Browsing by Author "Sorensen, Reed J.D. (57196918748)"
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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. 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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 Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))(2019) ;Stanaway, Jeffrey D. (57201210928) ;Afshin, Ashkan (57217465455) ;Gakidou, Emmanuela (57202567277) ;Lim, Stephen S. (7404081544) ;Abate, Degu (57204237665) ;Abate, Kalkidan Hassen (57207943858) ;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) ;Abera, Semaw F. 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(6505920990) ;Tabarés-Seisdedos, Rafael (6602981102) ;Tabuchi, Takahiro (55177892400) ;Tadakamadla, Santosh Kumar (57207799926) ;Takahashi, Ken (55741242600) ;Tandon, Nikhil (7101833756) ;Tassew, Segen Gebremeskel (57204569108) ;Tavakkoli, Mohammad (57202524239) ;Taveira, Nuno (6602731390) ;Tehrani-Banihashemi, Arash (57204006020) ;Tekalign, Tigist Gashaw (57204558037) ;Tekelemedhin, Shishay Wahdey (57204566273) ;Tekle, Merhawi Gebremedhin (57204237146) ;Temesgen, Habtamu (57205011874) ;Temsah, Mohamad-Hani (56115852000) ;Temsah, Omar (57204559820) ;Terkawi, Abdullah Sulieman (57211144258) ;Tessema, Belay (20735503600) ;Teweldemedhin, Mebrahtu (57193667629) ;Thankappan, Kavumpurathu Raman (57202955435) ;Theis, Andrew (57196076787) ;Thirunavukkarasu, Sathish (54407369300) ;Thomas, Hannah J. (55925904000) ;Thomas, Matthew Lloyd (57191835351) ;Thomas, Nihal (7401830494) ;Thurston, George D. (7102270013) ;Tilahun, Binyam (57212075730) ;Tillmann, Taavi (57190211142) ;To, Quyen G. (55827789100) ;Tobollik, Myriam (56549045300) ;Tonelli, Marcello (7103102534) ;Topor-Madry, Roman (57211182892) ;Torre, Anna E. (57196074351) ;Tortajada-Girbés, Miguel (16242320900) ;Touvier, Mathilde (8877033300) ;Tovani-Palone, Marcos Roberto (56644977900) ;Towbin, Jeffrey A. (7102520568) ;Tran, Bach Xuan (57209107515) ;Tran, Khanh Bao (57201651536) ;Truelsen, Thomas Clement (57202824565) ;Truong, Nu Thi (57204178907) ;Tsadik, Afewerki Gebremeskel (57204562442) ;Tudor Car, Lorainne (48561867100) ;Tuzcu, E. Murat (7005951350) ;Tymeson, Hayley D. (57194139009) ;Tyrovolas, Stefanos (57207793475) ;Ukwaja, Kingsley N. (57202824584) ;Ullah, Irfan (56992676600) ;Updike, Rachel L. (57204698680) ;Usman, Muhammad Shariq (57203046075) ;Uthman, Olalekan A. (23026328100) ;Vaduganathan, Muthiah (16417973600) ;Vaezi, Afsane (55698015300) ;Valdez, Pascual R. (57202115577) ;Van Donkelaar, Aaron (15926418500) ;Varavikova, Elena (7801408611) ;Varughese, Santosh (22942817500) ;Vasankari, Tommi Juhani (23096834700) ;Venkateswaran, Vidhya (59829999400) ;Venketasubramanian, Narayanaswamy (56804702100) ;Villafaina, Santos (57195804127)Violante, Francesco S. (7003555890)Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. 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 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. (57190285707) ;Abd-Allah, Foad (36503428900) ;Abera, Semaw Ferede (57205180598) ;Aboyans, Victor (56214736500) ;Adetokunboh, Olatunji (56598104300) ;Ärnlöv, Johan (6602512227) ;Afshin, Ashkan (57217465455) ;Agrawal, Anurag (35214460700) ;Kiadaliri, Aliasghar Ahmad (57199100665) ;Ahmadi, Alireza (56336080700) ;Ahmed, Muktar Beshir (57207802317) ;Aichour, Amani Nidhal (57195486768) ;Aichour, Ibtihel (57195485980) ;Aichour, Miloud Taki Eddine (57195488258) ;Aiyar, Sneha (57216813717) ;Al-Eyadhy, Ayman (24554080400) ;Alahdab, Fares (55135922900) ;Al-Aly, Ziyad (9738161500) ;Alam, Khurshid (57203681299) ;Alam, Noore (57202437697) ;Alam, Tahiya (57205589820) ;Alene, Kefyalew Addis (57202583764) ;Ali, Syed Danish (57191597869) ;Alizadeh-Navaei, Reza (36024974700) ;Alkaabi, Juma M. 