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1. Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Murray, Christopher JL, Callender, Charlton SKH, Kulikoff, Xie Rachel, Srinivasan, Vinay, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbasi, Nooshin, Abbastabar, Hedayat, Abdela, Jemal, Abdelalim, Ahmed, Abdel-Rahman, Omar, Abdi, Alireza, Abdoli, Nasrin, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abebo, Teshome Abuka, Abejie, Ayenew Negesse, Aboyans, Victor, Abraha, Haftom Niguse, Abreu, Daisy Maria Xavier, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Pawan, Adamu, Abdu A, Adebayo, Oladimeji M, Adedeji, Isaac Akinkunmi, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adhikari, Tara Ballav, Adib, Mina G, Adou, Arsène Kouablan, Adsuar, Jose C, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmed, Muktar Beshir, Ahmed, Sayem, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akanda, Ali S, Akbari, Mohammad Esmaeil, Akibu, Mohammed, Akinyemi, Rufus Olusola, Akinyemiju, Tomi, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alebel, Animut, Aleman, Alicia V, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Ali, Raghib, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Almasi, Ali, Alonso, Jordi, Al-Raddadi, Rajaa M, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Ammar, Walid, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Appiah, Seth Christopher Yaw, Aremu, Olatunde, Areri, Habtamu Abera, Arian, Nicholas, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Asfaw, Ephrem Tsegay, Asgedom, Solomon Weldegebreal, Assadi, Reza, Atey, Tesfay Mehari Mehari, and Atique, Suleman

Subjects
Health Sciences, Behavioral and Social Science, Contraception/Reproduction, Basic Behavioral and Social Science, Aging, Aetiology, 2.4 Surveillance and distribution, Reproductive health and childbirth, Good Health and Well Being, Adolescent, Adult, Aged, Birth Rate, Child, Child, Preschool, Female, Global Burden of Disease, Global Health, Humans, Infant, Infant, Newborn, Male, Maternal Age, Middle Aged, Mortality, Population Density, Population Growth, Young Adult, GBD 2017 Population and Fertility Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundPopulation estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.MethodsWe estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories.FindingsFrom 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4-52·0). The TFR decreased from 4·7 livebirths (4·5-4·9) to 2·4 livebirths (2·2-2·5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3-200·8) since 1950, from 2·6 billion (2·5-2·6) to 7·6 billion (7·4-7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9-1·2) in Cyprus to a high of 7·1 livebirths (6·8-7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07-0·09) in South Korea to 2·4 livebirths (2·2-2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3-0·4) in Puerto Rico to a high of 3·1 livebirths (3·0-3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger.InterpretationPopulation trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress.FundingBill & Melinda Gates Foundation.

Published
2018

2. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Collaborators, GBD 2017 Causes of Death, Roth, Gregory A, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abejie, Ayenew Negesse, Abera, Semaw F, Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Adamu, Abdu A, Adebayo, Oladimeji M, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adib, Mina G, Admasie, Amha, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmed, Muktar Beshir, Ahmed, Sayem, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akbari, Mohammad Esmaeil, Akinyemi, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Raddadi, Rajaa M, Alahdab, Fares, Alam, Khurshid, Alam, Tahiya, Alebel, Animut, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Alonso, Jordi, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Aminde, Leopold N, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Aremu, Olatunde, Ärnlöv, Johan, Arora, Amit, Arora, Monika, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Asfaw, Ephrem Tsegay, Ataro, Zerihun, Atique, Suleman, Atre, Sachin R, Ausloos, Marcel, Avokpaho, Euripide FGA, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Ayele, Yohanes, Ayer, Rakesh, Azzopardi, Peter S, Babazadeh, Arefeh, Bacha, Umar, Badali, Hamid, and Badawi, Alaa

Subjects
Brain Disorders, Pediatric, Prevention, Aetiology, 2.4 Surveillance and distribution, Infection, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Female, Global Burden of Disease, Global Health, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Sex Distribution, Socioeconomic Factors, Young Adult, GBD 2017 Causes of Death Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundGlobal development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.MethodsThe causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.FindingsAt the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases.InterpretationImprovements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.FundingBill & Melinda Gates Foundation.

Published
2018

3. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

James, Spencer L, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Zegeye, Abera, Semaw F, Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Ackerman, Ilana N, Adamu, Abdu A, Adebayo, Oladimeji M, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adib, Mina G, Adsuar, Jose C, Afanvi, Kossivi Agbelenko, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Aggarwal, Rakesh, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akinyemiju, Tomi, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Mekhlafi, Hesham M, Al-Raddadi, Rajaa M, Alahdab, Fares, Alam, Khurshid, Alam, Tahiya, Alashi, Alaa, Alavian, Seyed Moayed, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Alouani, Mohamed ML, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Aminde, Leopold N, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Arabloo, Jalal, Arauz, Antonio, Aremu, Olatunde, Ariani, Filippo, Armoon, Bahroom, Ärnlöv, Johan, Arora, Amit, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Asghar, Rana Jawad, Ataro, Zerihun, Atre, Sachin R, Ausloos, Marcel, Avila-Burgos, Leticia, Avokpaho, Euripide FGA, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Ayer, Rakesh, Azzopardi, Peter S, Babazadeh, Arefeh, Badali, Hamid, Badawi, Alaa, and Bali, Ayele Geleto

Subjects
Prevention, 2.4 Surveillance and distribution, Aetiology, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, Disabled Persons, Female, Global Burden of Disease, Global Health, Humans, Incidence, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Morbidity, Prevalence, Sex Distribution, Socioeconomic Factors, Wounds and Injuries, Young Adult, GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.MethodsWe estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting.FindingsGlobally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]).InterpretationGlobal all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.FundingBill & Melinda Gates Foundation.

Published
2018

4. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Author

Collaborators, GBD 2017 SDG, Lozano, Rafael, Fullman, Nancy, Abate, Degu, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdel-Rahman, Omar, Abdi, Alireza, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Nebiyu Dereje, Abebe, Zegeye, Abejie, Ayenew Negesse, Abera, Semaw F, Abil, Olifan Zewdie, Aboyans, Victor, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen Me, Abyu, Gebre Y, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Adamu, Abdu A, Adebayo, Oladimeji M, Adedeji, Isaac Akinkunmi, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adhikari, Tara Ballav, Adib, Mina G, Adou, Arsène Kouablan, Adsuar, Jose C, Afarideh, Mohsen, Afshari, Afshin, Ashkan, Agarwal, Gina, Aghayan, Sargis Aghasi, Agius, Dominic, Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Ahmed, Sayem, Akalu, Temesgen Yihunie, Akanda, Ali S, Akbari, Mohammad Esmaeil, Akibu, Mohammed, Akinyemi, Rufus Olusola, Akinyemiju, Tomi, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Tahiya, Albujeer, Ammar, Alebel, Animut, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Alhabib, Samia, Ali, Raghib, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine A, Almasi, Ali, Al-Maskari, Fatma, Al-Mekhlafi, Hesham M, Alonso, Jordi, Al-Raddadi, Rajaa M, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amenu, Kebede, Amini, Erfan, Ammar, Walid, Anber, Nahla Hamed, Anderson, Jason A, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansari, Hossein, Ansariadi, Ansariadi, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, and Anwari, Palwasha

Subjects
Prevention, Pediatric, Good Health and Well Being, Peace, Justice and Strong Institutions, Female, Global Burden of Disease, Global Health, Goals, Health Status, Health Status Indicators, Humans, Male, Mortality, Risk Factors, Sex Offenses, Sustainable Development, United Nations, GBD 2017 SDG Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.FindingsThe global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.InterpretationThe GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.FundingBill & Melinda Gates Foundation.

Published
2018

5. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Collaborators, GBD 2017 Risk Factor, Stanaway, Jeffrey D, Afshin, Ashkan, Gakidou, Emmanuela, Lim, Stephen S, Abate, Degu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Molla, Abebe, Zegeye, Abera, Semaw F, Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Adamu, Abdu A, Adane, Akilew Awoke, Adebayo, Oladimeji M, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Ademi, Zanfina, Adetokunboh, Olatunji O, Adib, Mina G, Admasie, Amha, Adsuar, Jose C, Afanvi, Kossivi Agbelenko, Afarideh, Mohsen, Agarwal, Gina, Aggarwal, Anju, Aghayan, Sargis Aghasi, Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akbari, Mohammad Esmaeil, Akinyemiju, Tomi, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Mekhlafi, Hesham M, Alahdab, Fares, Alam, Khurshid, Alam, Samiah, Alam, Tahiya, Alashi, Alaa, Alavian, Seyed Moayed, Alene, Kefyalew Addis, Ali, Komal, Ali, Syed Mustafa, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Ammar, Walid, Anber, Nahla Hamed, Anderson, Jason A, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansha, Mustafa Geleto, Antó, Josep M, Antonio, Carl Abelardo T, Anwari, Palwasha, Appiah, Lambert Tetteh, Appiah, Seth Christopher Yaw, Arabloo, Jalal, Aremu, Olatunde, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Ataro, Zerihun, Ausloos, Marcel, Avokpaho, Euripide FGA, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Ayer, Rakesh, and Ayuk, Tambe B

Subjects
Prevention, Aetiology, 2.2 Factors relating to the physical environment, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, Disabled Persons, Environmental Exposure, Female, Global Burden of Disease, Global Health, Health Risk Behaviors, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Metabolic Diseases, Middle Aged, Occupational Diseases, Occupational Exposure, Quality-Adjusted Life Years, Risk Assessment, Sex Distribution, Socioeconomic Factors, Young Adult, GBD 2017 Risk Factor Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations.MethodsWe used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.FindingsIn 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.InterpretationBy quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.FundingBill & Melinda Gates Foundation.

Published
2018

6. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Collaborators, GBD 2017 Mortality, Dicker, Daniel, Nguyen, Grant, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdel-Rahman, Omar, Abdi, Alireza, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abdurahman, Ahmed Abdulahi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abebo, Teshome Abuka, Aboyans, Victor, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Pawan, Adebayo, Oladimeji M, Adedeji, Isaac Akinkunmi, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adhikari, Tara Ballav, Adib, Mina G, Adou, Arsène Kouablan, Adsuar, Jose C, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Aggarwal, Rakesh, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Agrawal, Anurag, Ahmadi, Mehdi, Ahmadi, Alireza, Ahmadieh, Hamid, Ahmed, Mohamed Lemine Cheikh brahim, Ahmed, Sayem, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akanda, Ali S, Akbari, Mohammad Esmaeil, Akibu, Mohammed, Akinyemi, Rufus Olusola, Akinyemiju, Tomi, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alebel, Animut, Aleman, Alicia V, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Ali, Raghib, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine A, Alonso, Jordi, Al-Raddadi, Rajaa M, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Anlay, Degefaye Zelalem, Ansari, Hossein, Ansariadi, Ansariadi, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Appiah, Seth Christopher Yaw, Aremu, Olatunde, Areri, Habtamu Abera, Ärnlöv, Johan, Arora, Megha, and Artaman, Al

Subjects
Behavioral and Social Science, Pediatric, Prevention, Basic Behavioral and Social Science, 2.4 Surveillance and distribution, Aetiology, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Global Burden of Disease, Global Health, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Mortality, Sex Distribution, Socioeconomic Factors, Young Adult, GBD 2017 Mortality Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundAssessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally.MethodsThe GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950.FindingsGlobally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development.InterpretationThis analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing.FundingBill & Melinda Gates Foundation.

Published
2018

7. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Kyu, Hmwe Hmwe, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Molla, Abebe, Zegeye, Abil, Olifan Zewdie, Aboyans, Victor, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Ackerman, Ilana N, Adamu, Abdu A, Adebayo, Oladimeji M, Adekanmbi, Victor, Ademi, Zanfina, Adetokunboh, Olatunji O, Adib, Mina G, Adsuar, Jose C, Afanvi, Kossivi Agbelenko, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Aggarwal, Rakesh, Aghayan, Sargis Aghasi, Agrawal, Anurag, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Ahmed, Sayem, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akinyemiju, Tomi, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Mekhlafi, Hesham M, Al-Raddadi, Rajaa M, Alahdab, Fares, Alam, Khurshid, Alam, Tahiya, Alashi, Alaa, Alavian, Seyed Moayed, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Alonso, Jordi, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Aminde, Leopold N, Amini, Erfan, Amiresmaili, Mohammadreza, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Arabloo, Jalal, Aremu, Olatunde, Ärnlöv, Johan, Arora, Amit, Arora, Megha, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Ataro, Zerihun, Ausloos, Marcel, Avila-Burgos, Leticia, Avokpaho, Euripide FGA, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Ayer, Rakesh, Azzopardi, Peter S, Babazadeh, Arefeh, Badali, Hamid, and Balakrishnan, Kalpana

Subjects
Prevention, Aging, Good Health and Well Being, Aged, Communicable Diseases, Disabled Persons, Female, Global Burden of Disease, Health Status, Healthy Lifestyle, Humans, Life Expectancy, Male, Mortality, Mortality, Premature, Prevalence, Quality-Adjusted Life Years, Risk Factors, Socioeconomic Factors, Wounds and Injuries, GBD 2017 DALYs and HALE Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2).InterpretationWith increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.FundingBill & Melinda Gates Foundation.

Published
2018

8. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Collaborators, GBD 2016 Risk Factors, Gakidou, Emmanuela, Afshin, Ashkan, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Abyu, Gebre Yitayih, Adedeji, Isaac Akinkunmi, Adetokunboh, Olatunji, Afarideh, Mohsen, Agrawal, Anurag, Agrawal, Sutapa, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Akinyemi, Rufus Olusola, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Komal, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansari, Hossein, Antó, Josep M, Antonio, Carl Abelardo T, Anwari, Palwasha, Arian, Nicholas, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Ballew, Shoshana H, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Batis, Carolina, Battle, Katherine E, Baumgarner, Blair R, Baune, Bernhard T, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhutta, Zulfiqar A, Bicer, Burcu Kucuk, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Blosser, Christopher D, Boneya, Dube Jara, Bou-Orm, Ibrahim R, Brauer, Michael, and Breitborde, Nicholas JK

Subjects
Epidemiology, Health Sciences, Prevention, Aetiology, 2.2 Factors relating to the physical environment, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Air Pollution, Body Mass Index, Cause of Death, Child, Child, Preschool, Communicable Diseases, Disabled Persons, Environmental Health, Female, Global Burden of Disease, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Metabolic Diseases, Middle Aged, Noncommunicable Diseases, Occupational Diseases, Quality-Adjusted Life Years, Risk Assessment, Sex Distribution, Smoking, Water Supply, Young Adult, GBD 2016 Risk Factors Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.FindingsSince 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.InterpretationIncreasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.FundingThe Bill & Melinda Gates Foundation, Bloomberg Philanthropies.

Published
2017

9. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Collaborators, GBD 2016 DALYs and HALE, Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, and Beyene, Addisu Shunu

Subjects
Epidemiology, Public Health, Health Sciences, Clinical Research, Behavioral and Social Science, Burden of Illness, Prevention, Social Determinants of Health, 2.4 Surveillance and distribution, Good Health and Well Being, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Communicable Diseases, Disabled Persons, Female, Global Burden of Disease, Global Health, Humans, Life Expectancy, Male, Middle Aged, Noncommunicable Diseases, Quality-Adjusted Life Years, Residence Characteristics, Sex Distribution, Wounds and Injuries, GBD 2016 DALYs and HALE Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundMeasurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.FindingsThe highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.InterpretationAt a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.FundingBill & Melinda Gates Foundation.

Published
2017

10. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Collaborators, GBD 2016 Causes of Death, Naghavi, Mohsen, Abajobir, Amanuel Alemu, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abera, Semaw Ferede, Aboyans, Victor, Adetokunboh, Olatunji, Afshin, Ashkan, Agrawal, Anurag, Ahmadi, Alireza, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Miloud Taki Eddine, Aichour, Ibtihel, Aiyar, Sneha, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Ali, Syed Danish, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla, Andersen, Hjalte H, Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon W, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G, Awasthi, Ashish, Babalola, Tesleem Kayode, Bacha, Umar, Balakrishnan, Kalpana, Barac, Aleksandra, Barboza, Miguel A, Barker-Collo, Suzanne L, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Baune, Bernhard T, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, James R, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Boris, Bisanzio, Donal, Bourne, Rupert RA, Breitborde, Nicholas JK, Bulto, Lemma Negesa Bulto, Bumgarner, Blair R, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Campuzano, Julio Cesar, Car, Josip, Cárdenas, Rosario, Carrero, Juan Jesus, Carter, Austin, Casey, Daniel C, Castañeda-Orjuela, Carlos A, Catalá-López, Ferrán, Charlson, Fiona J, Chibueze, Chioma Ezinne, and Chimed-Ochir, Odgerel

Subjects
Pediatric, Clinical Research, Infant Mortality, Infectious Diseases, 2.4 Surveillance and distribution, Aetiology, Infection, Cardiovascular, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Communicable Diseases, Disasters, Female, Global Burden of Disease, Global Health, Humans, Infant, Infant, Newborn, Male, Middle Aged, Noncommunicable Diseases, Nutrition Disorders, Pregnancy, Pregnancy Complications, Socioeconomic Factors, Wounds and Injuries, Young Adult, GBD 2016 Causes of Death Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundMonitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.MethodsWe estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.FindingsThe quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.InterpretationThe past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.FundingBill & Melinda Gates Foundation.

Published
2017

11. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

Author

Collaborators, GBD 2016 SDG, Fullman, Nancy, Barber, Ryan M, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Adedeji, Isaac Akinkunmi, Adetokunboh, Olatunji, Afshin, Ashkan, Agrawal, Anurag, Agrawal, Sutapa, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemi, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alasfoor, Deena, Alene, Kefyalew Addis, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Palwasha, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Assadi, Reza, Atey, Tesfay Mehari, Atre, Sachin R, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barrero, Lope H, Basu, Sanjay, Battle, Katherine E, Baune, Bernhard T, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Bicer, Burcu Kucuk, Bidgoli, Hassan Haghparast, Bikbov, Boris, Bilal, Arebu I, Birungi, Charles, Biryukov, Stan, Bizuayehu, Habtamu Mellie, Blosser, Christopher D, Boneya, Dube Jara, Bose, Dipan, and Bou-Orm, Ibrahim R

Subjects
Infectious Diseases, Pediatric, Prevention, Rare Diseases, Good Health and Well Being, Adolescent, Adult, Child, Child Abuse, Sexual, Child, Preschool, Conservation of Natural Resources, Female, Global Burden of Disease, Global Health, Health Status, Health Status Indicators, Humans, Infant, Infant Mortality, Infant, Newborn, Male, Middle Aged, Noncommunicable Diseases, Quality-Adjusted Life Years, Sex Offenses, Young Adult, GBD 2016 SDG Collaborators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.MethodsWe used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment.FindingsGlobally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past.InterpretationGBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations.FundingBill & Melinda Gates Foundation.

