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Browsing by Author "Wang, Haidong (16507828100)"

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    Publication
    Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013
    (2016)
    Khalil, Ibrahim (58255049500)
    ;
    Colombara, Danny V. (37025591000)
    ;
    Forouzanfar, Mohammad Hossein (57202562738)
    ;
    Troeger, Christopher (57195223624)
    ;
    Daoud, Farah (57201079837)
    ;
    Moradi-Lakeh, Maziar (35617421300)
    ;
    El Bcheraoui, Charbel (25027689700)
    ;
    Rao, Puja C. (57191835613)
    ;
    Afshin, Ashkan (57217465455)
    ;
    Charara, Raghid (56514085300)
    ;
    Abate, Kalkidan Hassen (57207943858)
    ;
    Abd El Razek, Mohammed Magdy (57192379650)
    ;
    Abd-Allah, Foad (36503428900)
    ;
    Abu-Elyazeed, Remon (57224428155)
    ;
    Kiadaliri, Aliasghar Ahmad (57199100665)
    ;
    Akanda, Ali Shafqat (35290419100)
    ;
    Akseer, Nadia (57207801968)
    ;
    Alam, Khurshid (57203681299)
    ;
    Alasfoor, Deena (57211114684)
    ;
    Ali, Raghib (57196506541)
    ;
    AlMazroa, Mohammad A. (35572530900)
    ;
    Alomari, Mahmoud A. (57219982609)
    ;
    Salem Al-Raddadi, Rajaa Mohammad (57192371411)
    ;
    Alsharif, Ubai (57211633255)
    ;
    Alsowaidi, Shirina (26867516400)
    ;
    Altirkawi, Khalid A. (57202762923)
    ;
    Alvis-Guzman, Nelson (57210741239)
    ;
    Ammar, Walid (57208159281)
    ;
    Antonio, Carl Abelardo T. (55247644500)
    ;
    Asayesh, Hamid (55334322800)
    ;
    Asghar, Rana Jawad (57209013760)
    ;
    Atique, Suleman (56505419100)
    ;
    Awasthi, Ashish (57200155811)
    ;
    Bacha, Umar (57200173721)
    ;
    Badawi, Alaa (57216776029)
    ;
    Barac, Aleksandra (55550748700)
    ;
    Bedi, Neeraj (57988442200)
    ;
    Bekele, Tolesa (57195086149)
    ;
    Bensenor, Isabela M. (7004830338)
    ;
    Betsu, Balem Demtsu (57196316128)
    ;
    Bhutta, Zulfiqar (24342648300)
    ;
    Abdulhak, Aref A. Bin (57201757922)
    ;
    Butt, Zahid A. (57202522739)
    ;
    Danawi, Hadi (57201079895)
    ;
    Dubey, Manisha (57219898654)
    ;
    Endries, Aman Yesuf (57216324852)
    ;
    Faghmous, Imad M.D.A. (57190290003)
    ;
    Farid, Talha (24824364300)
    ;
    Farvid, Maryam S. (8273562500)
    ;
    Farzadfar, Farshad (57195049611)
    ;
    Fereshtehnejad, Seyed-Mohammad (57202557520)
    ;
    Fischer, Florian (55508208800)
    ;
    Anderson Fitchett, Joseph Robert (57192378614)
    ;
    Gibney, Katherine B. (57202564104)
    ;
    Mohamed Ginawi, Ibrahim Abdelmageem (57192378390)
    ;
    Gishu, Melkamu Dedefo (57190277898)
    ;
    Gugnani, Harish Chander (7005567008)
    ;
    Gupta, Rahul (57204120071)
    ;
    Hailu, Gessessew Bugssa (57219637263)
    ;
    Hamadeh, Randah Ribhi (57202769526)
    ;
    Hamidi, Samer (24366336000)
    ;
    Harb, Hilda L. (57221443122)
    ;
    Hedayati, Mohammad T. (23979915700)
    ;
    Hsairi, Mohamed (57209033943)
    ;
    Husseini, Abdullatif (6603689690)
    ;
    Jahanmehr, Nader (57203122718)
    ;
    Javanbakht, Mehdi (57204619886)
    ;
    Jibat, Tariku (57201181881)
    ;
    Jonas, Jost B. (7202492953)
    ;
    Kasaeian, Amir (57195540738)
    ;
    Khader, Yousef Saleh (55654192600)
    ;
    Khan, Abdur Rahman (55520620000)
    ;
    Khan, Ejaz Ahmad (57218791274)
    ;
    Khan, Gulfaraz (6701635515)
    ;
    Khoja, Tawfik Ahmed Muthafer (7003561381)
    ;
    Kinfu, Yohannes (12770281900)
    ;
    Kissoon, Niranjan (7006364038)
    ;
    Koyanagi, Ai (57197741912)
    ;
    Lal, Aparna (55163011100)
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    Abdul Latif, Asma Abdul (57192380848)
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    Lunevicius, Raimundas (57216165063)
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    Abd El Razek, Hassan Magdy (57195948985)
    ;
    Majeed, Azeem (7102027801)
    ;
    Malekzadeh, Reza (7005197760)
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    Mehari, Alem (57211114616)
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    Mekonnen, Alemayehu B. (57200179648)
    ;
    Melaku, Yohannes Adama (57203122720)
    ;
    Memish, Ziad A. (7005059350)
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    Mendoza, Walter (57216905642)
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    Misganaw, Awoke (57202808713)
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    Ibrahim Mohamed, Layla Abdalla (57192381009)
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    Nachega, Jean B. (6701544088)
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    Nguyen, Quyen Le (57223642100)
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    Nisar, Muhammad Imran (57191774461)
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    Peprah, Emmanuel Kwame (57195257834)
    ;
    Platts-Mills, James A. (8540918800)
    ;
    Pourmalek, Farshad (8309390500)
    ;
    Qorbani, Mostafa (24831040300)
    ;
    Rafay, Anwar (57212263323)
    ;
    Rahimi-Movaghar, Vafa (6507646446)
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    Ur Rahman, Sajjad (15835524800)
    ;
    Rai, Rajesh Kumar (51864423900)
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    Rana, Saleem M. (57204884092)
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    Ranabhat, Chhabi L. (56719695500)
    ;
    Rao, Sowmya R. (15760668600)
    ;
    Refaat, Amany H. (57216641565)
    ;
    Riddle, Mark (7102072160)
    ;
    Roshandel, Gholamreza (14034446800)
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    Ruhago, George Mugambage (50761517500)
    ;
    Saleh, Muhammad Muhammad (57190288485)
    ;
    Sanabria, Juan R. (7006262917)
    ;
    Sawhney, Monika (57217153893)
    ;
    Sepanlou, Sadaf G. (36248136000)
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    Setegn, Tesfaye (37075667700)
    ;
    Sliwa, Karen (57207223988)
    ;
    Sreeramareddy, Chandrashekhar T. (57212263335)
    ;
    Sykes, Bryan L. (57211183396)
    ;
    Tavakkoli, Mohammad (57202524239)
    ;
    Tedla, Bemnet Amare (57211142920)
    ;
    Terkawi, Abdullah S. (57211144258)
    ;
    Ukwaja, Kingsley (57202824584)
    ;
    Uthman, Olalekan A. (23026328100)
    ;
    Westerman, Ronny (57218361023)
    ;
    Wubshet, Mamo (54409732600)
    ;
    Yenesew, Muluken A. (39361108000)
    ;
    Yonemoto, Naohiro (57204947657)
    ;
    Younis, Mustafa Z. (8549393000)
    ;
    Zaidi, Zoubida (57197376721)
    ;
    El Sayed Zaki, Maysaa (57203666922)
    ;
    Al Rabeeah, Abdullah A. (6603625258)
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    Wang, Haidong (16507828100)
    ;
    Naghavi, Mohsen (57207906323)
    ;
    Vos, Theo (57223885848)
    ;
    Lopez, Alan D. (7401455668)
    ;
    Murray, Christopher J. L. (55481130700)
    ;
    Mokdad, Ali H. (7004813962)
    Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene.
