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414 results on '"Mehari, Alem"'

101. Obesity and Pulmonary Function in African Americans

Author

Mehari, Alem, primary, Afreen, Samina, additional, Ngwa, Julius, additional, Setse, Rosanna, additional, Thomas, Alicia N., additional, Poddar, Vishal, additional, Davis, Wayne, additional, Polk, Octavius D., additional, Hassan, Sheik, additional, and Thomas, Alvin V., additional

Published
2015
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106. Airflow obstruction, cognitive function and mortality in a US national cohort: NHANES‐III.

Author

Odeyemi, Yewande E., Mehari, Alem, Meda, Edris, Ogundipe, Funmilola, Russ, Ebony, Obisesan, Thomas, and Gillum, Richard F.

Subjects
*COGNITIVE ability, *RESPIRATORY obstructions, *MORTALITY, *HEALTH & Nutrition Examination Survey, *EXPIRATORY flow
Abstract

Abstract: Objective: To test the hypothesis that cognitive impairment increases mortality independent of airflow obstruction. Materials and Methods: In 1988‐1994 the Third National Health and Nutrition Examination Survey (NHANES III) measured forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) and selected items on cognitive function with mortality follow‐up. For this survival analysis 4365 persons aged 60 and over with complete data formed the analytic sample. Results: The FEV1/FVC less than the lower limit of predicted ratio (LLP) defined airflow obstruction and Composite Cognitive Function Score (CCF) ≤4, cognitive impairment. The percentage who died during follow up was 67% among those with neither FEV1/FVC < LLP nor CCF ≤4, 82% with FEV1/FVC < LLP only, 85% with CCF score ≤4 only and 93% with both FEV1/FVC LLP and CCF score ≤4 (P < .001). Weighted Cox proportional hazards regression revealed an increased hazard ratio (HR) in persons with FEV1/FVC P = .051). Conclusion: Elderly persons with either airflow obstruction or cognitive impairment or both had increased all‐cause mortality when compared to those with neither after adjusting for confounders. However, cognitive impairment was not a predictor of increased mortality independent of airflow obstruction. [ABSTRACT FROM AUTHOR]

Published
2018
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111. 979

Author

Biney, Isaac, primary and Mehari, Alem, additional

Published
2014
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131. Characterizing non-linear dependencies among pairs of clinical variables and imaging data.

Author

Caban, Jesus J., Bagci, Ulas, Mehari, Alem, Alam, Shoaib, Fontana, Joseph R., Kato, Gregory J., and Mollura, Daniel J.

Abstract

Advances in computer-aided diagnosis (CAD) systems have shown the benefits of using computer-based techniques to obtain quantitative image measurements of the extent of a particular disease. Such measurements provide more accurate information that can be used to better study the associations between anatomical changes and clinical findings. Unfortunately, even with the use of quantitative image features, the correlations between anatomical changes and clinical findings are often not apparent and definite conclusions are difficult to reach. This paper uses nonparametric exploration techniques to demonstrate that even when the associations between two-variables seems weak, advanced properties of the associations can be studied and used to better understand the relationships between individual measurements. This paper uses quantitative imaging findings and clinical measurements of 85 patients with pulmonary fibrosis to demonstrate the advantages of non-linear dependency analysis. Results show that even when the correlation coefficients between imaging and clinical findings seem small, statistical measurements such as the maximum asymmetry score (MAS) and maximum edge value (MEV) can be used to better understand the hidden associations between the variables [ABSTRACT FROM PUBLISHER]

Published
2012
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134. Chronic Pulmonary Complications of Sickle Cell Disease

Author

Mehari, Alem and Klings, Elizabeth S.

Abstract

Sickle cell disease (SCD), the most common genetic hemolytic anemia worldwide, affects 250,000 births annually. In the United States, SCD affects approximately 100,000 individuals, most of African descent. Hemoglobin S (HbS) results from a glutamate-to-valine mutation of the sixth codon of the β-hemoglobin allele; the homozygous genotype (HbSS) is associated with the most prevalent and severe form of the disease. Other SCD genotypes include HbSC, composed of one HbS allele and one HbC (glutamate-to-lysine mutation) allele; and HbS-β-thalassemia0or HbS-β-thalassemia+, composed of one HbS allele and one β-thalassemia allele with absent or reduced β-chain production, respectively. Despite advances in care, median survival remains in the fifth decade, due in large part to chronic complications of the disease. Chronic pulmonary complications in SCD are major contributors to this early mortality. Although our understanding of these conditions has improved much over the past 10 to 15 years, there remains no specific treatment for pulmonary complications of SCD. It is unclear whether conventional treatment regimens directed at non-SCD populations have equivalent efficacy in patients with SCD. This represents a critical research need. In this review, the authors review the state-of-the-art understanding of the following pulmonary complications of SCD: (1) pulmonary hypertension; (2) venous thromboembolic disease; (3) sleep-disordered breathing; (4) asthma and recurrent wheezing; and (5) pulmonary function abnormalities. This review highlights the advances as well as the knowledge gaps in this field to update clinicians and other health care providers and to garner research interest from the medical community.

Published
2016
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137. A Resource for Planning for Disasters and Outbreaks: Lessons From the West African Ebola Epidemic.

