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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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5
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Renedo D, Acosta JN, Leasure AC, Sharma R, Krumholz HM, de Havenon A, Alahdab F, Aravkin AY, Aryan Z, Bärnighausen TW, Basu S, Burkart K, Coberly K, Criqui MH, Dai X, Desai R, Dharmaratne SD, Doshi R, Elgendy IY, Feigin VL, Filip I, Gad MM, Ghozy S, Hafezi-Nejad N, Kalani R, Karaye IM, Kisa A, Krishnamoorthy V, Lo W, Mestrovic T, Miller TR, Misganaw A, Mokdad AH, Murray CJL, Natto ZS, Radfar A, Ram P, Roth GA, Seylani A, Shah NS, Sharma P, Sheikh A, Singh JA, Song S, Sotoudeh H, Vervoort D, Wang C, Xiao H, Xu S, Zand R, Falcone GJ, Sheth KN. Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019. JAMA Neurol 2024; 81:2815830. [PMID: 38436973 PMCID: PMC10913004 DOI: 10.1001/jamaneurol.2024.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Importance Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. Objective To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. Design, Setting, and Participants An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020. Exposures In this study, no particular exposure was specifically targeted. Main Outcomes and Measures The primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals. Results In 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota). Conclusions and Relevance In this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.
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Affiliation(s)
- Daniela Renedo
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Julian N. Acosta
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Audrey C. Leasure
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Richa Sharma
- Yale Center for Brain & Mind Health, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Fares Alahdab
- Evidence-Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota
| | - Aleksandr Y. Aravkin
- Department of Applied Mathematics, University of Washington, Seattle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Zahra Aryan
- Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Sanjay Basu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of General Internal Medicine, San Francisco General Hospital, San Francisco, California
| | - Katrin Burkart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Kaleb Coberly
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Michael H. Criqui
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph’s University Medical Center, Paterson, New Jersey
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L. Feigin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
- Research Center of Neurology, Moscow, Russia
| | - Irina Filip
- Avicenna Medical and Clinical Research Institute, Oak Lawn, Illinois
| | - Mohamed M. Gad
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Nima Hafezi-Nejad
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Rizwan Kalani
- Department of Neurology, University of Washington, Seattle
| | - Ibraheem M. Karaye
- School of Health Professions and Human Services, Hofstra University, Hempstead, New York
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of International Health and Sustainability, Tulane University, New Orleans, Louisiana
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle
| | - Warren Lo
- Department of Pediatrics, Ohio State University, Columbus
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Tomislav Mestrovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Ted R. Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Awoke Misganaw
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- School of Public Health, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Zuhair S. Natto
- Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Health Policy and Oral Epidemiology, Harvard University, Boston, Massachusetts
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando
| | - Pradhum Ram
- Division of Cardiology, UPMC Western Maryland, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Division of Cardiology, University of Washington, Seattle
| | - Allen Seylani
- National Heart, Lung, and Blood Institute, National Institute of Health, Rockville, Maryland
| | - Nilay S. Shah
- Department of Medicine (Cardiology), Northwestern University, Chicago, Illinois
| | - Purva Sharma
- Department of Medical Oncology, Kent Hospital, Warwick, Rhode Island
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, United Kingdom
| | - Jasvinder A. Singh
- School of Medicine, University of Alabama at Birmingham, Birmingham
- Medicine Service, US Department of Veterans Affairs (VA), Birmingham, Alabama
| | - Suhang Song
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens
| | - Houman Sotoudeh
- Department of Radiology, University of Alabama at Birmingham, Birmingham
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Cong Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hong Xiao
- Department of Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Suowen Xu
- Department of Endocrinology, University of Science and Technology of China, Hefei, China
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Ramin Zand
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Brain & Mind Health, Yale School of Medicine, New Haven, Connecticut
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Brain & Mind Health, Yale School of Medicine, New Haven, Connecticut
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Kalani R, Bartz TM, Psaty BM, Elkind MSV, Floyd JS, Gerszten RE, Shojaie A, Heckbert SR, Bis JC, Austin TR, Tirschwell DL, Delaney JAC, Longstreth WT. Plasma Proteomic Associations With Incident Ischemic Stroke in Older Adults: The Cardiovascular Health Study. Neurology 2023; 100:e2182-e2190. [PMID: 37015819 DOI: 10.1212/wnl.0000000000207242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/16/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Plasma proteomics may elucidate novel insights into the pathophysiology of ischemic stroke (IS), identify biomarkers of IS risk, and guide development of nascent prevention strategies. We evaluated the relationship between the plasma proteome and IS risk in the population-based Cardiovascular Health Study (CHS). METHODS Eligible CHS participants were free of prevalent stroke and underwent quantification of 1298 plasma proteins using the aptamer-based SOMAScan assay platform from the 1992-1993 study visit. Multivariable Cox proportional hazards regression was used to evaluate associations between a 1-standard deviation increase in the log-2 transformed estimated plasma protein concentrations and incident IS, adjusting for demographics, IS risk factors, and estimated glomerular filtration rate. For proteins independently associated with incident IS, a secondary stratified analysis evaluated associations in subgroups defined by sex and race. Exploratory analyses evaluated plasma proteomic associations with cardioembolic and non-cardioembolic IS as well as proteins associated with IS risk in participants with left atrial dysfunction but without atrial fibrillation. RESULTS Of 2983 eligible participants, the mean age was 74.3 (± 4.8) years, 61.2% were women, and 15.4% were Black. Over a median follow-up of 12.6 years, 450 participants experienced an incident IS. N-terminal pro-brain natriuretic peptide (NTproBNP, adjusted HR 1.37, 95% CI 1.23-1.53, P=2.08x10-08) and macrophage metalloelastase (MMP12, adjusted HR 1.30, 95% CI 1.16-1.45, P=4.55x10-06) were independently associated with IS risk. These two associations were similar in men and women and in Black and non-Black participants. In exploratory analyses, NTproBNP was independently associated with incident cardioembolic IS, E-selectin with incident non-cardioembolic IS, and secreted frizzled-related protein 1 with IS risk in participants with left atrial dysfunction. CONCLUSIONS In a cohort of older adults, NTproBNP and MMP12 were independently associated with IS risk. We identified plasma proteomic determinants of incident cardioembolic and non-cardioembolic IS and found a novel protein associated with IS risk in those with left atrial dysfunction.
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Affiliation(s)
- Rizwan Kalani
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James S Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ali Shojaie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas R Austin
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Joseph A C Delaney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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8
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 859] [Impact Index Per Article: 859.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Sharma M, Longstreth WT, Kalani R, Psaty B, Elkind M, Floyd JS, Heckbert SR, Buckwalter MS, Gomez G, Walker K, Bartz T, Austin T, Bis J, Brody J, Tirschwell DL, Tracy RP, Gerszten RE, Fohner A. Abstract WMP101: Plasma Proteomic Determinants Of White Matter Hyperintensities And Covert Brain Infarction In The Cardiovascular Health Study. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Identification of novel biomarkers of cerebral small vessel disease is critical to elucidate pathophysiology and guide therapeutic development for prevention. We evaluated plasma proteomic associations of clinically asymptomatic, covert brain infarction (cBI) and white matter hyperintensity (WMH) burden on cranial magnetic resonance imaging (MRI) in the population-based Cardiovascular Health Study (CHS).
Methods:
Eligible CHS participants underwent one or two cranial MRI scans (~5 years apart) and aptamer-based SOMAScan platform measurement of up to 7288 plasma proteins concurrent with the initial MRI. cBI was defined by MRI signal characteristics and size ≥ 3 mm, and WMH burden was graded (WMG) 0 (least) to 9 (most severe). The relationship between 1-standard deviation increase in each log
2
-normalized plasma protein fluorescence was modeled separately with incident cBI and WMG worsening (≥1 grade increase) using multivariable relative risk regression, adjusting for demographics, estimated glomerular filtration rate (eGFR), and stroke risk factors. In secondary analyses, multivariable linear regression evaluated the cross-sectional relationship between each plasma protein with number of cBI and WMG on initial MRI. Bonferroni correction, based on the number of principal components that explained 99% of the protein fluorescence variance in CHS participants, accounted for multiple comparisons (p<2.1x10
-5
(0.05/2377)).
Results:
For eligible participants (n=2615), mean age was 74.4 ± 4.9 years, 61.7% were women, and 16.4% were Black. After adjustment for demographics, eGFR, and stroke risk factors, multiple circulating proteins were associated with cBI and WMG (Table).
Conclusion:
Multiple plasma proteins - implicated in systemic inflammation, fatty acid metabolism, neuronal adhesion/migration, and cellular cytoskeletal integrity/remodeling - were independently associated with cBI and WMG in a cohort of older adults.
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Vaisar T, Miller RG, Kalani R, Orchard T, Costacou T. Abstract 551: HDL Particle Concentration And Incident Ischemic Stroke In Type 1 Diabetes. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Recently, we showed that HDL particle concentration (HDL-P) and cholesterol efflux capacity (CEC) predict coronary artery disease (CAD) better than HDL-C in people with type 1 diabetes (T1D). Cardiovascular risk factors have been shown to associate with different cardiovascular outcomes differently. We therefore investigated the association of HDL-P and CEC with ischemic stroke (IS) incidence in people with T1D. We quantified HDL-P using calibrated differential ion mobility and total and ABCA1-specific HDL CEC in 549 participants with childhood-onset (<17 years) T1D from the Epidemiology of Diabetes Complications study using the first available blood sample. The participants were free of cerebrovascular disease at baseline (mean age 27.8 years, T1D duration 19.6 years, 49% women). Stroke incidence/type was determined by self-report of physician diagnosis and confirmed by medical record review. During the follow-up (median 25 years), there were 35 (6.5%) incident IS events. Participants with IS were more likely to be older, have a longer T1D duration, have hypertension, a history of smoking, and a worse lipid, inflammatory and renal markers’ profile at baseline; HDL-C, HDL-P, and CEC did not differ between participants with and without IS. While HDL-C, total HDL-P, and CEC were not associated with IS risk, extra-small HDL-P (xsHDL-P, ~7.8nm) subspecies were strongly associated with incident IS (HR=4.49, 95% CI: 1.72-11.74), even after adjustment for IS risk factors (including smoking, diabetes duration, hypertension as well as HDL-C), in multivariable Cox proportional hazards regression analyses. When all stroke events including hemorrhagic stroke were considered the association was weaker (n=47 events, HR=2.5, 95% CI: 0.97-6.47) suggesting specificity in the association of xsHDL-P with ischemic stroke.In contrast to a strong protective association of total HDL-P and CEC against CAD in the same T1D population, these HDL metrics were not associated with IS. However, the xsHDL-P subspecies were specifically associated with increased IS risk. These striking findings require further investigation and suggest a differential association of HDL particle metrics with CAD and IS.
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11
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Abburi N, Longstreth WT, Kalani R, Weathered N, Davis A, de Havenon AH, Tirschwell DL. Abstract TP211: Identifying Factors Associated With Higher Risk Of Stroke In Patients With Infective Endocarditis Using The National Inpatient Sample. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Cerebrovascular complications (ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)) of infective endocarditis (IE) are common and substantially increase morbidity and mortality. We aimed to identify risk factors for stroke in a nationally representative population of hospitalized IE patients from the US.
Methods:
Patient hospitalizations for IE and stroke were identified using validated International Classification of Diseases 10 diagnosis codes from the Q4 2015-2018 National Inpatient Sample. We evaluated the association between demographics, known risk factors (opioid use, cardiac valve replacement, and mitral valve disease), and Elixhauser comorbidity index-defined factors with the diagnosis of stroke using logistic regression.
Results:
Of the 53,557 patients with a diagnosis of IE, 5,754 (10.7%) had a concurrent diagnosis of stroke (75% IS, 6.9% ICH, 4.5% SAH, 14% multiple stroke types). The mean age at IE diagnosis was 59 years; 42.3% were female; 71.8% Caucasian, 14.2% Black, 7.8% Hispanic, 2.7% Asian, and 0.8% Native American; 9.2% of patients died during hospitalization (7.5% without stroke, 23% with stroke, p<0.001). Factors independently associated with stroke are shown in the Table; the C-statistic was 0.63. Opioid use and cardiac valve replacement were not associated with stroke.
Conclusion:
In this large, nationally representative sample of hospitalized IE patients, comorbidities independently associated with higher odds of stroke included mitral valve disease, metastatic cancer, coagulopathy, weight loss, and electrolyte disorders. Detailed clinical data, not available from this administrative data set, may allow better prediction of stroke, but our findings may suggest areas for additional research.
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Kalani R, Bartz T, Psaty B, Delaney J, Elkind M, Tirschwell DL, Longstreth WT. Abstract 122: Untargeted Proteomics And Carotid Artery Atherosclerosis: The Cardiovascular Health Study. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Increased carotid intima-media thickness (cIMT) and moderate-severe carotid artery atherosclerosis (CAA≥50%) are associated with increased risk of stroke. We evaluated proteomic determinants of increased cIMT and CAA≥50% in the population-based Cardiovascular Health Study (CHS).
Methods:
Eligible participants underwent carotid artery ultrasound and aptamer-based SOMAScan platform measurement of 1298 serum proteins from the concurrent study visit. cIMT was defined as the average of the standardized values of the maximal common carotid artery IMT and maximal internal carotid artery IMT. CAA≥50% was defined as carotid plaque resulting in ≥50% luminal stenosis. The relationship between each log-normalized protein concentration with cIMT and CAA≥50% was modeled separately using multivariable linear regression and logistic regression, respectively, adjusting for demographics, estimated glomerular filtration rate (eGFR), and CAA risk factors. Bonferroni correction, based on the number of principal components that explained 95% of the protein concentration variance in CHS participants, was employed to account for multiple hypothesis testing, yielding a
p
-value for significance of <7.6x10
-5
(0.05/661).
Results:
For eligible participants (n=2783), mean age was 74.4 ± 4.9 years, 39.5% were men, and 15.8% were Black. After adjustment for demographics, eGFR, and CAA risk factors, 13 proteins were independently associated with increased cIMT (Table). The magnitude and direction of the associations were similar in subgroups defined by sex and race. Three proteins were associated with CAA≥50%, after adjusting for eGFR and demographics (Table); however, associations were no longer significant after adjusting for CAA risk factors.
Conclusion:
Multiple novel serum proteins - implicated in extracellular matrix remodeling, systemic inflammation, and coagulation - were independently associated with increased cIMT in a cohort of older adults.
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Steinberg A, Pankaj P, Marsden K, de Havenon A, Davis A, Kalani R, Longstreth WT, Tirschwell DL. Abstract TP189: Atrial Fibrillation, Age, And Ischemic Stroke Severity In A Nationally Representative Dataset. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Atrial fibrillation (AF), a well-defined ischemic stroke (IS) risk factor whose prevalence increases with age, is associated with higher stroke severity. We aimed to evaluate stroke severity and hospital mortality in a nationally representative sample of AF-related IS patients.
