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Alshahrani AM, Ibrahim ME, Aldossary AK, Alghamdi MA, Ahmed OB, Bin Abdulhak AA. Molecular Epidemiology of Carbapenem-Resistant K. pneumoniae Clinical Isolates from the Adult Patients with Comorbidities in a Tertiary Hospital, Southern Saudi Arabia. Antibiotics (Basel) 2022; 11:antibiotics11121697. [PMID: 36551354 PMCID: PMC9774885 DOI: 10.3390/antibiotics11121697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Hospitalized patients are likely to have chronic illnesses and are at an increased risk of mortality due to infection caused by MDR bacteria. We aimed to identify carbapenem-resistant genes carrying Klebsiella pneumoniae (K. pneumoniae) isolates and their risk factors recovered from adult patients with comorbidities. A cross-sectional study was carried out between April 2021 and December 2021 at King Abdullah Hospital (KAH) in Bisha province, Saudi Arabia. Seventy-one multi-drug resistant K. pneumoniae recovered from clinical samples and screened for carbapenemase genes of blaOXA-48-like, blaNDM-1, blaKPC, blaVIM, and blaIMP. Of 71 MDR K. pneumoniae examined, 47 (66.2%) isolates harbored various carbapenemase genes. The most prevalent single resistance gene was blaOXA-48-like (62.5%; n = 25), and 33.3% of them were recovered from sputum isolates. The blaNDM-1 gene was detected in 12 (30.0%) isolates, and eight of them were recovered from urine (n = 4) and blood (n = 4). Two (5.0%) single blaKPC genes were recovered from the sputum (n = 1) and blood (n = 1) isolates. In contrast, no blaIMP- and blaVIM-carrying isolates were detected. The co-existence of two resistance genes between blaOXA-48-like and blaNDM-1 was found in six strains, whereas only one strain was found to be produced in the three genes of blaNDM-1, blaKPC, and blaOXA-48-like. There were statistically significant associations between the presence of carbapenem-gene-carrying K. pneumoniae and patients' gender (χ2(1) = 5.94, p = 0.015), intensive care unit admission (χ2(1) = 7.649, p = 0.002), and chronic obstructive pulmonary disease (χ2(1) = 4.851, p = 0.028). The study highlighted the existence of carbapenemase-producing K. pneumoniae, particularly blaOXA-48-like and blaNDM-1, in patients with comorbidities. Our findings emphasize the importance of the molecular characterization of resistance-determinant-carrying bacterial pathogens as a part of infection control and prevention in hospital settings.
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Affiliation(s)
- Abdullah M. Alshahrani
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha 67614, Saudi Arabia
| | - Mutasim E. Ibrahim
- Department of Basic Medical Sciences (Microbiology Unit), College of Medicine, University of Bisha, Bisha 67614, Saudi Arabia
- Correspondence: or ; Tel.: +966-502656995
| | - Ahmed K. Aldossary
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha 67614, Saudi Arabia
| | - Mushabab A. Alghamdi
- Department of Internal Medicine, College of Medicine, University of Bisha, Bisha 67614, Saudi Arabia
| | - Omar B. Ahmed
- Department of Environmental and Health Research, The Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Aref A. Bin Abdulhak
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
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Tleyjeh IM, Kashour Z, AlDosary O, Riaz M, Tlayjeh H, Garbati MA, Tleyjeh R, Al-Mallah MH, Sohail MR, Gerberi D, Bin Abdulhak AA, Giudicessi JR, Ackerman MJ, Kashour T. Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis. Mayo Clin Proc Innov Qual Outcomes 2020; 5:137-150. [PMID: 33163895 PMCID: PMC7605861 DOI: 10.1016/j.mayocpiqo.2020.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19). Methods We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences. Results A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; I 2 =96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; I 2 =98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; I 2 =97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity. Conclusion Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.
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Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zakariya Kashour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Oweida AlDosary
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Riaz
- Department of Statistics, Quaid Azam University Islamabad, Pakistan
| | - Haytham Tlayjeh
- Department of Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Musa A Garbati
- Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Rana Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN
| | | | - John R Giudicessi
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
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Bahaj W, Albawaliz A, Qureini A, Abughanimeh OKM, Younis M, Tahboub M, Noman A, Bin Abdulhak AA. Angiotensin converting enzyme inhibitors use and development of lung cancer: A systematic review and meta-analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13093 Background: Angiotensin-converting enzyme inhibitors (ACEIs) are commonly prescribed medications for hypertension and heart failure. Generally, ACEIs are well-tolerated medications with reasonable safety profile making them a favorable choice by many clinicians. However, several studies with conflicting results have signaled an association between ACEIs use and the development of lung cancer. We sought to systematically review the literature and perform the first meta-analysis to study the risk of lung cancer among ACEI users. Methods: We performed a literature review by searching multiple databases. A random effect meta-analysis approach was used to pool the data and relative risk was used to calculate the overall effect estimate. Results: A total of 423 articles were identified but only 6 observational studies were included with a total of 872,220 patients (634,672. ACEIs users). The relative risk of lung cancer development among ACEIs users was 1.02 (CI 0.89-1.16) compared to non-ACEIs users. Conclusions: Current systematic review and meta-analysis show no significant association between ACEIs use and the development of lung cancer. The result of our meta-analysis provides further assurance to the health care providers regarding ACEIs use.