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    Publication
    Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013
    (2016)
    Khalil, Ibrahim (58255049500)
    ;
    Colombara, Danny V. (37025591000)
    ;
    Forouzanfar, Mohammad Hossein (57202562738)
    ;
    Troeger, Christopher (57195223624)
    ;
    Daoud, Farah (57201079837)
    ;
    Moradi-Lakeh, Maziar (35617421300)
    ;
    El Bcheraoui, Charbel (25027689700)
    ;
    Rao, Puja C. (57191835613)
    ;
    Afshin, Ashkan (57217465455)
    ;
    Charara, Raghid (56514085300)
    ;
    Abate, Kalkidan Hassen (57207943858)
    ;
    Abd El Razek, Mohammed Magdy (57192379650)
    ;
    Abd-Allah, Foad (36503428900)
    ;
    Abu-Elyazeed, Remon (57224428155)
    ;
    Kiadaliri, Aliasghar Ahmad (57199100665)
    ;
    Akanda, Ali Shafqat (35290419100)
    ;
    Akseer, Nadia (57207801968)
    ;
    Alam, Khurshid (57203681299)
    ;
    Alasfoor, Deena (57211114684)
    ;
    Ali, Raghib (57196506541)
    ;
    AlMazroa, Mohammad A. (35572530900)
    ;
    Alomari, Mahmoud A. (57219982609)
    ;
    Salem Al-Raddadi, Rajaa Mohammad (57192371411)
    ;
    Alsharif, Ubai (57211633255)
    ;
    Alsowaidi, Shirina (26867516400)
    ;
    Altirkawi, Khalid A. (57202762923)
    ;
    Alvis-Guzman, Nelson (57210741239)
    ;
    Ammar, Walid (57208159281)
    ;
    Antonio, Carl Abelardo T. (55247644500)
    ;
    Asayesh, Hamid (55334322800)
    ;
    Asghar, Rana Jawad (57209013760)
    ;
    Atique, Suleman (56505419100)
    ;
    Awasthi, Ashish (57200155811)
    ;
    Bacha, Umar (57200173721)
    ;
    Badawi, Alaa (57216776029)
    ;
    Barac, Aleksandra (55550748700)
    ;
    Bedi, Neeraj (57988442200)
    ;
    Bekele, Tolesa (57195086149)
    ;
    Bensenor, Isabela M. (7004830338)
    ;
    Betsu, Balem Demtsu (57196316128)
    ;
    Bhutta, Zulfiqar (24342648300)
    ;
    Abdulhak, Aref A. Bin (57201757922)
    ;
    Butt, Zahid A. (57202522739)
    ;
    Danawi, Hadi (57201079895)
    ;
    Dubey, Manisha (57219898654)
    ;
    Endries, Aman Yesuf (57216324852)
    ;
    Faghmous, Imad M.D.A. (57190290003)
    ;
    Farid, Talha (24824364300)
    ;
    Farvid, Maryam S. (8273562500)
    ;
    Farzadfar, Farshad (57195049611)
    ;
    Fereshtehnejad, Seyed-Mohammad (57202557520)
    ;
    Fischer, Florian (55508208800)
    ;
    Anderson Fitchett, Joseph Robert (57192378614)
    ;
    Gibney, Katherine B. (57202564104)
    ;
    Mohamed Ginawi, Ibrahim Abdelmageem (57192378390)
    ;
    Gishu, Melkamu Dedefo (57190277898)
    ;
    Gugnani, Harish Chander (7005567008)
    ;
    Gupta, Rahul (57204120071)
    ;
    Hailu, Gessessew Bugssa (57219637263)
    ;
    Hamadeh, Randah Ribhi (57202769526)
    ;
    Hamidi, Samer (24366336000)
    ;
    Harb, Hilda L. (57221443122)
    ;
    Hedayati, Mohammad T. (23979915700)
    ;
    Hsairi, Mohamed (57209033943)
    ;
    Husseini, Abdullatif (6603689690)
    ;
    Jahanmehr, Nader (57203122718)
    ;
    Javanbakht, Mehdi (57204619886)
    ;
    Jibat, Tariku (57201181881)
    ;
    Jonas, Jost B. (7202492953)
    ;
    Kasaeian, Amir (57195540738)
    ;
    Khader, Yousef Saleh (55654192600)
    ;
    Khan, Abdur Rahman (55520620000)
    ;
    Khan, Ejaz Ahmad (57218791274)
    ;
    Khan, Gulfaraz (6701635515)
    ;
    Khoja, Tawfik Ahmed Muthafer (7003561381)
    ;
    Kinfu, Yohannes (12770281900)
    ;
    Kissoon, Niranjan (7006364038)
    ;
    Koyanagi, Ai (57197741912)
    ;
    Lal, Aparna (55163011100)
    ;
    Abdul Latif, Asma Abdul (57192380848)
    ;
    Lunevicius, Raimundas (57216165063)
    ;
    Abd El Razek, Hassan Magdy (57195948985)
    ;
    Majeed, Azeem (7102027801)
    ;
    Malekzadeh, Reza (7005197760)
    ;
    Mehari, Alem (57211114616)
    ;
    Mekonnen, Alemayehu B. (57200179648)
    ;
    Melaku, Yohannes Adama (57203122720)
    ;
    Memish, Ziad A. (7005059350)
    ;
    Mendoza, Walter (57216905642)
    ;
    Misganaw, Awoke (57202808713)
    ;
    Ibrahim Mohamed, Layla Abdalla (57192381009)
    ;
    Nachega, Jean B. (6701544088)
    ;
    Nguyen, Quyen Le (57223642100)
    ;
    Nisar, Muhammad Imran (57191774461)
    ;
    Peprah, Emmanuel Kwame (57195257834)
    ;
    Platts-Mills, James A. (8540918800)
    ;
    Pourmalek, Farshad (8309390500)
    ;
    Qorbani, Mostafa (24831040300)
    ;
    Rafay, Anwar (57212263323)
    ;
    Rahimi-Movaghar, Vafa (6507646446)
    ;
    Ur Rahman, Sajjad (15835524800)
    ;
    Rai, Rajesh Kumar (51864423900)
    ;
    Rana, Saleem M. (57204884092)
    ;
    Ranabhat, Chhabi L. (56719695500)
    ;
    Rao, Sowmya R. (15760668600)
    ;
    Refaat, Amany H. (57216641565)
    ;
    Riddle, Mark (7102072160)
    ;
    Roshandel, Gholamreza (14034446800)
    ;
    Ruhago, George Mugambage (50761517500)
    ;
    Saleh, Muhammad Muhammad (57190288485)
    ;
    Sanabria, Juan R. (7006262917)
    ;
    Sawhney, Monika (57217153893)
    ;
    Sepanlou, Sadaf G. (36248136000)
    ;
    Setegn, Tesfaye (37075667700)
    ;
    Sliwa, Karen (57207223988)
    ;
    Sreeramareddy, Chandrashekhar T. (57212263335)
    ;
    Sykes, Bryan L. (57211183396)
    ;
    Tavakkoli, Mohammad (57202524239)
    ;
    Tedla, Bemnet Amare (57211142920)
    ;
    Terkawi, Abdullah S. (57211144258)
    ;
    Ukwaja, Kingsley (57202824584)
    ;
    Uthman, Olalekan A. (23026328100)
    ;
    Westerman, Ronny (57218361023)
    ;
    Wubshet, Mamo (54409732600)
    ;
    Yenesew, Muluken A. (39361108000)
    ;
    Yonemoto, Naohiro (57204947657)
    ;
    Younis, Mustafa Z. (8549393000)
    ;
    Zaidi, Zoubida (57197376721)
    ;
    El Sayed Zaki, Maysaa (57203666922)
    ;
    Al Rabeeah, Abdullah A. (6603625258)
    ;
    Wang, Haidong (16507828100)
    ;
    Naghavi, Mohsen (57207906323)
    ;
    Vos, Theo (57223885848)
    ;
    Lopez, Alan D. (7401455668)
    ;
    Murray, Christopher J. L. (55481130700)
    ;
    Mokdad, Ali H. (7004813962)
    Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene.
