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Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, Novotney A, LeGrand KE, Xu YY, Dai X, Nicholson SI, Stafford LK, Carter A, Ross JM, Abbastabar H, Abdoun M, Abdulah DM, Aboagye RG, Abolhassani H, Abrha WA, Abubaker Ali H, Abu-Gharbieh E, Aburuz S, Addo IY, Adepoju AV, Adhikari K, Adnani QES, Adra S, Afework A, Aghamiri S, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed H, Ahmed M, Ahmed A, Akinosoglou K, AL-Ahdal TMA, Alam N, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Ali A, Ali EA, Ali L, Ali Z, Ali SSS, Allel K, Altaf A, Al-Tawfiq JA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amani R, Amusa GA, Amzat J, Andrews JR, Anil A, Anwer R, Aravkin AY, Areda D, Artamonov AA, Aruleba RT, Asemahagn MA, Atre SR, Aujayeb A, Azadi D, Azadnajafabad S, Azzam AY, Badar M, Badiye AD, Bagherieh S, Bahadorikhalili S, Baig AA, Banach M, Banik B, Bardhan M, Barqawi HJ, Basharat Z, Baskaran P, Basu S, Beiranvand M, Belete MA, Belew MA, Belgaumi UI, Beloukas A, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhargava A, Bhat V, Bhatti JS, Bhatti GK, Bikbov B, Bitra VR, Bjegovic-Mikanovic V, Buonsenso D, Burkart K, Bustanji Y, Butt ZA, Camargos P, Cao Y, Carr S, Carvalho F, Cegolon L, Cenderadewi M, Cevik M, Chahine Y, Chattu VK, Ching PR, Chopra H, Chung E, Claassens MM, Coberly K, Cruz-Martins N, Dabo B, Dadana S, Dadras O, Darban I, Darega Gela J, Darwesh AM, Dashti M, Demessa BH, Demisse B, Demissie S, Derese AMA, Deribe K, Desai HD, Devanbu VGC, Dhali A, Dhama K, Dhingra S, Do THP, Dongarwar D, Dsouza HL, Dube J, Dziedzic AM, Ed-Dra A, Efendi F, Effendi DE, Eftekharimehrabad A, Ekadinata N, Ekundayo TC, Elhadi M, Elilo LT, Emeto TI, Engelbert Bain L, Fagbamigbe AF, Fahim A, Feizkhah A, Fetensa G, Fischer F, Gaipov A, Gandhi AP, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebrekidan KG, Ghaffari K, Ghassemi F, Ghazy RM, Goodridge A, Goyal A, Guan SY, Gudeta MD, Guled RA, Gultom NB, Gupta VB, Gupta VK, Gupta S, Hagins H, Hailu SG, Hailu WB, Hamidi S, Hanif A, Harapan H, Hasan RS, Hassan S, Haubold J, Hezam K, Hong SH, Horita N, Hossain MB, Hosseinzadeh M, Hostiuc M, Hostiuc S, Huynh HH, Ibitoye SE, Ikuta KS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Ismail F, Jafarzadeh A, Jakovljevic M, Jalili M, Janodia MD, Jomehzadeh N, Jonas JB, Joseph N, Joshua CE, Kabir Z, Kamble BD, Kanchan T, Kandel H, Kanmodi KK, Kantar RS, Karaye IM, Karimi Behnagh A, Kassa GG, Kaur RJ, Kaur N, Khajuria H, Khamesipour F, Khan YH, Khan MN, Khan Suheb MZ, Khatab K, Khatami F, Kim MS, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krishan K, Kucuk Bicer B, Kuddus MA, Kulimbet M, Kumar N, Lal DK, Landires I, Latief K, Le TDT, Le TTT, Ledda C, Lee M, Lee SW, Lerango TL, Lim SS, Liu C, Liu X, Lopukhov PD, Luo H, Lv H, Mahajan PB, Mahboobipour AA, Majeed A, Malakan Rad E, Malhotra K, Malik MSA, Malinga LA, Mallhi TH, Manilal A, Martinez-Guerra BA, Martins-Melo FR, Marzo RR, Masoumi-Asl H, Mathur V, Maude RJ, Mehrotra R, Memish ZA, Mendoza W, Menezes RG, Merza MA, Mestrovic T, Mhlanga L, Misra S, Misra AK, Mithra P, Moazen B, Mohammed H, Mokdad AH, Monasta L, Moore CE, Mousavi P, Mulita F, Musaigwa F, Muthusamy R, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nair S, Nair TS, Natto ZS, Nayak BP, Negash H, Nguyen DH, Nguyen VT, Niazi RK, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Oancea B, Obamiro KO, Odetokun IA, Odo DBO, Odukoya OO, Oh IH, Okereke CO, Okonji OC, Oren E, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Parija PP, Parikh RR, Park S, Parthasarathi A, Patil S, Pawar S, Peng M, Pepito VCF, Peprah P, Perdigão J, Perico N, Pham HT, Postma MJ, Prabhu ARA, Prasad M, Prashant A, Prates EJS, Rahim F, Rahman M, Rahman MA, Rahmati M, Rajaa S, Ramasamy SK, Rao IR, Rao SJ, Rapaka D, Rashid AM, Ratan ZA, Ravikumar N, Rawaf S, Reddy MMRK, Redwan EMM, Remuzzi G, Reyes LF, Rezaei N, Rezaeian M, Rezahosseini O, Rodrigues M, Roy P, Ruela GDA, Sabour S, Saddik B, Saeed U, Safi SZ, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahiledengle B, Sahoo SS, Salam N, Salami AA, Saleem S, Saleh MA, Samadi Kafil H, Samadzadeh S, Samodra YL, Sanjeev RK, Saravanan A, Sawyer SM, Selvaraj S, Senapati S, Senthilkumaran S, Shah PA, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Sharath M, Sherchan SP, Shetty RS, Shirzad-Aski H, Shittu A, Siddig EE, Silva JP, Singh S, Singh P, Singh H, Singh JA, Siraj MS, Siswanto S, Solanki R, Solomon Y, Soriano JB, Sreeramareddy CT, Srivastava VK, Steiropoulos P, Swain CK, Tabuchi T, Tampa M, Tamuzi JJLL, Tat NY, Tavakoli Oliaee R, Teklay G, Tesfaye EG, Tessema B, Thangaraju P, Thapar R, Thum CCC, Ticoalu JHV, Tleyjeh IM, Tobe-Gai R, Toma TM, Tram KH, Udoakang AJ, Umar TP, Umeokonkwo CD, Vahabi SM, Vaithinathan AG, van Boven JFM, Varthya SB, Wang Z, Warsame MSA, Westerman R, Wonde TE, Yaghoubi S, Yi S, Yiğit V, Yon DK, Yonemoto N, Yu C, Zakham F, Zangiabadian M, Zeukeng F, Zhang H, Zhao Y, Zheng P, Zielińska M, Salomon JA, Reiner Jr RC, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis 2024:S1473-3099(24)00007-0. [PMID: 38518787 DOI: 10.1016/s1473-3099(24)00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. METHODS We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. FINDINGS We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. INTERPRETATION Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. FUNDING Bill & Melinda Gates Foundation.
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Tleyjeh IM. Which trial do we need? Comparison of 7 versus 14 days of antibiotic therapy for ventilator-associated pneumonia due to highly resistant gram-negative bacteria. Clin Microbiol Infect 2023; 29:1114-1116. [PMID: 37088422 DOI: 10.1016/j.cmi.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Alkodaymi MS, Omrani OA, Fawzy NA, Shaar BA, Almamlouk R, Riaz M, Obeidat M, Obeidat Y, Gerberi D, Taha RM, Kashour Z, Kashour T, Berbari EF, Alkattan K, Tleyjeh IM. Prevalence of post-acute COVID-19 syndrome symptoms at different follow-up periods: a systematic review and meta-analysis. Clin Microbiol Infect 2022; 28:657-666. [PMID: 35124265 PMCID: PMC8812092 DOI: 10.1016/j.cmi.2022.01.014] [Citation(s) in RCA: 195] [Impact Index Per Article: 97.5] [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: 07/02/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-acute coronavirus 2019 (COVID-19) syndrome is now recognized as a complex systemic disease that is associated with substantial morbidity. OBJECTIVES To estimate the prevalence of persistent symptoms and signs at least 12 weeks after acute COVID-19 at different follow-up periods. DATA SOURCES Searches were conducted up to October 2021 in Ovid Embase, Ovid Medline, and PubMed. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Articles in English that reported the prevalence of persistent symptoms among individuals with confirmed severe acute respiratory syndrome coronavirus 2 infection and included at least 50 patients with a follow-up of at least 12 weeks after acute illness. METHODS Random-effect meta-analysis was performed to produce a pooled prevalence for each symptom at four different follow-up time intervals. Between-study heterogeneity was evaluated using the I2 statistic and was explored via meta-regression, considering several a priori study-level variables. Risk of bias was assessed using the Joanna Briggs Institute tool and the Newcastle-Ottawa Scale for prevalence studies and comparative studies, respectively. RESULTS After screening 3209 studies, a total of 63 studies were eligible, with a total COVID-19 population of 257 348. The most commonly reported symptoms were fatigue, dyspnea, sleep disorder, and difficulty concentrating (32%, 25%, 24%, and 22%, respectively, at 3- to <6-month follow-up); effort intolerance, fatigue, sleep disorder, and dyspnea (45%, 36%, 29%, and 25%, respectively, at 6- to <9-month follow-up); fatigue (37%) and dyspnea (21%) at 9 to <12 months; and fatigue, dyspnea, sleep disorder, and myalgia (41%, 31%, 30%, and 22%, respectively, at >12-month follow-up). There was substantial between-study heterogeneity for all reported symptom prevalences. Meta-regressions identified statistically significant effect modifiers: world region, male sex, diabetes mellitus, disease severity, and overall study quality score. Five of six studies including a comparator group consisting of COVID-19-negative cases observed significant adjusted associations between COVID-19 and several long-term symptoms. CONCLUSIONS This systematic review found that a large proportion of patients experience post-acute COVID-19 syndrome 3 to 12 months after recovery from the acute phase of COVID-19. However, available studies of post-acute COVID-19 syndrome are highly heterogeneous. Future studies need to have appropriate comparator groups, standardized symptom definitions and measurements, and longer follow-up.
