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1. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries

Author

Sykes, Alicia G, Seyi-Olajide, Justina, Ameh, Emmanuel A, Ozgediz, Doruk, Abbas, Alizeh, Abib, Simone, Ademuyiwa, Adesoji, Ali, Abdelbasit, Aziz, Tasmiah Tahera, Chowdhury, Tanvir Kabir, Abdelhafeez, Hafeez, Ignacio, Romeo C, Keller, Benjamin, Klazura, Greg, Kling, Karen, Martin, Benjamin, Philipo, Godfrey Sama, Thangarajah, Hariharan, Yap, Ava, Meara, John G, Bundy, Donald AP, Jamison, Dean T, Mock, Charles N, Bickler, Stephen W, and On behalf of the Global Initiative for Children’s Surgery

Subjects
Pediatric, Physical Injury - Accidents and Adverse Effects, Adolescent, Clinical Sciences, Infant, 8.1 Organisation and delivery of services, Health Services, Perinatal Period - Conditions Originating in Perinatal Period, Newborn, Global Health, Hospitals, Good Health and Well Being, Clinical Research, Infant Mortality, Income, Humans, Surgery, Patient Safety, Child, Preschool, On behalf of the Global Initiative for Children’s Surgery, Developing Countries, Health and social care services research
Abstract

BackgroundSurgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20years of life.MethodsEpidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries.ResultsAn estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20years of age in LMICs per year.ConclusionsImproving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20years of life.

Published
2022

2. Essential surgery: key messages from Disease Control Priorities, 3rd edition

Author

Mock, Charles N, Donkor, Peter, Gawande, Atul, Jamison, Dean T, Kruk, Margaret E, Debas, Haile T, and DCP3 Essential Surgery Author Group

Subjects
DCP3 Essential Surgery Author Group, Health Services Needs and Demand, Surgical Procedures, Cost-Benefit Analysis, 8.1 Organisation and delivery of services, Health Care Costs, Health Services, Global Health, Basic Behavioral and Social Science, Medical and Health Sciences, Operative, Good Health and Well Being, Clinical Research, General & Internal Medicine, Practice Guidelines as Topic, Behavioral and Social Science, Humans, Preventive Medicine, Patient Safety, Generic health relevance, Developing Countries, Health and social care services research
Abstract

The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.