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Affiliation(s)
- Waled Bahaj
- University of Missouri at Kansas City, Kansas City, MO
| | | | - Aref Qureini
- University of Missouri at Kansas City, Kansas City, MO
| | | | | | | | - Anas Noman
- University of Missouri at Kansas City, Kansas City, MO
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Noman AT, Qazi AH, Alqasrawi M, Ayinde H, Tleyjeh IM, Lindower P, Bin Abdulhak AA. Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis. Int J Cardiol 2019; 274:299-302. [DOI: 10.1016/j.ijcard.2018.09.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/29/2018] [Accepted: 09/19/2018] [Indexed: 01/01/2023]
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Abstract
Infective endocarditis (IE) is associated with significant serious adverse outcomes including death. IE usually presents with diverse clinical picture and syndromic diagnoses including heart failure, stroke, and peripheral embolization. Given variable, vague, and syndromic presentations, the diagnosis of IE may be delayed for days to weeks. Maintaining a high index of suspicion among clinicians is the key to early recognition of the disease and prompt initiation of antimicrobial therapy to prevent IE-associated mortality and morbidity. Blood culture and echocardiography remain essential tools in the diagnosis of infective endocarditis. However, advances in molecular techniques, serology testing, computed tomography scan, and nuclear medicine have led to growth in the available tools that may aid in early diagnosis of infective endocarditis. Antimicrobial agents are the mainstay of IE therapy; however, as many as 50% of endocarditis cases will undergo valve surgery, even on an urgent or emergent basis.
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Affiliation(s)
- Aref A Bin Abdulhak
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Abdul H Qazi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. .,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA. .,Department of Medicine, Infectious Diseases Section, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Saudi Arabia. .,College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Al-Ghamdi MA, Bin Abdulhak AA. Pattern, duration of stay, and outcomes of medical admissions: a report from teaching community hospital in Assir region, Saudi Arabia. J Community Hosp Intern Med Perspect 2018; 8:53-56. [PMID: 29686787 PMCID: PMC5906764 DOI: 10.1080/20009666.2018.1454789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Population-based studies are the gold standard to understand the burden of different diseases, plan health care policy and resource allocation, and provide an accurate estimate of disease several disease indices including mortality. However, population-based studies are difficult to undertake in a resource-limited situation where no robust data bases and disease registries are available. Therefore, hospital-based cohorts may be used to inform about the community health. Objectives: We sought to study the pattern of disease causing admission, hospital stay, and outcomes of medical admissions to King Abdullah Hospital in Bisha in order to inform clinicians, public health professionals, and policymakers about the current status of diseases within the community in Bisha. Methods:This is a cross-sectional study including all adult patients aged above 18 years who were admitted to King Abdullah Hospital in Bisha, Assir region, to medical services including general internal medicine, general cardiology, nephrology, gastroenterology, rheumatology, and neurology during the study period between 1 June 2015 and 31 May 2016. Common causes of hospital admission, outcomes of hospitalization, and length of stay were estimated and the data were presented as frequency and percentage for categorical valve and mean and standard deviation for continuous variables. Results: Cardiovascular diseases including stroke are considered the leading cause of hospital admission in a teaching community hospital in Bisha, Assir region. Diabetes mellitus and hypertension are prevalent comorbidities among hospitalized patients. Majority of admitted patients have improved and discharged home (83.3%). However, 6.7% were transferred to another facility, 4.1% have left against medical advice, and 5.9% died. Conclusion: Health-related data bases and disease registries are urgently needed to precisely estimate the burden of cardiovascular disease in Assir region in Saudi Arabia. Lifestyle changes, healthy diet, aggressive management of hypertension and diabetes within the community, and allocating necessary resources are urgently to combat the growing burden of cardiovascular disease.
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Affiliation(s)
- Mushabab A Al-Ghamdi
- Internal Medicine Department, University of Bisha, Bisha, Kingdom of Saudi Arabia
| | - Aref A Bin Abdulhak
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Bin Abdulhak AA, Vaughan-Sarrzin M, Kaboli P, Horwitz PA, Mosher H, Sigurdsson G, Walker NE, Wallace R, Robinson JG. Temporal Trends of High-Intensity Statin Therapy Among Veterans Treated With Percutaneous Coronary Intervention. J Am Heart Assoc 2018; 7:JAHA.117.007370. [PMID: 29503265 PMCID: PMC5866316 DOI: 10.1161/jaha.117.007370] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The 2013 American College of Cardiology/American Heart Association blood cholesterol guideline recommends high-intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory. We aimed to investigate the temporal trends and predictors of high-intensity statin therapy among veterans who had been treated with percutaneous coronary intervention (PCI) and followed up by cardiologists within the Veterans Health Administrative system. METHODS AND RESULTS A retrospective cohort study was conducted at the Veterans Health Administrative system including all patients >18 years old who had their PCI procedure between October 2010 and September 2016. National Veterans Health Administrative databases were used to retrieve study participant's demographics, comorbid conditions, statin type and dose within 90 days before and after the PCI procedure. There were 48 862 patients who underwent a PCI procedure during the study period. High-intensity statin use at 90 days post-PCI rose from 23% in 2010 to 37% before release of the 2013 American College of Cardiology/American Heart Association cholesterol guideline, then rose sharply to 80% by 2016. The projected 10-year risk of arteriosclerotic cardiovascular disease events among our study population was projected to be ≈1841 fewer if the cohort had received high-intensity statin therapy versus moderate-intensity statin. CONCLUSIONS By 2016, the 2013 American College of Cardiology/American Heart Association blood cholesterol guideline was well implemented among veterans who had a PCI procedure in the Veterans Health Administrative system, suggesting systems of care can be improved to increase rates of high-intensity statin initiation.
