Browsing by Author "Rao, Puja C. (57191835613)"
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Publication Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013(2016) ;Khalil, Ibrahim (58255049500) ;Colombara, Danny V. (37025591000) ;Forouzanfar, Mohammad Hossein (57202562738) ;Troeger, Christopher (57195223624) ;Daoud, Farah (57201079837) ;Moradi-Lakeh, Maziar (35617421300) ;El Bcheraoui, Charbel (25027689700) ;Rao, Puja C. (57191835613) ;Afshin, Ashkan (57217465455) ;Charara, Raghid (56514085300) ;Abate, Kalkidan Hassen (57207943858) ;Abd El Razek, Mohammed Magdy (57192379650) ;Abd-Allah, Foad (36503428900) ;Abu-Elyazeed, Remon (57224428155) ;Kiadaliri, Aliasghar Ahmad (57199100665) ;Akanda, Ali Shafqat (35290419100) ;Akseer, Nadia (57207801968) ;Alam, Khurshid (57203681299) ;Alasfoor, Deena (57211114684) ;Ali, Raghib (57196506541) ;AlMazroa, Mohammad A. (35572530900) ;Alomari, Mahmoud A. (57219982609) ;Salem Al-Raddadi, Rajaa Mohammad (57192371411) ;Alsharif, Ubai (57211633255) ;Alsowaidi, Shirina (26867516400) ;Altirkawi, Khalid A. (57202762923) ;Alvis-Guzman, Nelson (57210741239) ;Ammar, Walid (57208159281) ;Antonio, Carl Abelardo T. (55247644500) ;Asayesh, Hamid (55334322800) ;Asghar, Rana Jawad (57209013760) ;Atique, Suleman (56505419100) ;Awasthi, Ashish (57200155811) ;Bacha, Umar (57200173721) ;Badawi, Alaa (57216776029) ;Barac, Aleksandra (55550748700) ;Bedi, Neeraj (57988442200) ;Bekele, Tolesa (57195086149) ;Bensenor, Isabela M. (7004830338) ;Betsu, Balem Demtsu (57196316128) ;Bhutta, Zulfiqar (24342648300) ;Abdulhak, Aref A. Bin (57201757922) ;Butt, Zahid A. (57202522739) ;Danawi, Hadi (57201079895) ;Dubey, Manisha (57219898654) ;Endries, Aman Yesuf (57216324852) ;Faghmous, Imad M.D.A. (57190290003) ;Farid, Talha (24824364300) ;Farvid, Maryam S. (8273562500) ;Farzadfar, Farshad (57195049611) ;Fereshtehnejad, Seyed-Mohammad (57202557520) ;Fischer, Florian (55508208800) ;Anderson Fitchett, Joseph Robert (57192378614) ;Gibney, Katherine B. (57202564104) ;Mohamed Ginawi, Ibrahim Abdelmageem (57192378390) ;Gishu, Melkamu Dedefo (57190277898) ;Gugnani, Harish Chander (7005567008) ;Gupta, Rahul (57204120071) ;Hailu, Gessessew Bugssa (57219637263) ;Hamadeh, Randah Ribhi (57202769526) ;Hamidi, Samer (24366336000) ;Harb, Hilda L. (57221443122) ;Hedayati, Mohammad T. (23979915700) ;Hsairi, Mohamed (57209033943) ;Husseini, Abdullatif (6603689690) ;Jahanmehr, Nader (57203122718) ;Javanbakht, Mehdi (57204619886) ;Jibat, Tariku (57201181881) ;Jonas, Jost B. (7202492953) ;Kasaeian, Amir (57195540738) ;Khader, Yousef Saleh (55654192600) ;Khan, Abdur Rahman (55520620000) ;Khan, Ejaz Ahmad (57218791274) ;Khan, Gulfaraz (6701635515) ;Khoja, Tawfik Ahmed Muthafer (7003561381) ;Kinfu, Yohannes (12770281900) ;Kissoon, Niranjan (7006364038) ;Koyanagi, Ai (57197741912) ;Lal, Aparna (55163011100) ;Abdul Latif, Asma Abdul (57192380848) ;Lunevicius, Raimundas (57216165063) ;Abd El Razek, Hassan Magdy (57195948985) ;Majeed, Azeem (7102027801) ;Malekzadeh, Reza (7005197760) ;Mehari, Alem (57211114616) ;Mekonnen, Alemayehu B. (57200179648) ;Melaku, Yohannes Adama (57203122720) ;Memish, Ziad A. (7005059350) ;Mendoza, Walter (57216905642) ;Misganaw, Awoke (57202808713) ;Ibrahim Mohamed, Layla Abdalla (57192381009) ;Nachega, Jean B. (6701544088) ;Nguyen, Quyen Le (57223642100) ;Nisar, Muhammad Imran (57191774461) ;Peprah, Emmanuel Kwame (57195257834) ;Platts-Mills, James A. (8540918800) ;Pourmalek, Farshad (8309390500) ;Qorbani, Mostafa (24831040300) ;Rafay, Anwar (57212263323) ;Rahimi-Movaghar, Vafa (6507646446) ;Ur Rahman, Sajjad (15835524800) ;Rai, Rajesh Kumar (51864423900) ;Rana, Saleem M. (57204884092) ;Ranabhat, Chhabi L. (56719695500) ;Rao, Sowmya R. (15760668600) ;Refaat, Amany H. (57216641565) ;Riddle, Mark (7102072160) ;Roshandel, Gholamreza (14034446800) ;Ruhago, George Mugambage (50761517500) ;Saleh, Muhammad Muhammad (57190288485) ;Sanabria, Juan R. (7006262917) ;Sawhney, Monika (57217153893) ;Sepanlou, Sadaf G. (36248136000) ;Setegn, Tesfaye (37075667700) ;Sliwa, Karen (57207223988) ;Sreeramareddy, Chandrashekhar T. (57212263335) ;Sykes, Bryan L. (57211183396) ;Tavakkoli, Mohammad (57202524239) ;Tedla, Bemnet Amare (57211142920) ;Terkawi, Abdullah S. (57211144258) ;Ukwaja, Kingsley (57202824584) ;Uthman, Olalekan A. (23026328100) ;Westerman, Ronny (57218361023) ;Wubshet, Mamo (54409732600) ;Yenesew, Muluken A. (39361108000) ;Yonemoto, Naohiro (57204947657) ;Younis, Mustafa Z. (8549393000) ;Zaidi, Zoubida (57197376721) ;El Sayed Zaki, Maysaa (57203666922) ;Al Rabeeah, Abdullah A. (6603625258) ;Wang, Haidong (16507828100) ;Naghavi, Mohsen (57207906323) ;Vos, Theo (57223885848) ;Lopez, Alan D. (7401455668) ;Murray, Christopher J. L. (55481130700)Mokdad, Ali H. (7004813962)Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene. - Some of the metrics are blocked by yourconsent settings
Publication Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013(2016) ;Khalil, Ibrahim (58255049500) ;Colombara, Danny V. (37025591000) ;Forouzanfar, Mohammad Hossein (57202562738) ;Troeger, Christopher (57195223624) ;Daoud, Farah (57201079837) ;Moradi-Lakeh, Maziar (35617421300) ;El Bcheraoui, Charbel (25027689700) ;Rao, Puja C. (57191835613) ;Afshin, Ashkan (57217465455) ;Charara, Raghid (56514085300) ;Abate, Kalkidan Hassen (57207943858) ;Abd El Razek, Mohammed Magdy (57192379650) ;Abd-Allah, Foad (36503428900) ;Abu-Elyazeed, Remon (57224428155) ;Kiadaliri, Aliasghar Ahmad (57199100665) ;Akanda, Ali Shafqat (35290419100) ;Akseer, Nadia (57207801968) ;Alam, Khurshid (57203681299) ;Alasfoor, Deena (57211114684) ;Ali, Raghib (57196506541) ;AlMazroa, Mohammad A. (35572530900) ;Alomari, Mahmoud A. (57219982609) ;Salem Al-Raddadi, Rajaa Mohammad (57192371411) ;Alsharif, Ubai (57211633255) ;Alsowaidi, Shirina (26867516400) ;Altirkawi, Khalid A. (57202762923) ;Alvis-Guzman, Nelson (57210741239) ;Ammar, Walid (57208159281) ;Antonio, Carl Abelardo T. (55247644500) ;Asayesh, Hamid (55334322800) ;Asghar, Rana Jawad (57209013760) ;Atique, Suleman (56505419100) ;Awasthi, Ashish (57200155811) ;Bacha, Umar (57200173721) ;Badawi, Alaa (57216776029) ;Barac, Aleksandra (55550748700) ;Bedi, Neeraj (57988442200) ;Bekele, Tolesa (57195086149) ;Bensenor, Isabela M. (7004830338) ;Betsu, Balem Demtsu (57196316128) ;Bhutta, Zulfiqar (24342648300) ;Abdulhak, Aref A. Bin (57201757922) ;Butt, Zahid A. (57202522739) ;Danawi, Hadi (57201079895) ;Dubey, Manisha (57219898654) ;Endries, Aman Yesuf (57216324852) ;Faghmous, Imad M.D.A. (57190290003) ;Farid, Talha (24824364300) ;Farvid, Maryam S. (8273562500) ;Farzadfar, Farshad (57195049611) ;Fereshtehnejad, Seyed-Mohammad (57202557520) ;Fischer, Florian (55508208800) ;Anderson Fitchett, Joseph Robert (57192378614) ;Gibney, Katherine B. (57202564104) ;Mohamed Ginawi, Ibrahim Abdelmageem (57192378390) ;Gishu, Melkamu Dedefo (57190277898) ;Gugnani, Harish Chander (7005567008) ;Gupta, Rahul (57204120071) ;Hailu, Gessessew Bugssa (57219637263) ;Hamadeh, Randah Ribhi (57202769526) ;Hamidi, Samer (24366336000) ;Harb, Hilda L. (57221443122) ;Hedayati, Mohammad T. (23979915700) ;Hsairi, Mohamed (57209033943) ;Husseini, Abdullatif (6603689690) ;Jahanmehr, Nader (57203122718) ;Javanbakht, Mehdi (57204619886) ;Jibat, Tariku (57201181881) ;Jonas, Jost B. (7202492953) ;Kasaeian, Amir (57195540738) ;Khader, Yousef Saleh (55654192600) ;Khan, Abdur Rahman (55520620000) ;Khan, Ejaz Ahmad (57218791274) ;Khan, Gulfaraz (6701635515) ;Khoja, Tawfik Ahmed Muthafer (7003561381) ;Kinfu, Yohannes (12770281900) ;Kissoon, Niranjan (7006364038) ;Koyanagi, Ai (57197741912) ;Lal, Aparna (55163011100) ;Abdul Latif, Asma Abdul (57192380848) ;Lunevicius, Raimundas (57216165063) ;Abd El Razek, Hassan Magdy (57195948985) ;Majeed, Azeem (7102027801) ;Malekzadeh, Reza (7005197760) ;Mehari, Alem (57211114616) ;Mekonnen, Alemayehu B. (57200179648) ;Melaku, Yohannes Adama (57203122720) ;Memish, Ziad A. (7005059350) ;Mendoza, Walter (57216905642) ;Misganaw, Awoke (57202808713) ;Ibrahim Mohamed, Layla Abdalla (57192381009) ;Nachega, Jean B. (6701544088) ;Nguyen, Quyen Le (57223642100) ;Nisar, Muhammad Imran (57191774461) ;Peprah, Emmanuel Kwame (57195257834) ;Platts-Mills, James A. (8540918800) ;Pourmalek, Farshad (8309390500) ;Qorbani, Mostafa (24831040300) ;Rafay, Anwar (57212263323) ;Rahimi-Movaghar, Vafa (6507646446) ;Ur Rahman, Sajjad (15835524800) ;Rai, Rajesh Kumar (51864423900) ;Rana, Saleem M. (57204884092) ;Ranabhat, Chhabi L. (56719695500) ;Rao, Sowmya R. (15760668600) ;Refaat, Amany H. (57216641565) ;Riddle, Mark (7102072160) ;Roshandel, Gholamreza (14034446800) ;Ruhago, George Mugambage (50761517500) ;Saleh, Muhammad Muhammad (57190288485) ;Sanabria, Juan R. (7006262917) ;Sawhney, Monika (57217153893) ;Sepanlou, Sadaf G. (36248136000) ;Setegn, Tesfaye (37075667700) ;Sliwa, Karen (57207223988) ;Sreeramareddy, Chandrashekhar T. (57212263335) ;Sykes, Bryan L. (57211183396) ;Tavakkoli, Mohammad (57202524239) ;Tedla, Bemnet Amare (57211142920) ;Terkawi, Abdullah S. (57211144258) ;Ukwaja, Kingsley (57202824584) ;Uthman, Olalekan A. (23026328100) ;Westerman, Ronny (57218361023) ;Wubshet, Mamo (54409732600) ;Yenesew, Muluken A. (39361108000) ;Yonemoto, Naohiro (57204947657) ;Younis, Mustafa Z. (8549393000) ;Zaidi, Zoubida (57197376721) ;El Sayed Zaki, Maysaa (57203666922) ;Al Rabeeah, Abdullah A. (6603625258) ;Wang, Haidong (16507828100) ;Naghavi, Mohsen (57207906323) ;Vos, Theo (57223885848) ;Lopez, Alan D. (7401455668) ;Murray, Christopher J. L. (55481130700)Mokdad, Ali H. (7004813962)Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene. - Some of the metrics are blocked by yourconsent settings
Publication Erratum: 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 (The Lancet (2018) 392(10159) (1736–1788)(S0140673618322037)(10.1016/S0140-6736(18)32203-7))(2018) ;Roth, Gregory A. (55074747400) ;Abate, Degu (57204237665) ;Abate, Kalkidan Hassen (57207943858) ;Abay, Solomon M. (35306466900) ;Abbafati, Cristiana (54917122400) ;Abbasi, Nooshin (57212442022) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdela, Jemal (57200613000) ;Abdelalim, Ahmed (7801307783) ;Abdollahpour, Ibrahim (36997151900) ;Abdulkader, Rizwan Suliankatchi (57195295816) ;Abebe, Haftom Temesgen (55950002100) ;Abebe, Molla (57211131124) ;Abebe, Zegeye (57193002719) ;Abejie, Ayenew Negesse (57203015573) ;Abera, Semaw F. (57205180598) ;Abil, Olifan Zewdie (57204558002) ;Abraha, Haftom Niguse (57195289877) ;Abrham, Aklilu Roba (57202704637) ;Abu-Raddad, Laith Jamal (14032724700) ;Accrombessi, Manfred Mario Kokou (55353650500) ;Acharya, Dilaram (56770895600) ;Adamu, Abdu A. (57202024381) ;Adebayo, Oladimeji M. (57194329853) ;Adedoyin, Rufus Adesoji (55947572800) ;Adekanmbi, Victor (53463192900) ;Adetokunboh, Olatunji O. (56598104300) ;Adhena, Beyene Meressa (57322512000) ;Adib, Mina G. (57204560513) ;Admasie, Amha (56609274200) ;Afshin, Ashkan (57217465455) ;Agarwal, Gina (57220151944) ;Agesa, Kareha M. (57204562362) ;Agrawal, Anurag (35214460700) ;Agrawal, Sutapa (57202841733) ;Ahmadi, Alireza (56336080700) ;Ahmadi, Mehdi (16644923000) ;Ahmed, Muktar Beshir (57207802317) ;Ahmed, Sayem (58601030100) ;Aichour, Amani Nidhal (57195486768) ;Aichour, Ibtihel (57195485980) ;Aichour, Miloud Taki Eddine (57195488258) ;Akbari, Mohammad Esmaeil (56666938200) ;Akinyemi, Rufus Olusola (25633566800) ;Akseer, Nadia (57207801968) ;Al-Aly, Ziyad (9738161500) ;Al-Eyadhy, Ayman (24554080400) ;Al-Raddadi, Rajaa M. (57219673720) ;Alahdab, Fares (55135922900) ;Alam, Khurshid (57203681299) ;Alam, Tahiya (57205589820) ;Alebel, Animut (57195961302) ;Alene, Kefyalew Addis (57202583764) ;Alijanzadeh, Mehran (56236864700) ;Alizadeh-Navaei, Reza (36024974700) ;Aljunid, Syed Mohamed (6504304159) ;Alkerwi, Ala'a (57197724313) ;Alla, Francois (6701580827) ;Allebeck, Peter (7005187575) ;Alonso, Jordi (7403482329) ;Altirkawi, Khalid (57202762923) ;Alvis-Guzman, Nelson (57210741239) ;Amare, Azmeraw T. (57202220009) ;Aminde, Leopold N. (56287711300) ;Amini, Erfan (35073393800) ;Ammar, Walid (57208159281) ;Amoako, Yaw Ampem (44960986700) ;Anber, Nahla Hamed (57202351369) ;Andrei, Catalina Liliana (36543507200) ;Androudi, Sofia (6603286512) ;Animut, Megbaru Debalkie (57204558749) ;Anjomshoa, Mina (57204563282) ;Ansari, Hossein (56919376000) ;Ansha, Mustafa Geleto (57195329453) ;Antonio, Carl Abelardo T. (55247644500) ;Anwari, Palwasha (57217465526) ;Aremu, Olatunde (57214958833) ;Arnlov, Johan (6602512227) ;Arora, Amit (36676951800) ;Arora, Monika (8700408200) ;Artaman, Al (57217223811) ;Aryal, Krishna K. (57203859052) ;Asayesh, Hamid (55334322800) ;Asfaw, Ephrem Tsegay (57203306449) ;Ataro, Zerihun (57204563849) ;Atique, Suleman (56505419100) ;Atre, Sachin R. (22933845900) ;Ausloos, Marcel (7101798907) ;Avokpaho, Euripide F.G.A. (57209842037) ;Awasthi, Ashish (58420926700) ;Ayala Quintanilla, Beatriz Paulina (55598298700) ;Ayele, Yohanes (57195129631) ;Ayer, Rakesh (56051098100) ;Azzopardi, Peter S. (56861081000) ;Babazadeh, Arefeh (57200079032) ;Bacha, Umar (57200173721) ;Badali, Hamid (15123728900) ;Badawi, Alaa (57216776029) ;Bali, Ayele Geleto (57204564615) ;Ballesteros, Katherine E. (57207968050) ;Banach, Maciej (22936699500) ;Banerjee, Kajori (57193448932) ;Bannick, Marlena S. (57206834518) ;Banoub, Joseph Adel Mattar (57204568975) ;Barboza, Miguel A. (56650777100) ;Barker-Collo, Suzanne Lyn (57193065514) ;Barnighausen, Till Winfried (23011726900) ;Barquera, Simon (6601928375) ;Barrero, Lope H. (57208560675) ;Bassat, Quique (23024176000) ;Basu, Sanjay (9335409500) ;Baune, Bernhard T. (6603807336) ;Baynes, Habtamu Wondifraw (57192710748) ;Bazargan-Hejazi, Shahrzad (57205912040) ;Bedi, Neeraj (57988442200) ;Beghi, Ettore (7004809655) ;Behzadifar, Masoud (57204671696) ;Behzadifar, Meysam (59429991000) ;Bejot, Yannick (14038743100) ;Bekele, Bayu Begashaw (57196083941) ;Belachew, Abate Bekele (57201657313) ;Belay, Ezra (56372891800) ;Belay, Yihalem Abebe (57202972558) ;Bell, Michelle L. (7401466450) ;Bello, Aminu K. (12759638700) ;Bennett, Derrick A. (57650836400) ;Bensenor, Isabela M. (7004830338) ;Berman, Adam E. (7201959854) ;Bernabe, Eduardo (57194696150) ;Bernstein, Robert S. (56971681200) ;Bertolacci, Gregory J. (57204558417) ;Beuran, Mircea (25229806700) ;Beyranvand, Tina (57203000763) ;Bhalla, Ashish (57202555305) ;Bhattarai, Suraj (55646532200) ;Bhaumik, Soumyadeeep (55643126300) ;Bhutta, Zulfiqar A. (24342648300) ;Biadgo, Belete (55672090500) ;Biehl, Molly H. 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(7006079405) ;Weldegebreal, Fitsum (56112812300) ;Weldegwergs, Kidu Gidey (57203308107) ;Werdecker, Andrea (57208964895) ;Werkneh, Adhena Ayaliew (57195675398) ;West, T. Eoin (57756844000) ;Westerman, Ronny (57218361023) ;Whiteford, Harvey A. (55906494000)Widecka, Justyna (15047205800)GBD 2017 Causes of Death Collaborators. 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: 1736–88—The bottom row in figure 7 was cut off. This correction has been made to the online version as of Nov 9, 2018, and has been made to the printed Article. © 2018 Elsevier Ltd - Some of the metrics are blocked by yourconsent settings
Publication Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019(2020) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. (57190285707) ;Abbasi-Kangevari, Mohsen (57193543882) ;Abd-Allah, Foad (36503428900) ;Abdelalim, Ahmed (7801307783) ;Abdollahi, Mohammad (57940559800) ;Abdollahpour, Ibrahim (36997151900) ;Abegaz, Kedir Hussein (57200726326) ;Abolhassani, Hassan (58597704600) ;Aboyans, Victor (56214736500) ;Abreu, Lucas Guimarães (55937631400) ;Abrigo, Michael R.M. (56018773400) ;Abualhasan, Ahmed (57211135523) ;Abu-Raddad, Laith Jamal (14032724700) ;Abushouk, Abdelrahman I. (57191479876) ;Adabi, Maryam (57190491886) ;Adekanmbi, Victor (53463192900) ;Adeoye, Abiodun Moshood (26654031000) ;Adetokunboh, Olatunji O. (56598104300) ;Adham, Davoud (55346682700) ;Advani, Shailesh M. 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(57224556036)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. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license - Some of the metrics are blocked by yourconsent settings