Published
2015

3. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Forouzanfar, Mohammad H., Afshin, Ashkan, Alexander, Lily T., Anderson, H. Ross, Bhutta, Zulfiqar A., Biryukov, Stan, Brauer, Michael, Burnett, Richard, Cercy, Kelly, Charlson, Fiona J., Cohen, Aaron J., Dandona, Lalit, Estep, Kara, Ferrari, Alize J., Frostad, Joseph J., Fullman, Nancy, Gething, Peter W., Godwin, William W., Griswold, Max, Hay, Simon I., Kinfu, Yohannes, Kyu, Hmwe H., Larson, Heidi J., Liang, Xiaofeng, Lim, Stephen S., Liu, Patrick Y., Lopez, Alan D., Lozano, Rafael, Marczak, Laurie, Mensah, George A., Mokdad, Ali H., Moradi-Lakeh, Maziar, Naghavi, Mohsen, Neal, Bruce, Reitsma, Marissa B., Roth, Gregory A., Salomon, Joshua A., Sur, Patrick J., Vos, Theo, Wagner, Joseph A., Wang, Haidong, Zhao, Yi, Zhou, Maigeng, Aasvang, Gunn Marit, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abdulle, Abdishakur M., Abera, Semaw Ferede, Abraham, Biju, Abu-Raddad, Laith J., Abyu, Gebre Yitayih, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C., Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N., Akinyemiju, Tomi F., Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K. M., Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala A., Alla, François, Allebeck, Peter, Alsharif, Ubai, Altirkawi, Khalid A., Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T., Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H., Anderson, Benjamin O., Antonio, Carl Abelardo T., Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C., Balakrishnan, Kalpana, Barac, Aleksandra, Barber, Ryan M., Barker-Collo, Suzanne L., Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H., Basu, Sanjay, Batis, Carolina, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Brent, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bensenor, Isabela M., Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhatt, Samir, Biadgilign, Sibhatu, Bikbov, Boris, Bisanzio, Donal, Bjertness, Espen, Blore, Jed D., Borschmann, Rohan, Boufous, Soufiane, Bourne, Rupert R. A., Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J. K., Brenner, Hermann, Broday, David M., Brugha, Traolach S., Brunekreef, Bert, Butt, Zahid A., Cahill, Leah E., Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Cárdenas, Rosario, Carpenter, David O., Carrero, Juan Jesus, Casey, Daniel C., Castañeda-Orjuela, Carlos A., Rivas, Jacqueline Castillo, Castro, Ruben Estanislao, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A., Choi, Jee-Young Jasmine, Christensen, Hanne, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G., Coates, Matthew M., Colquhoun, Samantha M., Manzano, Alejandra G. Contreras, Cooper, Leslie Trumbull, Cooperrider, Kimberly, Cornaby, Leslie, Cortinovis, Monica, Crump, John A., Cuevas-Nasu, Lucia, Damasceno, Albertino, Dandona, Rakhi, Darby, Sarah C., Dargan, Paul I., Das Neves, José, Davis, Adrian C., Davletov, Kairat, Castro, E. Filipa, La Cruz-Góngora, Vanessa, Leo, Diego, Degenhardt, Louisa, Del Gobbo, Liana C., Del Pozo-Cruz, Borja, Dellavalle, Robert P., Deribew, Amare, Jarlais, Don C. Des, Dharmaratne, Samath D., Dhillon, Preet K., Diaz-Torné, Cesar, Dicker, Daniel, Ding, Eric L., Dorsey, E. Ray, Doyle, Kerrie E., Driscoll, Tim R., Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E., Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A., Farinha, Carla Sofia E. Sa, Faro, André, Farvid, Maryam S., Farzadfar, Farshad, Feigin, Valery L., Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G., Fischer, Florian, Fitchett, Joseph R. A., Fleming, Tom, Foigt, Nataliya, Foreman, Kyle, Fowkes, F. Gerry R., Franklin, Richard C., Fürst, Thomas, Futran, Neal D., Gakidou, Emmanuela, Garcia-Basteiro, Alberto L., Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Geleijnse, Johanna M., Gessner, Bradford D., Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Goenka, Shifalika, Gomez-Cabrera, Mari Carmen, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C., Goto, Atsushi, Gouda, Hebe N., Gugnani, Harish Chander, Guillemin, Francis, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A., Haagsma, Juanita A., Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Gessessew Bugssa, Halasa, Yara A., Hamadeh, Randah Ribhi, Hamidi, Samer, Handal, Alexis J., Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Hassen, Tahir Ahmed, Havmoeller, Rasmus, Heredia-Pi, Ileana Beatriz, Hernández-Llanes, Norberto Francisco, Heydarpour, Pouria, Hoek, Hans W., Hoffman, Howard J., Horino, Masako, Horita, Nobuyuki, Hosgood, H. Dean, Hoy, Damian G., Hsairi, Mohamed, Htet, Aung Soe, Hu, Guoqing, Huang, John