Methods:
We utilized data from the National (Nationwide) Inpatient Sample databases from 2015 - 2018 using ICD-10 diagnostic codes to identify individuals with IS and comorbid AF. The NIHSS was used to characterize stroke severity in a subset of cases after 10/1/2016. Nonparametric statistics and logistic regression analyses were conducted to evaluate associations between AF and hospital death.
Results:
Of the 382,758 IS cases, 99,566 (26%) had comorbid AF. AF increased linearly with age, reaching at 47% of all hospitalized IS patients 85+ years of age or older (Figure). Higher age, male sex, white race, obesity, and higher median income were associated with comorbid AF, whereas diabetes, hypertension, tobacco use, and hyperlipidemia were associated with reduced odds of comorbid AF. While 5.8% of all IS patients died during hospitalization, mortality was increased nearly two-fold in those with AF (9.0% vs. 4.6%, p<.001). Among in-hospital deaths from IS, comorbid AF increased with age, present in 59% of those 85+ years of age or older (Figure). NIHSS, reported in 21% of patients, was higher in AF patients (mean NIHSS 6 vs. 9, p<.001). High NIHSS was the strongest independent predictor of hospital death.
Conclusion:
The burden of AF in a nationally representative sample of hospitalized IS patients is substantial, present in nearly 50% of the 85+ age group. AF-related IS is more severe and more likely to be fatal. As our population ages, the prevalence of AF will only increase. Understanding the severity and fatality of AF-related IS will have profound implications for health systems and may better facilitate anticipatory guidance and AF treatment.
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Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, Abdoli A, Abualhasan A, Abu-Gharbieh E, Akram TT, Al Hamad H, Alahdab F, Alanezi FM, Alipour V, Almustanyir S, Amu H, Ansari I, Arabloo J, Ashraf T, Astell-Burt T, Ayano G, Ayuso-Mateos JL, Baig AA, Barnett A, Barrow A, Baune BT, Béjot Y, Bezabhe WMM, Bezabih YM, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bijani A, Biswas A, Bolla SR, Boloor A, Brayne C, Brenner H, Burkart K, Burns RA, Cámera LA, Cao C, Carvalho F, Castro-de-Araujo LFS, Catalá-López F, Cerin E, Chavan PP, Cherbuin N, Chu DT, Costa VM, Couto RAS, Dadras O, Dai X, Dandona L, Dandona R, De la Cruz-Góngora V, Dhamnetiya D, Dias da Silva D, Diaz D, Douiri A, Edvardsson D, Ekholuenetale M, El Sayed I, El-Jaafary SI, Eskandari K, Eskandarieh S, Esmaeilnejad S, Fares J, Faro A, Farooque U, Feigin VL, Feng X, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fillit H, Fischer F, Gaidhane S, Galluzzo L, Ghashghaee A, Ghith N, Gialluisi A, Gilani SA, Glavan IR, Gnedovskaya EV, Golechha M, Gupta R, Gupta VB, Gupta VK, Haider MR, Hall BJ, Hamidi S, Hanif A, Hankey GJ, Haque S, Hartono RK, Hasaballah AI, Hasan MT, Hassan A, Hay SI, Hayat K, Hegazy MI, Heidari G, Heidari-Soureshjani R, Herteliu C, Househ M, Hussain R, Hwang BF, Iacoviello L, Iavicoli I, Ilesanmi OS, Ilic IM, Ilic MD, Irvani SSN, Iso H, Iwagami M, Jabbarinejad R, Jacob L, Jain V, Jayapal SK, Jayawardena R, Jha RP, Jonas JB, Joseph N, Kalani R, Kandel A, Kandel H, Karch A, Kasa AS, Kassie GM, Keshavarz P, Khan MAB, Khatib MN, Khoja TAM, Khubchandani J, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Koroshetz WJ, Koyanagi A, Kumar GA, Kumar M, Lak HM, Leonardi M, Li B, Lim SS, Liu X, Liu Y, Logroscino G, Lorkowski S, Lucchetti G, Lutzky Saute R, Magnani FG, Malik AA, Massano J, Mehndiratta MM, Menezes RG, Meretoja A, Mohajer B, Mohamed Ibrahim N, Mohammad Y, Mohammed A, Mokdad AH, Mondello S, Moni MAA, Moniruzzaman M, Mossie TB, Nagel G, Naveed M, Nayak VC, Neupane Kandel S, Nguyen TH, Oancea B, Otstavnov N, Otstavnov SS, Owolabi MO, Panda-Jonas S, Pashazadeh Kan F, Pasovic M, Patel UK, Pathak M, Peres MFP, Perianayagam A, Peterson CB, Phillips MR, Pinheiro M, Piradov MA, Pond CD, Potashman MH, Pottoo FH, Prada SI, Radfar A, Raggi A, Rahim F, Rahman M, Ram P, Ranasinghe P, Rawaf DL, Rawaf S, Rezaei N, Rezapour A, Robinson SR, Romoli M, Roshandel G, Sahathevan R, Sahebkar A, Sahraian MA, Sathian B, Sattin D, Sawhney M, Saylan M, Schiavolin S, Seylani A, Sha F, Shaikh MA, Shaji KS, Shannawaz M, Shetty JK, Shigematsu M, Shin JI, Shiri R, Silva DAS, Silva JP, Silva R, Singh JA, Skryabin VY, Skryabina AA, Smith AE, Soshnikov S, Spurlock EE, Stein DJ, Sun J, Tabarés-Seisdedos R, Thakur B, Timalsina B, Tovani-Palone MR, Tran BX, Tsegaye GW, Valadan Tahbaz S, Valdez PR, Venketasubramanian N, Vlassov V, Vu GT, Vu LG, Wang YP, Wimo A, Winkler AS, Yadav L, Yahyazadeh Jabbari SH, Yamagishi K, Yang L, Yano Y, Yonemoto N, Yu C, Yunusa I, Zadey S, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Murray CJL, Vos T. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2022; 7:e105-e125. [PMID: 34998485 PMCID: PMC8810394 DOI: 10.1016/s2468-2667(21)00249-8] [Citation(s) in RCA: 983] [Impact Index Per Article: 491.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. METHODS We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. FINDINGS We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4-65·1) million cases globally in 2019 to 152·8 (130·8-175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [-7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64-1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52-1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. INTERPRETATION Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. FUNDING Bill & Melinda Gates Foundation and Gates Ventures.
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2147] [Impact Index Per Article: 1073.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V, Abualhasan A, Abu-Rmeileh NME, Abushouk AI, Adebayo OM, Agarwal G, Agasthi P, Ahinkorah BO, Ahmad S, Ahmadi S, Ahmed Salih Y, Aji B, Akbarpour S, Akinyemi RO, Al Hamad H, Alahdab F, Alif SM, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Shahi Salman R, Alvis-Guzman N, Ancuceanu R, Anderlini D, Anderson JA, Ansar A, Antonazzo IC, Arabloo J, Ärnlöv J, Artanti KD, Aryan Z, Asgari S, Ashraf T, Athar M, Atreya A, Ausloos M, Baig AA, Baltatu OC, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barone MTU, Basu S, Bazmandegan G, Beghi E, Beheshti M, Béjot Y, Bell AW, Bennett DA, Bensenor IM, Bezabhe WM, Bezabih YM, Bhagavathula AS, Bhardwaj P, Bhattacharyya K, Bijani A, Bikbov B, Birhanu MM, Boloor A, Bonny A, Brauer M, Brenner H, Bryazka D, Butt ZA, Caetano dos Santos FL, Campos-Nonato IR, Cantu-Brito C, Carrero JJ, Castañeda-Orjuela CA, Catapano AL, Chakraborty PA, Charan J, Choudhari SG, Chowdhury EK, Chu DT, Chung SC, Colozza D, Costa VM, Costanzo S, Criqui MH, Dadras O, Dagnew B, Dai X, Dalal K, Damasceno AAM, D'Amico E, Dandona L, Dandona R, Darega Gela J, Davletov K, De la Cruz-Góngora V, Desai R, Dhamnetiya D, Dharmaratne SD, Dhimal ML, Dhimal M, Diaz D, Dichgans M, Dokova K, Doshi R, Douiri A, Duncan BB, Eftekharzadeh S, Ekholuenetale M, El Nahas N, Elgendy IY, Elhadi M, El-Jaafary SI, Endres M, Endries AY, Erku DA, Faraon EJA, Farooque U, Farzadfar F, Feroze AH, Filip I, Fischer F, Flood D, Gad MM, Gaidhane S, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Ghozy S, Gialluisi A, Giampaoli S, Gilani SA, Gill PS, Gnedovskaya EV, Golechha M, Goulart AC, Guo Y, Gupta R, Gupta VB, Gupta VK, Gyanwali P, Hafezi-Nejad N, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hashi A, Hassan TS, Hassen HY, Havmoeller RJ, Hay SI, Hayat K, Hegazy MI, Herteliu C, Holla R, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iacoviello L, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Iqbal U, Irvani SSN, Islam SMS, Ismail NE, Iso H, Isola G, Iwagami M, Jacob L, Jain V, Jang SI, Jayapal SK, Jayaram S, Jayawardena R, Jeemon P, Jha RP, Johnson WD, Jonas JB, Joseph N, Jozwiak JJ, Jürisson M, Kalani R, Kalhor R, Kalkonde Y, Kamath A, Kamiab Z, Kanchan T, Kandel H, Karch A, Katoto PDMC, Kayode GA, Keshavarz P, Khader YS, Khan EA, Khan IA, Khan M, Khan MAB, Khatib MN, Khubchandani J, Kim GR, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Kolte D, Koolivand A, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Krishnamurthi RV, Kumar GA, Kusuma D, La Vecchia C, Lacey B, Lak HM, Lallukka T, Lasrado S, Lavados PM, Leonardi M, Li B, Li S, Lin H, Lin RT, Liu X, Lo WD, Lorkowski S, Lucchetti G, Lutzky Saute R, Magdy Abd El Razek H, Magnani FG, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Manafi N, Mansournia MA, Mantovani LG, Martini S, Mazzaglia G, Mehndiratta MM, Menezes RG, Meretoja A, Mersha AG, Miao Jonasson J, Miazgowski B, Miazgowski T, Michalek IM, Mirrakhimov EM, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Mokhayeri Y, Molokhia M, Moni MA, Montasir AA, Moradzadeh R, Morawska L, Morze J, Muruet W, Musa KI, Nagarajan AJ, Naghavi M, Narasimha Swamy S, Nascimento BR, Negoi RI, Neupane Kandel S, Nguyen TH, Norrving B, Noubiap JJ, Nwatah VE, Oancea B, Odukoya OO, Olagunju AT, Orru H, Owolabi MO, Padubidri JR, Pana A, Parekh T, Park EC, Pashazadeh Kan F, Pathak M, Peres MFP, Perianayagam A, Pham TM, Piradov MA, Podder V, Polinder S, Postma MJ, Pourshams A, Radfar A, Rafiei A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmani AM, Rajai N, Ranasinghe P, Rao CR, Rao SJ, Rathi P, Rawaf DL, Rawaf S, Reitsma MB, Renjith V, Renzaho AMN, Rezapour A, Rodriguez JAB, Roever L, Romoli M, Rynkiewicz A, Sacco S, Sadeghi M, Saeedi Moghaddam S, Sahebkar A, Saif-Ur-Rahman KM, Salah R, Samaei M, Samy AM, Santos IS, Santric-Milicevic MM, Sarrafzadegan N, Sathian B, Sattin D, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Sepanlou SG, Seylani A, Sha F, Shahabi S, Shaikh MA, Shannawaz M, Shawon MSR, Sheikh A, Sheikhbahaei S, Shibuya K, Siabani S, Silva DAS, Singh JA, Singh JK, Skryabin VY, Skryabina AA, Sobaih BH, Stortecky S, Stranges S, Tadesse EG, Tarigan IU, Temsah MH, Teuschl Y, Thrift AG, Tonelli M, Tovani-Palone MR, Tran BX, Tripathi M, Tsegaye GW, Ullah A, Unim B, Unnikrishnan B, Vakilian A, Valadan Tahbaz S, Vasankari TJ, Venketasubramanian N, Vervoort D, Vo B, Volovici V, Vosoughi K, Vu GT, Vu LG, Wafa HA, Waheed Y, Wang Y, Wijeratne T, Winkler AS, Wolfe CDA, Woodward M, Wu JH, Wulf Hanson S, Xu X, Yadav L, Yadollahpour A, Yahyazadeh Jabbari SH, Yamagishi K, Yatsuya H, Yonemoto N, Yu C, Yunusa I, Zaman MS, Zaman SB, Zamanian M, Zand R, Zandifar A, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhong C, Zuniga YMH, Murray CJL. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20:795-820. [PMID: 34487721 PMCID: PMC8443449 DOI: 10.1016/s1474-4422(21)00252-0] [Citation(s) in RCA: 1651] [Impact Index Per Article: 550.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. METHODS We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. FINDINGS In 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING Bill & Melinda Gates Foundation.