Publication Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016(2017) ;Naghavi, Mohsen (57207906323) ;Abajobir, Amanuel Alemu (57203613441) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. 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(7005209601) ;Dandona, Lalit (7007017243) ;Dandona, Rakhi (57203043697) ;Dargan, Paul I. (57212154356) ;Das Neves, José (57208073193) ;Davitoiu, Dragos V. (57202555163) ;Davletov, Kairat (6602803024) ;De Courten, Barbora (57208309416) ;Degenhardt, Louisa (7004040033) ;Deiparine, Selina (57205252200) ;Deribe, Kebede (57193912587) ;Deribew, Amare (25625914400) ;Dey, Subhojit (25958052600) ;Dicker, Daniel (57196026676) ;Ding, Eric L. (54413849800) ;Djalalinia, Shirin (37113718000) ;Do, Huyen Phuc (57200737094) ;Doku, David Teye (36015210300) ;Douwes-Schultz, Dirk (57196081398) ;Driscoll, Tim R. (7005928308) ;Dubey, Manisha (57219898654) ;Duncan, Bruce Bartholow (35476478500) ;Echko, Michelle (57196076782) ;El-Khatib, Ziad Ziad (54908919000) ;Ellingsen, Christian Lycke (7801360950) ;Enayati, Ahmadali (6507139052) ;Erskine, Holly E. (57202798676) ;Eskandarieh, Sharareh (57211720158) ;Esteghamati, Alireza (11240321100) ;Ermakov, Sergey P. (7006796196) ;Estep, Kara (57216550964) ;Sa Farinha, Carla Sofae (57190279273) ;Faro, André (36770969600) ;Farzadfar, Farshad (57195049611) ;Feigin, Valery L. (57203677957) ;Fereshtehnejad, Seyed-Mohammad (57202557520) ;Fernandes, João C (35274726800) ;Ferrari, Alize J. (57195348907) ;Feyissa, Tesfaye Regassa (57222562476) ;Filip, Irina (55570061400) ;Finegold, Samuel (57195558156) ;Fischer, Florian (55508208800) ;Fitzmaurice, Christina (57212628757) ;Flaxman, Abraham D. (6602883567) ;Foigt, Nataliya (57216998893) ;Frank, Tahvi (57195993514) ;Fraser, Maya (57202561859) ;Fullman, Nancy (57211064970) ;Fürst, Thomas (57208431345) ;Furtado, Joao M. (36801755000) ;Gakidou, Emmanuela (57202567277) ;Garcia-Basteiro, Alberto L (57200187168) ;Gebre, Teshome (57202565005) ;Gebregergs, Gebremedhin Berhe (57078990000) ;Gebrehiwot, Tsegaye Tewelde (57216482917) ;Gebremichael, Delelegn Yilma (57015331400) ;Geleijnse, Johanna M. (35195702500) ;Genova-Maleras, Ricard (15070563900) ;Gesesew, Hailay Abrha (56412148300) ;Gething, Peter W. (57193559189) ;Gillum, Richard F. (7103181331) ;Ginawi, Ibrahim Abdelmageem Mohamed (57192378390) ;Giref, Ababi Zergaw (57219994468) ;Giroud, Maurice (7203027541) ;Giussani, Giorgia (57200843076) ;Godwin, William W. (57191841675) ;Gold, Audra L. (57194129483) ;Goldberg, Ellen M. (57191842703) ;Gona, Philimon N. (57219703762) ;Gopalani, Sameer Vali (57190277891) ;Gouda, Hebe N. (57202432343) ;Goulart, Alessandra Carvalho (57201181348) ;Griswold, Max (57191836595) ;Gupta, Prakash C. (58767181900) ;Gupta, Rajeev (55705295300) ;Gupta, Tanush (57219956402) ;Gupta, Vipin (57199940653) ;Haagsma, Juanita A. (57202571125) ;Hafezi-Nejad, Nima (57216814261) ;Hailu, Alemayehu Desalegne (57225733572) ;Hailu, Gessessew Bugssa (57219637263) ;Hamadeh, Randah Ribhi (57202769526) ;Hambisa, Mitiku Teshome (57203666810) ;Hamidi, Samer (24366336000) ;Hammami, Mouhanad (57216961083) ;Hancock, Jamie (57202975481) ;Handal, Alexis J. (57208977398) ;Hankey, Graeme J. (7102816661) ;Hao, Yuantao (57202554333) ;Harb, Hilda L. (57221443122) ;Hareri, Habtamu Abera (57195292447) ;Hassanvand, Mohammad Sadegh (35085056400) ;Havmoeller, Rasmus (57212075728) ;Hay, Simon I. (7101875313) ;He, Fei (59031207400) ;Hedayati, Mohammad T. (23979915700) ;Henry, Nathaniel J. (57196076616) ;Heredia-Pi, Ileana Beatriz (36941085200) ;Herteliu, Claudiu (26035943100) ;Hoek, Hans W. (57202570421) ;Horino, Masako (57195769276) ;Horita, Nobuyuki (57217110823) ;Hosgood, H. Dean (56353204400) ;Hostiuc, Sorin (24829099800) ;Hotez, Peter J. (7004958298) ;Hoy, Damian G. 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(57202562224) ;Katikireddi, Srinivasa Vittal (6508254091) ;Kawakami, Norito (35377339000) ;Keiyoro, Peter Njenga (57203177260) ;Kemmer, Laura (57205017265) ;Kesavachandran, Chandrasekharan Nair (57218000521) ;Khader, Yousef Saleh (55654192600) ;Khan, Ejaz Ahmad (57218791274) ;Khang, Young-Ho (57198904674) ;Khoja, Abdullah Tawfh Abdullah (57194229795) ;Khosravi, Ardeshir (57201190837) ;Khosravi, Mohammad Hossein (56524167000) ;Khubchandani, Jagdish (57211720011) ;Kieling, Christian (57218820714) ;Kievlan, Daniel (55940685500) ;Kim, Daniel (57223019104) ;Kim, Yun Jin (57211086375) ;Kimokoti, Ruth W. (8647554600) ;Kinfu, Yohannes (12770281900) ;Kissoon, Niranjan (7006364038) ;Kivimaki, Mika (7004391239) ;Knudsen, Ann Kristin (57192966362) ;Kopec, Jacek A. (7006284395) ;Kosen, Soewarta (57211346192) ;Koul, Parvaiz A. (14022262900) ;Koyanagi, Ai (57197741912) ;Defo, Barthelemy Kuate (6602271655) ;Kulikof, Xie Rachel (57202024253) ;Kumar, G. Anil (57139550500) ;Kumar, Pushpendra (57208849920) ;Kutz, Michael (57195617315) ;Kyu, Hmwe H. (57217040073) ;Lal, Dharmesh Kumar (57222488984) ;Lalloo, Ratilal (57189334553) ;Lambert, Tea Lallukka Nkurunziza (57208159086) ;Lan, Qing (56682598900) ;Lansingh, Van C. (57194598546) ;Larsson, Anders (56381985300) ;Lee, Paul H. (57200302692) ;Leigh, James (7202089604) ;Leung, Janni (57214397752) ;Levi, Miriam (54893035000) ;Li, Yongmei (56147667800) ;Kappe, Darya Li (57202014108) ;Liang, Xiaofeng (26662590300) ;Liben, Misgan Legesse (57188568119) ;Lim, Stephen S. (57201800433) ;Liu, Angela (57196080772) ;Liu, Patrick Y. (56170368200) ;Liu, Yang (57202561981) ;Lodha, Rakesh (7007019609) ;Logroscino, Giancarlo (7004888005) ;Lorkowski, Stefan (57203677656) ;Lotufo, Paulo A. (7003331101) ;Lozano, Rafael (7102198442) ;Lucas, Timothy C.D. (57216683591) ;Ma, Stefan (7403723389) ;Macarayan, Erlyn Rachelle King (56330601800) ;Maddison, Emilie R. (57196084094) ;Abd El Razek, Mohammed Magdy (57192379650) ;Majdan, Marek (36147855100) ;Majdzadeh, Reza (9246620000) ;Majeed, Azeem (7102027801) ;Malekzadeh, Reza (7005197760) ;Malhotra, Rajesh (7202423297) ;Malta, Deborah Carvalho (15835283500) ;Manguerra, Helena (57208121153) ;Manyazewal, Tsegahun (55414403100) ;Mapoma, Chabila C. (57208956832) ;Marczak, Laurie B. (57200295553) ;Markos, Desalegn (57210741352) ;Martinez-Raga, Jose (57202861191) ;Martins-Melo, Francisco Rogerlândio (57204796807) ;Martopullo, Ira (57193550189) ;McAlinden, Colm (35325278500) ;McGaughey, Madeline (57206867033) ;McGrath, John J. (57202560550) ;Mehata, Suresh (57211773159) ;Meier, Toni (36678887300) ;Meles, Kidanu Gebremariam (57951018400) ;Memiah, Peter (57217207827) ;Memish, Ziad A. (7005059350) ;Mengesha, Melkamu Merid (57192953602) ;Mengistu, Desalegn Tadese (57194776802) ;Menota, Bereket Gebremichael (57195329507) ;Mensah, George A. (57196028147) ;Meretoja, Atte (12775885500) ;Meretoja, Tuomo J. (57202554188) ;Millear, Anoushka (57204879537) ;Miller, Ted R. (7403948600) ;Minnig, Shawn (57193238817) ;Mirarefn, Mojde (57202024712) ;Mirrakhimov, Erkin M. (57216202888) ;Misganaw, Awoke (57202808713) ;Mishra, Shiva Raj (57208010960) ;Mohammad, Karzan Abdulmuhsin (57205300378) ;Mohammadi, Alireza (56720095000) ;Mohammed, Shafu (57838689000) ;Mokdad, Ali H. (7004813962) ;Mola, Glen Liddell D. (57221824056) ;Mollenkopf, Sarah K. (57203646247) ;Molokhia, Mariam (7004121920) ;Monasta, Lorenzo (7801520497) ;Hernandez, Julio C. Montañez (57199371040) ;Montico, Marcella (57202563609) ;Mooney, Meghan D. (57216598823) ;Moradi-Lakeh, Maziar (35617421300) ;Moraga, Paula (46761426800) ;Morawska, Lidia (7004773965) ;Morrison, Shane D. (45661573100) ;Morozof, Chloe (57202020530) ;Mountjoy-Venning, Clif (57210505240) ;Mruts, Kalayu Birhane (57221822877) ;Muller, Kate (57196075658) ;Murthy, Gudlavalleti Venkata Satyanarayana (7101778322) ;Musa, Kamarul Imran (57194536466) ;Nachega, Jean B. (6701544088) ;Naheed, Aliya (57202560989) ;Naldi, Luigi (7004954781) ;Nangia, Vinay (57201490837) ;Nascimento, Bruno Ramos (14424406800) ;Nasher, Jamal T. (56003685800) ;Natarajan, Gopalakrishnan (55804491100) ;Negoi, Ionut (57200640014) ;Ngunjiri, Josephine Wanjiku (57195296110) ;Nguyen, Cuong Tat (56531347200) ;Nguyen, Grant (57191591002) ;Nguyen, Minh (58203329200) ;Nguyen, Quyen Le (57223642100) ;Nguyen, Trang Huyen (59142352200) ;Nichols, Emma (57205756163) ;Ningrum, Dina Nur Anggraini (57195329470) ;Nong, Vuong Minh (55507077200) ;Noubiap, Jean Jacques N. (55490374000) ;Ogbo, Felix Akpojene (57200737136) ;Oh, In-Hwan (57204090669) ;Okoro, Anselm (54682112200) ;Olagunju, Andrew Toyin (26029995700) ;Olsen, Helen E. (57203080494) ;Olusanya, Bolajoko Olubukunola (57218504682) ;Olusanya, Jacob Olusegun (57222488860) ;Ong, Kanyin (57224697159) ;Opio, John Nelson (57200124403) ;Oren, Eyal (36815569400) ;Ortiz, Alberto (7201911399) ;Osman, Majdi (59804857900) ;Ota, Erika (57202554474) ;Mahesh, P.A. (57202421244) ;Pacella, Rosana E. (57194839077) ;Pakhale, Smita (57220937499) ;Pana, Adrian (57191837583) ;Panda, Basant Kumar (57196077672) ;Jonas, Songhomitra (57198344150) ;Papachristou, Christina (7005498635) ;Park, Eun-Kee (57216814178) ;Patten, Scott B. (57201492915) ;Patton, George C. (7102184358) ;Paudel, Deepak (57207871851) ;Paulson, Katherine (57203437789) ;Pereira, David M. (57200690024) ;Perez-Ruiz, Fernando (57190090281) ;Perico, Norberto (56481931200) ;Pervaiz, Aslam (57202521714) ;Petzold, Max (7003628893) ;Phillips, Michael Robert (57202563610) ;Pigott, David M. (55320335600) ;Pinho, Christine (57212482983) ;Plass, Dietrich (57217142114) ;Pletcher, Martin A. (57196075669) ;Polinder, Suzanne (12766122200) ;Postma, Maarten J. (7006296502) ;Pourmalek, Farshad (8309390500) ;Purcell, Caroline (56203575500) ;Qorbani, Mostafa (24831040300) ;Radfar, Amir (57194428768) ;Rafay, Anwar (57212263323) ;Rahimi-Movaghar, Vafa (6507646446) ;Rahman, Mahfuzar (35571661300) ;Ur Rahman, Mohammad Hifz (57202017378) ;Rai, Rajesh Kumar (51864423900) ;Ranabhat, Chhabi Lal (56719695500) ;Rankin, Zane (57200251742) ;Rao, Puja C. (57191835613) ;Rath, Goura Kishor (35444818200) ;Rawaf, Salman (6602475959) ;Ray, Sarah E. (57196078769) ;Rehm, Jürgen (7102718648) ;Reiner, Robert C. (57203229088) ;Reitsma, Marissa B. (57208766315) ;Remuzzi, Giuseppe (56466188600) ;Rezaei, Satar (55273796300) ;Rezai, Mohammad Sadegh (57226200664) ;Rokni, Mohammad Bagher (36119103200) ;Ronfani, Luca (6602565620) ;Roshandel, Gholamreza (14034446800) ;Roth, Gregory A. (55074747400) ;Rothenbacher, Dietrich (7004765162) ;Ruhago, George Mugambage (50761517500) ;Rizwan, S.A. (57195295816) ;Saadat, Soheil (16310355800) ;Sachdev, Perminder S. (7102284091) ;Sadat, Nafs (57219687343) ;Safdarian, Mahdi (57203849024) ;Saf, Sare (57202019735) ;Safiri, Saeid (56009654100) ;Sagar, Rajesh (26643103100) ;Sahathevan, Ramesh (35332739200) ;Salama, Joseph (57202975625) ;Salamati, Payman (14045860600) ;Salomon, Joshua A. (56745638600) ;Samy, Abdallah M. (36973661300) ;Sanabria, Juan Ramon (7006262917) ;Sanchez-Niño, Maria Dolores (57202569015) ;Santomauro, Damian (56912450700) ;Santos, Itamar S. (57198312911) ;Milicevic, Milena M. Santric (57211144346) ;Sartorius, Benn (12788526800) ;Satpathy, Maheswar (57202563691) ;Shahraz, Saeid (57215142060) ;Schmidt, Maria Inês (7404398885) ;Schneider, Ione J.C. (57201292772) ;Schulhofer-Wohl, Sam (14322452700) ;Schutte, Aletta E. (57216814352) ;Schwebel, David C. (6603681532) ;Schwendicke, Falk (55639536600) ;Sepanlou, Sadaf G. (36248136000) ;Servan-Mori, Edson E. (57202594826) ;Shackelford, Katya Anne (57202959163) ;Shaikh, Masood Ali (57203122601) ;Shamsipour, Mansour (57197846052) ;Shamsizadeh, Morteza (57195940127) ;Islam, Sheikh Mohammed Shariful (56400111100) ;Sharma, Jayendra (57195329457) ;Sharma, Rajesh (58228412600) ;She, Jun (57209122131) ;Sheikhbahaei, Sara (57219637352) ;Shey, Muki (10138820000) ;Shi, Peilin (57203064901) ;Shields, Chloe (57196083232) ;Shigematsu, Mika (23968093000) ;Shiri, Rahman (57200737050) ;Shirude, Shreya (57216599051) ;Shiue, Ivy (35811219800) ;Shoman, Haitham (57208324664) ;Shrime, Mark G. (57204703404) ;Sigfusdottir, Inga Dora (57195363778) ;Silpakit, Naris (57202401404) ;Silva, João Pedro (7403023631) ;Singh, Abhishek (59639211800) ;Singh, Jasvinder A. (7404421736) ;Skiadaresi, Eirini (37100428500) ;Sligar, Amber (57190284582) ;Smith, Alison (57191843859) ;Smith, David L. (55574206203) ;Smith, Mari (57195484737) ;Sobaih, Badr H.A. (57202564080) ;Soneji, Samir (57204096389) ;Sorensen, Reed J.D. (57196918748) ;Soriano, Joan B. (7101973935) ;Sreeramareddy, Chandrashekhar T. (57212263335) ;Srinivasan, Vinay (57196077031) ;Stanaway, Jefrey D. (57201210928) ;Stathopoulou, Vasiliki (57209726581) ;Steel, Nicholas (6603791873) ;Stein, Dan J. (55769747595) ;Steiner, Caitlyn (57205358084) ;Steinke, Sabine (57203777687) ;Stokes, Mark Andrew (7102859000) ;Strong, Mark (12783473200) ;Strub, Bryan (57211781720) ;Subart, Michelle (57194140438) ;Sufyan, Muawiyyah Babale (57203947220) ;Sunguya, Bruno F. (57209060557) ;Sur, Patrick J. (57218360398) ;Swaminathan, Soumya (7102380757) ;Sykes, Bryan L. (57211183396) ;Tabarés-Seisdedos, Rafael (6602981102) ;Tadakamadla, Santosh Kumar (57207799926) ;Takahashi, Ken (55741242600) ;Takala, Jukka S. (35425471300) ;Talongwa, Roberto Tchio (57195568335) ;Tarawneh, Mohammed Rasoul (56742235200) ;Tavakkoli, Mohammad (57202524239) ;Taveira, Nuno (6602731390) ;Tegegne, Teketo Kassaw (57216998561) ;Tehrani-Banihashemi, Arash (57204006020) ;Temsah, Mohamad-Hani (56115852000) ;Terkawi, Abdullah Sulieman (57211144258) ;Thakur, J.S. (57204002123) ;Thamsuwan, Ornwipa (55484605700) ;Thankappan, Kavumpurathu Raman (57202955435) ;Thomas, Katie E. (56239717800) ;Thompson, Alex H. (57196083297) ;Thomson, Alan J. (57969994200) ;Thrift, Amanda G. (7004824524) ;Tobe-Gai, Ruoyan (57209276611) ;Topor-Madry, Roman (57211182892) ;Torre, Anna (57196074351) ;Tortajada, Miguel (16242320900) ;Towbin, Jefrey Allen (7102520568) ;Tran, Bach Xuan (57209107515) ;Troeger, Christopher (57195223624) ;Truelsen, Thomas (57202824565) ;Tsoi, Derrick (57196074984) ;Tuzcu, Emin Murat (7005951350) ;Tyrovolas, Stefanos (57207793475) ;Ukwaja, Kingsley N. (57202824584) ;Undurraga, Eduardo A. (57204092789) ;Updike, Rachel (57204698680) ;Uthman, Olalekan A. (23026328100) ;Uzochukwu, Benjamin S. Chudi (57211633289) ;Van Boven, Job F.M. (53464198500) ;Vasankari, Tommi (57200592416) ;Venketasubramanian, Narayanaswamy (56804702100) ;Violante, Francesco S. (7003555890) ;Vlassov, Vasiliy Victorovich (57211633239) ;Vollset, Stein Emil (57196315778) ;Vos, Theo (57223885848) ;Wakayo, Tolassa (57205609717) ;Wallin, Mitchell T. (57201573668) ;Wang, Yuan-Pang (8576812100) ;Weiderpass, Elisabete (57205018947) ;Weintraub, Robert G. (7006079405) ;Weiss, Daniel J. (8609275600) ;Werdecker, Andrea (57208964895) ;Westerman, Ronny (57218361023) ;Whetter, Brian (57201998502) ;Whiteford, Harvey A. (55906494000) ;Wijeratne, Tissa (14051317700) ;Wiysonge, Charles Shey (6507441509) ;Woldeyes, Belete Getahun (57195329524) ;Wolfe, Charles D.A. (57202754705) ;Woodbrook, Rachel (57200298006) ;Workicho, Abdulhalik (56720337100) ;Xavier, Denis (55403963100) ;Xiao, Qingyang (59797114300) ;Xu, Gelin (57203583113) ;Yaghoubi, Mohsen (57212400558) ;Yakob, Bereket (57203811497) ;Yano, Yuichiro (57196965200) ;Yaseri, Mehdi (23029507000) ;Yimam, Hassen Hamid (57196325590) ;Yonemoto, Naohiro (57204947657) ;Yoon, Seok-Jun (24823148900) ;Yotebieng, Marcel (26325950800) ;Younis, Mustafa Z. (8549393000) ;Zaidi, Zoubida (57197376721) ;El Sayed Zaki, Maysaa (57203666922) ;Zegeye, Elias Asfaw (57209171278) ;Zenebe, Zerihun Menlkalew (57200737185) ;Zerfu, Taddese Alemu (55358278900) ;Zhang, Anthony Lin (56391112900) ;Zhang, Xueying (56283378700) ;Zipkin, Ben (57200737130) ;Zodpey, Sanjay (7003415080) ;Lopez, Alan D. (7401455668)Murray, Christopher J.L. (55481130700)Background: Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specifc mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods: We estimated cause-specifc deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specifc causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specifc deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings: The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16 - age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL signifcantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the fve leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a fner level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation: The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and confict and terrorism. Increasing levels of YLLs might refect outcomes from conditions that required high levels of care but for which efective treatments remain elusive, potentially increasing costs to health systems. Copyright © 2017 The Author(s). Published by Elsevier Ltd. - Some of the metrics are blocked by yourconsent settings