Author

Berhane, Firehiwot, Mehari, Alem, and Gillum, Richard

Subjects
EMERGENCY management, EBOLA virus disease, EPIDEMICS, COMMUNICABLE diseases, DISEASE outbreaks
Abstract

Keywords: communicable diseases; disaster planning; epidemics; mortality EN communicable diseases disaster planning epidemics mortality 143 143 1 06/23/21 20210401 NES 210401 The extent of the West African Ebola virus disease (EVD) epidemic and the role of inadequate preparedness at the national, regional, and international levels has been well documented.1,2 Lack of communication and coordination among disaster preparedness and outbreak response agencies contributed to the toll of illness and death. In conclusion, disaster preparedness and outbreak response agencies working jointly to prepare for future EVD epidemics can use GBD data to enhance the planning process. [Extracted from the article]

Published
2021
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138. Computer-assisted diagnostic tool to quantify the pulmonary veins in sickle cell associated pulmonary hypertension

Author

Jajamovich, Guido H., Pamulapati, Vivek, Alam, Shoaib, Mehari, Alem, Kato, Gregory J., Wood, Bradford J., and Linguraru, Marius George

Abstract

Pulmonary hypertension is a common cause of death among patients with sickle cell disease. This study investigates the use of pulmonary vein analysis to assist the diagnosis of pulmonary hypertension non-invasively with CT-Angiography images. The characterization of the pulmonary veins from CT presents two main challenges. Firstly, the number of pulmonary veins is unknown a priori and secondly, the contrast material is degraded when reaching the pulmonary veins, making the edges of these vessels to appear faint. Each image is first denoised and a fast marching approach is used to segment the left atrium and pulmonary veins. Afterward, a geodesic active contour is employed to isolate the left atrium. A thinning technique is then used to extract the skeleton of the atrium and the veins. The locations of the pulmonary veins ostia are determined by the intersection of the skeleton and the contour of the atrium. The diameters of the pulmonary veins are measured in each vein at fixed distances from the corresponding ostium, and for each distance, the sum of the diameters of all the veins is computed. These indicators are shown to be significantly larger in sickle-cell patients with pulmonary hypertension as compared to controls (p-values < 0.01).

