 [9.5] years), 9272 in the postoperative observation group and 814 in the adjuvant chemotherapy group. Patients receiving adjuvant chemotherapy were younger (18-54 years: 252 [31%] vs 1989 [21%]; P < .001) and were more likely to have advanced disease (ypT3/4: 458 [62%] vs 3531 [46%]; P < .001; ypN+: 572 [72%] vs 3428 [39%]; P < .001), as well as shorter postoperative inpatient stays (>2 weeks: 94 [13%] vs 1589 [20%]; P < .001). A total of 732 patients in the adjuvant chemotherapy group were matched by propensity score to 3660 patients in the postoperative observation group. Adjuvant chemotherapy was associated with improved overall survival compared with postoperative observation (median survival: 40 months; 95% CI, 36-46 months vs 34 months; 95% CI, 32-35 months; stratified log-rank P < .001; hazard ratio, 0.79; 95% CI, 0.72-0.88). Overall survival at 1, 3, and 5 years was 88%, 47%, and 34% in the observation group, and 94%, 54%, and 38% in the adjuvant chemotherapy group, respectively. Adjuvant chemotherapy was associated with a survival benefit compared with postoperative observation in most patient subgroups. Conclusions and Relevance For patients with locally advanced gastroesophageal adenocarcinoma treated with preoperative chemoradiotherapy and resection, adjuvant chemotherapy was associated with improved overall survival. Our findings have important implications for the postoperative treatment of this patient group for which few data are available.
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Affiliation(s)
- Ali A Mokdad
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - John C Mansour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Scott I Reznik
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Daniel F Heitjan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.,Department of Statistical Science, Southern Methodist University, Dallas, Texas
| | - Michael A Choti
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Rebecca R Minter
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas
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Mokdad AA, Zhu H, Beg MS, Arriaga Y, Dowell JE, Singal AG, Yopp AC. Efficacy and Safety of Bavituximab in Combination with Sorafenib in Advanced Hepatocellular Carcinoma: A Single-Arm, Open-Label, Phase II Clinical Trial. Target Oncol 2019; 14:541-550. [DOI: 10.1007/s11523-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Mokdad AA, Minter RM, Yopp AC, Porembka MR, Wang SC, Zhu H, Augustine MM, Mansour JC, Choti MA, Polanco PM. Comparison of Overall Survival Between Preoperative Chemotherapy and Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma. J Natl Compr Canc Netw 2018; 16:1468-1475. [DOI: 10.6004/jnccn.2018.7068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 07/31/2018] [Indexed: 11/17/2022]
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9
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Mokdad AA, Nwariaku F, Wolf LL, Qureshi FG. Patterns of Pediatric Mortality from Motor Vehicle Crashes among US Counties: Where Are the Disparities? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Mokdad AA, Xie XJ, Zhu H, Gerber DE, Heitjan DF. Statistical justification of expansion cohorts in phase 1 cancer trials. Cancer 2018; 124:3339-3345. [PMID: 29975406 PMCID: PMC6108930 DOI: 10.1002/cncr.31577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Phase I cancer trials increasingly incorporate dose-expansion cohorts (DECs), reflecting a growing demand to acquire more information about investigational drugs. Protocols commonly fail to provide a sample-size justification or analysis plan for the DEC. In this study, we develop a statistical framework for the design of DECs. METHODS We assume the maximum tolerated dose (MTD) for the investigational drug has been identified in the dose-escalation stage of the trial. We use the 80% lower confidence bound and the 90% upper confidence bound for the response and toxicity rates, respectively, as decision thresholds for the dose-expansion stage. We calculate the operating characteristics with reference to prespecified minimum effective response rates and maximum safe DLT rates. RESULTS We apply our framework to specify a system of DEC plans. The design comprises three components: 1) the number of subjects enrolled at the MTD, 2) the minimum number of responses necessary to indicate provisional drug efficacy, and 3) the maximum number of dose-limiting toxicities (DLTs) permitted to indicate drug safety. We demonstrate our method in an application to a cancer immunotherapy trial. CONCLUSIONS Our simple and practical tool enables creation of DEC designs that appropriately address the safety and efficacy objectives of the trial.
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Affiliation(s)
- Ali A. Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX
- Department of Statistical Science, Southern Methodist University, Dallas, TX
| | - Xian-Jin Xie
- College of Dentistry and College of Public Health, University of Iowa, Iowa City, IA
| | - Hong Zhu
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel F. Heitjan
- Department of Statistical Science, Southern Methodist University, Dallas, TX
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
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11
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Imran JB, Renteria O, Ruiz M, Pham TH, Mokdad AA, Huerta S. Assessing the Veterans Affairs Surgical Quality Improvement Program Risk Calculator in Cholecystectomy. Am Surg 2018. [DOI: 10.1177/000313481808400662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk calculator has been validated for several operations but has not been assessed specifically for cholecystectomy. Our aim was to externally validate the VASQIP calculator's accuracy in predicting 30-day morbidity and mortality (M&M) for patients undergoing cholecystectomy. A retrospective review of patients undergoing cholecystectomy at the North Texas Veterans Affairs hospital was performed. The VASQIP risk calculator was used to determine predicted 30-day M&M, which was compared with actual M&M. The predictive accuracy of the Veterans Affairs risk calculator was assessed using the C-statistic and a graphical assessment of a locally weighted least squares regression smoother. Overall, 848 patients were included in the study. Actual M&M were 6.3 and 0.94 per cent, respectively, whereas predicted M&M were 6.0 and 0.54 per cent. The C-statistic was 0.75 for morbidity and 0.78 for mortality. In our analysis, the VASQIP risk calculator reasonably predicted 30-day M&M.
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Affiliation(s)
- Jonathan B. Imran
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
| | - Oswaldo Renteria
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
| | - Maria Ruiz
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
| | - Thai H. Pham
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
- VA North Texas Health Care System, Dallas, Texas
| | - Ali A. Mokdad
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
| | - Sergio Huerta
- University of Texas Southwestern Medical Center Department of Surgery, Dallas, Texas and
- VA North Texas Health Care System, Dallas, Texas
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12
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Imran JB, Renteria O, Ruiz M, Pham TH, Mokdad AA, Huerta S. Assessing the Veterans Affairs Surgical Quality Improvement Program Risk Calculator in Cholecystectomy. Am Surg 2018; 84:1039-1042. [PMID: 29981645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk calculator has been validated for several operations but has not been assessed specifically for cholecystectomy. Our aim was to externally validate the VASQIP calculator's accuracy in predicting 30-day morbidity and mortality (M&M) for patients undergoing cholecystectomy. A retrospective review of patients undergoing cholecystectomy at the North Texas Veterans Affairs hospital was performed. The VASQIP risk calculator was used to determine predicted 30-day M&M, which was compared with actual M&M. The predictive accuracy of the Veterans Affairs risk calculator was assessed using the C-statistic and a graphical assessment of a locally weighted least squares regression smoother. Overall, 848 patients were included in the study. Actual M&M were 6.3 and 0.94 per cent, respectively, whereas predicted M&M were 6.0 and 0.54 per cent. The C-statistic was 0.75 for morbidity and 0.78 for mortality. In our analysis, the VASQIP risk calculator reasonably predicted 30-day M&M.