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Nichols E, Abd-Allah F, Abdoli A, Abualhasan A, Abu-Gharbieh E, Afshin A, Akinyemi RO, Alanezi FM, Alipour V, Almasi-Hashiani A, Arabloo J, Ashraf-Ganjouei A, Ayano G, Ayuso-Mateos JL, Baig AA, Banach M, Barboza MA, Barker-Collo SL, Baune BT, Bhagavathula AS, Bhattacharyya K, Bijani A, Biswas A, Boloor A, Brayne C, Brenner H, Burkart K, Burugina Nagaraja S, Carvalho F, Castro-de-Araujo LFS, Catalá-López F, Cerin E, Cherbuin N, Chu DT, Dai X, de Sá-Junior AR, Djalalinia S, Douiri A, Edvardsson D, El-Jaafary SI, Eskandarieh S, Faro A, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Gaidhane S, Galluzzo L, Gebremeskel GG, Ghashghaee A, Gialluisi A, Gnedovskaya EV, Golechha M, Gupta R, Hachinski V, Haider MR, Haile TG, Hamiduzzaman M, Hankey GJ, Hay SI, Heidari G, Heidari-Soureshjani R, Ho HC, Househ M, Hwang BF, Iacoviello L, Ilesanmi OS, Ilic IM, Ilic MD, Irvani SSN, Iwagami M, Iyamu IO, Jha RP, Kalani R, Karch A, Kasa AS, Khader YS, Khan EA, Khatib MN, Kim YJ, Kisa S, Kisa A, Kivimäki M, Koyanagi A, Kumar M, Landires I, Lasrado S, Li B, Lim SS, Liu X, Madhava Kunjathur S, Majeed A, Malik P, Mehndiratta MM, Menezes RG, Mohammad Y, Mohammed S, Mokdad AH, Moni MA, Nagel G, Naveed M, Nayak VC, Nguyen CT, Nguyen HLT, Nunez-Samudio V, Olagunju AT, Ostroff SM, Otstavnov N, Owolabi MO, Pashazadeh Kan F, Patel UK, Phillips MR, Piradov MA, Pond CD, Pottoo FH, Prada SI, Radfar A, Rahim F, Rana J, Rashedi V, Rawaf S, Rawaf DL, Reinig N, Renzaho AMN, Rezaei N, Rezapour A, Romoli M, Roshandel G, Sachdev PS, Sahebkar A, Sahraian MA, Samaei M, Saylan M, Sha F, Shaikh MA, Shibuya K, Shigematsu M, Shin JI, Shiri R, Silva DAS, Singh JA, Singhal D, Skryabin VY, Skryabina AA, Soheili A, Sotoudeh H, Spurlock EE, Szoeke CEI, Tabarés-Seisdedos R, Taddele BW, Tovani-Palone MR, Tsegaye GW, Vacante M, Venketasubramanian N, Vidale S, Vlassov V, Vu GT, Wang YP, Weiss J, Weldemariam AH, Westerman R, Wimo A, Winkler AS, Wu C, Yadollahpour A, Yesiltepe M, Yonemoto N, Yu C, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Murray CJL, Vos T. Use of multidimensional item response theory methods for dementia prevalence prediction: an example using the Health and Retirement Survey and the Aging, Demographics, and Memory Study. BMC Med Inform Decis Mak 2021; 21:241. [PMID: 34380485 PMCID: PMC8356410 DOI: 10.1186/s12911-021-01590-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation samples from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally. METHODS Using cognitive testing data and data on functional limitations from Wave A (2001-2003) of the ADAMS study (n = 744) and the 2000 wave of the HRS study (n = 6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all individuals over 70. Based on diagnostic information from the formal clinical adjudication in ADAMS, we fit a logistic regression model for the classification of dementia status using cognition and function scores and applied this algorithm to the full HRS sample to calculate dementia prevalence by age and sex. RESULTS Our algorithm had a cross-validated predictive accuracy of 88% (86-90), and an area under the curve of 0.97 (0.97-0.98) in ADAMS. Prevalence was higher in females than males and increased over age, with a prevalence of 4% (3-4) in individuals 70-79, 11% (9-12) in individuals 80-89 years old, and 28% (22-35) in those 90 and older. CONCLUSIONS Our model had similar or better accuracy as compared to previously reviewed algorithms for the prediction of dementia prevalence in HRS, while utilizing more flexible methods. These methods could be more easily generalized and utilized to estimate dementia prevalence in other national surveys.
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Harding BN, Avoundjian T, Heckbert SR, Whitney BM, Nance RM, Ruderman SA, Kalani R, Tirschwell DL, Ho EL, Becker KJ, Zunt J, Chow F, Huffer A, Mathews WC, Eron J, Moore RD, Marra CM, Burkholder G, Saag MS, Kitahata MM, Crane HM, Delaney JC. HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy. Epidemiology 2021; 32:457-464. [PMID: 33591056 PMCID: PMC8012252 DOI: 10.1097/ede.0000000000001331] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined. METHODS Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy-days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile ("high VL") to the 25th percentile ("low VL") of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL. RESULTS Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk. CONCLUSIONS Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
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Affiliation(s)
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Rizwan Kalani
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Emily L Ho
- Department of Medicine, University of Washington, Seattle, WA
| | - Kyra J Becker
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph Zunt
- Department of Medicine, University of Washington, Seattle, WA
| | - Felicia Chow
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrew Huffer
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Crane HM, Nance RM, Avoundjian T, Harding BN, Whitney BM, Chow FC, Becker KJ, Marra CM, Zunt JR, Ho EL, Kalani R, Huffer A, Burkholder GA, Willig AL, Moore RD, Mathews WC, Eron JJ, Napravnik S, Lober WB, Barnes GS, McReynolds J, Feinstein MJ, Heckbert SR, Saag MS, Kitahata MM, Delaney JA, Tirschwell DL. Types of Stroke Among People Living With HIV in the United States. J Acquir Immune Defic Syndr 2021; 86:568-578. [PMID: 33661824 PMCID: PMC9680532 DOI: 10.1097/qai.0000000000002598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes. SETTING CNICS, a U.S. multisite clinical cohort of PLWH in care. METHODS We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort. RESULTS Among 26,514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes. CONCLUSION Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Christina M. Marra
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
| | - Joseph R. Zunt
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
- Epidemiology, University of Washington, Seattle, USA
| | - Emily L. Ho
- Neurology, University of Washington, Seattle, USA
- Swedish Neuroscience Institute, Seattle, USA
| | | | | | | | | | | | | | | | | | - William B. Lober
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Greg S. Barnes
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Justin McReynolds
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | | | | | | | | | - Joseph A.C. Delaney
- Epidemiology, University of Washington, Seattle, USA
- University of Manitoba, Manitoba, Canada
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20
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Feigin VL, Vos T, Alahdab F, Amit AML, Bärnighausen TW, Beghi E, Beheshti M, Chavan PP, Criqui MH, Desai R, Dhamminda Dharmaratne S, Dorsey ER, Wilder Eagan A, Elgendy IY, Filip I, Giampaoli S, Giussani G, Hafezi-Nejad N, Hole MK, Ikeda T, Owens Johnson C, Kalani R, Khatab K, Khubchandani J, Kim D, Koroshetz WJ, Krishnamoorthy V, Krishnamurthi RV, Liu X, Lo WD, Logroscino G, Mensah GA, Miller TR, Mohammed S, Mokdad AH, Moradi-Lakeh M, Morrison SD, Shivamurthy VKN, Naghavi M, Nichols E, Norrving B, Odell CM, Pupillo E, Radfar A, Roth GA, Shafieesabet A, Sheikh A, Sheikhbahaei S, Shin JI, Singh JA, Steiner TJ, Stovner LJ, Wallin MT, Weiss J, Wu C, Zunt JR, Adelson JD, Murray CJL. Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study. JAMA Neurol 2021; 78:165-176. [PMID: 33136137 PMCID: PMC7607495 DOI: 10.1001/jamaneurol.2020.4152] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Question What is the current burden of neurological disorders in the US by states, and what are the temporal trends (from 1990 to 2017)? Findings Systematic analysis of the Global Burden of Disease study shows that, in 2017, the 3 most burdensome neurological disorders in the US were stroke, Alzheimer disease and other dementias, and migraine. The burden of individual neurological disorders varied moderately to widely by states (a 1.2-fold to 7.5-fold difference), and the absolute numbers of incident, prevalent, and fatal cases and disability-adjusted life-years of neurological disorders (except for traumatic brain injury incidence; spinal cord injury prevalence; meningitis prevalence, deaths, and disability-adjusted life-years; and encephalitis disability-adjusted life-years) across all US states increased from 1990 to 2017. Meaning A large and increasing number of people have various neurological disorders in the US, with significant variation in the burden of and trends in neurological disorders across the US states, and the reasons for these geographic variations need to be explored further. Importance Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures Any of the 14 listed neurological diseases. Main Outcome and Measure Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (−29.1% [95% UI, −32.4% to −25.8%]); spinal cord injury prevalence (−38.5% [95% UI, −43.1% to −34.0%]); meningitis prevalence (−44.8% [95% UI, −47.3% to −42.3%]), deaths (−64.4% [95% UI, −67.7% to −50.3%]), and DALYs (−66.9% [95% UI, −70.1% to −55.9%]); and encephalitis DALYs (−25.8% [95% UI, −30.7% to −5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.
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Affiliation(s)
| | - Valery L Feigin
- Faculty of Health and Environmental Sciences, Auckland University of Technology School of Public Health and Psychosocial Studies, Auckland, New Zealand.,Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Research Center of Neurology, Moscow, Russia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle
| | - Fares Alahdab
- Mayo Evidence-Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota
| | - Arianna Maever L Amit
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, Philippines.,Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Mahya Beheshti
- Department of Physical Medicine and Rehabilitation, New York University, New York
| | - Prachi P Chavan
- Department of Epidemiology and Environmental Health, the University of Buffalo, Buffalo, New York
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle.,Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Arielle Wilder Eagan
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts.,Department of Social Services, Tufts Medical Center, Boston, Massachusetts
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital, Boston.,Division of Cardiology, Harvard University, Boston, Massachusetts
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California.,A.T. Still University School of Osteopathic Medicine in Arizona, Arizona School of Health Sciences, Mesa, Arizona
| | - Simona Giampaoli
- Department of Cardiovascular Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Nima Hafezi-Nejad
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.,Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Michael K Hole
- Department of Pediatrics, The University of Texas, Austin, Austin
| | - Takayoshi Ikeda
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | | | - Rizwan Kalani
- Department of Neurology, University of Washington, Seattle
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom.,Ohio University College of Arts and Sciences, Zanesville
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Walter J Koroshetz
- National Institutes of Neurological Disorders and Stroke, National Institute of Health, Bethesda, Maryland
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University, Durham, North Carolina.,Department of Anesthesiology, University of Washington, Seattle
| | - Rita V Krishnamurthi
- Faculty of Health and Environmental Sciences, Auckland University of Technology School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Xuefeng Liu
- Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor
| | - Warren David Lo
- Department of Pediatrics, Ohio State University, Columbus.,Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland.,School of Public Health, Curtin University, Perth, Australia
| | - Salahuddin Mohammed
- Department of Biomolecular Sciences, University of Mississippi, Oxford.,Department of Pharmacy, Mizan-Tepi University, Mizan, Ethiopia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle
| | - Emma Nichols
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Bo Norrving
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christopher M Odell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Elisabetta Pupillo
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Amir Radfar
- University of Central Florida College of Medicine, Orlando
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle.,Division of Cardiology, University of Washington, Seattle
| | - Azadeh Shafieesabet
- Department of Cardiology, Charité Medical University Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany
| | - Aziz Sheikh
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom.,Division of General Internal Medicine, Harvard University, Boston, Massachusetts
| | - Sara Sheikhbahaei
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Jae Il Shin
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jasvinder A Singh
- The University of Alabama at Birmingham School of Medicine, Birmingham.,Medicine Service, US Department of Veterans Affairs, Birmingham, Alabama
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway
| | - Mitchell Taylor Wallin
- Department of Neurology, George Washington University, Washington, DC.,University of Maryland School of Medicine, Baltimore
| | - Jordan Weiss
- Department of Demography, University of California, Berkeley, Berkeley
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Jaimie D Adelson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle
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Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko NI, Britton GB, Bryazka D, Buchbinder R, Bumgarner BR, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castle CD, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AR, Charlson FJ, Chattu VK, Chaturvedi S, Chimed-Ochir O, Chin KL, Cho DY, Christensen H, Chu DT, Chung MT, Cicuttini FM, Ciobanu LG, Cirillo M, Collins EL, Compton K, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cowie BC, Cromwell EA, Cross DH, Crowe CS, Cruz JA, Cunningham M, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davletov K, De Leo D, Dean FE, DeCleene NK, Deen A, Degenhardt L, Dellavalle RP, Demeke FM, Demsie DG, Denova-Gutiérrez E, Dereje ND, Dervenis N, Desai R, Desalew A, Dessie GA, Dharmaratne SD, 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Gebrehiwot AM, Gebremedhin KB, Gebreslassie AAAA, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghafourifard M, Ghajar A, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Gilani SA, Gill PS, Gitimoghaddam M, Giussani G, Goli S, Gomez RS, Gopalani SV, Gorini G, Gorman TM, Gottlich HC, Goudarzi H, Goulart AC, Goulart BNG, Grada A, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimaraes ALS, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Haagsma JA, Haddock B, Hafezi-Nejad N, Hafiz A, Hagins H, Haile LM, Hall BJ, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Hamilton EB, Han C, Han H, Hankey GJ, Haro JM, Harvey JD, Hasaballah AI, Hasanzadeh A, Hashemian M, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay RJ, Hay SI, Hayat K, Heidari B, Heidari G, Heidari-Soureshjani R, Hendrie D, Henrikson HJ, Henry NJ, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Hole MK, Holla R, Hoogar P, Hosgood HD, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hsairi M, Hsieh VCR, Hu G, Huda 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Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6299] [Impact Index Per Article: 1574.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang KL, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chimed-Ochir O, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Classen TKD, Cohen AJ, Compton K, Cooper OR, Costa VM, Cousin E, Cowden RG, Cross DH, Cruz JA, Dahlawi SMA, Damasceno AAM, Damiani G, Dandona L, Dandona R, Dangel WJ, Danielsson AK, Dargan PI, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davitoiu DV, De Leo D, Degenhardt L, DeLang M, Dellavalle RP, Demeke FM, Demoz GT, Demsie DG, Denova-Gutiérrez E, Dervenis N, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dibaji Forooshani ZS, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshmangir L, Driscoll TR, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Nahas N, El Sayed I, El 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Zandian H, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao JT, Zhao XJG, Zhao Y, Zhou M, Ziapour A, Zimsen SRM, Brauer M, Afshin A, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3234] [Impact Index Per Article: 808.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Haagsma JA, James SL, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, Lucchesi LR, Roberts NLS, Sylte DO, Adebayo OM, Ahmadi A, Ahmed MB, Aichour MTE, Alahdab F, Alghnam SA, Aljunid SM, Al-Raddadi RM, Alsharif U, Altirkawi K, Anjomshoa M, Antonio CAT, Appiah SCY, Aremu O, Arora A, Asayesh H, Assadi R, Awasthi A, Ayala Quintanilla BP, Balalla S, Banstola A, Barker-Collo SL, Bärnighausen TW, Bazargan-Hejazi S, Bedi N, Behzadifar M, Behzadifar M, Benjet C, Bennett DA, Bensenor IM, Bhaumik S, Bhutta ZA, Bijani A, Borges G, Borschmann R, Bose D, Boufous S, Brazinova A, Campuzano Rincon JC, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Catalá-López F, Choi JYJ, Christopher DJ, Crowe CS, Dalal K, Daryani A, Davitoiu DV, Degenhardt L, De Leo D, De Neve JW, Deribe K, Dessie GA, deVeber GA, Dharmaratne SD, Doan LP, Dolan KA, Driscoll TR, Dubey M, El-Khatib Z, Ellingsen CL, El Sayed Zaki M, Endries AY, Eskandarieh S, Faro A, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Franklin RC, Fukumoto T, Gezae KE, Gill TK, Goulart AC, Grada A, Guo Y, Gupta R, Haghparast Bidgoli H, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hendrie D, Henok A, Híjar M, Hole MK, Homaie Rad E, Hossain N, Hostiuc S, Hu G, Igumbor EU, Ilesanmi OS, Irvani SSN, Islam SMS, Ivers RQ, Jacobsen KH, Jahanmehr N, Jakovljevic M, Jayatilleke AU, Jha RP, Jonas JB, Jorjoran Shushtari Z, Jozwiak JJ, Jürisson M, Kabir A, Kalani R, Kasaeian A, Kelbore AG, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khan EA, Khoja AT, Kiadaliri AA, Kim YE, Kim D, Kisa A, Koyanagi A, Kuate Defo B, Kucuk Bicer B, Kumar M, Lalloo R, Lam H, Lami FH, Lansingh VC, Leasher JL, Li S, Linn S, Lunevicius R, Machado FR, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahotra NB, Majdan M, Majeed A, Malekzadeh R, Malik MA, Malta DC, Manda AL, Mansournia MA, Massenburg BB, Maulik PK, Meheretu HAA, Mehndiratta MM, Melese A, Mendoza W, Mengesha MM, Meretoja TJ, Meretoja A, Mestrovic T, Miazgowski T, Miller TR, Mini GK, Mirrakhimov EM, Moazen B, Mohammad Gholi Mezerji N, Mohammadibakhsh R, Mohammed S, Molokhia M, Monasta L, Mondello S, Montero-Zamora PA, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Morawska L, Velásquez IM, Morrison SD, Moschos MM, Mousavi SM, Murthy S, Musa KI, Naik G, Najafi F, Nangia V, Nascimento BR, Ndwandwe DE, Negoi I, Nguyen TH, Nguyen SH, Nguyen LH, Nguyen HLT, Ningrum DNA, Nirayo YL, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Orpana HM, Otstavnov SS, P A M, Pakhale S, Park EK, Patton GC, Pesudovs K, Phillips MR, Polinder S, Prakash S, Radfar A, Rafay A, Rafiei A, Rahimi S, Rahimi-Movaghar V, Rahman MA, Rai RK, Ramezanzadeh K, Rawaf S, Rawaf DL, Renzaho AMN, Resnikoff S, Rezaeian S, Roever L, Ronfani L, Roshandel G, Sabde YD, Saddik B, Salamati P, Salimi Y, Salz I, Samy AM, Sanabria J, Sanchez Riera L, Santric Milicevic MM, Satpathy M, Sawhney M, Sawyer SM, Saxena S, Saylan M, Schneider IJC, Schwebel DC, Seedat S, Sepanlou SG, Shaikh MA, Shams-Beyranvand M, Shamsizadeh M, Sharif-Alhoseini M, Sheikh A, Shen J, Shigematsu M, Shiri R, Shiue I, Silva JP, Singh JA, Sinha DN, Soares Filho AM, Soriano JB, Soshnikov S, Soyiri IN, Starodubov VI, Stein DJ, Stokes MA, Sufiyan MB, Sunshine JE, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tehrani-Banihashemi A, Tessema GA, Thakur JS, Tran KB, Tran BX, Tudor Car L, Uthman OA, Uzochukwu BSC, Valdez PR, Varavikova E, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov V, Waheed Y, Wang YP, Wijeratne T, Winkler AS, Yadav P, Yano Y, Yenesew MA, Yip P, Yisma E, Yonemoto N, Younis MZ, Yu C, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zhao Y, Zodpey S, Hay SI, Lopez AD, Mokdad AH, Vos T. Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017. Inj Prev 2020; 26:i12-i26. [PMID: 31915273 PMCID: PMC7571356 DOI: 10.1136/injuryprev-2019-043296] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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Affiliation(s)
- Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Lydia R Lucchesi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Alireza Ahmadi
- Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | - Suliman A Alghnam
- Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Rajaa M Al-Raddadi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ubai Alsharif
- Department of Oral and Maxillofacial Surgery, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | | | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Amit Arora
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | | | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Shivanthi Balalla
- School of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | | | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neeraj Bedi
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Department of Epidemiology and Biostatistics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Derrick A Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Isabela M Bensenor
- Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Guilherme Borges
- Department of Epidemiology and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dipan Bose
- Transport & Digital Development, World Bank, Washington, District of Columbia, USA
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Julio Cesar Campuzano Rincon
- National Institute of Public Health, Cuernavaca, Mexico
- School of Medicine, University of the Valley of Cuernavaca, Cuernavaca, Mexico
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
- Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
| | - Ferrán Catalá-López
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jee-Young J Choi
- Department of Biochemistry and Biomedical Science, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Dragos Virgil Davitoiu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, Clinical Emergency Hospital Sf. Pantelimon, Bucharest, Romania
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Gabrielle Aline deVeber
- Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Linh Phuong Doan
- Center of Excellence in Health Service Management, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Kate A Dolan
- University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Robert Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Manisha Dubey
- United Nations World Food Programme, New Delhi, India
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | | | | | - Aman Yesuf Endries
- Public Health Department, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA
- School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
- Internal Medicine Department, University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Ayman Grada
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Rahul Gupta
- March of Dimes, Arlington, Virginia, USA
- School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | | | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Randah R Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
| | - Hadi Hassankhani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Department of Public Health, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
| | - Rasmus Havmoeller
- Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andualem Henok
- Department of Public Health, Mizan-Tepi University, Teppi, Ethiopia
| | - Martha Híjar
- Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
- CISS, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, Texas, USA
| | - Enayatollah Homaie Rad
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Naznin Hossain
- Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka University, Dhaka, Bangladesh
- Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
| | - Sorin Hostiuc
- Faculty of Dentistry, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Central South University, Changsha, China
| | - Ehimario U Igumbor
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Q Ivers
- Injury Division, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Nader Jahanmehr
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihajlo Jakovljevic
- Department for Health Care and Public Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Ravi Prakash Jha
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rizwan Kalani
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nauman Khalid
- School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Abdullah T Khoja
- Department of Public Health, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Young-Eun Kim
- Department of Preventive Medicine, Korea University, Seoul, South Korea
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Ai Koyanagi
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Barthelemy Kuate Defo
- Department of Demography, University of Montreal, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Burcu Kucuk Bicer
- Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
- Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Hilton Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Faris Hasan Lami
- Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
| | - Van C Lansingh
- HelpMeSee, New York City, New York, USA
- International Relations Department, Mexican Institute of Ophthalmology, Queretaro, Mexico
| | - Janet L Leasher
- College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shai Linn
- School of Public Health, University of Haifa, Haifa, Israel
| | - Raimundas Lunevicius
- Department of General Surgery, Aintree University Hospital National Health Service (NHS) Foundation Trust, Liverpool, UK
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Sao Paulo, Brazil
| | | | | | | | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manzoor Ahmad Malik
- Department of Humanities and Social Sciences, Indian Institute of Technology, Roorkee, Haridwar, India
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pallab K Maulik
- Research Department, The George Institute for Global Health, New Delhi, India
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hailemariam Abiy Alemu Meheretu
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Man Mohan Mehndiratta
- Neurology Department, Janakpuri Super Specialty Hospital Society, New Delhi, India
- Neurology Department, Govind Ballabh Institute of Medical Education and Research, New Delhi, India
| | - Addisu Melese
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
| | - G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
| | - Erkin M Mirrakhimov
- Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | | | | | - Shafiu Mohammed
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Neurology, Oasi Research Institute, Troina, Italy
| | - Pablo A Montero-Zamora
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Yoshan Moodley
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Marilita M Moschos
- 1st Department of Ophthalmology, University of Athens, Athens, Greece
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Seyyed Meysam Mousavi
- Health Management Reserach Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamarul Imran Musa
- School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
| | - Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Bruno Ramos Nascimento
- Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | | | - Dina Nur Anggraini Ningrum
- Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
| | - Olanrewaju Oladimeji
- HAST, Human Sciences Research Council, Durban, South Africa
- School of Public Health, Faculty of Health Sciences, University of Namibia, Osakhati, Namibia
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pedro R Olivares
- Institute of Physical Activity and Health, Autonomous University of Chile, Talca, Chile
| | - Heather M Orpana
- Applied Research Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanislav S Otstavnov
- Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia
| | - Mahesh P A
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Population Health Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Konrad Pesudovs
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, Department of Epidemiology, Columbia University, New York City, New York, USA
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Swayam Prakash
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, Florida, USA
- College of Graduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Anwar Rafay
- Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
| | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Rahimi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare Professions, Federation University, Heidelberg, Victoria, Australia
- National Centre for Farmer Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, India
- Department of Economics, University of Göttingen, Göttingen, Germany
| | - Kiana Ramezanzadeh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
- University College London Hospitals, London, UK
| | - Andre M N Renzaho
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- Organization for the Prevention of Blindness, Paris, France
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Yogesh Damodar Sabde
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Basema Saddik
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yahya Salimi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Inbal Salz
- Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Juan Sanabria
- Department of Surgery, Marshall University, Huntington, West Virginia, USA
- Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lidia Sanchez Riera
- Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Institute of Bone and Joint Research, University of Sydney, Syndey, New South Wales, Australia
| | - Milena M Santric Milicevic
- Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
- Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Mete Saylan
- Market Access Department, Bayer, Istanbul, Turkey
| | - Ione J C Schneider
- School of Health Sciences, Federal University of Santa Catarina, Ararangua, Brazil
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehran Shams-Beyranvand
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aziz Sheikh
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, Massachusetts, USA
| | - Jiabin Shen
- Center for Pediatric Trauma Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Institute of Medical Epidemiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, US Department of Veteran Affairs, Birmingham, Alabama, USA
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Adauto Martins Soares Filho
- Department of Diseases and Noncommunicable Diseases and Health Promotion, Federal Ministry of Health, Brasilia, Brazil
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Sergey Soshnikov
- Department of Research Development, Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Ireneous N Soyiri
- Hull York Medical School, University of Hull, Hull City, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Vladimir I Starodubov
- Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Dan J Stein
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, California, USA
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, Illinois, USA
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gizachew Assefa Tessema
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jarnail Singh Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Khanh Bao Tran
- Molecular Medicine and Pathology Department, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Elena Varavikova
- Central Research Institute of Cytology and Genetics, Federal Research Institute for Health Organization and Informatics of the Ministry of Health (FRIHOI), Moscow, Russia
| | - Ana Maria Nogales Vasconcelos
- Department of Statistics, University of Brasília, Brasília, Brazil
- Directorate of Social Studies and Policies, Federal District Planning Company, Brasília, Brazil
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Vasily Vlassov
- Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
| | - Yasir Waheed
- Foundation University Medical College, Foundation University, Islamabad, Pakistan
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Tissa Wijeratne
- Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Andrea Sylvia Winkler
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Priyanka Yadav
- Centre for the Study of Regional Development, Jawahar Lal Nehru University, New Delhi, India
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mustafa Z Younis
- Health Economics & Finance, Jackson State University, Jackson, Mississippi, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Shamsa Zafar
- Department of Obstetrics & Gynaecology, A.C.S. Medical College and Hospital, Islamabad, Pakistan
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- University of Melbourne, Melbourne, Queensland, Australia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Shukla A, Sharda B, Sharma S, Bhardwaj S, Kailash U, Kalani R, Satyanarayana L, Shrivastava A. Association Between Serum Testosterone and Serum PSA Among Men With and Without Partial Androgen Deficiency. Indian J Clin Biochem 2020; 35:127-131. [PMID: 32071506 DOI: 10.1007/s12291-018-0785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/25/2018] [Indexed: 01/28/2023]
Abstract
Serum prostatic specific antigen (PSA) and serum testosterone levels share an undefined relationship with each other, with many conflicting studies showing both positive and negative correlation between them. Our aim was to assess association between serum PSA and serum testosterone in healthy men with normal testosterone levels and men with partial androgen deficiency (PADAM). A cross sectional study was conducted at a teaching hospital setting where serum testosterone and aging male symptom scale (AMS) scores along with PSA were studied in 255 men (> 50 years) with and without PADAM. Mean total testosterone and serum PSA was 9.35 ± 1.33 nmol/L, 1.96 ± 0.76 ng/mL in males with PADAM and 15.30 ± 1.95 nmol/L, 1.85 ± 0.73 ng/mL respectively in males without PADAM. No significant relationship was observed between serum PSA and serum testosterone levels among healthy males irrespective of PADAM in the study population. We suggest, there is no need to adjust PSA values for biopsy decisions according to testosterone levels.
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Affiliation(s)
- A Shukla
- Department of Biochemistry, Rajiv Gandhi Super Specialty Hospital, Dilshad Garden, New Delhi, 110093 India
| | - B Sharda
- 2Department of Urology, RG Stone Urology and Laparoscopy Hospital, F-12, East of Kailash, New Delhi, 110065 India
| | - S Sharma
- 3Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Basni Industrial Area, Phase-2, Jodhpur, Rajasthan 342005 India
| | - S Bhardwaj
- Department of Biochemistry, Rajiv Gandhi Super Specialty Hospital, Dilshad Garden, New Delhi, 110093 India
| | - U Kailash
- 4ICMR-National Institute of Cancer Prevention and Research, Sector-39, Noida, Uttar Pradesh 201301 India
| | - R Kalani
- Department of Biochemistry, Rajiv Gandhi Super Specialty Hospital, Dilshad Garden, New Delhi, 110093 India
| | - L Satyanarayana
- 4ICMR-National Institute of Cancer Prevention and Research, Sector-39, Noida, Uttar Pradesh 201301 India
| | - A Shrivastava
- 4ICMR-National Institute of Cancer Prevention and Research, Sector-39, Noida, Uttar Pradesh 201301 India
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Harding B, Avoundjian T, Heckbert SR, Whitney BM, Nance RM, Tirschwell DL, Kalani R, Ho EL, Becker KJ, Zunt J, Chow F, Huffer A, Mathews WC, Eron J, Moore R, Marra CM, Burkholder G, Saag M, Kitahata MM, Crane H, Delaney JC. Abstract WMP55: HIV Viral Load and Stroke Risk. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Among people living with HIV (PLWH), elevated plasma HIV RNA (viral load, [VL]), indicative of increased inflammation, may be associated with greater risk of stroke.
Methods:
Among adult PLWH receiving clinical care at six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites across the U.S. from January 2006 through January 2015, first ischemic or hemorrhagic stroke was identified from adjudicated clinical events. We considered baseline and time-updated VL. Baseline viral load was defined as the most recent viral load before 2006 or at CNICS cohort entry (if after 2006). Cox proportional hazards models were used to assess the relationship between baseline VL and time-updated VL and stroke. We estimated hazard ratios for risk of stroke (all stroke, and ischemic and hemorrhagic stroke separately) comparing the 75
th
percentile of VL (“high VL”) to the 25
th
percentile (“low VL”). All models were adjusted for age, sex, race/ethnicity, CNICS site, diabetes, treated hypertension, statin use, smoking, nadir CD4, BMI, hepatitis C virus coinfection, and baseline ART use. The hemorrhagic stroke model was also adjusted for FIB-4.