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Affiliation(s)
| | - Osama Ali Omrani
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom,Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Nader A. Fawzy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Muhammad Riaz
- Center for Trial Research, School of Medicine, Cardiff University, United Kingdom
| | - Mustafa Obeidat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Yasin Obeidat
- UMass Chan Medical School–Baystate, Springfield, MA, USA
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Rand M. Taha
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zakaria Kashour
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Elie F. Berbari
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Imad M. Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,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, USA,Department of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA,Corresponding author. Imad M. Tleyjeh, Section of Infectious Diseases, King Fahd Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia
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Almamlouk R, Kashour T, Obeidat S, Bois MC, Maleszewski JJ, Omrani OA, Tleyjeh R, Berbari E, Chakhachiro Z, Zein-Sabatto B, Gerberi D, Tleyjeh IM. COVID-19-associated cardiac pathology at post-mortem evaluation: A Collaborative systematic Review. Clin Microbiol Infect 2022; 28:1066-1075. [PMID: 35339672 PMCID: PMC8941843 DOI: 10.1016/j.cmi.2022.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 01/06/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
Abstract
Background Many postmortem studies address the cardiovascular effects of COVID-19 and provide valuable information, but are limited by their small sample size. Objectives The aim of this systematic review is to better understand the various aspects of the cardiovascular complications of COVID-19 by pooling data from a large number of autopsy studies. Data sources We searched the online databases Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science for concepts of autopsy or histopathology combined with COVID-19, published between database inception and February 2021. We also searched for unpublished manuscripts using the medRxiv services operated by Cold Spring Harbor Laboratory. Study eligibility criteria Articles were considered eligible for inclusion if they reported human postmortem cardiovascular findings among individuals with a confirmed SARS coronavirus type 2 (CoV-2) infection. Participants Confirmed COVID-19 patients with post-mortem cardiovascular findings. Interventions None. Methods Studies were individually assessed for risk of selection, detection, and reporting biases. The median prevalence of different autopsy findings with associated interquartile ranges (IQRs). Results This review cohort contained 50 studies including 548 hearts. The median age of the deceased was 69 years. The most prevalent acute cardiovascular findings were myocardial necrosis (median: 100.0%; IQR, 20%–100%; number of studies = 9; number of patients = 64) and myocardial oedema (median: 55.5%; IQR, 19.5%–92.5%; number of studies = 4; number of patients = 46). The median reported prevalence of extensive, focal active, and multifocal myocarditis were all 0.0%. The most prevalent chronic changes were myocyte hypertrophy (median: 69.0%; IQR, 46.8%–92.1%) and fibrosis (median: 35.0%; IQR, 35.0%–90.5%). SARS-CoV-2 was detected in the myocardium with median prevalence of 60.8% (IQR 40.4-95.6%). Conclusions Our systematic review confirmed the high prevalence of acute and chronic cardiac pathologies in COVID-19 and SARS-CoV-2 cardiac tropism, as well as the low prevalence of myocarditis in COVID-19.
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Affiliation(s)
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Sawsan Obeidat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Osama A Omrani
- The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Rana Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Elie Berbari
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Zaher Chakhachiro
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Bassel Zein-Sabatto
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Imad M Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Tleyjeh IM, Saddik B, Ramakrishnan RK, AlSwaidan N, AlAnazi A, Alhazmi D, Aloufi A, AlSumait F, Berbari EF, Halwani R. Long term predictors of breathlessness, exercise intolerance, chronic fatigue and well-being in hospitalized patients with COVID-19: A cohort study with 4 months median follow-up. J Infect Public Health 2022; 15:21-28. [PMID: 34861604 PMCID: PMC8600938 DOI: 10.1016/j.jiph.2021.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. We therefore aimed to determine predictors of different functional outcomes after hospital discharge in patients with COVID-19. METHODS An ambidirectional cohort study was conducted between May and July 2020, in which PCR-confirmed COVID-19 patients underwent a standardized telephone assessment between 6 weeks and 6 months post discharge. We excluded patients who died, had a mental illness or failed to respond to two follow-up phone calls. The medical research council (MRC) dyspnea scale, metabolic equivalent of task (MET) score for exercise tolerance, chronic fatigability syndrome (CFS) scale and World Health Organization-five well-being index (WHO-5) for mental health were used to evaluate symptoms at follow-up. RESULTS 375 patients were contacted and 153 failed to respond. The median timing for the follow-up assessment was 122 days (IQR, 109-158). On multivariate analyses, female gender, pre-existing lung disease, headache at presentation, intensive care unit (ICU) admission, critical COVID-19 and post-discharge ER visit were predictors of higher MRC scores at follow-up. Female gender, older age >67 years, arterial hypertension and emergency room (ER) visit were associated with lower MET exercise tolerance scores. Female gender, pre-existing lung disease, and ER visit were associated with higher risk of CFS. Age, dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms were negatively associated with WHO-5 score. CONCLUSIONS Several risk factors were associated with an increased risk of PACS. Hospitalized patients with COVID-19 who are at risk for PACS may benefit from a targeted pre-emptive follow-up and rehabilitation programs.
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Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Basema Saddik
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rakhee K Ramakrishnan
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nourah AlSwaidan
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed AlAnazi
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Deema Alhazmi
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Aloufi
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad AlSumait
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Elie F Berbari
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rabih Halwani
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Prince Abdullah Ben Khaled Celiac Disease Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Tleyjeh IM, Saddik B, AlSwaidan N, AlAnazi A, Ramakrishnan RK, Alhazmi D, Aloufi A, AlSumait F, Berbari E, Halwani R. Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up. PLoS One 2021; 16:e0260568. [PMID: 34874962 PMCID: PMC8651136 DOI: 10.1371/journal.pone.0260568] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 07/06/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. The risk factors associated with PACS remain largely unclear. The aim of this study was to evaluate the frequency of new or persistent symptoms in COVID-19 patients post hospital discharge and identify associated risk factors. METHODS Our prospective cohort comprised of PCR-confirmed COVID-19 patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia between May and July 2020. The patients were interviewed through phone calls by trained physicians from 6 weeks up to 6 months post hospital discharge. Multivariate Cox proportional hazards and logistic regression models were used to examine for predictors associated with persistence of symptoms and non-return to baseline health. RESULTS 222 COVID-19 patients responded to follow-up phone interviews after a median of 122 days post discharge. The majority of patients were men (77%) with mean age of 52.47 (± 13.95) years. 56.3% of patients complained of persistent symptoms; 66 (29.7%) experiencing them for >21 days and 64 (28.8%) reporting not having returned to their baseline health. Furthermore, 39 patients (17.6%) reported visiting an emergency room post discharge for COVID-19-related symptoms while 16 (7.2%) had required re-hospitalization. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms at follow-up. After multivariable adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not fully recovering from acute COVID-19. Patients who were treated with interferon β-1b based triple antiviral therapy during hospital stay were less likely to experience new or persistent symptoms and more likely to return to their baseline health. CONCLUSIONS COVID-19 survivors continued to suffer from dyspnea, cough and fatigue at 4 months post hospital discharge. Several risk factors could predict which patients are more likely to experience PACS and may benefit from individualized follow-up and rehabilitation programs.
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Affiliation(s)
- Imad M. Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America
| | - Basema Saddik
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Nourah AlSwaidan
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed AlAnazi
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rakhee K. Ramakrishnan
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Deema Alhazmi
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Aloufi
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad AlSumait
- Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Elie Berbari
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America
| | - Rabih Halwani
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pediatrics, Prince Abdullah Ben Khaled Celiac Disease Research Chair, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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7
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Affiliation(s)
- Ali S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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8
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Mir T, Uddin M, Qureshi WT, Regmi N, Tleyjeh IM, Saydain G. Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016-2018). Infect Dis Ther 2021; 11:305-321. [PMID: 34817839 PMCID: PMC8847467 DOI: 10.1007/s40121-021-00563-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/05/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE. Methods Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications. Results Out of 255,838 adult IE patients (mean age 60.3 ± 20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11–1.13, p < 0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27–1.30, p < 0.001), cardiogenic shock (RR 1.24, 95% CI 1.20–1.29, p < 0.001), DIC (RR 1.4, 95% CI 1.35–1.46, p < 0.001), and STE (RR 1.07, 95% CI 1.05–1.08, p < 0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% (p-trend 0.04).