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13
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Mokdad AA, Hester CA, Singal AG, Yopp AC. Management of hepatocellular in the United States. Chin Clin Oncol 2018; 6:21. [PMID: 28482674 DOI: 10.21037/cco.2017.04.04] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 11/06/2022]
Abstract
Hepatocellular carcinoma (HCC) is a major cause of cancer burden globally. In the United States, the incidence of HCC is forecast to continue to rise for the next 15 years. Patients with HCC vary markedly owing to heterogeneous tumor characteristics and concomitant liver dysfunction. In the United States and Europe, HCC is staged and managed according to the Barcelona Clinic Liver Cancer (BCLC) system. For very early and early stage HCC, or BCLC 0/A, liver transplant is the optimal treatment option. Liver resection and radiofrequency or microwave ablation are alternative treatment options. For intermediate stage HCC, or BCLC B, transarterial chemoembolization (TACE) is the standard of care. An alternative locoregional therapy, transarterial radioembolization using yttrium-90, has shown comparable outcomes with TACE and may be used in patients for whom TACE is contraindicated. For advanced stage HCC, or BCLC C, systemic chemotherapy with sorafenib, a multikinase inhibitor, is the only evidence-based treatment option available. Another multikinase inhibitor, regorafenib, was recently approved as a second-line therapy for this patient group. Randomized clinical trials investigating other agents in enriched patient groups and novel therapeutics including checkpoint inhibitors are underway. Patient with prohibitive performance status and/or end stage liver dysfunction are classified terminal stage HCC, or BCLC D, and are managed with best supportive care. The future direction for the management of HCC will rely on continuing efforts to uncover molecular pathways and actionable genetic aberrations in HCC.
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Affiliation(s)
- Ali A Mokdad
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA
| | - Caitlin A Hester
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA
| | - Amit G Singal
- Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA
| | - Adam C Yopp
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA.
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14
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Nassour I, Mokdad AA, Porembka MR, Choti MA, Polanco PM, Mansour JC, Minter RM, Wang SC, Yopp AC. Adjuvant Therapy Is Associated With Improved Survival in Resected Perihilar Cholangiocarcinoma: A Propensity Matched Study. Ann Surg Oncol 2018; 25:1193-1201. [PMID: 29488187 DOI: 10.1245/s10434-018-6388-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited well-controlled studies that conclusively demonstrate a benefit of adjuvant therapy in resected perihilar cholangiocarcinoma. Most studies include all biliary tract tumors as one entity despite the heterogeneity of these diseases. METHODS We identified patients with resected perihilar cholangiocarcinoma from the National Cancer Database between 2006 and 2013. Patients who received adjuvant therapy (AT) were compared to an observation (OB) cohort by propensity score matching. RESULTS We identified 1846 patients: 1053 patients (57%) in the OB group, and 793 (43%) in the AT group. Patients who received adjuvant therapy were more likely to be younger, have a higher rate of private insurance, have higher T and N stage tumors, and were more likely to have positive resection margins. After 1:1 propensity score matching, 577 OB group patients were compared with 577 AT group patients. The AT cohort was associated with better overall survival compared with the OB cohort (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.64-0.83). The median survival was 29.5 and 23.3 months for the AT and OB groups, respectively (P < 0.01). Subgroup analysis demonstrated a survival advantage for adjuvant therapy in disease with positive resection margins (HR 0.53; 95% CI 0.42-0.67). CONCLUSIONS Adjuvant therapy is associated with improved survival in resected perihilar cholangiocarcinoma, especially in disease with positive resection margins. This study supports the use of adjuvant therapy in high-risk patients.
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Affiliation(s)
- Ibrahim Nassour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali A Mokdad
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Choti
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Veterans Affairs, North Texas Health Care System, Dallas, TX, USA
| | - John C Mansour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca M Minter
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Mokdad AA, Ali A, Yopp AC, Polanco PM, Nassour I, Mansour JC, Choti MA, Minter RM, Wang SC, Porembka MR. Adoption of evidence-based novel therapies in the treatment of gastric cancer: A national observational study. Cancer 2017; 124:1122-1131. [PMID: 29211302 DOI: 10.1002/cncr.31179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The adoption of novel and effective gastric cancer therapies into general clinical practice has crucial implications for patient outcomes. The current study explored trends in treatment use and overall survival in patients with gastric cancer in the United States. METHODS Patients with adenocarcinoma of the gastric cardia and noncardia were identified in the National Cancer Data Base between 2006 and 2014. Tumor stages were divided into early (IA), locally advanced (IB-IIIC), and metastatic (IV) stage. Treatment use was examined according to tumor stage and location. Time trend analyses of treatment use and overall survival were conducted. RESULTS A total of 89,098 patients with gastric adenocarcinoma were identified. In those with early-stage cancer, endoscopic treatment increased over time in patients with cardia and noncardia disease. In patients with locally advanced cardia disease, preoperative therapy use increased over time (2013-2014 [vs 2006-2008]: odds ratio [OR], 3.09; 95% confidence interval [95% CI], 2.80-3.41). In patients with locally advanced noncardia disease, the use of preoperative therapy also increased (2013-2014: OR, 3.32; 95% CI, 2.88-3.82) as did the use of perioperative therapy (2013-2014: OR, 4.21; 95% CI, 3.52-5.03) in lieu of postoperative treatment (2013-2014: OR, 0.66; 95% CI, 0.60-0.71). In patients with metastatic disease, approximately 34% of patients with cardia and 40% of patients with noncardia cancer did not receive treatment. Stage-specific and location-specific overall survival was found to improve over the study period. CONCLUSIONS Practice patterns for the treatment of gastric cancer in the United States reflect the increased adoption of evidence-based therapies, including endoscopic resection of early-stage cancer and preoperative therapy for patients with locally advanced disease. Treatment for metastatic disease remains markedly underused. Cancer 2018;124:1122-31. © 2017 American Cancer Society.