Published
2012
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139. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Forouzanfar, Mohammad H., Afshin, Ashkan, Alexander, Lily T., Anderson, H. Ross, Bhutta, Zulfiqar A., Biryukov, Stan, Brauer, Michael, Burnett, Richard, Cercy, Kelly, Charlson, Fiona J., Cohen, Aaron J., Dandona, Lalit, Estep, Kara, Ferrari, Alize J., Frostad, Joseph J., Fullman, Nancy, Gething, Peter W., Godwin, William W., Griswold, Max, Hay, Simon I., Kinfu, Yohannes, Kyu, Hmwe H., Larson, Heidi J., Liang, Xiaofeng, Lim, Stephen S., Liu, Patrick Y., Lopez, Alan D., Lozano, Rafael, Marczak, Laurie, Mensah, George A., Mokdad, Ali H., Moradi-Lakeh, Maziar, Naghavi, Mohsen, Neal, Bruce, Reitsma, Marissa B., Roth, Gregory A., Salomon, Joshua A., Sur, Patrick J., Vos, Theo, Wagner, Joseph A., Wang, Haidong, Zhao, Yi, Zhou, Maigeng, Aasvang, Gunn Marit, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abdulle, Abdishakur M., Abera, Semaw Ferede, Abraham, Biju, Abu-Raddad, Laith J., Abyu, Gebre Yitayih, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C., Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N., Akinyemiju, Tomi F., Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K. M., Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala A., Alla, François, Allebeck, Peter, Alsharif, Ubai, Altirkawi, Khalid A., Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T., Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H., Anderson, Benjamin O., Antonio, Carl Abelardo T., Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C., Balakrishnan, Kalpana, Barac, Aleksandra, Barber, Ryan M., Barker-Collo, Suzanne L., Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H., Basu, Sanjay, Batis, Carolina, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Brent, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bensenor, Isabela M., Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhatt, Samir, Biadgilign, Sibhatu, Bikbov, Boris, Bisanzio, Donal, Bjertness, Espen, Blore, Jed D., Borschmann, Rohan, Boufous, Soufiane, Bourne, Rupert R. A., Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J. K., Brenner, Hermann, Broday, David M., Brugha, Traolach S., Brunekreef, Bert, Butt, Zahid A., Cahill, Leah E., Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Cárdenas, Rosario, Carpenter, David O., Carrero, Juan Jesus, Casey, Daniel C., Castañeda-Orjuela, Carlos A., Rivas, Jacqueline Castillo, Castro, Ruben Estanislao, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A., Choi, Jee-Young Jasmine, Christensen, Hanne, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G., Coates, Matthew M., Colquhoun, Samantha M., Manzano, Alejandra G. Contreras, Cooper, Leslie Trumbull, Cooperrider, Kimberly, Cornaby, Leslie, Cortinovis, Monica, Crump, John A., Cuevas-Nasu, Lucia, Damasceno, Albertino, Dandona, Rakhi, Darby, Sarah C., Dargan, Paul I., Das Neves, José, Davis, Adrian C., Davletov, Kairat, Castro, E. Filipa, La Cruz-Góngora, Vanessa, Leo, Diego, Degenhardt, Louisa, Del Gobbo, Liana C., Del Pozo-Cruz, Borja, Dellavalle, Robert P., Deribew, Amare, Jarlais, Don C. Des, Dharmaratne, Samath D., Dhillon, Preet K., Diaz-Torné, Cesar, Dicker, Daniel, Ding, Eric L., Dorsey, E. Ray, Doyle, Kerrie E., Driscoll, Tim R., Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E., Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A., Farinha, Carla Sofia E. Sa, Faro, André, Farvid, Maryam S., Farzadfar, Farshad, Feigin, Valery L., Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G., Fischer, Florian, Fitchett, Joseph R. A., Fleming, Tom, Foigt, Nataliya, Foreman, Kyle, Fowkes, F. Gerry R., Franklin, Richard C., Fürst, Thomas, Futran, Neal D., Gakidou, Emmanuela, Garcia-Basteiro, Alberto L., Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Geleijnse, Johanna M., Gessner, Bradford D., Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Goenka, Shifalika, Gomez-Cabrera, Mari Carmen, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C., Goto, Atsushi, Gouda, Hebe N., Gugnani, Harish Chander, Guillemin, Francis, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A., Haagsma, Juanita A., Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Gessessew Bugssa, Halasa, Yara A., Hamadeh, Randah Ribhi, Hamidi, Samer, Handal, Alexis J., Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Hassen, Tahir Ahmed, Havmoeller, Rasmus, Heredia-Pi, Ileana Beatriz, Hernández-Llanes, Norberto Francisco, Heydarpour, Pouria, Hoek, Hans W., Hoffman, Howard J., Horino, Masako, Horita, Nobuyuki, Hosgood, H. Dean, Hoy, Damian G., Hsairi, Mohamed, Htet, Aung Soe, Hu, Guoqing, Huang, John J., Husseini, Abdullatif, Hutchings, Sally J., Huybrechts, Inge, Iburg, Kim Moesgaard, Idrisov, Bulat T., Ileanu, Bogdan Vasile, Inoue, Manami, Jacobs, Troy A., Jacobsen, Kathryn H., Jahanmehr, Nader, Jakovljevic, Mihajlo B., Jansen, Henrica A. F. M., Jassal, Simerjot K., Javanbakht, Mehdi, Jayaraman, Sudha P., Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Ying, Jibat, Tariku, Jin, Ye, Johnson, Catherine O., Jonas, Jost B., Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S., Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khatibzadeh, Shahab, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Khubchandani, Jagdish, Kieling, Christian, Kim, Cho-Il, Kim, Daniel, Kimokoti, Ruth W., Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D., Kokubo, Yoshihiro, Kopec, Jacek A., Koul, Parvaiz A., Koyanagi, Ai, Kravchenko, Michael, Kromhout, Hans, Krueger, Hans, Ku, Tiffany, Defo, Barthelemy Kuate, Kuchenbecker, Ricardo S., Bicer, Burcu Kucuk, Kuipers, Ernst J., Kumar, G. Anil, Kwan, Gene F., Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lan, Qing, Larsson, Anders, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leasher, Janet L., Leigh, James, Leung, Janni, Levi, Miriam, Li, Xiaohong, Li, Yichong, Liang, Juan, Liu, Shiwei, Lloyd, Belinda K., Logroscino, Giancarlo, Lotufo, Paulo A., Lunevicius, Raimundas, Macintyre, Michael, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Manamo, Wondimu Ayele Ayele, Mapoma, Chabila C., Marcenes, Wagner, Martin, Randall V., Martinez-Raga, Jose, Masiye, Felix, Matsushita, Kunihiro, Matzopoulos, Richard, Mayosi, Bongani M., Mcgrath, John J., Mckee, Martin, Meaney, Peter A., Medina, Catalina, Mehari, Alem, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B., Melaku, Yohannes Adama, Memish, Ziad A., Mendoza, Walter, Mensink, Gert B. M., Meretoja, Atte, Meretoja, Tuomo J., Mesfin, Yonatan Moges, Mhimbira, Francis Apolinary, Millear, Anoushka, Miller, Ted R., Mills, Edward J., Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N., Mohammadi, Alireza, Mohammed, Shafiu, Mola, Glen Liddell D., Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Morawska, Lidia, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O., Mullany, Erin, Mumford, John Everett, Murthy, Gudlavalleti Venkata Satyanarayana, Nachega, Jean B., Naheed, Aliya, Nangia, Vinay, Nassiri, Nariman, Newton, John N., Ng, Marie, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olivares, Pedro R., Olsen, Helen, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Orozco, Ricardo, Ortiz, Alberto, Ota, Erika, Pa, Mahesh, Pana, Adrian, Park, Eun-Kee, Parry, Charles D., Parsaeian, Mahboubeh, Patel, Tejas, Caicedo, Angel J. Paternina, Patil, Snehal T., Patten, Scott B., Patton, George C., Pearce, Neil, Pereira, David M., Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B., Pillay, Julian David, Plass, Dietrich, Polinder, Suzanne, Pond, Constance D., Pope, C. Arden, Pope, Daniel, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prasad, Noela M., Qorbani, Mostafa, Rabiee, Rynaz H. S., Amir Radfar, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Murugesan, Ram, Usha, Rana, Saleem M., Ranganathan, Kavitha, Rao, Puja, García, Christian Aspacia Razo, Refaat, Amany H., Rehm, Colin D., Rehm, Jürgen, Reinig, Nikolas, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Rivera, Juan A., Roba, Hirbo Shore, Rodriguez, Alina, Rodriguez-Ramirez, Sonia, Rojas-Rueda, David, Roman, Yesenia, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Saleh, Muhammad Muhammad, Sanabria, Juan R., Sanchez-Riera, Lidia, Sanchez-Niño, Maria Dolores, Sánchez-Pimienta, Tania G., Sandar, Logan, Santomauro, Damian F., Santos, Itamar S., Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schmidhuber, Josef, Schmidt, Maria Inês, Schneider, Ione J. C., Schöttker, Ben, Schutte, Aletta E., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Levy, Teresa Shamah, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N., Shi, Peilin, Shibuya, Kenji, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Silveira, Dayane Gabriele Alves, Silverberg, Jonathan I., Simard, Edgar P., Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A., Singh, Prashant Kumar, Slepak, Erica Leigh, Soljak, Michael, Soneji, Samir, Sorensen, Reed J. D., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stathopoulou, Vasiliki, Steckling, Nadine, Steel, Nicholas, Stein, Dan J., Stein, Murray B., Stöckl, Heidi, Stranges, Saverio, Stroumpoulis, Konstantinos, Sunguya, Bruno F., Swaminathan, Soumya, Sykes, Bryan L., Szoeke, Cassandra E. I., Tabarés-Seisdedos, Rafael, Takahashi, Ken, Talongwa, Roberto Tchio, Tandon, Nikhil, Tanne, David, Tavakkoli, Mohammad, Taye, Belaynew Wasie, Taylor, Hugh R., Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Tegegne, Teketo Kassaw, Tekle, Dejen Yemane, Terkawi, Abdullah Sulieman, Thakur, J. S., Thomas, Bernadette