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    Publication
    Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study
    (2018)
    Mokdad, Ali H (7004813962)
    ;
    El Bcheraoui, Charbel (25027689700)
    ;
    Afshin, Ashkan (57217465455)
    ;
    Charara, Raghid (56514085300)
    ;
    Khalil, Ibrahim (58255049500)
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    Moradi-Lakeh, Maziar (35617421300)
    ;
    Kassebaum, Nicholas J (57202562224)
    ;
    Collison, Michael (57202309052)
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    Daoud, Farah (57201079837)
    ;
    Krohn, Kristopher J (57194138806)
    ;
    Chew, Adrienne (57209171085)
    ;
    Biryukov, Stan H (57195296731)
    ;
    Cornaby, Leslie (57191837051)
    ;
    Foreman, Kyle J (57209064414)
    ;
    Kutz, Michael (57195617315)
    ;
    Liu, Patrick (56170368200)
    ;
    Reitsma, Marissa (57208766315)
    ;
    Sur, Patrick (57218360398)
    ;
    Wang, Haidong (16507828100)
    ;
    Zipkin, Ben (57200737130)
    ;
    Ärnlöv, Johan (6602512227)
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    Abbafati, Cristiana (54917122400)
    ;
    Abdulle, Abdishakur M (6603592018)
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    Abu-Rmeileh, Niveen M.E. (57216675148)
    ;
    Ahmed, Muktar Beshir (57207802317)
    ;
    Al-Aly, Ziyad (9738161500)
    ;
    Alam, Khurshid (57203681299)
    ;
    Alizadeh-Navaei, Reza (36024974700)
    ;
    Alkerwi, Ala'a (57197724313)
    ;
    Altirkawi, Khalid A (57202762923)
    ;
    Alvis-Guzman, Nelson (57210741239)
    ;
    Baune, Bernhard T (6603807336)
    ;
    Bedi, Neeraj (57988442200)
    ;
    Bennett, Derrick A (57650836400)
    ;
    Beyene, Addisu S (57209036705)
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    Bhutta, Zulfiqar A (24342648300)
    ;
    Birhanu, Mulugeta M (57195446157)
    ;
    Danawi, Hadi (57201079895)
    ;
    Fereshtehnejad, Seyed-Mohammad (57202557520)
    ;
    Fischer, Florian (55508208800)
    ;
    Gebrehiwot, Tsegaye Tewelde (57216482917)
    ;
    Gill, Paramjit Singh (7202766660)
    ;
    Gona, Philimon N (57219703762)
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    Gupta, Vipin (57199940653)
    ;
    Habtewold, Tesfa Dejenie (57079013900)
    ;
    Hamadeh, Randah Ribhi (57202769526)
    ;
    Hamidi, Samer (24366336000)
    ;
    Hareri, Habtamu Abera (57195292447)
    ;
    Horino, Masako (57195769276)
    ;
    Hsairi, Mohamed (57209033943)
    ;
    Javanbakht, Mehdi (57204619886)
    ;
    John, Denny (57194230095)
    ;
    Jonas, Jost B (7202492953)
    ;
    Joshua, Vasna (57196474987)
    ;
    Kasaeian, Amir (57195540738)
    ;
    Ketema, Ezra B (56866354200)
    ;
    Khader, Yousef Saleh (55654192600)
    ;
    Khan, Ejaz Ahmad (57218791274)
    ;
    Khubchandani, Jagdish (57211720011)
    ;
    Kim, Daniel (57223019104)
    ;
    Kim, Yun Jin (57211086375)
    ;
    Kinfu, Yohannes (12770281900)
    ;
    Kokubo, Yoshihiro (56155004000)
    ;
    Larson, Heidi J (57202559142)
    ;
    Lee, Paul H (57200302692)
    ;
    Lunevicius, Raimundas (57216165063)
    ;
    Abd El Razek, Hassan Magdy (57195948985)
    ;
    Abd El Razek, Mohammed Magdy (57192379650)
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    Malekzadeh, Reza (7005197760)
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    Mate, Kedar K (57209031379)
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    Memish, Ziad A (7005059350)
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    Mengistie, Mubarek Abera (56045752700)
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    Mensah, George A (57196028147)
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    Ogbo, Felix Akpojene (57200737136)
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    Pourmalek, Farshad (8309390500)
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    Rafay, Anwar (57212263323)
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    Qorbani, Mostafa (24831040300)
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    Rahimi-Movaghar, Vafa (6507646446)
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    Rana, Saleem M (57204884092)
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    Rawaf, Salman (6602475959)
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    Renzaho, Andre M.N. (6505786588)
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    Rezaei, Satar (55791003000)
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    Rezai, Mohammad Sadegh (55273796300)
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    Safdarian, Mahdi (57203849024)
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    Sahraian, Mohammad Ali (55886074600)
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    Salamati, Payman (14045860600)
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    Samy, Abdallah M (36973661300)
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    Sanabria, Juan Ramon (7006262917)
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    Santric Milicevic, Milena M. (57211144346)
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    Sartorius, Benn (12788526800)
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    Sepanlou, Sadaf G (36248136000)
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    Shaikh, Masood Ali (57203122601)
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    Shiri, Rahman (57200737050)
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    Silva, Diego Augusto Santos (36985158000)
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    Singh, Jasvinder A (7404421736)
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    Terkawi, Abdullah Sulieman (57211144258)
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    Tiruye, Tenaw Yimer (57194055872)
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    Ukwaja, Kingsley Nnanna (57202824584)
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    Vasankari, Tommi (57200592416)
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    Vlassov, Vasiliy Victorovich (57211633239)
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    Wakayo, Tolassa (57205609717)
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    Werdecker, Andrea (57210505244)
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    Yonemoto, Naohiro (57204947657)
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    Younis, Mustafa Z (8549393000)
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    Zein, Bassel (57195293856)
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    Jumaan, Aisha O (6603612494)
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    Vos, Theo (57223885848)
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    Hay, Simon I (7101875313)
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    Naghavi, Mohsen (57207906323)
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    Murray, Christopher J.L. (55481130700)
    Objectives: We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). Methods: We estimated the prevalence of overweight and obesity among children (2–19 years) and adults (≥20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach. Results: The prevalence of obesity increased for adults from 15.1% (95% UI 13.4–16.9) in 1980 to 20.7% (95% UI 18.8–22.8) in 2015. It increased from 4.1% (95% UI 2.9–5.5) to 4.9% (95% UI 3.6–6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages. Conclusions: This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden. © 2017, The Author(s).
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    Erratum: Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 (The Lancet (2016) 388(10053) (1725–1774)(S0140673616315756)(10.1016/S0140-6736(16)31575-6))
    (2017)
    Wang, Haidong (16507828100)
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    Bhutta, Zulfiqar A (24342648300)
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    Coates, Matthew M (57211076754)
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    Coggeshall, Megan (56132969600)
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    Franca, Elisabeth Barboza (16031258100)
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    Fullman, Nancy (57211064970)
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    Gething, Peter W (57193559189)
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    Hay, Simon I (7101875313)
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    Kita, Maaya (57208149285)
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    Kulikoff, Xie Rachel (57191837748)
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    Liang, Xiaofeng (26662590300)
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    Lim, Stephen S (7404081544)
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    Lind, Margaret (57189271761)
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    Lopez, Alan D (7401455668)
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    Mensah, George A (57196028147)
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    Mokdad, Ali H (7004813962)
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    Salomon, Joshua A (56745638600)
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    Butt, Zahid A (57202522739)
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    Campos-Nonato, Ismael Ricardo (57203424784)
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    Carpenter, David O (7201795413)
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    Carrero, Juan Jesus (16834646800)
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    Casey, Daniel C (56844735100)
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    Castañeda-Orjuela, Carlos A (35769124700)
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    Chang, Hsing-Yi (7407523087)
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    Chang, Jung-Chen (57202568248)
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    Chibueze, Chioma Ezinne (57244744000)
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    Christopher, Devasahayam Jesudas (57209863533)
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    Ellingsen, Christian Lycke (7801360950)
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    Farid, Talha A (57226213785)
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    Faro, André (36770969600)
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    Fereshtehnejad, Seyed-Mohammad (57202557520)
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    Fernandes, Joao C (35274726800)
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    Fitchett, Joseph R A (57219697690)
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    Gebre, Teshome (57202565005)
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    Gebrehiwot, Tsegaye Tewelde (57216482917)
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    Gebremedhin, Amanuel Tesfay (57202566187)
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    Gebru, Alemseged Aregay (57196196083)
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    Geleijnse, Johanna M (35195702500)
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    Gessner, Bradford D (7005779769)
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    Ginawi, Ibrahim Abdelmageem Mohamed (57192378390)
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    Giref, Ababi Zergaw (57219994468)
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    Gishu, Melkamu Dedefo (57202568734)
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    Gomez-Dantes, Hector (57202555692)
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    Gona, Philimon (57219703762)
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    Goodridge, Amador (55801980200)
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    Gopalani, Sameer Vali (57190277891)
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    Goto, Atsushi (36339255500)
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    Gouda, Hebe N (57202432343)
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    Gugnani, Harish Chander (7005567008)
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    Liu, Shiwei (57209574351)
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    Murray, Christopher J L (55481130700)
    GBD 2015 Child Mortality Collaborators. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1725–74—In this Article, Mohsen Naghavi, Michael J Kutz, Chantal Huynh, Samer Hamidi, Addisu Shunu Beyene, and Stephen S Lim should have been listed as authors. The affiliation details for Simon I Hay have been updated. The funding statement for Simon I Hay has been added. These corrections have been made to the online version as of Jan 5, 2017. © 2017 Elsevier Ltd
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    Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
    (2015)
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    Shackelford, Katya (57202959163)
    ;
    Shaheen, Amira (57202560956)
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    Shahraz, Saeid (57215142060)
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    Shakh-Nazarova, Marina (56133525500)
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    Shangguan, Siyi (55983936400)
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    She, Jun (57209122131)
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    Sheikhbahaei, Sara (57219637352)
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    Shepard, Donald S. (56425525300)
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    Shibuya, Kenji (8948057900)
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    Shinohara, Yukito (57203303862)
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    Shishani, Kawkab (14025005500)
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    Shiue, Ivy (35811219800)
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    Shivakoti, Rupak (57202563142)
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    Shrime, Mark G. (57204703404)
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    Sigfusdottir, Inga Dora (57195363778)
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    Silberberg, Donald H. (57223420256)
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    Silva, Andrea P. (59594831400)
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    Simard, Edgar P. (57211913376)
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    Sindi, Shireen (57209045912)
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    Singh, Jasvinder A. (7404421736)