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(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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(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 comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016(2017) ;Gakidou, Emmanuela (57202567277) ;Afshin, Ashkan (57217465455) ;Abajobir, Amanuel Alemu (57203613441) ;Abate, Kalkidan Hassen (57207943858) ;Abbafati, Cristiana (54917122400) ;Abbas, Kaja M. (57190285707) ;Abd-Allah, Foad (36503428900) ;Abdulle, Abdishakur M. (6603592018) ;Abera, Semaw Ferede (57205180598) ;Aboyans, Victor (56214736500) ;Abu-Raddad, Laith J. (14032724700) ;Abu-Rmeileh, Niveen M.E. 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(8549393000) ;Zaidi, Zoubida (57197376721) ;El Sayed Zaki, Maysaa (57203666922) ;Zavala-Arciniega, Luis (57196083471) ;Zhang, Xueying (56283378700) ;Zimsen, Stephanie Raman M. (57196078433) ;Zipkin, Ben (57200737130) ;Zodpey, Sanjay (7003415080) ;Lim, Stephen S. (57201800433)Murray, Christopher J.L. (55481130700)Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings: Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124.1 million DALYs [95% UI 111.2 million to 137.0 million]), high systolic blood pressure (122.2 million DALYs [110.3 million to 133.3 million], and low birthweight and short gestation (83.0 million DALYs [78.3 million to 87.7 million]), and for women, were high systolic blood pressure (89.9 million DALYs [80.9 million to 98.2 million]), high body-mass index (64.8 million DALYs [44.4 million to 87.6 million]), and high fasting plasma glucose (63.8 million DALYs [53.2 million to 76.3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9.3% (6.9-11.6) decline in deaths and a 10.8% (8.3-13.1) decrease in DALYs at the global level, while population ageing accounts for 14.9% (12.7-17.5) of deaths and 6.2% (3.9-8.7) of DALYs, and population growth for 12.4% (10.1-14.9) of deaths and 12.4% (10.1-14.9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27.3% (24.9-29.7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation: Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. © The Author(s). Published by Elsevier Ltd. - 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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(57193559189) ;Ghajar, Alireza (56226089600) ;Gibney, Katherine B. (57202564104) ;Gill, Paramjit Singh (7202766660) ;Gillum, Richard F. (7103181331) ;Ginawi, Ibrahim Abdelmageem Mohamed (57192378390) ;Giref, Ababi Zergay (57219994468) ;Gishu, Melkamu Dedefo (57202568734) ;Giussani, Giorgia (57200843076) ;Godwin, William W. (57191841675) ;Gold, Audra L. (57194129483) ;Goldberg, Ellen M. (57191842703) ;Gona, Philimon N. (57219703762) ;Goodridge, Amador (55801980200) ;Gopalani, Sameer Vali (57190277891) ;Goto, Atsushi (36339255500) ;Goulart, Alessandra Carvalho (57201181348) ;Griswold, Max (57191836595) ;Gugnani, Harish Chander (7005567008) ;Gupta, Rahul (57204120071) ;Gupta, Rajeev (55705295300) ;Gupta, Tanush (57219956402) ;Gupta, Vipin (57199940653) ;Hafezi-Nejad, Nima (57216814261) ;Hailu, Alemayehu Desalegne (57225733572) ;Hailu, Gessessew Bugssa (57219637263) ;Hamadeh, Randah Ribhi (57202769526) ;Hamidi, Samer (24366336000) ;Handal, Alexis J. (57208977398) ;Hankey, Graeme