A., Thomas, Matthew Lloyd, Thomson, Alan J., Thorne-Lyman, Andrew L., Thrift, Amanda G., Thurston, George D., Tillmann, Taavi, Tobe-Gai, Ruoyan, Tobollik, Myriam, Topor-Madry, Roman, Topouzis, Fotis, Towbin, Jeffrey Allen, Tran, Bach Xuan, Dimbuene, Zacharie Tsala, Tsilimparis, Nikolaos, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley N., Undurraga, Eduardo A., Uneke, Chigozie Jesse, Uthman, Olalekan A., Donkelaar, Aaron, Os, Jim, Varakin, Yuri Y., Vasankari, Tommi, Veerman, J. Lennert, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vollset, Stein Emil, Wagner, Gregory R., Waller, Stephen G., Wang, Jian Li, Wang, Linhong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wijeratne, Tissa, Wiysonge, Charles Shey, Wolfe, Charles D. A., Won, Sungho, Woolf, Anthony D., Wubshet, Mamo, Xavier, Denis, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zhu, Jun, Zipkin, Ben, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Murray, Christopher J. L., Forouzanfar, Mohammad H, Afshin, Ashkan, Alexander, Lily T, Anderson, H Ro, Bhutta, Zulfiqar A, Biryukov, Stan, Brauer, Michael, Burnett, Richard, Cercy, Kelly, Charlson, Fiona J, Cohen, Aaron J, Dandona, Lalit, Estep, Kara, Ferrari, Alize J, Frostad, Joseph J, Fullman, Nancy, Gething, Peter W, Godwin, William W, Griswold, Max, Kinfu, Yohanne, Kyu, Hmwe H, Larson, Heidi J, Liang, Xiaofeng, Lim, Stephen S, Liu, Patrick Y, Lopez, Alan D, Lozano, Rafael, Marczak, Laurie, Mensah, George A, Mokdad, Ali H, Moradi-Lakeh, Maziar, Naghavi, Mohsen, Neal, Bruce, Reitsma, Marissa B, Roth, Gregory A, Salomon, Joshua A, Sur, Patrick J, Vos, Theo, Wagner, Joseph A, Wang, Haidong, Zhao, Yi, Zhou, Maigeng, Aasvang, Gunn Marit, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Abraham, Biju, Abu-Raddad, Laith J, Abyu, Gebre Yitayih, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N, Akinyemiju, Tomi F, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'A, Alla, Françoi, Allebeck, Peter, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C, Balakrishnan, Kalpana, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barquera, Simon, Barregard, Lar, Barrero, Lope H, Basu, Sanjay, Batis, Carolina, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhatt, Samir, Biadgilign, Sibhatu, Bikbov, Bori, Bisanzio, Donal, Bjertness, Espen, Blore, Jed D, Borschmann, Rohan, Boufous, Soufiane, Bourne, Rupert R A, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Broday, David M, Brugha, Traolach S, Brunekreef, Bert, Butt, Zahid A, Cahill, Leah E, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Cárdenas, Rosario, Carpenter, David O, Casey, Daniel C, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Castro, Ruben Estanislao, Catalá-López, Ferrán, Chang, Jung-Chen, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Choi, 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Farzadfar, Farshad, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fischer, Florian, Fitchett, Joseph R A, Fleming, Tom, Foigt, Nataliya, Foreman, Kyle, Fowkes, F Gerry R, Franklin, Richard C, Fürst, Thoma, Futran, Neal D, Gakidou, Emmanuela, Garcia-Basteiro, Alberto L, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Geleijnse, Johanna M, Gessner, Bradford D, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Goenka, Shifalika, Gomez-Cabrera, Mari Carmen, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Gugnani, Harish Chander, Guillemin, Franci, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A, Haagsma, Juanita A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Hassen, Tahir Ahmed, Havmoeller, Rasmu, Heredia-Pi, Ileana Beatriz, Hernández-Llanes, Norberto Francisco, Heydarpour, Pouria, Hoek, Hans W, Hoffman, Howard J, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Hu, Guoqing, Huang, John J, Husseini, Abdullatif, Hutchings, Sally J, Huybrechts, Inge, Iburg, Kim Moesgaard, Idrisov, Bulat T, Ileanu, Bogdan Vasile, Inoue, Manami, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, Jansen, Henrica A F M, Jassal, Simerjot K, Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Ying, Jibat, Tariku, Jin, Ye, Johnson, Catherine O, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Kasaeian, Amir, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S, Keiyoro, Peter Njenga, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khatibzadeh, Shahab, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Khubchandani, Jagdish, Kieling, Christian, Kim, Cho-il, Kim, Daniel, Kimokoti, Ruth W, Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D, Kokubo, Yoshihiro, Kopec, Jacek A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Kromhout, Han, Krueger, Han, Ku, Tiffany, Defo, Barthelemy Kuate, Kuchenbecker, Ricardo S, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kumar, G Anil, Kwan, Gene F, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lan, Qing, Larsson, Ander, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leasher, Janet L, Leigh, Jame, Leung, Janni, Levi, Miriam, Li, Xiaohong, Li, Yichong, Liang, Juan, Liu, Shiwei, Lloyd, Belinda K, Logroscino, Giancarlo, Lotufo, Paulo A, Lunevicius, Raimunda, Macintyre, Michael, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Manamo, Wondimu Ayele Ayele, Mapoma, Chabila C, Marcenes, Wagner, Martin, Randall V, Martinez-Raga, Jose, Masiye, Felix, Matsushita, Kunihiro, Matzopoulos, Richard, Mayosi, Bongani M, Mcgrath, John J, Mckee, Martin, Meaney, Peter A, Medina, Catalina, Mehari, Alem, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memish, Ziad A, Mendoza, Walter, Mensink, Gert B M, Meretoja, Atte, Meretoja, Tuomo J, Mesfin, Yonatan Moge, Mhimbira, Francis Apolinary, Miller, Ted R, Mills, Edward J, Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N, Mohammadi, Alireza, Mohammed, Shafiu, Mola, Glen Liddell D, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montico, Marcella, Morawska, Lidia, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O, Mullany, Erin, Mumford, John Everett, Murthy, Gudlavalleti Venkata Satyanarayana, Nachega, Jean B, Naheed, Aliya, Nangia, Vinay, Nassiri, Nariman, Newton, John N, Ng, Marie, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nyakarahuka, Luke, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olivares, Pedro R, Olsen, Helen, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Orozco, Ricardo, Ortiz, Alberto, Ota, Erika, Pa, Mahesh, Pana, Adrian, Park, Eun-Kee, Parry, Charles D, Parsaeian, Mahboubeh, Patel, Teja, Caicedo, Angel J Paternina, Patil, Snehal T, Patten, Scott B, Patton, George C, Pearce, Neil, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Plass, Dietrich, Polinder, Suzanne, Pond, Constance D, Pope, C Arden, Pope, Daniel, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prasad, Noela M, Qorbani, Mostafa, Rabiee, Rynaz H S, Radfar, Amir, Rafay, Anwar, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Murugesan, Ram, Usha, Rana, Saleem M, Ranganathan, Kavitha, Rao, Puja, García, Christian Aspacia Razo, Refaat, Amany H, Rehm, Colin D, Rehm, Jürgen, Reinig, Nikola, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Rivera, Juan A, Roba, Hirbo Shore, Rodriguez, Alina, Rodriguez-Ramirez, Sonia, Rojas-Rueda, David, Roman, Yesenia, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Saleh, Muhammad Muhammad, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Sánchez-Pimienta, Tania G, Sandar, Logan, Santomauro, Damian F, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schmidhuber, Josef, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Levy, Teresa Shamah, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N, Shi, Peilin, Shibuya, Kenji, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Silverberg, Jonathan I, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A, Singh, Prashant Kumar, Slepak, Erica Leigh, Soljak, Michael, Soneji, Samir, Sorensen, Reed J D, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steckling, Nadine, Steel, Nichola, Stein, Dan J, Stein, Murray B, Stöckl, Heidi, Stranges, Saverio, Stroumpoulis, Konstantino, Sunguya, Bruno F, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Takahashi, Ken, Talongwa, Roberto Tchio, Tandon, Nikhil, Tanne, David, Tavakkoli, Mohammad, Taye, Belaynew Wasie, Taylor, Hugh R, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Tegegne, Teketo Kassaw, Tekle, Dejen Yemane, Terkawi, Abdullah Sulieman, Thakur, J.S., Thomas, Bernadette A, Thomas, Matthew Lloyd, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tobe-Gai, Ruoyan, Tobollik, Myriam, Topor-Madry, Roman, Topouzis, Foti, Towbin, Jeffrey Allen, Tran, Bach Xuan, Dimbuene, Zacharie Tsala, Tsilimparis, Nikolao, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefano, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Donkelaar, Aaron, van Os, Jim, Varakin, Yuri Y, Vasankari, Tommi, Veerman, J Lennert, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vollset, Stein Emil, Wagner, Gregory R, Waller, Stephen G, Wang, Jian Li, Wang, Linhong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wijeratne, Tissa, Wiysonge, Charles Shey, Wolfe, Charles D A, Won, Sungho, Woolf, Anthony D, Wubshet, Mamo, Xavier, Deni, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zhu, Jun, Zipkin, Ben, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Murray, Christopher J L, Public Health, Gastroenterology & Hepatology, Health Services Management & Organisation (HSMO), Psychiatry, Kardiyoloji, RS: MHeNs - R2 - Mental Health, MUMC+: MA Psychiatrie (3), MUMC+: Hersen en Zenuw Centrum (3), and Psychiatrie & Neuropsychologie