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    Singh, Lavanya (55823444300)
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    Sioson, Edgar (55314211200)
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    Skirbekk, Vegard (57202564482)
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    Sliwa, Karen (57207223988)
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    So, Samuel (7102397384)
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    Soljak, Michael (57202841728)
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    Soneji, Samir (57204096389)
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    Soshnikov, Sergey S. (57195195606)
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    Sposato, Luciano A. (25640261000)
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    Sreeramareddy, Chandrashekhar T. (57212263335)
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    Stanaway, Jeffrey D. (57201210928)
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    Stathopoulou, Vasiliki Kalliopi (57195644148)
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    Steenland, Kyle (56841699000)
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    Stein, Claudia (55436356400)
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    Steiner, Caitlyn (57205358084)
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    Straif, Kurt (6701403417)
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    Swaminathan, Soumya (7102380757)
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    Swaroop, Mamta (8635158800)
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    Sykes, Bryan L. (57211183396)
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    Tabb, Karen M. (51162023700)
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    Takahashi, Ken (55741242600)
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    Talongwa, Roberto Tchio (57195568335)
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    Tan, Feng (56429971500)
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    Tanne, David (7006302238)
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    Tanner, Marcel (7202127772)
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    Tavakkoli, Mohammad (57202524239)
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    Te Ao, Braden (55480837300)
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    Teixeira, Carolina Maria (56133286100)
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    Templin, Tara (56133572500)
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    Tenkorang, Eric Yeboah (57216997115)
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    Terkawi, Abdullah Sulieman (57211144258)
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    Thomas, Bernadette A. (7401507541)
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    Thorne-Lyman, Andrew L. (57194437700)
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    Thrift, Amanda G. (7004824524)
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    Thurston, George D. (7102270013)
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    Tillmann, Taavi (57190211142)
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    Tirschwell, David L. (7003788101)
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    Tleyjeh, Imad M. (8525790600)
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    Tonelli, Marcello (7103102534)
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    Topouzis, Fotis (57194262710)
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    Towbin, Jeffrey A. (7102520568)
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    Toyoshima, Hideaki (7103228330)
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    Traebert, Jefferson (57190586198)
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    Tsilimbaris, Miltiadis (6701721894)
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    Vasconcelos, Ana Maria Nogales (57208202014)
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    Vavilala, Monica S. (7004076648)
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    Venketasubramanian, N. (56804702100)
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    Vijayakumar, Lakshmi (57202973343)
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    Villalpando, Salvador (7005159171)
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    Violante, Francesco S. (7003555890)
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    Vlassov, Vasiliy Victorovich (57211633239)
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    Wagner, Gregory R. (57219005948)
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    Waller, Stephen G. (57201445180)
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    Wang, Jian Li (9250575900)
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    Wang, Linhong (57303731300)
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    Wang, XiaoRong (59881699400)
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    Wang, Yanping (57215440165)
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    Warouw, Tati Suryati (57202569029)
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    Whiteford, Harvey A. (55906494000)
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    Wilkinson, James D. (57207903571)
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    Woldeyohannes, Solomon Meseret (57195461619)
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    Wolfe, Charles D.A. (57202754705)
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    Woolf, Anthony D. (7102882171)
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    Xu, Gelin (14049536200)
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    Yang, Yang C. (39763666500)
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    Yoon, Seok-Jun (24823148900)
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    Yu, Chuanhua (57201889726)
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    Yun Jin, Kim (57190155872)
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    Zaki, Maysaa El Sayed (57203666922)
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    Zamakhshary, Mohammed Fouad (22837435200)
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    Zeeb, Hajo (57203073012)
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    Zhang, Yong (55891238500)
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    Zhao, Yong (59798995400)
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    Zheng, Yingfeng (58918045300)
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    Zhu, Jun (56215097100)
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    Zhu, Shankuan (7404391225)
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    Zonies, David (6507066392)
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    Zou, Xiao Nong (57216284159)
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    Zunt, Joseph R. (6602746216)
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    Vos, Theo (57223885848)
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    Lopez, Alan D. (7401455668)
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    Murray, Christopher J.L. (55481130700)
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    Alcalá-Cerra, G. (35769097100)
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    Hu, H. (55740738900)
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    Karam, N. (57221993192)
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    Sabin, N. (57202568454)
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    Temesgen, A.M. (56541894900)
    Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0-65·6) in 1990, to 71·5 years (UI 71·0-71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8-48·2) to 54·9 million (UI 53·6-56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. Funding Bill & Melinda Gates Foundation. © 2015 Elsevier Ltd.
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    Global, regional, and national burden of tuberculosis, 1990-2016: Results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study
    (2018)
    Kyu, Hmwe Hmwe (57217040073)
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    Maddison, Emilie R. (57196084094)
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    Henry, Nathaniel J. (57196076616)
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    Ledesma, Jorge R. (57204449040)
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    Wiens, Kirsten E. (55515807800)
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    Reiner, Robert (57203229088)
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    Biehl, Molly H. (57196041812)
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    Shields, Chloe (57196083232)
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    Osgood-Zimmerman, Aaron (57195835977)
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    Ross, Jennifer M. (56895463600)
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    Carter, Austin (57201756395)
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    Frank, Tahvi D. (57203197110)
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    Wang, Haidong (16507828100)
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    Srinivasan, Vinay (57196077031)
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    Abebe, Zegeye (57193002719)
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    Agarwal, Sanjay Kumar (57206276269)
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    Alahdab, Fares (55135922900)
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    Alene, Kefyalew Addis (57202583764)
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    Ali, Beriwan Abdulqadir (57208356112)
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    Alvis-Guzman, Nelson (57210741239)
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    Andrews, Jason R. (15058787200)
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    Antonio, Carl Abelardo T. (55247644500)
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    Atique, Suleman (56505419100)
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    Atre, Sachin R. (22933845900)
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    Awasthi, Ashish (58420926700)
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    Ayele, Henok Tadesse (55573710400)
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    Badali, Hamid (15123728900)
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    Badawi, Alaa (57216776029)
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    Barac, Aleksandra (55550748700)
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    Bedi, Neeraj (57988442200)
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    Behzadifar, Masoud (57204671696)
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    Behzadifar, Meysam (59429991000)
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    Bekele, Bayu Begashaw (57196083941)
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    Belay, Saba Abraham (57203298880)
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    Bensenor, Isabela M. (7004830338)
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    Butt, Zahid A. (57202522739)
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    Carvalho, Félix (7103070417)
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    Cercy, Kelly (57208777587)
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    Christopher, Devasahayam J. (57209863533)
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    Daba, Alemneh Kabeta (57203300408)
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    Dandona, Lalit (7007017243)
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    Dandona, Rakhi (57203043697)
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    Daryani, Ahmad (16021522200)
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    Demeke, Feleke Mekonnen (57204717669)
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    Deribe, Kebede (57193912587)
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    Dharmaratne, Samath Dhamminda (57216324802)
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    Doku, David Teye (36015210300)
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    Dubey, Manisha (57219898654)
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    Edessa, Dumessa (56922334200)
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    El-Khatib, Ziad (54908919000)
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    Enany, Shymaa (23972375400)
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    Fernandes, Eduarda (34770207500)
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    Fischer, Florian (55508208800)
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    Garcia-Basteiro, Alberto L. (57200187168)
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    Gebre, Abadi Kahsu (59426751000)
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    Gebregergs, Gebremedhin Berhe (57078990000)
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    Gebremichael, Teklu Gebrehiwo (57204566728)
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    Gelano, Tilayie Feto (57200628899)
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    Geremew, Demeke (57196299505)
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    Gona, Philimon N. (57219703762)
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    Goodridge, Amador (55801980200)
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    Gupta, Rahul (57204120071)
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    Bidgoli, Hassan Haghparast (57201491554)
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    Hailu, Gessessew Bugssa (57219637263)
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    Hassen, Hamid Yimam (57188660707)
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    Hedayati, Mohammad T. Tadesse (23979915700)
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    Henok, Andualem (57196451824)
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    Hostiuc, Sorin (24829099800)
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    Hussen, Mamusha Aman (57221268448)
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    Ilesanmi, Olayinka Stephen (54782692800)
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    Irvani, Seyed Sina Naghibi (57202975543)
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    Jacobsen, Kathryn H. (26029163100)