J. (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. (26029163100) ;Jahanmehr, Nader (57203122718) ;Jakovljevic, Mihajlo B. (14318929700) ;Jassal, Simerjot K. (57190118903) ;Javanbakht, Mehdi (57204619886) ;Jayaraman, Sudha P. (57204716526) ;Jeemon, Panniyammakal (57216324831) ;Jensen, Paul N. (57224209864) ;Jha, Vivekanand (7005119423) ;Jiang, Guohong (56984997300) ;John, Denny (57194230095) ;Johnson, Catherine O. (57212301236) ;Johnson, Sarah Charlotte (57207904886) ;Jonas, Jost B. (7202492953) ;Jürisson, Mikk (55547524800) ;Kabir, Zubair (57207901718) ;Kadel, Rajendra (57196080325) ;Kahsay, Amaha (57216608121) ;Kamal, Ritul (57203177242) ;Kan, Haidong (7101602991) ;Karam, Nadim E. (57221993192) ;Karch, André (57223444197) ;Karema, Corine Kakizi (57202557522) ;Kasaeian, Amir (57195540738) ;Kassa, Getachew Mullu (56229895500) ;Kassaw, Nigussie Assefa (57196473578) ;Kassebaum, Nicholas J. (57202562224) ;Kastor, Anshul (56652275600) ;Katikireddi, Srinivasa Vittal (6508254091) ;Kaul, Anil (16156995700) ;Kawakami, Norito (35377339000) ;Keiyoro, Peter Njenga (57203177260) ;Kengne, Andre Pascal (7801322838) ;Keren, Andre (7005620132) ;Khader, Yousef Saleh (55654192600) ;Khalil, Ibrahim A. (58255049500) ;Khan, Ejaz Ahmad (57218791274) ;Khang, Young-Ho (57198904674) ;Khosravi, Ardeshir (57201190837) ;Khubchandani, Jagdish (57211720011) ;Kieling, Christian (57218820714) ;Kim, Daniel (57223019104) ;Kim, Pauline (57191593761) ;Kim, Yun Jin (57211086375) ;Kimokoti, Ruth W. (8647554600) ;Kinfu, Yohannes (12770281900) ;Kisa, Adnan (6603346067) ;Kissimova-Skarbek, Katarzyna A. (6508376962) ;Kivimaki, Mika (7004391239) ;Knudsen, Ann Kristin (57192966362) ;Kokubo, Yoshihiro (56155004000) ;Kolte, Dhaval (26321613900) ;Kopec, Jacek A. (7006284395) ;Kosen, Soewarta (57211346192) ;Koul, Parvaiz A. (14022262900) ;Koyanagi, Ai (57197741912) ;Kravchenko, Michael (57202569007) ;Krishnaswami, Sanjay (7101616028) ;Krohn, Kristopher J. (57194138806) ;Kuate Defo, Barthelemy (6602271655) ;Kucuk Bicer, Burcu (57204528360) ;Kumar, G. Anil (57139550500) ;Kumar, Pushpendra (57208849920) ;Kumar, Sanjiv (57202477407) ;Kyu, Hmwe H. (57217040073) ;Lal, Dharmesh Kumar (57222488984) ;Lalloo, Ratilal (57189334553) ;Lambert, Nkurunziza (57196083761) ;Lan, Qing (23970641100) ;Larsson, Anders (56381985300) ;Lavados, Pablo M. (57188955599) ;Leasher, Janet L. (57197789738) ;Lee, Jong-Tae (57196083400) ;Lee, Paul H. (57200302692) ;Leigh, James (7202089604) ;Leshargie, Cheru Tesema (57195295462) ;Leung, Janni (57214397752) ;Leung, Ricky (56276497100) ;Levi, Miriam (54893035000) ;Li, Yichong (57218426673) ;Li, Yongmei (56147667800) ;Li Kappe, Darya (57215878218) ;Liang, Xiaofeng (26662590300) ;Liben, Misgan Legesse (57188568119) ;Lim, Stephen S. (57201800433) ;Linn, Shai (7102590173) ;Liu, Angela (57196080772) ;Liu, Patrick Y. (56170368200) ;Liu, Shiwei (57209574351) ;Liu, Yang (57202561981) ;Lodha, Rakesh (7007019609) ;Logroscino, Giancarlo (7004888005) ;London, Stephanie J. (56988756100) ;Looker, Katharine J. (57202553673) ;Lopez, Alan D. (7401455668) ;Lorkowski, Stefan (57203677656) ;Lotufo, Paulo A. (7003331101) ;Low, Nicola (7006432437) ;Lozano, Rafael (7102198442) ;Lucas, Timothy C.D. (57216683591) ;Macarayan, Erlyn Rachelle King (56330601800) ;Magdy Abd El Razek, Hassan (57195948985) ;Magdy Abd El Razek, Mohammed (57201191366) ;Mahdavi, Mahdi (57190276959) ;Majdan, Marek (36147855100) ;Majdzadeh, Reza (9246620000) ;Majeed, Azeem (7102027801) ;Malekzadeh, Reza (7005197760) ;Malhotra, Rajesh (7202423297) ;Malta, Deborah Carvalho (15835283500) ;Mamun, Abdullah A. (55666602500) ;Manguerra, Helena (57208121153) ;Manhertz, Treh (57195486490) ;Mantilla, Ana (57215877671) ;Mantovani, Lorenzo G. (7006357517) ;Mapoma, Chabila C. (57208956832) ;Marczak, Laurie B. (57200295553) ;Martinez-Raga, Jose (57202861191) ;Martins-Melo, Francisco Rogerlândio (57204796807) ;Martopullo, Ira (57193550189) ;März, Winfried (57220877383) ;Mathur, Manu Raj (55270329300) ;Mazidi, Mohsen (57200232563) ;McAlinden, Colm (35325278500) ;McGaughey, Madeline (57206867033) ;McGrath, John J. (57202560550) ;McKee, Martin (7202304775) ;McNellan, Claire (56771422500) ;Mehata, Suresh (57211773159) ;Mehndiratta, Man Mohan (57202557864) ;Mekonnen, Tefera Chane (57193872649) ;Memiah, Peter (57217207827) ;Memish, Ziad A. (7005059350) ;Mendoza, Walter (57216905642) ;Mengistie, Mubarek Abera (56045752700) ;Mengistu, Desalegn Tadese (57194776802) ;Mensah, George A. (57196028147) ;Meretoja, Atte (12775885500) ;Meretoja, Tuomo J. (57202554188) ;Mezgebe, Haftay Berhane (57222113213) ;Micha, Renata (25632461800) ;Millear, Anoushka (57204879537) ;Miller, Ted R. (7403948600) ;Mills, Edward J. (57205301363) ;Mirarefin, Mojde (57222113397) ;Mirrakhimov, Erkin M. (57216202888) ;Misganaw, Awoke (57202808713) ;Mishra, Shiva Raj (57208010960) ;Mitchell, Philip B. (35354747000) ;Mohammad, Karzan Abdulmuhsin (57205300378) ;Mohammadi, Alireza (56720095000) ;Mohammed, Kedir Endris (57216551957) ;Mohammed, Shafiu (57838689000) ;Mohanty, Sanjay K. (59796713300) ;Mokdad, Ali H. (7004813962) ;Mollenkopf, Sarah K. (57203646247) ;Monasta, Lorenzo (7801520497) ;Hernandez, Julio Montañez (57199371040) ;Montico, Marcella (57202563609) ;Moradi-Lakeh, Maziar (35617421300) ;Moraga, Paula (46761426800) ;Mori, Rintaro (57072757600) ;Morozoff, Chloe (57190373716) ;Morrison, Shane D. (45661573100) ;Moses, Mark (57117385200) ;Mountjoy-Venning, Cliff (57196081878) ;Mruts, Kalayu Birhane (57221822877) ;Mueller, Ulrich O. (8512347500) ;Muller, Kate (57196075658) ;Murdoch, Michele E. (57202097865) ;Murthy, Gudlavalleti Venkata Satyanarayana (7101778322) ;Musa, Kamarul Imran (57194536466) ;Nachega, Jean B. (6701544088) ;Nagel, Gabriele (7103201623) ;Naghavi, Mohsen (57207906323) ;Naheed, Aliya (57202560989) ;Naidoo, Kovin S. (35564549000) ;Naldi, Luigi (7004954781) ;Nangia, Vinay (57201490837) ;Natarajan, Gopalakrishnan (55804491100) ;Negasa, Dumessa Edessa (57196084386) ;Negoi, Ionut (57200640014) ;Negoi, Ruxandra Irina (55566106200) ;Newton, Charles R. (35465836500) ;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) ;Nolte, Sandra (24073274400) ;Nong, Vuong Minh (55507077200) ;Norrving, Bo (12792377500) ;Noubiap, Jean Jacques N. (55490374000) ;O'Donnell, Martin J. (57210591242) ;Ogbo, Felix Akpojene (57200737136) ;Oh, In-Hwan (57204090669) ;Okoro, Anselm (54682112200) ;Oladimeji, Olanrewaju (57216495380) ;Olagunju, Andrew Toyin (26029995700) ;Olagunju, Tinuke Oluwasefunmi (57203076824) ;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) ;Osgood-Zimmerman, Aaron (57195835977) ;Osman, Majdi (59804857900) ;Owolabi, Mayowa O. (57222581892) ;Pa, Mahesh (57212735186) ;Pacella, Rosana E. (57194839077) ;Pana, Adrian (57191837583) ;Panda, Basant Kumar (57196077672) ;Papachristou, Christina (7005498635) ;Park, Eun-Kee (57216814178) ;Parry, Charles D. (7102561312) ;Parsaeian, Mahboubeh (57196467994) ;Patten, Scott B. (57201492915) ;Patton, George C. (7102184358) ;Paulson, Katherine (57203437789) ;Pearce, Neil (56491440700) ;Pereira, David