Publication 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(2018) ;Roth, Gregory A. (55074747400) ;Abate, Degu (57204237665) ;Abate, Kalkidan Hassen (57207943858) ;Abay, Solomon M. (35306466900) ;Abbafati, Cristiana (54917122400) ;Abbasi, Nooshin (57212442022) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdela, Jemal (57200613000) ;Abdelalim, Ahmed (7801307783) ;Abdollahpour, Ibrahim (36997151900) ;Abdulkader, Rizwan Suliankatchi (57195295816) ;Abebe, Haftom Temesgen (55950002100) ;Abebe, Molla (57211131124) ;Abebe, Zegeye (57193002719) ;Abejie, Ayenew Negesse (57203015573) ;Abera, Semaw F. 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(7004824524) ;Thurston, George D. (7102270013) ;Tilahun, Binyam (57212075730) ;To, Quyen G. (55827789100) ;Tobe-Gai, Ruoyan (57209276611) ;Tonelli, Marcello (7103102534) ;Topor-Madry, Roman (57211182892) ;Torre, Anna E. (57196074351) ;Tortajada-Girbes, Miguel (16242320900) ;Touvier, Mathilde (8877033300) ;Tovani-Palone, Marcos Roberto (56644977900) ;Tran, Bach Xuan (57209107515) ;Tran, Khanh Bao (57201651536) ;Tripathi, Suryakant (57225821627) ;Troeger, Christopher E. (57195223624) ;Truelsen, Thomas Clement (57202824565) ;Truong, Nu Thi (57204178907) ;Tsadik, Afewerki Gebremeskel (57204562442) ;Tsoi, Derrick (57196074984) ;Tudor Car, Lorainne (48561867100) ;Murat Tuzcu, E. (7005951350) ;Tyrovolas, Stefanos (57207793475) ;Ukwaja, Kingsley N. (57202824584) ;Ullah, Irfan (56992676600) ;Undurraga, Eduardo A. (57204092789) ;Updike, Rachel L. (57204698680) ;Usman, Muhammad Shariq (57203046075) ;Uthman, Olalekan A. (23026328100) ;Uzun, Selen Begum (57200327315) ;Vaduganathan, Muthiah (16417973600) ;Vaezi, Afsane (55698015300) ;Vaidya, Gaurang (55551507300) ;Valdez, Pascual R. (57202115577) ;Varavikova, Elena (7801408611) ;Vasankari, Tommi Juhani (57200592416) ;Venketasubramanian, Narayanaswamy (56804702100) ;Villafaina, Santos (57195804127) ;Violante, Francesco S. (7003555890) ;Vladimirov, Sergey Konstantinovitch (57195959162) ;Vlassov, Vasily (57211633239) ;Vollset, Stein Emil (57196315778) ;Vos, Theo (57223885848) ;Wagner, Gregory R. (57219005948) ;Wagnew, Fasil Shiferaw (57200917385) ;Waheed, Yasir (35303643700) ;Wallin, Mitchell Taylor (57201573668) ;Walson, Judd L. (57203254111) ;Wang, Yanping (57215440165) ;Wang, Yuan-Pang (8576812100) ;Wassie, Molla Mesele (56499356400) ;Weiderpass, Elisabete (57205018947) ;Weintraub, Robert G. (7006079405) ;Weldegebreal, Fitsum (56112812300) ;Weldegwergs, Kidu Gidey (57203308107) ;Werdecker, Andrea (57208964895) ;Werkneh, Adhena Ayaliew (57195675398) ;West, T. Eoin (57756844000) ;Westerman, Ronny (57218361023) ;Whiteford, Harvey A. (55906494000)Widecka, Justyna (15047205800)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. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license - Some of the metrics are blocked by yourconsent settings
Publication Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016(2017) ;Hay, Simon I. (7101875313) ;Abajobir, Amanuel Alemu (57203613441) ;Abate, Kalkidan Hassen (57207943858) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. (57190285707) ;Abd-Allah, Foad (36503428900) ;Abdulle, Abdishakur M. (6603592018) ;Abebo, Teshome Abuka (57195738441) ;Abera, Semaw Ferede (57205180598) ;Aboyans, Victor (56214736500) ;Abu-Raddad, Laith J. (14032724700) ;Ackerman, Ilana N. (8925517400) ;Adedeji, Isaac A. 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(35554564000) ;Gakidou, Emmanuela (57202567277) ;Garcia-Basteiro, Alberto L. (57200187168) ;Gebre, Teshome (57202565005) ;Gebregergs, Gebremedhin Berhe (57078990000) ;Gebrehiwot, Tsegaye Tewelde (57216482917) ;Geleijnse, Johanna M. (35195702500) ;Geleto, Ayele (57204564615) ;Gemechu, Bikila Lencha (57201195568) ;Gesesew, Hailay Abrha (56412148300) ;Gething, Peter W. (57193559189) ;Ghajar, Alireza (56226089600) ;Gibney, Katherine B. (57202564104) ;Gillum, Richard F. (7103181331) ;Ginawi, Ibrahim Abdelmageem Mohamed (57218390192) ;Gishu, Melkamu Dedefo (57202568734) ;Giussani, Giorgia (57200843076) ;Godwin, William W. (57191841675) ;Goel, Kashish (24576314100) ;Goenka, Shifalika (57217111080) ;Goldberg, Ellen M. (57191842703) ;Gona, Philimon N. (57219703762) ;Goodridge, Amador (55801980200) ;Gopalani, Sameer Vali (57190277891) ;Gosselin, Richard A. (57193194468) ;Gotay, Carolyn C. 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(57207920084)Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE difered from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs ofset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the fve lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs ofset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention eforts, and development assistance for health, including fnancial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. - Some of the metrics are blocked by yourconsent settings
Publication Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017(2018) ;Kyu, Hmwe Hmwe (57217040073) ;Abate, Degu (57204237665) ;Abate, Kalkidan Hassen (57207943858) ;Abay, Solomon M. (35306466900) ;Abbafati, Cristiana (54917122400) ;Abbasi, Nooshin (57212442022) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdela, Jemal (57200613000) ;Abdelalim, Ahmed (7801307783) ;Abdollahpour, Ibrahim (36997151900) ;Abdulkader, Rizwan Suliankatchi (57195295816) ;Abebe, Molla (57211131124) ;Abebe, Zegeye (57193002719) ;Abil, Olifan Zewdie (57204558002) ;Aboyans, Victor (56214736500) ;Abrham, Aklilu Roba (57202704637) ;Abu-Raddad, Laith Jamal (14032724700) ;Abu-Rmeileh, Niveen M.E. 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(55481130700)Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the ?ve leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. - Some of the metrics are blocked by yourconsent settings
Publication Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016(2017) ;Vos, Theo (57223885848) ;Abajobir, Amanuel Alemu (57203613441) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. (57190285707) ;Abate, Kalkidan Hassen (57207943858) ;Abd-Allah, Foad (36503428900) ;Abdulle, Abdishakur M. (6603592018) ;Abebo, Teshome Abuka (57195738441) ;Abera, Semaw Ferede (57205180598) ;Aboyans, Victor (56214736500) ;Abu-Raddad, Laith J. (14032724700) ;Ackerman, Ilana N. 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(7102816661) ;Hao, Yuantao (57202554333) ;Harb, Hilda L. (57221443122) ;Hareri, Habtamu Abera (57195292447) ;Haro, Josep Maria (57215877903) ;Harvey, James (57196074369) ;Hassanvand, Mohammad Sadegh (35085056400) ;Havmoeller, Rasmus (57212075728) ;Hawley, Caitlin (57196078801) ;Hay, Roderick J. (56785229200) ;Hay, Simon I. (7101875313) ;Henry, Nathaniel J. (57196076616) ;Heredia-Pi, Ileana Beatriz (36941085200) ;Heydarpour, Pouria (57189359029) ;Hoek, Hans W. (57202570421) ;Hoffman, Howard J. (7201677665) ;Horita, Nobuyuki (57217110823) ;Hosgood, H. Dean (56353204400) ;Hostiuc, Sorin (24829099800) ;Hotez, Peter J. (7004958298) ;Hoy, Damian G. (57216593652) ;Htet, Aung Soe (57202555179) ;Hu, Guoqing (57218106596) ;Huang, Hsiang (57202278530) ;Huynh, Chantal (57202556112) ;Iburg, Kim Moesgaard (57216814160) ;Igumbor, Ehimario Uche (26537691100) ;Ikeda, Chad (57202720108) ;Irvine, Caleb Mackay Salpeter (57203666733) ;Jacobsen, Kathryn H. 