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    Johnson, Sarah C. (57207904886)
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    Jonas, Jost B. (7202492953)
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    Kahsay, Amaha (57216608121)
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    Kant, Surya (59567335600)
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    Kasaeian, Amir (57195540738)
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    Kassa, Tesfaye Dessale (58686045600)
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    Khader, Yousef Saleh (55654192600)
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    Khafaie, Morteza Abdullatif (55608324700)
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    Khalil, Ibrahim (58255049500)
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    Khan, Ejaz Ahmad (57218791274)
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    Khang, Young-Ho (57198904674)
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    Kim, Yun Jin (57211086375)
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    Kochhar, Sonali (57214107714)
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    Koyanagi, Ai (57197741912)
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    Krohn, Kristopher J. (57194138806)
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    Kumar, G. Anil (57139550500)
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    Lakew, Ayenew Molla (57200821341)
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    Leshargie, Cheru Tesema (57195295462)
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    Lodha, Rakesh (7007019609)
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    MacArayan, Erlyn Rachelle King (56330601800)
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    Majdzadeh, Reza (9246620000)
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    Martins-Melo, Francisco Rogerlândio (57204796807)
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    Melese, Addisu (56901393600)
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    Memish, Ziad A. (7005059350)
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    Mendoza, Walter (57216905642)
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    Mengistu, Desalegn Tadese (57194776802)
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    Mengistu, Getnet (57193539632)
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    Mestrovic, Tomislav (6507240107)
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    Moazen, Babak (57204324006)
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    Mohammad, Karzan Abdulmuhsin (57205300378)
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    Mohammed, Shafiu (57838689000)
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    Mokdad, Ali H. (7004813962)
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    Moosazadeh, Mahmood (35771326500)
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    Mousavi, Seyyed Meysam (56165159700)
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    Mustafa, Ghulam (57190395960)
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    Nachega, Jean B. (6701544088)
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    Nguyen, Long Hoang (56567321800)
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    Nguyen, Son Hoang (59662830400)
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    Nguyen, Trang Huyen (59142352200)
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    Ningrum, Dina Nur Anggraini (57195329470)
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    Nirayo, Yirga Legesse (57201651103)
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    Nong, Vuong Minh (55507077200)
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    Ofori-Asenso, Richard (57209300265)
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    Ogbo, Felix Akpojene (57217186813)
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    Oh, In-Hwan (57204090669)
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    Oladimeji, Olanrewaju (57216495380)
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    Olagunju, Andrew T. (26029995700)
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    Oren, Eyal (36815569400)
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    Pereira, David M. (57200690024)
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    Prakash, Swayam (57212263375)
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    Qorbani, Mostafa (24831040300)
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    Rafay, Anwar (57212263323)
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    Rai, Rajesh Kumar (51864423900)
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    Ram, Usha (26653819000)
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    Rubino, Salvatore (55240504800)
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    Safiri, Saeid (56009654100)
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    Salomon, Joshua A. (56745638600)
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    Samy, Abdallah M. (36973661300)
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    Sartorius, Benn (12788526800)
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    Satpathy, Maheswar (57202563691)
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    Seyedmousavi, Seyedmojtaba (57204698893)
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    Sharif, Mehdi (16022734200)
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    Silva, João Pedro (57204703526)
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    Silveira, Dayane Gabriele Alves (57190284103)
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    Singh, Jasvinder A. (7404421736)
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    Sreeramareddy, Chandrashekhar T. (57212263335)
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    Tran, Bach Xuan (57209107515)
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    Tsadik, Afewerki Gebremeskel (57204562442)
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    Ukwaja, Kingsley Nnanna (57202824584)
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    Ullah, Irfan (56992676600)
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    Uthman, Olalekan A. (23026328100)
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    Vlassov, Vasily (57211633239)
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    Vollset, Stein Emil (57196315778)
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    Vu, Giang (57202424871)
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    Weldegebreal, Fitsum (56112812300)
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    Werdecker, Andrea (57208964895)
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    Yimer, Ebrahim M. (57202256312)
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    Yonemoto, Naohiro (57204947657)
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    Yotebieng, Marcel (26325950800)
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    Naghavi, Mohsen (57207906323)
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    Vos, Theo (57223885848)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (55481130700)
    Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation. © 2018 The Author(s).
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    Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study Global Burden of Disease Cancer Collaboration
    (2017)
    Fitzmaurice, Christina (57212628757)
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    Allen, Christine (57200170678)
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    Barber, Ryan M. (57202560423)
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    Barregard, Lars (57226221232)
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    Bhutta, Zulfiqar A. (24342648300)
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    Brenner, Hermann (7201832825)
    ;
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    ;
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    Le Nguyen, Quyen (57204521771)
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    Nolte, Sandra (24073274400)
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    Ogbo, Felix A. (57217186813)
    ;
    Oladimeji, Kelechi E. (57194580686)
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    Oren, Eyal (36815569400)
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    Pa, Mahesh (57212735186)
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    Park, Eun-Kee (57216814178)
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    ;
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    ;
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    ;
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    ;
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    ;
    Younis, Mustafa Z. (8549393000)
    ;
    Yu, Chuanhua (57208140344)
    ;
    Zaidi, Zoubida (57197376721)
    ;
    Zaki, Maysaa El Sayed (57203666922)
    ;
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    Murray, Christopher J. L. (57224556036)
    ;
    Naghavi, Mohsen (57207906323)
    IMPORTANCE: Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW: Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. FINDINGS: In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. CONCLUSION AND RELEVANCE: As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet. Copyright 2017 American Medical Association. All rights reserved.
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    Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study Global Burden of Disease Cancer Collaboration
    (2017)
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    Chudi Uzochukwu, Benjamin S. (57194422038)
    ;
    Vlassov, Vasiliy Victorovich (57211633239)
    ;
    Weiderpass, Elisabete (57205018947)
    ;
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    ;
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    Murray, Christopher J. L. (57224556036)
    ;
    Naghavi, Mohsen (57207906323)
    IMPORTANCE: Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW: Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. FINDINGS: In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. CONCLUSION AND RELEVANCE: As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet. Copyright 2017 American Medical Association. All rights reserved.
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    Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition
    (2015)
    Murray, Christopher J. L. (57224556036)
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    Barber, Ryan M. (57202560423)
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    Foreman, Kyle J. (57209064414)
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    Ozgoren, Ayse Abbasoglu (59158236200)
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    Abd-Allah, Foad (36503428900)
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    Abera, Semaw F. (57205180598)
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    Aboyans, Victor (56214736500)
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    Abraham, Jerry P. (57203894879)
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    Abubakar, Ibrahim (57220174401)
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    Abu-Raddad, Laith J. (14032724700)
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    Abu-Rmeileh, Niveen M. (57216675148)
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    Achoki, Tom (57202561099)
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    Ackerman, Ilana N. (8925517400)
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    Ademi, Zanfina (32867460300)
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    Adou, Arsène K. (56531895000)
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    Afshin, Ashkan (57217465455)
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    Alam, Sayed Saidul (56809534300)
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    Alasfoor, Deena (57211114684)
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    Albittar, Mohammed I. (56276571900)
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    Wan, Xia (59833223800)
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    Wang, Haidong (16507828100)
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    Wang, Jianli (9250575900)
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    Wang, Linhong (57303731300)
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    Wolock, Timothy M. (57210784314)
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    Wulf, Sarah (57212263269)
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    Wurtz, Brittany (57202555477)
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    Xu, Gelin (57203583113)
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    Yan, Lijing L. (57198311895)
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    Yano, Yuichiro (57196965200)
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    Ye, Pengpeng (57202839295)
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    Yentür, Gökalp K. (57211728019)
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    Yip, Paul (7102503720)
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    Yonemoto, Naohiro (57204947657)
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    Yoon, Seok-Jun (24823148900)
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    Younis, Mustafa Z. (8549393000)
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    Yu, Chuanhua (57201889726)
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    Zaki, Maysaa E. (57203666922)
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    Zhao, Yong (59798995400)
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    Zheng, Yingfeng (58918045300)
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    Zonies, David (6507066392)
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    Zou, Xiaonong (57216284159)
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    Salomon, Joshua A. (56745638600)
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    Lopez, Alan D. (7401455668)
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    Vos, Theo (57223885848)
    Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition - in which increasing sociodemographic status brings structured change in disease burden - is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. © 2015 Elsevier Ltd.