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Affiliation(s)
- Aref A Bin Abdulhak
- Center for Access Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.,College of Public Health, University of Iowa, Iowa City, IA
| | - Mary Vaughan-Sarrzin
- Center for Access Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Peter Kaboli
- Center for Access Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Hilary Mosher
- Center for Access Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Gardar Sigurdsson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Nicholas E Walker
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Robert Wallace
- College of Public Health, University of Iowa, Iowa City, IA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jennifer G Robinson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA .,College of Public Health, University of Iowa, Iowa City, IA
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Batais MA, Almigbal TH, Bin Abdulhak AA, Altaradi HB, AlHabib KF. Assessment of physicians' awareness and knowledge of familial hypercholesterolemia in Saudi Arabia: Is there a gap? PLoS One 2017; 12:e0183494. [PMID: 28817709 PMCID: PMC5560711 DOI: 10.1371/journal.pone.0183494] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/05/2017] [Indexed: 12/20/2022] Open
Abstract
Background The scarcity of familial hypercholesterolemia (FH) cases reported in Saudi Arabia might be indicative of a lack of awareness of this common genetic disease among physicians. Objective To assess physicians’ awareness, practice, and knowledge of FH in Saudi Arabia. Methods This is a cross-sectional study conducted among physicians at four tertiary hospitals in Riyadh, Saudi Arabia between March 2016 and May 2016 using a self-administered questionnaire. Results A total of 294 physicians completed the survey (response rate 90.1%). Overall, 92.9% of the participants have poor knowledge of FH while only 7.1% have acceptable knowledge. The majority (68.7%) of physicians rated their familiarity with FH as average or above average, and these had higher mean knowledge scores than participants with self-reported below average familiarity (mean 3.4 versus 2.6) (P < 0.001). Consultant physicians were 4.2 times more likely to be familiar with FH than residents or registrars (OR = 4.2, 95% CI = 1.9–9.1, P < 0.001). Physicians who currently managed FH patients had higher mean knowledge scores compared to those without FH patients in their care (3.5 versus 2.9) (P = 0.006). In addition, there were statistically significant differences between physicians’ mean knowledge scores and their ages, levels of training, and years in practice. Moreover, a substantial deficit was identified in the awareness of various clinical algorithms to diagnose patients with FH, cascade screening, specialist lipid services, and the existence of statin alternatives, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Conclusion A substantial deficit was found in the awareness, knowledge, practice, and detection of FH among physicians in Saudi Arabia. Extensive educational programs are required to raise physician awareness and implement best practices; only then can the impact of these interventions on FH management and patient outcome be assessed.
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Affiliation(s)
- Mohammed Ali Batais
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Turky H. Almigbal
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aref A. Bin Abdulhak
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States of America
| | - Hani B. Altaradi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Khan AR, Golwala H, Tripathi A, Bin Abdulhak AA, Bavishi C, Riaz H, Mallipedi V, Pandey A, Bhatt DL. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 2017; 38:3082-3089. [DOI: 10.1093/eurheartj/ehx418] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
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Abstract
PURPOSE OF THE REVIEW Community-acquired pneumonia (CAP) is still associated with a large burden and causes significant morbidity and mortality. Besides universal vaccination and antibiotic treatment, statins as adjunctive therapy may also have a beneficial role in the prevention and treatment of CAP. Our goal from this review is to discuss the epidemiology of CAP, and role of statins as adjunctive therapy in the development of CAP. RECENT FINDINGS Statins are lipid-lowering medications characterized by their ability to control hypercholesterolemia in addition to other pleiotropic effects that could explain their role in the pathogenesis of CAP. While most observational studies have shown that statins reduce risk of pneumonia in the general population, patients with diabetes, and recently in patients with myocardial infarction, no randomized controlled trial (RCT) to date has been conducted to assess the efficacy of statins to prevent development of CAP. Given the paucity of robust randomized evidence to assess statin use and the development of CAP, and considering conflicting results of the observational studies, we are not in favor of initiation of statins for either the prevention or treatment of CAP.