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Affiliation(s)
- Ali A Mokdad
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amna Ali
- University of Missouri School of Medicine, Columbia, Missouri
| | - Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ibrahim Nassour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Choti
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca M Minter
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Nassour I, Wang SC, Christie A, Mokdad AA, Porembka MR, Choti MA, Augustine MM, Yopp AC, Xie XJ, Mansour JC, Minter RM, Polanco PM. Nomogram to predict non-home discharge following pancreaticoduodenectomy in a national cohort of patients. HPB (Oxford) 2017; 19:1037-1045. [PMID: 28867297 DOI: 10.1016/j.hpb.2017.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the development of pathways to enhance recovery and discharge to home, a significant proportion of patients are discharged to inpatient facilities after pancreaticoduodenectomy (PD). The aim of this study was to determine the rate of non-home discharge (NHD) following PD in a national cohort of patients and to develop predictive nomograms for NHD. METHODS The National Surgical Quality Improvement Program was used to construct and validate pre- and postoperative nomograms for NHD following PD. RESULTS A total of 6856 patients who underwent PD were identified, of which 927 (13.5%) had an NHD. The independent preoperative predictors of NHD were being female, older age, higher BMI, low serum albumin, >10% weight loss, ASA class III/IV, and being diagnosed with a bile duct/ampullary neoplasm or neuroendocrine tumor. A preoperative nomogram was constructed with a concordance index of 0.77. When postoperative variables were added to the model, the concordance index increased to 0.82. The postoperative predictors of NHD were return to the operating room, length of stay of ≥14 days, and any inpatient complications. CONCLUSIONS These nomograms could be useful risk assessment tools to predict NHD after PD and therefore facilitate patient counseling and improve resource utilization and discharge planning.
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Affiliation(s)
- Ibrahim Nassour
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Sam C Wang
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Alana Christie
- University of Texas Southwestern Medical Center, Division of Biostatistics, Simmons Cancer Center, USA
| | - Ali A Mokdad
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Matthew R Porembka
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Michael A Choti
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Mathew M Augustine
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Adam C Yopp
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Xian-Jin Xie
- University of Texas Southwestern Medical Center, Division of Biostatistics, Simmons Cancer Center, USA
| | - John C Mansour
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Rebecca M Minter
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA
| | - Patricio M Polanco
- University of Texas Southwestern Medical Center, Division of Surgical Oncology, USA; Department of Veterans Affairs North Texas Health Care System, USA.
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Renteria O, Mokdad AA, Imran J, Huerta S. Resident postgraduate year does not influence rate of complications following inguinal herniorrhaphy. J Surg Res 2017; 219:61-65. [DOI: 10.1016/j.jss.2017.05.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/25/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Mokdad AA, Murphy CC, Pruitt SL, Mansour JC, Marrero JA, Singal AG, Yopp AC. Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma. Cancer 2017; 124:743-751. [DOI: 10.1002/cncr.31066] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/02/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Ali A. Mokdad
- Division of Surgical Oncology, Department of Surgery; University of Texas Southwestern Medical Center; Dallas Texas
| | - Caitlin C. Murphy
- Department of Clinical Science; University of Texas Southwestern Medical Center; Dallas Texas
| | - Sandi L. Pruitt
- Department of Clinical Science; University of Texas Southwestern Medical Center; Dallas Texas
| | - John C. Mansour
- Division of Surgical Oncology, Department of Surgery; University of Texas Southwestern Medical Center; Dallas Texas
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Medicine; University of Texas Southwestern Medical Center; Dallas Texas
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Medicine; University of Texas Southwestern Medical Center; Dallas Texas
| | - Adam C. Yopp
- Division of Surgical Oncology, Department of Surgery; University of Texas Southwestern Medical Center; Dallas Texas
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Mokdad AA, Singal AG, Marrero JA, Zhu H, Yopp AC. Vascular Invasion and Metastasis is Predictive of Outcome in Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma. J Natl Compr Canc Netw 2017; 15:197-204. [PMID: 28188189 DOI: 10.6004/jnccn.2017.0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/13/2016] [Indexed: 11/17/2022]
Abstract
Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) have variable long-term outcomes. Better delineation of prognosis is important for clinical trial enrollment and clinical practice in an era of precision medicine. We hypothesized that stratification of patients with BCLC stage C HCC by presence of vascular invasion and/or metastasis improves prognostic discrimination. Methods: Using a prospectively maintained database, we identified 234 patients diagnosed with BCLC stage C HCC between 2005 and 2015. Patients were stratified into 3 groups based on tumor characteristics: (1) vascular invasion alone, (2) metastasis alone, and (3) vascular invasion and metastasis. Overall survival (OS) was compared using a Cox model. A subgroup analysis was performed based on extent of vascular invasion and site of metastasis. Results: The cohort comprised 123 patients (53%) with vascular invasion alone, 34 (15%) with metastasis alone, and 77 (33%) with both vascular invasion and metastasis. Median survival was 5.7, 3.9, and 3.0 months, respectively (P<.01). Patients with vascular invasion or metastasis alone had significantly better survival compared with those with vascular invasion and metastasis (adjusted hazard ratio [HR],0.68; 95% CI, 0.49-0.94, and HR, 0.61; 95% CI, 0.39-0.96, respectively). Compared with tumoral invasion of branch portal veins, involvement of the main portal vein was associated with worse survival (HR, 2.13; 95% CI, 1.29-3.49). OS did not differ by site of metastasis. Conclusions: Stratification of patients within the BCLC stage C staging subgroup by vascular invasion and presence of metastasis further discriminates patient prognosis. This substratification may have implications for therapy and more accurate prognostic features.
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Affiliation(s)
- Ali A Mokdad
- Department of Surgery, Division of Surgical Oncology
| | - Amit G Singal
- Department of Medicine, Division of Digestive and Liver Diseases
| | - Jorge A Marrero
- Department of Medicine, Division of Digestive and Liver Diseases
| | - Hao Zhu
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adam C Yopp
- Department of Surgery, Division of Surgical Oncology
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Nassour I, Mokdad AA, Minter RM, Polanco PM, Augustine MM, Mansour JC, Porembka MR, Wang SC. Racial and ethnic disparities in a national cohort of ampullary cancer patients. J Surg Oncol 2017; 117:220-227. [PMID: 28968918 DOI: 10.1002/jso.24835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Racial and ethnic variations have been described in the different malignancies, but no such data exists for ampullary cancer. The aim of this study was to present an updated report on the epidemiology, treatment patterns, and survival of a national cohort of ampullary cancer patients. METHODS Patients diagnosed with ampullary cancer between 2004 and 2014 were identified in the National Cancer Database. Overall survival was estimated and compared between racial/ethnic groups using the log-rank test. RESULTS A total of 14 879 patients were identified; 78% of the patients were White, 9% Hispanic, 8% Black, and 5% Asian. We noted significant differences in disease presentation, socioeconomic status, and outcomes. Blacks had the lowest median overall survival at 18.9 months followed by Whites at 23.9 months, Hispanics at 32.7 months, and Asians at 37.4 months. On a multivariate Cox proportional-hazards model, being Black was associated with worse survival compared to being White while being Asian and Hispanic were associated with better survival. CONCLUSIONS Overall survival of ampullary cancer patients was independently associated with race and ethnicity. Further studies are needed to clarify whether these disparities are primarily due to socioeconomic status or biologic factors.