Conclusion Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis.
Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00563-y.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA. .,Internal Medicine, Baptist Health System, 300 Taylor Road,, Montgomery, AL, 36117, USA.
| | - Mohammed Uddin
- Internal Medicine, Detroit Medical Center Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Neelambuj Regmi
- Division of Pulmonary and Critical Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ghulam Saydain
- Division of Pulmonary and Critical Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
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9
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Talha KM, Dayer MJ, Thornhill MH, Tariq W, Arshad V, Tleyjeh IM, Bailey KR, Palraj R, Anavekar NS, Rizwan Sohail M, DeSimone DC, Baddour LM. Temporal Trends of Infective Endocarditis in North America From 2000 to 2017-A Systematic Review. Open Forum Infect Dis 2021; 8:ofab479. [PMID: 35224128 PMCID: PMC8864733 DOI: 10.1093/ofid/ofab479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%. Conclusions The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Epidemiology, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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10
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Talha KM, Baddour LM, Thornhill MH, Arshad V, Tariq W, Tleyjeh IM, Scott CG, Hyun MC, Bailey KR, Anavekar NS, Palraj R, Sohail MR, DeSimone DC, Dayer MJ. Escalating incidence of infective endocarditis in Europe in the 21st century. Open Heart 2021; 8:e001846. [PMID: 34670832 PMCID: PMC8529987 DOI: 10.1136/openhrt-2021-001846] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
AIM To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe. METHODS A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence. RESULTS Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%. CONCLUSION Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase. TRIAL REGISTERATION NUMBER CRD42020191196.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin H Thornhill
- School of Clinical Dentistry, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Meredith C Hyun
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Dayer
- Taunton and Somerset NHS Foundation Trust, Taunton, UK
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11
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Ahmed AI, Abebe AT, Han Y, Alnabelsi T, Agrawal T, Kassi M, Aljizeeri A, Taylor A, Tleyjeh IM, Al-Mallah MH. The prognostic role of cardiac positron emission tomography imaging in patients with sarcoidosis: A systematic review. J Nucl Cardiol 2021; 28:1545-1552. [PMID: 34228337 DOI: 10.1007/s12350-021-02681-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sarcoidosis is a multi-systemic inflammatory disease of unknown etiology. Cardiac sarcoidosis (CS) has been reported in as much as 25% of patients with systemic involvement. 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) has a high diagnostic sensitivity/specificity in the diagnosis of CS. The aim of this review is to summarize evidence on the prognostic role of FDG PET. METHODS Studies were identified by searching MEDLINE from inception to October 2020. Medical subject headings (MeSH) terms for sarcoidosis; cardiac and FDG PET imaging were used. Studies of any design assessing the prognostic role of FDG PET in patients with either suspected or confirmed cardiac sarcoidosis imaging done at baseline were included. Abnormal PET was defined as abnormal metabolism (presence of focal or focal-on-diffuse uptake of FDG) OR abnormal metabolism and a perfusion defect. Studies reporting any outcome measure were included. Pooled risk ratio for the composite outcome of MACE was done. RESULTS A total of 6 studies were selected for final inclusion (515 patients, 53.4% women, 19.8% racial minorities.) Studies were institution based, retrospective in design and enrolled consecutive patients. All were observational in nature and published in English. All studies used a qualitative assessment of PET scans (abnormal FDG uptake with or without abnormal perfusion). Two studies assessed quantitative metrics (summed stress score in segments with abnormal FDG uptake, standardized uptake value and cardiac metabolic activity.) All studies reported major adverse cardiovascular events (MACE) as a composite outcome. After a mean follow up ranging from 1.4 to 4.1 years, there were a total of 105 MACE. All studies included death (either all-cause death or sudden cardiac death) and ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) as a component of MACE. Four of the six studies adjusted for several characteristics in their analysis. All four studies used left ventricular ejection fraction (LVEF). However, other adjustment variables were not consistent across studies. Five studies found a positive prognostic association with the primary outcome, two of which assessing right ventricular uptake. CONCLUSION Although available evidence indicates FDG PET can be used in the risk stratification of patients with CS, our findings show further studies are needed to quantify the effect in this patient group.
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Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Abel Tsehay Abebe
- Department of Radiology, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Tanushree Agrawal
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amy Taylor
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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12
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Yetmar ZA, Chesdachai S, Kashour T, Riaz M, Gerberi DJ, Badley AD, Berbari EF, Tleyjeh IM. Prior Statin Use and Risk of Mortality and Severe Disease From Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2021; 8:ofab284. [PMID: 34258316 PMCID: PMC8244756 DOI: 10.1093/ofid/ofab284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Statins up-regulate angiotensin-converting enzyme 2, the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while also exhibiting pleiotropic antiviral, antithrombotic, and anti-inflammatory properties. Uncertainties exist about their effect on the course of SARS-CoV-2 infection. We sought to systematically review the literature and perform a meta-analysis to examine the association between prior statin use and outcomes of patients with coronavirus disease 2019 (COVID-19). METHODS We searched Ovid Medline, Web of Science, Scopus, and the preprint server medRxiv from inception to December 2020. We assessed the quality of eligible studies with the Newcastle-Ottawa quality scale. We pooled adjusted relative risk (aRRs) of the association between prior statin use and outcomes of patients with COVID-19 using the DerSimonian-Laird random-effects model and assessed heterogeneity using the I 2 index. RESULTS Overall, 19 (16 cohorts and 3 case-control) studies were eligible, with a total of 395 513 patients. Sixteen of 19 studies had low or moderate risk of bias. Among 109 080 patients enrolled in 13 separate studies, prior statin use was associated with a lower risk of mortality (pooled aRR, 0.65 [95% confidence interval {CI}, .56-.77], I 2 = 84.1%) and a reduced risk of severe COVID-19 was also observed in 48 110 patients enrolled in 9 studies (pooled aRR, 0.73 [95% CI, .57-.94], I 2 = 82.8%), with no evidence of publication bias. CONCLUSIONS Cumulative evidence suggests that prior statin use is associated with lower risks of mortality or severe disease in patients with COVID-19. These data support the continued use of statins medications in patients with an indication for lipid-lowering therapy during the COVID-19 pandemic.
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Affiliation(s)
- Zachary A Yetmar
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Muhammad Riaz
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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13
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Tleyjeh IM, Kashour T, Mandrekar J, Petitti DB. Overlooked Shortcomings of Observational Studies of Interventions in Coronavirus Disease 2019: An Illustrated Review for the Clinician. Open Forum Infect Dis 2021; 8:ofab317. [PMID: 34377723 PMCID: PMC8339279 DOI: 10.1093/ofid/ofab317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
The rapid spread of severe acute respiratory syndrome coronavirus 2 infection across the globe triggered an unprecedented increase in research activities that resulted in an astronomical publication output of observational studies. However, most studies failed to apply fully the necessary methodological techniques that systematically deal with different biases and confounding, which not only limits their scientific merit but may result in harm through misleading information. In this article, we address a few important biases that can seriously threaten the validity of observational studies of coronavirus disease 2019 (COVID-19). We focus on treatment selection bias due to patients’ preference on goals of care, medical futility and disability bias, survivor bias, competing risks, and the misuse of propensity score analysis. We attempt to raise awareness and to help readers assess shortcomings of observational studies of interventions in COVID-19.
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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, Minnesota, USA.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Jay Mandrekar
- Department of Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Diana B Petitti
- Department of Biomedical Informatics, University of Arizona College of Medicine, Phoenix, Arizona, USA
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14
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Ramakrishnan RK, Kashour T, Hamid Q, Halwani R, Tleyjeh IM. Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19. Front Immunol 2021; 12:686029. [PMID: 34276671 PMCID: PMC8278217 DOI: 10.3389/fimmu.2021.686029] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [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: 03/26/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
More than one year since its emergence, corona virus disease 2019 (COVID-19) is still looming large with a paucity of treatment options. To add to this burden, a sizeable subset of patients who have recovered from acute COVID-19 infection have reported lingering symptoms, leading to significant disability and impairment of their daily life activities. These patients are considered to suffer from what has been termed as “chronic” or “long” COVID-19 or a form of post-acute sequelae of COVID-19, and patients experiencing this syndrome have been termed COVID-19 long-haulers. Despite recovery from infection, the persistence of atypical chronic symptoms, including extreme fatigue, shortness of breath, joint pains, brain fogs, anxiety and depression, that could last for months implies an underlying disease pathology that persist beyond the acute presentation of the disease. As opposed to the direct effects of the virus itself, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be largely responsible for the appearance of these lasting symptoms, possibly through facilitating an ongoing inflammatory process. In this review, we hypothesize potential immunological mechanisms underlying these persistent and prolonged effects, and describe the multi-organ long-term manifestations of COVID-19.