Published
2017

12. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Collaborators, GBD 2016 Disease and Injury Incidence and Prevalence, Vos, Theo, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adamu, Abdu Abdullahi, Adetokunboh, Olatunji, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Sanjay Kumar, Aggarwal, Rakesh, Agrawal, Anurag, Agrawal, Sutapa, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemi, Rufus Olusola, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Altirkawi, Khalid A, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Andersen, Hjalte H, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon W, Assadi, Reza, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Atre, Sachin R, Avila-Burgos, Leticia, Avokphako, Euripide Frinel G Arthur, Awasthi, Ashish, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Bannick, Marlena S, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Basu, Sanjay, Battista, Bob, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, and Beyene, Addisu Shunu

Subjects
Biomedical and Clinical Sciences, Epidemiology, Public Health, Clinical Sciences, Health Sciences, Neurosciences, Behavioral and Social Science, Burden of Illness, Aging, Brain Disorders, Mental Health, Women's Health, 2.4 Surveillance and distribution, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Communicable Diseases, Disabled Persons, Female, Global Burden of Disease, Global Health, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Noncommunicable Diseases, Prevalence, Sex Distribution, Wounds and Injuries, Young Adult, GBD 2016 Disease and Injury Incidence and Prevalence Collaborators, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundAs mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.MethodsWe estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FindingsGlobally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).InterpretationThe decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.FundingBill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

Published
2017

13. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Roth, Gregory A., Collaborotors, G. B. D.Causes Death, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M., Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Load, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abejie, Ayenew Negesse, Abera, Semaw F., Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Adamu, Abdu A., Adebayo, Oladimeji, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adookunboh, Olatunii, Adhena, Beyene Meressa, Adib, Mina G., Admasie, Aniha, Afshin, Ashkan, Agarwal, Gina, Agesa, Karelia M., Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Melidi, Ahmed, Muktar Beshir, Ahmed, Sayent, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Fddine, Akbari, Mohammad Esmaeil, Akinyeniti, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Raddadi, Rajaa M., Alandab, Fares, Alam, Khurshid, Alam, Tahiya, Alebel, Animut, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Alonso, Jordi, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T., Aminde, Leopold N., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampern, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansari, Hossein, Aniha, Mustafa Geleto, Antonio, Carl Abelardo T., Anwari, Palwasha, Aremu, Olatunde, Arnlov, Johan, Arora, Amit, Arora, Monika, Artaman, Al, Aryal, Krishna K., Asayesh, Hamid, Asfaw, Ephremi Tsegay, Ataro, Zerihun, Atique, Suleman, Atre, Sachin R., Ausloos, Marcel, Avokpaho, Euripide F. G. A., Awasthi, Ashish, Quintattilla, Beatriz Paulina Ayala, Ayele, Yohanes, Ayer, Rakesh, Azzopardi, Peter S., Babazadeh, Arefeh, Bacha, Umar, Badali, Hamid, Badawi, Alaa, Bali, Ayele Geleto, Ballesteros, Katherine E., Banach, Maciej, Banerjee, Kajori, Bannick, Marlena S., Banoub, Joseph Adel Mattar, Barboza, Miguel A., Barker-Collo, Suzanne Lyu, Barnighausen, Till Winfried, Barquera, Simon, Barrero, Lope, Bassat, Quique, Base, Sanjay, Baune, Bernhard T., Baynes, Habtamu Wondifraw, Bazargan-Hejazi, Shahrzad, Beth, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Mcysam, Bejot, Yannick, Bekele, Bayu Begashaw, Belacliew, Abate Bekele, Belay, Ezra, Belay, Yihalem Abebe, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bensenor, Isabela M., Berman, Adam F., Bernabe, Eduardo, Bernstein, Robert S., Bertolacci, Gregory J., Beuran, Mircea, Beyranvand, Tina, Bhalla, Ashish, Bhattarai, Suraj, Bhaumik, Sounayadeeep, Bhutta, Zulfiqar A., Biadgo, Belete, Biehl, Molly H., Bijani, Ali, Bikbov, Boris, Bilano, Ver, Bililign, Nigus, Bin Sayeed, Muhammad Shandaat, Bisanzio, Donal, Biswas, Tuhin, Blacker, Brigitte F., Basara, Berrak Bora, Borschmann, Rohan, Bosetti, Cristina, Bozorgmehr, Kayvan, Brady, Oliver J., Brant, Luisa C., Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J. K., Brenner, Hermann, Briant, Paul Svitil, Britton, Gabrielle, Brugha, Traolach, Busse, Reinhard, Butt, Zahid A., Callender, Charlton S. K. H., Campos-Nonato, Ismael R., Rincon, Julio Cesar Canapuzano, Cano, Jorge, Car, Mate, Cardenas, Rosario, Carreras, Giulia, Carrero, Juan J., Carter, Austin, Carvalho, Felix, Castaneda-Orjuela, Carlos A., Rivas, Jacqueline Castillo, Castle, Chris D., Castro, Clara, Castro, Franz, Catala-Lopez, Ferran, Cerin, Ester, Chaiah, Yazan, Chang, Jung -Chen, Chanson, Fiona J., Chaturvedi, Pankaj, Chiang, Peggy Pei-Chia, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheet, Abdulaal, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam J., Chiang, Sheng-Chia, Cicuttini, Flavia M., Ciobanu, Liliana G., Cirillo, Massimo, Cohen, Aaron J., Cooper, Leslie Trumbull, Cortesi, Paolo Angelo, Cortinovis, Monica, Cousin, Ewerton, Cowie, Benjamin C., Criqui, Michael H., Cromwell, Elizabeth A., Crowe, Christopher Stephen, Crump, John A., Cunningham, Matthew, Daba, Alemneh Kabeta, Dadi, Abel Fekadu, Dandona, Lalit, Dandona, Rakhi, Dang, Anh Kim, Dargan, Paul I., Daryani, Ahmad, Das, Siddharth K., Das Gupta, Rajat, Das Neves, Jose, Dasa, Tamirat Tesfaye, Dash, Aditya Prasad, Davis, Adrian C., Weaver, Nicole Davis, Davitoiu, Dragos Virgil, Davletov, Kairat, De La Hoz, Fernando Pio, De Neve, Jan-Walter, Degefa, Meaza Girma, Degenhardt, Louisa, Degfie, Tizta T., Deiparine, Selina, Demoz, Gebre Teklemariam, Demtsu, Baleen Betsu, Denova-Gutierrez, Edgar, Deribe, Kebede, Dervenis, Nikolaos, Jarlais, Don C. Des, Dessie, Getenet Ayalew, Dey, Subhojit, Dhannaratne, Samath D., Dicker, Daniel, Dinberu, Mesfin Tadese, Ding, Eric L., Dirac, M. Ashworth, Djalalinia, Shirin, Dokova, Klara, Ter Doku, David, Donnelly, Christl A., Dorsey, E. Ray, Doshi, Pratik P., Douwes-Schultz, Dirk, Doyle, Kerrie E., Driscoll, Tim R., Dubey, Manisha, Dubljanin, Eleonora, Duken, Eyasu Ejeta, Duncan, Bruce B., Duraes, Andre R., Ebrahimi, Hedyeh, Ebrahimpour, Soheil, Edessa, Dumessa, Edvardsson, David, Eggen, Anne Elise, El Bcheraoui, Charbel, Zaki, Maysaa El Sayed, El-Khatib, Ziad, Elkout, Hajer, Eltinsel, Christian Lycke, Endres, Matthias, Endries, Aman Yesuf, Er, Benjamin, Erskine, Holly E., Eshrati, Babak, Eskandarieh, Sharareh, Esmaeili, Reza, Esteghamati, Alireza, Fakhar, Mahdi, Fakhim, Hamed, Faramarzi, Mahbobeh, Fareed, Mohammad, Farhadi, Farzaneh, Faninha, Carla Sofia E. Sa, Faro, Andre, Farvid, Maryam S., Farzadfar, Farshad, Farzaei, Mohammad Hosein, Feign, Valery L., Feigl, Andrea B., Fentahun, Netsanet, Eereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, Fernandes, Joao C., Ferrari, Alice J., Feyissa, Garumma Tolu, Filip, Irina, Finegold, Samuel, Fischer, Florian, Eitzmaurice, Christina, Foigt, Nataliya A., Foreman, Kyle J., Fornari, Carla, Frank, Tahvi D., Fukumoto, Takeshi, Fuller, John E., Fullman, Nancy, Furst, Thomas, Furtado, Joao M., Futran, Neal D., Gallus, Silvano, Garcia-Basteiro, Alberto L., Garcia-Gordillo, Miguel A., Gardner, William M., Gebre, Abadi Kahsu, Gebrehiwol, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Gebremichael, Bereket, Gebremichael, Teklu Gebrehiwo, Gelano, Tilayie Feto, Geleijinse, Johanna M., Genova-Maleras, Ricard, Geramo, Yilma Chisha Dea, Gething, Peter W., Gezae, Kebede Embaye, Ghadami, Mohammad Rasoul, Ghadimi, Reza, Falavarjani, Khalil Ghasemi, Ghasemi-Kasman, Maryam, Ghimire, Mamata, Gibney, Katherine B., Gill, Paramjit Singh, Gill, Tiffany K., Gillum, Richard F., Ginawi, Ibrahim Abdelmageed, Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goldberg, Ellen M., Goli, Srinivas, Gomez-Dantes, Hector, Gona, Philimon N., Gopalani, Sameer Vali, Gorman, Taren M., Goto, Atsushi, Goulart, Alessandra C., Gnedovskaya, Elena V., Grada, Aymara, Grosso, Giuseppe, Gugnani, Hanish Chander, Guimaraes, Andre Luiz Sena, Gun, Nailing, Gupta, Prakash C., Gupta, Rahid, Gupta, Rajenv, Gupta, Tanush, Gutierrez, Reyna Alma, Gyawali, Bishal, Haagsma, Juanita A., Hafezi-Nejad, Nima, Hagos, Tekleberhan B., Hailegiyorgis, Tewodros Tesfa, Hailu, Gessessew Bugssa, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hamadeh, Randall R., Hamidi, Sinner, Handal, Meads J., Hankey, Graeme J., Harb, Hilda L., Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hasan, Mehedi, Hassankhani, Hadi, Hassen, Hamid, Havmoeller, Rasmus, Hay, Roderick J., Hay, Simon I., He, Yihua, Hedayatizadeh-Omran, Akbar, Hegazy, Mohamed I., Heibati, Behzad, Heidari, Mohsen, Hendrie, Delia, Henok, Andualem, Henry, Nathaniel J., Herteliu, Claudiu, Heydarpour, Fatemeh, Heydarpour, Pouria, Heydarpour, Sousan, Hibstu, Desalegn Tsegaw, Hoek, Hans W., Hole, Michael K., Red, Enayatollah Homaie, Hoogar, Praveen, Hosgood, H. Dean, Hosseini, Seyed Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hotez, Peter J., Hoy, Damian C., Hsiao, Thomas, Hu, Guoqing, Huang, John J., Husseini, Abdullatif, Hussen, Mohammedaman Mama, Hutfless, Susan, Idrisov, Bulat, Ilesanmi, Olayinka Stephen, Iqbal, Usman, Irvani, Seyed Sina Naghibi, Irvine, Caleb Mackay Salpeter, Islam, Nazrul, Islam, Sheikh Mohammed Shariful, Islami, Farhad, Jacobsen, Kathryn H., Jahangiry, Leila, Jahanmehr, Nader, Jain, Sudhir Kumar, Jakovlievic, Mihajlo, Jalu, Moti Tolera, James, Spencer L., Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jenkins, Kathy J., Jha, Ravi Prakash, Jha, Vivekanand, Johnson, Catherine O., Johnson, Sarah C., Jonas, Jost B., Joshi, Ankur, Jozwiak, Jacek Jerzy, Jungari, Suresh Banayya, Jurisson, Mikk, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kalani, Rizwan, Karami, Manoochehr, Matin, Behzad Karami, Karch, Andre, Karema, Corine, Karimi-Sari, Hamidreza, Kasaeian, Amir, Kassa, Dessalegn H., Kassa, Getachew Mullu, Kassa, Tesfaye Dessale, Kassebaum, Nicholas J., Katikireddi, Srinivasa Vittal, Kaul, Anil, Kazemi, Zhila, Karyani, Ali Kazemi, Kazi, Dhruv Satish, Kefale, Adane Teshome, Keiyoro, Peter Njenga, Kemp, Grant Rodgers, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khafaei, Behzad, Khafaie, Morteza Abdullatif, Khajavi, Alireza, Khalid, Nauman, Khalil, Ibrahim A., Khan, Ejaz Ahmad, Khan, Muhammad Shahzeb, Khan, Muhammad Ali, Khang, Young-Ho, Khater, Mona M., Khoja, Abdullah T., Khosravi, Ardeshir, Khosravi, Mohammad Hossein, Khubchandani, Jagdish, Kiadaliri, Aliasghar A., Kibret, Getiye D., Kidanemariam, Zelalem Teklemariam, Kiirithio, Daniel N., Kim, Daniel, Kim, Young-Eun, Kim, Yun Jin, Kimokoti, Ruth W., Kinfu, Yohannes, Kisa, Adnan, Kissimova-Skarbek, Katarzyna, Kivimaki, Mika, Knudsen, Ann Kristin Skrindo, Kocarnik, Jonathan M., Kochhar, Sonali, Kokubo, Yoshihiro, Kolola, Tufa, Kopec, Jacek A., Koul, Parvaiz A., Koyanagi, Ai, Kravchenko, Michael A., Krishan, Kewal, Defo, Barthelemy Kuate, Bicer, Burcu Kinuk, Kumar, G. Anil, Kumar, Manasi, Kumar, Pushpendra, Kutz, Michael J., Kuzin, Igor, Kyu, Hmwe Hmwe, Lad, Deepesh P., Lad, Sheetal D., Lafranconi, Alessandra, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lam, Jennifer O., Lami, Faris Hasan, Van Lansingh, C., Lansky, Sonia, Larson, Heidi J., Latifi, Amman, Lau, Kathryn Mei-Ming, Lazarus, Jeffrey V., Lebedev, Georgy, Lee, Paul H., Leigh, James, Leili, Mostafa, Leshargie, Cheru Tesema, Li, Shanshan, Li, Yichong, Liang, Juan, Lim, Lee-Ling, Lim, Stephen S., Limenih, Miteku Andualem, Linn, Shai, Liu, Shiwei, Liu, Yang, Lodha, Rakesh, Lansdale, Chris, Lopez, Alan D., Lorkowski, Stefan, Lotufo, Paulo A., Lozano, Rafael, Lunevicius, Raimundas, Ma, Stefan, Macarayan, Erlyn Rachelle King, Mackay, Mark T., MacLachlan, Jennifer H., Maddison, Emilie R., Nadotto, Fabiana, Abd El Razek, Hassan Magdy, Abd El Razek, Muhammed Magdy, Maghavani, Dhaval P., Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Manda, Ana-Laura, Mandarano-Filho, Luiz Garcia, Manguerra, Helena, Mansournia, Mohammad Ali, Mapoma, Chabila Christopher, Marami, Dadi, Maravilla, Joemer C., Marcenes, Wagner, Marczak, Laurie, Marks, Ashley, Marks, Guy B., Martinez, Gabriel, Martins-Melo, Francisco Rogerlandio, Martopullo, Ira, Marz, Winfried, Marron, Melvin B., Masci, Joseph R., Lylassenburg, Benjamin Ballard, Mathur, Manu Raj, Mathur, Prashant, Matzopoulos, Richard, Maulik, Pallab K., Mazidi, Mohsen, McAlinden, Cohn, McGrath, John J., McKee, Martin, McMahon, Brian J., Mehata, Suiiesh, Mehndiratta, Man Mohan, Mehrotra, Ravi, Mehta, Kala M., Mehta, Varshil, Mekonnen, Tefera C., Melese, Addisu, Melku, Mulugeta, Memiah, Peter T. N., Memish, Ziad A., Mendoza, Walter, Mengistu, Desalegn Tadese, Mengistu, Getnet, Mensah, George A., Mereta, Seid Tiku, Meretoja, Atte, Meretoja, Tuomo J., Meshovic, Tbmislav, Mezgebe, Haftay Berhane, Miazgowski, Bartosz, Miazgowski, Tomasz, Millear, Anoushka I., Miller, Ted R., Katherine, Molly, Petrie, Miller, Mini, G. K., Mirabi, Parvaneh, Mirarefin, Mojde, Mirica, Andreea, Mirrakhimov, Erkin M., Misganaw, Awoke Temesgen, Mitiku, Habtamu, Moazen, Babak, Mohammad, Karzan Abdulmuhsin, Mohammad, Moslem, Mohammadifard, Noushin, Mohammed, A. Mohammed, Mohammed, Shafiu, Mohan, Viswanathan, Mokdad, Ali H., Molokhia, Mariam, Monasta, Lorenzo, Moradi, Ghobad, Moradi-Lakeh, Maziar, Moradinazar, Mehdi, Moraga, Paula, Morawska, Lidia, Velasquez, Ilais Moreno, Morgado-Da-Costa, Joana, Morrison, Shane Douglas, Moschos, Marilita M., Mouodi, Simin, Mousavi, Seyyed Meysam, Muchie, Kindie Eentahun, Mueller, Ulrich Otto, Mukhopadhyay, Satinath, Muller, Kate, Mumford, John Everett, Musa, Jonah, Musa, Kamand Imran, Mustafa, Ghulam, Muthupandian, Saravanan, Nachega, Jean B., Nagel, Gabriele, Naheed, Aliya, Nahvijou, Azin, Naik, Gunidatta, Nair, Sanjeev, Najafi, Farid, Naldi, Luigi, Nam, Hae Sung, Nangia, Vinay, Nansseu, Jobert Richie, Nascirnento, Bruno Ramos, Natarajan, Gopalakrishnan, Nearnati, Nahid, Negoi, Ionut, Negoi, Ruxcandra Irina, Nettpane, Subas, Newton, Charles R. J., Ngalesoni, Frida N., Ngunjiri, Josephine W., Anh Quynh Nguyen, Nguyen, Grant, Ha Thu Nguyen, Luong Thanh Nguyen, Long Hoang Nguyen, Nguyen, Minh, Trang Huyen Nguyen, Nichols, Emma, Ningnun, Dina Nur Anggraini, Nirayo, Yirga Legesse, Nixon, Molly R., Nolutshungu, Nomonde, Nomura, Shhhei, Norhelin, Ole F., Noroozi, Mehdi, Norrving, Bo, Noubiap, Jean Jacques, Nouri, Hamid Reza, Shiadeh, Malihe Nourollahpour, Nowroozi, Mohammad Reza, Nyasulu, Peter S., Odell, Christopher M., Ofori-Asenso, Richard, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olagunju, Andrew T., Olivares, Pedro R., Olsen, Helen Elizabeth, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ong, Kanyin L., Ong, Sok King Sk, Oren, Eyal, Orpana, Heather M., Ortiz, Alberto, Ortiz, Justin R., Otstavnov, Stanislav S., Overland, Simon, Owolabi, Mayowa Ojo, Ozdemir, Raziye, Mahesh, P. A., Pacella, Rosana, Pakhale, Smita, Pakhare, Abhijit P., Pakpour, Amir H., Pana, Adrian, Panda-Jonas, Songhomitra, Pandian, Jeyaraj Durai, Parisi, Andrea, Park, Eun-Kee, Parry, Charles D. H., Parsian, Hadi, Patel, Shanti, Pati, Sanghamitra, Patton, George C., Paturi, Vishnupriya Rao, Paulson, Katherine R., Pereira, Alexandre, Pereira, David M., Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael R., Piel, Frederic B., Pigott, David M., Pillay, Julian David, Pirsaheb, Meghdad, Pishgar, Farhad, Polinder, Suzanne, Postma, Maarten J., Pourshams, Akram, Poustchi, Hossein, Pujar, Ashwini, Prakash, Swayam, Prasad, Narayan, Purcell, Caroline A., Qorbani, Mostafa, Quintana, Hedley, Quistberg, D. Alex, Rade, Kirankumar Waman, Radfah, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi, Kazem, Rahimi-Movaghar, Afarin, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Muhammad Aziz, Rai, Rajesh Kumar, Rajsic, Sasa, Ram, Usha, Ranabhat, Chhabi Lal, Ranjan, Prabhat, Rao, Puja C., Rawaf, David Laith, Rawaf, Salman, Razo-Garcia, Christian, Reddy, K. Srinath, Reiner, Robert C., Reitsma, Marissa B., Remuzzi, Giuseppe, Renzaho, Andre M. N., Resnikoff, Serge, Rezaei, Satar, Rezaeian, Shahab, Rezai, Mohammad Sadegh, Riahi, Seyed Mohammad, Ribeiro, Antonio Luiz P., Rios-Blancas, Maria Jesus, Roba, Kedir Teji, Roberts, Nicholas L. 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Tortajada-Girbés, M, Tovani-Palone, Mr, Tran, Bx, Tran, Kb, Troeger, Ce, Truelsen, Tc, Truong, Nt, Tsadik, Ag, Tuzcu, Em, Ukwaja, Kn, Undurraga, Ea, Updike, Rl, Uthman, Oa, Uzun, Sb, Valdez, Pr, Vasankari, Tj, Vladimirov, Sk, Vollset, Se, Wagner, Gr, Wallin, Mt, Walson, Jl, Wang, Yp, Wassie, Mm, Weintraub, Rg, Weldegwergs, Kg, Werkneh, Aa, West, Te, Whiteford, Ha, Wilner, Lb, Wolfe, Cda, Wu, Yc, Wyper, Gma, Yahyazadeh Jabbari, Sh, Yan, Ll, Yasin, Yj, Yentür, Gk, Yimer, Em, Yirsaw, Bd, Yoon, Sj, Younis, Mz, Zaman, Sb, Zeleke, Aj, Zenebe, Zm, Zhang, Al, Zuhlke, Lj, and Murray, Cjl.