Results:
Among 16,648 PLWH over an average follow-up of 4.7 years, there were 146 total strokes (119 ischemic; 19 hemorrhagic). At baseline, the median VL was 41 copies/mL (IQR: 24, 3860). Individuals with high baseline VL were 1.57 times more likely to have a stroke than individuals with low baseline VL (95% CI: 1.22, 2.04). In addition, high baseline VL was associated with increased risk of ischemic stroke (HR: 1.48; 95% CI: 1.11, 1.97) and hemorrhagic stroke (HR: 2.5; 95% CI: 1.25, 4.98). The HR for all strokes comparing high VL and low VL individuals using time-updated VL was 1.84 (95% CI: 1.42-2.40).
Conclusion:
Our findings suggest that higher VL is associated with stroke risk after adjusting for traditional stroke risk factors, and may have a greater impact on incidence of hemorrhagic stroke. In addition to reducing HIV-related morbidity and mortality, improving HIV care may also reduce stroke risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Felicia Chow
- Univ of California San Francisco, San Francisco, CA
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Kalani R, Bartz TM, Suchy-Dicey A, Elkind MSV, Psaty BM, Leung LY, Rice K, Tirschwell D, Longstreth WT. Cholesterol Variability and Cranial Magnetic Resonance Imaging Findings in Older Adults: The Cardiovascular Health Study. Stroke 2019; 51:69-74. [PMID: 31842691 DOI: 10.1161/strokeaha.119.026698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and Purpose- Serum cholesterol variability, independent of mean, has been associated with stroke, white matter hyperintensities on cranial magnetic resonance imaging (MRI), and other cardiovascular events. We sought to assess the relationship between total serum cholesterol (TC) variability and cranial MRI findings of subclinical or covert vascular brain injury in a longitudinal, population-based cohort study of older adults. Methods- In the Cardiovascular Health Study, we assessed associations between intraindividual TC mean, trend, and variability over ≈5 years with covert brain infarction (CBI) and white matter grade (WMG) on cranial MRI. Mean TC was calculated for each study participant from 4 annual TC measurements between 2 MRI scans. TC trend was calculated as the slope of the linear regression of the TC measurements, and TC variability was calculated as the SD of the residuals from the linear regression. We evaluated the association of intraindividual TC variability with incident CBI and worsening WMG between 2 MRI scans in primary analyses and with prevalent CBI number and WMG on the follow-up MRI scan in secondary analyses. Results- Among participants who were eligible for the study and free of clinical stroke before the follow-up MRI, 17.9% of 1098 had incident CBI, and 27.8% of 1351 had worsening WMG on the follow-up MRI. Mean, trend, and variability of TC were not associated with these outcomes. TC variability, independent of mean and trend, was significantly associated with the number of CBI (β=0.009 [95% CI, 0.003-0.016] P=0.004; N=1604) and was associated with WMG (β, 0.009 [95% CI, -0.0002 to 0.019] P=0.055; N=1602) on the follow-up MRI. Conclusions- Among older adults, TC variability was not associated with incident CBI or worsening WMG but was associated with the number of prevalent CBI on cranial MRI. More work is needed to validate and to clarify the mechanisms underlying such associations.
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Affiliation(s)
- Rizwan Kalani
- From the Department of Neurology (R.K., D.T.), University of Washington, Seattle
| | - Traci M Bartz
- Department of Biostatistics (T.M.B., K.R.), University of Washington, Seattle
| | - Astrid Suchy-Dicey
- Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (A.S.-D.)
| | - Mitchell S V Elkind
- Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (M.S.V.E.)
| | - Bruce M Psaty
- Cardiovascular Health Research Unit and Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle, WA (B.M.P.)
| | - Lester Y Leung
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.)
| | - Kenneth Rice
- Department of Biostatistics (T.M.B., K.R.), University of Washington, Seattle
| | - David Tirschwell
- From the Department of Neurology (R.K., D.T.), University of Washington, Seattle
| | - W T Longstreth
- Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle
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Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, Abd-Allah F, Abdelalim A, Abraha HN, Abu-Rmeileh NME, Adebayo OM, Adeoye AM, Agarwal G, Agrawal S, Aichour AN, Aichour I, Aichour MTE, Alahdab F, Ali R, Alvis-Guzman N, Anber NH, Anjomshoa M, Arabloo J, Arauz A, Ärnlöv J, Arora A, Awasthi A, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Belachew AB, Belayneh YM, Bennett DA, Bensenor IM, Bhattacharyya K, Biadgo B, Bijani A, Bikbov B, Bin Sayeed MS, Butt ZA, Cahuana-Hurtado L, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castro F, Catalá-López F, Chaiah Y, Chiang PPC, Choi JYJ, Christensen H, Chu DT, Cortinovis M, Damasceno AAM, Dandona L, Dandona R, Daryani A, Davletov K, de Courten B, De la Cruz-Góngora V, Degefa MG, Dharmaratne SD, Diaz D, Dubey M, Duken EE, Edessa D, Endres M, FARAON EMERITOJOSEA, Farzadfar F, Fernandes E, Fischer F, Flor LS, Ganji M, Gebre AK, Gebremichael TG, Geta B, Gezae KE, Gill PS, Gnedovskaya EV, Gómez-Dantés H, Goulart AC, Grosso G, Guo Y, Gupta R, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Hankey GJ, Hassen HY, Hay SI, Hegazy MI, Heidari B, Herial NA, Hosseini MA, Hostiuc S, Irvani SSN, Islam SMS, Jahanmehr N, Javanbakht M, Jha RP, Jonas JB, Jozwiak JJ, Jürisson M, Kahsay A, Kalani R, Kalkonde Y, Kamil TA, Kanchan T, Karch A, Karimi N, Karimi-Sari H, Kasaeian A, Kassa TD, Kazemeini H, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Kim D, Kim YJ, Kisa A, Kivimäki M, Koyanagi A, Krishnamurthi RK, Kumar GA, Lafranconi A, Lewington S, Li S, Lo WD, Lopez AD, Lorkowski S, Lotufo PA, Mackay MT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Manafi N, Mansournia MA, Mehndiratta MM, Mehta V, Mengistu G, Meretoja A, Meretoja TJ, Miazgowski B, Miazgowski T, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Y, Mohammadoo-khorasani M, Mohammed S, Mohebi F, Mokdad AH, Mokhayeri Y, Moradi G, Morawska L, Moreno Velásquez I, Mousavi SM, Muhammed OSS, Muruet W, Naderi M, Naghavi M, Naik G, Nascimento BR, Negoi RI, Nguyen CT, Nguyen LH, Nirayo YL, Norrving B, Noubiap JJ, Ofori-Asenso R, Ogbo FA, Olagunju AT, Olagunju TO, Owolabi MO, Pandian JD, Patel S, Perico N, Piradov MA, Polinder S, Postma MJ, Poustchi H, Prakash V, Qorbani M, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MA, Reis C, Remuzzi G, Renzaho AM, Ricci S, Roberts NLS, Robinson SR, Roever L, Roshandel G, Sabbagh P, Safari H, Safari S, Safiri S, Sahebkar A, Salehi Zahabi S, Samy AM, Santalucia P, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Sawant AR, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shams-Beyranvand M, Sheikh A, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiue I, Siabani S, Sobaih BH, Sposato LA, Sutradhar I, Sylaja PN, Szoeke CEI, Te Ao BJ, Temsah MH, Temsah O, Thrift AG, Tonelli M, Topor-Madry R, Tran BX, Tran KB, Truelsen TC, Tsadik AG, Ullah I, Uthman OA, Vaduganathan M, Valdez PR, Vasankari TJ, Vasanthan R, Venketasubramanian N, Vosoughi K, Vu GT, Waheed Y, Weiderpass E, Weldegwergs KG, Westerman R, Wolfe CDA, Wondafrash DZ, Xu G, Yadollahpour A, Yamada T, Yatsuya H, Yimer EM, Yonemoto N, Yousefifard M, Yu C, Zaidi Z, Zamani M, Zarghi A, Zhang Y, Zodpey S, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:439-458. [PMID: 30871944 PMCID: PMC6494974 DOI: 10.1016/s1474-4422(19)30034-1] [Citation(s) in RCA: 1622] [Impact Index Per Article: 324.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. METHODS We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. FINDINGS In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. INTERPRETATION Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. FUNDING Bill & Melinda Gates Foundation.
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Nichols E, Szoeke CEI, Vollset SE, Abbasi N, Abd-Allah F, Abdela J, Aichour MTE, Akinyemi RO, Alahdab F, Asgedom SW, Awasthi A, Barker-Collo SL, Baune BT, Béjot Y, Belachew AB, Bennett DA, Biadgo B, Bijani A, Bin Sayeed MS, Brayne C, Carpenter DO, Carvalho F, Catalá-López F, Cerin E, Choi JYJ, Dang AK, Degefa MG, Djalalinia S, Dubey M, Duken EE, Edvardsson D, Endres M, Eskandarieh S, Faro A, Farzadfar F, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Gebre AK, Geremew D, Ghasemi-Kasman M, Gnedovskaya EV, Gupta R, Hachinski V, Hagos TB, Hamidi S, Hankey GJ, Haro JM, Hay SI, Irvani SSN, Jha RP, Jonas JB, Kalani R, Karch A, Kasaeian A, Khader YS, Khalil IA, Khan EA, Khanna T, Khoja TAM, Khubchandani J, Kisa A, Kissimova-Skarbek K, Kivimäki M, Koyanagi A, Krohn KJ, Logroscino G, Lorkowski S, Majdan M, Malekzadeh R, März W, Massano J, Mengistu G, Meretoja A, Mohammadi M, Mohammadi-Khanaposhtani M, Mokdad AH, Mondello S, Moradi G, Nagel G, Naghavi M, Naik G, Nguyen LH, Nguyen TH, Nirayo YL, Nixon MR, Ofori-Asenso R, Ogbo FA, Olagunju AT, Owolabi MO, Panda-Jonas S, Passos VMDA, Pereira DM, Pinilla-Monsalve GD, Piradov MA, Pond CD, Poustchi H, Qorbani M, Radfar A, Reiner RC, Robinson SR, Roshandel G, Rostami A, Russ TC, Sachdev PS, Safari H, Safiri S, Sahathevan R, Salimi Y, Satpathy M, Sawhney M, Saylan M, Sepanlou SG, Shafieesabet A, Shaikh MA, Sahraian MA, Shigematsu M, Shiri R, Shiue I, Silva JP, Smith M, Sobhani S, Stein DJ, Tabarés-Seisdedos R, Tovani-Palone MR, Tran BX, Tran TT, Tsegay AT, Ullah I, Venketasubramanian N, Vlassov V, Wang YP, Weiss J, Westerman R, Wijeratne T, Wyper GM, Yano Y, Yimer EM, Yonemoto N, Yousefifard M, Zaidi Z, Zare Z, Vos T, Feigin VL, Murray CJL. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:88-106. [PMID: 30497964 PMCID: PMC6291454 DOI: 10.1016/s1474-4422(18)30403-4] [Citation(s) in RCA: 1284] [Impact Index Per Article: 256.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide. FUNDING Bill & Melinda Gates Foundation.
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James SL, Theadom A, Ellenbogen RG, Bannick MS, Montjoy-Venning W, Lucchesi LR, Abbasi N, Abdulkader R, Abraha HN, Adsuar JC, Afarideh M, Agrawal S, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemi RO, Akseer N, Alahdab F, Alebel A, Alghnam SA, Ali BA, Alsharif U, Altirkawi K, Andrei CL, Anjomshoa M, Ansari H, Ansha MG, Antonio CAT, Appiah SCY, Ariani F, Asefa NG, Asgedom SW, Atique S, Awasthi A, Ayala Quintanilla BP, Ayuk TB, Azzopardi PS, Badali H, Badawi A, Balalla S, Banstola A, Barker-Collo SL, Bärnighausen TW, Bedi N, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay YA, Bennett DA, Bensenor IM, Berhane A, Beuran M, Bhalla A, Bhaumik S, Bhutta ZA, Biadgo B, Biffino M, Bijani A, Bililign N, Birungi C, Boufous S, Brazinova A, Brown AW, Car M, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Catalá-López F, Chaiah Y, Champs AP, Chang JC, Choi JYJ, Christopher DJ, Cooper C, Crowe CS, Dandona L, Dandona R, Daryani A, Davitoiu DV, Degefa MG, Demoz GT, Deribe K, Djalalinia S, Do HP, Doku DT, Drake TM, Dubey M, Dubljanin E, El-Khatib Z, Ofori-Asenso R, Eskandarieh S, Esteghamati A, Esteghamati S, Faro A, Farzadfar F, Farzaei MH, Fereshtehnejad SM, Fernandes E, Feyissa GT, Filip I, Fischer F, Fukumoto T, Ganji M, Gankpe FG, Gebre AK, Gebrehiwot TT, Gezae KE, Gopalkrishna G, Goulart AC, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hawley C, Hay SI, Hegazy MI, Hendrie D, Henok A, Hibstu DT, Hoffman HJ, Hole MK, Homaie Rad E, Hosseini SM, Hostiuc S, Hu G, Hussen MA, Ilesanmi OS, Irvani SSN, Jakovljevic M, Jayaraman S, Jha RP, Jonas JB, Jones KM, Jorjoran Shushtari Z, Jozwiak JJ, Jürisson M, Kabir A, Kahsay A, Kahssay M, Kalani R, Karch A, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khalil I, Khan EA, Khan MS, Khang YH, Khazaie H, Khoja AT, Khubchandani J, Kiadaliri AA, Kim D, Kim YE, Kisa A, Koyanagi A, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Lalloo R, Lami FH, Lansingh VC, Laryea DO, Latifi A, Leshargie CT, Levi M, Li S, Liben ML, Lotufo PA, Lunevicius R, Mahotra NB, Majdan M, Majeed A, Malekzadeh R, Manda AL, Mansournia MA, Massenburg BB, Mate KKV, Mehndiratta MM, Mehta V, Meles H, Melese A, Memiah PTN, Mendoza W, Mengistu G, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Moazen B, Mohammadi M, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mondello S, Moosazadeh M, Moradi G, Moradi M, Moradi-Lakeh M, Moradinazar M, Morrison SD, Moschos MM, Mousavi SM, Murthy S, Musa KI, Mustafa G, Naghavi M, Naik G, Najafi F, Nangia V, Nascimento BR, Negoi I, Nguyen TH, Nichols E, Ningrum DNA, Nirayo YL, Nyasulu PS, Ogbo FA, Oh IH, Okoro A, Olagunju AT, Olagunju TO, Olivares PR, Otstavnov SS, Owolabi MO, P A M, Pakhale S, Pandey AR, Pesudovs K, Pinilla-Monsalve GD, Polinder S, Poustchi H, Prakash S, Qorbani M, Radfar A, Rafay A, Rafiei A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MA, Rai RK, Rajati F, Ram U, Rawaf DL, Rawaf S, Reiner RC, Reis C, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Roever L, Ronfani L, Roshandel G, Roy N, Ruhago GM, Saddik B, Safari H, Safiri S, Sahraian MA, Salamati P, Saldanha RDF, Samy AM, Sanabria J, Santos JV, Santric Milicevic MMM, Sartorius B, Satpathy M, Savuon K, Schneider IJC, Schwebel DC, Sepanlou SG, Shabaninejad H, Shaikh MAA, Shams-Beyranvand M, Sharif M, Sharif-Alhoseini M, Shariful Islam SM, She J, Sheikh A, Shen J, Sheth KN, Shibuya K, Shiferaw MS, Shigematsu M, Shiri R, Shiue I, Shoman H, Siabani S, Siddiqi TJ, Silva JP, Silveira DGA, Sinha DN, Smith M, Soares Filho AM, Sobhani S, Soofi M, Soriano JB, Soyiri IN, Stein DJ, Stokes MA, Sufiyan MB, Sunguya BF, Sunshine JE, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Te Ao BJ, Tehrani-Banihashemi A, Tekle MG, Temsah MH, Temsah O, Topor-Madry R, Tortajada-Girbés M, Tran BX, Tran KB, Tudor Car L, Ukwaja KN, Ullah I, Usman MS, Uthman OA, Valdez PR, Vasankari TJ, Venketasubramanian N, Violante FS, Wagnew FWS, Waheed Y, Wang YP, Weldegwergs KG, Werdecker A, Wijeratne T, Winkler AS, Wyper GMA, Yano Y, Yaseri M, Yasin YJ, Ye P, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yost MG, Younis MZ, Yousefifard M, Yu C, Zaidi Z, Zaman SB, Zamani M, Zenebe ZM, Zodpey S, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:56-87. [PMID: 30497965 PMCID: PMC6291456 DOI: 10.1016/s1474-4422(18)30415-0] [Citation(s) in RCA: 908] [Impact Index Per Article: 181.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/02/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. FUNDING Bill & Melinda Gates Foundation.