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Affiliation(s)
- Rakhee K Ramakrishnan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Qutayba Hamid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Meakins-Christie Laboratories, Research Institute of the McGill University Healthy Center, McGill University, Montreal, QC, Canada
| | - Rabih Halwani
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates.,Prince Abdullah Ben Khaled Celiac Disease Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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15
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Tleyjeh IM. The Misleading "Pooled Effect Estimate" of Crude Data from Observational Studies at Critical Risk of Bias: The Case of Tocilizumab in Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 72:e1154-e1155. [PMID: 33201228 PMCID: PMC7717230 DOI: 10.1093/cid/ciaa1735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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, Minnesota, USA.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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A. Malhani A, A. Enani M, Saheb Sharif-Askari F, R. Alghareeb M, T. Bin-Brikan R, A. AlShahrani S, Halwani R, Tleyjeh IM. Combination of (interferon beta-1b, lopinavir/ritonavir and ribavirin) versus favipiravir in hospitalized patients with non-critical COVID-19: A cohort study. PLoS One 2021; 16:e0252984. [PMID: 34111191 PMCID: PMC8191942 DOI: 10.1371/journal.pone.0252984] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/27/2021] [Accepted: 05/27/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives Our study aims at comparing the efficacy and safety of IFN-based therapy (lopinavir/ritonavir, ribavirin, and interferon β-1b) vs. favipiravir (FPV) in a cohort of hospitalized patients with non-critical COVID-19. Methods Single center observational study comparing IFN-based therapy (interferon β-1b, ribavirin, and lopinavir/ritonavir) vs. FPV in non-critical hospitalized COVID-19 patients. Allocation to either treatment group was non-random but based on changes to national treatment protocols rather than physicians’ selection (quasi-experimental). We examined the association between IFN-based therapy and 28-day mortality using Cox regression model with treatment as a time-dependent covariate. Results The study cohort included 222 patients, of whom 68 (28%) received IFN-based therapy. Antiviral therapy was started at a median of 5 days (3–6 days) from symptoms onset in the IFN group vs. 6 days (4–7 days) for the FPV group, P <0.0001. IFN-based therapy was associated with a lower 28-day mortality as compared to FPV (6 (9%) vs. 18 (12%)), adjusted hazard ratio [aHR] (95% Cl) = 0.27 (0.08–0.88)). No difference in hospitalization duration between the 2 groups, 9 (7–14) days vs. 9 (7–13) days, P = 0.732 was found. IFN treated group required less use of systemic corticosteroids (57%) as compared to FPV (77%), P = 0.005 after adjusting for disease severity and other confounders. Patients in the IFN treated group were more likely to have nausea and diarrhea as compared to FPV group (13%) vs. (3%), P = 0.013 and (18%) vs. (3%), P<0.0001, respectively. Conclusion Early IFN-based triple therapy was associated with lower 28-days mortality as compared to FPV.
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Affiliation(s)
- Areej A. Malhani
- Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushira A. Enani
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatemeh Saheb Sharif-Askari
- Sharjah Medical Institute of Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mona R. Alghareeb
- Clinical Research Coordinator, Collage of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Roaa T. Bin-Brikan
- Clinical Research Coordinator, Collage of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Safar A. AlShahrani
- Outpatient Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Sharjah Medical Institute of Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Prince Abdullah Ben Khaled Celiac Disease Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Saudi Arabia
| | - Imad M. Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States of America
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States of America
- * E-mail:
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Kashour Z, Kashour T, Gerberi D, Tleyjeh IM. Mortality, viral clearance, and other clinical outcomes of hydroxychloroquine in COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials. Clin Transl Sci 2021; 14:1101-1112. [PMID: 33606894 PMCID: PMC8013604 DOI: 10.1111/cts.13001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Many meta-analyses have been published about the efficacy of hydroxychloroquine (HCQ) in coronavirus disease 2019 (COVID-19). Most of them included observational studies, and few have assessed HCQ as a prophylaxis or evaluated its safety profile. We searched multiple databases and preprint servers for randomized controlled trials (RCTs) that assessed HCQ for the treatment or prevention of COVID-19. We summarized the effect of HCQ on mortality, viral clearance, and other clinical outcomes. Out of 768 papers screened, 21 RCTs with a total of 14,138 patients were included. A total of 9 inpatient and 3 outpatient RCTs assessed mortality in 8596 patients with a pooled risk difference of 0.01 (95% confidence interval [CI] 0.00-0.03, I2 = 1%, p = 0.07). Six studies assessed viral clearance at 7 days with a pooled risk ratio (RR) of 1.11 (95% CI 0.86-1.42, I2 = 61%, p = 0.44) and 5 studies at 14 days with a pooled RR of 0.96 (95% CI 0.89-1.04, I2 = 0%, p = 0.34). Several trials showed no significant effect of HCQ on other clinical outcomes and. Five prevention RCTs with 5012 patients found no effect of HCQ on the risk of acquiring COVID-19. Thirteen trials showed that HCQ was associated with increased risk of adverse events. We observed, with high level of certainty of evidence, that HCQ is not effective in reducing mortality in patients with COVID-19. Lower certainty evidence also suggests that HCQ neither improves viral clearance and other clinical outcomes, nor prevents COVID-19 infection in patients with high-risk exposure. HCQ is associated with an increased rate of adverse events.
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Affiliation(s)
| | - Tarek Kashour
- Department of Cardiac SciencesKing Fahad Cardiac CenterKing Saud University Medical CityRiyadh Saudi Arabia
| | | | - Imad M. Tleyjeh
- Infectious Diseases SectionDepartment of Medical Specialties King Fahad Medical CityRiyadhSaudi Arabia
- Division of Infectious DiseasesMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
- Division of EpidemiologyMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
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18
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Kashour T, Tleyjeh IM. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis - Author's reply. Clin Microbiol Infect 2021; 27:1177-1178. [PMID: 33705848 PMCID: PMC7938745 DOI: 10.1016/j.cmi.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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19
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Tleyjeh IM, Kashour T. Letter About: Risk Factors for Mortality in Patients with COVID-19 in New York City. J Gen Intern Med 2021; 36:811-812. [PMID: 33432434 PMCID: PMC7799422 DOI: 10.1007/s11606-020-06369-x] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
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, USA.
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Tleyjeh IM, Kashour Z, Damlaj M, Riaz M, Tlayjeh H, Altannir M, Altannir Y, Al-Tannir M, Tleyjeh R, Hassett L, Kashour T. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:215-227. [PMID: 33161150 PMCID: PMC7644182 DOI: 10.1016/j.cmi.2020.10.036] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Cytokine release syndrome with elevated interleukin-6 (IL-6) levels is associated with multiorgan damage and death in severe coronavirus disease 2019 (COVID-19). Our objective was to perform a living systematic review of the literature concerning the efficacy and toxicity of the IL-6 receptor antagonist tocilizumab in COVID-19 patients. METHODS Data sources were Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus up, preprint servers and Google up to October 8, 2020. Study eligibility criteria were randomized controlled trials (RCTs) and observational studies at low or moderate risk of bias. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo or standard of care. We pooled crude risk ratios (RRs) of RCTs and adjusted RRs from cohorts, separately. We evaluated inconsistency between studies with I2. We assessed the certainty of evidence using the GRADE approach. RESULTS Of 1156 citations, 24 studies were eligible (five RCTs and 19 cohorts). Five RCTs at low risk of bias, with 1325 patients, examined the effect of tocilizumab on short-term mortality; pooled RR was 1.09 (95%CI 0.80-1.49, I2 = 0%). Four RCTs with 771 patients examined the effect of tocilizumab on risk of mechanical ventilation; pooled RR was 0.71 (95%CI 0.52-0.96, I2 = 0%), with a corresponding number needed to treat of 17 (95%CI 9-100). Among 18 cohorts at moderate risk of bias with 9850 patients, the pooled adjusted RR for mortality was 0.58 (95%CI 0.51-0.66, I2 = 2.5%). This association was observed over all degrees of COVID-19 severity. Data from the RCTs did not show a higher risk of infections or adverse events with tocilizumab: pooled RR 0.63 (95%CI 0.38-1.06, five RCTs) and 0.83 (95%CI 0.55-1.24, five RCTs), respectively. CONCLUSIONS Cumulative moderate-certainty evidence shows that tocilizumab reduces the risk of mechanical ventilation in hospitalized COVID-19 patients. While RCTs showed that tocilizumab did not reduce short-term mortality, low-certainty evidence from cohort studies suggests an association between tocilizumab and lower mortality. We did not observe a higher risk of infections or adverse events with tocilizumab use. This review will continuously evaluate the role of tocilizumab in COVID-19 treatment.