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Affiliation(s)
- Mohammed A Batais
- College of Medicine, King Saud University, Riyadh, 29391, Saudi Arabia.
| | - Abdur Rahman Khan
- Department of Medicine, Division of Cardiovascular Diseases, University of Louisville, Louisville, KY, USA
| | - Aref A Bin Abdulhak
- Department of Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int. Med. E315 GH, Iowa City, IA, 52242, USA
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Abstract
PURPOSE OF THE REVIEW Infective endocarditis (IE) is a serious disease with significant morbidity and mortality. Valve surgery is fundamental in the standard of care of selected IE patients. Indeed, valve surgery can be a lifesaving procedure in critically ill endocarditis patients. Our goal from this review is to discuss the indications of surgery in IE population and international cardiac societies' guideline recommendations. RECENT FINDINGS Though IE is an uncommon disease, its incidence is noted to be on rise in some parts of the world, and the disease is expected to continue to be a major health problem. Antimicrobials remain the mainstay of IE therapy, but as many as 50% of endocarditis patients will undergo surgical intervention. Heart failure most commonly from acute valvular insufficiency, uncontrolled and persistent infection, and recurrent embolic events are the major indications for valve surgery in IE population. Heart failure is by far the most common indication for surgery in IE patients. Despite the fact that many IE patients will require surgical interventions, most of the international societies' recommendations to perform valve surgery are based on observational studies or experts' opinion. Surgery plays a major role in the management of IE patients, and it is most commonly performed in patients with heart failure, persistent or uncontrolled infection, and recurrent emboli. Most of the current evidence supporting surgical intervention in IE patients is based on observational studies and experts' opinion. Randomized clinical trials are urgently needed to guide surgical therapy in IE.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int. Med. E315 GH, Iowa City, IA, 52242, USA.,College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. .,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA. .,Department of Medicine, Infectious Diseases Section, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Saudi Arabia. .,College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Khalil I, Colombara DV, Forouzanfar MH, Troeger C, Daoud F, Moradi-Lakeh M, Bcheraoui CE, Rao PC, Afshin A, Charara R, Abate KH, Razek MMAE, Abd-Allah F, Abu-Elyazeed R, Kiadaliri AA, Akanda AS, Akseer N, Alam K, Alasfoor D, Ali R, AlMazroa MA, Alomari MA, Al-Raddadi RMS, Alsharif U, Alsowaidi S, Altirkawi KA, Alvis-Guzman N, Ammar W, Antonio CAT, Asayesh H, Asghar RJ, Atique S, Awasthi A, Bacha U, Badawi A, Barac A, Bedi N, Bekele T, Bensenor IM, Betsu BD, Bhutta Z, Abdulhak AAB, Butt ZA, Danawi H, Dubey M, Endries AY, Faghmous IDA, Farid T, Farvid MS, Farzadfar F, Fereshtehnejad SM, Fischer F, Fitchett JRA, Gibney KB, Ginawi IAM, Gishu MD, Gugnani HC, Gupta R, Hailu GB, Hamadeh RR, Hamidi S, Harb HL, Hedayati MT, Hsairi M, Husseini A, Jahanmehr N, Javanbakht M, Jibat T, Jonas JB, Kasaeian A, Khader YS, Khan AR, Khan EA, Khan G, Khoja TAM, Kinfu Y, Kissoon N, Koyanagi A, Lal A, Latif AAA, Lunevicius R, Razek HMAE, Majeed A, Malekzadeh R, Mehari A, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Misganaw A, Mohamed LAI, Nachega JB, Nguyen QL, Nisar MI, Peprah EK, Platts-Mills JA, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Rahman SU, Rai RK, Rana SM, Ranabhat CL, Rao SR, Refaat AH, Riddle M, Roshandel G, Ruhago GM, Saleh MM, Sanabria JR, Sawhney M, Sepanlou SG, Setegn T, Sliwa K, Sreeramareddy CT, Sykes BL, Tavakkoli M, Tedla BA, Terkawi AS, Ukwaja K, Uthman OA, Westerman R, Wubshet M, Yenesew MA, Yonemoto N, Younis MZ, Zaidi Z, Zaki MES, Rabeeah AAA, Wang H, Naghavi M, Vos T, Lopez AD, Murray CJL, Mokdad AH. Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. Am J Trop Med Hyg 2016; 95:1319-1329. [PMID: 27928080 PMCID: PMC5154365 DOI: 10.4269/ajtmh.16-0339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 04/29/2016] [Accepted: 07/03/2016] [Indexed: 12/22/2022] Open
Abstract
Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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Affiliation(s)
- Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Maziar Moradi-Lakeh
- Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | | | | | | | - Aliasghar Ahmad Kiadaliri
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Nadia Akseer
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Khurshid Alam
- University of Sydney, Sydney, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Raghib Ali
- University of Oxford, Oxford, United Kingdom
| | | | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Shirina Alsowaidi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, College of Public Health, University of the Philippines, Manila, Philippines
| | - Hamid Asayesh
- Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
| | | | - Suleman Atique
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Ashish Awasthi
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, Canada
| | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | | | | | - Zulfiqar Bhutta
- Medical Center, Aga Khan University, Karachi, Pakistan.,The Hospital for Sick Children, Toronto, Canada
| | | | - Zahid A Butt
- Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Imad D A Faghmous
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Talha Farid
- University of Louisville, Louisville, Kentucky
| | - Maryam S Farvid
- Institute for Health Policy, Boston, Massachusetts.,University of Louisville, Louisville, Kentucky
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Katherine B Gibney
- Melbourne Health, Parkville, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Melkamu Dedefo Gishu
- Kersa Health and Demographic Surveillance System, Harar, Ethiopia.,Haramaya University, Dire Dawa, Ethiopia
| | - Harish Chander Gugnani
- Department of Epidemiology and Biostatistics, Saint James School of Medicine, Anguilla, British West Indies.,Department of Microbiology, Saint James School of Medicine, Anguilla, British West Indies
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston, West Virginia
| | - Gessessew Bugssa Hailu
- Kilte Awlaelo Health and Demographic Surveillance System, Ethiopia.,Mekelle University, Mekelle, Ethiopia
| | | | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Mohammad T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohamed Hsairi