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Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Béjot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jóźwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang YH, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Nguyen M, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Anggraini Ningrum DN, Norrving B, Noubiap JJ, O’Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AMN, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin MJ, Shiue I, Silva DAS, Sobngwi E, Soljak M, Sorensen RJD, Sposato LA, Stranges S, Suliankatchi RA, Tabarés-Seisdedos R, Tanne D, Nguyen CT, Thakur JS, Thrift AG, Tirschwell DL, Topor-Madry R, Tran BX, Nguyen LT, Truelsen T, Tsilimparis N, Tyrovolas S, Ukwaja KN, Uthman OA, Varakin Y, Vasankari T, Venketasubramanian N, Vlassov VV, Wang W, Werdecker A, Wolfe CDA, Xu G, Yano Y, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Zhou M, Ziaeian B, Zipkin B, Vos T, Naghavi M, Murray CJL, Roth GA. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379:2429-2437. [PMID: 30575491 PMCID: PMC6247346 DOI: 10.1056/nejmoa1804492] [Citation(s) in RCA: 813] [Impact Index Per Article: 135.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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Dicker D, Nguyen G, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abdurahman AA, Abebe HT, Abebe M, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Aggarwal R, Aghayan SA, Agrawal S, Agrawal A, Ahmadi M, Ahmadi A, Ahmadieh H, Ahmed MLCB, Ahmed S, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Anlay DZ, Ansari H, Ansariadi A, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asadi-Lari M, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Ataro Z, Atey TMM, Athari SS, Atique S, Atre SR, Atteraya MS, Attia EF, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awuah B, Ayala Quintanilla BP, Ayele HT, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Azzopardi-Muscat N, Badali H, Badawi A, Balakrishnan K, Bali AG, Banach M, Banstola A, Barac A, Barboza MA, Barquera S, Barrero LH, Basaleem H, Bassat Q, Basu A, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhala N, Bhatia E, Bhatt S, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Bisanzio D, Biswas T, Bjørge T, Bleyer A, Basara BB, Bose D, Bosetti C, Boufous S, Bourne R, Brady OJ, Bragazzi NL, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha T, Burke KE, Busse R, Butt ZA, Cahuana-Hurtado L, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Çavlin A, Cerin E, Chaiah Y, Champs AP, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chen W, Chiang PPC, Chimed-Ochir O, Chin KL, Chisumpa VH, Chitheer A, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Cohen AJ, Collado-Mateo D, Constantin MM, Conti S, Cooper C, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cucu A, Cunningham M, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Das Gupta R, das Neves J, Dasa TT, Dash AP, Weaver ND, Davitoiu DV, Davletov K, Dayama A, Courten BD, De la Hoz FP, De leo D, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Dellavalle RP, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dhimal M, Ding EL, Djalalinia S, Doku DT, Dolan KA, Donnelly CA, Dorsey ER, Douwes-Schultz D, Doyle KE, Drake TM, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, Elfaramawi M, El-Khatib Z, Ellingsen CL, Elyazar IRF, Enayati A, Endries AYY, Er B, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Fakhar M, Fakhim H, Farag T, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Feyissa GT, Fijabi DO, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Ford JA, Foreman KJ, Fornari C, Frank TD, Franklin RC, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Galan A, Gallus S, Gambashidze K, Gamkrelidze A, Gankpe FG, Garcia-Basteiro AL, Garcia-Gordillo MA, Gebre T, Gebre AK, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gessner BD, Getachew S, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Giussani G, Goenka S, Goli S, Gomez RS, Gomez-Cabrera MC, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Goulart BNG, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haririan H, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Heredia-Pi I, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Horino M, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc S, Hostiuc M, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Iburg KM, Igumbor EU, Ikeda CT, Ilesanmi OS, Iqbal U, Irvani SSN, Isehunwa OO, Islam SMS, Islami F, Jahangiry L, Jahanmehr N, Jain R, Jain SK, Jakovljevic M, James SL, Javanbakht M, Jayaraman S, Jayatilleke AU, Jee SH, Jeemon P, Jha RP, Jha V, Ji JS, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, K M, Kabir Z, Kadel R, Kahsay A, Kahssay M, Kalani R, Kapil U, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Karimi-Sari H, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kassebaum NJ, Katibeh M, Katikireddi SV, Kaul A, Kawakami N, Kazemeini H, Kazemi Z, Karyani AK, K C P, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kereselidze M, Khader YS, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan G, Khan MS, Khan MA, Khang YH, Khanna T, Khater MM, Khatony A, Khazaie H, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GDD, Kim CI, Kim D, Kim JY, Kim YE, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissimova-Skarbek K, Kissoon N, Kivimäki M, Kleber ME, Knibbs LD, Knudsen AKS, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosek MN, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kudom AA, Kuipers EJ, Kulikoff XR, Kumar GA, Kumar M, Kumar P, Kumsa FA, Kutz MJ, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lam H, Lami FH, Lan Q, Langan SM, Lansingh VC, Lansky S, Larson HJ, Laryea DO, Lassi ZS, Latifi A, Lavados PM, Laxmaiah A, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leshargie CT, Leta S, Levi M, Li S, Li Y, Li X, Liang J, Liang X, Liben ML, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Logroscino G, Lonsdale C, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Lyons RA, Ma S, Mabika C, Macarayan ERK, Mackay MT, Maddison ER, Maddison R, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malik MA, Malta DC, Mamun AA, Manamo WA, Manda AL, Mansournia MA, Mantovani LG, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marina S, Martinez-Raga J, Martins SCO, Martins-Melo FR, März W, Marzan MB, Mashamba-Thompson TP, Masiye F, Massenburg BB, Maulik PK, Mazidi M, McGrath JJ, McKee M, Mehata S, Mehendale SM, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonen T, Mekonnen TC, Meles HG, Meles KG, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miangotar Y, Miazgowski B, Miazgowski T, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Misganaw AT, 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Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Ye P, Yearwood JA, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, York HW, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zachariah G, Zadnik V, Zafar S, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeeb H, Zeleke MM, Zenebe ZM, Zerfu TA, Zhang K, Zhang X, Zhou M, Zhu J, Zodpey S, Zucker I, Zuhlke LJJ, Lopez AD, Gakidou E, Murray CJL. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1684-1735. [PMID: 30496102 PMCID: PMC6227504 DOI: 10.1016/s0140-6736(18)31891-9] [Citation(s) in RCA: 575] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING Bill & Melinda Gates Foundation.
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Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Wagner GR, Wagnew FS, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weiderpass E, Weintraub RG, Weldegebreal F, Weldegwergs KG, Werdecker A, Werkneh AA, West TE, Westerman R, Whiteford HA, Widecka J, Wilner LB, Wilson S, Winkler AS, Wiysonge CS, Wolfe CDA, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yakob B, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang AL, Zhang K, Zhou M, Zodpey S, Zuhlke LJ, Naghavi M, Murray CJL. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736(18)32203-7] [Citation(s) in RCA: 4178] [Impact Index Per Article: 696.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Saylan M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shishani K, Shiue I, Shokraneh F, Shoman H, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak ELN, Sliwa K, Smith DL, Smith M, Soares Filho AM, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Soosaraei M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan MB, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7] [Citation(s) in RCA: 7041] [Impact Index Per Article: 1173.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe HT, Abebe M, Abebe Z, Abejie AN, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Accrombessi MMK, Acharya D, Adamu AA, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adib MG, Admasie A, Afshin A, Agarwal G, Agesa KM, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmed MB, Ahmed S, Aichour AN, Aichour I, Aichour MTE, Akbari ME, Akinyemi RO, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alebel A, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alonso J, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansari H, Ansha MG, Antonio CAT, Anwari P, Aremu O, Ärnlöv J, Arora A, Arora M, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Ataro Z, Atique S, Atre SR, Ausloos M, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Ayele Y, Ayer R, Azzopardi PS, Babazadeh A, Bacha U, Badali H, Badawi A, Bali AG, Ballesteros KE, Banach M, Banerjee K, Bannick MS, Banoub JAM, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barquera S, Barrero LH, Bassat Q, Basu S, Baune BT, Baynes HW, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay E, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhalla A, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Biehl MH, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Biswas T, Blacker BF, Basara BB, Borschmann R, Bosetti C, Bozorgmehr K, Brady OJ, Brant LC, Brayne C, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Britton G, Brugha T, Busse R, Butt ZA, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castle CD, Castro C, Castro F, Catalá-López F, Cerin E, Chaiah Y, Chang JC, Charlson FJ, Chaturvedi P, Chiang PPC, Chimed-Ochir O, Chisumpa VH, Chitheer A, Chowdhury R, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Cohen AJ, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Cowie BC, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cunningham M, Daba AK, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Gupta RD, Neves JD, Dasa TT, Dash AP, Davis AC, Davis Weaver N, Davitoiu DV, Davletov K, De La Hoz FP, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dicker D, Dinberu MT, Ding EL, Dirac MA, Djalalinia S, Dokova K, Doku DT, Donnelly CA, Dorsey ER, Doshi PP, Douwes-Schultz D, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Ellingsen CL, Endres M, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Fakhar M, Fakhim H, Faramarzi M, Fareed M, Farhadi F, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Feigin VL, Feigl AB, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Finegold S, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fornari C, Frank TD, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gebre AK, Gebrehiwot TT, Gebremedhin AT, Gebremichael B, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Gibney KB, Gill PS, Gill TK, Gillum RF, Ginawi IA, Giroud M, Giussani G, Goenka S, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goto A, Goulart AC, Gnedovskaya EV, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gutiérrez RA, Gyawali B, Haagsma JA, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsiao T, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Idrisov B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam N, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Jalu MT, James SL, Javanbakht M, Jayatilleke AU, Jeemon P, Jenkins KJ, Jha RP, Jha V, Johnson CO, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Karami M, Karami Matin B, Karch A, Karema C, Karimi-Sari H, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kazemi Z, Karyani AK, Kazi DS, Kefale AT, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khater MM, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GD, Kidanemariam ZT, Kiirithio DN, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kumar P, Kutz MJ, Kuzin I, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lallukka T, Lam JO, Lami FH, Lansingh VC, Lansky S, Larson HJ, Latifi A, Lau KMM, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leili M, Leshargie CT, Li S, Li Y, Liang J, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Lonsdale C, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Ma S, Macarayan ERK, Mackay MT, MacLachlan JH, Maddison ER, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Manda AL, Mandarano-Filho LG, Manguerra H, Mansournia MA, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marczak L, Marks A, Marks GB, Martinez G, Martins-Melo FR, Martopullo I, März W, Marzan MB, Masci JR, Massenburg BB, Mathur MR, Mathur P, Matzopoulos R, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, McMahon BJ, Mehata S, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonnen TC, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miller-Petrie MK, Mini GK, Mirabi P, Mirarefin M, Mirica A, Mirrakhimov EM, Misganaw AT, Mitiku H, Moazen B, Mohammad KA, Mohammadi M, Mohammadifard N, Mohammed MA, Mohammed S, Mohan V, Mokdad AH, Molokhia M, Monasta L, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mouodi S, Mousavi SM, Muchie KF, Mueller UO, Mukhopadhyay S, Muller K, Mumford JE, Musa J, Musa KI, Mustafa G, Muthupandian S, Nachega JB, Nagel G, Naheed A, Nahvijou A, Naik G, Nair S, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngalesoni FN, Ngunjiri JW, Nguyen AQ, Nguyen G, Nguyen HT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen TH, Nichols E, Ningrum DNA, Nirayo YL, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong KL, Ong SKS, Oren E, Orpana HM, Ortiz A, Ortiz JR, Otstavnov SS, Øverland S, Owolabi MO, Özdemir R, P A M, Pacella R, Pakhale S, Pakhare AP, Pakpour AH, Pana A, Panda-Jonas S, Pandian JD, Parisi A, Park EK, Parry CDH, Parsian H, Patel S, Pati S, Patton GC, Paturi VR, Paulson KR, Pereira A, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pigott DM, Pillay JD, Pirsaheb M, Pishgar F, Polinder S, Postma MJ, Pourshams A, Poustchi H, Pujar A, Prakash S, Prasad N, Purcell CA, Qorbani M, Quintana H, Quistberg DA, Rade KW, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahman M, Rahman MHU, Rahman MA, Rai RK, Rajsic S, Ram U, Ranabhat CL, Ranjan P, Rao PC, Rawaf DL, Rawaf S, Razo-García C, Reddy KS, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Rezai MS, Riahi SM, Ribeiro ALP, Rios-Blancas MJ, Roba KT, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Rothenbacher D, Roy A, Rubagotti E, Sachdev PS, Saddik B, Sadeghi E, Safari H, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Salam N, Salama JS, Salamati P, Saldanha RDF, Saleem Z, Salimi Y, Salvi SS, Salz I, Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santomauro DF, Santos IS, Santos JV, Milicevic MMS, Sao Jose BP, Sarker AR, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Sayyah M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shackelford KA, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma R, She J, Sheikh A, Shi P, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silberberg DH, Silva DAS, Silva JP, Silva NTD, Silveira DGA, Singh JA, Singh NP, Singh PK, Singh V, Sinha DN, Sliwa K, Smith M, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Starodubov VI, Stathopoulou V, Stein DJ, Steiner C, Stewart LG, Stokes MA, Subart ML, Sudaryanto A, Sufiyan MB, Sur PJ, Sutradhar I, Sykes BL, Sylaja PN, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew SG, Taveira N, Tehrani-Banihashemi A, Tekalign TG, Tekle MG, Temsah MH, Temsah O, Terkawi AS, Teshale MY, Tessema B, Tessema GA, Thankappan KR, Thirunavukkarasu S, Thomas N, Thrift AG, Thurston GD, Tilahun B, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Tran BX, Tran KB, Tripathi S, Troeger CE, Truelsen TC, Truong NT, Tsadik AG, Tsoi D, Tudor Car L, Tuzcu EM, Tyrovolas S, Ukwaja KN, Ullah I, Undurraga EA, Updike RL, Usman MS, Uthman OA, Uzun SB, Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Wagner GR, Wagnew FS, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weiderpass E, Weintraub RG, Weldegebreal F, Weldegwergs KG, Werdecker A, Werkneh AA, West TE, Westerman R, Whiteford HA, Widecka J, Wilner LB, Wilson S, Winkler AS, Wiysonge CS, Wolfe CDA, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yakob B, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang AL, Zhang K, Zhou M, Zodpey S, Zuhlke LJ, Naghavi M, Murray CJL. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736%2818%2932203-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 01/19/2024]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Lozano R, Fullman N, Abate D, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abebe ND, Abebe Z, Abejie AN, Abera SF, Abil OZ, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NM, Abyu GY, Accrombessi MMK, Acharya D, Acharya P, Adamu AA, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshari M, Afshin A, Agarwal G, Aghayan SA, Agius D, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Ahmed S, Akalu TY, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alam T, Albujeer A, Alebel A, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Almasi A, Al-Maskari F, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amenu K, Amini E, Ammar 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Zucker I, Zuhlke LJJ, Lim SS, Murray CJL. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:2091-2138. [PMID: 30496107 PMCID: PMC6227911 DOI: 10.1016/s0140-6736(18)32281-5] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. FINDINGS The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. INTERPRETATION The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. FUNDING Bill & Melinda Gates Foundation.