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    Publication
    Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
    (2014)
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    De Lima, Graça Maria Ferreira (56133968700)
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    Olusanya, Bolajoko O. (57218504682)
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    Omer, Saad B. (57216065685)
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    Opio, John Nelson (57200124403)
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    Orisakwe, Orish Ebere (7003998930)
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    Papachristou, Christina (7005498635)
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    Terkawi, Abdullah Sulieman (57211144258)
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    Thomson, Alan J. (57969994200)
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    Thorne-Lyman, Andrew L. (57194437700)
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    Towbin, Jeffrey A. (7102520568)
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    Tsilimbaris, Miltiadis (6701721894)
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    Uchendu, Uche S. (56328470200)
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    Ukwaja, Kingsley N. (57202824584)
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    Uzun, Selen Begüm (57200327315)
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    Vallely, Andrew J. (21744114400)
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    Vasankari, Tommi J. (57189653936)
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    Venketasubramanian, N. (56804702100)
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    Violante, Francesco S. (7003555890)
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    Vlassov, Vasiliy Victorovich (57211633239)
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    Vollset, Stein Emil (57196315778)
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    Waller, Stephen (57201445180)
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    Wallin, Mitchell T. (7005704608)
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    Wang, Linhong (57303731300)
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    Wang, Xiao Rong (59881699400)
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    Wang, Yanping (57215440165)
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    Weichenthal, Scott (57202555239)
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    Weintraub, Robert G. (7006079405)
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    Westerman, Ronny (57218361023)
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    White, Richard A. (57212709680)
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    Wilkinson, James D. (57207903571)
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    Williams, Thomas Neil (35430527200)
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    Woldeyohannes, Solomon Meseret (57195461619)
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    Wong, John Q. (56491997300)
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    Xu, Gelin (14049536200)
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    Yang, Yang C. (39763666500)
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    Yano, Yuichiro (57196965200)
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    Yentur, Gokalp Kadri (57211728019)
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    Yip, Paul (7102503720)
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    Yonemoto, Naohiro (57204947657)
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    Yoon, Seok-Jun (24823148900)
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    Younis, Mustafa (8549393000)
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    Yu, Chuanhua (57201889726)
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    Jin, Kim Yun (57211086375)
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    El Sayed Zaki, Maysaa (57203666922)
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    Zhao, Yong (59798995400)
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    Zheng, Yingfeng (58918045300)
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    Zhou, Maigeng (57054557200)
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    Zhu, Jun (56215097100)
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    Zou, Xiao Nong (57216284159)
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    Lopez, Alan D. (7401455668)
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    Vos, Theo (57223885848)
    Background The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. Methods To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modifi ed based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fi t vital registration data corrected for misclassifi cation of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifi cations, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specifi c mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. Findings Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. Interpretation Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. Incidence rates for HIV, tuberculosis, and malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. Funding Bill & Melinda Gates Foundation.
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    Publication
    Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
    (2019)
    Frank, Tahvi D. (57203197110)
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    Carter, Austin (57201756395)
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    Larson, Samantha Leigh (57204569813)
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    Arora, Megha (57196080797)
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    Adebayo, Oladimeji M. (57194329853)
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    Burugina Nagaraja, Sharath B.N. (46961272800)
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    Cahuana-Hurtado, Lucero (57207890731)
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    Campuzano Rincon, Julio Cesar (6505846919)
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    Chattu, Vijay Kumar (55743746500)
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    Christopher, Devasahayam J. (57209863533)
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    Chu, Dinh-Toi (56239816300)
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    Crider, Raquel (6603551162)
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    Naghavi, Mohsen (57207906323)
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    Vollset, Stein Emil (57196315778)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Kyu, Hmwe Hmwe (57217040073)
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    Murray, Christopher J.L. (55481130700)
    Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package - a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex- specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. © 2019 The Author(s).
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    Publication
    Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
    (2019)
    Frank, Tahvi D. (57203197110)
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    Carter, Austin (57201756395)
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    Jahagirdar, Deepa (57213764835)
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    Biehl, Molly H. (57196041812)
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    Douwes-Schultz, Dirk (57196081398)
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    Larson, Samantha Leigh (57204569813)
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    Arora, Megha (57196080797)
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    Dwyer-Lindgren, Laura (50461317900)
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    Steuben, Krista M. (57208867341)
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    Abbastabar, Hedayat (57212441848)
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    Abu-Raddad, Laith Jamal (14032724700)
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    Adabi, Maryam (57190491886)
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    Adebayo, Oladimeji M. (57194329853)
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    Adekanmbi, Victor (53463192900)
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    Adetokunboh, Olatunji O. (56598104300)
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    Ahmadi, Alireza (56336080700)
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    Ahmadi, Keivan (59396073300)
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    Ahmadian, Elham (57210821126)
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    Ahmadpour, Ehsan (55067754700)
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    Ahmed, Muktar Beshir (57207802317)
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    Alahdab, Fares (55135922900)
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    Alam, Noore (57202437697)
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    Murray, Christopher J.L. (55481130700)
    Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package - a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex- specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. © 2019 The Author(s).
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    Publication
    Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
    (2014)
    Kassebaum, Nicholas J. (55522621100)
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    Lozano, Rafael (7102198442)
    Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.