Subjects
Adult, Male, Adolescent, national age-sex-specific mortality, UNITED-STATES, Global Health, Socioeconomic Factor, Global Burden of Disease, GBD, causes of death, Young Adult, Age Distribution, Life Expectancy, General & Internal Medicine, Cause of Death, PUBLIC-HEALTH PROBLEM, mortality, 282 causes global burden of disease, Sex Distribution, Child, Aged, Aged, 80 and over, BARRIERS, DEMENTIA, Medicine (all), Infant, Newborn, Infant, 11 Medical And Health Sciences, Middle Aged, TRENDS, PREVENTION, PREVALENCE, ALZHEIMERS-DISEASE, INDIVIDUALS, 3121 General medicine, internal medicine and other clinical medicine, Child, Preschool, REGISTRATION, Female, Human medicine, Human
Abstract

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

Published
2018

14. Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Murray, Christopher J L, Callender, Charlton S K H, Kulikoff, Xie Rachel, Srinivasan, Vinay, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M, Abbasi, Nooshin, Abbastabar, Hedayat, Abdela, Jemal, Abdelalim, Ahmed, Abdel-Rahman, Omar, Abdi, Alireza, Abdoli, Nasrin, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abebo, Teshome Abuka, Abejie, Ayenew Negesse, Aboyans, Victor, Abraha, Haftom Niguse, Abreu, Daisy Maria Xavier, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen M E, Accrombessi, Manfred Mario Kokou, Acharya, Pawan, Adamu, Abdu A, Adebayo, Oladimeji M, Adedeji, Isaac Akinkunmi, Adekanmbi, Victor, Adetokunboh, Olatunji O, Adhena, Beyene Meressa, Adhikari, Tara Ballav, Adib, Mina G, Adou, Arsène Kouablan, Adsuar, Jose C, Afarideh, Mohsen, Afshin, Ashkan, Agarwal, Gina, Agesa, Kareha M, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmed, Muktar Beshir, Ahmed, Sayem, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akanda, Ali S, Akbari, Mohammad Esmaeil, Akibu, Mohammed, Akinyemi, Rufus Olusola, Akinyemiju, Tomi, Akseer, Nadia, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alebel, Animut, Aleman, Alicia V, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Ali, Raghib, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Almasi, Ali, Alonso, Jordi, Al-Raddadi, Rajaa M, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T, Ammar, Walid, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Appiah, Seth Christopher Yaw, Aremu, Olatunde, Areri, Habtamu Abera, Arian, Nicholas, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Asfaw, Ephrem Tsegay, Asgedom, Solomon Weldegebreal, Assadi, Reza, Atey, Tesfay Mehari Mehari, Atique, Suleman, Atteraya, 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Harb, H, Haro, J, Hassen, H, Hay, S, Hegazy, M, Henry, N, Hibstu, D, Hole, M, Hosgood, H, Hosseini, S, Hosseini Chavoshi, M, Huang, J, Iburg, K, Igumbor, E, Ikeda, C, Irenso, A, Irvani, S, Isehunwa, O, Islam, S, Jain, S, Jalu, M, James, S, Jassal, S, Jayatilleke, A, Jha, R, Jonas, J, Jozwiak, J, Jungari, S, Matin, B, Karimi, S, Kassa, D, Kassa, G, Kassa, T, Kassa, Z, Kassebaum, N, Katikireddi, S, Karyani, A, Keiyoro, P, Kemp, G, Kengne, A, Khafaie, M, Khalil, I, Khan, E, Khang, Y, Khater, M, Khoja, A, Khosravi, M, Kibret, G, Kidanemariam, Z, Kiirithio, D, Kilgore, P, Kim, J, Kim, Y, Kimokoti, R, Kopec, J, Kosek, M, Koul, P, Krohn, K, Defo, B, Bicer, B, Kumar, G, Kumsa, F, Kutz, M, Lad, S, Lal, D, Lami, F, Lang, J, Lansingh, V, Laryea, D, Lazarus, J, Lee, J, Lee, P, Leshargie, C, Liben, M, Lim, L, Limenih, M, Lotufo, P, Mabika, C, Macarayan, E, Mackay, M, Mahmood, T, Mahotra, N, Malik, M, Mamun, A, Manamo, W, Manda, A, Mansournia, M, Mantovani, L, Mapoma, C, Maravilla, J, Martins-Melo, F, Marzan, M, Mashamba-Thompson, T, Mason-Jones, A, Massenburg, B, Mathur, M, Maulik, P, Mcgrath, J, Mehendale, S, Mehndiratta, M, Mehta, K, Mekonnen, T, Meles, H, Meles, K, Memiah, P, Memish, Z, Mengesha, M, Mengistu, D, Mensah, G, Mereta, S, Meretoja, T, Mezgebe, H, Miller, T, Miller-Petrie, M, Mini, G, Mirrakhimov, E, Misganaw, A, Mohammad, K, Mohammed, M, Mokdad, A, Mola, G, Montañez, J, Morrison, S, Moschos, M, Mousavi, S, Muche, A, Muchie, K, Mueller, U, Murphy, T, Murthy, G, Musa, K, Nachega, J, Nansseu, J, Nascimento, B, Ncama, B, Negoi, R, Newton, C, Ngalesoni, F, Ngunjiri, J, Nguyen, L, Nguyen, T, Ningrum, D, Nirayo, Y, Nisar, M, Nixon, M, Noubiap, J, Nouri, H, Shiadeh, M, Nowroozi, M, Odell, C, Ogbo, F, Oh, I, Olagunju, A, Olagunju, T, Olivares, P, Olusanya, B, Olusanya, J, Ong, S, Otieno, B, Owolabi, M, Pakhare, A, Panda, B, Pandey, A, Park, E, Patil, S, Patton, G, Paturi, V, Pedroso, M, Peprah, E, Pereira, D, Petri, W, Pigott, D, Pillay, J, Polanczyk, G, Postma, M, Purcell, C, Purwar, M, Rahman, S, Rai, R, Ranabhat, C, Rawaf, D, Ray, S, Reiner, R, Renzaho, A, Riahi, S, Rios-Blancas, M, Roba, K, Roberts, N, Ruhago, G, Sabde, Y, Sahraian, M, Saldanha, R, Salomon, J, Sambala, E, Samy, A, Sanchez-Niño, M, Santric Milicevic, M, Sao Jose, B, Sarker, A, Sawant, A, Schneider, I, Schwebel, D, Sepanlou, S, Shackelford, K, Shaheen, A, Shaikh, M, Shakir, R, Shukla, S, Sibai, A, Siddiqi, T, Sigfusdottir, I, Silva, D, Silva, J, Silveira, D, Singam, N, Singh, J, Singh, N, Sinha, D, Soares Filho, A, Sobaih, B, Soriano, J, Soyiri, I, Sreeramareddy, C, Starodubov, V, Stewart, L, Stokes, M, Subart, M, Sufiyan, M, Sunguya, B, Sur, P, Sykes, B, Sylaja, P, Sylte, D, Szoeke, C, Tabb, K, Tadakamadla, S, Tassew, A, Tassew, S, Tawye, N, Tekalign, T, Tekle, M, Temsah, M, Teshale, M, Thankappan, K, Thomson, A, To, Q, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Tripathy, S, Truelsen, T, Truong, N, Tsadik, A, Ukwaja, K, Uthman, O, Uzun, S, Valdez, P, Vasankari, T, Vasconcelos, A, Vladimirov, S, Vollset, S, Walson, J, Weintraub, R, Weldegwergs, K, Wolfe, C, Wyper, G, Yasin, Y, Yentür, G, Yimer, E, Yoon, S, Younis, M, Zaman, S, Zeleke, M, Zenebe, Z, Zerfu, T, Zhao, X, Zimsen, S, Lopez, A, and Lim, S

Subjects
Adult, Male, Population Density, GBD, population, fertility, Adolescent, Medicine (all), Infant, Newborn, Infant, 11 Medical And Health Sciences, Middle Aged, Global Health, Global Burden of Disease, Young Adult, Child, Preschool, General & Internal Medicine, Female, Human medicine, Mortality, Child, Population Growth, Birth Rate, Aged, Human, Maternal Age
Abstract

Background Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-cotnponent method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings From 1950 to 2017, TFRs decreased by 49.4% (95% uncertainty interval [UI] 46.4-52.0). The TFR decreased from 4.7 livebirths (4.5-4.9) to 2.4 livebirths (2.2-2.5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83.8 million people per year since 1985. The global population increased by 197-2% (193.3-200.8) since 1950, from 2.6 billion (2.5-2.6) to 7.6 billion (7.4-7.9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2.0%; this rate then remained nearly constant until 1970 and then decreased to 1.1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2.5% in 1963 to O7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2.7%. The global average age increased from 26.6 years in 1950 to 32.1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59.9% to 65.3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1.0 livebirths (95% UI 0. 9-1.2) in Cyprus to a high of 7.1 livebirths (6.8-7.4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0.08 livebirths (0.07-0.09) in South Korea to 2.4 livebirths (2.2-2.6) in Niger, and the TFR over age 30 years (I F030; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0.3 livebirths (0.3-0-4) in Puerto Rico to a high of 3.1 livebirths (3.0-3.2) in Niger. TF030 was higher than TFU25 in 145 countries and territories in 2017.33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2.0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

Published
2018

15. Burden of lower respiratory infections in the Eastern Mediterranean Region between 1990 and 2015: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Moradi-Lakeh, Maziar, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Afshin, Ashkan, Kassebaum, Nicholas J, Collison, Michael, Daoud, Farah, Chew, Adrienne, Krohn, Kristopher J, Colombara, Danny, Ehrenkranz, Rebecca, Foreman, Kyle J, Frostad, Joseph, Godwin, William W, Kutz, Michael, Rao, Puja C, Reiner, Robert, Troeger, Christopher, Wang, Haidong, Abajobir, Amanuel Alemu, Abbas, Kaja M, Abera, Semaw Ferede, Abu-Raddad, Laith J, Adane, Kelemework, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Beshir, Muktar, Al-Eyadhy, Ayman, Alam, Khurshid, Alam, Noore, Alasfoor, Deena, Alizadeh-Navaei, Reza, Al-Maskari, Fatma, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Anber, Nahla, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Palwasha, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Atey, Tesfay Mehari, Arthur, Euripide Frinel G, Bacha, Umar, Barac, Aleksandra, Bazargan-Hejazi, Shahrzad, Drew, Charles R, Geffen, David, Bedi, Neeraj, Bhutta, Zulfiqar A, Michael, Brauer, Butt, Zahid A, Castaneda-Orjuela, Carlos A, Danawi, Hadi, Djalalinia, Shirin, Endries, Aman Yesuf, Eshrati, Babak, Farvid, Maryam S, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Garcia-Basteiro, Alberto L, Gebrehiwot, Kiros Tedla, Gebrehiwot, Tsegaye Tewelde, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Hassanvand, Mohammad Sadegh, Hedayati, Mohammad T, Horita, Nobuyuki, Husseini, Abdullatif, Spencer, Lewis James, Javanbakht, Mehdi, Jonas, Jost B, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khoja, Abdullah Tawfih Abdullah, Khubchandani, Jagdish, Kim, Yun Jin, Kissoon, Niranjan, Larson, Heidi J, Latif, Asma Abdul, Leshargie, Cheru Tesema, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Farid, Habibolah Masoudi, Mehari, Alem, Memish, Ziad A, Mengistu, Desalegn Tadese, Mensah, George A, Mezgebe, Haftay Berhane, Nakamura, Sachiko, Oren, Eyal, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Vafa, Rahimi-Movaghar, Rai, Rajesh Kumar, Rawaf, David Laith, Rawaf, Salman, Refaat, Amany H, Rezaei, Satar, Rezai, Mohammad Sadegh, Roba, Hirbo Shore, Roshandel, Gholamreza, Safdarian, Mahdi, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sartorius, Benn, Sepanlou, Sadaf G, Shaikh, Masood Ali, Shamsizadeh, Morteza, Shigematsu, Mika, Singh, Jasvinder A, Sufiyan, Muawiyyah Babale, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Topor-Madry, Roman, Uthman, Olalekan A, Vollset, Stein Emil, Wakayo, Tolassa, Werdecker, Andrea, Wijeratne, Tissa, Yaghoubi, Mohsen, Yimam, Hassen Hamid, Yonemoto, Naohiro, Younis, Mustafa Z, Zaki, Maysaa El Sayed, Jumaan, Aisha O, Vos, Theo, Naghavi, Mohsen, Hay, Simon I, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, and Hay, S

Subjects
Adult, Male, medicine.medical_specialty, Health (social science), Adolescent, 030231 tropical medicine, Disease, Eastern, Global Health, Eastern Mediterranean Region, Global Burden of Disease, 03 medical and health sciences, Middle East, Young Adult, 0302 clinical medicine, Risk Factors, Environmental health, medicine, Global health, Humans, 030212 general & internal medicine, Mortality, Child, Respiratory Tract Infections, Aged, DALY, Respiratory tract infections, business.industry, Mediterranean Region, Public health, Incidence (epidemiology), Incidence, Public Health, Environmental and Occupational Health, Age Factors, Infant, Middle Aged, medicine.disease, Quality-adjusted life year, Lower respiratory infection, Malnutrition, 1117 Public Health And Health Services, Child, Preschool, Life expectancy, Female, Original Article, Quality-Adjusted Life Years, Public Health, business
Abstract

We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations. Horizon Pharmaceuticals; American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC); Veterans Affairs Rheumatology Field Advisory Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee Dr. Carl Abelardo T. Antonio reports Grants and personal fees from Johnson and Johnson (Philippines), Inc. outside the submitted work. Dr. Jasvinder Singh serves as the principal investigator for an investigator-initiated study funded by Horizon Pharmaceuticals through a grant to DINORA, Inc., a 501 (c)(3) entity. Dr. Singh is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. Other authors have no conflict of interest.

Published
2017
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16. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibtihel, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bicer, Burcu Kucuk, Bienhoff, Kelly, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Blyth, Fiona M, Boneya, Dube Jara, Bose, Dipan, Bou-Orm, Ibrahim R, Bourne, Rupert R A, Brainin, Michael, Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J K, Briant, Paul S, Britton, Gabrielle, Brugha, Traolach S, Buchbinder, Rachelle, Bulto, Lemma Negesa Bulto, Bumgarner, Blair R, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Campos-Nonato, Ismael Ricardo, Carabin, Hélène, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Carvalho, Felix, Casey, Daniel, Castañeda-Orjuela, Carlos A, Castle, Chris D, Catalá-López, Ferrán, Chang, Jung-Chen, Charlson, Fiona J, Chaturvedi, Pankaj, Chen, Honglei, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Colombara, Danny, Cooper, Leslie Trumbull, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Dadi, Abel Fekadu, Dalal, Koustuv, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, das Neves, José, Davitoiu, Dragos V, Davletov, Kairat, de Courten, Barbora, De Leo, Diego, De Steur, Hans, Defo, Barthelemy Kuate, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Dicker, Daniel, Djalainia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Dorsey, E Ray, dos Santos, Kadine Priscila Bender, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Ebel, Beth E, Echko, Michelle, El-Khatib, Ziad Ziad, Enayati, Ahmadali, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshetie, Setegn, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fanuel, Fanuel Belayneh Bekele, Farag, Tamer, Farinha, Carla Sofia e Sa, Faro, André, Farzadfar, Farshad, Fazeli, Mir Sohail, Feigin, Valery L, Feigl, Andrea B, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C, Ferrari, Alize J, Feyissa, Tesfaye Regassa, Filip, Irina, Fischer, Florian, Fitzmaurice, Christina, Flaxman, Abraham D, Foigt, Nataliya, Foreman, Kyle J, Franklin, Richard C, Frostad, Joseph J, Fullman, Nancy, Fürst, Thomas, Furtado, Joao M, Futran, Neal D, Gakidou, Emmanuela, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Geleto, Ayele, Gemechu, Bikila Lencha, Gesesew, Hailay Abrha, Gething, Peter W, Ghajar, Alireza, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim Abdelmageem Mohamed, Gishu, Melkamu Dedefo, Giussani, Giorgia, Godwin, William W, Goel, Kashish, Goenka, Shifalika, Goldberg, Ellen M, Gona, Philimon N, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Goulart, Alessandra Carvalho, Graetz, Nicholas, Gugnani, Harish 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Subjects
Male, Dánarmein, AUSTRALIA, GBD, disability-adjusted life-years (DALYs), Heilsufar, Lífslíkur, Epidemiology, Life expectancy, Diseases, Global Health, THERAPY, Global Burden of Disease, Residence Characteristics, Fullorðnir, Cause of Death, Medicine and Health Sciences, Psychology, Konur, Aged, 80 and over, Tölfræði, PLASMODIUM-FALCIPARUM, Aldraðir, Sjúkdómar, Medicine (all), Fatlaðir, Men, Þjóðir, 11 Medical And Health Sciences, ASSOCIATION, Middle Aged, Health policy, PREVALENCE, Sálfræði, disability-adjusted life-years (DALYs), Female, Lýðheilsa, Quality-Adjusted Life Years, Life Sciences & Biomedicine, Global Health Metrics, Adult, AFRICA, Quality of life, People with disabilities, GBD, WEIGHTS, Social ecology, Lífsgæði, Communicable Diseases, World health/statistics, Age Distribution, Life Expectancy, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, Heilbrigðisstefna, Humans, Adults, Disabled Persons, Women, Sex Distribution, Mortality, Noncommunicable Diseases, Aged, Science & Technology, Faraldsfræði, MORTALITY, Wounds and injuries, EPIDEMIOLOGIC TRANSITION, HIV, Áverkar, Karlar, Wounds and Injuries, Félagshagfræði, Older people
Abstract