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Affiliation(s)
- Ibrahim Nassour
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ali A Mokdad
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca M Minter
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mathew M Augustine
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew R Porembka
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
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Da Silva M, Porembka J, Mokdad AA, Seiler S, Huth J, Rivers A, Wooldridge R, Chu A, Brown E, Bao J, Farr D, Hansen M, Unzeitig-Barron A, Leitch M, Rao R. Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery. Breast J 2017; 24:161-166. [DOI: 10.1111/tbj.12854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/27/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Monica Da Silva
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jessica Porembka
- Department of Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Ali A. Mokdad
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Stephen Seiler
- Department of Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - James Huth
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Aeisha Rivers
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Rachel Wooldridge
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Amanda Chu
- Department of Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Emily Brown
- Department of Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jean Bao
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Deborah Farr
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Meghan Hansen
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Alison Unzeitig-Barron
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Marilyn Leitch
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Roshni Rao
- Division of Surgical Oncology; Department of Surgery; University of Texas Southwestern Medical Center; Dallas TX USA
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Li KY, Mokdad AA, Minter RM, Mansour JC, Choti MA, Augustine MM, Polanco PM. Failure to rescue following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Res 2017. [DOI: 10.1016/j.jss.2017.02.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pham TH, Melton SD, McLaren PJ, Mokdad AA, Huerta S, Wang DH, Perry KA, Hardaker HL, Dolan JP. Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer. J Surg Oncol 2017; 116:391-397. [PMID: 28556988 DOI: 10.1002/jso.24668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/16/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull-up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy. METHODS A retrospective review of a prospectively maintained database identified 30 patients who underwent esophagectomy. The patients were divided into three groups: control (no preconditioning, n = 9), partial (short gastric vessel ligation only, n = 8), and complete ischemic preconditioning (left and short gastric vessel ligation, n = 13). Microvessel counts were assessed, using immunohistologic analysis to determine the degree of neovascularization at the distal gastric margin. RESULTS The groups did not differ in age, gender, BMI, pathologic stage, or cancer subtype. Ischemic preconditioning durations were 163 ± 156 days for partial ischemic preconditioning, compared to 95 ± 50 days for complete ischemic preconditioning (P = 0.2). Immunohistologic analysis demonstrated an increase in microvessel counts of 29% following partial ischemic preconditioning (P = 0.3) and 67% after complete ischemic preconditioning (P < 0.0001), compared to controls. CONCLUSIONS Our study indicates that prolonged ischemic preconditioning is safe and does not interfere with subsequent esophagectomy. Complete ischemic preconditioning increased neovascularization in the distal gastric conduit.
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Affiliation(s)
- Thai H Pham
- Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shelby D Melton
- Pathology Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patrick J McLaren
- Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon
| | - Ali A Mokdad
- Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sergio Huerta
- Surgical Services, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - David H Wang
- Hematology Oncology, North Texas Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kyle A Perry
- Department of Surgery, Ohio State University Medical Center, Columbus, Ohio
| | - Hope L Hardaker
- Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon
| | - James P Dolan
- Division of Gastrointestinal and General Surgery and the Digestive Health Center, Department of Surgery, Oregon Health & Science University Medical Center, Portland, Oregon
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Affiliation(s)
- Ali A. Mokdad
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rebecca M. Minter
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hong Zhu
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
| | - John C. Mansour
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael A. Choti
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
| | - Patricio M. Polanco
- Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, John C. Mansour, Michael A. Choti, and Patricio M. Polanco, University of Texas Southwestern Medical Center, Dallas, TX
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Imran JB, Madni TD, Minshall CT, Mokdad AA, Subramanian M, Clark AT, Phelan HA, Cripps MW. Predictors of a histopathologic diagnosis of complicated appendicitis. J Surg Res 2017. [PMID: 28624044 DOI: 10.1016/j.jss.2017.02.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite its utilization, the intraoperative (IO) assessment of complicated appendicitis (CA) is subjective. The histopathologic (HP) diagnosis should be the gold standard in identifying patients with CA; however, it is not immediately available to guide postoperative management. The objective of this study was to identify predictors of an HP diagnosis of CA. MATERIALS AND METHODS A retrospective review of all patients who underwent appendectomy at our institution from 2011-2013 was conducted. CA was defined by perforation or abscess on pathology report. Predictors of an HP diagnosis of CA were evaluated using a multivariable regression model. RESULTS A total of 239 of 1066 patients had CA based on IO assessment, whereas 143 of 239 patients (60%) had CA on HP and IO assessment. On multivariable analysis, an IO diagnosis of CA was associated with an HP diagnosis of CA (odds ratio [OR]: 10.92; 95% confidence interval [CI]: 7.19-16.58). Other risk factors were age (OR: 1.28; 95% CI: 1.09-1.49), number of days of pain (OR: 1.20; 95% CI: 1.07-1.37), increased heart rate (OR: 1.14; 95% CI: 1.02-1.26), appendix size (OR: 1.09; 95% CI: 1.03-1.16), and an appendicolith (OR: 1.74; 95% CI: 1.12-2.71) on preoperative CT imaging. CONCLUSIONS In addition to age, increased heart rate, pain duration, appendix size and appendicolith, the IO assessment is also associated with an HP diagnosis of CA; however, 40% of patients were incorrectly classified. Using these predictors with improved IO grading may achieve more accurate diagnosis of CA.
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Affiliation(s)
- Jonathan B Imran
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarik D Madni
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christian T Minshall
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ali A Mokdad
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhu Subramanian
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Audra T Clark
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herb A Phelan
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael W Cripps
- Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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Mokdad AA, Wang SC, Porembka MR. Abstract C38: Racial and ethnic disparity in presentation and outcomes in gastric adenocarcinoma: A national study. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-c38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Patient presentation, management, and outcomes in gastric cancer are variable. This study explores the impact of race and ethnicity on differences in presentation, treatment utilization, and survival among patients with gastric adenocarcinoma in a national cohort.
Methods: A total of 96,976 adult patients with gastric adenocarcinoma were identified in the National Cancer Data Base between 2006 and 2013. Facility information as well as patient demographics, tumor characteristics, and treatment modalities were compared among whites, African-Americans, Hispanics, and Asians. Risk adjusted treatment utilization, namely operative resection, systemic chemotherapy, neoadjuvant and adjuvant therapy, as well as palliative care, were examined. Overall survival was compared among ethnicities. A Cox proportional hazards model was used to identify predictors of overall survival; the reference group was white patients unless otherwise noted.