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(55074747400) ;Roy, Ambuj (7402704658) ;Rubagotti, Enrico (57208389589) ;Ruhago, George Mugambage (50761517500) ;Saadat, Soheil (16310355800) ;Sadat, Nafis (57219687343) ;Safdarian, Mahdi (57203849024) ;Safi, Sare (57219477293) ;Safiri, Saeid (56009654100) ;Sagar, Rajesh (26643103100) ;Sahathevan, Ramesh (35332739200) ;Salama, Joseph (57202975625) ;Salomon, Joshua A. (56745638600) ;Salvi, Sundeep Santosh (7005258777) ;Samy, Abdallah M. (36973661300) ;Sanabria, Juan R. (7006262917) ;Santomauro, Damian (56912450700) ;Santos, Itamar S. (57198312911) ;Santos, João Vasco (57226214352) ;Santric Milicevic, Milena M. (57211144346) ;Sartorius, Benn (12788526800) ;Satpathy, Maheswar (57202563691) ;Sawhney, Monika (57217153893) ;Saxena, Sonia (57203151746) ;Schmidt, Maria Inês (7404398885) ;Schneider, Ione J.C. (57201292772) ;Schöttker, Ben (37665918200) ;Schwebel, David C. (6603681532) ;Schwendicke, Falk (55639536600) ;Seedat, Soraya (7003445887) ;Sepanlou, Sadaf G. (36248136000) ;Servan-Mori, Edson E. (57202594826) ;Setegn, Tesfaye (37075667700) ;Shackelford, Katya Anne (57202959163) ;Shaheen, Amira (57202560956) ;Shaikh, Masood Ali (57203122601) ;Shamsipour, Mansour (57197846052) ;Shariful Islam, Sheikh Mohammed (56400111100) ;Sharma, Jayendra (57195329457) ;Sharma, Rajesh (58228412600) ;She, Jun (57209122131) ;Shi, Peilin (57203064901) ;Shields, Chloe (57196083232) ;Shigematsu, Mika (23968093000) ;Shinohara, Yukito (57203303862) ;Shiri, Rahman (57200737050) ;Shirkoohi, Reza (12776374400) ;Shirude, Shreya (57216599051) ;Shishani, Kawkab (14025005500) ;Shrime, Mark G. (57204703404) ;Sibai, Abla Mehio (7005466998) ;Sigfusdottir, Inga Dora (57195363778) ;Silva, Diego Augusto Santos (36985158000) ;Silva, João Pedro (7403023631) ;Silveira, Dayane Gabriele Alves (57190284103) ;Singh, Jasvinder A. (7404421736) ;Singh, Narinder Pal (57211864736) ;Sinha, Dhirendra Narain (7201637609) ;Skiadaresi, Eirini (37100428500) ;Skirbekk, Vegard (57202564482) ;Slepak, Erica Leigh (57205356367) ;Sligar, Amber (57190284582) ;Smith, David L. (55574206203) ;Smith, Mari (57195484737) ;Sobaih, Badr H.A. (57202564080) ;Sobngwi, Eugene (6701427993) ;Sorensen, Reed J.D. (57196918748) ;Sousa, Tatiane Cristina Moraes (57195329460) ;Sposato, Luciano A. (25640261000) ;Sreeramareddy, Chandrashekhar T. (57212263335) ;Srinivasan, Vinay (57196077031) ;Stanaway, Jeffrey D. (57201210928) ;Stathopoulou, Vasiliki (57195644148) ;Steel, Nicholas (6603791873) ;Stein, Dan J. (55769747595) ;Stein, Murray B. (7402996817) ;Steiner, Caitlyn (57205358084) ;Steiner, Timothy J. 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(57195959162) ;Vlassov, Vasiliy Victorovich (57211633239) ;Vollset, Stein Emil (57196315778) ;Wadilo, Fiseha (57194049305) ;Wakayo, Tolassa (57205609717) ;Wang, Yuan-Pang (8576812100) ;Weaver, Marcia (7201548872) ;Weichenthal, Scott (57202555239) ;Weiderpass, Elisabete (57205018947) ;Weintraub, Robert G. (7006079405) ;Werdecker, Andrea (57208964895) ;Westerman, Ronny (57218361023) ;Whiteford, Harvey A. (55906494000) ;Wijeratne, Tissa (14051317700) ;Wiysonge, Charles Shey (6507441509) ;Wolfe, Charles D.A. (57202754705) ;Woodbrook, Rachel (57200298006) ;Woolf, Anthony D. (7102882171) ;Workicho, Abdulhalik (56720337100) ;Wulf Hanson, Sarah (57212263269) ;Xavier, Denis (55403963100) ;Xu, Gelin (57203583113) ;Yadgir, Simon (57192837280) ;Yaghoubi, Mohsen (56402926900) ;Yakob, Bereket (57203811497) ;Yan, Lijing L. (35933756700) ;Yano, Yuichiro (57196965200) ;Ye, Pengpeng (57202839295) ;Yimam, Hassen Hamid (57196325590) ;Yip, Paul (7102503720) ;Yonemoto, Naohiro (57204947657) ;Yoon, Seok-Jun (24823148900) ;Yotebieng, Marcel (26325950800) ;Younis, Mustafa Z. (8549393000) ;Zaidi, Zoubida (57197376721) ;Zaki, Maysaa El Sayed (57203666922) ;Zegeye, Elias Asfaw (57209171278) ;Zenebe, Zerihun Menlkalew (57200737185) ;Zhang, Xueying (56283378700) ;Zhou, Maigeng (57054557200) ;Zipkin, Ben (57200737130) ;Zodpey, Sanjay (7003415080) ;Zuhlke, Liesl Joanna (57209027746)Murray, Christopher J.L. (55481130700)Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-todate information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. © The Author(s). Published by Elsevier Ltd. - Some of the metrics are blocked by yourconsent settings
Publication 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(2018) ;James, Spencer L. (57202557998) ;Abate, Degu (57204237665) ;Abate, Kalkidan Hassen (57207943858) ;Abay, Solomon M. (35306466900) ;Abbafati, Cristiana (54917122400) ;Abbasi, Nooshin (57212442022) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdela, Jemal (57200613000) ;Abdelalim, Ahmed (7801307783) ;Abdollahpour, Ibrahim (36997151900) ;Abdulkader, Rizwan Suliankatchi (57195295816) ;Abebe, Zegeye (57193002719) ;Abera, Semaw F. (57205180598) ;Abil, Olifan Zewdie (57204558002) ;Abraha, Haftom Niguse (57195289877) ;Abu-Raddad, Laith Jamal (14032724700) ;Abu-Rmeileh, Niveen M.E. (57216675148) ;Accrombessi, Manfred Mario Kokou (55353650500) ;Acharya, Dilaram (56770895600) ;Acharya, Pawan (56435749900) ;Ackerman, Ilana N. 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(57201445180) ;Wang, Yafeng (57208674780) ;Wang, Yuan-Pang (8576812100) ;Weiderpass, Elisabete (57205018947) ;Weintraub, Robert G. (7006079405) ;Weiss, Daniel J. (8609275600) ;Weldegebreal, Fitsum (56112812300) ;Weldegwergs, Kidu Gidey (57203308107) ;Werdecker, Andrea (57208964895) ;West, T. Eoin (57756844000) ;Whiteford, Harvey A. (55906494000) ;Widecka, Justyna (15047205800) ;Wijeratne, Tissa (14051317700) ;Wilner, Lauren B. (57193699787) ;Wilson, Shadrach (57204557765) ;Winkler, Andrea Sylvia (58323746700) ;Wiyeh, Alison B. (57196222987) ;Wiysonge, Charles Shey (6507441509) ;Wolfe, Charles D.A. (57202754705) ;Woolf, Anthony D. (7102882171) ;Wu, Shouling (57744442000) ;Wu, Yun-Chun (56095674500) ;Wyper, Grant M.A. (56503829800) ;Xavier, Denis (55403963100) ;Xu, Gelin (57203583113) ;Yadgir, Simon (57192837280) ;Yadollahpour, Ali (57204564896) ;Yahyazadeh Jabbari, Seyed Hossein (26029029100) ;Yamada, Tomohide (37662679800) ;Yan, Lijing L. (57198311895) ;Yano, Yuichiro (57196965200) ;Yaseri, Mehdi (23029507000) ;Yasin, Yasin Jemal (57204565144) ;Yeshaneh, Alex (57204564144) ;Yimer, Ebrahim M. (57202256312) ;Yip, Paul (7102503720) ;Yisma, Engida (55556060700) ;Yonemoto, Naohiro (57204947657) ;Yoon, Seok-Jun (24823148900) ;Yotebieng, Marcel (26325950800) ;Younis, Mustafa Z. (8549393000) ;Yousefifard, Mahmoud (57204566585) ;Yu, Chuanhua (57208140344) ;Zadnik, Vesna (57202975428) ;Zaidi, Zoubida (57197376721) ;Zaman, Sojib Bin (57193070058) ;Zamani, Mohammad (59866744200) ;Zare, Zohreh (35436578700)Zeleke, Ayalew Jejaw (57193096860)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 1400 [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. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. - Some of the metrics are blocked by yourconsent settings
Publication Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the global burden of disease study 2015(2017) ;Barber, Ryan M. (57202560423) ;Fullman, Nancy (57211064970) ;Sorensen, Reed J.D. (57196918748) ;Bollyky, Thomas (36677045500) ;McKee, Martin (7202304775) ;Nolte, Ellen (7005556106) ;Abajobir, Amanuel Alemu (57203613441) ;Abate, Kalkidan Hassen (57207943858) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. (57190285707) ;Abd-Allah, Foad (36503428900) ;Abdulle, Abdishakur M. (6603592018) ;Abdurahman, Ahmed Abdulahi (56677630600) ;Abera, Semaw Ferede (57205180598) ;Abraham, Biju (57202568691) ;Abreha, Girmatsion Fisseha (6504124710) ;Adane, Kelemework (57202841698) ;Adelekan, Ademola Lukman (57216109261) ;Adetifa, Ifedayo Morayo O. (13609887500) ;Afshin, Ashkan (57217465455) ;Agarwal, Arnav (56865159500) ;Agarwal, Sanjay Kumar (7403190321) ;Agarwal, Sunilkumar (57213773193) ;Agrawal, Anurag (35214460700) ;Ahmad Kiadaliri, Aliasghar (57199100665) ;Ahmadi, Alireza (56336080700) ;Ahmed, Kedir Yimam (57190386244) ;Ahmed, Muktar Beshir (57207802317) ;Akinyemi, Rufus Olusola (25633566800) ;Akinyemiju, Tomi F. (57202561503) ;Akseer, Nadia (57207801968) ;Al-Aly, Ziyad (9738161500) ;Alam, Khurshid (57203681299) ;Alam, Noore (57202437697) ;Alam, Sayed Saidul (56809534300) ;Alemu, Zewdie Aderaw (57202557784) ;Alene, Kefyalew Addis (57202583764) ;Alexander, Lily (57222226543) ;Ali, Raghib (57196506541) ;Ali, Syed Danish (57191597869) ;Alizadeh-Navaei, Reza (36024974700) ;Alkerwi, Ala'a (57197724313) ;Alla, François (6701580827) ;Allebeck, Peter (7005187575) ;Allen, Christine (57200170678) ;Al-Raddadi, Rajaa (57219673720) ;Alsharif, Ubai (57211633255) ;Altirkawi, Khalid A. 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Arthur (57209842037) ;Ayala Quintanilla, Beatriz Paulina (55598298700) ;Awasthi, Ashish (57200155811) ;Ayele, Nebiyu Negussu (57195329447) ;Azzopardi, Peter (56861081000) ;Ba Saleem, Huda Omer (36704374300) ;Bärnighausen, Till (23011726900) ;Bacha, Umar (57200173721) ;Badawi, Alaa (57216776029) ;Banerjee, Amitava (57208560645) ;Barac, Aleksandra (55550748700) ;Barboza, Miguel A. (56650777100) ;Barker-Collo, Suzanne L. (57193065514) ;Barrero, Lope H. (57208560675) ;Basu, Sanjay (9335409500) ;Baune, Bernhard T. (6603807336) ;Baye, Kaleab (15724300900) ;Bayou, Yibeltal Tebekaw (57202895869) ;Bazargan-Hejazi, Shahrzad (57205912040) ;Bedi, Neeraj (57988442200) ;Beghi, Ettore (7004809655) ;Béjot, Yannick (14038743100) ;Bello, Aminu K. (12759638700) ;Bennett, Derrick A. (57650836400) ;Bensenor, Isabela M. 