Subjects
Blood Glucose, Alcohol Drinking, Global Health, Risk Assessment, Body Mass Index, Middle East, Life Expectancy, Risk-Taking, Africa, Northern, General & Internal Medicine, Quality-Adjusted Life Year, Occupational Exposure, Africa South of the Sahara, Medicine(all), Unsafe Sex, Risk Factor, Medicine (all), Malnutrition, Smoking, Public Health, Global Health, Social Medicine and Epidemiology, Sodium, Dietary, Articles, 11 Medical And Health Sciences, Biomarker, Environmental Exposure, Substance-Related Disorder, Cost of Illne, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Cholesterol, Air Pollution, Indoor, Hypertension, Disabled Person, Human
Abstract

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

141. Disparities in Sarcoidosis Mortality by Region, Urbanization, and Race in the United States: A Multiple Cause of Death Analysis.

Author

Ogundipe, Funmilola, Mehari, Alem, and Gillum, Richard

Subjects
*SARCOIDOSIS, *CAUSES of death, *DEATH rate, *MORTALITY, *RACE
Abstract

Purpose: Sex, race/ethnicity, and geographic disparities in sarcoidosis-associated mortality were assessed for the most recent period.Methods: US data for multiple causes of death for 1999-2016 were used to determine numbers of deaths and age-adjusted rates for sarcoidosis as an underlying or a contributing cause of death using International Classification of Diseases, 10th Revision code D86 for Hispanics, non-Hispanic blacks, and non-Hispanic whites.Results: For persons of all ages in the United States in 1999-2016, there were a total of 28,923 sarcoidosis-associated deaths. In 2008-2016, 9112 deaths had sarcoidosis as the underlying cause (56%) compared with 16,129 with sarcoidosis listed as any cause. Age-adjusted annual death rates per 100,000 were 5.7 (95% confidence interval [CI], 5.6-5.8) for females and 4.1 (95% CI, 4.0-4.2) for males. Age-adjusted annual death rates were 1.5 (95% CI, 1.4-1.6) for Hispanics and 5.4 (95% CI, 5.3-5.4) for non-Hispanics. Rates in non-Hispanic blacks were 8 times those in non-Hispanic whites. Among females, the highest rate was in non-Hispanic blacks in the East-Central division. Between 1999-2007 and 2008-2016, rates increased most in non-Hispanic white males (52.5%) and least in non-Hispanic black females (5.8%).Conclusions: Sarcoidosis-related multiple cause of death mortality rates were highest in females and in non-Hispanic blacks, and they varied geographically. [ABSTRACT FROM AUTHOR]

Published
2019
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144. Pulmonary Kaposi Sarcoma: An Uncommon Cause of Respiratory Failure in the Era of Highly Active Antiretroviral Therapy—Case Report and Review of the Literature