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    Publication
    Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
    (2021)
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    Kassebaum, Nicholas J. (57202562224)
    Background: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019
    (2021)
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    Shetty, Adithi (57315189400)
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    Shin, Jae Il (57964880100)
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    Shivakumar, K.M. (57221603938)
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    Singh, Jasvinder A. (7404421736)
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    Skryabin, Valentin Yurievich (57226830981)
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    Skryabina, Anna Aleksandrovna (57218875198)
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    Somayaji, Ranjani (6507727557)
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    Soshnikov, Sergey (57195195606)
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    Spurlock, Emma Elizabeth (57218543838)
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    Stein, Dan J. (55769747595)
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    Sufiyan, Mu'awiyyah Babale (58294633600)
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    Tadbiri, Hooman (57138410000)
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    Tadesse, Birkneh Tilahun (56811144600)
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    Tadesse, Eyayou Girma (57221591705)
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    Tamiru, Animut Tagele (57218877788)
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    Tarkang, Elvis Enowbeyang (55351474900)
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    Taveira, Nuno (6602731390)
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    Tekalegn, Yohannes (57201033519)
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    Tesfay, Fisaha Haile (57203977293)
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    Tessema, Gizachew Assefa (57196316304)
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    Thapar, Rekha (36337431900)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Traini, Eugenio (57211137081)
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    Tran, Bach Xuan (57209107515)
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    Tsai, Alexander C. (35362700200)
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    Tusa, Biruk Shalmeno (57216200356)
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    Ullah, Saif (57219395828)
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    Umeokonkwo, Chukwuma David (57204448015)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Tahbaz, Sahel Valadan (57216154072)
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    Villafañe, Jorge Hugo (57197861057)
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    Vladimirov, Sergey Konstantinovitch (57195959162)
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    Vo, Bay (35147075900)
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    Vu, Giang Thu (57202424871)
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    Waheed, Yasir (35303643700)
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    Wamai, Richard G. (23969762700)
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    Wang, Guan (55503825500)
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    Ward, Paul (7402101951)
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    Westerman, Ronny (57218361023)
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    Winkler, Andrea Sylvia (58323746700)
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    Yadav, Lalit (57211483937)
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    Jabbari, Seyed Hossein Yahyazadeh (57207954055)
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    Yazie, Taklo Simeneh (57207254034)
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    Yi, Siyan (16837551600)
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    Yonemoto, Naohiro (57204947657)
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    Yu, Chuanhua (57208140344)
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    Yunusa, Ismaeel (57202137670)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Zhi-Jiang (56068578400)
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    Zumla, Alimuddin (7006170723)
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    Salomon, Joshua A. (56745638600)
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    Eaton, Jeffrey W. (58553535300)
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    Naghavi, Mohsen (57207906323)
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    Dwyer-Lindgren, Laura (50461317900)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (57224556036)
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    Kyu, Hmwe H. (57217040073)
    Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019
    (2021)
    Jahagirdar, Deepa (57213764835)
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    Novotney, Amanda (57224408265)
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    Frank, Tahvi D. (57203197110)
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    Carter, Austin (57201756395)
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    Abbastabar, Hedayat (57212441848)
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    Adekanmbi, Victor (53463192900)
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    Pinheiro, Marina (54397531500)
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    Pokhrel, Khem Narayan (57189445377)
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    Polibin, Roman V. (36721857100)
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    Pollok, Richard Charles G. (6603865038)
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    Postma, Maarten J. (7006296502)
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    Syed, Zahiruddin Quazi (36337182700)
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    Radfar, Amir (57194428768)
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    Radhakrishnan, Raghu Anekal (7103113006)
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    Rahim, Fakher (23052247800)
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    Rahimi-Movaghar, Vafa (6507646446)
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    Rahimzadeh, Shadi (48061460300)
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    Rahman, Mosiur (55457953000)
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    Rahmani, Amir Masoud (57204588830)
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    Ram, Pradhum (55961669800)
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    Ranabhat, Chhabi Lal (56719695500)
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    Ranasinghe, Priyanga (6602322079)
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    Rao, Chythra R. (35771430100)
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    Rao, Sowmya J. (57195423591)
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    Rathi, Priya (57216633909)
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    Rawaf, David Laith (57209228052)
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    Rawaf, Salman (6602475959)
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    Regassa, Lemma Demissie (57208704471)
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    ur Rehman, Inayat (57201810654)
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    Renzaho, Andre M.N. (6505786588)
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    Rezaei, Nima (57216077273)
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    Rezahosseini, Omid (57194737361)
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    Rezai, Mohammad Sadegh (55273796300)
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    Rezapour, Aziz (55548281300)
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    Ripon, Rezaul Karim (57219948722)
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    Rodrigues, Voilet (57222324984)
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    Roshchin, Denis O. (57194175724)
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    Rwegerera, Godfrey M. (56033523400)
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    Saeed, Umar (36612315100)
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    Moghaddam, Sahar Saeedi (56071020000)
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    Sagar, Rajesh (26643103100)
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    Saif-Ur-Rahman, K.M. (55990659300)
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    Salem, Marwa Rashad (57194137372)
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    Samaei, Mehrnoosh (57225273791)
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    Samy, Abdallah M. (36973661300)
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    Santric-Milicevic, Milena M. (57211144346)
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    Saroshe, Satish (36125578600)
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    Sathian, Brijesh (27467953500)
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    Satpathy, Maheswar (57202563691)
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    Sawhney, Monika (57217153893)
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    Schutte, Aletta Elisabeth (57216814352)
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    Seylani, Allen (57222325334)
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    Shaikh, Masood Ali (57203122601)
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    Shaka, Mohammed Feyisso (57205107107)
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    Shamshad, Hina (24722237000)
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    Shamsizadeh, Morteza (57195940127)
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    Shannawaz, Mohammed (56349680200)
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    Shetty, Adithi (57315189400)
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    Shin, Jae Il (57964880100)
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    Shivakumar, K.M. (57221603938)
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    Singh, Jasvinder A. (7404421736)
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    Skryabin, Valentin Yurievich (57226830981)
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    Skryabina, Anna Aleksandrovna (57218875198)
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    Somayaji, Ranjani (6507727557)
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    Soshnikov, Sergey (57195195606)
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    Spurlock, Emma Elizabeth (57218543838)
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    Stein, Dan J. (55769747595)
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    Sufiyan, Mu'awiyyah Babale (58294633600)
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    Tadbiri, Hooman (57138410000)
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    Tadesse, Birkneh Tilahun (56811144600)
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    Tadesse, Eyayou Girma (57221591705)
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    Tamiru, Animut Tagele (57218877788)
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    Tarkang, Elvis Enowbeyang (55351474900)
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    Taveira, Nuno (6602731390)
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    Tekalegn, Yohannes (57201033519)
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    Tesfay, Fisaha Haile (57203977293)
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    Tessema, Gizachew Assefa (57196316304)
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    Thapar, Rekha (36337431900)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Traini, Eugenio (57211137081)
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    Tran, Bach Xuan (57209107515)
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    Tsai, Alexander C. (35362700200)
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    Tusa, Biruk Shalmeno (57216200356)
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    Ullah, Saif (57219395828)
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    Umeokonkwo, Chukwuma David (57204448015)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Tahbaz, Sahel Valadan (57216154072)
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    Villafañe, Jorge Hugo (57197861057)
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    Vladimirov, Sergey Konstantinovitch (57195959162)
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    Vo, Bay (35147075900)
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    Vongpradith, Avina (57216661011)
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    Vu, Giang Thu (57202424871)
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    Waheed, Yasir (35303643700)
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    Wamai, Richard G. (23969762700)
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    Wang, Guan (55503825500)
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    Wang, Yanzhong (59417336500)
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    Ward, Paul (7402101951)
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    Westerman, Ronny (57218361023)
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    Winkler, Andrea Sylvia (58323746700)
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    Yadav, Lalit (57211483937)
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    Jabbari, Seyed Hossein Yahyazadeh (57207954055)
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    Yazie, Taklo Simeneh (57207254034)
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    Yi, Siyan (16837551600)
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    Yiğit, Vahit (57222328239)
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    Yirdaw, Birhanu Wubale (57219148502)
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    Yonemoto, Naohiro (57204947657)
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    Yu, Chuanhua (57208140344)
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    Yunusa, Ismaeel (57202137670)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Zhi-Jiang (56068578400)
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    Zumla, Alimuddin (7006170723)
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    Salomon, Joshua A. (56745638600)
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    Eaton, Jeffrey W. (58553535300)
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    Naghavi, Mohsen (57207906323)
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    Dwyer-Lindgren, Laura (50461317900)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (57224556036)
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    Kyu, Hmwe H. (57217040073)
    Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: A systematic analysis for the Global Burden of Disease Study 2016
    (2017)
    Wang, Haidong (16507828100)
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    Abajobir, Amanuel Alemu (57203613441)
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    Abate, Kalkidan Hassen (57207943858)
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    Abbafati, Cristiana (54917122400)
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    Abbas, Kaja M. (57190285707)
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    Abd-Allah, Foad (36503428900)
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    Abera, Semaw Ferede (57205180598)
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    Abraha, Haftom Niguse (57195289877)
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    Abu-Raddad, Laith J. (14032724700)
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    Abu-Rmeileh, Niveen M.E. (57216675148)
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    Adedeji, Isaac Akinkunmi (57208456508)
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    Adedoyin, Rufus Adesoji (55947572800)
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    Adetifa, Ifedayo Morayo O. (13609887500)
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    Adetokunboh, Olatunji (56598104300)
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    Afshin, Ashkan (57217465455)
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    Aggarwal, Rakesh (7203024985)
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    Ahmad Kiadaliri, Aliasghar (57199100665)
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    Androudi, Sofia (6603286512)
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    Bell, Michelle L. (7401466450)
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    Burch, Michael (7005588453)
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    Cahill, Leah E. (35087909400)
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    Campos-Nonato, Ismael Ricardo (57203424784)
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    Car, Josip (6701783618)
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    Car, Mate (57113377700)
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    Carpenter, David O. (7201795413)
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    Castañeda-Orjuela, Carlos A. (35769124700)
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    Chiang, Peggy Pei-Chia (59846886500)
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    Christopher, Devasahayam Jesudas (57209863533)
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    Cirillo, Massimo (35247478400)
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    Cohen, Aaron J. (7404780942)
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    Coresh, Josef (7005367498)
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    Criqui, Michael H. (7005209601)
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    Cromwell, Elizabeth A. (15727546000)
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    Crump, John A. (57202595111)
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    Dandona, Lalit (7007017243)
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    Dargan, Paul I. (57212154356)
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    Das Neves, José (57208073193)
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    Davey, Gail (7102000901)
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    Davletov, Kairat (6602803024)
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    De Leo, Diego (7006128644)
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    Dellavalle, Robert P. (7003806771)
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    Deribew, Amare (25625914400)
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    Des Jarlais, Don C. (56990451200)
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    Dharmaratne, Samath D. (57216324802)
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    Diaz-Torné, Cesar (12779759300)
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    Ding, Eric L. (54413849800)
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    Djalalinia, Shirin (37113718000)
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    Do, Huyen Phuc (57200737094)
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    Doku, David Teye (36015210300)
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    Donnelly, Christl Ann (35468127900)
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    Dos Santos, Kadine Priscila Bender (57194581321)
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    Douwes-Schultz, Dirk (57196081398)
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    Driscoll, Tim R. (7005928308)
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    Duan, Leilei (56150781400)
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    Ellingsen, Christian Lycke (7801360950)
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    Gankpé, Fortuné Gbètoho (57201341525)
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    Garcia-Basteiro, Alberto L. (57200187168)
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    Gebregergs, Gebremedhin Berhe (57078990000)
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    Gebrehiwot, Tsegaye Tewelde (57216482917)
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    Gebrekidan, Kahsu Gebrekirstos (57908382800)
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    Gebremichael, Mengistu Welday (57195329489)
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    Zenebe, Zerihun Menlkalew (57200737185)
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    Zerfu, Taddese Alemu (55358278900)
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    Zhang, Anthony Lin (56391112900)
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    Zhang, Xueying (56283378700)
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    Zodpey, Sanjay (7003415080)
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    Zuhlke, Liesl Joanna (57209027746)
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    Lopez, Alan D. (7401455668)
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    Murray, Christopher J.L. (55481130700)
    Background: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0.5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates - a measure of relative inequality - increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86.9 years (95% UI 86.7-87.2), and for men in Singapore, at 81.3 years (78.8-83.7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Copyright © The Author(s).