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Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Zakariya Kashour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Moussab Damlaj
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muhammad Riaz
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Haytham Tlayjeh
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Rana Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
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21
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DeSimone DC, Lahr BD, Anavekar NS, Sohail MR, Tleyjeh IM, Wilson WR, Baddour LM. Temporal Trends of Infective Endocarditis in Olmsted County, Minnesota, Between 1970 and 2018: A Population-Based Analysis. Open Forum Infect Dis 2021; 8:ofab038. [PMID: 33728357 PMCID: PMC7944350 DOI: 10.1093/ofid/ofab038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
Background A population-based study of infective endocarditis (IE) in Olmsted County, Minnesota, provides a unique opportunity to define temporal and seasonal variations in IE incidence over an extended time period. Methods This was a population-based review of all adults (≥18 years) residing in Olmsted County, Minnesota, with definite or possible IE using the Rochester Epidemiology Project from January 1, 1970, through December 31, 2018. Poisson regression was used to characterize the trends in IE incidence; models were fitted with age, sex, calendar time, and season, allowing for nonlinearity and nonadditivity of their effects. Results Overall, 269 cases of IE were identified over a 49-year study period. The median age of IE cases was 67.2 years, and 33.8% were female. The overall age- and sex-adjusted incidence of IE was 7.9 cases per 100 000 person-years (95% CI, 7.0-8.9), with corresponding rates of 2.4, 2.4, 0.9, and 0.7 per 100 000 person-years for Staphylococcus aureus, viridans group streptococci (VGS), Enterococcus species, and coagulase-negative staphylococci IE, respectively. Temporal trends varied by age, sex, and season, but on average IE incidence increased over time (P = .021). Enterococcal IE increased the most (P = .018), while S. aureus IE appeared to increase but mostly in the winter months (P = .018). Between 1996 and 2018, the incidence of VGS IE was relatively stable, with no statistically significant difference in the trends before and after the 2007 AHA IE prevention guidelines. Conclusions Overall, IE incidence, and specifically enterococcal IE, increased over time, while S. aureus IE was seasonally dependent. There was no statistically significant difference in VGS IE incidence in the periods before and after publication of the 2007 AHA IE prevention guidelines.
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Affiliation(s)
- Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Section of Infectious Diseases, King Fahd Medical City, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Walter R Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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22
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Kashour T, Halwani R, Arabi YM, Sohail MR, O'Horo JC, Badley AD, Tleyjeh IM. Statins as an adjunctive therapy for COVID-19: the biological and clinical plausibility. Immunopharmacol Immunotoxicol 2021; 43:37-50. [PMID: 33406943 DOI: 10.1080/08923973.2020.1863984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes the coronavirus disease 2019 (COVID-19) has infected millions of individuals and has claimed hundreds of thousands of human lives worldwide. Patients with underlying cardiovascular conditions are at high risk for SARS-CoV-2 infection, and COVID-19 patients have high incidence of cardiovascular complications such as acute cardiac injury, arrhythmias, heart failure, and thromboembolism. The disease has no approved proven effective therapy and hence repurposing of existing approved drugs has been considered as the fastest treatment approach. Statins have been shown to exhibit lipid lowering dependent and independent cardiovascular protective effects as well as favorable effects in various other pathophysiological states. These beneficial properties of statins are a result of their multiple pleotropic effects that include, anti-inflammatory, immunomodulatory, antithrombotic and antimicrobial properties. In this review, we provide a comprehensive description of the mechanisms of the pleotropic effects of statins, the relevant pre-clinical and clinical data pertinent to their role in infections and acute lung injury, the possible cardiovascular benefits of statins in COVID-19, and the implications of the therapeutic potential of statins in COVID-19 disease. We conclude with the rationale for conducting randomized controlled trials of statins in COVID-19 disease.
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Affiliation(s)
- Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine Houston, TX, USA.,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Molecular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Medical Specialties, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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23
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Kashour Z, Riaz M, Garbati MA, AlDosary O, Tlayjeh H, Gerberi D, Murad MH, Sohail MR, Kashour T, Tleyjeh IM. Efficacy of chloroquine or hydroxychloroquine in COVID-19 patients: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 76:30-42. [PMID: 33031488 PMCID: PMC7665543 DOI: 10.1093/jac/dkaa403] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [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: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Clinical studies of chloroquine (CQ) and hydroxychloroquine (HCQ) in COVID-19 disease reported conflicting results. We sought to systematically evaluate the effect of CQ and HCQ with or without azithromycin on outcomes of COVID-19 patients. METHODS We searched multiple databases, preprints and grey literature up to 17 July 2020. We pooled only adjusted-effect estimates of mortality using a random-effect model. We summarized the effect of CQ or HCQ on viral clearance, ICU admission/mechanical ventilation and hospitalization. RESULTS Seven randomized clinical trials (RCTs) and 14 cohort studies were included (20 979 patients). Thirteen studies (1 RCT and 12 cohort studies) with 15 938 hospitalized patients examined the effect of HCQ on short-term mortality. The pooled adjusted OR was 1.05 (95% CI 0.96-1.15, I2 = 0%). Six cohort studies examined the effect of the HCQ+azithromycin combination with a pooled adjusted OR of 1.32 (95% CI 1.00-1.75, I2 = 68.1%). Two cohort studies and four RCTs found no effect of HCQ on viral clearance. One small RCT demonstrated improved viral clearance with CQ and HCQ. Three cohort studies found that HCQ had no significant effect on mechanical ventilation/ICU admission. Two RCTs found no effect for HCQ on hospitalization risk in outpatients with COVID-19. CONCLUSIONS Moderate certainty evidence suggests that HCQ, with or without azithromycin, lacks efficacy in reducing short-term mortality in patients hospitalized with COVID-19 or risk of hospitalization in outpatients with COVID-19.
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Affiliation(s)
- Zakariya Kashour
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Muhammad Riaz
- Department of Statistics, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Musa A Garbati
- Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Oweida AlDosary
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - 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
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Preventive, Occupational and Aerospace Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - 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, USA
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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24
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Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020; 76:2982-3021. [PMID: 33309175 PMCID: PMC7755038 DOI: 10.1016/j.jacc.2020.11.010] [Citation(s) in RCA: 3756] [Impact Index Per Article: 939.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.
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Affiliation(s)
| | - George A Mensah
- National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA.
| | - Catherine O Johnson
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | | | - Noël C Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | | | - Emelia J Benjamin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Aimé Bonny
- District Hospital of Bonassama-University of Douala, Douala, Cameroon
| | - Michael Brauer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sumeet S Chugh
- Cedars-Sinai, Smidt Heart Institute, Los Angeles, California, USA
| | | | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Criqui
- University of California at San Diego, San Diego, California, USA
| | - Nicole DeCleene
- The University of Michigan Samuel and Jean Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Kim A Eagle
- The University of Michigan Samuel and Jean Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Sophia Emmons-Bell
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | - Gerry Fowkes
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - Scott M Grundy
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Feng J He
- Queen Mary University of London, London, United Kingdom
| | - George Howard
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Frank Hu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley Inker
- Tufts Medical Center, Boston, Massachusetts, USA
| | - Ganesan Karthikeyan
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Carl Lavie
- Ochsner Health, New Orleans, Louisiana, USA
| | - Donald Lloyd-Jones
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hong S Lu
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Antonio Mirijello
- IRCCS Casa Sollievo della Sofferenza Hospital, Department of Medical Sciences, San Giovanni Rotondo, Italy
| | - Awoke Misganaw Temesgen
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Ali Mokdad
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Andrew E Moran
- Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Muntner
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Neal
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | | | | | | | | | - Michael Pratt
- University of California at San Diego, San Diego, California, USA
| | - Sanjay Rajagopalan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Marissa Reitsma
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy Rigotti
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anthony Rodgers
- The George Institute for Global Health, Newtown, New South Wales, Australia; Imperial College of London, London, United Kingdom
| | - Craig Sable
- Children's National Hospital, Washington, DC, USA
| | - Saate Shakil
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | - Theo Vos
- University of Washington, Seattle, Washington, USA
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Magdi Yacoub
- Imperial College of London, London, United Kingdom
| | - Liesl Zuhlke
- University of Cape Town, Cape Town, South Africa
| | - Christopher Murray
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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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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26
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Tlayjeh H, Mhish OH, Enani MA, Alruwaili A, Tleyjeh R, Thalib L, Hassett L, Arabi YM, Kashour T, Tleyjeh IM. Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health 2020; 13:1652-1663. [PMID: 33008778 PMCID: PMC7522674 DOI: 10.1016/j.jiph.2020.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. METHODS We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach. RESULTS Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69-1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23-0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11-1.93, I2 = 43.38%). CONCLUSION In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients' population that could benefit from CST.
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Affiliation(s)
- Haytham Tlayjeh
- Department of Intensive Care, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Olaa H Mhish
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Mushira A Enani
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alya Alruwaili
- Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rana Tleyjeh
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Imad M Tleyjeh
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; 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, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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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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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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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1799] [Impact Index Per Article: 199.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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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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32
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DeSimone DC, Tleyjeh IM, Correa de Sa DD, Anavekar NS, Lahr BD, Sohail MR, Steckelberg JM, Wilson WR, Baddour LM. Incidence of Infective Endocarditis Due to Viridans Group Streptococci Before and After the 2007 American Heart Association's Prevention Guidelines: An Extended Evaluation of the Olmsted County, Minnesota, Population and Nationwide Inpatient Sample. Mayo Clin Proc 2015; 90:874-81. [PMID: 26141329 PMCID: PMC4560595 DOI: 10.1016/j.mayocp.2015.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/24/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether the incidence of infective endocarditis (IE) due to viridans group streptococci (VGS) increased after the publication of the 2007 American Heart Association (AHA) IE prevention guidelines. PATIENTS AND METHODS We performed a population-based survey of all adults (18 years and older) residing in Olmsted County, Minnesota, from January 1, 1999, through December 31, 2013, to identify definite or possible cases of VGS-IE using the Rochester Epidemiology Project. The National (Nationwide) Inpatient Sample hospital discharge database was examined to determine the number of VGS-IE cases in the United States between 2000 and 2011. RESULTS Rates of incidence (per 100,000 person-years) during the intervals of 1999-2002, 2003-2006, 2007-2010, and 2011-2013 were 3.6 (95% CI, 1.3-5.9), 2.7 (95% CI, 0.9-4.4), 0.7 (95% CI, 0.0-1.6), and 1.5 (95% CI, 0.2-2.9), respectively, reflecting an overall significant decrease (P=.03 from Poisson regression). Likewise, nationwide estimates of hospital discharges with a VGS-IE diagnosis trended downward during 2000-2011, with a mean number per year of 15,853 and 16,157 for 2000-2003 and 2004-2007, respectively, decreasing to 14,231 in 2008-2011 (P=.05 from linear regression using weighted least squares method). CONCLUSION Despite major reductions in the number of indications for antibiotic prophylaxis for invasive dental procedures espoused by the 2007 AHA IE prevention guidelines, both local and national data indicate that the incidence of VGS-IE has not increased.