- Department of Epidemiology, Salah Azaiz Institute, Tunis, Tunisia
| | | | - Nader Jahanmehr
- Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tariku Jibat
- Wageningen University, Wageningen, Netherlands.,Addis Ababa University, Debre Zeit, Ethiopia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Yohannes Kinfu
- Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain
| | - Aparna Lal
- Australian National University, Canberra, Australia
| | | | - Raimundas Lunevicius
- School of Medicine, University of Liverpool, Liverpool, United Kingdom.,Aintree University Hospital, National Health Service Foundation Trust, Liverpool, United Kingdom
| | | | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alem Mehari
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Yohannes Adama Melaku
- School of Medicine, University of Adelaide, Adelaide, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Ministry of Health, Riyadh, Saudi Arabia
| | | | - Awoke Misganaw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Jean B Nachega
- Stellenbosch University, Cape Town, Western Cape, South Africa.,University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Quyen Le Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | | | | | | | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Chhabi L Ranabhat
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.,Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Sowmya R Rao
- Department of Surgery, School of Medicine, Boston University, Boston, Massachusetts
| | - Amany H Refaat
- Suez Canal University, Ismailia, Egypt.,Walden University, Minneapolis, Minnesota
| | - Mark Riddle
- Naval Medical Research Center, Silver Spring, Maryland
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.,Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Juan R Sanabria
- Case Western Reserve University, Cleveland, Ohio.,Department of Surgery and Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | | | - Sadaf G Sepanlou
- Digestive Disease Research Institute, 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
| | | | - Bryan L Sykes
- Departments of Criminology, Law and Society, Sociology, and Public Health, University of California-Irvine, Irvine, California
| | | | - Bemnet Amare Tedla
- James Cook University, Cairns, Australia.,University of Gondar, Gondar, Ethiopia
| | - Abdullah S Terkawi
- Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Kingsley Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Olalekan A Uthman
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ronny Westerman
- German National Cohort Consortium, Heidelberg, Germany.,Federal Institute for Population Research, Wiesbaden, Germany
| | - Mamo Wubshet
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,University of Gondar, Gondar, Ethiopia
| | | | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | | | | | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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14
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Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR, Kutz M, Kyu HH, Larson HJ, Leung J, Liang X, Lim SS, Lind M, Lozano R, Marquez N, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Roth GA, Salomon JA, Sandar L, Silpakit N, Sligar A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Thomas BA, Troeger C, VanderZanden A, Vollset SE, Wanga V, Whiteford HA, Wolock T, Zoeckler L, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abreu DMX, Abu-Raddad LJ, Abyu GY, Achoki T, Adelekan AL, Ademi Z, Adou AK, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Lami FHA, Alabed S, Al-Aly Z, Alam K, Alam NKM, Alasfoor D, Aldhahri SF, Aldridge RW, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Alhabib S, Ali R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amegah AK, Ameh EA, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Aregay AF, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu A, Basu S, Bayou YT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Belay HA, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhalla A, Biadgilign S, Bikbov B, Abdulhak AAB, Biroscak BJ, Biryukov S, Bjertness E, Blore JD, Blosser CD, Bohensky MA, Borschmann R, Bose D, Bourne RRA, Brainin M, Brayne CEG, Brazinova A, Breitborde NJK, Brenner H, Brewer JD, Brown A, Brown J, Brugha TS, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cercy K, Cerda J, Chen W, Chew A, Chiang PPC, Chibalabala M, Chibueze CE, Chimed-Ochir O, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colistro V, Colomar M, Colquhoun SM, Cooper C, Cooper LT, Cortinovis M, Cowie BC, Crump JA, Damsere-Derry J, Danawi H, Dandona R, Daoud F, Darby SC, Dargan PI, das Neves J, Davey G, Davis AC, Davitoiu DV, de Castro EF, de Jager P, Leo DD, Degenhardt L, Dellavalle RP, Deribe K, Deribew A, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Ding EL, dos Santos KPB, Dossou E, Driscoll TR, Duan L, Dubey M, Duncan BB, Ellenbogen RG, Ellingsen CL, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Faghmous IDA, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Flaxman A, Foigt N, Fowkes FGR, Franca EB, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gall SL, Gambashidze K, Gamkrelidze A, Ganguly P, Gankpé FG, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Geleijnse JM, Gessner BD, Ghoshal AG, Gibney KB, Gillum RF, Gilmour S, Giref AZ, Giroud M, Gishu MD, Giussani G, Glaser E, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gosselin RA, Gotay CC, Goto A, Gouda HN, Greaves F, Gugnani HC, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Havmoeller R, Heckbert SR, Heredia-Pi IB, Heydarpour P, Hilderink HBM, Hoek HW, Hogg RS, Horino M, Horita N, Hosgood HD, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Htike MMT, Hu G, Huang C, Huang H, Huiart L, Husseini A, Huybrechts I, Huynh G, Iburg KM, Innos K, Inoue M, Iyer VJ, 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Mackay MT, MacLachlan JH, Razek HMAE, Magdy M, Razek AE, Majdan M, Majeed A, Malekzadeh R, Manamo WAA, Mandisarisa J, Mangalam S, Mapoma CC, Marcenes W, Margolis DJ, Martin GR, Martinez-Raga J, Marzan MB, Masiye F, Mason-Jones AJ, Massano J, Matzopoulos R, Mayosi BM, McGarvey ST, McGrath JJ, McKee M, McMahon BJ, Meaney PA, Mehari A, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Micha R, Millear A, Miller TR, Mirarefin M, Misganaw A, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Mohan V, Mola GLD, Monasta L, Hernandez JCM, Montero P, Montico M, Montine TJ, Moradi-Lakeh M, Morawska L, Morgan K, Mori R, Mozaffarian D, Mueller UO, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naidoo KS, Naik N, Naldi L, Nangia V, Nash D, Nejjari C, Neupane S, Newton CR, Newton JN, Ng M, Ngalesoni FN, de Dieu Ngirabega J, Nguyen QL, Nisar