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(35769124700) ;Castillo Rivas, Jacqueline (57197814657) ;Catalá-López, Ferrán (57202553733) ;Cecilio, Pedro (56450999300) ;Cercy, Kelly (57208777587) ;Charlson, Fiona J. (57191632086) ;Chen, Alan Z. (57212272676) ;Chew, Adrienne (57209171085) ;Chibalabala, Mirriam (57202553736) ;Chibueze, Chioma Ezinne (57244744000) ;Chisumpa, Vesper Hichilombwe (56761895800) ;Chitheer, Abdulaal A. (57209314488) ;Chowdhury, Rajiv (57216138475) ;Christensen, Hanne (57202099623) ;Christopher, Devasahayam Jesudas (57209863533) ;Ciobanu, Liliana G. (57201603453) ;Cirillo, Massimo (35247478400) ;Coggeshall, Megan S. (56132969600) ;Cooper, Leslie Trumbull (15754277900) ;Cortinovis, Monica (57207893885) ;Crump, John A. (57202595111) ;Dalal, Koustuv (23469128200) ;Danawi, Hadi (57201079895) ;Dandona, Lalit (7007017243) ;Dandona, Rakhi (57203043697) ;Dargan, Paul I. (57212154356) ;Das Neves, Jose (57208073193) ;Davey, Gail (7102000901) ;Davitoiu, Dragos V. 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(57226213785) ;Farinha, Carla Sofia E. Sa (57190279273) ;Faro, Andre (36770969600) ;Farvid, Maryam S. (57216534761) ;Farzadfar, Farshad (57195049611) ;Feigin, Valery L. (57203677957) ;Feigl, Andrea B. (57202461042) ;Fereshtehnejad, Seyed-Mohammad (57202557520) ;Fernandes, Jefferson G. (57220736619) ;Fernandes, João C. (35274726800) ;Feyissa, Tesfaye Regassa (57222562476) ;Fischer, Florian (55508208800) ;Fitzmaurice, Christina (57212628757) ;Fleming, Thomas D. (57222727747) ;Foigt, Nataliya (57216998893) ;Foreman, Kyle J. (57209064414) ;Forouzanfar, Mohammad H. (57202562738) ;Franklin, Richard C. (7201428429) ;Frostad, Joseph (57222306717) ;Ghiwot, Tsegaye Tewelde (57195446566) ;Gakidou, Emmanuela (57202567277) ;Gambashidze, Ketevan (13610194000) ;Gamkrelidze, Amiran (6506029209) ;Gao, Wayne (57194140360) ;Garcia-Basteiro, Alberto L. (57200187168) ;Gebre, Teshome (57202565005) ;Gebremedhin, Amanuel Tesfay (57202566187) ;Gebremichael, Mengistu Welday (57195329489) ;Gebru, Alemseged Aregay (57196196083) ;Gelaye, Amha Admasie (56609274200) ;Geleijnse, Johanna M. (35195702500) ;Genova-Maleras, Ricard (15070563900) ;Gibney, Katherine B. (57202564104) ;Giref, Ababi Zergaw (57219994468) ;Gishu, Melkamu Dedefo (57202568734) ;Giussani, Giorgia (57200843076) ;Godwin, William W. (57191841675) ;Gold, Audra (57194129483) ;Goldberg, Ellen M. (57191842703) ;Gona, Philimon N. (57219703762) ;Goodridge, Amador (55801980200) ;Gopalani, Sameer Vali (57190277891) ;Goto, Atsushi (36339255500) ;Graetz, Nicholas (56276346000) ;Greaves, Felix (57211346256) ;Griswold, Max (57191836595) ;Guban, Peter Imre (57200816495) ;Gugnani, Harish Chander (7005567008) ;Gupta, Prakash C. (58767181900) ;Gupta, Rahul (57204120071) ;Gupta, Rajeev (55705295300) ;Gupta, Tanush (57219956402) ;Gupta, Vipin (57199940653) ;Habtewold, Tesfa Dejenie (57079013900) ;Hafezi-Nejad, Nima (57216814261) ;Haile, Demewoz (40861134200) ;Hailu, Alemayehu Desalegne (57225733572) ;Hailu, Gessessew Bugssa (57219637263) ;Hakuzimana, Alex (40761558700) ;Hamadeh, Randah Ribhi (57202769526) ;Hambisa, Mitiku Teshome (57203666810) ;Hamidi, Samer (24366336000) ;Hammami, Mouhanad (57216961083) ;Hankey, Graeme J. (7102816661) ;Hao, Yuantao (57202554333) ;Harb, Hilda L. (57221443122) ;Hareri, Habtamu Abera (57195292447) ;Haro, Josep Maria (57215877903) ;Hassanvand, Mohammad Sadegh (35085056400) ;Havmoeller, Rasmus (57212075728) ;Hay, Roderick J. (56785229200) ;Hay, Simon I. (7101875313) ;Hendrie, Delia (6602071966) ;Heredia-Pi, Ileana Beatriz (36941085200) ;Hoek, Hans W. (57202570421) ;Horino, Masako (57195769276) ;Horita, Nobuyuki (57217110823) ;Hosgood, H. Dean (56353204400) ;Htet, Aung Soe (57202555179) ;Hu, Guoqing (57218106596) ;Huang, Hsiang (57202278530) ;Huang, John J. (56135699200) ;Huntley, Bethany M. (57195329465) ;Huynh, Chantal (57202556112) ;Iburg, Kim Moesgaard (57216814160) ;Ileanu, Bogdan Vasile (57202148423) ;Innos, Kaire (57217314902) ;Irenso, Asnake Ararsa (57195329443) ;Jahanmehr, Nader (57203122718) ;Jakovljevic, Mihajlo B. (14318929700) ;James, Peter (7402640931) ;James, Spencer Lewis (57202557998) ;Javanbakht, Mehdi (57204619886) ;Jayaraman, Sudha P. (57204716526) ;Jayatilleke, Achala Upendra (23389151200) ;Jeemon, Panniyammakal (57216324831) ;Jha, Vivekanand (7005119423) ;John, Denny (57194230095) ;Johnson, Catherine (57212301236) ;Johnson, Sarah C. (57207904886) ;Jonas, Jost B. (7202492953) ;Juel, Knud (7005077250) ;Kabir, Zubair (57207901718) ;Kalkonde, Yogeshwar (57200250807) ;Kamal, Ritul (57203177242) ;Kan, Haidong (7101602991) ;Karch, Andre (57223444197) ;Karema, Corine Kakizi (57202557522) ;Karimi, Seyed M. (57220096578) ;Kasaeian, Amir (57195540738) ;Kassebaum, Nicholas J. (57202562224) ;Kastor, Anshul (56652275600) ;Katikireddi, Srinivasa Vittal (6508254091) ;Kazanjan, Konstantin (57193091626) ;Keiyoro, Peter Njenga (57203177260) ;Kemmer, Laura (57205017265) ;Kemp, Andrew Haddon (57218313462) ;Kengne, Andre Pascal (7801322838) ;Kerbo, Amene Abebe (57195329387) ;Kereselidze, Maia (55659152900) ;Kesavachandran, Chandrasekharan Nair (57218000521) ;Khader, Yousef Saleh (55654192600) ;Khalil, Ibrahim (58255049500) ;Khan, Abdur Rahman (55520620000) ;Khan, Ejaz Ahmad (57218791274) ;Khan, Gulfaraz (6701635515) ;Khang, Young-Ho (57198904674) ;Khoja, Abdullah Tawfih Abdullah (57194229795) ;Khonelidze, Irma (57202287317) ;Khubchandani, Jagdish (57211720011) ;Kibret, Getiye Dejenu (57194615380) ;Kim, Daniel (57223019104) ;Kim, Pauline (57191593761) ;Kim, Yun Jin (57211086375) ;Kimokoti, Ruth W. 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(57202559142) ;Larsson, Anders (56381985300) ;Laryea, Dennis Odai (57201281307) ;Latif, Asma Abdul (57201620992) ;Lawrynowicz, Alicia Elena Beatriz (57202559908) ;Leasher, Janet L. (57197789738) ;Leigh, James (7202089604) ;Leinsalu, Mall (6603447541) ;Leshargie, Cheru Tesema (57195295462) ;Leung, Janni (57214397752) ;Leung, Ricky (56276497100) ;Levi, Miriam (54893035000) ;Liang, Xiaofeng (26662590300) ;Lim, Stephen S. (57201800433) ;Lind, Margaret (57189271761) ;Linn, Shai (7102590173) ;Lipshultz, Steven E. (7006950713) ;Liu, Patrick (56170368200) ;Liu, Yang (57202561981) ;Lo, Loon-Tzian (57214204231) ;Logroscino, Giancarlo (7004888005) ;Lopez, Alan D. (7401455668) ;Lorch, Scott A. (6701858100) ;Lotufo, Paulo A. (7003331101) ;Lozano, Rafael (7102198442) ;Lunevicius, Raimundas (57216165063) ;Lyons, Ronan A. (55574561400) ;Macarayan, Erlyn Rachelle King (56330601800) ;Mackay, Mark T. 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(55481130700)Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd. - Some of the metrics are blocked by yourconsent settings
Publication Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17(2020) ;Deshpande, Aniruddha (57208579336) ;Miller-Petrie, Molly K. (56387657900) ;Lindstedt, Paulina A. (57211558396) ;Baumann, Mathew M. (57211550981) ;Johnson, Kimberly B. (57207359220) ;Blacker, Brigette F. (57202420381) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdelalim, Ahmed (7801307783) ;Abdollahpour, Ibrahim (36997151900) ;Abegaz, Kedir Hussein (57200726326) ;Abejie, Ayenew Negesse (57203015573) ;Abreu, Lucas Guimarães (55937631400) ;Abrigo, Michael R. M. (56018773400) ;Abualhasan, Ahmed (57211135523) ;Accrombessi, Manfred Mario Kokou (55353650500) ;Adamu, Abdu A. (57202024381) ;Adebayo, Oladimeji M. (57194329853) ;Adedeji, Isaac Akinkunmi (57208456508) ;Adedoyin, Rufus Adesoji (55947572800) ;Adekanmbi, Victor (53463192900) ;Adetokunboh, Olatunji O. 