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Affiliation(s)
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, King Fahd Medical Center, Riyadh, Saudi Arabia
| | | | | | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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DeSimone DC, DeSimone CV, Tleyjeh IM, Correa de Sa DD, Anavekar NS, Lahr BD, Sohail MR, Steckelberg JM, Wilson WR, Baddour LM. Association of Mitral Valve Prolapse With Infective Endocarditis Due to Viridans Group Streptococci. Clin Infect Dis 2015; 61:623-5. [PMID: 25963288 DOI: 10.1093/cid/civ375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/14/2015] [Accepted: 04/29/2015] [Indexed: 11/12/2022] Open
Abstract
Although patients with certain cardiac valve abnormalities have increased risk of infective endocarditis (IE), it is unknown whether these abnormalities are associated with specific pathogens in IE cases. We report a strong association between mitral valve prolapse and viridans group streptococcal IE in a population-based cohort from Olmsted County, Minnesota.
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Affiliation(s)
| | | | - Imad M Tleyjeh
- Division of Infectious Diseases Division of Infectious Diseases, King Fahd Medical Center, Riyadh, Saudi Arabia
| | | | - Nandan S Anavekar
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Brian D Lahr
- Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Muhammad R Sohail
- Division of Infectious Diseases Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | | | - Larry M Baddour
- Division of Infectious Diseases Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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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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Llovet JM, Bruix J, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014. [PMID: 25530442 DOI: 10.1016/s0140-6736] [Citation(s) in RCA: 460] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. METHODS We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. FINDINGS Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. INTERPRETATION For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. FUNDING Bill & Melinda Gates Foundation.
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Pandit A, Aryal MR, Aryal Pandit A, Jalota L, Hakim FA, Mookadam F, Lee HR, Tleyjeh IM. Cangrelor versus clopidogrel in percutaneous coronary intervention: a systematic review and meta-analysis. EUROINTERVENTION 2014; 9:1350-8. [PMID: 24080586 DOI: 10.4244/eijv9i11a226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Cangrelor is a new antiplatelet agent that has been used in percutaneous coronary intervention (PCI) with mixed results. We aimed to review the evidence on the efficacy of cangrelor in comparison to clopidogrel in reducing ischaemic endpoints at 48 hours in patients undergoing PCI in large randomised trials. METHODS AND RESULTS In three large clinical trials involving 25,107 participants, the risk of the primary composite efficacy endpoint of death, MI and ischaemia-driven revascularisation at 48 hours, (pooled OR 0.94; 95% CI: 0.77-1.14, p=0.51, I2=68%), death from all cause (pooled OR 0.72, 95% CI: 0.36-1.43, p=0.34, I2=52%), myocardial infarction (pooled OR 0.94, 95% CI: 0.77-1.14, p=0.51, I2=68%) was not significantly different between cangrelor and clopidogrel. Likewise, severe or life-threatening bleeding was similar between cangrelor and clopidogrel (pooled OR 1.21, 95% CI: 0.70-2.12, p=0.50, I2=0%). The risk of stent thrombosis (pooled OR 0.59, 95% CI: 0.43-0.81, p=0.001, I2=0%), Q-wave myocardial infarction (pooled OR 0.53, 95% CI: 0.30-0.92, p=0.02, I2=0%) and ischaemia-driven revascularisation (pooled OR 0.71, 95% CI: 0.52-0.98, p=0.04, I2=0%) was lower in the cangrelor group. CONCLUSIONS Based on this meta-analysis, we did not find any difference in the risk of the primary composite efficacy endpoint of all-cause death, ischaemia-driven revascularisation, and myocardial infarction at 48hours between cangrelor and clopidogrel use. Given that cangrelor was associated with a lower risk of stent thrombosis, ischaemia-driven revascularisation and Q-wave myocardial infarction compared to clopidogrel, cangrelor can be considered as a suitable alternative during PCI.
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Affiliation(s)
- Anil Pandit
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
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Abstract
BACKGROUND Organ transplant recipients are at increased risk of infection as a result of immunosuppression caused inadvertently by medical treatment. Tuberculosis (TB) is a challenging infection to manage among organ transplant recipients that can be transmitted from infected people or triggered from latent infection. Organ transplant recipients have been reported to be up to 300 times more likely to develop TB than the general population. Consensus about the use of antibiotic prophylaxis to prevent post solid organ transplant TB has not been achieved. OBJECTIVES This review assessed the benefits and harms of antibiotic prophylaxis to prevent post solid organ transplant TB. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register up to 30 April 2013 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE and handsearching conference proceedings. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs that compared antibiotic prophylaxis with a placebo or no intervention for recipients of solid organ transplants were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool. MAIN RESULTS We identified three studies (10 reports) that involved 558 kidney transplant recipients which met our inclusion criteria. All studies were conducted in countries that have high prevalence of TB (India and Pakistan), and investigated isoniazid, an oral antibacterial drug. Control in all studies was no antibiotic prophylaxis. Prophylactic administration of isoniazid reduced the risk of developing TB post-transplant (3 studies, RR 0.35 95% CI 0.14 to 0.89), and there was no significant effect on all-cause mortality (2 studies, RR 1.39, 95% CI 0.70 to 2.78). There was however substantial risk of liver damage (3 studies, RR 2.74, 95% CI 1.22 to 6.17).Reporting of methodological quality parameters was incomplete in all three studies. Overall, risk of bias was assessed as suboptimal. AUTHORS' CONCLUSIONS Isoniazid prophylaxis for kidney transplant recipients reduced the risk of developing TB post-transplant. Kidney transplant recipients in settings that have high prevalence of TB should receive isoniazid during the first year following transplant. There is however, significant risk of liver damage, particularly among those who are hepatitis B or C positive. Further studies are needed among recipients of other solid organ transplants and in settings with low prevalence of TB to determine the benefits and harms of anti-TB prophylaxis in those populations.
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Affiliation(s)
- Bappa Adamu
- Aminu Kano Teaching HospitalDepartment of MedicineNo 1 Hospital RoadKanoKanoNigeriaPMB 3452
| | - Aliyu Abdu
- Aminu Kano Teaching HospitalDepartment of MedicineNo 1 Hospital RoadKanoKanoNigeriaPMB 3452
| | - Abdullahi A Abba
- King Saud UniversityDepartment of MedicineRiyadhRiyadhSaudi ArabiaRiyadh 11451
| | - Musa M Borodo
- Aminu Kano Teaching HospitalDepartment of MedicineNo 1 Hospital RoadKanoKanoNigeriaPMB 3452
| | - Imad M Tleyjeh
- King Fahad Medical CityDepartment of MedicineRiyadhRiyadhSaudi ArabiaRiyadh 11525
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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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Tleyjeh IM, Abdulhak AB, Riaz M, Garbati MA, Al-Tannir M, Alasmari FA, Alghamdi M, Khan AR, Erwin PJ, Sutton AJ, Baddour LM. The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis. PLoS One 2013; 8:e56498. [PMID: 23469173 PMCID: PMC3587620 DOI: 10.1371/journal.pone.0056498] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/10/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. PURPOSE We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. DATA SOURCE We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. STUDY SELECTION Two authors independently reviewed the studies for eligibility. DATA EXTRACTION Data about studies characteristics, adjusted effect estimates and quality were extracted. DATA SYNTHESIS Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). CONCLUSION In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics.
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Affiliation(s)
- Imad M Tleyjeh
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013. [PMID: 23245604 DOI: 10.1016/s01406736(12)61728-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013. [PMID: 23245604 DOI: 10.1016/s0140-6736(12)61728-0s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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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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Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng ATA, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KMV, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJC, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SRM, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AKM, Zheng ZJ, Zonies D, Lopez AD, Murray CJL, AlMazroa MA, Memish ZA. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2163-96. [PMID: 23245607 PMCID: PMC6350784 DOI: 10.1016/s0140-6736(12)61729-2] [Citation(s) in RCA: 5377] [Impact Index Per Article: 448.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. INTERPRETATION Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Theo Vos
- School of Population Health, Brisbane, QLD, Australia
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Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng ATA, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FGR, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KMV, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJC, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SRM, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AKM, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197-223. [PMID: 23245608 DOI: 10.1016/s0140-6736(12)61689-4] [Citation(s) in RCA: 5803] [Impact Index Per Article: 483.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. METHODS We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. FINDINGS Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. INTERPRETATION Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. FUNDING Bill & Melinda Gates Foundation.