Author

M. Nwabudike, Stanley, Hemmings, Stefan, Paul, Yonette, Habtegebriel, Yordanis, Polk, Octavius, and Mehari, Alem

Abstract

Kaposi Sarcoma (KS) is the most common malignancy associated with Acquired Immune Deficiency Syndrome (AIDS) and is caused by Human Herpesvirus 8 (HHV 8) or Kaposi Sarcoma Herpesvirus (KSHV). In about 90% of cases Kaposi Sarcoma is associated with cutaneous lesions; however visceral disease can occur in the absence of cutaneous involvement. In the era of Highly Active Antiretroviral Therapy (HAART), the incidence of KS has declined. Clinical features of pulmonary KS might be difficult to distinguish from pneumonia in the immunocompromised patients and could lead to diagnostic challenges. First-line treatment of KS is with HAART and the incidence has declined with its use. Systemic chemotherapy may play a role depending on the extent of the disease. We report the case of a young man who presented with pulmonary symptoms and was later found to have pulmonary KS. Interestingly this diagnosis was made in the absence of the classic skin lesions. His disease was complicated by progressive respiratory failure and he eventually died.

Published
2016
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146. NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS AND STEVEN JOHNSONS SYNDROME WITH SEVERE ARDS HERALDED BY POST-COVID-19 INFECTION MULTISYSTEM INFLAMMATORY SYNDROME IN AN ADULT (MIS-A).

Author

NGONGE, ANTHONY LYONGA, YIBELTAL, EMNET, K PANESAR, NOORDEEP, I, IKWU, ISAAC, MEHARI, ALEM, and A PODDAR, VISHAL

Subjects
*MULTISYSTEM inflammatory syndrome, *SYSTEMIC lupus erythematosus, *COVID-19 pandemic, *ADULT respiratory distress syndrome, *INFECTION, *MACROPHAGE activation syndrome
Published
2022
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148. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Author