M. (57200690024) ;Perico, Norberto (56481931200) ;Pesudovs, Konrad (7004576721) ;Peterson, Carrie Beth (57202568667) ;Petzold, Max (7003628893) ;Phillips, Michael Robert (57202563610) ;Pigott, David M. (55320335600) ;Pillay, Julian David (57197803061) ;Pinho, Christine (57212482983) ;Plass, Dietrich (57217142114) ;Pletcher, Martin A. (57196075669) ;Popova, Svetlana (56848085800) ;Poulton, Richie G. (7006256743) ;Pourmalek, Farshad (8309390500) ;Prabhakaran, Dorairaj (7004283783) ;Prasad, Narayan (23028765700) ;Prasad, Noela M. (8899838800) ;Purcell, Carrie (56203575500) ;Qorbani, Mostafa (24831040300) ;Quansah, Reginald (14825606700) ;Rabiee, Rynaz H.S. (57205452058) ;Radfar, Amir (57194428768) ;Rafay, Anwar (57212263323) ;Rahimi, Kazem (58482212900) ;Rahimi-Movaghar, Afarin (8696686900) ;Rahimi-Movaghar, Vafa (6507646446) ;Rahman, Mahfuzar (35571661300) ;Rahman, Mohammad Hifz Ur (57208867497) ;Rai, Rajesh Kumar (51864423900) ;Rajsic, Sasa (57196448260) ;Ram, Usha (26653819000) ;Ranabhat, Chhabi Lal (56719695500) ;Rankin, Zane (57200251742) ;Rao, Paturi Vishnupriya (7404661983) ;Rao, Puja C. (57191835613) ;Rawaf, Salman (6602475959) ;Ray, Sarah E. (57196078769) ;Reiner, Robert C. (57203229088) ;Reinig, Nikolas (57208577401) ;Reitsma, Marissa B. (57208766315) ;Remuzzi, Giuseppe (56466188600) ;Renzaho, Andre M.N. (6505786588) ;Resnikoff, Serge (7006012071) ;Rezaei, Satar (55791003000) ;Ribeiro, Antonio L. (7201676223) ;Ronfani, Luca (6602565620) ;Roshandel, Gholamreza (14034446800) ;Roth, Gregory A. (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. (16837503200) ;Steinke, Sabine (57203777687) ;Stokes, Mark Andrew (7102859000) ;Stovner, Lars Jacob (57201788390) ;Strub, Bryan (57211781720) ;Subart, Michelle (57194140438) ;Sufiyan, Muawiyyah Babale (58294633600) ;Suliankatchi Abdulkader, Rizwan (57195295816) ;Sunguya, Bruno F. (57209060557) ;Sur, Patrick J. (57218360398) ;Swaminathan, Soumya (7102380757) ;Sykes, Bryan L. (57211183396) ;Sylte, Dillon O. (57211183601) ;Tabarés-Seisdedos, Rafael (6602981102) ;Taffere, Getachew Redae (59807215200) ;Takala, Jukka S. (35425471300) ;Tandon, Nikhil (7101833756) ;Tavakkoli, Mohammad (57202524239) ;Taveira, Nuno (6602731390) ;Taylor, Hugh R. (55550572900) ;Tehrani-Banihashemi, Arash (57204006020) ;Tekelab, Tesfalidet (56721378300) ;Temam Shifa, Girma (57217000284) ;Terkawi, Abdullah Sulieman (57211144258) ;Tesfaye, Dawit Jember (59264414500) ;Tesssema, Belay (57195294962) ;Thamsuwan, Ornwipa (55484605700) ;Thomas, Katie E. (56239717800) ;Thrift, Amanda G. (7004824524) ;Tiruye, Tenaw Yimer (57194055872) ;Tobe-Gai, Ruoyan (57209276611) ;Tollanes, Mette C. (16833860000) ;Tonelli, Marcello (7103102534) ;Topor-Madry, Roman (57211182892) ;Tortajada, Miguel (16242320900) ;Touvier, Mathilde (8877033300) ;Tran, Bach Xuan (57209107515) ;Tripathi, Suryakant (57225821627) ;Troeger, Christopher (57195223624) ;Truelsen, Thomas (57202824565) ;Tsoi, Derrick (57196074984) ;Tuem, Kald Beshir (57216106503) ;Tuzcu, Emin Murat (7005951350) ;Tyrovolas, Stefanos (57207793475) ;Ukwaja, Kingsley N. (57202824584) ;Undurraga, Eduardo A. (57204092789) ;Uneke, Chigozie Jesse (57202824589) ;Updike, Rachel (57204698680) ;Uthman, Olalekan A. (23026328100) ;Uzochukwu, Benjamin S. Chudi (57211633289) ;Van Boven, Job F.M. (53464198500) ;Varughese, Santosh (22942817500) ;Vasankari, Tommi (23096834700) ;Venkatesh, S. (57201538443) ;Venketasubramanian, Narayanaswamy (56804702100) ;Vidavalur, Ramesh (57201445172) ;Violante, Francesco S. (7003555890) ;Vladimirov, Sergey K. (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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(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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(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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(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. 