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Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, AlMazroa MA, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Abdulhak AB, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, Leo DD, Degenhardt L, Delossantos A, Denenberg J, Jarlais DCD, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Memish ZA, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O’Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJL. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095-128. [PMID: 23245604 PMCID: PMC10790329 DOI: 10.1016/s0140-6736(12)61728-0] [Citation(s) in RCA: 9084] [Impact Index Per Article: 757.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rafael Lozano
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Kyle Foreman
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Stephen Lim
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | - Kenji Shibuya
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ali A Mokdad
- Institute for Health Metrics and Evaluation (Prof R Lozano MD, M Naghavi PhD, S S Lim PhD, S Y Ahn MPH, M Alvarado BA, K G Andrews MPH, C Atkinson BS, I Bolliger AB, D Chou BA, K E Colson BA, A Delossantos BS, Prof S D Dharmaratne MBBS, A D Flaxman PhD, M H Forouzanfar MD, M K Freeman BA, E Gakidou PhD, D Gonzalez-Medina BA, D Haring BS, S L James MPH, R Jasrasaria BA, N Johns BA, S Lockett Ohno BA, M F MacIntyre EdM, L Mallinger MPH, A A Mokdad MD, M N Nair MD, K Ortblad BA, D Phillips BS, K Pierce BA, D Ranganathan BS, T Roberts BA, L C Rosenfeld MPH, E Sanman BS, M Wang MPH, S Wulf MPH, Prof C J L Murray MD), Department of Anesthesiology and Pain Medicine (N Kassebaum MD), Department of Epidemiology, School of Public Health (L M Anderson PhD), University of Washington, Seattle, WA, USA (Prof W Couser MD, H Duber MD, B Ebel MD, Prof C Mock MD, Prof F P Rivara MD, B Thomas MD); School of Public Health (Prof M Ezzati PhD), Imperial College London, London, UK (K Foreman MPH, Prof P Burney MD, L Rushton PhD); Department of Global Health, University of Tokyo, Tokyo, Japan (Prof K Shibuya MD); Department of Cardiology, Dupuytren University Hospital, Limoges, France (Prof V Aboyans MD); School of Medicine, University of Texas, San Antonio, TX, USA (J Abraham MPH); School of Population Health (T Adair PhD, Prof A D Lopez PhD, Prof T Vos PhD), Queensland Centre for Mental Health Research (J-P Khoo MBBS), Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia (Prof J McGrath MD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (Prof R Aggarwal MD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, Prof Z A Memish MD); St George’s, University of London, London, UK (Prof H R Anderson MD); Mayo Clinic, Rochester, MN, USA (Prof L M Baddour MD, P J Erwin MLS, Prof S E Gabriel MD); University of Auckland, Auckland, New Zealand (S Barker-Collo PhD); Brigham and Women’s Hospital (S Jayaraman MD), Harvard Medical School (D H Bartels BA, Prof S D Colan MD), Harvard Humanitarian Initiative (L M Knowlton MD), School of Public Health (M Miller MD, Prof J A Salomon PhD), Harvard University, Boston, MA, USA (K Bhalla PhD); Global Partners in Anesthesia and Surgery (D Ozgediz MD), Yale University, New Haven, CT, USA (Prof M L Bell PhD); Boston University, Boston, MA, USA (Prof E J Benjamin MD); Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK (D Bennett PhD); Research Institute of Transplantology and Artificial Organs, Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); King Fahad Medical City, Riyadh, Saudi Arabia (A Bin Abdulhak MD, I M Tleyjeh MD); Michigan State University, East Lansing, MI, USA (Prof G Birbeck MD); School of Public Health (T Driscoll PhD), Faculty of Health Sciences (M Fransen PhD), Department of Rheumatology, Northern Clinical School (E Smith PhD), Institute of Bone and Joint Research (Prof L March MD), University of Sydney, Sydney, NSW, Australia (F Blyth PhD, Prof G B Marks PhD, M Cross PhD); Transport and Road Safety Research (S Boufous PhD), National Drug and Alcohol Research Centre (J Singleton MIPH, Prof L Degenhardt PhD), University of New South Wales, Sydney, NSW, Australia (C Bucello BPsych); Great Ormond Street Hospital, London, UK (M Burch MD); Telethon Institute for Child Health Research, Centre for Child Health Research (Prof J Carapetis MBBS), University of Western Australia, Perth, WA, Australia (Prof P Norman MD); National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA (H Chen PhD); Cedars-Sinai Medical Center, Los Angeles, CA, USA (Prof S S Chugh MD, R Havmoeller MD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (L E Coffeng MD); Menzies School of Health Research, Darwin, NT, Australia (S Colquhoun MPH, J Condon PhD); National Health Services, Fife, Edinburgh, UK (M D Connor PhD); University of Edinburgh, Edinburgh, UK (M D Connor, Prof F G R Fowkes FRCPE); University of the Witwatersrand, Johannesburg, South Africa (M D Connor); Loyola University Medical School, Chicago, IL, USA (Prof L T Cooper MD); Department of Epidemiology, School of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA (M Corriere MD); Mario Negri Institute for Pharmacological Research, Bergamo, Italy (M Cortinovis BiotechD, F Gaspari ChemD, N Perico MD, Prof G Remuzzi MD); Hospital Dr Gustavo N Collado, Puerto Chitre, Panama (K Courville de Vaccaro MD); Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia (B C Cowie MBBS); University of California, San Diego, San Diego, CA, USA (Prof M H Criqui MD, J Denenberg MA); Schools of Public Health and Medicine (S B Omer MBBS), Emory University, Atlanta, GA, USA (K C Dabhadkar MBBS, A Zabetian MD, K M V Narayan MD); University of Pennsylvania, Philadelphia, PA, USA (N Dahodwala MD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); Beth Israel Medical Center, New York City, NY, USA (D C Des Jarlais PhD); University of Peradeniya, Peradeniya, Sri Lanka (Prof S D Dharmaratne); Johns Hopkins University, Baltimore, MD, USA (E R Dorsey MD); Hospital Maciel, Montevideo, Uruguay (P Espindola MD); MRC-HPA Centre for Environment and Health, London, UK (Prof M Ezzati PhD); National Institute for Stroke and Applied Neurosciences, Auckland Technical University, Auckland, New Zealand (Prof V Feigin MD, R Krishnamurthi PhD); Royal Life Saving Society, Sydney, NSW, Australia (R Franklin PhD); James Cook University, Townsville, QLD, Australia (K Watt PhD, R Franklin PhD); Howard University College of Medicine, Washington, DC, USA (Prof R F Gillum MD); Brandeis University, Waltham, MA, USA (Y A Halasa DDS, Prof D S Shepard PhD, E A Undurraga PhD); Flinders University, Adelaide, SA, Australia (Prof J E Harrison MBBS); Karolinska University Hospital, Stockholm, Sweden (R Havmoeller MD); King’s College Hospital NHS Trust, King’s College, London, UK (Prof R J Hay DM); Université de Franche-Comté, Besançon, France (Prof B Hoen MD); Centre Hospitalier Régional Universitaire de Basençon, Besançon, France (Prof B Hoen); National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA (Prof P J Hotez MD); Monash University, Melbourne, VIC, Australia (D Hoy PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); All India Institute of Medical Sciences, New Delhi, India (G Karthikeyan MD); Department of Cardiology, Hebrew University Hadassah Medical School, Jerusalem, Israel (Prof A Keren MD); School of Public Health (O Kobusingye MMed), Makerere University, Kampala, Uganda (J Mabweijano MMed); University of South Africa, Johannesburg, South Africa (O Kobusingye MMed); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (A Koranteng MSc); University of California, San Francisco, San Francisco, CA, USA (M Lipnick MD); University of Miami Miller School of Medicine, Miami, FL, USA (Prof S E Lipshultz MD, Prof R L Sacco MD, Prof J D Wilkinson MD); Mulago Hospital, Kampala, Uganda (J Mabweijano MMed); Centre for International Child Health (A Steer MBBS), Department of Paediatrics, Royal Children’s Hospital (R Weintraub MBBS), University of Melbourne, Melbourne, VIC, Australia (Prof R Marks MBBS); Asian Pacific Society of Cardiology, Kyoto, Japan (A Matsumori MD); Medical Research Council, Tygerberg, South Africa (R Matzopoulos MPhil); Hatter Institute (Prof K Sliwa MD), Department of Medicine (Prof G A Mensah MD), University of Cape Town, Cape Town, South Africa (R Matzopoulos, Prof B M Mayosi DPhil); Legacy Health System, Portland, OR, USA (J H McAnulty MD); Northwestern University Feinberg School of Medicine, Evanston, IL, USA (Prof M M McDermott MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish); University of Otago, Dunedin, New Zealand (T R Merriman PhD); China Medical Board, Boston, MA, USA (C Michaud MD); Pacific Institute for Research and Evaluation, Calverton, MD, USA (T R Miller PhD); National Institute of Health, Maputo, Mozambique (Prof A O Mocumbi MD); University Eduardo Mondlane, Maputo, Mozambique (Prof A O Mocumbi); Columbia University, New York City, NY, USA (A Moran MD); London School of Hygiene and Tropical Medicine, London, UK (Prof K Mulholland