Correction in: LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017, Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support., Bill & Melinda Gates Foundation

Published
2017

17. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries : an analysis from the Global Burden of Disease Study 2016

Author

Fullman, Nancy, Barber, Ryan M, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulkader, Rizwan Suliankatchi, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, De Steur, Hans, Gupta, Vipin, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Nguyen, Quyen Le, Stanaway, Jeffrey D, Atre, Sachin R, Kim, Daniel, Criqui, Michael H, Aryal, Krishna Kumar, Ahmadieh, Hamid, Stein, Dan J, Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Strub, Bryan, Aichour, Miloud Taki Eddine, Nguyen, Trang Huyen, Defo, Barthelemy Kuate, Sufiyan, Muawiyyah Babale, Dandona, Rakhi, Mantovani, Lorenzo G, Sunguya, Bruno F, Sur, Patrick J, Mazidi, Mohsen, Kimokoti, Ruth W, Swaminathan, Soumya, Sykes, Bryan L, Avila-Burgos, Leticia, Sylte, Dillon O, Nguyen, Grant, Schwebel, David C, Szoeke, Cassandra E I, Murthy, Gudlavalleti Venkata Satyanarayana, Tabarés-Seisdedos, Rafael, Hafezi-Nejad, Nima, Tadakamadla, Santosh Kumar, Degenhardt, Louisa, McAlinden, Colm, Tandon, Nikhil, Kinfu, Yohannes, Tao, Tianchan, Schwendicke, Falk, Tarekegn, Yihunie L, Giref, Ababi Zergaw, Ahmed, Muktar Beshir, Tavakkoli, Mohammad, Taveira, Nuno, Tegegne, Teketo Kassaw, Avokpaho, Euripide Frinel G Arthur, Terkawi, Abdullah Sulieman, Hailu, Gessessew Bugssa, Alla, François, Seedat, Soraya, Tessema, Gizachew Assefa, Thakur, JS, Alam, Khurshid, Rajsic, Sasa, Nguyen, Minh, Deiparine, Selina, Thankappan, Kavumpurathu Raman, Thrift, Amanda G, Tiruye, Tenaw Yimer, Tobe-Gai, Ruoyan, Martin, Randall V, Topor-Madry, Roman, Torre, Anna, McGaughey, Madeline, Tortajada, Miguel, Ram, Usha, Hamadeh, Randah Ribhi, Nichols, Emma, Awasthi, Ashish, Fürst, Thomas, Tran, Bach Xuan, Sepanlou, Sadaf G, Troeger, Christopher, Deribe, Kebede, Truelsen, Thomas, Tsoi, Derrick, Tuem, Kald Beshir, Ranabhat, Chhabi Lal, McGrath, John J, Tuzcu, Emin Murat, Majeed, Azeem, Tyrovolas, Stefanos, Servan-Mori, Edson E, Ukwaja, Kingsley N, Hammami, Mouhanad, Kisa, 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Chitheer, A, Christensen, H, Christopher, D, Cirillo, M, Cooper, C, Criqui, M, Cromwell, E, Crump, J, Dandona, L, Dandona, R, Dargan, P, Das Neves, J, Davitoiu, D, De Courten, B, De Steur, H, Degenhardt, L, Deiparine, S, Deribe, K, Deveber, G, Ding, E, Djalalinia, S, Do, H, Dokova, K, Doku, D, Dorsey, E, Driscoll, T, Dubey, M, Duncan, B, Ebel, B, Ebrahimi, H, El-Khatib, Z, Enayati, A, Endries, A, Ermakov, S, Erskine, H, Eshrati, B, Eskandarieh, S, Esteghamati, A, Estep, K, Faraon, E, Sofia E Sa Farinha, C, Faro, A, Farzadfar, F, Fazeli, M, Feigin, V, Feigl, A, Fereshtehnejad, S, Fernandes, J, Ferrari, A, Feyissa, T, Filip, I, Fischer, F, Fitzmaurice, C, Flaxman, A, Foigt, N, Foreman, K, Frank, T, Franklin, R, Friedman, J, Frostad, J, Fürst, T, Furtado, J, Gakidou, E, Garcia-Basteiro, A, Gebrehiwot, T, Geleijnse, J, Geleto, A, Gemechu, B, Gething, P, Gibney, K, Gill, P, Gillum, R, Giref, A, Gishu, M, Giussani, G, Glenn, S, Godwin, W, Goldberg, E, Gona, P, Goodridge, A, Gopalani, S, Goryakin, Y, Griswold, M, Gugnani, H, Gupta, R, Gupta, T, Gupta, V, Hafezi-Nejad, N, Bidgoli, H, Hailu, G, Hamadeh, R, Hammami, M, Hankey, G, Harb, H, Hareri, H, Hassanvand, M, Havmoeller, R, Hawley, C, Hay, S, He, J, Hendrie, D, Henry, N, Heredia-Pi, I, Hoek, H, Holmberg, M, Horita, N, Hosgood, H, Hostiuc, S, Hoy, D, Hsairi, M, Htet, A, Huang, H, Huang, J, Huynh, C, Iburg, K, Ikeda, C, Inoue, M, Irvine, C, Jacobsen, K, Jahanmehr, N, Jakovljevic, M, Jauregui, A, Javanbakht, M, Jeemon, P, Jha, V, John, D, Johnson, C, Johnson, S, Jonas, J, Jürisson, M, Kabir, Z, Kadel, R, Kahsay, A, Kamal, R, Karch, A, Karema, C, Kasaeian, A, Kassebaum, N, Kastor, A, Katikireddi, S, Kawakami, N, Keiyoro, P, Kelbore, S, Kemmer, L, Kengne, A, Kesavachandran, C, Khader, Y, Khalil, I, Khan, E, Khang, Y, Khosravi, A, Khubchandani, J, Kieling, C, Kim, D, Kim, J, Kim, Y, Kimokoti, R, Kinfu, Y, Kisa, A, Kissimova-Skarbek, K, Kivimaki, M, Kokubo, Y, Kopec, J, Kosen, S, Koul, P, Koyanagi, A, Kravchenko, M, Krohn, K, Defo, B, Bicer, B, Kulikoff, X, Kumar, G, Kutz, M, Kyu, H, Lal, D, Lalloo, R, Lansingh, V, Larsson, A, Lazarus, J, Lee, P, Leigh, J, Leung, J, Leung, R, Levi, M, Li, Y, Liben, M, Linn, S, Liu, P, Liu, S, Lodha, R, Looker, K, Lopez, A, Lorkowski, S, Lotufo, P, Lozano, R, Lucas, T, Lunevicius, R, Mackay, M, Maddison, E, El Razek, H, El Razek, M, Majdan, M, Majdzadeh, R, Majeed, A, Malekzadeh, R, Malhotra, R, Malta, D, Mamun, A, Manguerra, H, Mantovani, L, Manyazewal, T, Mapoma, C, Marks, G, Martin, R, Martinez-Raga, J, Martins-Melo, F, Martopullo, I, Mathur, M, Mazidi, M, Mcalinden, C, Mcgaughey, M, Mcgrath, J, Mckee, M, Mehata, S, Mehndiratta, M, Meier, T, Meles, K, Memish, Z, Mendoza, W, Mengesha, M, Mengistie, M, Mensah, G, Mensink, G, Mereta, S, Meretoja, A, Meretoja, T, Mezgebe, H, Micha, R, Millear, A, Miller, T, Minnig, S, Mirarefin, M, Mirrakhimov, E, Misganaw, A, Mishra, S, Mitchell, P, Mohammad, K, Mohammed, K, Mohammed, S, Mohan, M, Mokdad, A, Mollenkopf, S, Monasta, L, Hernandez, J, Montico, M, Moradi-Lakeh, M, Moraga, P, Morawska, L, Morrison, S, Moses, M, Mountjoy-Venning, C, Mueller, U, Muller, K, Murthy, G, Musa, K, Naghavi, M, Naheed, A, Naidoo, K, Nangia, V, Natarajan, G, Negoi, I, Negoi, R, Nguyen, C, Nguyen, G, Nguyen, M, Nguyen, Q, Nguyen, T, Nichols, E, Ningrum, D, Nomura, M, Nong, V, Norheim, O, Noubiap, J, Obermeyer, C, Ogbo, F, Oh, I, Oladimeji, O, Olagunju, A, Olagunju, T, Olivares, P, Olsen, H, Olusanya, B, Olusanya, J, Ong, K, Oren, E, Ortiz, A, Owolabi, M, Mahesh, P, Pana, A, Panda, B, Panda-Jonas, S, Papachristou, C, Park, E, Patton, G, Paulson, K, Pereira, D, Perico, D, Pesudovs, K, Petzold, M, Phillips, M, Pigott, D, Pillay, J, Pinho, C, Piradov, M, Pishgar, F, Poulton, R, Pourmalek, F, Qorbani, M, Radfar, A, Rafay, A, Rao, P, Rahimi-Movaghar, V, Rahman, M, Ur Rahman, M, Rai, R, Rajsic, S, Ram, U, Ranabhat, C, Rawaf, S, Reidy, P, Reiner, R, Reinig, N, Reitsma, M, Remuzzi, G, Renzaho, A, Resnikoff, S, Rezaei, S, Blancas, M, Roba, K, Rojas-Rueda, D, Rokni, M, Roshandel, G, Roth, G, Roy, A, Rubagotti, E, Sadat, N, Safdarian, M, Safi, S, Safiri, S, Sagar, R, Salama, J, Salomon, J, Samy, A, Sanabria, J, Santomauro, D, Santos, I, Santos, J, Santric Milicevic, M, Sartorius, B, Satpathy, M, Sawhney, M, Saxena, S, Saylan, M, Shirude, S, Schmidt, M, Schneider, I, Schneider, M, Schöttker, B, Schutte, A, Schwebel, D, Schwendicke, F, Seedat, S, Sepanlou, S, Servan-Mori, E, Shackelford, K, Shaheen, A, Shahraz, S, Shaikh, M, Shamsipour, M, Shamsizadeh, M, Islam, S, Sharma, J, Sharma, R, She, J, Shi, P, Shibuya, K, Shields, C, Shiferaw, M, Shigematsu, M, Shin, M, Shiri, R, Shirkoohi, R, Shishani, K, Shoman, H, Shrime, M, Silberberg, D, Silva, D, Silva, J, Silveira, D, Singh, J, Singh, V, Sinha, D, Skiadaresi, E, Slepak, E, Sligar, A, Smith, A, Smith, D, Smith, M, Sobaih, B, Sobngwi, E, Soljak, M, Soneji, S, Sorensen, R, Sposato, L, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, D, Steiner, C, Steinke, S, Stokes, M, Strub, B, Sufiyan, M, Abdulkader, R, Sunguya, B, Sur, P, Swaminathan, S, Sykes, B, Sylte, D, Szoeke, C, Tabarés-Seisdedos, R, Tadakamadla, S, Tandon, N, Tao, T, Tarekegn, Y, Tavakkoli, M, Taveira, N, Tegegne, T, Shifa, G, Terkawi, A, Tessema, G, Thakur, J, Thankappan, K, Thrift, A, Tiruye, T, Tobe-Gai, R, Topor-Madry, R, Torre, A, Tortajada, M, Tran, B, Troeger, C, Truelsen, T, Tsoi, D, Tuem, K, Tuzcu, E, Tyrovolas, S, Ukwaja, K, Uneke, C, Updike, R, Uthman, O, Van Boven, J, Van Donkelaar, A, Varughese, S, Vasankari, T, Venketasubramanian, N, Vidavalur, R, Violante, F, Vladimirov, S, Vlassov, V, Vollset, S, Vos, T, Wadilo, F, Wakayo, T, Wallin, M, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, R, Weiss, D, Werdecker, A, Westerman, R, Whiteford, H, Wijeratne, T, Wiysonge, C, Woldeyes, B, Wolfe, C, Woodbrook, R, Xavier, D, Xu, G, Yadgir, S, Yakob, B, Yan, L, Yano, Y, Yaseri, M, Ye, P, Yimam, H, Yip, P, Yonemoto, N, Yoon, S, Yotebieng, M, Younis, M, Zaidi, Z, El Sayed Zaki, M, Zavala-Arciniega, L, Zhang, X, Zipkin, B, Zodpey, S, Lim, S, and Murray, C

Subjects
Adult, Male, Adolescent, DEVELOPMENT ASSISTANCE, Global Health, projection indicators to 2030, CHINA, Global Burden of Disease, Health Statu, MEXICO, Noncommunicable Disease, Young Adult, SYSTEMS, Quality-Adjusted Life Year, General & Internal Medicine, Infant Mortality, Medicine and Health Sciences, Conservation of Natural Resource, gains and gaps for the health-related SDGs,annualized rates of change, projection indicators to 2030, Health Status Indicator, annualized rates of change, Child, Medicine (all), MORTALITY, Infant, Newborn, Infant, Child Abuse, Sexual, Middle Aged, PREPAID PRIVATE, CARE, COVERAGE, Sex Offense, Child, Preschool, Female, 40-PERCENT, GOVERNMENT, gains and gaps for the health-related SDGs, Human
Abstract

Background The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. Methods We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2.5th percentile estimated between 1990 and 2030, and 100 as the 97.5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. Findings Globally, the median health-related SDG index was 56.7 (IQR 31.9-66.8) in 2016 and country-level performance markedly varied, with Singapore (86.8, 95% uncertainty interval 84.6-88.9), Iceland (86.0, 84.1-87.6), and Sweden (85.6, 81.8-87.8) having the highest levels in 2016 and Afghanistan (10.9, 9.6-11.9), the Central African Republic (11.0, 8.8-13.8), and Somalia (11.3, 9.5-13.1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. Interpretation GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. Copyright The Authors. Published by Elsevier Ltd. This is an Open Access article published under the CC BY 4.0 license.

Published
2017

18. Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, El Bcheraoui, Charbel, Afshin, Ashkan, Charara, Raghid, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Kassebaum, Nicholas J, Collison, Michael, Daoud, Farah, Krohn, Kristopher J, Chew, Adrienne, Biryukov, Stan H, Cornaby, Leslie, Foreman, Kyle J, Kutz, Michael, Liu, Patrick, Reitsma, Marissa, Sur, Patrick, Wang, Haidong, Zipkin, Ben, Arnlov, Johan, Abbafati, Cristiana, Abdulle, Abdishakur M, Abu-Rmeileh, Niveen ME, Ahmed, Muktar Beshir, Al-Aly, Ziyad, Alam, Khurshid, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Baune, Bernhard T, Bedi, Neeraj, Bennett, Derrick A, Beyene, Addisu S, Bhutta, Zulfiqar A, Birhanu, Mulugeta M, Danawi, Hadi, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Gill, Paramjit Singh, Gona, Philimon N, Gupta, Vipin, Habtewold, Tesfa Dejenie, Hamadeh, Randah Ribhi, Hamidi, Samer, Hareri, Habtamu Abera, Horino, Masako, Hsairi, Mohamed, Javanbakht, Mehdi, John, Denny, Jonas, Jost B, Joshua, Vasna, Kasaeian, Amir, Ketema, Ezra B, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khubchandani, Jagdish, Kim, Daniel, Kim, Yun Jin, Kinfu, Yohannes, Kokubo, Yoshihiro, Larson, Heidi J, Lee, Paul H, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Malekzadeh, Reza, Mate, Kedar K, Memish, Ziad A, Mengistie, Mubarek Abera, Mensah, George A, Ogbo, Felix Akpojene, Pourmalek, Farshad, Rafay, Anwar, Qorbani, Mostafa, Rahimi-Movaghar, Vafa, Rana, Saleem M, Rawaf, Salman, Renzaho, Andre MN, Rezaei, Satar, Rezai, Mohammad Sadegh, Safdarian, Mahdi, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Milicevic, Milena M Santric, Sartorius, Benn, Sepanlou, Sadaf G, Shaikh, Masood Ali, Shiri, Rahman, Santos Silva, Diego Augusto, Singh, Jasvinder A, Terkawi, Abdullah Sulieman, Tiruye, Tenaw Yimer, Ukwaja, Kingsley Nnanna, Vasankari, Tommi, Vlassov, Vasiliy Victorovich, Wakayo, Tolassa, Werdecker, Andrea, Yonemoto, Naohiro, Younis, Mustafa Z, Zein, Bassel, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Mokdad, Ali H, El Bcheraoui, Charbel, Afshin, Ashkan, Charara, Raghid, Ahmed, Muktar Beshir, Tiruye, Tenaw Yimer, Murray, Christopher JL, GBD 2015 Eastern Mediterranean Region Obesity Collaborators, Department of Public Health, Clinicum, University of Helsinki, Bennett, D, and Hay, S

Subjects
Male, obesity, Health (social science), 030204 cardiovascular system & hematology, Overweight, burden of disease, Obesity, Burden of disease, Eastern Mediterranean Region, Body Mass Index, Global Burden of Disease, 0302 clinical medicine, Epidemiology, 030212 general & internal medicine, Young adult, Child, 2. Zero hunger, Mediterranean Region, eastern mediterranean region, Middle Aged, 3142 Public health care science, environmental and occupational health, 3. Good health, PREVALENCE, 1117 Public Health And Health Services, Child, Preschool, Original Article, Female, Quality-Adjusted Life Years, SCHOOL-AGED CHILDREN, HEALTH, Public Health, medicine.symptom, Risk assessment, Adult, medicine.medical_specialty, Adolescent, Public Health, Environmental and Occupational Health, Risk Assessment, EGYPT, Middle East, Young Adult, 03 medical and health sciences, Environmental health, medicine, SYSTEMATIC ANALYSIS, Humans, METAANALYSIS, Aged, ENVIRONMENT, OVERWEIGHT, business.industry, MORTALITY, Environmental and Occupational Health, Klinisk medicin, medicine.disease, TRENDS, Quality-adjusted life year, Clinical Medicine, business, Body mass index, RC
Abstract

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. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1002-5) contains supplementary material, which is available to authorized users.