Results: The dataset included 60,647 (66%) whites, 14,126 (15%) African-Americans, 10,054 (11%) Hispanics, and 6,275 (7%) Asians. Hispanics presented at an earlier age; 24% were diagnosed before the age of 50. Hispanic patients were more likely to present with metastatic disease (39%, P < 0.01) and high grade cancer (grade 3/4, 74%, P < 0.01). Conversely, Asian patients were more likely to present with early stage disease (Stage I, 25%, P < 0.01), and they were more likely to undergo resection (59%, adjusted odds ratio [OR], 1.2; 95% confidence interval, 1.2-1.3). Administration of neoadjuvant chemotherapy increased over the study period, 14% in 2006-2007 versus 31% in 2012-2013 (P < 0.01, OR, 3.3; 95% CI, 3.0-3.5). Compared to all other ethnicities, white patients were more likely to receive neoadjuvant therapy (27%, OR, 1.4; 95% CI, 1.3-1.5) while African-American, Hispanic, and Asian patients were more likely to receive adjuvant therapy (41%, OR, 1.2; 95% CI, 1.1-1.2). Hispanic and Asian patients survived longer than whites and African-Americans; median survivals were 13, 12, 16, and 25 months, respectively (log-rank P < 0.01). On multivariable analysis, significant predictors of favorable overall survival were treatment at an academic institution, younger age, Asian race, early stage, high income, private insurance, and multimodality treatment.
Conclusions: Race and ethnicity were associated with tumor presentation, treatment utilization, and survival. Disparity in survival among racial and ethnic groups was not completely accounted for by differences in tumor features and treatment.
Citation Format: Ali A. Mokdad, Sam C. Wang, Matthew R. Porembka. Racial and ethnic disparity in presentation and outcomes in gastric adenocarcinoma: A national study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C38.
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Affiliation(s)
| | - Sam C. Wang
- University of Texas Southwestern, Dallas, TX
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Charara R, Forouzanfar M, Naghavi M, Moradi-Lakeh M, Afshin A, Vos T, Daoud F, Wang H, El Bcheraoui C, Khalil I, Hamadeh RR, Khosravi A, Rahimi-Movaghar V, Khader Y, Al-Hamad N, Makhlouf Obermeyer C, Rafay A, Asghar R, Rana SM, Shaheen A, Abu-Rmeileh NME, Husseini A, Abu-Raddad LJ, Khoja T, Al Rayess ZA, AlBuhairan FS, Hsairi M, Alomari MA, Ali R, Roshandel G, Terkawi AS, Hamidi S, Refaat AH, Westerman R, Kiadaliri AA, Akanda AS, Ali SD, Bacha U, Badawi A, Bazargan-Hejazi S, Faghmous IAD, Fereshtehnejad SM, Fischer F, Jonas JB, Kuate Defo B, Mehari A, Omer SB, Pourmalek F, Uthman OA, Mokdad AA, Maalouf FT, Abd-Allah F, Akseer N, Arya D, Borschmann R, Brazinova A, Brugha TS, Catalá-López F, Degenhardt L, Ferrari A, Haro JM, Horino M, Hornberger JC, Huang H, Kieling C, Kim D, Kim Y, Knudsen AK, Mitchell PB, Patton G, Sagar R, Satpathy M, Savuon K, Seedat S, Shiue I, Skogen JC, Stein DJ, Tabb KM, Whiteford HA, Yip P, Yonemoto N, Murray CJL, Mokdad AH. The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PLoS One 2017; 12:e0169575. [PMID: 28095477 PMCID: PMC5240956 DOI: 10.1371/journal.pone.0169575] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/19/2016] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- Raghid Charara
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Mohammad Forouzanfar
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Anwar Rafay
- Contech International Health Consultants, Lahore, Pakistan
| | - Rana Asghar
- South Asian Public Health Forum, Islamabad, Pakistan
| | - Saleem M. Rana
- Contech International Health Consultants, Lahore, Pakistan
| | - Amira Shaheen
- Department of Public Health, An-Najah University, Nablus, Palestine
| | | | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
| | - Laith J. Abu-Raddad
- Harvard University, Boston, MA, United States of America
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Tawfik Khoja
- Health Ministers’ Council for Cooperation Council States, Riyadh, Saudi Arabia
| | | | - Fadia S. AlBuhairan
- King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Hsairi
- Ministry of Health—Tunisia (Faculty of Medicine Tunis), Tunis, Tunisia
| | - Mahmoud A. Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Raghib Ali
- University of Oxford, Oxford, United Kingdom
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States of America
- Department of Anesthesiology, King Fahad medical city, Riyadh, Saudi Arabia
- OUTCOMES RESEARCH Consortium, Cleveland, OH, United States of America
| | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Amany H. Refaat
- Suez Canal University, Ismailia, Egypt
- Walden University, Minneapolis, MN, United States of America
| | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany
| | - Aliasghar Ahmad Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Ali S. Akanda
- University of Rhode Island, Kingston, RI, United States of America
| | | | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Imad A. D. Faghmous
- Tehran University of Medical Sciences, Tehran, Iran
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany
| | - Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, Quebec, Canada
| | - Alem Mehari
- Howard University College of Medicine, Howard University, Washington DC, United States of America
| | - Saad B. Omer
- Emory University, Atlanta, GA, United States of America
| | | | - Olalekan A. Uthman
- Warwick—Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ali A. Mokdad
- Department of Surgery, University of Texas Southwestern, Dallas, Texas, United States of America
| | - Fadi T. Maalouf
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | | | - Nadia Akseer
- The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Dinesh Arya
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | | | - Ferrán Catalá-López
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Alize Ferrari
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- School of Public Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu—CIBERSAM, Sant Boi de Llobregat, Spain
| | - Masako Horino
- Nevada Division of Behavior and Public Health, Carson City, NV, United States of America
| | - John C. Hornberger
- National Institutes of Health, Bethesda, MD, United States of America
- Cedar Associates, Menlo Park, CA, United States of America
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States of America
| | | | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Yunjin Kim
- Southern University College, Johor, Malaysia
| | - Ann Kristin Knudsen
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - George Patton
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Maheswar Satpathy
- UGC Centre for Advanced Studies in Psychology, Utkal University, Vani Vihar, Bhubaneswar, Odisha, INDIA
| | - Kim Savuon
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
- Mental Health Association of Cambodia, Phnom Penh, Cambodia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Ivy Shiue
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jens Christoffer Skogen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Karen M. Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | | | - Paul Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Social Work and Social Administration Department, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- * E-mail:
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Mokdad AA, Minter RM, Zhu H, Augustine MM, Porembka MR, Wang SC, Yopp AC, Mansour JC, Choti MA, Polanco PM. Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis. J Clin Oncol 2016; 35:515-522. [PMID: 27621388 DOI: 10.1200/jco.2016.68.5081] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)-as well as a subgroup of UR patients who also received adjuvant therapy-for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P < .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P < .01), higher positive lymph nodes (73% v 48%; P < .01), and higher positive resection margin (24% v 17%; P < .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.