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    Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015
    (2016)
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    Murray, Christopher J L (55481130700)
    Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
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    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)
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    ;
    Murray, Christopher J.L. (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.
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    Publication
    Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study
    (2018)
    Mokdad, Ali H (7004813962)
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    Moradi-Lakeh, Maziar (35617421300)
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    Charara, Raghid (56514085300)
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    El Bcheraoui, Charbel (25027689700)
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    Khalil, Ibrahim (58255049500)
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    Afshin, Ashkan (57217465455)
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    Kassebaum, Nicholas J (57202562224)
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    Collison, Michael (57202309052)
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    Chew, Adrienne (57209171085)
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    Krohn, Kristopher J (57194138806)
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    Daoud, Farah (57201079837)
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    Colombara, Danny (37025591000)
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    Graetz, Nicholas (56276346000)
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    Kutz, Michael (57195617315)
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    Wang, Haidong (16507828100)
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    Abd-Allah, Foad (36503428900)
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    Abu-Raddad, Laith J. (14032724700)
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    Ahmad Kiadaliri, Aliasghar (57199100665)
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    Beshir Ahmed, Muktar (57207802317)
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    Alam, Khurshid (57203681299)
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    Alghnam, Suliman (57200675199)
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    Alizadeh-Navaei, Reza (36024974700)
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    Al-Raddadi, Rajaa (57219673720)
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    Altirkawi, Khalid A (57202762923)
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    Anber, Nahla (57202351369)
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    Anwari, Palwasha (57217465526)
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    Avila-Burgos, Leticia (8530790100)
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    Awasthi, Ashish (57200155811)
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    Barac, Aleksandra (55550748700)
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    Barker-Collo, Suzanne L. (57193065514)
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    Bedi, Neeraj (57988442200)
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    Bhutta, Zulfiqar A (24342648300)
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    Borschmann, Rohan (35091024300)
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    Boufous, Soufiane (6507794444)
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    Butt, Zahid A (57202522739)
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    Castañeda-Orjuela, Carlos A. (35769124700)
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    Dalal, Koustuv (23469128200)
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    Danawi, Hadi (57201079895)
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    De Leo, Diego (7006128644)
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    Dharmaratne, Samath D (57216324802)
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    Djalalinia, Shirin (37113718000)
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    Doyle, Kerrie E (55693710800)
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    Esteghamati, Alireza (11240321100)
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    Faro, André (36770969600)
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    Farvid, Maryam S (57216534761)
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    Fereshtehnejad, Seyed-Mohammad (57202557520)
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    Fischer, Florian (55508208800)
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    Tewelde Gebrehiwot, Tsegaye (57202401977)
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    Gutiérrez, Reyna A. (57200298415)
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    Hafezi-Nejad, Nima (57216814261)
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    Ribhi Hamadeh, Randah (57202769526)
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    Hamidi, Samer (24366336000)
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    Maria Haro, Josep (57221369192)
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    Hendrie, Delia (6602071966)
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    Hu, Guoqing (57218106596)
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    Jonas, Jost B (7202492953)
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    Kasaeian, Amir (57195540738)
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    Njenga Keiyoro, Peter (57202495897)
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    Saleh Khader, Yousef (55654192600)
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    Ahmad Khan, Ejaz (55583420000)
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    Khubchandani, Jagdish (57211720011)
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    Kopec, Jacek A (7006284395)
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    Larson, Heidi J (57202559142)
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    Abdul Latif, Asma (57192380848)
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    Tesema Leshargie, Cheru (57202505340)
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    Lunevicius, Raimundas (57216165063)
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    Magdy Abd El Razek, Mohammed (57201191366)
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    Majeed, Azeem (7102027801)
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    Malekzadeh, Reza (7005197760)
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    Memish, Ziad A (7005059350)
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    Meretoja, Tuomo J (57202554188)
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    Miller, Ted R (7403948600)
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    Mohammed, Shafiu (57838689000)
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    Makhlouf Obermeyer, Carla (57209300189)
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    Akpojene Ogbo, Felix (57200737136)
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    Robert Phillips, Michael (57223805257)
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    Pourmalek, Farshad (8309390500)
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    Qorbani, Mostafa (24831040300)
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    Radfar, Amir (57194428768)
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    Rafay, Anwar (57212263323)
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    Rahimi-Movaghar, Afarin (8696686900)
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    Rahimi-Movaghar, Vafa (6507646446)
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    Kumar Rai, Rajesh (55621126400)
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    Laith Rawaf, David (57202399089)
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    Rawaf, Salman (6602475959)
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    Rezaei, Satar (55791003000)
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    Sadegh Rezai, Mohammad (55273796300)
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    Roshandel, Gholamreza (14034446800)
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    Safdarian, Mahdi (57203849024)
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    Safiri, Saeid (56009654100)
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    Salamati, Payman (14045860600)
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    Samy, Abdallah M (36973661300)
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    Sartorius, Benn (12788526800)
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    Seedat, Soraya (7003445887)
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    Sepanlou, Sadaf G (36248136000)
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    Ali Shaikh, Masood (57203122601)
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    Sobaih, Badr H.A. (57202564080)
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    Tabb, Karen M (51162023700)
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    Tehrani-Banihashemi, Arash (57204006020)
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    Temsah, Mohamad-Hani (56115852000)
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    Sulieman Terkawi, Abdullah (57211144258)
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    Topor-Madry, Roman (57211182892)
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    Nnanna Ukwaja, Kingsley (57202824584)
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    Uthman, Olalekan A (23026328100)
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    Yaseri, Mehdi (23029507000)
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    Yonemoto, Naohiro (57204947657)
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    Younis, Mustafa Z (8549393000)
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    Jumaan, Aisha O (6603612494)
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    Vos, Theo (57223885848)
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    Hay, Simon I (7101875313)
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    Naghavi, Mohsen (57207906323)
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    Murray, Christopher J.L. (55481130700)
    Objectives: We used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015. Methods: The Global Burden of Disease (GBD) study defines intentional injuries as a combination of self-harm (including suicide), interpersonal violence, collective violence (war), and legal intervention. We estimated number of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for each type of intentional injuries. Results: In 2015, 28,695 individuals (95% UI: 25,474–37,832) died from self-harm, 35,626 (95% UI: 20,947–41,857) from interpersonal violence, and 143,858 (95% UI: 63,554–223,092) from collective violence and legal interventions. In 2015, collective violence and legal intervention was the fifth-leading cause of DALYs in the EMR and the leading cause in Syria, Yemen, Iraq, Afghanistan, and Libya; they account for 49.7% of total DALYs in Syria. Conclusions: Our findings call for increased efforts to stabilize the region and assist in rebuilding the health systems, as well as increasing transparency and employing preventive strategies to reduce self-harm and interpersonal injuries. © 2017, The Author(s).
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