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Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe M, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Adamu AA, Adane AA, Adebayo OM, Adedoyin RA, Adekanmbi V, Ademi Z, Adetokunboh OO, Adib MG, Admasie A, Adsuar JC, Afanvi KA, Afarideh M, Agarwal G, Aggarwal A, Aghayan SA, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akbari ME, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Alahdab F, Alam K, Alam S, Alam T, Alashi A, Alavian SM, Alene KA, Ali K, Ali SM, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Ammar W, Anber NH, Anderson JA, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antó JM, Antonio CAT, Anwari P, Appiah LT, Appiah SCY, Arabloo J, Aremu O, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Ataro Z, Ausloos M, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Ayuk TB, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Balakrishnan K, Bali AG, Ball K, Ballew SH, Banach M, Banoub JAM, Barac A, Barker-Collo SL, Bärnighausen TW, Barrero LH, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Bekru ET, Belay E, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Bergeron G, Berhane A, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhalla A, Bhattarai S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Biswas T, Bjørge T, Blacker BF, Bleyer A, Borschmann R, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Briko AN, Britton G, Brugha T, Buchbinder R, Burnett RT, Busse R, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Causey K, Cercy KM, Cerin E, Chaiah Y, Chang HY, Chang JC, Chang KL, Charlson FJ, Chattopadhyay A, Chattu VK, Chee ML, Cheng CY, Chew A, Chiang PPC, Chimed-Ochir O, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Cirillo M, Cohen AJ, Collado-Mateo D, Cooper C, Cooper OR, Coresh J, Cornaby L, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cundiff DK, Daba AK, Dachew BA, Dadi AF, Damasceno AAM, Dandona L, Dandona R, Darby SC, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Dash AP, Davitoiu DV, Davletov K, De la Cruz-Góngora V, De La Hoz FP, De Leo D, De Neve JW, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Denova-Gutiérrez E, Deribe K, Dervenis N, Deshpande A, Des Jarlais DC, Dessie GA, Deveber GA, Dey S, Dharmaratne SD, Dhimal M, Dinberu MT, Ding EL, Diro HD, Djalalinia S, Do HP, Dokova K, Doku DT, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebert N, Ebrahimi H, Ebrahimpour S, Edvardsson D, Effiong A, Eggen AE, El Bcheraoui C, El-Khatib Z, Elyazar IR, Enayati A, Endries AY, Er B, Erskine HE, Eskandarieh S, Esteghamati A, Estep K, Fakhim H, Faramarzi M, Fareed M, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzaei MH, Fatima B, Fay KA, Fazaeli AA, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrara G, Ferrari AJ, Ferreira ML, Filip I, Finger JD, Fischer F, Foigt NA, Foreman KJ, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Gallus S, Gamkrelidze A, Ganji M, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Geramo YCD, Gething PW, Gezae KE, Ghadimi R, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Gillum RF, Ginawi IA, Giussani G, Gnedovskaya EV, Godwin WW, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Goulart AC, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta R, Gupta R, Gupta T, Gutiérrez RA, Gutiérrez-Torres DS, Haagsma JA, Habtewold TD, Hachinski V, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay SI, Hedayatizadeh-Omran A, Heibati B, Heidari B, Heidari M, Hendrie D, Henok A, Heredia-Pi I, Herteliu C, Heydarpour F, Heydarpour S, Hibstu DT, Higazi TB, Hilawe EH, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hoy DG, Hsairi M, Hsiao T, Hu G, Hu H, Huang JJ, Hussen MA, Huynh CK, Iburg KM, Ikeda N, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jackson MD, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, James SL, Jassal SK, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Jonas JB, Jonnagaddala J, Jorjoran Shushtari Z, Joshi A, Jozwiak JJ, Jürisson M, Kabir Z, Kahsay A, Kalani R, Kanchan T, Kant S, Kar C, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kawakami N, Kazemi Z, Karyani AK, Kefale AT, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan G, Khan MS, Khan MA, Khang YH, Khater MM, Khazaei M, Khazaie H, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knibbs LD, Knudsen AKS, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kromhout H, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kuzin I, Kyu HH, Lachat C, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lang JJ, Lansingh VC, Larson SL, Latifi A, Lazarus JV, Lee PH, Leigh J, Leili M, Leshargie CT, Leung J, Levi M, Lewycka S, Li S, Li Y, Liang J, Liang X, Liao Y, Liben ML, Lim LL, Linn S, Liu S, Lodha R, Logroscino G, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Ma S, Macarayan ERK, Machado ÍE, Madotto F, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Mansournia MA, Mantovani LG, Maravilla JC, Marcenes W, Marks A, Martin RV, Martins SCO, Martins-Melo FR, März W, Marzan MB, Massenburg BB, Mathur MR, Mathur P, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehrotra R, Mehta KM, Mehta V, Meier T, Mekonnen FA, Melaku YA, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mensah GA, Mensink GBM, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miller-Petrie MK, Mini GK, Mirarefin M, Mirica A, Mirrakhimov EM, Misganaw AT, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadi M, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed S, Mohebi F, Mokdad AH, Molokhia M, Momeniha F, Monasta L, Moodley Y, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mouodi S, Mousavi SM, Mozaffarian D, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Musa KI, Mustafa G, Nabhan AF, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Nangia V, Nansseu JR, Nascimento BR, Neal B, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen G, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen M, Nguyen NB, Nichols E, Nie J, Ningrum DNA, Nirayo YL, Nishi N, Nixon MR, Nojomi M, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Obermeyer CM, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong KL, Ong SK, Oren E, Orpana HM, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakhare AP, Pakpour AH, Pana A, Panda-Jonas S, Park EK, Parry CDH, Parsian H, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paudel D, Paulson KR, Paz Ballesteros WC, Pearce N, Pereira A, Pereira DM, Perico N, Pesudovs K, Petzold M, Pham HQ, Phillips MR, Pillay JD, Piradov MA, Pirsaheb M, Pischon T, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Polkinghorne KR, Postma MJ, Poulton R, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prasad N, Purcell CA, Purwar MB, Qorbani M, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi Z, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rai RK, Rajati F, Rajsic S, Raju SB, Ram U, Ranabhat CL, Ranjan P, Rath GK, Rawaf DL, Rawaf S, Reddy KS, Rehm CD, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Reynales-Shigematsu LM, Rezaei S, Ribeiro ALP, Rivera JA, Roba KT, Rodríguez-Ramírez S, Roever L, Román Y, Ronfani L, Roshandel G, Rostami A, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Rushton L, Sabanayagam C, Sachdev PS, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salamati P, Saleem Z, Salimi Y, Salimzadeh H, Salomon JA, Salvi DD, Salz I, Samy AM, Sanabria J, Sanchez-Niño MD, Sánchez-Pimienta TG, Sanders T, Sang Y, Santomauro DF, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saylan M, Sayyah M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Seedat S, Sekerija M, Sepanlou SG, Serre ML, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shaddick G, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shamah Levy T, Shams-Beyranvand M, Shamsi M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharifi H, Sharma J, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shoman H, Shrime MG, Shupler MS, Si S, Siabani S, Sibai AM, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Skirbekk V, Smith DL, Smith M, Sobaih BH, Sobhani S, Somayaji R, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Spinelli A, Sposato LA, Sreeramareddy CT, Srinivasan V, Starodubov VI, Steckling N, Stein DJ, Stein MB, Stevanovic G, Stockfelt L, Stokes MA, Sturua L, Subart ML, Sudaryanto A, Sufiyan MB, Sulo G, Sunguya BF, Sur PJ, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Tessema B, Teweldemedhin M, Thankappan KR, Theis A, Thirunavukkarasu S, Thomas HJ, Thomas ML, Thomas N, Thurston GD, Tilahun B, Tillmann T, To QG, Tobollik M, Tonelli M, Topor-Madry R, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Truelsen TC, Truong NT, Tsadik AG, Tudor Car L, Tuzcu EM, Tymeson HD, Tyrovolas S, Ukwaja KN, Ullah I, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Van Donkelaar A, Varavikova E, Varughese S, Vasankari TJ, Venkateswaran V, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vu GT, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Walson JL, Wang Y, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weldegebreal F, Werdecker A, Werkneh AA, West JJ, Westerman R, Whiteford HA, Widecka J, Wijeratne T, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Wong TY, Wu S, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zaidi Z, Zaman SB, Zamani M, Zavala-Arciniega L, Zhang AL, Zhang H, Zhang K, Zhou M, Zimsen SRM, Zodpey S, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1923-1994. [PMID: 30496105 PMCID: PMC6227755 DOI: 10.1016/s0140-6736(18)32225-6] [Citation(s) in RCA: 2618] [Impact Index Per Article: 436.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING Bill & Melinda Gates Foundation.
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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, De Courten B, De La Hoz FP, De Leo D, De Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay RJ, Hay SI, Hedayatizadeh-Omran A, Heibati B, Hendrie D, Henok A, Herteliu C, Heydarpour S, Hibstu DT, Hoang HT, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huynh CK, Iburg KM, Ikeda CT, Ileanu B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kanchan T, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kawakami N, Karyani AK, Keighobadi MM, Keiyoro PN, Kemmer L, Kemp GR, Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, 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Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 08/12/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Callender CSKH, Kulikoff XR, Srinivasan V, Abate D, Abate KH, Abay SM, Abbasi N, Abbastabar H, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdoli N, Abdollahpour I, Abdulkader RS, Abebe HT, Abebe M, Abebe Z, Abebo TA, Abejie AN, Aboyans V, Abraha HN, Abreu DMX, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya P, Adamu AA, Adebayo OM, Adedeji IA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmed MB, Ahmed S, Aichour AN, Aichour I, Aichour MTE, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alebel A, Aleman AV, Alene KA, Al-Eyadhy A, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Almasi A, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Ammar W, Anber NH, Andrei CL, Androudi S, Animut MD, Ansari H, Ansha MG, Antonio CAT, Appiah SCY, Aremu O, Areri HA, Arian N, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Asgedom SW, Assadi R, Atey TMM, Atique S, Atteraya MS, Ausloos M, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayele Y, Ayer R, Ayuk TB, Azzopardi PS, Babalola TK, Babazadeh A, Badali H, Badawi A, Bali AG, Banach M, Barker-Collo SL, Bärnighausen TW, Barrero LH, Basaleem H, Bassat Q, Basu A, Baune BT, Baynes HW, Beghi E, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay AG, Belay E, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Bergeron G, Berhane A, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bililign N, Bin Sayeed MS, Birlik SM, Birungi C, Biswas T, Bizuneh H, Bleyer A, Basara BB, Bosetti C, Boufous S, Brady OJ, Bragazzi NL, Brainin M, Brazinova A, Breitborde NJK, Brenner H, Brewer JD, Briant PS, Britton G, Burstein R, Busse R, Butt ZA, Cahuana-Hurtado L, Campos-Nonato IR, 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Ebrahimpour S, Edvardsson D, El Bcheraoui C, El-Khatib Z, Elyazar IR, Enayati A, Endries AY, Ermakov SP, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Esteghamati S, Estep K, Fakhim H, Farag T, Faramarzi M, Fareed M, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Fay KA, Fazeli MS, Feigin VL, Feigl AB, Feizy F, Fenny AP, Fentahun N, Fereshtehnejad SM, Fernandes E, Feyissa GT, Filip I, Finegold S, Fischer F, Flor LS, Foigt NA, Foreman KJ, Fornari C, Fürst T, Fukumoto T, Fuller JE, Fullman N, Gakidou E, Gallus S, Gamkrelidze A, Ganji M, Gankpe FG, Garcia GM, Garcia-Gordillo MÁ, Gebre AK, Gebre T, Gebregergs GB, Gebrehiwot TT, Gebremedhin AT, Gelano TF, Gelaw YA, Geleijnse JM, Genova-Maleras R, Gething P, Gezae KE, Ghadami MR, Ghadimi R, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghiasvand H, Ghimire M, Ghoshal AG, Gill PS, Gill TK, Giussani G, Gnedovskaya EV, Goli S, Gomez RS, Gómez-Dantés H, Gona PN, Goodridge A, Gopalani SV, Goulart AC, Goulart BNG, Grada A, 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Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1995-2051. [PMID: 30496106 PMCID: PMC6227915 DOI: 10.1016/s0140-6736(18)32278-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. METHODS We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. FINDINGS From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4-52·0). The TFR decreased from 4·7 livebirths (4·5-4·9) to 2·4 livebirths (2·2-2·5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3-200·8) since 1950, from 2·6 billion (2·5-2·6) to 7·6 billion (7·4-7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9-1·2) in Cyprus to a high of 7·1 livebirths (6·8-7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07-0·09) in South Korea to 2·4 livebirths (2·2-2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3-0·4) in Puerto Rico to a high of 3·1 livebirths (3·0-3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. INTERPRETATION Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. FUNDING Bill & Melinda Gates Foundation.