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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 Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016(2018) ;Fullman, Nancy (57211064970) ;Yearwood, Jamal (57202282849) ;Abay, Solomon M. (35306466900) ;Abbafati, Cristiana (54917122400) ;Abd-Allah, Foad (36503428900) ;Abdela, Jemal (57200613000) ;Abdelalim, Ahmed (7801307783) ;Abebe, Zegeye (57193002719) ;Abebo, Teshome Abuka (57195738441) ;Aboyans, Victor (56214736500) ;Abraha, Haftom Niguse (57195289877) ;Abreu, Daisy M.X. (9747083200) ;Abu-Raddad, Laith J. 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(57198311895) ;Yano, Yuichiro (57196965200) ;Yaseri, Mehdi (23029507000) ;Yimer, Nigus Bililign (57216264444) ;Yin, Peng (7103219312) ;Yip, Paul (7102503720) ;Yirsaw, Biruck Desalegn (49664327400) ;Yonemoto, Naohiro (57204947657) ;Yonga, Gerald (57203907041) ;Yoon, Seok-Jun (24823148900) ;Yotebieng, Marcel (26325950800) ;Younis, Mustafa Z. (8549393000) ;Yu, Chuanhua (57201889726) ;Zadnik, Vesna (57202975428) ;Zaidi, Zoubida (57197376721) ;El Sayed Zaki, Maysaa (57203666922) ;Zaman, Sojib Bin (57193070058) ;Zamani, Mohammad (57096222300) ;Zenebe, Zerihun Menlkalew (57200737185) ;Zhou, Maigeng (57054557200) ;Zhu, Jun (56215097100) ;Zimsen, Stephanie R.M. (57196078433) ;Zipkin, Ben (57200737130) ;Zodpey, Sanjay (7003415080) ;Zuhlke, Liesl Joanna (57209027746) ;Murray, Christopher J.L. (55481130700)Lozano, Rafael (7102198442)Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations. Copyright © 2018 The Author(s). Published by Elsevier Ltd. - Some of the metrics are blocked by yourconsent settings
Publication Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019(2020) ;Lozano, Rafael (7102198442) ;Fullman, Nancy (57211064970) ;Mumford, John Everett (57221821974) ;Knight, Megan (57218877591) ;Barthelemy, Celine M (57204563787) ;Abbafati, Cristiana (54917122400) ;Abbastabar, Hedayat (57212441848) ;Abd-Allah, Foad (36503428900) ;Abdollahi, Mohammad (57940559800) ;Abedi, Aidin (56673854800) ;Abolhassani, Hassan (58597704600) ;Abosetugn, Akine Eshete (57041277200) ;Abreu, Lucas Guimarães (55937631400) ;Abrigo, Michael R M (56018773400) ;Abu Haimed, Abdulaziz Khalid (57218875672) ;Abushouk, Abdelrahman I (57191479876) ;Adabi, Maryam (57190491886) ;Adebayo, Oladimeji M (57194329853) ;Adekanmbi, Victor (53463192900) ;Adelson, Jaimie (16678347700) ;Adetokunboh, Olatunji O (56598104300) ;Adham, Davoud (55346682700) ;Advani, Shailesh M 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Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation. © 2020 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
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(57220989340) ;Yigit, Arzu (57820497600) ;Yiğit, Vahit (57222328239) ;Yimaw, Ayenew Engida (57851194400) ;Yon, Dong Keon (57193675906) ;Yonemoto, Naohiro (57204947657) ;Yu, Chuanhua (57208140344) ;Zadey, Siddhesh (57188589258) ;Zahir, Mazyar (57226481652) ;Zare, Iman (57224488480) ;Zastrozhin, Mikhail Sergeevich (56728932200) ;Zastrozhina, Anasthasia (57210832491) ;Zhang, Zhi-Jiang (56068578400) ;Zhong, Chenwen (59289905900) ;Zmaili, Mohammad (57188702157) ;Zuniga, Yves Miel H. (57194979049)Gakidou, Emmanuela (57202567277)Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding: Bill & Melinda Gates Foundation. © 2022 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