Published
2018

19. Intentional injuries in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Moradi-Lakeh, Maziar, Charara, Raghid, El Bcheraoui, Charbel, Khalil, Ibrahim, Afshin, Ashkan, Kassebaum, Nicholas J, Collison, Michael, Chew, Adrienne, Krohn, Kristopher J, Daoud, Farah, Colombara, Danny, Graetz, Nicholas, Kutz, Michael, Wang, Haidong, Abd-Allah, Foad, Abu-Raddad, Laith J, Kiadaliri, Aliasghar Ahmad, Ahmed, Muktar Beshir, Alam, Khurshid, Alghnam, Suliman, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Anber, Nahla, Anwari, Palwasha, Avila-Burgos, Leticia, Awasthi, Ashish, Barac, Aleksandra, Barker-Collo, Suzanne L, Bedi, Neeraj, Bhutta, Zulfiqar A, Borschmann, Rohan, Boufous, Soufiane, Butt, Zahid A, Castaneda-Orjuela, Carlos A, Dalal, Koustuv, Danawi, Hadi, De Leo, Diego, Dharmaratne, Samath D, Djalalinia, Shirin, Doyle, Kerrie E, Esteghamati, Alireza, Faro, Andre, Farvid, Maryam S, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Gutierrez, Reyna A, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hamidi, Samer, Haro, Josep Maria, Hendrie, Delia, Hu, Guoqing, Jonas, Jost B, Kasaeian, Amir, Keiyoro, Peter Njenga, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khubchandani, Jagdish, Kopec, Jacek A, Larson, Heidi J, Latif, Asma Abdul, Leshargie, Cheru Tesema, Lunevicius, Raimundas, Abd El Razek, Mohammed Magdy, Majeed, Azeem, Malekzadeh, Reza, Memish, Ziad A, Meretoja, Tuomo J, Miller, Ted R, Mohammed, Shafiu, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Afarin, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rawaf, David Laith, Rawaf, Salman, Rezaei, Satar, Rezai, Mohammad Sadegh, Roshandel, Gholamreza, Safdarian, Mahdi, Safiri, Saeid, Salamati, Payman, Samy, Abdallah M, Sartorius, Benn, Seedat, Soraya, Sepanlou, Sadaf G, Shaikh, Masood Ali, Sobaih, Badr HA, Tabb, Karen M, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, RomanTopor-Madry, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Yaseri, Mehdi, NaohiroYonemoto, Younis, Mustafa Z, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Mokdad, AH, Moradi-Lakeh, M, Charara, R, Ahmed, M Beshir, Murray, C hristopher JL, GBD 2015 Eastern Mediterranean Region Intentional Injuries Collaborators, Department of Surgery, University of Helsinki, Clinicum, II kirurgian klinikka, Department of Oncology, and HUS Comprehensive Cancer Center

Subjects
Adult, Male, Burden of disease, SUICIDE, Health (social science), Adolescent, Scopus, Violence, Global Health, Global Burden of Disease, Middle East, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Environmental health, parasitic diseases, Global health, Cost of illness, Humans, 030212 general & internal medicine, Young adult, CONFLICT, MORTALITY, Public Health, Environmental and Occupational Health, Eastern mediterranean region, Intentional injuries, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 16. Peace & justice, 3142 Public health care science, environmental and occupational health, humanities, 3. Good health, Quality-adjusted life year, Eastern mediterranean, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Geography, 1117 Public Health And Health Services, Female, Original Article, Public Health, Quality-Adjusted Life Years, HEALTH, Self-Injurious Behavior, 030217 neurology & neurosurgery
Abstract

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., Funding Agency:Bill & Melinda Gates Foundation

Published
2018

20. Burden of diarrhea in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Khalil, Ibrahim, El Bcheraoui, Charbel, Charara, Raghid, Moradi-Lakeh, Maziar, Afshin, Ashkan, Kassebaum, Nicholas J, Collison, Michael, Chew, Adrienne, Krohn, Kristopher J, Daoud, Farah, Colombara, Danny, Foreman, Kyle J, Godwin, William W, Kutz, Michael, Mirarefin, Mojde, Rao, Puja C, Jr, Reiner Robert, Troeger, Christopher, Wang, Haidong, Abraha, Haftom Niguse, Abu-Elyazeed, Remon, Abu-Raddad, Laith J, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Muktar Beshir, Alam, Khurshid, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Anber, Nahla, Anwari, Palwasha, Atey, Tesfay Mehari, Avokpaho, Euripide Frinel G Arthur, Bacha, Umar, Bazargan-Hejazi, Shahrzad, Geffen, David, Bedi, Neeraj, Bensenor, Isabela M, Berhane, Adugnaw, Bessong, Pascal Obong, Beyene, Addisu Shunu, Bhutta, Zulfiqar A, Buckle, Geoffrey Colin, Butt, Zahid A, Danawi, Hadi, Deribew, Amare, Djalalinia, Shirin, Dubey, Manisha, Endries, Aman Yesuf, Eshrati, Babak, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Gugnani, Harish Chander, Hamadeh, Randah Ribhi, Hamidi, Samer, Husseini, Abdullatif, James, Spencer Lewis, Jonas, Jost B, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khubchandani, Jagdish, Kissoon, Niranjan, Kopec, Jacek A, Koyanagi, Ai, Defo, Barthelemy Kuate, Larson, Heidi J, Latif, Asma Abdul, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mengistu, Desalegn Tadese, Mohammed, Shafiu, Murthy, Srinivas, Ngunjiri, Josephine Wanjiku, Ogbo, Felix Akpojene, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Ram, Usha, Rawaf, David Laith, Rawaf, Salman, Renzaho, Andre MN, Rezaei, Satar, Roshandel, Gholamreza, Safdarian, Mahdi, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Sartorius, Benn, Sepanlou, Sadaf G, Shaikh, Masood Ali, Shigematsu, Mika, Sobaih, Badr HA, Sreeramareddy, Chandrashekhar T, Sykes, Bryan L, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tiruye, Tenaw Yimer, Topor-Madry, Roman, Ukwaja, Kingsley Nnanna, Vollset, Stein Emil, Wakayo, Tolassa, Werdecker, Andrea, Wiysonge, Charles Shey, Workicho, Abdulhalik, Yaghoubi, Mohsen, Yaseri, Mehdi, Yenesew, Muluken, Yonemoto, Naohiro, Younis, Mustafa Z, Zaki, Maysaa El Sayed, Zodpey, Sanjay, Zein, Bassel, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Mokdad, AH, Khalil, I, El Bcheraoui, C, Beshir Ahmed, M, Tiruye, Tenaw Yimer, Murray, CJL, and GBD 2015 Eastern Mediterranean Region Diarrhea Collaborators

Subjects
Male, Health (social science), Psychological intervention, Eastern Mediterranean region, burden of disease, Global Health, Global Burden of Disease, 0302 clinical medicine, Risk Factors, Prevalence, Global health, 030212 general & internal medicine, Child, Mediterranean Region, Health Policy, Mortality rate, Burden of disease, MEDITERRÂNEO, Middle Aged, 3. Good health, Diarrhea, 1117 Public Health And Health Services, Child, Preschool, Original Article, Female, Quality-Adjusted Life Years, Public Health, medicine.symptom, Adult, medicine.medical_specialty, Adolescent, 030231 tropical medicine, Eastern Mediterranean Region, Middle East, Young Adult, 03 medical and health sciences, Environmental health, medicine, Humans, Diarrheal diseases, Poverty, Health policy, Disease burden, Aged, business.industry, Public health, Public Health, Environmental and Occupational Health, Infant, Years of potential life lost, business
Abstract

Objectives Diarrheal diseases (DD) are an important cause of disease burden, especially in children in low-income settings. DD can also impact children’s potential livelihood through growth faltering, cognitive impairment, and other sequelae. Methods As part of the Global Burden of Disease study, we estimated DD burden, and the burden attributable to specific risk factors and etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2015. We calculated disability-adjusted life-years (DALYs)—the sum of years of life lost and years lived with disability—for both sexes and all ages. Results We estimate that over 103,692 diarrhea deaths occurred in the EMR in 2015 (95% uncertainty interval: 87,018–124,692), and the mortality rate was 16.0 deaths per 100,000 persons (95% UI: 13.4–19.2). The majority of these deaths occurred in children under 5 (63.3%) (65,670 deaths, 95% UI: 53,640–79,486). DALYs per 100,000 ranged from 304 (95% UI 228–400) in Kuwait to 38,900 (95% UI 25,900–54,300) in Somalia. Conclusions Our findings will guide evidence-based health policy decisions for interventions to achieve the ultimate goal of reducing the DD burden. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1008-z) contains supplementary material, which is available to authorized users.

Published
2018

21. Transport injuries and deaths in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 Study

Author

Mokdad, Ali H, Khalil, Ibrahim, El Bcheraoui, Charbel, Charara, Raghid, Moradi-Lakeh, Maziar, Afshin, Ashkan, Kassebaum, Nicholas J, Collison, Michael, Daoud, Farah, Chew, Adrienne, Krohn, Kristopher J, Colombara, Danny, Cornaby, Leslie, Ehrenkranz, Rebecca, Graetz, Nicholas, Kutz, Michael, Troeger, Christopher, Wang, Haidong, Abate, Kalkidan Hassen, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Muktar Beshir, Alam, Khurshid, Alasfoor, Deena, Alghnam, Suliman, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Anber, Nahla, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Philippines Palwasha, Asayesh, Hamid, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Barker-Collo, Suzanne L, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beyene, Addisu Shunu, Bhutta, Zulfiqar A, Boufous, Soufiane, Butt, Zahid A, Castaneda-Orjuela, Carlos A, Chitheer, Abdulaal A, Dalal, Koustuv, Danawi, Hadi, Davitoiu, Dragos V, Djalalinia, Shirin, Endries, Aman Yesuf, Eshrati, Babak, Esteghamati, Alireza, Faro, Andre, Farvid, Maryam S, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gao, Wayne, Gebrehiwot, Tsegaye Tewelde, Hafezi-Nejad, Nima, Bidgoli, Hassan Haghparast, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hamidi, Samer, Hendrie, Delia, Heredia-Pi, Ileana Beatriz, Jacobsen, Kathryn H, James, Spencer Lewis, Jayatilleke, Achala Upendra, Jiang, Guohong, Jonas, Jost B, Kasaeian, Amir, Keiyoro, Peter Njenga, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khoja, Abdullah Tawfih Abdullah, Khosravi, Ardeshir, Khubchandani, Jagdish, Kim, Yun Jin, Kosen, Soewarta, Defo, Barthelemy Kuate, Larson, Heidi J, Linn, Shai, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mengistie, Mubarek Abera, Meretoja, Tuomo J, Miller, Ted R, Mohammed, Shafiu, Assaye, Ashagre Molla, Obermeyer, Carla Makhlouf, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rai, Rajesh Kumar, Ranganathan, Kavitha, Rawaf, David Laith, Rawaf, Salman, Refaat, Amany H, Renzaho, Andre MN, Rezaei, Satar, Rojas-Rueda, David, Roshandel, Gholamreza, Safdarian, Mahdi, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Milicevic, Milena M Santric, Sartorius, Benn, Schwebel, David C, Sepanlou, Sadaf G, Shaheen, Amira, Shaikh, Masood Ali, Shamsipour, Mansour, Shamsizadeh, Morteza, Sobaih, Badr HA, Sufiyan, Muawiyyah Babale, Sunshine, Jacob E, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thakur, JS, Topor-Madry, Roman, Uthman, Olalekan A, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wakayo, Tolassa, Werdecker, Andrea, Yaghoubi, Mohsen, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z, Zaki, Maysaa El Sayed, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Department of Surgery, University of Helsinki, Clinicum, II kirurgian klinikka, Department of Oncology, and HUS Comprehensive Cancer Center

Subjects
Male, Health (social science), Poison control, Global Health, Suicide prevention, Occupational safety and health, Global Burden of Disease, 0302 clinical medicine, Medicine, 030212 general & internal medicine, Cause of death, CASUALTIES, OUTCOMES, Mediterranean Region, 030503 health policy & services, Accidents, Traffic, Burden of disease, Human factors and ergonomics, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, 3. Good health, MEDICAL-TREATMENT, POLICE, OPPORTUNITIES, 1117 Public Health And Health Services, Original Article, Female, Public Health, Quality-Adjusted Life Years, HEALTH, 0305 other medical science, Adult, COUNTRIES, Adolescent, Eastern Mediterranean Region, Middle East, Young Adult, 03 medical and health sciences, EPIDEMIC, Environmental health, Injury prevention, Transport injuries, SYSTEMATIC ANALYSIS, Humans, ROAD-TRAFFIC INJURIES, Estimation, business.industry, Public Health, Environmental and Occupational Health, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Wounds and Injuries, business
Abstract

Objectives Transport injuries (TI) are ranked as one of the leading causes of death, disability, and property loss worldwide. This paper provides an overview of the burden of TI in the Eastern Mediterranean Region (EMR) by age and sex from 1990 to 2015. Methods Transport injuries mortality in the EMR was estimated using the Global Burden of Disease mortality database, with corrections for ill-defined causes of death, using the cause of death ensemble modeling tool. Morbidity estimation was based on inpatient and outpatient datasets, 26 cause-of-injury and 47 nature-of-injury categories. Results In 2015, 152,855 (95% uncertainty interval: 137,900–168,100) people died from TI in the EMR countries. Between 1990 and 2015, the years of life lost (YLL) rate per 100,000 due to TI decreased by 15.5%, while the years lived with disability (YLD) rate decreased by 10%, and the age-standardized disability-adjusted life years (DALYs) rate decreased by 16%. Conclusions Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-0987-0) contains supplementary material, which is available to authorized users.

Published
2018

22. Neonatal, infant, and under-5 mortality and morbidity burden in the Eastern Mediterranean region: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Khalil, Ibrahim, Collison, Michael, El Bcheraoui, Charbel, Charara, Raghid, Moradi-Lakeh, Maziar, Afshin, Ashkan, Krohn, Kristopher J, Daoud, Farah, Chew, Adrienne, Kassebaum, Nicholas J, Colombara, Danny, Cornaby, Leslie, Ehrenkranz, Rebecca, Foreman, Kyle J, Fraser, Maya, Frostad, Joseph, Kemmer, Laura, Kulikoff, Xie Rachel, Kutz, Michael, Kyu, Hmwe H, Liu, Patrick, Mikesell, Joseph, Nguyen, Grant, Rao, Puja C, Silpakit, Naris, Sligar, Amber, Smith, Alison, Stanaway, Jeffrey D, Arnlov, Johan, Abate, Kalkidan Hassen, Kiadaliri, Aliasghar Ahmad, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Alraddadi, Rajaa, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Anber, Nahla, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Palwasha, Artaman, Al, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Azzopardi, Peter, Bacha, Umar, Barac, Aleksandra, Barker-Collo, Suzanne L, Bedi, Neeraj, Beghi, Ettore, Bennett, Derrick A, Bhutta, Zulfiqar A, Bisanzio, Donal, Castaneda-Orjuela, Carlos A, Estanislao Castro, Ruben, Danawi, Hadi, Deribe, Kebede, Deribew, Amare, Jarlais, Don C Des, deVeber, Gabrielle A, Dey, Subhojit, Dharmaratne, Samath D, Djalalinia, Shirin, Do, Huyen Phuc, Esteghamati, Alireza, Farvid, Maryam S, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Giussani, Giorgia, Gona, Philimon N, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hamidi, Samer, Hoy, Damian G, Hu, Guoqing, John, Denny, Jonas, Jost B, Karimi, Seyed M, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khan, Gulfaraz, Kim, Daniel, Kim, Yun Jin, Kinfu, Yohannes, Larson, Heidi J, Latif, Asma Abdul, Leasher, Janet L, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majeed, Azeem, Malekzadeh, Reza, Memish, Ziad A, Mendoza, Walter, Mezgebe, Haftay Berhane, Miller, Ted R, Monasta, Lorenzo, Nguyen, Quyen Le, Obermeyer, Carla Makhlouf, Ortiz, Alberto, Papachristou, Christina, Park, Eun-Kee, Pereira, Claudia C, Petzold, Max, Pereira, David M, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M, Rawaf, David Laith, Rawaf, Salman, Renzaho, Andre MN, Rezaei, Satar, Rezai, Mohammad Sadegh, Ronfani, Luca, Roshandel, Gholamreza, Ruhago, George Mugambage, Safdarian, Mahdi, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Sartorius, Benn, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Setegn, Tesfaye, Shaheen, Amira, Shaikh, Masood Ali, Shamsizadeh, Morteza, Shiri, Rahman, Skirbekk, Vegard, Sobaih, Badr HA, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Abdulkader, Rizwan Suliankatchi, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Thakur, Arabia JS, Thomson, Alan J, Tran, Bach Xuan, Truelsen, Thomas, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vasankari, Tommi, Vlassov, Vasiliy Victorovich, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Yaghoubi, Mohsen, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Wang, Haidong, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Department of Public Health, Clinicum, and University of Helsinki

Subjects
Male, PNEUMONIA, Pediatrics, Health (social science), Poison control, 030204 cardiovascular system & hematology, Infant mortality, Global Health, Global Burden of Disease, 0302 clinical medicine, Neonatal, Global health, LIFE EXPECTANCY, 030212 general & internal medicine, health care economics and organizations, Mediterranean Region, Child Health, Burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, UPDATED SYSTEMATIC ANALYSIS, 1117 Public Health And Health Services, Child, Preschool, Female, Original Article, Public Health, CHILD-MORTALITY, INTERVENTIONS, COUNTRIES, Child mortality, medicine.medical_specialty, INTEGRATED APPROACH, Eastern Mediterranean Region, 03 medical and health sciences, Middle East, Neonatal mortality, Environmental health, Injury prevention, medicine, Humans, PROGRESS, Perinatal Mortality, METAANALYSIS, business.industry, Public Health, Environmental and Occupational Health, Infant, Newborn, Klinisk medicin, Infant, DIARRHEA, mortality, Eastern mediterranean, Life expectancy, Morbidity, Clinical Medicine, business
Abstract

Objectives Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. Methods We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. Results In 2015, 755,844 (95% uncertainty interval (UI) 712,064–801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812–181,463) in 1990 to 80,985 (76,308–85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Conclusions Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-0998-x) contains supplementary material, which is available to authorized users.