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Affiliation(s)
- Ali A Mokdad
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Rebecca M Minter
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Hong Zhu
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Mathew M Augustine
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew R Porembka
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Sam C Wang
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Adam C Yopp
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - John C Mansour
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael A Choti
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
| | - Patricio M Polanco
- All authors: University of Texas Southwestern Medical Center, Dallas, TX
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Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, Abu-Raddad LJ, Assadi R, Bhala N, Cowie B, Forouzanfour MH, Groeger J, Hanafiah KM, Jacobsen KH, James SL, MacLachlan J, Malekzadeh R, Martin NK, Mokdad AA, Mokdad AH, Murray CJL, Plass D, Rana S, Rein DB, Richardus JH, Sanabria J, Saylan M, Shahraz S, So S, Vlassov VV, Weiderpass E, Wiersma ST, Younis M, Yu C, El Sayed Zaki M, Cooke GS. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016; 388:1081-1088. [PMID: 27394647 PMCID: PMC5100695 DOI: 10.1016/s0140-6736(16)30579-7] [Citation(s) in RCA: 908] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013. METHODS We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). FINDINGS Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990. INTERPRETATION Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham, Birmingham, UK; University of Otago Medical School, Wellington, New Zealand
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia; Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Khayriyyah Mohd Hanafiah
- Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia; School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Spencer L James
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Jennifer MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia; Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Natasha K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Dietrich Plass
- Section Exposure Assessment and Environmental Health Indicators, Federal Environmental Agency, Berlin, Germany
| | - Saleem Rana
- Contech School of Public Health, Lahore, Pakistan; Contech International Health Consultants, Lahore, Pakistan
| | - David B Rein
- NORC at the University of Chicago, Chicago, IL, USA
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Juan Sanabria
- Case Western Reserve University, Cleveland, OH, USA; Cancer Treatment Centers of America, Rosalind Franklin University Chicago Medical School, North Chicago, IL, USA
| | - Mete Saylan
- Bayer AG Turkey, Fatih Sultan Mehmet Mah Balkan Cad, Istanbul, Turkey
| | | | - Samuel So
- Asian Liver Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vasiliy V Vlassov
- National Research University Higher School of Economics, Moscow, Russia
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
| | | | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | | | - Graham S Cooke
- Division of Infectious Diseases, Imperial College, London, UK.
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Huerta S, Patel PM, Mokdad AA, Chang J. Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients. Am J Surg 2016; 212:391-8. [DOI: 10.1016/j.amjsurg.2016.01.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/13/2016] [Accepted: 01/24/2016] [Indexed: 10/21/2022]
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Mokdad AH, Forouzanfar MH, Daoud F, El Bcheraoui C, Moradi-Lakeh M, Khalil I, Afshin A, Tuffaha M, Charara R, Barber RM, Wagner J, Cercy K, Kravitz H, Coates MM, Robinson M, Estep K, Steiner C, Jaber S, Mokdad AA, O'Rourke KF, Chew A, Kim P, El Razek MMA, Abdalla S, Abd-Allah F, Abraham JP, Abu-Raddad LJ, Abu-Rmeileh NME, Al-Nehmi AA, Akanda AS, Al Ahmadi H, Al Khabouri MJ, Al Lami FH, Al Rayess ZA, Alasfoor D, AlBuhairan FS, Aldhahri SF, Alghnam S, Alhabib S, Al-Hamad N, Ali R, Ali SD, Alkhateeb M, AlMazroa MA, Alomari MA, Al-Raddadi R, Alsharif U, Al-Sheyab N, Alsowaidi S, Al-Thani M, Altirkawi KA, Amare AT, Amini H, Ammar W, Anwari P, Asayesh H, Asghar R, Assabri AM, Assadi R, Bacha U, Badawi A, Bakfalouni T, Basulaiman MO, Bazargan-Hejazi S, Bedi N, Bhakta AR, Bhutta ZA, Bin Abdulhak AA, Boufous S, Bourne RRA, Danawi H, Das J, Deribew A, Ding EL, Durrani AM, Elshrek Y, Ibrahim ME, Eshrati B, Esteghamati A, Faghmous IAD, Farzadfar F, Feigl AB, Fereshtehnejad SM, Filip I, Fischer F, Gankpé FG, Ginawi I, Gishu MD, Gupta R, Habash RM, Hafezi-Nejad N, Hamadeh RR, Hamdouni H, Hamidi S, Harb HL, Hassanvand MS, Hedayati MT, Heydarpour P, Hsairi M, Husseini A, Jahanmehr N, Jha V, Jonas JB, Karam NE, Kasaeian A, Kassa NA, Kaul A, Khader Y, Khalifa SEA, Khan EA, Khan G, Khoja T, Khosravi A, Kinfu Y, Defo BK, Balaji AL, Lunevicius R, Obermeyer CM, Malekzadeh R, Mansourian M, Marcenes W, Farid HM, Mehari A, Mehio-Sibai A, Memish ZA, Mensah GA, Mohammad KA, Nahas Z, Nasher JT, Nawaz H, Nejjari C, Nisar MI, Omer SB, Parsaeian M, Peprah EK, Pervaiz A, Pourmalek F, Qato DM, Qorbani M, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Rai RK, Rana SM, Rao SR, Refaat AH, Resnikoff S, Roshandel G, Saade G, Saeedi MY, Sahraian MA, Saleh S, Sanchez-Riera L, Satpathy M, Sepanlou SG, Setegn T, Shaheen A, Shahraz S, Sheikhbahaei S, Shishani K, Sliwa K, Tavakkoli M, Terkawi AS, Uthman OA, Westerman R, Younis MZ, El Sayed Zaki M, Zannad F, Roth GA, Wang H, Naghavi M, Vos T, Al Rabeeah AA, Lopez AD, Murray CJL. Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Glob Health 2016; 4:e704-13. [PMID: 27568068 PMCID: PMC6660972 DOI: 10.1016/s2214-109x(16)30168-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 12/30/2022]
Abstract
Background 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. Methods 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. Findings 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. Interpretation 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. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | | | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marwa Tuffaha
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ryan M Barber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Wagner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hannah Kravitz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew M Coates
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Margaret Robinson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kara Estep
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caitlyn Steiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sara Jaber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali A Mokdad
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin F O'Rourke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Adrienne Chew
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Pauline Kim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Safa Abdalla
- Sudanese Public Health Consultancy Group, Solihull, UK
| | | | - Jerry P Abraham
- Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA; Institute for Global Health, Harvard University, Boston, MA, USA
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
| | | | | | | | | | | | | | - Zulfa A Al Rayess
- The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia
| | | | - Fadia S AlBuhairan
- King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh F Aldhahri
- King Saud University, Riyadh, Saudi Arabia; King Fahad Medical City, Riyadh, Saudi Arabia
| | - Suliman Alghnam
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samia Alhabib
- King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | | | | | - Syed Danish Ali
- University of London, London, UK; Institute and Faculty of Actuaries, Oxford, UK
| | - Mohammad Alkhateeb
- Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
| | | | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan
| | - Rajaa Al-Raddadi
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | | | | | - Shirina Alsowaidi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | | | - Azmeraw T Amare
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia; College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Heresh Amini
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | | | - Hamid Asayesh
- Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
| | - Rana Asghar
- South Asian Public Health Forum, Islamabad, Pakistan
| | - Ali M Assabri
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | - Amit R Bhakta
- National Institute of Mental Health, Montgomery Village, MD, USA
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Soufiane Boufous
- Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Jai Das
- Department of Paediatrics and Child Health, Karachi, Pakistan
| | - Amare Deribew
- Nuffield Department of Medicine, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Eric L Ding
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Yousef Elshrek
- Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya
| | - Mohamed E Ibrahim
- Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia
| | - Babak Eshrati
- Ministry of Health and Medical Education, Tehran, Iran; Arak University of Medical Sciences, Arak, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Andrea B Feigl
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | | | - Irina Filip
- Kaiser Permanente Psychiatry Residency Program, Fontana, CA, USA
| | | | | | - Ibrahim Ginawi
- College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Melkamu Dedefo Gishu
- Haramaya University, Dira Dawa, Ethiopia; Kersa Health and Demographic Surveillance System, Harar, Ethiopia
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Rami M Habash
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hayet Hamdouni
- Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia
| | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran
| | - Pouria Heydarpour
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Nader Jahanmehr
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vivekanand Jha
- The George Institute for Global Health India, University of Oxford, New Delhi, India
| | - Jost B Jonas
- Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
| | | | - Amir Kasaeian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Anil Kaul
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Ejaz A Khan
- Health Services Academy, Islamabad, Pakistan
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Tawfik Khoja
- Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Ardeshir Khosravi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Ministry of Health and Medical Education, Tehran, Iran
| | - Yohannes Kinfu
- Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Barthelemy Kuate Defo
- Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | | | - Raimundas Lunevicius
- Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Mansourian
- Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Alem Mehari
- Howard University College of Medicine, Washington, DC, USA
| | - Abla Mehio-Sibai
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ziad A Memish
- Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USA
| | | | - Ziad Nahas
- Medical Center, American University of Beirut, Beirut, Lebanon
| | | | - Haseeb Nawaz
- Southern Illinois University, Springfield, IL, USA
| | | | | | | | - Mahboubeh Parsaeian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Dima M Qato
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Amir Radfar
- A T Still University of Health Sciences, Kirksville, MO, USA
| | - Anwar Rafay
- Contech International Health Consultants, Lahore, Pakistan
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rajesh K Rai
- Society for Health and Demographic Surveillance, Suri, India
| | - Saleem M Rana
- Contech International Health Consultants, Lahore, Pakistan; Contech School of Public Health, Lahore, Pakistan
| | - Sowmya R Rao
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Amany H Refaat
- Walden University, Minneapolis, MN, USA; Suez Canal University, Ismailia, Egypt
| | - Serge Resnikoff
- Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia; International Health and Development, Geneva, Switzerland
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Georges Saade
- Lebanese University, Beirut, Lebanon; Bellevue Medical Center, Mansourieh El Metn, Lebanon
| | | | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Saleh
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Lidia Sanchez-Riera
- Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amira Shaheen
- Department of Public Health, An-Najah University, Nablus, Palestine
| | | | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | | | - Abdullah S Terkawi
- Department of Anesthesiology, Riyadh, Saudi Arabia; Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | | | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany; German National Cohort Consortium, Heidelberg, Germany
| | | | | | - Faiez Zannad
- Clinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, France; CHU de Nancy, Vandoeuvre les Nancy, France
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Llovet JM, Bruix J, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. 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 2014. [PMID: 25530442 DOI: 10.1016/s0140-6736] [Citation(s) in RCA: 460] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Bill & Melinda Gates Foundation.
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Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJL, Naghavi M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014; 12:145. [PMID: 25242656 PMCID: PMC4169640 DOI: 10.1186/s12916-014-0145-y] [Citation(s) in RCA: 672] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in prevalence of risk factors such as alcohol use and hepatitis B and C infection. We estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010. METHODS We systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. We corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. We used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country and year. We used out-of-sample predictive validity to select the optimal model. RESULTS Global liver cirrhosis deaths increased from around 676,000 (95% uncertainty interval: 452,863 to 1,004,530) in 1980 to over 1 million (1,029,042; 670,216 to 1,554,530) in 2010 (about 2% of the global total). Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US and countries in Western Europe. In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45- to 54-years old were due to liver cirrhosis. Liver cirrhosis mortality in Mexico is the highest in Latin America. In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third. Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon. CONCLUSIONS Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. Our study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.
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Roth GA, Gillespie CW, Mokdad AA, Shen DD, Fleming DW, Stergachis A, Murray CJL, Mokdad AH. Aspirin use and knowledge in the community: a population- and health facility based survey for measuring local health system performance. BMC Cardiovasc Disord 2014; 14:16. [PMID: 24507089 PMCID: PMC3922250 DOI: 10.1186/1471-2261-14-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/29/2014] [Indexed: 02/06/2023] Open
Abstract
Background Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community. Methods The Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for all respondents. For a subgroup free of CAD or cerebral infarction that underwent physical examination, we measured 10-year coronary heart disease risk and blood salicylate concentration. Results Two in five respondents reported using aspirin routinely while one in five with a history of CAD or cerebral infarction and without contraindication did not report routine use of aspirin. Women with these conditions used less aspirin than men (65.0% vs. 76.5%) and reported more health problems that would make aspirin unsafe (29.4% vs. 21.2%). In a subgroup undergoing phlebotomy a third of respondents with low cardiovascular risk used aspirin routinely and only 4.6% of all aspirin users had no detectable salicylate in their blood. Conclusions In this large urban county where health care delivery should be of high quality, there is insufficient aspirin use among those with high cardiovascular risk or disease and routine aspirin use by many at low risk. Further efforts are needed to promote shared-decision making between patients and clinicians as well as inform the public about appropriate use of routine aspirin to reduce the burden of atherosclerotic vascular disease.