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Obaidur (57222599251) ;Rahman, Mosiur (55457953000) ;Rahman, Muhammad Aziz (55327627600) ;Rahmani, Amir Masoud (57204588830) ;Rahmani, Shayan (57226290079) ;Rahmanian, Vahid (55367908800) ;Rajai, Nazanin (57203222349) ;Rajesh, Aashish (57193435213) ;Ram, Pradhum (55961669800) ;Ramezanzadeh, Kiana (57200621924) ;Rana, Juwel (57191591600) ;Ranabhat, Kamal (56622984700) ;Ranasinghe, Priyanga (6602322079) ;Rao, Chythra R. (35771430100) ;Rao, Sowmya J. (57195423591) ;Rashedi, Sina (57222342404) ;Rashidi, Amirfarzan (57719761500) ;Rashidi, Mahsa (57440729700) ;Rashidi, Mohammad-Mahdi (57324471900) ;Ratan, Zubair Ahmed (56769961300) ;Rawaf, David Laith (57209228052) ;Rawaf, Salman (6602475959) ;Rawal, Lal (37262106500) ;Rawassizadeh, Reza (36634807900) ;Razeghinia, Mohammad Sadegh (57203060460) ;Rehman, Ashfaq Ur (57218240182) ;Rehman, Inayat Ur (57201810654) ;Reitsma, Marissa B. (57208766315) ;Renzaho, Andre M.N. (6505786588) ;Rezaei, Maryam (57211678662) ;Rezaei, Nazila (36700192900) ;Rezaei, Negar (57218820767) ;Rezaei, Nima (57216077273) ;Rezaei, Saeid (57720486000) ;Rezaeian, Mohsen (15053682700) ;Rezapour, Aziz (55548281300) ;Riad, Abanoub (57218221621) ;Rikhtegar, Reza (55349287000) ;Rios-Blancas, Maria (57208577330) ;Roberts, Thomas J. (57190111163) ;Rohloff, Peter (55533870500) ;Romero-Rodríguez, Esperanza (57189989890) ;Roshandel, Gholamreza (14034446800) ;Rwegerera, Godfrey M. (56033523400) ;Manjula, S. (57405727400) ;Saber-Ayad, Maha Mohamed (36100701200) ;Saberzadeh-Ardestani, Bahar (57202441557) ;Sabour, Siamak (16307842100) ;Saddik, Basema (23020079300) ;Sadeghi, Erfan (56785668000) ;Saeb, Mohammad Reza (24833454900) ;Saeed, Umar (36612315100) ;Safaei, Mohsen (36612136800) ;Safary, Azam (56070686400) ;Sahebazzamani, Maryam (57350889700) ;Sahebkar, Amirhossein (26639699900) ;Sahoo, Harihar (44462008100) ;Sajid, Mirza Rizwan (35249305600) ;Salari, Hedayat (55508243600) ;Salehi, Sana (57209618440) ;Salem, Marwa Rashad (57194137372) ;Salimzadeh, Hamideh (23052386900) ;Samodra, Yoseph Leonardo (57363130700) ;Samy, Abdallah M. (36973661300) ;Sanabria, Juan (57226829732) ;Sankararaman, Senthilkumar (57210591338) ;Sanmarchi, Francesco (57221791070) ;Santric-Milicevic, Milena M. (57211144346) ;Saqib, Muhammad Arif Nadeem (57213570386) ;Sarveazad, Arash (54882387000) ;Sarvi, Fatemeh (57156400200) ;Sathian, Brijesh (27467953500) ;Satpathy, Maheswar (57202563691) ;Sayegh, Nicolas (57221718821) ;Schneider, Ione Jayce Ceola (57201292772) ;Schwarzinger, Michaël (6603951747) ;Šekerija, Mario (30268005400) ;Senthilkumaran, Subramanian (36191387000) ;Sepanlou, Sadaf G. (36248136000) ;Seylani, Allen (57222325334) ;Seyoum, Kenbon (57221085996) ;Sha, Feng (57190308655) ;Shafaat, Omid (55567483500) ;Shah, Pritik A. (57202065760) ;Shahabi, Saeed (57211581903) ;Shahid, Izza (57207033505) ;Shahrbaf, Mohammad Amin (57203360325) ;Shahsavari, Hamid R. (6505834447) ;Shaikh, Masood Ali (57203122601) ;Shaka, Mohammed Feyisso (57205107107) ;Shaker, Elaheh (57216727831) ;Shannawaz, Mohammed (56349680200) ;Sharew, Mequannent Melaku Sharew (57224505062) ;Sharifi, Azam (57189848279) ;Sharifi-Rad, Javad (56022647300) ;Sharma, Purva (57861896700) ;Shashamo, Bereket Beyene (57223025060) ;Sheikh, Aziz (7202522962) ;Sheikh, Mahdi (56081367100) ;Sheikhbahaei, Sara (57219637352) ;Sheikhi, Rahim Ali (39962437200) ;Sheikhy, Ali (57223137774) ;Shepherd, Peter Robin (7101657448) ;Shetty, Adithi (57315189400) ;Shetty, Jeevan K. (15844347300) ;Shetty, Ranjitha S. (57219384456) ;Shibuya, Kenji (8948057900) ;Shirkoohi, Reza (12776374400) ;Shirzad-Aski, Hesamaddin (36021125600) ;Shivakumar, K.M. (57221603938) ;Shivalli, Siddharudha (55604704500) ;Shivarov, Velizar (15623607900) ;Shobeiri, Parnian (57218601156) ;Shokri Varniab, Zahra (59454592800) ;Shorofi, Seyed Afshin (35086976700) ;Shrestha, Sunil (56453947500) ;Sibhat, Migbar Mekonnen (57222351357) ;Siddappa Malleshappa, Sudeep K. (57208838253) ;Sidemo, Negussie Boti (57204638690) ;Silva, Diego Augusto Santos (36985158000) ;Silva, Luís Manuel Lopes Rodrigues (11838952800) ;Silva Julian, Guilherme (57194717539) ;Silvestris, Nicola (7004428325) ;Simegn, Wudneh (57216389675) ;Singh, Achintya Dinesh (57192070816) ;Singh, Ambrish (57214875932) ;Singh, Garima (57224794687) ;Singh, Harpreet (57215069784) ;Singh, Jasvinder A. (7404421736) ;Singh, Jitendra Kumar (56770483800) ;Singh, Paramdeep (57202809996) ;Singh, Surjit (55740397100) ;Sinha, Dhirendra Narain (7201637609) ;Sinke, Abiy H. (57195329519) ;Siraj, Md. Shahjahan (57216886120) ;Sitas, Freddy (7003393668) ;Siwal, Samarjeet Singh (56225532200) ;Skryabin, Valentin Yurievich (57226830981) ;Skryabina, Anna Aleksandrovna (57218875198) ;Socea, Bogdan (32267661900) ;Soeberg, Matthew J. (24734336300) ;Sofi-Mahmudi, Ahmad (57216854132) ;Solomon, Yonatan (57220875005) ;Soltani-Zangbar, Mohammad Sadegh (57189099987) ;Song, Suhang (57194455017) ;Song, Yimeng (57194728629) ;Sorensen, Reed J.D. (57196918748) ;Soshnikov, Sergey (57195195606) ;Sotoudeh, Houman (14054801700) ;Sowe, Alieu (57208392783) ;Sufiyan, Mu’awiyyah Babale (58294633600) ;Suk, Ryan (57197819192) ;Suleman, Muhammad (57196800921) ;Suliankatchi Abdulkader, Rizwan (57226832737) ;Sultana, Saima (57404748200) ;Sur, Daniel (57194064798) ;Szócska, Miklós (13410278600) ;Tabaeian, Seidamir Pasha (57217530354) ;Tabarés-Seisdedos, Rafael (6602981102) ;Tabatabaei, Seyyed Mohammad (55935372700) ;Tabuchi, Takahiro (55177892400) ;Tadbiri, Hooman (57138410000) ;Taheri, Ensiyeh (54997206100) ;Taheri, Majid (57196608691) ;Taheri Soodejani, Moslem (57200541349) ;Takahashi, Ken (55741242600) ;Talaat, Iman M. (7801465176) ;Tampa, Mircea (55324899600) ;Tan, Ker-Kan (16745396700) ;Tat, Nathan Y. (57820156400) ;Tat, Vivian Y. (57221326673) ;Tavakoli, Ahmad (57189869940) ;Tavakoli, Arash (57819456000) ;Tehrani-Banihashemi, Arash (57204006020) ;Tekalegn, Yohannes (57201033519) ;Tesfay, Fisaha Haile (57203977293) ;Thapar, Rekha (36337431900) ;Thavamani, Aravind (57202135529) ;Thoguluva Chandrasekar, Viveksandeep (57207827433) ;Thomas, Nihal (7401830494) ;Thomas, Nikhil Kenny (57218603966) ;Ticoalu, Jansje Henny Vera (57580368800) ;Tiyuri, Amir (57201850751) ;Tollosa, Daniel Nigusse (57197807985) ;Topor-Madry, Roman (57211182892) ;Touvier, Mathilde (8877033300) ;Tovani-Palone, Marcos Roberto (56644977900) ;Traini, Eugenio (57211137081) ;Tran, Mai Thi Ngoc (57225047867) ;Tripathy, Jaya Prasad (55290251600) ;Ukke, Gebresilasea Gendisha (57208651311) ;Ullah, Irfan (56992676600) ;Ullah, Saif (57219395828) ;Ullah, Sana (56402784100) ;Unnikrishnan, Bhaskaran (12790012100) ;Vacante, Marco (23037085900) ;Vaezi, Maryam (55644006900)Valadan Tahbaz, Sahel (57356986200)Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