Barber R. M. a, Fullman N. a, Sorensen R. J. D. a, Bollyky T. f, McKee M. i, Nolte E. g, Abajobir A. A. j, Abate K. H. n, Abbafati C. o, Abbas K. M. p, Abd-Allah F. q, Abdulle A. M. r, Abdurahman, A. A. ac, Abera, S. F. ad, ah Abraham, B. ai, Abreha, G. F. ad, Adane, K. af, Adelekan, A. L. aj, ak Adetifa, I. M. O. i al, Afshin A. a, Agarwal, A. ao, ap Agarwal, S. K. aq, S. ar, Agrawal, A. as, Ahmad Kiadaliri, A. au, Ahmadi, A. ax, Ahmed, K. Y. ay, Ahmed M. B. m, Akinyemi, R. O. ak, az Akinyemiju, T. F. ba, Akseer, N. am, bc Al-Aly, Z. bd, Alam, K. be, bf dn, dq Alam, N. bg, S. S. bh, Alemu, Z. A. ay, Alene, K. A. bi, Alexander L. a, Ali, R. bm, S. D. bn, bo bp, Alizadeh-Navaei, R. bq, Alkerwi, A. bs, Alla, F. bt, Allebeck, P. bu, Allen C. a, Al-Raddadi, R. cb, Alsharif, U. cd, Altirkawi, K. A. ce, Alvarez Martin, E. cf, Alvis-Guzman, N. cg, Amare, A. T. ch, cj gr, Amini E. s, t wy, Ammar, W. cl, Amo-Adjei, J. cm, cn Amoako, Y. A. co, Anderson B. O. e, Androudi, S. cq, Ansari, H. cr, Ansha, M. G. cs, Antonio, C. A. T. ct, Ärnlöv, J. bv, cv Artaman, A. cw, Asayesh, H. cx, Assadi, R. cy, Astatkie, A. cz, Atey, T. M. ag, Atique, S. da, Atnafu, N. T. dc, dd Atre, S. R. de, Avila-Burgos, L. df, Avokpaho, E. F. G. A. dg, Ayala Quintanilla, B. P. di, dj Awasthi, A. dk, Ayele, N. N. dl, Azzopardi, P. dm, dn dr, Ba Saleem, H. O. dt, Bärnighausen, T. du, dz ea, Bacha, U. eb, Badawi, A. an, ec Banerjee, A. ed, Barac, A. eg, Barboza, M. A. ej, ek Barker-Collo, S. L. el, Barrero, L. H. en, Basu, S. eo, Baune, B. T. ch, gr Baye, K. eq, Bayou, Y. T. er, Bazargan-Hejazi, S. es, et Bedi, N. eu, Beghi, E. ev, Béjot, Y. ew, Bello, A. K. ex, Bennett, D. A. bm, Bensenor, I. M. ez, Berhane, A. fa, Bernabé, E. fd, Bernal, O. A. fe, Beyene, A. S. ff, ki Beyene, T. J. eq, fi Bhutta, Z. A. bc, fj Biadgilign, S. fk, Bikbov, B. fl, Birlik, S. M. fm, Birungi, C. ef, Biryukov S. a, Bisanzio, D. bk, Bizuayehu, H. M. fn, Bose, D. fo, Brainin, M. fp, Brauer M. a, fq Brazinova, A. fr, fs Breitborde, N. J. K. fu, Brenner, H. fw, Butt, Z. A. fx, Cárdenas, R. fy, Cahuana-Hurtado, Campos-Nonato, I. R. df, dx Car, J. fz, Carrero, J. J. bw, Casey D. a, Caso, V. ga, Castañeda-Orjuela, C. A. gb, Castillo Rivas, J. gd, ge Catalá-López, F. gf, gg Cecilio, P. gh, Cercy K. a, Charlson F. J. a, j gi, Chen A. Z. a, Chew A. a, Chibalabala, M. gj, Chibueze, C. E. gk, Chisumpa, V. H. gl, gm Chitheer, A. A. gn, Chowdhury, R. go, Christensen, H. gp, Christopher, D. J. gq, Ciobanu, L. G. ci, Cirillo, M. gs, Coggeshall M. S. a, Cooper, L. T. gt, Cortinovis, M. fl, Crump, J. A. gu, Dalal, K. gv, Danawi, H. gw, Dandona L. a, gy Dandona, R. a gy, Dargan, P. I. gz, Das Neves, J. ha, hb Davey, G. hd, Davitoiu, D. V. he, Davletov, K. hf, De Leo, D. hh, Del Gobbo, L. C. eo, Del Pozo-Cruz, B. em, Dellavalle, R. P. hi, Deribe, K. ep, hj Deribew, A. al, Des Jarlais, D. C. hk, hl Dey, S. hm, Dharmaratne, S. D. hn, Dicker D. a, Ding, E. L. dx, Dokova, K. ho, Dorsey, E. R. hp, Doyle, K. E. hq, hr Dubey, M. hs, Ehrenkranz R. a, Ellingsen, C. L. hu, Elyazar, I. hv, Enayati, A. hw, Ermakov, S. P. hx, hy Eshrati, B. hz, ia Esteghamati, A. t wz, Estep K. a, Fürst T. h, ic ie, Faghmous I. D. A. i, Fanuel, F. B. B. cz, if Faraon, E. J. A. cu, ig Farid, T. A. ih, Farinha, C. S. E. S. ii, ij Faro, A. ik, Farvid, M. S. dw, il Farzadfar, F. u xa, Feigin, V. L. im, Feigl, A. B. du, Fereshtehnejad, S. -M. bx, Fernandes, J. G. in, J. C. io, Feyissa, T. R. ip, Fischer, F. iq, Fitzmaurice C. a, b ir, Fleming T. D. a, Foigt, N. is, Foreman K. J. a, ib Forouzanfar, M. H. it, Franklin, R. C. iu, Frostad J. a, Ghiwot T. T. n, Gakidou E. a, Gambashidze, K. iv, Gamkrelidze, A. iv, Gao, W. ix, Garcia-Basteiro, A. L. iy, iz Gebre, T. ja, Gebremedhin A. T. n, jb Gebremichael, M. W. ag, Gebru, A. A. ag, jc Gelaye, A. A. jd, Geleijnse, J. M. fh, Genova-Maleras, R. je, jf Gibney, K. B. jg, Giref, A. Z. eq, Gishu, M. D. fg, jh Giussani, G. ev, Godwin W. W. a, Gold A. a, Goldberg E. M. a, Gona, P. N. ji, Goodridge, A. jj, Gopalani, S. V. jk, Goto, A. jl, Graetz N. a, Greaves, F. ib, jm Griswold, M. a Guban, P. I. jn, Gugnani, H. C. jo, Gupta, P. C. jp, R. jq, R. jr, T. js, V. jt, Habtewold, T. D. fb, jv Hafezi-Nejad, N. t xb, Haile, D. eq, Hailu, A. D. ep, jx Hailu, G. B. ag, jc Hakuzimana, A. jz, ka Hamadeh, R. R. kb, Hambisa, M. T. ff, Hamidi, S. kc, Hammami, M. kd, Hankey, G. J. ke, kf kg, Hao, Y. kh, Harb, H. L. cl, Hareri, H. A. eq, Haro, J. M. mw, Hassanvand M. S. w, xc Havmoeller, R. ca, Hay, R. J. fd, kk Hay, S. I. a bl, Hendrie, D. kl, Heredia-Pi, I. B. df, Hoek, H. W. ju, km Horino, M. ko, Horita, N. kp, Hosgood, H. D. kq, Htet, A. S. kr, ks Hu, G. kt, Huang, H. ku, J. J. kv, Huntley B. M. a, Huynh C. a, Iburg, K. M. kw, Ileanu, B. V. kx, Innos, K. ky, Irenso, A. A. fg, kj Jahanmehr, N. kz, Jakovljevic, M. B. lb, James, P. dv, S. L. lc, Javanbakht, M. ld, Jayaraman, S. P. le, Jayatilleke, A. U. lf, lg