MI, Pete PMN, Nomura M, Norheim OF, Norman PE, Norrving B, Nyakarahuka L, Ogbo 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M, Savic M, Sawhney M, Schaub MP, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Sharma R, She J, Sheikhbahaei S, Shen J, Shen Z, Shepard DS, Sheth KN, Shetty BP, Shi P, Shibuya K, Shin MJ, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Singh V, Soneji S, Søreide K, Soriano JB, Sposato LA, Sreeramareddy CT, Stathopoulou V, Stein DJ, Stein MB, Stranges S, Stroumpoulis K, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Takahashi K, Takala JS, Talongwa RT, Tandon N, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tedla BA, Tefera WM, Have MT, Terkawi AS, Tesfay FH, Tessema GA, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tirschwell DL, Tonelli M, Topor-Madry R, Topouzis F, Towbin JA, Traebert J, Tran BX, Truelsen T, Trujillo U, Tura AK, Tuzcu EM, Uchendu US, Ukwaja KN, Undurraga EA, Uthman OA, Dingenen RV, van Donkelaar A, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Vidavalur R, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Wagner JA, Wagner GR, Wallin MT, Wang L, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, White RA, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Wong JQ, Woolf AD, Xavier D, Xiao Q, Xu G, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yebyo HG, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Younis MZ, Yu S, Zaidi Z, Zaki MES, Zannad F, Zavala DE, Zeeb H, Zeleke BM, Zhang H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1459-1544. [PMID: 27733281 PMCID: PMC5388903 DOI: 10.1016/s0140-6736(16)31012-1] [Citation(s) in RCA: 4031] [Impact Index Per Article: 503.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. INTERPRETATION At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. FUNDING Bill & Melinda Gates Foundation.
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Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, Casey DC, Charlson FJ, Coates MM, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kemmer L, Khalil IA, Kinfu Y, Kutz MJ, Kyu HH, Leung J, Liang X, Lim SS, Lozano R, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Naghavi M, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Rankin Z, Reinig N, Salomon JA, Sandar L, Smith A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Troeger C, Truelsen T, VanderZanden A, Wagner JA, Wanga V, Whiteford HA, Zhou M, Zoeckler L, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Achoki T, Ackerman IN, Adebiyi AO, Adedeji IA, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agarwal SK, Ahmed MB, Kiadaliri AA, Ahmadieh H, Akseer N, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Ali R, Alkerwi A, Alla F, Allebeck P, Allen C, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Anderson GM, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu S, Bayou TA, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Benjet C, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Abdulhak AAB, Biryukov S, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brugha TS, Buchbinder R, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carabin H, Carapetis JR, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Chang JC, Chiang PPC, Chibalabala M, Chibueze CE, Chisumpa VH, Choi JYJ, Choudhury L, Christensen H, Ciobanu LG, Colistro V, Colomar M, Colquhoun SM, Cortinovis M, Crump JA, Damasceno A, Dandona R, Dargan PI, das Neves J, Davey G, Davis AC, Leo DD, Degenhardt L, Gobbo LCD, Derrett S, Jarlais DCD, deVeber GA, Dharmaratne SD, Dhillon PK, Ding EL, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Ellenbogen RG, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Foigt N, Fowkes FGR, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gabbe B, Gankpé FG, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gibney KB, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Hay RJ, Hedayati MT, Heredia-Pi IB, Heydarpour P, Hoek HW, Hoffman DJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Huang H, Huang JJ, Iburg KM, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jauregui A, Jayatilleke AU, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jin Y, Jonas JB, Kabir Z, Kajungu DK, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kim YJ, Kissoon N, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Koul PA, Koyanagi A, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lalloo R, Lallukka T, Larsson A, Latif AA, Lavados PM, Lawrynowicz AEB, Leasher JL, Leigh J, Leung R, Li Y, Li Y, Lipshultz SE, Liu PY, Liu Y, Lloyd BK, Logroscino G, Looker KJ, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Razek HMAE, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Marcenes W, Martinez-Raga J, Masiye F, Mason-Jones AJ, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Mitchell PB, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Monasta L, Hernandez JCM, Montico M, Moradi-Lakeh M, Mori R, Mueller UO, Mumford JE, Murdoch ME, Murthy GVS, Nachega JB, Naheed A, Naldi L, Nangia V, Newton JN, Ng M, Ngalesoni FN, Nguyen QL, Nisar MI, Pete PMN, Nolla JM, Norheim OF, Norman RE, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Ota E, Oyekale AS, PA M, Park EK, Parsaeian M, Patten SB, Patton GC, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pishgar F, Plass D, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai D, Rai RK, Rajsic S, Raju M, Ram U, Ranganathan K, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Reynolds A, Ribeiro AL, Ricci S, Roba HS, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Roy A, Sackey BB, Sagar R, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shahraz S, Shaikh MA, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Sigfusdottir ID, Silva DAS, Silverberg JI, Simard EP, Singh A, Singh JA, Singh PK, Skirbekk V, Skogen JC, Soljak M, Søreide K, Sorensen RJD, Sreeramareddy CT, Stathopoulou V, Steel N, Stein DJ, Stein MB, Steiner TJ, Stovner LJ, Stranges S, Stroumpoulis K, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tandon N, Tanne D, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tegegne TK, Tekle DY, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tsilimbaris M, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Gool CH, van Os J, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Wallin MT, Wang L, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Xu G, Yadav AK, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zeeb H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1603-1658. [PMID: 27733283 PMCID: PMC5388857 DOI: 10.1016/s0140-6736(16)31460-x] [Citation(s) in RCA: 1387] [Impact Index Per Article: 173.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING Bill & Melinda Gates Foundation.