Published
2018

23. Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Tehrani-Banihashemi, Arash, Moradi-Lakeh, Maziar, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Afshin, Ashkan, Collison, Michael, Daoud, Farah, Krohn, Kristopher J, Chew, Adrienne, Cornaby, Leslie, Foreman, Kyle J, Frostad, Joseph, Kassebaum, Nicholas J, Kemmer, Laura, Kutz, Michael, Liu, Patrick, Mirarefin, Mojde, Nguyen, Grant, Wang, Haidong, Zipkin, Ben, Abajobir, Amanuel Alemu, Abouzeid, Marian, Abu-Rmeileh, Niveen ME, Kiadaliri, Aliasghar Ahmad, Ahmed, Muktar Beshir, Aksut, Baran, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Anber, Nahla, Anwari, Palwasha, Arnlov, Johan, Asgedom, Solomon Weldegebreal, Atey, Tesfay Mehari, Awasthi, Ashish, Baernighausen, Till, Bacha, Umar, Barac, Aleksandra, Barker-Collo, Suzanne L, Bedi, Neeraj, Bennett, Derrick A, Berhe, Derbew Fikadu, Biadgilign, Sibhatu, Butt, Zahid A, Carapetis, Jonathan R, Estanislao Castro, Ruben, Chitheer, Abdulaal A, Davletov, Kairat, Dharmaratne, Samath D, Djalalinia, Shirin, Do, Huyen Phuc, Dubey, Manisha, Ebrahimi, Hedyeh, Eshrati, Babak, Esteghamati, Alireza, Farvid, Maryam S, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Solomon Weldemariam, Gebrehiwot, Tsegaye Tewelde, Gillum, Richard F, Gona, Philimon N, Gupta, Rajeev, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hamidi, Samer, Hsairi, Mohamed, Jee, Sun Ha, Jonas, Jost B, Karimkhani, Chante, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Kim, Daniel, Lal, Dharmesh Kumar, Larson, Heidi J, Latif, Asma Abdul, Linn, Shai, Lotufo, Paulo A, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Meier, Toni, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mensah, George A, Meretoja, Atte, Miller, Ted R, Mirrakhimov, Erkin M, Mohammed, Shafiu, Nguyen, Quyen Le, Nong, Vuong Minh, Pearson-Stuttard, Jonathan, Pishgar, Farhad, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M, Rawaf, David Laith, Rawaf, Salman, Renzaho, Andre MN, Rezaei, Satar, Roba, Kedir Teji, Roshandel, Gholamreza, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Milicevic, Milena M Santric, Sartorius, Benn, Sepanlou, Sadaf G, Shaikh, Masood Ali, Santos Silva, Diego Augusto, Singh, Jasvinder A, Sobaih, Badr HA, Stroumpoulis, Konstantinos, Abdulkader, Rizwan Suliankatchi, Szoeke, Cassandra EI, Temsah, Mohamad-Hani, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vasankari, Tommi, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wakayo, Tolassa, Weintraub, Robert G, Wessly, Priscilla R, Wijeratne, Tissa, Wolfe, Charles DA, Workicho, Abdulhalik, Yaghoubi, Mohsen, Yano, Yuichiro, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Zaki, Maysaa El Sayed, Jumaan, Aisha O, Vos, Theo, Roth, Gregory A, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Tehrani-Banihashemi, A, Moradi-Lakeh, M, El Bcheraoui, C, Ahmed, MB, Mokdad, AH, GBD 2015 Eastern Mediterranean Region Cardiovascular Disease Collaborators, Department of Neurosciences, Neurologian yksikkö, Clinicum, and HUS Neurocenter

Subjects
AFFORDABILITY, PERSONAL HEALTH-CARE, Health (social science), Heart disease, Eastern Mediterranean region, 030204 cardiovascular system & hematology, burden of disease, Global Health, Body Mass Index, Global Burden of Disease, Cardiovascular disease, Burden of disease, Eastern Mediterranean Region, 0302 clinical medicine, SAUDI-ARABIA, Risk Factors, cardiovascular disease, Global health, 030212 general & internal medicine, PREDICTORS, 2. Zero hunger, Middle East, Mediterranean Region, Middle Aged, 3142 Public health care science, environmental and occupational health, 3. Good health, MIDDLE-INCOME, Cholesterol, 1117 Public Health And Health Services, Cardiovascular Diseases, MEDICINES, Hypertension, Original Article, Female, Quality-Adjusted Life Years, Public Health, Adult, 03 medical and health sciences, Environmental health, medicine, Humans, INCOME COUNTRIES, ARÁBIA SAUDITA, business.industry, MORTALITY, AVAILABILITY, Public Health, Environmental and Occupational Health, Klinisk medicin, Middle income, medicine.disease, Quality-adjusted life year, Eastern mediterranean, Clinical Medicine, business, Body mass index
Abstract

Objectives To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990–2015. Methods We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. Results A total of 1.4 million CVD deaths (95% UI: 1.3–1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. Conclusions The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1012-3) contains supplementary material, which is available to authorized users.

Published
2018

24. Maternal mortality and morbidity burden in the Eastern Mediterranean Region : findings from the Global Burden of Disease 2015 study

Author

Mokdad, Ali H, Khalil, Ibrahim, Collison, Michael, El Bcheraoui, Charbel, Charara, Raghid, Moradi-Lakeh, Maziar, Afshin, Ashkan, Chew, Adrienne, Daoud, Farah, Krohn, Kristopher J, Colombara, Danny, Ehrenkranz, Rebecca, Kutz, Michael, Wang, Haidong, Abajobir, Amanuel Alemu, Abd-Allah, Foad, Abraha, Haftom Niguse, Abu-Raddad, Laith J, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Kedir Yimam, Ahmed, Muktar Beshir, Al Lami, Faris Hasan, Alam, Khurshid, Alasfoor, Deena, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Al-Maskari, Fatma, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Anber, Nahla, Ansari, Hossein, Asayesh, Hamid, Asghar, Rana Jawad, Atey, Tesfay Mehari, Ayele, Tadesse Awoke, Baernighausen, Till, Bacha, Umar, Barac, Aleksandra, Barker-Collo, Suzanne L, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Geffen, David, Bedi, Neeraj, Bensenor, Isabela M, Berhane, Adugnaw, Beyene, Addisu Shunu, Bhutta, Zulfiqar A, Boneya, Dube Jara, Borschmann, Rohan, Breitborde, Nicholas JK, Butt, Zahid A, Catala-Lopez, Ferran, Ciobanu, Liliana G, Danawi, Hadi, Deribew, Amare, Dharmaratne, Samath D, Doyle, Kerrie E, Endries, Aman Yesuf, Faraon, Emerito Jose Aquino, Faro, Andre, Farvid, Maryam S, Fekadu, Wubalem, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Giref, Ababi Zergaw, Gishu, Melkamu Dedefo, Goulart, Alessandra Carvalho, Habtewold, Tesfa Dejenie, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Maria Haro, Josep, Hassanvand, Mohammad Sadegh, Horita, Nobuyuki, Hsairi, Mohamed, Huang, Hsiang, Husseini, Abdullatif, Jakovljevic, Mihajlo B, James, Spencer Lewis, Jonas, Jost B, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khoja, Abdullah Tawfih Abdullah, Khosravi, Ardeshir, Khubchandani, Jagdish, Kim, Daniel, Kim, Yun Jin, Kokubo, Yoshihiro, Koyanagi, Ai, Defo, Barthelemy Kuate, Larson, Heidi J, Latif, Asma Abdul, Lee, Paul H, Leshargie, Cheru Tesema, Leung, Ricky, Lo, Loon-Tzian, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Martinez-Raga, Jose, Farid, Habibolah Masoudi, Mazidi, Mohsen, McGrath, John J, Memish, Ziad A, Mendoza, Walter, Mengesha, Melkamu Merid, Mengistie, Mubarek Abera, Mensah, George A, Mezgebe, Haftay Berhane, Miller, Ted R, Mitchell, Philip B, Mohammadi, Alireza, Mohammed, Shafiu, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Palomares Castillo, Elizabeth, Papachristou, Christina, Patten, Scott B, Patton, George C, Pereira, David M, Pervaiz, Aslam, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rawaf, David Laith, Rawaf, Salman, Refaat, Amany H, Rezaei, Satar, Rezai, Mohammad Sadegh, Roshandel, Gholamreza, Safdarian, Mahdi, Safiabadi, Mahdi, Safiri, Saeid, Sagar, Rajesh, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sartorius, Benn, Saylan, Mete I, Seedat, Soraya, Sepanlou, Sadaf G, Shaikh, Masood Ali, Shamsizadeh, Morteza, Santos Silva, Diego Augusto, Singh, Jasvinder A, Sobaih, Badr HA, Sreeramareddy, Chandrashekhar T, Stein, Dan J, Abdulkader, Rizwan Suliankatchi, Sykes, Bryan L, Tabares-Seisdedos, Rafael, Sufiyan, Muawiyyah, Tabb, Karen M, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Topor-Madry, Roman, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vollset, Stein Emil, Wakayo, Tolassa, Wang, Yuan-Pang, Werdecker, Andrea, Westerman, Ronny, Workicho, Abdulhalik, Yaghoubi, Mohsen, Yimam, Hassen Hamid, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Zaki, Maysaa El Sayed, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Kassebaum, Nicholas J, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, UCH. Departamento de Farmacia, Producción Científica UCH 2018, Mokdad, Ali H, Khalil, Ibrahim, Collison, Michael, El Bcheraou, Charbel, Ciobanu, Liliana G, and Murray, Christopher JL

Subjects
Adult, Burden of disease, Maternal mortality, medicine.medical_specialty, Health (social science), Psychological intervention, SAÚDE DA MULHER, Global Health, maternal health, Eastern Mediterranean Region, Global Burden of Disease, Middle East, 03 medical and health sciences, 0302 clinical medicine, Environmental health, medicine, Global health, Journal Article, Humans, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, Mediterranean Region, maternal mortality, business.industry, Public health, Age Factors, 1. No poverty, Public Health, Environmental and Occupational Health, Reproductive life, 3. Good health, Eastern mediterranean, Pregnant women - Mortality - Eastern Mediterranean, Standardized mortality ratio, 1117 Public Health And Health Services, Life expectancy, Mujeres embarazadas - Mortalidad - Mediterráneo oriental (Región), Original Article, Female, Public Health, Maternal health, Morbidity, business
Abstract

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://link.springer.com/article/10.1007%2Fs00038-017-1004-3 Este artículo forma parte del suplemento titulado "The state of health in the Eastern Mediterranean Region, 1990-2015". Objectives Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. Methods We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. Results The maternal mortality ratio in the EMR decreased 16.3% from 283 (241–328) maternal deaths per 100,000 live births in 1990 to 237 (188–293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Conclusion Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.

Published
2018

25. The burden of mental disorders in the Eastern Mediterranean region, 1990-2015 : findings from the global burden of disease 2015 study

Author

Mokdad, Ali H, Charara, Raghid, El Bcheraoui, Charbel, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Afshin, Ashkan, Kassebaum, Nicholas J, Collison, Michael, Krohn, Kristopher J, Chew, Adrienne, Daoud, Farah, Charlson, Fiona J, Colombara, Danny, Degenhardt, Louisa, Ehrenkranz, Rebecca, Erskine, Holly E, Ferrari, Alize J, Kutz, Michael, Leung, Janni, Santomauro, Damian, Wang, Haidong, Whiteford, Harvey A, Abajobir, Amanuel Alemu, Abd-Allah, Foad, Abraha, Haftom Niguse, Abu-Raddad, Laith J, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Yimam, Kedir, Beshir, Muktar, Al Lami, Faris Hasan, Alam, Khurshid, Alasfoor, Deena, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Al-Maskari, Fatma, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Anber, Nahla, Ansari, Hossein, Asayesh, Hamid, Asghar, Rana Jawad, Atey, Tesfay Mehari, Ayele, Tadesse Awoke, Baernighausen, Till, Bacha, Umar, Barac, Aleksandra, Barker-Collo, Suzanne L, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Drew, Charles R, Geffen, David, Bedi, Neeraj, Bensenor, Isabela M, Berhane, Adugnaw, Beyene, Addisu Shunu, Bhutta, Zulfiqar A, Boneya, Dube Jara, Borschmann, Rohan, Breitborde, Nicholas JK, Butt, Zahid A, Catala-Lopez, Ferran, Ciobanu, Liliana G, Danawi, Hadi, Deribew, Amare, Dharmaratne, Samath D, Doyle, Kerrie E, Endries, Aman Yesuf, Faraon, Emerito Jose Aquino, Faro, Andre, Farvid, Maryam S, Fekadu, Wubalem, Fereshtehnejad, Seyed-Mohammad, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Giref, Ababi Zergaw, Gishu, Melkamu Dedefo, Carvalho, Alessandra, Habtewold, Tesfa Dejenie, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Horita, Nobuyuki, Hsairi, Mohamed, Huang, Hsiang, Husseini, Abdullatif, Jakovljevic, Mihajlo B, James, Spencer Lewis, Jonas, Jost B, Kasaeian, Amir, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khoja, Abdullah Tawfih Abdullah, Khosravi, Ardeshir, Khubchandani, Jagdish, Kim, Daniel, Kim, Yun Jin, Kokubo, Yoshihiro, Koyanagi, Ai, Defo, Barthelemy Kuate, Larson, Heidi J, Latif, Asma Abdul, Lee, Paul H, Leshargie, Cheru Tesema, Leung, Ricky, Lo, Loon-Tzian, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Abd El Razek, Mohammed Magdy, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Martinez-Raga, Jose, Farid, Habibolah Masoudi, Mazidi, Mohsen, McGrath, John J, Memish, Ziad A, Mendoza, Walter, Mengesha, Melkamu Merid, Mengistie, Mubarek Abera, Mezgebe, Haftay Berhane, Miller, Ted R, Mitchell, Philip B, Mohammadi, Alireza, Mohammed, Shafiu, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Castillo, Elizabeth Palomares, Papachristou, Christina, Patten, Scott B, Patton, George C, Pervaiz, Aslam, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rawaf, David Laith, Rawaf, Salman, Refaat, Amany H, Rezaei, Satar, Rezai, Mohammad Sadegh, Roshandel, Gholamreza, Safdarian, Mahdi, Safiabadi, Mahdi, Safiri, Saeid, Sagar, Rajesh, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sartorius, Benn, Saylan, Mete I, Seedat, Soraya, Sepanlou, Sadaf G, Shaikh, Masood Ali, Shamsizadeh, Morteza, Silva, Diego Augusto Santos, Singh, Jasvinder A, Sobaih, Badr HA, Stein, Dan J, Abdulkader, Rizwan Suliankatchi, Sykes, Bryan L, Tabares-Seisdedos, Rafael, Tabb, Karen M, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Topor-Madry, Roman, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vollset, Stein Emil, Wakayo, Tolassa, Wang, Yuan-Pang, Werdecker, Andrea, Westerman, Ronny, Workicho, Abdulhalik, Yaghoubi, Mohsen, Yimam, Hassen Hamid, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Zaki, Maysaa El Sayed, Zein, Bassel, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, UCH. Departamento de Farmacia, Producción Científica UCH 2018, Hay, S, Mokdad, Ali H, Charara, Raghid, El Bcheraoui, Charbel, Khalil, Ibrahim, Ciobanu, Liliana G, and Murray, Christopher JL

Subjects
Male, Health (social science), Eastern Mediterranean region, Poison control, burden of disease, Global Health, Global Burden of Disease, Depression, Mental - Eastern Mediterranean, 0302 clinical medicine, Risk Factors, Global health, Medicine, 030212 general & internal medicine, Mental illness - Eastern Mediterranean, Mediterranean Region, Mental Disorders, Epidemiología psiquiátrica, Burden of disease, Middle Aged, 3. Good health, 1117 Public Health And Health Services, Anxiety, Original Article, Mental health, Female, Quality-Adjusted Life Years, Public Health, medicine.symptom, mental health, Adult, Depressive disorders, medicine.medical_specialty, Adolescent, Anxiety - Eastern Mediterranean, Mental health - Eastern Mediterranean, Middle East, Young Adult, 03 medical and health sciences, anxiety disorders, Injury prevention, Journal Article, Humans, Depresión mental - Mediterráneo oriental (Región), Psychiatry, Disease burden, Aged, DEPRESSÃO, business.industry, Public health, Enfermedades mentales - Mediterráneo oriental (Región), Public Health, Environmental and Occupational Health, Salud mental - Mediterráneo oriental (Región), Ansiedad - Mediterráneo oriental (Región), 030227 psychiatry, Quality-adjusted life year, Psychiatric epidemiology, depressive disorders, business, Anxiety disorders
Abstract

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://link.springer.com/article/10.1007%2Fs00038-017-1006-1 Este artículo forma parte del suplemento titulado "The state of health in the Eastern Mediterranean Region, 1990-2015". Objectives. Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods. We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7–5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

Published
2018

26. Adolescent health in the Eastern Mediterranean Region : findings from the global burden of disease 2015 study

Author

Mokdad, Ali H, Azzopardi, Peter, Cini, Karly, Kennedy, Elissa, Sawyer, Susan, El Bcheraoui, Charbel, Charara, Raghid, Khalil, Ibrahim, Moradi-Lakeh, Maziar, Collison, Michael, Afifi, Rima A, Al-Raiby, Jamela, Krohn, Kristopher J, Daoud, Farah, Chew, Adrienne, Afshin, Ashkan, Foreman, Kyle J, Kassebaum, Nicholas J, Kutz, Michael, Kyu, Hmwe H, Liu, Patrick, Olsen, Helen E, Smith, Alison, Stanaway, Jeffrey D, Wang, Haidong, Arnlov, Johan, Kiadaliri, Aliasghar Ahmad, Alam, Khurshid, Alasfoor, Deena, Ali, Raghib, Alizadeh-Navaei, Reza, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Anber, Nahla, Antonio, Carl Abelardo T, Anwari, Palwasha, Artaman, Al, Asayesh, Hamid, Barker-Collo, Suzanne L, Bedi, Neeraj, Beghi, Ettore, Bennett, Derrick A, Bensenor, Isabela M, Bhutta, Zulfiqar A, Butt, Zahid A, Castaneda-Orjuela, Carlos A, Catala-Lopez, Ferran, Charlson, Fiona J, Danawi, Hadi, De Leo, Diego, Degenhardt, Louisa, Denno, Donna, Deribe, Kebede, Jarlais, Don C Des, Dey, Subhojit, Dharmaratne, Samath D, Djalalinia, Shirin, Erskine, Holly E, Fereshtehnejad, Seyed-Mohammad, Ferrari, Alize J, Fischer, Florian, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Gona, Philimon N, Gugnani, Harish Chander, Gupta, Rajeev, Hamadeh, Randah Ribhi, Hamidi, Samer, Maria Haro, Josep, Hay, Roderick J, Hearps, Stephen JC, Hendrie, Delia, Hotez, Peter J, Hu, Guoqing, Jonas, Jost B, Karch, Andre, Karimi, Seyed M, Kasaeian, Amir, Kebede, Seifu, Kengne, Andre Pascal, Khan, Ejaz Ahmad, Khosravi, Ardeshir, Khubchandani, Jagdish, Kokubo, Yoshihiro, Kopec, Jacek A, Kosen, Soewarta, Larson, Heidi J, Larsson, Anders, Leasher, Janet L, Leung, Janni, Li, Yongmei, Lotufo, Paulo A, Lunevicius, Raimundas, Abd El Razek, Hassan Magdy, Majdzadeh, Reza, Majeed, Azeem, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mhimbira, Francis Apolinary, Miller, Ted R, Mitchell, Philip B, Monasta, Lorenzo, Obermeyer, Carla Makhlouf, Oh, In-Hwan, Olusanya, Bolajoko Olubukunola, Ortiz, Alberto, Park, Eun-Kee, Parry, Matti, Pereira, David M, Phillips, Michael Robert, Pourmalek, Farshad, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Rana, Saleem M, Rawaf, David Laith, Rawaf, Salman, Reavley, Nicola, Renzaho, Andre MN, Rezaei, Satar, Sadegh-Rezai, Mohammad, Rios-Zertuche, Diego, Roshandel, Gholamreza, Rothenbacher, Dietrich, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sahraian, Mohammad Ali, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan Ramon, Santomauro, Damian, Sartorius, Benn, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Setegn, Tesfaye, Shaheen, Amira, Shaikh, Masood Ali, Shiri, Rahman, Sigfusdottir, Inga Dora, Singh, Jasvinder A, Sobaih, Badr HA, Sreeramareddy, Chandrashekhar T, Abdulkader, Rizwan Suliankatchi, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thomson, Alan J, Tonelli, Marcello, Topor-Madry, Roman, Tran, Bach Xuan, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Whiteford, Harvey A, Yano, Yuichiro, Yaseri, Mehdi, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Jumaan, Aisha O, Vos, Theo, Hay, Simon I, Naghavi, Mohsen, Patton, George C, Murray, Christopher JL, Reg, GBD 2015 Eastern Mediterranean, Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany., Department of Public Health, Secure Systems research group / N. Asokan, and Clinicum

Subjects
Male, Health (social science), Nutrition and Disease, Laboratory of Virology, Poison control, Adolescent health, 030204 cardiovascular system & hematology, Global Health, Occupational safety and health, Global Burden of Disease, Disasters, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, Prevalence, Global health, 030212 general & internal medicine, Child, education.field_of_study, Middle East, Mediterranean Region, Mental Disorders, Smoking, 1. No poverty, Burden of disease, Public Health, Global Health, Social Medicine and Epidemiology, MEDITERRÂNEO, 3142 Public health care science, environmental and occupational health, 3. Good health, Contraception, 1117 Public Health And Health Services, OBESITY, Original Article, Female, Public Health, medicine.medical_specialty, Adolescent, Population, OS Groenvoorziening, Developing country, Communicable Diseases, Eastern Mediterranean Region, Laboratorium voor Virologie, Young Adult, 03 medical and health sciences, FUTURE, Environmental health, SYSTEMATIC ANALYSIS, medicine, Humans, Noncommunicable Diseases, education, VLAG, Public health, Public Health, Environmental and Occupational Health, Klinisk medicin, Overweight, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, RISK-FACTORS, INJURIES, Morbidity, Clinical Medicine
Abstract

Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10–24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Methods Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Results Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Conclusions Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR. Electronic supplementary material The online version of this article (doi:10.1007/s00038-017-1003-4) contains supplementary material, which is available to authorized users.