J., Husseini, Abdullatif, Hutchings, Sally J., Huybrechts, Inge, Iburg, Kim Moesgaard, Idrisov, Bulat T., Ileanu, Bogdan Vasile, Inoue, Manami, Jacobs, Troy A., Jacobsen, Kathryn H., Jahanmehr, Nader, Jakovljevic, Mihajlo B., Jansen, Henrica A. F. M., Jassal, Simerjot K., Javanbakht, Mehdi, Jayaraman, Sudha P., Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Ying, Jibat, Tariku, Jin, Ye, Johnson, Catherine O., Jonas, Jost B., Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S., Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khatibzadeh, Shahab, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Khubchandani, Jagdish, Kieling, Christian, Kim, Cho-Il, Kim, Daniel, Kimokoti, Ruth W., Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D., Kokubo, Yoshihiro, Kopec, Jacek A., Koul, Parvaiz A., Koyanagi, Ai, Kravchenko, Michael, Kromhout, Hans, Krueger, Hans, Ku, Tiffany, Defo, Barthelemy Kuate, Kuchenbecker, Ricardo S., Bicer, Burcu Kucuk, Kuipers, Ernst J., Kumar, G. Anil, Kwan, Gene F., Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lan, Qing, Larsson, Anders, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leasher, Janet L., Leigh, James, Leung, Janni, Levi, Miriam, Li, Xiaohong, Li, Yichong, Liang, Juan, Liu, Shiwei, Lloyd, Belinda K., Logroscino, Giancarlo, Lotufo, Paulo A., Lunevicius, Raimundas, Macintyre, Michael, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Manamo, Wondimu Ayele Ayele, Mapoma, Chabila C., Marcenes, Wagner, Martin, Randall V., Martinez-Raga, Jose, Masiye, Felix, Matsushita, Kunihiro, Matzopoulos, Richard, Mayosi, Bongani M., Mcgrath, John J., Mckee, Martin, Meaney, Peter A., Medina, Catalina, Mehari, Alem, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B., Melaku, Yohannes Adama, Memish, Ziad A., Mendoza, Walter, Mensink, Gert B. M., Meretoja, Atte, Meretoja, Tuomo J., Mesfin, Yonatan Moges, Mhimbira, Francis Apolinary, Millear, Anoushka, Miller, Ted R., Mills, Edward J., Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N., Mohammadi, Alireza, Mohammed, Shafiu, Mola, Glen Liddell D., Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Morawska, Lidia, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O., Mullany, Erin, Mumford, John Everett, Murthy, Gudlavalleti Venkata Satyanarayana, Nachega, Jean B., Naheed, Aliya, Nangia, Vinay, Nassiri, Nariman, Newton, John N., Ng, Marie, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olivares, Pedro R., Olsen, Helen, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Orozco, Ricardo, Ortiz, Alberto, Ota, Erika, Pa, Mahesh, Pana, Adrian, Park, Eun-Kee, Parry, Charles D., Parsaeian, Mahboubeh, Patel, Tejas, Caicedo, Angel J. Paternina, Patil, Snehal T., Patten, Scott B., Patton, George C., Pearce, Neil, Pereira, David M., Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B., Pillay, Julian David, Plass, Dietrich, Polinder, Suzanne, Pond, Constance D., Pope, C. Arden, Pope, Daniel, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prasad, Noela M., Qorbani, Mostafa, Rabiee, Rynaz H. S., Amir Radfar, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Murugesan, Ram, Usha, Rana, Saleem M., Ranganathan, Kavitha, Rao, Puja, García, Christian Aspacia Razo, Refaat, Amany H., Rehm, Colin D., Rehm, Jürgen, Reinig, Nikolas, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Rivera, Juan A., Roba, Hirbo Shore, Rodriguez, Alina, Rodriguez-Ramirez, Sonia, Rojas-Rueda, David, Roman, Yesenia, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Saleh, Muhammad Muhammad, Sanabria, Juan R., Sanchez-Riera, Lidia, Sanchez-Niño, Maria Dolores, Sánchez-Pimienta, Tania G., Sandar, Logan, Santomauro, Damian F., Santos, Itamar S., Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schmidhuber, Josef, Schmidt, Maria Inês, Schneider, Ione J. C., Schöttker, Ben, Schutte, Aletta E., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Levy, Teresa Shamah, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N., Shi, Peilin, Shibuya, Kenji, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Silveira, Dayane Gabriele Alves, Silverberg, Jonathan I., Simard, Edgar P., Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A., Singh, Prashant Kumar, Slepak, Erica Leigh, Soljak, Michael, Soneji, Samir, Sorensen, Reed J. D., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stathopoulou, Vasiliki, Steckling, Nadine, Steel, Nicholas, Stein, Dan J., Stein, Murray B., Stöckl, Heidi, Stranges, Saverio, Stroumpoulis, Konstantinos, Sunguya, Bruno F., Swaminathan, Soumya, Sykes, Bryan L., Szoeke, Cassandra