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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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Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NME, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs ADM, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PGJ, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TKD, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farzadfar F, Fay DFJ, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IAM, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VMP, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega JDD, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS, Pain AW, Pandian JD, Panelo CIA, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SAL, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DAA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJC, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJC, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AMN, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CDA, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, Murray CJ. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:2287-323. [PMID: 26364544 PMCID: PMC4685753 DOI: 10.1016/s0140-6736(15)00128-2] [Citation(s) in RCA: 1719] [Impact Index Per Article: 191.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING Bill & Melinda Gates Foundation.
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Khan AR, Bin Abdulhak AA, Luni FK, Assaly R. Platelet activation and myocardial infarction in patients with pneumonia: are statins the answer? J Am Coll Cardiol 2015; 65:1488-9. [PMID: 25857918 DOI: 10.1016/j.jacc.2014.11.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
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Tleyjeh IM, Alasmari FA, Bin Abdulhak AA, Riaz M, Garbati MA, Erwin PJ, Kashour T, Al-Mallah MH, Baddour LM. Association between Preoperative Statin Therapy and Postoperative Infectious Complications in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2015; 33:1143-51. [DOI: 10.1086/668019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections. We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery. We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64–1.01]; P = .06; I2 = 75%). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted.
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Bin Abdulhak AA, Khan AR, Wimmer AP. Azithromycin for elderly patients with pneumonia. JAMA 2014; 312:1352. [PMID: 25268448 DOI: 10.1001/jama.2014.10164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Abdur Rahman Khan
- Department of Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Alan P Wimmer
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City
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Bin Abdulhak AA, Khan AR, Wimmer AP. Dabigatran in catheter ablation of atrial fibrillation: a call for a randomized control trial. Am J Cardiol 2014; 113:2087-8. [PMID: 24878135 DOI: 10.1016/j.amjcard.2014.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Khan AR, Bin Abdulhak AA, Sheikh MA, Khan S, Erwin PJ, Tleyjeh I, Khuder S, Eltahawy EA. Device Closure of Patent Foramen Ovale Versus Medical Therapy in Cryptogenic Stroke. JACC Cardiovasc Interv 2013; 6:1316-23. [DOI: 10.1016/j.jcin.2013.08.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/08/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
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Bin Abdulhak AA, Khan AR, Tleyjeh IM, Spertus JA, Sanders SU, Steigerwalt KE, Garbati MA, Bahmaid RA, Wimmer AP. Safety and efficacy of interrupted dabigatran for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2013; 15:1412-20. [DOI: 10.1093/europace/eut239] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Khan AR, Riaz M, Bin Abdulhak AA, Al-Tannir MA, Garbati MA, Erwin PJ, Baddour LM, Tleyjeh IM. The role of statins in prevention and treatment of community acquired pneumonia: a systematic review and meta-analysis. PLoS One 2013; 8:e52929. [PMID: 23349694 PMCID: PMC3538683 DOI: 10.1371/journal.pone.0052929] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 09/11/2012] [Accepted: 11/22/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications. PURPOSE Performed a systematic review to address the role of statins in the prevention or treatment of CAP. DATA SOURCE Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies. STUDY SELECTION Two authors independently reviewed studies that examined the role of statins in CAP. DATA EXTRACTION Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted. DATA SYNTHESIS Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I(2) = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I(2) = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder. CONCLUSIONS Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias.