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(23026328100) ;Uzochukwu, Benjamin S. Chudi (57211633289) ;Valdez, Pascual R. (57202115577) ;Varughese, Santosh (22942817500) ;Veisani, Yousef (55370882600) ;Violante, Francesco S. (7003555890) ;Vollmer, Sebastian (24460878700) ;Whawariat, Feleke Gebremeskel (57220760447) ;Waheed, Yasir (35303643700) ;Wallin, Mitchell Taylor (57201573668) ;Wang, Yuan-Pang (8576812100) ;Wang, Yafeng (57208674780) ;Wangdi, Kinley (36469592800) ;Weiss, Daniel J. (8609275600) ;Weldesamuel, Girmay Teklay (57211811032) ;Werkneh, Adhena Ayaliew (57195675398) ;Westerman, Ronny (57218361023) ;Wiangkham, Taweewat (56829456300) ;Wiens, Kirsten E. (55515807800) ;Wijeratne, Tissa (14051317700) ;Wiysonge, Charles Shey (6507441509) ;Wolde, Haileab Fekadu (57199530258) ;Wondafrash, Dawit Zewdu (57207771936) ;Wonde, Tewodros Eshete (57207759070) ;Worku, Getasew Taddesse (57218197319) ;Yadollahpour, Ali (57204564896) ;Jabbari, Seyed Hossein Yahyazadeh (57207954055) ;Yamada, Tomohide (37662679800) ;Yaseri, Mehdi (23029507000) ;Yatsuya, Hiroshi (6603908304) ;Yeshaneh, Alex (57204564144) ;Yilma, Mekdes Tigistu (57212019529) ;Yip, Paul (7102503720) ;Yisma, Engida (55556060700) ;Yonemoto, Naohiro (57204947657) ;Younis, Mustafa Z. (8549393000) ;Yousof, Hebat-Allah Salah A. (56183368000) ;Yu, Chuanhua (57208140344) ;Yusefzadeh, Hasan (55887807200) ;Zadey, Siddhesh (57188589258) ;Moghadam, Telma Zahirian (57201718494) ;Zaidi, Zoubida (57197376721) ;Zaman, Sojib Bin (57193070058) ;Zamani, Mohammad (57096222300) ;Zandian, Hamed (57205175627) ;Zar, Heather J. (7006236599) ;Zerfu, Taddese Alemu (55358278900) ;Zhang, Yunquan (56568510200) ;Ziapour, Arash (57202571078) ;Zodpey, Sanjay (7003415080) ;Zuniga, Yves Miel H. (57194979049) ;Hay, Simon I. (7101875313)Reiner, Robert C. (57203229088)Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. - Some of the metrics are blocked by yourconsent settings
Publication Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017(2020) ;Troeger, Christopher E. (57195223624) ;Khalil, Ibrahim A. (58255049500) ;Blacker, Brigette F. (57202420381) ;Biehl, Molly H. (57196041812) ;Albertson, Samuel B. (57204573505) ;Zimsen, Stephanie R.M. (57196078433) ;Rao, Puja C. (57191835613) ;Abate, Degu (57204237665) ;Admasie, Amha (56609274200) ;Ahmadi, Alireza (56336080700) ;Ahmed, Mohamed Lemine Cheikh Brahim (57258605600) ;Akal, Chalachew Genet (57205385708) ;Alahdab, Fares (55135922900) ;Alam, Noore (57202437697) ;Alene, Kefyalew Addis (57202583764) ;Alipour, Vahid (56436629300) ;Aljunid, Syed Mohamed (6504304159) ;Al-Raddadi, Rajaa M. (57219673720) ;Alvis-Guzman, Nelson (57210741239) ;Amini, Saeed (57210811281) ;Anjomshoa, Mina (57204563282) ;Antonio, Carl Abelardo T. (55247644500) ;Arabloo, Jalal (57208760927) ;Aremu, Olatunde (57214958833) ;Atalay, Hagos Tasew (57203535974) ;Atique, Suleman (56505419100) ;Avokpaho, Euripide F.G.A. (57209842037) ;Awad, Samah (57192660810) ;Awasthi, Ashish (58420926700) ;Badawi, Alaa (57216776029) ;Balakrishnan, Kalpana (7103222725) ;Banoub, Joseph Adel Mattar (57204568975) ;Barac, Aleksandra (55550748700) ;Bassat, Quique (23024176000) ;Bedi, Neeraj (57988442200) ;Bennett, Derrick A. (57650836400) ;Bhattacharyya, Krittika (57204647266) ;Bhutta, Zulfiqar A. (24342648300) ;Bijani, Ali (23134684900) ;Bills, Corey B. (24528417100) ;Car, Josip (6701783618) ;Carvalho, Félix (7103070417) ;Castañeda-Orjuela, Carlos A. (35769124700) ;Causey, Kate (57204560479) ;Christopher, Devasahayam J. (57209863533) ;Cohen, Aaron J. (7404780942) ;Dandona, Lalit (7007017243) ;Dandona, Rakhi (57203043697) ;Daryani, Ahmad (16021522200) ;Demeke, Feleke Mekonnen (57204717669) ;Djalalinia, Shirin (37113718000) ;Dubey, Manisha (57219898654) ;Dubljanin, Eleonora (55957442600) ;Duken, Eyasu Ejeta (57204560558) ;Zaki, Maysaa El Sayed (57203666922) ;Endries, Aman Yesuf (57216324852) ;Fernandes, Eduarda (34770207500) ;Fischer, Florian (55508208800) ;Frostad, Joseph (57222306717) ;Fullman, Nancy (57211064970) ;Gardner, William M. (57204566870) ;Geta, Birhanu (57208190927) ;Ghadiri, Keyghobad (55409170000) ;Gorini, Giuseppe (56509988200) ;Goulart, Alessandra C. (57201181348) ;Guo, Yuming (55712472800) ;Hailu, Gessessew Bugssa (57219637263) ;Haj-Mirzaian, Arvin (57210768364) ;Haj-Mirzaian, Arya (57226201352) ;Hamidi, Samer (24366336000) ;Hassen, Hamid Yimam (57188660707) ;Hoang, Chi Linh (57205123375) ;Horita, Nobuyuki (57217110823) ;Hostiuc, Mihaela (51763789200) ;Hussain, Zakir (59269161900) ;Irvani, Seyed Sina Naghibi (57202975543) ;James, Spencer L. (57202557998) ;Jha, Ravi Prakash (58586863400) ;Jonas, Jost B. (7202492953) ;Karch, André (57223444197) ;Kasaeian, Amir (57195540738) ;Kassa, Tesfaye Dessale (58686045600) ;Kassebaum, Nicholas J. (57202562224) ;Kefale, Adane Teshome (57194507694) ;Khader, Yousef Saleh (55654192600) ;Khan, Ejaz Ahmad (57218791274) ;Khan, Gulfaraz (6701635515) ;Khan, Md Nuruzzaman (57209404949) ;Khang, Young-Ho (57198904674) ;Khoja, Abdullah T. (57203306097) ;Kimokoti, Ruth W. (8647554600) ;Kisa, Adnan (6603346067) ;Kisa, Sezer (14030019900) ;Kissoon, Niranjan (7006364038) ;Knibbs, Luke D. (16313525200) ;Kochhar, Sonali (57214107714) ;Kosen, Soewarta (57211346192) ;Koul, Parvaiz A. (14022262900) ;Koyanagi, Ai (57197741912) ;Defo, Barthelemy Kuate (6602271655) ;Anil Kumar, G. (57139550500) ;Lal, Dharmesh Kumar (57222488984) ;Leshargie, Cheru Tesema (57195295462) ;Lewycka, Sonia (57212496031) ;Li, Shanshan (57216631901) ;Lodha, Rakesh (7007019609) ;MacArayan, Erlyn Rachelle King (56330601800) ;Majdan, Marek (36147855100) ;Mamun, Abdullah A. (55666602500) ;Manguerra, Helena (57208121153) ;Mehta, Varshil (57158753300) ;Melese, Addisu (56901393600) ;Memish, Ziad A. (7005059350) ;Mengistu, Desalegn Tadese (57194776802) ;Meretoja, Tuomo J. (57202554188) ;Mestrovic, Tomislav (6507240107) ;Miazgowski, Bartosz (56857536900) ;Mirrakhimov, Erkin M. (57216202888) ;Moazen, Babak (57204324006) ;Mohammad, Karzan Abdulmuhsin (57205300378) ;Mohammed, Shafiu (57838689000) ;Monasta, Lorenzo (7801520497) ;Moore, Catrin E. (57195934063) ;Morawska, Lidia (7004773965) ;Mosser, Jonathan F. (56111776300) ;Mousavi, Seyyed Meysam (56165159700) ;Murthy, Srinivas (36247670800) ;Mustafa, Ghulam (57190395960) ;Nazari, Javad (57207759174) ;Nguyen, Cuong Tat (56531347200) ;Nguyen, Huong Lan Thi (57226837406) ;Nguyen, Long Hoang (56567321800) ;Nguyen, Son Hoang (59662830400) ;Nielsen, Katie R. (59847898200) ;Nisar, Muhammad Imran (57191774461) ;Nixon, Molly R. (57204562047) ;Ogbo, Felix Akpojene (57200737136) ;Okoro, Anselm (54682112200) ;Olagunju, Andrew T. (26029995700) ;Olagunju, Tinuke O. (57203076824) ;Oren, Eyal (36815569400) ;Ortiz, Justin R. (57201758478) ;Mahesh, P.A. (57202421244) ;Pakhale, Smita (57220937499) ;Postma, Maarten J. (7006296502) ;Qorbani, Mostafa (24831040300) ;Quansah, Reginald (14825606700) ;Rafiei, Alireza (13205769200) ;Rahim, Fakher (23052247800) ;Rahimi-Movaghar, Vafa (6507646446) ;Rai, Rajesh Kumar (51864423900) ;Reitsma, Marissa Bettay (57208766315) ;Rezai, Mohammad Sadegh (55273796300) ;Rezapour, Aziz (55548281300) ;Rios-Blancas, Maria Jesus (57208577330) ;Ronfani, Luca (6602565620) ;Rothenbacher, Dietrich (7004765162) ;Rubino, Salvatore (55240504800) ;Saleem, Zikria (56179814800) ;Sambala, Evanson Zondani (36718133800) ;Samy, Abdallah M. (36973661300) ;Milicevic, Milena M. Santric (57211144346) ;Sarmiento-Suárez, Rodrigo (57204744430) ;Sartorius, Benn (12788526800) ;Savic, Miloje (57204524150) ;Sawhney, Monika (57217153893) ;Saxena, Sonia (57203151746) ;Sbarra, Alyssa (57200546253) ;Seyedmousavi, Seyedmojtaba (57204698893) ;Shaikh, Masood Ali (57203122601) ;Sheikh, Aziz (7202522962) ;Shigematsu, Mika (23968093000) ;Smith, David L. (55574206203) ;Sreeramareddy, Chandrashekhar T. (57212263335) ;Stanaway, Jeffrey D. (57201210928) ;Sufiyan, Mu awiyyah Babale (58294633600) ;Temsah, Mohamad-Hani (56115852000) ;Tessema, Belay (20735503600) ;Tran, Bach Xuan (57209107515) ;Tran, Khanh Bao (57201651536) ;Tsadik, Afewerki Gebremeskel (57204562442) ;Ullah, Irfan (56992676600) ;Updike, Rachel L. (57204698680) ;Vasankari, Tommi Juhani (57200592416) ;Veisani, Yousef (55370882600) ;Wada, Fiseha Wadilo (57194049305) ;Waheed, Yasir (35303643700) ;Welgan, Katie (57212487910) ;Wiens, Kirsten E. (55515807800) ;Wiysonge, Charles Shey (6507441509) ;Yimer, Ebrahim M. (57204849530) ;Yonemoto, Naohiro (57204947657) ;Zaidi, Zoubida (57197376721) ;Zar, Heather J. (7006236599) ;Lim, Stephen S. (57201800433) ;Vos, Theo (57223885848) ;Mokdad, Ali H. (7004813962) ;Murray, Christopher J.L. (55481130700) ;Kyu, Hmwe Hmwe (57217040073) ;Hay, Simon I. (7101875313)Reiner, Robert C. (57203229088)Background: Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods: We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings: In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation: Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4·0 license