E. I., Tabarés-Seisdedos, Rafael, Takahashi, Ken, Talongwa, Roberto Tchio, Tandon, Nikhil, Tanne, David, Tavakkoli, Mohammad, Taye, Belaynew Wasie, Taylor, Hugh R., Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Tegegne, Teketo Kassaw, Tekle, Dejen Yemane, Terkawi, Abdullah Sulieman, Thakur, J. S., Thomas, Bernadette A., Thomas, Matthew Lloyd, Thomson, Alan J., Thorne-Lyman, Andrew L., Thrift, Amanda G., Thurston, George D., Tillmann, Taavi, Tobe-Gai, Ruoyan, Tobollik, Myriam, Topor-Madry, Roman, Topouzis, Fotis, Towbin, Jeffrey Allen, Tran, Bach Xuan, Dimbuene, Zacharie Tsala, Tsilimparis, Nikolaos, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley N., Undurraga, Eduardo A., Uneke, Chigozie Jesse, Uthman, Olalekan A., Donkelaar, Aaron, Os, Jim, Varakin, Yuri Y., Vasankari, Tommi, Veerman, J. Lennert, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vollset, Stein Emil, Wagner, Gregory R., Waller, Stephen G., Wang, Jian Li, Wang, Linhong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wijeratne, Tissa, Wiysonge, Charles Shey, Wolfe, Charles D. A., Won, Sungho, Woolf, Anthony D., Wubshet, Mamo, Xavier, Denis, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zhu, Jun, Zipkin, Ben, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Murray, Christopher J. L., Forouzanfar, Mohammad H, Afshin, Ashkan, Alexander, Lily T, Anderson, H Ro, Bhutta, Zulfiqar A, Biryukov, Stan, Brauer, Michael, Burnett, Richard, Cercy, Kelly, Charlson, Fiona J, Cohen, Aaron J, Dandona, Lalit, Estep, Kara, Ferrari, Alize J, Frostad, Joseph J, Fullman, Nancy, Gething, Peter W, Godwin, William W, Griswold, Max, Kinfu, Yohanne, Kyu, Hmwe H, Larson, Heidi J, Liang, Xiaofeng, Lim, Stephen S, Liu, Patrick Y, Lopez, Alan D, Lozano, Rafael, Marczak, Laurie, Mensah, George A, Mokdad, Ali H, Moradi-Lakeh, Maziar, Naghavi, Mohsen, Neal, Bruce, Reitsma, Marissa B, Roth, Gregory A, Salomon, Joshua A, Sur, Patrick J, Vos, Theo, Wagner, Joseph A, Wang, Haidong, Zhao, Yi, Zhou, Maigeng, Aasvang, Gunn Marit, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Abraham, Biju, Abu-Raddad, Laith J, Abyu, Gebre Yitayih, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N, Akinyemiju, Tomi F, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'A, Alla, Françoi, Allebeck, Peter, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C, Balakrishnan, Kalpana, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lar, Barrero, Lope H, Basu, Sanjay, Batis, Carolina, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhatt, Samir, Biadgilign, Sibhatu, Bikbov, Bori, Bisanzio, Donal, Bjertness, Espen, Blore, Jed D, Borschmann, Rohan, Boufous, Soufiane, Bourne, Rupert R A, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Broday, David M, Brugha, Traolach S, Brunekreef, Bert, Butt, Zahid A, Cahill, Leah E, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Cárdenas, Rosario, Carpenter, David O, Casey, Daniel C, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Castro, Ruben Estanislao, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Choi, Jee-Young Jasmine, Christensen, Hanne, Christopher, Devasahayam Jesuda, Ciobanu, Liliana G, Coates, Matthew M, Colquhoun, Samantha M, Cooper, Leslie Trumbull, Cooperrider, Kimberly, Cornaby, Leslie, Cortinovis, Monica, Crump, John A, Cuevas-Nasu, Lucia, Damasceno, Albertino, Dandona, Rakhi, Darby, Sarah C, Dargan, Paul I, das Neves, José, Davis, Adrian C, Davletov, Kairat, de Castro, E Filipa, De la Cruz-Góngora, Vanessa, De Leo, Diego, Degenhardt, Louisa, Del Gobbo, Liana C, del Pozo-Cruz, Borja, Dellavalle, Robert P, Deribew, Amare, Jarlais, Don C De, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Dicker, Daniel, Ding, Eric L, Dorsey, E Ray, Doyle, Kerrie E, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, 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Subjects
Blood Glucose, Alcohol Drinking, Global Health, Risk Assessment, Body Mass Index, Middle East, Life Expectancy, Risk-Taking, Africa, Northern, General & Internal Medicine, Quality-Adjusted Life Year, Occupational Exposure, Africa South of the Sahara, Medicine(all), Unsafe Sex, Risk Factor, Medicine (all), Malnutrition, Smoking, Public Health, Global Health, Social Medicine and Epidemiology, Sodium, Dietary, Articles, 11 Medical And Health Sciences, Biomarker, Environmental Exposure, Substance-Related Disorder, Cost of Illne, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Cholesterol, Air Pollution, Indoor, Hypertension, Disabled Person, Human
Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd.

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