Published
2018

27. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Naghavi, Mohsen, Abajobir, Amanuel Alemu, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abera, Semaw Ferede, Aboyans, Victor, Adetokunboh, Olatunji, Arnlov, Johan, Afshin, Ashkan, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Aiyar, Sneha, Al-Eyadhy, Ayman, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alene, Kefyalew Addis, Ali, Syed Danish, Alizadeh-Navaei, Reza, Alkaabi, Juma M., Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Amare, Azmeraw T., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla, Andersen, Hjalte H., Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Hossein, Antonio, Carl Abelardo T., Anwari, Palwasha, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon W., Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Paulina, Beatriz, Quintanilla, Ayala, Bejot, Yannick, Babalola, Tesleem Kayode, Bacha, Umar, Balakrishnan, Kalpana, Barac, Aleksandra, Barboza, Miguel A., Barker-Collo, Suzanne L., Barquera, Simon, Barregard, Lars, Barrero, Lope H., Baune, Bernhard T., Bedi, Neeraj, Beghi, Ettore, Bekele, Bayu Begashaw, Bell, Michelle L., Bennett, James R., Bensenor, Isabela M., Berhane, Adugnaw, Bernabe, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Boris, Bisanzio, Donal, Bourne, Rupert R. A., Breitborde, Nicholas J. K., Negesa, Lemma, Bulto, Bulto, Bumgarner, Blair R., Butt, Zahid A., Cardenas, Rosario, Cahuana-Hurtado, Lucero, Cameron, Ewan, Cesar Campuzano, Julio, Car, Josip, Jesus Carrero, Juan, Carter, Austin, Casey, Daniel C., Castaneda-Orjuela, Carlos A., Catala-Lopez, Ferran, Charlson, Fiona J., Chibueze, Chioma Ezinne, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A., Christopher, Devasahayam Jesudas, Ciobanu, Liliana G., Cirillo, Massimo, Cohen, Aaron J., Colombara, Danny, Cooper, Cyrus, Cowie, Benjamin C., Criqui, Michael H., Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I., das Neves, Jose, Davitoiu, Dragos V., Davletov, Kairat, de Courten, Barbora, Degenhardt, Louisa, Deiparine, Selina, Deribe, Kebede, Deribew, Amare, Dey, Subhojit, Dicker, Daniel, Ding, Eric L., Djalalinia, Shirin, Huyen Phuc Do, Huyen Phuc Do, Doku, David Teye, Douwes-Schultz, Dirk, Driscoll, Tim R., Dubey, Manisha, Duncan, Bruce Bartholow, Echko, Michelle, El-Khatib, Ziad Ziad, Ellingsen, Christian Lycke, Enayati, Ahmadali, Erskine, Holly E., Eskandarieh, Sharareh, Esteghamati, Alireza, Ermakov, Sergey P., Estep, Kara, E Sa Farinha, Carla Sofia, Faro, Andre, Farzadfar, Farshad, Feigin, Valery L., Fereshtehnejad, Seyed-Mohammad, Fernandes, Joao C., Ferrari, Alize J., Feyissa, Tesfaye Regassa, Filip, Irina, Finegold, Samuel, Fischer, Florian, Fitzmaurice, Christina, Flaxman, Abraham D., Foigt, Nataliya, Frank, Tahvi, Fraser, Maya, Fullman, Nancy, Furst, Thomas, Furtado, Joao M., Gakidou, Emmanuela, Garcia-Basteiro, Alberto L., Gebre, Teshome, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Gebremichael, Delelegn Yilma, Geleijnse, Johanna M., Genova-Maleras, Ricard, Gesesew, Hailay Abrha, Gething, Peter W., Gillum, Richard F., Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Giroud, Maurice, Giussani, Giorgia, Godwin, William W., Gold, Audra L., Goldberg, Ellen M., Gona, Philimon N., Gopalani, Sameer Vali, Gouda, Hebe N., Goulart, Alessandra Carvalho, Griswold, Max, Gupta, Prakash C., Gupta, Rajeev, Gupta, Tanush, Gupta, Vipin, Haagsma, Juanita A., Hafezi-Nejad, Nima, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Hammami, Mouhanad, Hancock, Jamie, Handal, Alexis J., Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Hareri, Habtamu Abera, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmus, Hay, Simon I., He, Fei, Hedayati, Mohammad T., Henry, Nathaniel J., Beatriz Heredia-Pi, Ileana, Herteliu, Claudiu, Hoek, Hans W., Horino, Masako, Horita, Nobuyuki, Hosgood, H. Dean, Hostiuc, Sorin, Hotez, Peter J., Hoy, Damian G., Huynh, Chantal, Iburg, Kim Moesgaard, Ikeda, Chad, Ileanu, Bogdan Vasile, Irenso, Asnake Ararsa, Irvine, Caleb Mackay Salpeter, Jurisson, Mikk, Jacobsen, Kathryn H., Jahanmehr, Nader, Jakovljevic, Mihajlo B., Javanbakht, Mehdi, Jayaraman, Sudha P., Jeemon, Panniyammakal, Jha, Vivekanand, John, Denny, Johnson, Catherine O., Johnson, Sarah Charlotte, Jonas, Jost B., Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kamal, Ritul, Karch, Andre, Karimi, Seyed M., Karimkhani, Chante, Kasaeian, Amir, Kassaw, Nigussie Assefa, Kassebaum, Nicholas J., Katikireddi, Srinivasa Vittal, Kawakami, Norito, Keiyoro, Peter Njenga, Kemmer, Laura, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khang, Young-Ho, Khoja, Abdullah Tawfih Abdullah, Khosravi, Ardeshir, Khosravi, Mohammad Hossein, Khubchandani, Jagdish, Kieling, Christian, Kievlan, Daniel, Kim, Daniel, Kim, Yun Jin, Kimokoti, Ruth W., Kinfu, Yohannes, Kissoon, Niranjan, Kivimaki, Mika, Knudsen, Ann Kristin, Kopec, Jacek A., Kosen, Soewarta, Koul, Parvaiz A., Koyanagi, Ai, Defo, Barthelemy Kuate, Kulikoff, Xie Rachel, Kumar, G. Anil, Kumar, Pushpendra, Kutz, Michael, Kyu, Hmwe H., Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lambert, Nkurunziza, Lan, Qing, Lansingh, Van C., Larsson, Anders, Lee, Paul H., Leigh, James, Leung, Janni, Levi, Miriam, Li, Yongmei, Kappe, Darya Li, Liang, Xiaofeng, Liben, Misgan Legesse, Lim, Stephen S., Liu, Angela, Liu, Patrick Y., Liu, Yang, Lodha, Rakesh, Logroscino, Giancarlo, Lorkowski, Stefan, Lotufo, Paulo A., Lozano, Rafael, Lucas, Timothy C. D., Ma, Stefan, Macarayan, Erlyn Rachelle King, Maddison, Emilie R., Abd el Razek, Mohammed Magdy, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malhotra, Rajesh, Malta, Deborah Carvalho, Manguerra, Helena, Manyazewal, Tsegahun, Mapoma, Chabila C., Marczak, Laurie B., Markos, Desalegn, Martinez-Raga, Jose, Martins-Melo, Francisco Rogerlandio, Martopullo, Ira, McAlinden, Colm, McGaughey, Madeline, McGrath, John J., Mehata, Suresh, Meier, Toni, Meles, Kidanu Gebremariam, Memiah, Peter, Memish, Ziad A., Mengesha, Melkamu Merid, Mengistu, Desalegn Tadese, Menota, Bereket Gebremichael, Mensah, George A., Meretoja, Atte, Meretoja, Tuomo J., Millear, Anoushka, Miller, Ted R., Minnig, Shawn, Mirarefin, Mojde, Mirrakhimov, Erkin M., Misganaw, Awoke, Mishra, Shiva Raj, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Mokdad, Ali H., Mola, Glen Liddell D., Mollenkopf, Sarah K., Molokhia, Mariam, Monasta, Lorenzo, Montanez Hernandez, Julio C., Montico, Marcella, Mooney, Meghan D., Moradi-Lakeh, Maziar, Moraga, Paula, Morawska, Lidia, Morrison, Shane D., Morozoff, Chloe, Mountjoy-Venning, Cliff, Mruts, Kalayu Birhane, Muller, Kate, Murthy, Gudlavalleti Venkata Satyanarayana, Musa, Kamarul Imran, Nachega, Jean B., Naheed, Aliya, Naldi, Luigi, Nangia, Vinay, Nascimento, Bruno Ramos, Nasher, Jamal T., Natarajan, Gopalakrishnan, Negoi, Ionut, Ngunjiri, Josephine Wanjiku, Cuong Tat Nguyen, Cuong Tat Nguyen, Grant Nguyen, Grant Nguyen, Minh Nguyen, Minh Nguyen, Quyen Le Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Trang Huyen Nguyen, Nichols, Emma, Ningrum, Dina Nur Anggraini, Vuong Minh Nong, Vuong Minh Nong, Noubiap, Jean Jacques N., Ogbo, Felix Akpojene, Oh, In-Hwan, Okoro, Anselm, Olagunju, Andrew Toyin, Olsen, Helen E., Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ong, Kanyin, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osman, Majdi, Ota, Erika, Pa, Mahesh, Pacella, Rosana E., Pakhale, Smita, Pana, Adrian, Panda, Basant Kumar, Panda-Jonas, Songhomitra, Papachristou, Christina, Park, Eun-Kee, Patten, Scott B., Patton, George C., Paudel, Deepak, Paulson, Katherine, Pereira, David M., Perez-Ruiz, Fernando, Perico, Norberto, Pervaiz, Aslam, Petzold, Max, Phillips, Michael Robert, Pigott, David M., Pinho, Christine, Plass, Dietrich, Pletcher, Martin A., Polinder, Suzanne, Postma, Maarten J., Pourmalek, Farshad, Purcell, Caroline, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rai, Rajesh Kumar, Ranabhat, Chhabi Lal, Rankin, Zane, Rao, Puja C., Rath, Goura Kishor, Rawaf, Salman, Ray, Sarah E., Rehm, Jurgen, Reiner, Robert C., Reitsma, Marissa B., Remuzzi, Giuseppe, Rezaei, Satar, Rezai, Mohammad Sadegh, Rokni, Mohammad Bagher, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A., Rothenbacher, Dietrich, Ruhago, George Mugambage, Saadat, Rizwan S. A. Soheil, Sachdev, Perminder S., Sadat, Nafis, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahathevan, Ramesh, Salama, Joseph, Salamati, Payman, Salomon, Joshua A., Samy, Abdallah M., Sanabria, Juan Ramon, Dolores Sanchez-Nino, Maria, Santomauro, Damian, Santos, Itamar S., Milicevic, Milena M. Santric, Sartorius, Benn, Satpathy, Maheswar, Shahraz, Saeid, Schmidt, Maria Ines, Schneider, Ione J. C., Schulhofer-Wohl, Sam, Schutte, Aletta E., Schwebel, David C., Schwendicke, Falk, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shackelford, Katya Anne, Shaikh, Masood Ali, Shamsipour, Mansour, Shamsizadeh, Morteza, Islam, Sheikh Mohammed Shariful, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shey, Muki, Shi, Peilin, Shields, Chloe, Shigematsu, Mika, Shiri, Rahman, Shirude, Shreya, Shiue, Ivy, Shoman, Haitham, Shrime, Mark G., Sigfusdottir, Inga Dora, Silpakit, Naris, Silva, Joao Pedro, Singh, Abhishek, Singh, Jasvinder A., Skiadaresi, Eirini, Sligar, Amber, Smith, Alison, Smith, David L., Smith, Mari, Sobaih, Badr H. A., Soneji, Samir, Sorensen, Reed J. D., Soriano, Joan B., Sreeramareddy, Chandrashekhar T., Srinivasan, Vinay, Stanaway, Jeffrey D., Stathopoulou, Vasiliki, Steel, Nicholas, Stein, Dan J., Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Strong, Mark, Strub, Bryan, Subart, Michelle, Sufiyan, Muawiyyah Babale, Sunguya, Bruno F., Sur, Patrick J., Swaminathan, Soumya, Sykes, Bryan L., Tabares-Seisdedos, Rafael, Tadakamadla, Santosh Kumar, Takahashi, Ken, Takala, Jukka S., Talongwa, Roberto Tchio, Tarawneh, Mohammed Rasoul, Tavakkoli, Mohammad, Taveira, Nuno, Tegegne, Teketo Kassaw, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thakur, J. S., Thamsuwan, Ornwipa, Thankappan, Kavumpurathu Raman, Thomas, Katie E., Thompson, Alex H., Thomson, Alan J., Thrift, Amanda G., Tobe-Gai, Ruoyan, Topor-Madry, Roman, Torre, Anna, Tortajada, Miguel, Towbin, Jeffrey Allen, Bach Xuan Tran, Bach Xuan Tran, Troeger, Christopher, Truelsen, Thomas, Tsoi, Derrick, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley N., Undurraga, Eduardo A., Updike, Rachel, Uthman, Olalekan A., Uzochukwu, Benjamin S. Chudi, van Boven, Job F. M., Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wakayo, Tolassa, Wallin, Mitchell T., Wang, Yuan-Pang, Weiderpass, Elisabete, Weintraub, Robert G., Weiss, Daniel J., Werdecker, Andrea, Westerman, Ronny, Whetter, Brian, Whiteford, Harvey A., Wijeratne, Tissa, Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D. A., Woodbrook, Rachel, Workicho, Abdulhalik, Xavier, Denis, Xiao, Qingyang, Xu, Gelin, Yaghoubi, Mohsen, Yakob, Bereket, Yano, Yuichiro, Yaseri, Mehdi, Yimam, Hassen Hamid, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z., Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zenebe, Zerihun Menlkalew, Zerfu, Taddese Alemu, Zhang, Anthony Lin, Zhang, Xueying, Zipkin, Ben, Zodpey, Sanjay, Lopez, Alan D., Murray, Christopher J. L., Abajobir, Amanuel Alemu, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abera, Semaw Ferede, Aboyans, Victor, Adetokunboh, Olatunji, Afshin, Ashkan, Agrawal, Anurag, Ahmadi, Alireza, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Miloud Taki Eddine, Aichour, Ibtihel, Aiyar, Sneha, Alahdab, Fare, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alene, Kefyalew Addi, Al-Eyadhy, Ayman, Ali, Syed Danish, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, Françoi, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla, Andersen, Hjalte H, Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Hossein, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon W, Atey, Tesfay Mehari, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G, Awasthi, Ashish, Babalola, Tesleem Kayode, Bacha, Umar, Balakrishnan, Kalpana, Barac, Aleksandra, Barboza, Miguel A, Barker-Collo, Suzanne L, Barquera, Simon, Barregard, Lar, Barrero, Lope H, Baune, Bernhard T, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, James R, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Bori, Bisanzio, Donal, Bourne, Rupert R A, Breitborde, Nicholas J K, Bulto, Lemma Negesa Bulto, Bumgarner, Blair R, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Campuzano, Julio Cesar, Car, Josip, Cárdenas, Rosario, Carrero, Juan Jesu, Carter, Austin, Casey, Daniel C, Castañeda-Orjuela, Carlos A, Catalá-López, Ferrán, Charlson, Fiona J, Chibueze, Chioma Ezinne, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Christopher, Devasahayam Jesuda, Ciobanu, Liliana G, Cirillo, Massimo, Cohen, Aaron J, Colombara, Danny, Cooper, Cyru, Cowie, Benjamin C, Criqui, Michael H, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I, das Neves, José, Davitoiu, Dragos V, Davletov, Kairat, de Courten, Barbora, Defo, Barthelemy Kuate, Degenhardt, Louisa, Deiparine, Selina, Deribe, Kebede, Deribew, Amare, Dey, Subhojit, Dicker, Daniel, Ding, Eric L, Djalalinia, Shirin, Do, Huyen Phuc, Doku, David Teye, Douwes-Schultz, Dirk, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Echko, Michelle, El-Khatib, Ziad Ziad, Ellingsen, Christian Lycke, Enayati, Ahmadali, Erskine, Holly E, Eskandarieh, Sharareh, Esteghamati, Alireza, Estep, Kara, Farinha, Carla Sofia e Sa, Faro, André, Farzadfar, Farshad, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C, Ferrari, Alize J, Feyissa, Tesfaye Regassa, Filip, Irina, Finegold, Samuel, Fischer, Florian, Fitzmaurice, Christina, Flaxman, Abraham D, Foigt, Nataliya, Frank, Tahvi, Fraser, Maya, Fullman, Nancy, Fürst, Thoma, Furtado, Joao M, Gakidou, Emmanuela, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Gebremichael, Delelegn Yilma, Geleijnse, Johanna M, Genova-Maleras, Ricard, Gesesew, Hailay Abrha, Gething, Peter W, Gillum, Richard F, Giroud, Maurice, Giussani, Giorgia, Godwin, William W, Gold, Audra L, Goldberg, Ellen M, Gona, Philimon N, Gopalani, Sameer Vali, Gouda, Hebe N, Goulart, Alessandra Carvalho, Griswold, Max, Gupta, Rajeev, Gupta, Tanush, Gupta, Vipin, Haagsma, Juanita A, Hafezi-Nejad, Nima, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Hammami, Mouhanad, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Hareri, Habtamu Abera, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmu, Hay, Simon I, He, Fei, Hedayati, Mohammad T, Henry, Nathaniel J, Heredia-Pi, Ileana Beatriz, Herteliu, Claudiu, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hostiuc, Sorin, Hotez, Peter J, Hoy, Damian G, Huynh, Chantal, Iburg, Kim Moesgaard, Ikeda, Chad, Ileanu, Bogdan Vasile, Irenso, Asnake Ararsa, Irvine, Caleb Mackay Salpeter, Islam, Sheikh Mohammed Shariful, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, Javanbakht, Mehdi, Jayaraman, Sudha P, Jeemon, Panniyammakal, Jha, Vivekanand, John, Denny, Johnson, Catherine O, Johnson, Sarah Charlotte, Jonas, Jost B, Jürisson, Mikk, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kamal, Ritul, Karch, André, Karimi, Seyed M, Karimkhani, Chante, Kasaeian, Amir, Kassaw, Nigussie Assefa, Kassebaum, Nicholas J, Katikireddi, Srinivasa Vittal, Kawakami, Norito, Keiyoro, Peter Njenga, Kemmer, Laura, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Ejaz Ahmad, Khang, Young-Ho, Khoja, Abdullah Tawfih Abdullah, Khosravi, Mohammad Hossein, Khosravi, Ardeshir, Khubchandani, Jagdish, Kiadaliri, Aliasghar Ahmad, Kieling, Christian, Kievlan, Daniel, Kim, Yun Jin, Kim, Daniel, Kimokoti, Ruth W, Kinfu, Yohanne, Kissoon, Niranjan, Kivimaki, Mika, Knudsen, Ann Kristin, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Kulikoff, Xie Rachel, Kumar, G Anil, Kumar, Pushpendra, Kutz, Michael, Kyu, Hmwe H, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lambert, Tea Lallukka Nkurunziza, Lan, Qing, Lansingh, Van C, Larsson, Ander, Lee, Paul H, Leigh, Jame, Leung, Janni, Levi, Miriam, Li, Yongmei, Li Kappe, Darya, Liang, Xiaofeng, Liben, Misgan Legesse, Lim, Stephen S, Liu, Patrick Y, Liu, Angela, Liu, Yang, Lodha, Rakesh, Logroscino, Giancarlo, Lopez, Alan D, Lorkowski, Stefan, Lotufo, Paulo A, Lozano, Rafael, Lucas, Timothy C D, Ma, Stefan, Macarayan, Erlyn Rachelle King, Maddison, Emilie R, Magdy Abd El Razek, Mohammed, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malhotra, Rajesh, Malta, Deborah Carvalho, Manguerra, Helena, Manyazewal, Tsegahun, Mapoma, Chabila C, Marczak, Laurie B, Markos, Desalegn, Martinez-Raga, Jose, Martins-Melo, Francisco Rogerlândio, Martopullo, Ira, McAlinden, Colm, McGaughey, Madeline, McGrath, John J, Mehata, Suresh, Meier, Toni, Meles, Kidanu Gebremariam, Memiah, Peter, Memish, Ziad A, Mengesha, Melkamu Merid, Mengistu, Desalegn Tadese, Menota, Bereket Gebremichael, Mensah, George A, Meretoja, Tuomo J, Meretoja, Atte, Millear, Anoushka, Miller, Ted R, Minnig, Shawn, Mirarefin, Mojde, Mirrakhimov, Erkin M, Misganaw, Awoke, Mishra, Shiva Raj, Mohamed, Ibrahim Abdelmageem, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Mokdad, Ali H, Mola, Glen Liddell D, Mollenkopf, Sarah K, Molokhia, Mariam, Monasta, Lorenzo, Montañez, Julio C, Montico, Marcella, Mooney, Meghan D, Moradi-Lakeh, Maziar, Moraga, Paula, Morawska, Lidia, Morozoff, Chloe, Morrison, Shane D, Mountjoy-Venning, Cliff, Mruts, Kalayu Birhane, Muller, Kate, Murray, Christopher J L, Murthy, Gudlavalleti Venkata Satyanarayana, Musa, Kamarul Imran, Nachega, Jean B, Naghavi, Mohsen, Naheed, Aliya, Naldi, Luigi, Nangia, Vinay, Nascimento, Bruno Ramo, Nasher, Jamal T, Natarajan, Gopalakrishnan, Negoi, Ionut, Ngunjiri, Josephine Wanjiku, Nguyen, Cuong Tat, Nguyen, Quyen Le, Nguyen, Trang Huyen, Nguyen, Grant, Nguyen, Minh, Nichols, Emma, Ningrum, Dina Nur Anggraini, Nong, Vuong Minh, Noubiap, Jean Jacques N, Ogbo, Felix Akpojene, Oh, In-Hwan, Okoro, Anselm, Olagunju, Andrew Toyin, Olsen, Helen E, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Ong, Kanyin, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osman, Majdi, Ota, Erika, PA, Mahesh, Pacella, Rosana E, Pakhale, Smita, Pana, Adrian, Panda, Basant Kumar, Panda-Jonas, Songhomitra, Papachristou, Christina, Park, Eun-Kee, Patten, Scott B, Patton, George C, Paudel, Deepak, Paulson, Katherine, Pereira, David M, Perez-Ruiz, Fernando, Perico, Norberto, Pervaiz, Aslam, Petzold, Max, Phillips, Michael Robert, Pigott, David M, Pinho, Christine, Plass, Dietrich, Pletcher, Martin A, Polinder, Suzanne, Postma, Maarten J, Pourmalek, Farshad, Purcell, Caroline, Qorbani, Mostafa, Quintanilla, Beatriz Paulina Ayala, Radfar, Amir, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur, Rahman, Mahfuzar, Rai, Rajesh Kumar, Ranabhat, Chhabi Lal, Rankin, Zane, Rao, Puja C, Rath, Goura Kishor, Rawaf, Salman, Ray, Sarah E, Rehm, Jürgen, Reiner, Robert C, Reitsma, Marissa B, Remuzzi, Giuseppe, Rezaei, Satar, Rezai, Mohammad Sadegh, Rokni, Mohammad Bagher, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Ruhago, George Mugambage, SA, Rizwan, Saadat, Soheil, Sachdev, Perminder S, Sadat, Nafi, Safdarian, Mahdi, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahathevan, Ramesh, Salama, Joseph, Salamati, Payman, Salomon, Joshua A, Samy, Abdallah M, Sanabria, Juan Ramon, Sanchez-Niño, Maria Dolore, Santomauro, Damian, Santos, Itamar S, Santric Milicevic, Milena M, Sartorius, Benn, Satpathy, Maheswar, Schmidt, Maria Inê, Schneider, Ione J C, Schulhofer-Wohl, Sam, Schutte, Aletta E, Schwebel, David C, Schwendicke, Falk, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya Anne, Shahraz, Saeid, Shaikh, Masood Ali, Shamsipour, Mansour, Shamsizadeh, Morteza, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shey, Muki, Shields, Chloe, Shigematsu, Mika, Shiri, Rahman, Shirude, Shreya, Shiue, Ivy, Shoman, Haitham, Shrime, Mark G, Sigfusdottir, Inga Dora, Silpakit, Nari, Silva, João Pedro, Singh, Jasvinder A, Singh, Abhishek, Skiadaresi, Eirini, Sligar, Amber, Smith, David L, Smith, Alison, Smith, Mari, Sobaih, Badr H A, Soneji, Samir, Sorensen, Reed J D, Soriano, Joan B, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Stanaway, Jeffrey D, Stathopoulou, Vasiliki, Steel, Nichola, Stein, Dan J, Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Strong, Mark, Strub, Bryan, Subart, Michelle, Sufiyan, Muawiyyah Babale, Sunguya, Bruno F, Sur, Patrick J, Swaminathan, Soumya, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tadakamadla, Santosh Kumar, Takahashi, Ken, Takala, Jukka S, Talongwa, Roberto Tchio, Tarawneh, Mohammed Rasoul, Tavakkoli, Mohammad, Taveira, Nuno, Tegegne, Teketo Kassaw, Tehrani-Banihashemi, Arash, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Thakur, J.S., Thamsuwan, Ornwipa, Thankappan, Kavumpurathu Raman, Thomas, Katie E, Thompson, Alex H, Thomson, Alan J, Thrift, Amanda G, Tobe-Gai, Ruoyan, Topor-Madry, Roman, Torre, Anna, Tortajada, Miguel, Towbin, Jeffrey Allen, Tran, Bach Xuan, Troeger, Christopher, Truelsen, Thoma, Tsoi, Derrick, Tyrovolas, Stefano, Ukwaja, Kingsley N, Undurraga, Eduardo A, Updike, Rachel, Uthman, Olalekan A, Uzochukwu, Benjamin S Chudi, van Boven, Job F M, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wakayo, Tolassa, Wallin, Mitchell T, Wang, Yuan-Pang, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Whetter, Brian, Whiteford, Harvey A, Wijeratne, Tissa, Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D A, Woodbrook, Rachel, Workicho, Abdulhalik, Xavier, Deni, Xiao, Qingyang, Xu, Gelin, Yaghoubi, Mohsen, Yakob, Bereket, Yano, Yuichiro, Yaseri, Mehdi, Yimam, Hassen Hamid, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zenebe, Zerihun Menlkalew, Zerfu, Taddese Alemu, Zhang, Anthony Lin, Zhang, Xueying, Zipkin, Ben, Zodpey, Sanjay, Giref, Ababi Zergaw, Rafay, Anwar, Tuzcu, Emin Murat, Ermakov, Sergey Petrovich, Shi, Peilin, Gupta, Parkash C, Erasmus MC other, Public Health, Neurosciences, Viðskiptadeild (HR), School of Business (RU), Háskólinn í Reykjavík, Reykjavik University, Mohsen, Naghavi, Amanuel, Alemu, Abajobir, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd Allah, Semaw, Ferede, Abera, Victor, Aboyan, Olatunji, Adetokunboh, Johan, Ärnlöv, Ashkan, Afshin, Anurag, Agrawal, Aliasghar, Ahmad, Kiadaliri, Alireza, Ahmadi, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Sneha, Aiyar, Ayman, Al Eyadhy, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Tahiya, Alam, Kefyalew, Addi, Alene, Syed, Danish, Ali, Reza, Alizadeh Navaei, Juma, M, Alkaabi, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis Guzman, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Amoako, Nahla, Anber, Hjalte, H, Andersen, Catalina, Liliana, Andrei, Sofia, Androudi, Hossein, Ansari, Carl, Abelardo, T, Antonio, Palwasha, Anwari, Megha, Arora, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, W, Asgedom, Tesfay, Mehari, Atey, Leticia, Avila Burgo, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Beatriz, Paulina, Ayala, Quintanilla, Yannick, Béjot, Tesleem, Kayode, Babalola, Umar, Bacha, Kalpana, Balakrishnan, Aleksandra, Barac, Miguel, A, Barboza, Suzanne, L, Barker, Collo, Simon, Barquera, Lars, Barregard, Lope, H, Barrero, Bernhard, T, Baune, Neeraj, Bedi, Ettore, Beghi, Bayu, Begashaw, Bekele, Michelle, L, Bell, James, R, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Balem, Demtsu, Betsu, Mircea, Beuran, Samir, Bhatt, Sibhatu, Biadgilign, Kelly, Bienhoff, Boris, Bikbov, Donal, Bisanzio, Rupert, R, A, Bourne, Nicholas, J, K, Breitborde, Lemma, Negesa, Bulto, Bulto, Blair, R, Bumgarner, Zahid, A, Butt, Rosario, Cárdena, Lucero, Cahuana Hurtado, Ewan, Cameron, Julio, Cesar, Campuzano, Josip, Car, Juan, Jesu, Carrero, Austin, Carter, Daniel, C, Casey, Carlo, A, Castañeda, Orjuela, Ferrán, Catalá López, Fiona, J, Charlson, Chioma, Ezinne, Chibueze, Odgerel, Chimed Ochir, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Devasahayam, Jesuda, Christopher, Liliana, G, Ciobanu, Aaron, J, and Cohen