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Affiliation(s)
- Abdur Rahman Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States of America
| | - Muhammad Riaz
- Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aref A. Bin Abdulhak
- Department of Internal Medicine, University of Missouri – Kansas City, Kansas City, Missouri, United States of America
| | - Mohamad A. Al-Tannir
- Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Musa A. Garbati
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Patricia J. Erwin
- Mayo Medical Library, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Larry M. Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Imad M. Tleyjeh
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Zaraket R, Al-Tannir MA, Bin Abdulhak AA, Shatila A, Lababidi H. Parental perceptions and beliefs about childhood asthma: a cross-sectional study. Croat Med J 2012; 52:637-43. [PMID: 21990082 PMCID: PMC3195973 DOI: 10.3325/cmj.2011.52.637] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim To assess parental perceptions and beliefs about asthma in children. Methods We invited 6000 children aged 3 to 15 years from different schools in Lebanon to participate in the study from September 2007 to May 2008. In the first phase, in order to determine the prevalence of asthma in children, parents of all participating children filled out a small questionnaire. In the second phase, only parents of children with asthma filled out a detailed questionnaire about their perceptions of asthma. Results Phase I included parents of 4051 children, 574 (14%) of whom had asthma and were recruited to phase II. Out of these, 389 parents entered the final data analysis. Around 54% of parents believed that asthma was hereditary and 7% believed it was contagious. When asked about triggering factors, 51% stated virus infection, 75% dust, and 17% food. Sixty percent of children with asthma lived with someone who smoked. Sixty-seven percent of parents believed that herbs had a role in asthma treatment and only 49% received asthma education. There was a significant difference in education level (P = 0.01) between the parents who denied the label of asthma (79%) and those who accepted it (21%). Sixty-seven percent of parents preferred oral over inhaler treatment, 48% believed inhalers were addictive, 56% worried about inhalers’ side effects, and 76% worried about using inhaled corticosteroids. Significantly more parents from rural (53%) than from urban areas (38%) believed that inhalers were addictive (P = 0.004). Conclusion Parents of children with asthma had considerable misperceptions about the use of inhalers and the safety of inhaled corticosteroids. To improve asthma care in children, it is necessary to provide adequate education to parents.
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Affiliation(s)
- Rola Zaraket
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
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Abdulhak AAB, Ba-Mougadam FA, Al-Nakshabandi NA, Al-Tannir MA. Transient osteoporosis of the hip/bone marrow edema syndrome with soft tissue involvement: a case report. Oman Med J 2011; 26:353-5. [PMID: 22125731 PMCID: PMC3215443 DOI: 10.5001/omj.2011.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 03/15/2011] [Accepted: 06/26/2011] [Indexed: 11/03/2022] Open
Abstract
Transient osteoporosis of the hip (TOH) is a rare condition mainly affecting pregnant women in their third trimester and middle aged men. We report a case of TOH/Bone marrow edema syndrome in pregnancy with involvement of the surrounding soft tissues on magnetic resonance image, which has not been previously reported. The presence of such edema in the soft tissues may help to differentiate this condition from early avascular necrosis of the hip, and may also provide an insight into the pathogenesis of the condition. The reported patient was treated conservatively and fully recovered.
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Affiliation(s)
| | - Fawziah A. Ba-Mougadam
- National Neuroscience Institute, Neurology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohamad A. Al-Tannir
- Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Bin Abdulhak AA, Altannir MA, Almansor MA, Almohaya MS, Onazi AS, Marei MA, Aldossary OF, Obeidat SA, Obeidat MA, Riaz MS, Tleyjeh IM. Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study. BMC Public Health 2011; 11:538. [PMID: 21736711 PMCID: PMC3146870 DOI: 10.1186/1471-2458-11-538] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/07/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios. METHODS A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women). RESULTS A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases. CONCLUSIONS We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.
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Affiliation(s)
- Aref A Bin Abdulhak
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Mohamad A Altannir
- Research and Scientific Publication Center, King Fahd Medical City, Aldabab street, Riyadh, 11525, Saudi Arabia
| | - Mohammed A Almansor
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Mohammed S Almohaya
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Atallah S Onazi
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Mohammed A Marei
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Oweida F Aldossary
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
| | - Sadek A Obeidat
- Alfaisal University, Takhassusi Street, Riyadh, 11533, Saudi Arabia
| | | | - Muhammad S Riaz
- Research and Scientific Publication Center, King Fahd Medical City, Aldabab street, Riyadh, 11525, Saudi Arabia
| | - Imad M Tleyjeh
- Internal Medicine Department, King Fahd Medical City, Aldabab Street, Riyadh, 11525, Saudi Arabia
- Research and Scientific Publication Center, King Fahd Medical City, Aldabab street, Riyadh, 11525, Saudi Arabia
- Infectious Diseases Division, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
- Division of Epidemiology, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA
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Bin Abdulhak AA, Zimmerman V, Al Beirouti BT, Baddour LM, Tleyjeh IM. Stenotrophomonas maltophilia infections of intact skin: a systematic review of the literature. Diagn Microbiol Infect Dis 2008; 63:330-3. [PMID: 19070451 DOI: 10.1016/j.diagmicrobio.2008.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 10/24/2008] [Accepted: 11/02/2008] [Indexed: 10/21/2022]
Abstract
To highlight the importance of intact skin infection syndromes caused by Stenotrophomonas maltophilia, we review 17 reported cases. Skin infection syndrome presentations included metastatic cellulitis (58%), primary cellulitis (23%), and ecthyma gangrenosum (17%). Associated risk factors were hematologic malignancies and chemotherapy (94%), neutropenia (94%), presence of central venous catheter (17%), and exposure to broad-spectrum antibiotics (84%). The diagnosis was supported by cultures of skin biopsy specimens (35%), blood cultures (24%), or both (41%). Trimethoprim-sulfamethoxazole was the treatment of choice (76%), and outcomes were favorable (71%).
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