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Jonas JB, Joshua V, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kar C, Karanikolos M, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Kereselidze M, Ketema EB, Khader YS, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan G, Khan MN, Khan MA, Khanal MN, Khang YH, Khater MM, Khoja ATA, Khosravi A, Khubchandani J, Kibret GD, Kiirithio DN, Kim D, Kim YJ, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissoon N, Kochhar S, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar P, Kutz M, Kuzin I, Kyu HH, Lad DP, Lafranconi A, Lal DK, Lalloo R, Lam H, Lan Q, Lang JJ, Lansingh VC, Lansky S, Larsson A, Latifi A, Lazarus JV, Leasher JL, Lee PH, Legesse Y, Leigh J, Leshargie CT, Leta S, Leung J, Leung R, Levi M, Li Y, Liang J, Liben ML, Lim LL, Lim SS, Lind M, Linn S, Listl S, Liu P, Liu S, Lodha R, Lopez AD, Lorch SA, Lorkowski S, Lotufo PA, Lucas TCD, Lunevicius R, Lurton G, Lyons RA, Maalouf F, Macarayan ERK, Mackay MT, Maddison ER, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manhertz T, Manguerra H, Mansournia MA, Mantovani LG, Manyazewal T, Mapoma CC, Margono C, Martinez-Raga J, Martins SCO, Martins-Melo FR, Martopullo I, März W, Massenburg BB, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehata S, Mehrotra R, Mehta KM, Mehta V, Meier T, Mejia-Rodriguez F, Meles KG, Melku M, Memiah P, Memish ZA, Mendoza W, Mengiste DA, Mengistu DT, Menota BG, Mensah GA, Meretoja A, Meretoja TJ, Mezgebe HB, Miazgowski T, Micha R, Milam R, Millear A, Miller TR, Mini GK, Minnig S, Mirica A, Mirrakhimov EM, Misganaw A, Mitchell PB, Mlashu FW, Moazen B, Mohammad KA, Mohammadibakhsh R, Mohammed E, Mohammed MA, Mohammed S, Mokdad AH, Mola GL, Molokhia M, Momeniha F, Monasta L, Montañez Hernandez JC, Moosazadeh M, Moradi-Lakeh M, Moraga P, Morawska L, Moreno Velasquez I, Mori R, Morrison SD, Moses M, Mousavi SM, Mueller UO, Murhekar M, Murthy GVS, Murthy S, Musa J, Musa KI, Mustafa G, Muthupandian S, Nagata C, Nagel G, Naghavi M, Naheed A, Naik GA, Naik N, Najafi F, Naldi L, Nangia V, Nansseu JRN, Narayan KMV, Nascimento BR, Negoi I, Negoi RI, Newton CR, Ngunjiri JW, Nguyen G, Nguyen L, Nguyen TH, Nichols E, Ningrum DNA, Nolte E, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyandwi A, Obermeyer CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Oliveira PPVD, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortega-Altamirano DV, Ortiz A, Ozdemir R, PA M, Pain AW, Palone MRT, Pana A, Panda-Jonas S, Pandian JD, Park EK, Parsian H, Patel T, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paudel D, Pedroso MDM, Pedroza SP, Pereira DM, Perico N, Peterson H, Petzold M, Peykari N, Phillips MR, Piel FB, Pigott DM, Pillay JD, Piradov MA, Polinder S, Pond CD, Postma MJ, Pourmalek F, Prakash S, Prakash V, Prasad N, Prasad NM, Purcell C, Qorbani M, Quintana HK, Radfar A, Rafay A, Rafiei A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahman SU, Rai RK, Raju SB, Ram U, Rana SM, Rankin Z, Rasella D, Rawaf DL, Rawaf S, Ray SE, Razo-García CA, Reddy P, Reiner RC, Reis C, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rios Blancas MJ, Rivera JA, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Rothenbacher D, Roy A, Roy N, Ruhago GM, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salama J, Salamati P, Saldanha RDF, Salimzadeh H, Salomon JA, Samy AM, Sanabria JR, Sancheti PK, Sanchez-Niño MD, Santomauro D, Santos IS, Santric Milicevic MM, Sarker AR, Sarrafzadegan N, Sartorius B, Satpathy M, Savic M, Sawhney M, Saxena S, Saylan MI, Schaeffner E, Schmidhuber J, Schmidt MI, Schneider IJC, Schumacher AE, Schutte AE, Schwebel DC, Schwendicke F, Sekerija M, Sepanlou SG, Servan-Mori EE, Shafieesabet A, Shaikh MA, Shakh-Nazarova M, Shams-Beyranvand M, Sharafi H, Sharif-Alhoseini M, Shariful Islam SM, Sharma M, Sharma R, She J, Sheikh A, Shfare MT, Shi P, Shields C, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shiue I, Shrime MG, Shukla SR, Siabani S, Sigfusdottir ID, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh L, Singh NP, Singh V, Sinha DN, Sinke AH, Sisay M, Skirbekk V, Sliwa K, Smith A, Soares Filho AM, Sobaih BHA, Somai M, Soneji S, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Stokes MA, Sturua L, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse AH, Taffere GR, Tandon N, Tariku AT, Taveira N, Tehrani-Banihashemi A, Temam Shifa G, Temsah MH, Terkawi AS, Tesema AG, Tesfaye DJ, Tessema B, Thakur JS, Thomas N, Thompson MJ, Tillmann T, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Torre A, Tortajada M, Tran BX, Tran KB, Tripathi A, Tripathy SP, Troeger C, Truelsen T, Tsoi D, Tudor Car L, Tuem KB, Tyrovolas S, Uchendu US, Ukwaja KN, Ullah I, Updike R, Uthman OA, Uzochukwu BSC, Valdez PR, van Boven JFM, Varughese S, Vasankari T, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagnew F, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weaver MR, Weiderpass E, Weintraub RG, Weiss J, Weldegwergs KG, Werdecker A, West TE, Westerman R, White RG, Whiteford HA, Widecka J, Winkler AS, Wiysonge CS, Wolfe CDA, Wondimkun YA, Workicho A, Wyper GMA, Xavier D, Xu G, Yan LL, Yano Y, Yaseri M, Yimer NB, Yin P, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yu C, Zadnik V, Zaidi Z, Zaki MES, Zaman SB, Zamani M, Zenebe ZM, Zhou M, Zhu J, Zimsen SRM, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL, Lozano R. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391:2236-2271. [PMID: 29893224 PMCID: PMC5986687 DOI: 10.1016/s0140-6736(18)30994-2] [Citation(s) in RCA: 504] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING Bill & Melinda Gates Foundation.
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D. S, Kalani R, Narayan KMV, Prabhakaran D, Tandon N, P. S. R. Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community. ACTA ACUST UNITED AC 2018. [DOI: 10.18203/2319-2003.ijbcp20180104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.
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Kalani R, Bernstein R, Passman R, Curran Y, Ruff I, Prabhakaran S. Factual Inaccuracies Contained in the Article Entitled "Low Yield of Mobile Cardiac Outpatient Telemetry after Cryptogenic Stroke in Patients with Extensive Cardiac Imaging". J Stroke Cerebrovasc Dis 2017; 26:3035. [PMID: 29054732 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Rod Passman
- University of Washington, Seattle, Washington
| | | | - Ilana Ruff
- University of Washington, Seattle, Washington
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Kalani R, Bernstein R, Passman R, Curran Y, Ruff I, Prabhakaran S. Low Yield of Mobile Cardiac Outpatient Telemetry after Cryptogenic Stroke in Patients with Extensive Cardiac Imaging. J Stroke Cerebrovasc Dis 2015; 24:2069-73. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/04/2015] [Accepted: 05/01/2015] [Indexed: 11/16/2022] Open
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Creutzfeldt C, Huffer A, Kalani R, Tirschwell DL. Abstract W MP101: Palliative Care Consultations for Stroke Patients in Washington State. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with stroke have a high risk of death, physical and cognitive impairments and therefore have a high degree of palliative care (PC) needs. The goal of this study is to explore the prevalence of and associations with PC consultation in stroke patients.
Methods:
Using the administrative hospital discharge database of Washington State, we reviewed all patients discharged with stroke (based on ICD-9 codes) from 2009-2011. Strokes were subclassified as ischemic, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). We collected information on demographics, outcome and presence of a “Palliative Care encounter” as defined by the ICD-9 code V66.7.
Results:
Overall, there were 33102 stroke patients with a mean age of 71.1 (SD 16), 52% were female and 49% white. The majority of patients had ischemic strokes (28581, 86%) followed by ICH (9.6%) and SAH (4%). A PC encounter was found in 1682 patients (5%) and was more common in patients with older age, hemorrhagic stroke types, those discharged from larger hospitals and in more recent years (all p<0.05). A trend for higher rate of PC encounters was found for women (OR 0.89, 95% CI 0.77-1.02). For those patients where race data was available, blacks and Hawaiian/Pacific Islanders had less use of PC than whites (all p <0.05). One tenth of patients died in hospital (n=3327), only one third of which (n=1024) received a PC encounter. PC encounter was significantly associated with hospital death, and led to a shorter length of stay in those who died (4.5 days, 95% CI 4.2-4.8 vs. 6.6 days, 95% CI 6.2 vs. 7.0, p < 0.05).
Conclusions:
PC encounters are becoming more common for stroke patients, especially in larger hospitals and are strongly associated with hospital death (i.e. more commonly used in more severe strokes). The unequal distribution across age, gender, stroke type and race suggests a need for more standardized methods to identify patients’ need for PC consultation such as validated PC consultation triggers.
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Kalani R, deHavenon A, Creutzfeldt C, Longstreth WT, Sultan-Qurraie A, Huffer A, Becker K, Tirschwell D. Abstract W MP116: Goals of Care Impact Early Outcome Estimates in Intracerebral Hemorrhage. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Objective:
Prior reports of ICH score-based early mortality rates included patients declared comfort measures only (CMO). We aimed to describe more clinical relevant mortality and functional outcomes restricted to patients in whom all care was continued (non-CMO).
Methods:
Using a single-center retrospective study design, admission ICH score, goals of care, hospital death (HD), and modified Rankin scale (mRS) at discharge were collected in patients with spontaneous ICH from June 2005 to September 2008. Use of CMO and proportions of outcome measures, stratified by admission ICH score, were compared using Pearson’s chi-square test statistics.
Results:
Of 657 patients with ICH, 56.5% were male, 74.7% Caucasian, with mean (SD) age of 66.6 (14.6) years. CMO was pursued in 30.6% of all patients, with a significant increase in use associated with increasing age (p=0.021) and increasing ICH score (p<0.001). HD occurred in 33.8% of all patients, but only 7.2% of non-CMO. In the non-CMO patients, the association between HD and ICH score remained significant (p<0.001), though values were substantially lower than those including CMO patients. An improved distribution of mRS at discharge, in non-CMO patients, was significantly associated with lower ICH score, (p<0.001).
Conclusions:
A significant association exists between ICH score on admission and decision for CMO. Although hospital discharge outcomes (death and mRS) worsen with increasing ICH score even in non-CMO patients, they are substantially improved compared to estimates which include CMO patients, including the original ICH cohorts in the literature. These findings have important implications for early discussions with families related to prognostication and decisions regarding goals of care, especially given a new mandate from The Joint Commission for reporting ICH scores at Comprehensive Stroke Centers.
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Sanz A, Hiona A, Kujoth GC, Seo AY, Hofer T, Kouwenhoven E, Kalani R, Prolla TA, Barja G, Leeuwenburgh C. Evaluation of sex differences on mitochondrial bioenergetics and apoptosis in mice. Exp Gerontol 2006; 42:173-82. [PMID: 17118599 PMCID: PMC1817668 DOI: 10.1016/j.exger.2006.10.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 09/29/2006] [Accepted: 10/03/2006] [Indexed: 11/19/2022]
Abstract
It has been postulated that the differences in longevity observed between organisms of different sexes within a species can be attributed to differences in oxidative stress. It is generally accepted that differences are due to the higher female estrogen levels. However, in some species males live the same or longer despite their lower estrogen values. Therefore, in the present study, we analyze key parameters of mitochondrial bioenergetics, oxidative stress and apoptosis in the B6 (C57Bl/6J) mouse strain. There are no differences in longevity between males and females in this mouse strain, although estrogen levels are higher in females. We did not find any differences in heart, skeletal muscle and liver mitochondrial oxygen consumption (State 3 and State 4) and ATP content between male and female mice. Moreover, mitochondrial H(2)O(2) generation and oxidative stress levels determined by cytosolic protein carbonyls and concentration of 8-hydroxy-2'-deoxyguanosine in mitochondrial DNA were similar in both sexes. In addition, markers of apoptosis (caspase-3, caspase-9 and mono- and oligonucleosomes: the apoptosis index) were not different between male and female mice. These data show that there are no differences in mitochondrial bioenergetics, oxidative stress and apoptosis due to gender in this mouse strain according with the lack of differences in longevity. These results support the Mitochondrial Free Radical Theory of Aging, and indicate that oxidative stress generation independent of estrogen levels determines aging rate.
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Affiliation(s)
- Alberto Sanz
- Department of Animal Physiology-II, Faculty of Biology, Complutense University, Madrid 28040, Spain.
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Kalani R, Judge S, Carter C, Pahor M, Leeuwenburgh C. Effects of Caloric Restriction and Exercise on Age-Related, Chronic Inflammation Assessed by C-Reactive Protein and Interleukin-6. J Gerontol A Biol Sci Med Sci 2006; 61:211-7. [PMID: 16567369 DOI: 10.1093/gerona/61.3.211] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chronic inflammation is associated with the aging process and numerous age-related pathologies. We evaluated the effects of age, caloric restriction (CR), and exercise on plasma C-reactive protein (CRP), interleukin-6, and total antioxidant capacity in Fisher 344 rats. The inflammatory markers were analyzed using enzyme-linked immunosorbent assays (ELISA), while total antioxidant potential was determined by a spectrophotometric method. An increase in circulating levels of CRP with age was attenuated with long-term 40% CR; short-term 40% CR in young animals also reduced CRP concentration compared to age-matched controls. Lifelong exercise with 8% CR showed a marked decrease in CRP levels compared to 8% CR controls and an even greater reduction compared to ad libitum-fed rats. Plasma interleukin-6 levels remained unchanged with age, CR, and exercise, whereas inflammation levels showed an inverse association with plasma antioxidant status. These studies highlight the anti-inflammatory effects of CR and exercise.
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Affiliation(s)
- Rizwan Kalani
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32608, USA
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