MD); Centro Studi GISED, Bergamo, Italy (L Naldi MD); School of Public Health, University of Liverpool, Liverpool, UK (Prof K Nasseri DVM); HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland, UK (M O’Donnell PhD); Deakin University, Melbourne, VIC, Australia (Prof R Osborne PhD); B P Koirala Institute of Health Sciences, Dharan, Nepal (B Pahari MD); Betty Cowan Research and Innovation Center, Ludhiana, India (J D Pandian MD); Hospital Juan XXIII, La Paz, Bolivia (A Panozo Rivero MD); Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico (R Perez Padilla MD); Hospital Universitario Cruces, Barakaldo, Spain (F Perez-Ruiz MD); Brigham Young University, Provo, UT, USA (Prof C A Pope III PhD); Hospital Universitario de Canarias, Tenerife, Spain (E Porrini MD); Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (F Pourmalek MD); Mason Eye Institute, University of Missouri, Columbia, MO, USA (M Raju PhD); Centre for Addiction and Mental Health, Toronto, ON, Canada (Prof J T Rehm PhD); National Opinion Research Center, University of Chicago, Chicago, IL, USA (D B Rein PhD); Complejo Hospitalario Caja De Seguro Social, Panama City, Panama (F Rodriguez de León MD); Vanderbilt University, Nashville, TN, USA (Prof U Sampson MD); University of Alabama at Birmingham, Birmingham, AL, USA (Prof D C Schwebel PhD); Ministry of Interior, Madrid, Spain (M Segui-Gomez MD); Queens Medical Center, Honolulu, HI, USA (D Singh MD); Drexel University School of Public Health, Philadelphia, PA, USA (J A Taylor PhD); Cincinnati Children’s Hospital, Cincinnati, OH, USA (Prof J A Towbin MD); Department of Neurology, Copenhagen University Hospital, Herlev, Denmark (T Truelsen MD); National University of Singapore, Singapore, (N Venketasubramanian FRCP); Voluntary Health Services, Sneha, Chennai, India (Prof L Vijayakumar MBBS); National Institute for Occupational Safety and Health, Baltimore, MD, USA (G R Wagner MD); Beijing Neurosurgical Institute, Capital Medical University, Beijing, China (Prof W Wang MD); Brown University, Providence, RI, USA (Prof M A Weinstock MD); Royal Cornwall Hospital, Truro, UK (Prof A D Woolf MBBS); London School of Economics, London, UK (P-H Yeh MS); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Prof P Yip PhD); and School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Prof Z-J Zheng MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christopher J L Murray
- Corresponding author: Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA,
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Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, Begum N, Shah R, Karyana M, Kosen S, Farje MR, Moncada G, Dutta A, Sazawal S, Dyer A, Seiler J, Aboyans V, Baker L, Baxter A, Benjamin EJ, Bhalla K, Bin Abdulhak A, Blyth F, Bourne R, Braithwaite T, Brooks P, Brugha TS, Bryan-Hancock C, Buchbinder R, Burney P, Calabria B, Chen H, Chugh SS, Cooley R, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, Davis A, Degenhardt L, Díaz-Torné C, Dorsey ER, Driscoll T, Edmond K, Elbaz A, Ezzati M, Feigin V, Ferri CP, Flaxman AD, Flood L, Fransen M, Fuse K, Gabbe BJ, Gillum RF, Haagsma J, Harrison JE, Havmoeller R, Hay RJ, Hel-Baqui A, Hoek HW, Hoffman H, Hogeland E, Hoy D, Jarvis D, Karthikeyan G, Knowlton LM, Lathlean T, Leasher JL, Lim SS, Lipshultz SE, Lopez AD, Lozano R, Lyons R, Malekzadeh R, Marcenes W, March L, Margolis DJ, McGill N, McGrath J, Mensah GA, Meyer AC, Michaud C, Moran A, Mori R, Murdoch ME, Naldi L, Newton CR, Norman R, Omer SB, Osborne R, Pearce N, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Pourmalek F, Prince M, Rehm JT, Remuzzi G, Richardson K, Room R, Saha S, Sampson U, Sanchez-Riera L, Segui-Gomez M, Shahraz S, Shibuya K, Singh D, Sliwa K, Smith E, Soerjomataram I, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Taylor HR, Tleyjeh IM, van der Werf MJ, Watson WL, Weatherall DJ, Weintraub R, Weisskopf MG, Whiteford H, Wilkinson JD, Woolf AD, Zheng ZJ, Murray CJL, Jonas JB. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 2012; 380:2129-43. [PMID: 23245605 PMCID: PMC10782811 DOI: 10.1016/s0140-6736(12)61680-8] [Citation(s) in RCA: 877] [Impact Index Per Article: 73.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results. FUNDING Bill & Melinda Gates Foundation.
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Alasmari FA, Tleyjeh IM, Riaz M, Greason KL, Berbari EF, Virk A, Baddour LM. Temporal trends in the incidence of surgical site infections in patients undergoing coronary artery bypass graft surgery: a population-based cohort study, 1993 to 2008. Mayo Clin Proc 2012; 87:1054-61. [PMID: 23127732 PMCID: PMC3532679 DOI: 10.1016/j.mayocp.2012.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/30/2012] [Accepted: 05/21/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the incidence of and temporal trends in surgical site infections (SSIs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS A population-based cohort study was conducted to describe the epidemiologic features of SSI in Olmsted County, Minnesota, between January 1, 1993, and December 31, 2008, using the Rochester Epidemiology Project. Period-specific incidence rates (in-hospital or within 30 days outside the hospital) were calculated. Logistic regression analysis was used to adjust for potential confounders that could affect temporal trends in SSI incidence rates. RESULTS During the 16-year study, of 1424 residents of Olmsted County who underwent CABG surgery, 1189 (83%) had isolated CABG and 235 (17%) had combined CABG and valve surgery. The overall SSI incidence rate was 7.0% (95% confidence interval [CI], 5.7%-8.4%). The incidence rate of superficial sternal SSI was 2.0% (95% CI, 1.2%-2.7%) and of deep sternal SSI was 1.5% (95% CI, 0.9%-2.2%). The leg harvest site infection rate was 3.6% (95% CI, 2.6 %-4.5%). The incidence rate decreased over time with a statistically significant linear trend. The adjusted odds ratio (95% CI) of SSI showed a decreasing linear trend: 0.39 (0.19-0.81) vs 0.50 (0.27-0.93) vs 0.83 (0.48-1.42) vs reference for 2005-2008 vs 2001-2004 vs 1997-2000 vs 1993-1996. CONCLUSION In this population-based surveillance study of patients undergoing CABG surgery, the incidence of SSI decreased markedly between 1993 and 2008 in patients in Olmsted County. The factors responsible for this decrease are the focus of ongoing investigations.
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Desimone DC, Tleyjeh IM, Correa de Sa DD, Anavekar NS, Lahr BD, Sohail MR, Steckelberg JM, Wilson WR, Baddour LM. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association's endocarditis prevention guidelines. Circulation 2012; 126:60-4. [PMID: 22689929 DOI: 10.1161/circulationaha.112.095281] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Heart Association published updated guidelines for infective endocarditis (IE) prevention in 2007 that markedly restricted the use of antibiotic prophylaxis in certain at-risk patients undergoing dental and other invasive procedures. The incidence of IE caused by viridans group streptococci (VGS) in the United States after publication of the 2007 American Heart Association guidelines has not been reported. METHODS AND RESULTS We performed a population-based review of all definite or possible cases of VGS-IE using the Rochester Epidemiology Project of Olmsted County, Minnesota. Patient demographics and microbiological data were collected for all VGS-IE cases diagnosed from January 1, 1999, through December 31, 2010. We also examined the Nationwide Inpatient Sample hospital discharge database to determine the number of VGS-IE cases included between 1999 and 2009. We identified 22 cases with VGS-IE in Olmsted County over the 12-year study period. Rates of incidence (per 100 000 person-years) during time intervals of 1999-2002, 2003-2006, and 2007-2010 were 3.19 (95% confidence interval, 1.20-5.17), 2.48 (95% confidence interval, 0.85-4.10), and 0.77 (95% confidence interval, 0.00-1.64), respectively (P=0.061 from Poisson regression). The number of hospital discharges with a VGS-IE diagnosis in the Nationwide Inpatient Sample database during 1999-2002, 2003-2006, and 2007-2009 ranged between 15 318 to 15 938, 16 214 to 17 433, and 14 728 to 15 479, respectively. CONCLUSIONS On the basis of data complete through 2010, there has been no perceivable increase in the incidence of VGS-IE in Olmsted County, Minnesota, since the publication of the 2007 American Heart Association endocarditis prevention guidelines.
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Affiliation(s)
- Daniel C Desimone
- Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Garbati MA, Alasmari FA, Al-Tannir MA, Tleyjeh IM. The role of combination antifungal therapy in the treatment of invasive aspergillosis: a systematic review. Int J Infect Dis 2012; 16:e76-81. [DOI: 10.1016/j.ijid.2011.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 10/02/2011] [Accepted: 10/03/2011] [Indexed: 11/28/2022] Open
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