Subjects
Dánarmein, Male, Heilsufar, Dánartíðni, Newborn infants, Lífslíkur, Life expectancy, Communicable diseases, Global Health, Global Burden of Disease, Disasters, Pregnancy, Cause of Death, Psychology, Child, Konur, Aged, 80 and over, Ungbörn, CLIMATE-CHANGE, PLASMODIUM-FALCIPARUM, Kransæðasjúkdómar, Global burden of disease/statistics and numerical data, Medicine (all), Men, Þjóðir, Öndunarfærasjúkdómar, 11 Medical And Health Sciences, Middle Aged, Nutrition Disorders, PREVALENCE, Coronary heart disease, Smitsjúkdómar, Death, Suicide, Cardiovascular diseases, Sálfræði, World health, Child, Preschool, Nýburar, Female, GBD, mortality, Infants, Life Sciences & Biomedicine, Age distribution, Global Health Metrics, Adult, Diarrhea, AFRICA, HUMAN HEALTH, Adolescent, GBD, UNITED-STATES, Socioeconomic factors, Communicable Diseases, Young Adult, Age Distribution, Heilbrigðisvísindi, Medicine, General & Internal, General & Internal Medicine, Humans, QUALITY, Women, Nutrition disorders, INCOME COUNTRIES, Mortality, Noncommunicable Diseases, Aged, Science & Technology, Infant, Newborn, Infant, Respiratory infections, Næringarskortur, ALCOHOL POLICY, mortality, Malaria, Pregnancy Complications, Socioeconomic Factors, Áverkar, Karlar, Wounds and Injuries, Félagshagfræði, Accidental Falls, Cause of death/trends, RESISTANCE
Abstract

Correction: Group Author(s): GBD 2016 Causes Death LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017 Group Author(s): GBD 2016 Dis Injury Incidence LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017, Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72.3% (95% uncertainty interval [UI] 71.2-73.2) of deaths in 2016 with 19.3% (18.5-20.4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8.43% (8.00-8.67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1.80 million deaths (95% UI 1.59 million to 1.89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2.89%); the median annualised rate of change for all other causes was lower (a decrease of 1.59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems., Bill & Melinda Gates Foundation.

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28. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Hay, Simon I, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abebo, Teshome Abuka, Abera, Semaw Ferede, Aboyans, Victor, Abu-Raddad, Laith J, Ackerman, Ilana N, Adedeji, Isaac A, Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Sutapa, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Aiyar, Sneha, Akinyemiju, Tomi F, Akseer, Nadia, Al Lami, Faris Hasan, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Tahiya, Alasfoor, Deena, Alene, Kefyalew Addis, Ali, Raghib, Alizadeh-Navaei, Reza, Alkaabi, Juma M, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Allen, Christine, Al-Maskari, Fatma, AlMazroa, Mohammad AbdulAziz, Al-Raddadi, Rajaa, Alsharif, Ubai, Alsowaidi, Shirina, Althouse, Benjamin M, Altirkawi, Khalid A, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Ampem, Yaw Amoako, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Anwari, Palwasha, Arnlov, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asgedom, Solomon W, Atey, Tesfay Mehari, Atnafu, Niguse Tadele, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Awasthi, Shally, Quintanilla, Beatriz Paulina Ayala, Azarpazhooh, Mahmoud Reza, Azzopardi, Peter, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Bannick, Marlena S, Barac, Aleksandra, Barker-Collo, Suzanne L, Barnighausen, Till, Barquera, Simon, Barrero, Lope H, Basu, Sanjay, Battista, Robert, Battle, Katherine E, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Bejot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L, Bennett, Derrick A, Bennett, James R, Bensenor, Isabela M, Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabe, Eduardo, Betsu, Balem Demtsu, Beuran, Mircea, Beyene, Addisu Shunu, Bhansali, Anil, Bhatt, Samir, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bienhoff, Kelly, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Blyth, Fiona M, Boneya, Dube Jara, Bose, Dipan, Bou-Orm, Ibrahim R, Bourne, Rupert RA, Brainin, Michael, Brayne, Carol EG, Brazinova, Alexandra, Breitborde, Nicholas JK, Briant, Paul S, Britton, Gabrielle, Brugha, Traolach S, Buchbinder, Rachelle, Bulto, Lemma Negesa Bulto, Bumgarner, Blair, Butt, Zahid A, Cahuana-Hurtado, Lucero, Cameron, Ewan, Ricardo Campos-Nonato, Ismael, Carabin, Helene, Cardenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Carvalho, Felix, Casey, Daniel, Castaneda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Castle, Chris D, Catala-Lopez, Ferran, Chang, Jung-Chen, Charlson, Fiona J, Chaturvedi, Pankaj, Chen, Honglei, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Colombara, Danny, Cooper, Leslie Trumbull, Cooper, Cyrus, Cortesi, Paolo Angelo, Cortinovis, Monica, Criqui, Michael H, Cromwell, Elizabeth A, Cross, Marita, Crump, John A, Dadi, Abel Fekadu, Dalal, Koustuv, Damasceno, Albertino, Dandona, Lalit, Dandona, Rakhi, Das Neves, Jose, Davitoiu, Dragos V, Davletov, Kairat, De Courten, Barbora, De Leo, Diego, De Steur, Hans, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Dicker, Daniel, Djalalinia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Dorsey, E Ray, Bender Dos Santos, Kadine Priscila, Driscoll, Tim R, Dubey, Manisha, Duncan, Bruce Bartholow, Ebel, Beth E, Echko, Michelle, El-Khatib, Ziad Ziad, Enayati, Ahmadali, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshetie, Setegn, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fanuel, Fanuel Belayneh Bekele, Farag, Tamer, Sofia, Carla, 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Zoubida, Zaki, Maysaa El Sayed, Zegeye, Elias Asfaw, Zenebe, Zerihun Menlkalew, Zhang, Xueying, Zheng, Yingfeng, Zhou, Maigeng, Zipkin, Ben, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, Murray, Christopher JL, and Collaborators, GBD DALYs HALE

Subjects
Adult, Aged, 80 and over, Male, 1. No poverty, Middle Aged, Global Health, Communicable Diseases, 3. Good health, Global Burden of Disease, Age Distribution, Life Expectancy, Residence Characteristics, Cause of Death, Humans, Wounds and Injuries, Disabled Persons, Female, sense organs, Quality-Adjusted Life Years, Sex Distribution, Noncommunicable Diseases, Aged
Abstract

Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).

29. Tabari cohort profile and preliminary results in urban areas and mountainous regions of Mazandaran, Iran

Author

Kheradmand, Motahareh, mahmood moosazadeh, Saeedi, Majid, Poustchi, Hossein, Eghtesad, Sareh, Esmaeili, Ravanbakhsh, Alizadeh-Navaei, Reza, Hedayatizadeh-Omran, Akbar, Nikaeein, Roja, Rafiei, Alireza, Janbabaee, Ghasem, Kashi, Zahra, Sohrab, Mehrnoush, Ahoodashti, Mahboobeh Shirzad, Afshari, Mahdi, Golpour, Bahareh, Aarabi, Mohsen, Maleki, Iradj, Fakheri, Hafez Tirgar, Ghaemian, Ali, Zarghami, Mehran, and Ghaemi, Alireza

Subjects
Adult, Male, Smoking, Iran, Middle Aged, Thyroid Diseases, Body Mass Index, Epidemiologic Studies, Risk Factors, Hypertension, Diabetes Mellitus, Prevalence, Humans, Female, Prospective Studies, Noncommunicable Diseases, Antihypertensive Agents, Aged
Abstract

The Tabari cohort study (TCS), part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), is a large longitudinal prospective cohort designed to better understand the risk factors associated with major non-communicable diseases (NCDs) across two urban and mountainous regions in north of Iran.The enrollment phase of TCS started in June 2015 and ended in November 2017. During this phase, individuals aged 35-70 years from urban and mountainous regions of Sari township (Mazandaran province) were invited to the cohort center by health volunteers (urban regions) and Behvarz (mountainous areas) using census information. Data was collected based on the PERSIAN cohort study protocols. Hypertension was defind as systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg or history of diagnosis with hypertension or taking antihypertensive medications among participants free from cardiovascular diseases. Diabetes was defined as fasting blood sugar ≥126 mg/dL or a history of diagnosis or taking glucoselowering medications among all participants.A total of 10,255 participants were enrolled in TCS, 59.5% of whom were female. Among the total population, 7,012 participants were urban residents (68.4%). The prevalence of daily smoking in the total population was 9.1%. Body mass index in 75.9% of participants was ≥25 kg/m2. The prevalence of hypertension, diabetes, and thyroid disorders were 22.2%, 17.2%, and 10.5%, respectively.The Tabari cohort is different from other cohorts in terms of levels of risk factors associated with NCDs. This study has certain important strengths including its population-based design and large sample size that provides a valid platform for conducting future investigations and trials. A biobank that has been designed to store blood, nail, hair and urine samples for future research is another strength of this study. Researchers who are interested in using the information can refer to the following web page: http://persiancohort.com.

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