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Affiliation(s)
- Gregory A Roth
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA.
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Mokdad AH, Jaber S, Aziz MIA, AlBuhairan F, AlGhaithi A, AlHamad NM, Al-Hooti SN, Al-Jasari A, AlMazroa MA, AlQasmi AM, Alsowaidi S, Asad M, Atkinson C, Badawi A, Bakfalouni T, Barkia A, Biryukov S, El Bcheraoui C, Daoud F, Forouzanfar MH, Gonzalez-Medina D, Hamadeh RR, Hsairi M, Hussein SS, Karam N, Khalifa SEAH, Khoja TAM, Lami F, Leach-Kemon K, Memish ZA, Mokdad AA, Naghavi M, Nasher J, Qasem MBH, Shuaib M, Al Thani AAM, Al Thani MH, Zamakhshary M, Lopez AD, Murray CJL. The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors. Lancet 2014; 383:309-20. [PMID: 24452042 DOI: 10.1016/s0140-6736(13)62189-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). METHODS We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. FINDINGS Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. INTERPRETATION Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Sara Jaber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Fadia AlBuhairan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Suad N Al-Hooti
- Kuwait Institute for Scientific Research, Kuwait City, Kuwait
| | | | | | | | | | | | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | - Stan Biryukov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Diego Gonzalez-Medina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Tawfik A M Khoja
- Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Faris Lami
- Baghdad College of Medicine, Baghdad, Iraq
| | - Katherine Leach-Kemon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ali A Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jamal Nasher
- Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | | | | | | | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Murray CJL, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, Dellavalle R, Danaei G, Ezzati M, Fahimi A, Flaxman D, Foreman, Gabriel S, Gakidou E, Kassebaum N, Khatibzadeh S, Lim S, Lipshultz SE, London S, Lopez, MacIntyre MF, Mokdad AH, Moran A, Moran AE, Mozaffarian D, Murphy T, Naghavi M, Pope C, Roberts T, Salomon J, Schwebel DC, Shahraz S, Sleet DA, Murray, Abraham J, Ali MK, Atkinson C, Bartels DH, Bhalla K, Birbeck G, Burstein R, Chen H, Criqui MH, Dahodwala, Jarlais, Ding EL, Dorsey ER, Ebel BE, Ezzati M, Fahami, Flaxman S, Flaxman AD, Gonzalez-Medina D, Grant B, Hagan H, Hoffman H, Kassebaum N, Khatibzadeh S, Leasher JL, Lin J, Lipshultz SE, Lozano R, Lu Y, Mallinger L, McDermott MM, Micha R, Miller TR, Mokdad AA, Mokdad AH, Mozaffarian D, Naghavi M, Narayan KMV, Omer SB, Pelizzari PM, Phillips D, Ranganathan D, Rivara FP, Roberts T, Sampson U, Sanman E, Sapkota A, Schwebel DC, Sharaz S, Shivakoti R, Singh GM, Singh D, Tavakkoli M, Towbin JA, Wilkinson JD, Zabetian A, Murray, Abraham J, Ali MK, Alvardo M, Atkinson C, Baddour LM, Benjamin EJ, Bhalla K, Birbeck G, Bolliger I, Burstein R, Carnahan E, Chou D, Chugh SS, Cohen A, Colson KE, Cooper LT, Couser W, Criqui MH, Dabhadkar KC, Dellavalle RP, Jarlais, Dicker D, Dorsey ER, Duber H, Ebel BE, Engell RE, Ezzati M, Felson DT, Finucane MM, Flaxman S, Flaxman AD, Fleming T, Foreman, Forouzanfar MH, Freedman G, Freeman MK, Gakidou E, Gillum RF, Gonzalez-Medina D, Gosselin R, Gutierrez HR, Hagan H, Havmoeller R, Hoffman H, Jacobsen KH, James SL, Jasrasaria R, Jayarman S, Johns N, Kassebaum N, Khatibzadeh S, Lan Q, Leasher JL, Lim S, Lipshultz SE, London S, Lopez, Lozano R, Lu Y, Mallinger L, Meltzer M, Mensah GA, Michaud C, Miller TR, Mock C, Moffitt TE, Mokdad AA, Mokdad AH, Moran A, Naghavi M, Narayan KMV, Nelson RG, Olives C, Omer SB, Ortblad K, Ostro B, Pelizzari PM, Phillips D, Raju M, Razavi H, Ritz B, Roberts T, Sacco RL, Salomon J, Sampson U, Schwebel DC, Shahraz S, Shibuya K, Silberberg D, Singh JA, Steenland K, Taylor JA, Thurston GD, Vavilala MS, Vos T, Wagner GR, Weinstock MA, Weisskopf MG, Wulf S, Murray. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310:591-608. [PMID: 23842577 PMCID: PMC5436627 DOI: 10.1001/jama.2013.13805] [Citation(s) in RCA: 1731] [Impact Index Per Article: 157.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
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Affiliation(s)
- Christopher J L Murray
- Institute for Health Metrics and Evaluation, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA.
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013. [PMID: 23245604 DOI: 10.1016/s01406736(12)61728-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013. [PMID: 23245604 DOI: 10.1016/s0140-6736(12)61728-0s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng ATA, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KMV, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJC, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SRM, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AKM, Zheng ZJ, Zonies D, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2163-96. [PMID: 23245607 PMCID: PMC6350784 DOI: 10.1016/s0140-6736(12)61729-2] [Citation(s) in RCA: 5377] [Impact Index Per Article: 448.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. INTERPRETATION Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Theo Vos
- School of Population Health, Brisbane, QLD, Australia
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, AlMazroa MA, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Abdulhak AB, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, Leo DD, Degenhardt L, Delossantos A, Denenberg J, Jarlais DCD, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Memish ZA, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O’Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095-128. [PMID: 23245604 PMCID: PMC10790329 DOI: 10.1016/s0140-6736(12)61728-0] [Citation(s) in RCA: 9089] [Impact Index Per Article: 757.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Kyle Foreman
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Stephen Lim
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Kenji Shibuya
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ali A Mokdad
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
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- Corresponding author: Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA,
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Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng ATA, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FGR, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KMV, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJC, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SRM, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AKM, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197-223. [PMID: 23245608 DOI: 10.1016/s0140-6736(12)61689-4] [Citation(s) in RCA: 5812] [Impact Index Per Article: 484.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. METHODS We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. FINDINGS Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. INTERPRETATION Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. FUNDING Bill & Melinda Gates Foundation.
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Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng ATA, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FGR, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CDH, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJC, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJL, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2224-60. [PMID: 23245609 PMCID: PMC4156511 DOI: 10.1016/s0140-6736(12)61766-8] [Citation(s) in RCA: 7149] [Impact Index Per Article: 595.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Stephen S Lim
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA.
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