Jeemon, P. gx, lh li, nh Jha, V. bm, lk John, D. ll, Johnson C. a, Johnson S. C. a, Jonas, J. B. lm, Juel, K. ln, Kabir, Z. lo, Kalkonde, Y. lp, Kamal, R. lq, Kan, H. ls, Karch, A. lt, lu Karema, C. K. id, lv Karimi, S. M. lw, Kasaeian A. t, y xd, Kassebaum N. J. a, lx Kastor, A. hs, Katikireddi, S. V. ly, Kazanjan, Keiyoro, P. N. lz, ma Kemmer, L. a Kemp, A. H. mc, me Kengne, A. P. jz, mf Kerbo, A. A. if, Kereselidze, M. iv, Kesavachandran, C. N. lq, Khader, Y. S. mg, Khalil I. a, Khan, A. R. ih, E. A. mh, G. mi, Khang, Y. -H. mj, Khoja, A. T. A. ml, Khonelidze, I. iv, Khubchandani, J. mm, Kibret, G. D. ay, Kim, D. mn, Kim P. a, Y. J. mo, Kimokoti, R. W. mp, Kinfu, Y. mq, Kissoon, N. fq, Kivipelto, M. by, Kokubo, Y. mr, Kolk, A. ms, Kolte, D. mt, Kopec, J. A. fq, Kosen, S. mu, Koul, P. A. mv, Koyanagi, A. mw, Kravchenko, M. mx, Krishnaswami, S. my, Krohn K. J. a, Kuate Defo, B. mz, Kucuk Bicer, B. nb, Kuipers, E. J. nd, Kulkarni, V. S. ne, Kumar, G. A. lj, Kumsa, F. A. fg, kj Kutz, M. a Kyu, H. H. a Lager, A. C. J. nf, Lal, A. ng, D. K. ni, Lalloo R. k, Lallukka, T. nj, Lan, Q. nl, Langan S. M. i, Lansingh, V. C. nm, nn Larson, H. J. a h, Larsson, A. no, Laryea, D. O. cp, Latif, A. A. np, Lawrynowicz, A. E. B. nq, Leasher, J. L. nr, Leigh, J. bf, Leinsalu, M. ky, nt Leshargie, C. T. ay, Leung J. e, j Leung, R. nu, Levi, M. nv, Liang, X. nw, Lim S. S. a, Lind M. a, Linn, S. nx, Lipshultz, S. E. ny, nz Liu, P. a Liu, Y. oa, L. -T. ob, oc Logroscino, G. od, Lopez, A. D. do, Lorch, S. A. oe, Lotufo, P. A. ez, Lozano, R. df, Lunevicius, R. of, og Lyons, R. A. mb, Macarayan, E. R. K. kv, Mackay, M. T. oh, Magdy Abd El Razek, H. oi, M. oj, Mahdavi, M. ok, ol Majeed, A. ib, Malekzadeh R. z, xe Malta, D. C. on, Mantovani LG, Manyazewal, T. op, Mapoma, C. C. gl, Marcenes, W. oq, Marks, G. B. md, ns Marquez, N. a Martinez-Raga, J. or, os Marzan, M. B. ot, Massano, J. hc, ou Mathur, M. R. ni, Maulik, P. K. ov, Mazidi, M. ow, McAlinden, C. ox, oy McGrath, J. J. l McNellan, C. a Meaney, P. A. oz, pa Mehari, A. pb, Mehndiratta, M. M. pc, Meier, T. pd, Mekonnen, A. B. bf, bj Meles, K. G. ad, Memish, Z. A. pe, pf Mengesha, M. M. ff, Mengiste, D. T. ae, Mengistie M. A. n, Menota, B. G. eq, Mensah, G. A. pg, Mereta S. T. n, Meretoja, A. dp, ph Meretoja, T. J. nk, pi Mezgebe, H. B. ag, Micha, R. pj, Millear A. a, Mills, E. J. pl, Minnig S. a, Mirarefin M. a, pm Mirrakhimov, E. M. pn, po Mock, C. N. c Mohammad, K. A. pp, Mohammed, S. ea, pq Mohanty, S. K. hs, Mokdad A. H. a, Mola, G. L. D. pr, Molokhia, M. fd, Monasta, L. ps, Montico, M. ps, Moradi-Lakeh M. a, pt Moraga, P. pz, Morawska, L. pv, pw Mori, R. qa, Moses M. a, Mueller, U. O. qc, Murthy, S. fq, Musa, K. I. qd, Nachega, J. B. qe, qf qg, Nagata, C. qh, Nagel, G. qj, Naghavi M. a, Naheed, A. bh, Naldi, L. qk, Nangia, V. ql, Nascimento, B. R. qm, qn Negoi, I. qo, Neupane, S. P. ks, Newton, C. R. qp, Ng M. a, Ngalesoni, F. N. qq, Ngunjiri, J. W. qr, Nguyen G. a, Ningrum, D. N. A. db, qs Nolte, S. cc, qt rj, Nomura, M. qv, Norheim, O. F. jx, Norrving, B. av, Noubiap, J. J. N. jz, qw Obermeyer, C. M. qx, Ogbo, F. A. qy, I. -H. ra, Okoro, A. rb, Oladimeji, O. rc, rd Olagunju, A. T. ci, Olivares, P. R. re, Olsen H. E. a, Olusanya, B. O. rf, J. O. rf, Opio, J. N. rg, Oren, E. rh, Ortiz, A. ri, Osborne, R. H. rk, Osman, M. dy, rl Owolabi, M. O. rm, rn Mahesh, P. A. ro, Pain A. W. a, Pakhale, S. rp, Palomares Castillo, E. rq, rr Pana, A. kx, Papachristou, C. cd, Parsaeian M. u, v xa, Patel, T. rs, Patton, G. C. dn, Paudel, D. rt, Paul, V. K. aq, Pearce N. i, Pereira, D. M. ru, Perez-Padilla, R. rv, Perez-Ruiz, F. rw, rx Perico, N. Pesudovs, K. ry, Petzold, M. rz, sa Phillips, M. R. oa, sb Pigott, D. M. a Pillay, J. D. sc, Pinho C. a, Polinder, S. nc, Pond, C. D. sd, Prakash, V. se, Purwar, M. sf, Qorbani, M. sg, Quistberg D. A. c, d Radfar, A. sh, Rafay, A. si, sj Rahimi, K. bm, Rahimi-Movaghar, V. aa, xf Rahman, M. sk, Rahman, M. H. U. hs, Rai, R. K. sl, Ram, U. hs, Rana, S. M. si, sj Rankin, Z. a Rao, P. V. sm, sn Rao, P. C. a Rawaf, S. ib, Rego, M. A. S. om, Reitsma M. a, Remuzzi, G. fl, so sp, Renzaho, A. M. N. N. qz, Resnikoff, S. sq, sr Rezaei, S. aw, Rezai, M. S. br, Ribeiro, A. L. qm, Roba, H. S. ff, Rokni, M. B. ac, Ronfani, Roshandel G. z, st xe, Roth G. A. a, Rothenbacher, D. qi, Roy, N. K. su, sv Sachdev, P. S. ss, sw Sackey, B. B. sx, Saeedi, M. Y. sy, Safiri, S. sz, Sagar, R. aq, Sahraian, M. A. ab, xg Saleh, M. M. ta, Salomon, J. A. du, Samy, A. M. tb, Sanabria, J. R. tc, td Sanchez-Niño, M. D. te, Sandar L. a, Santos, I. S. ey, J. V. hc, Santric Milicevic, M. M. eh, ei Sarmiento-Suarez, R. tf, Sartorius, B. tg, ti Satpathy, M. aq, Savic, M. hu, Sawhney, M. tj, Saylan, M. I. tk, Schöttker, B. fv, tl Schutte, A. E. tm, tn Schwebel, D. C. bb, Seedat, S. qf, Seid, A. M. ff, Seifu, C. N. if, Sepanlou S. G. z, xe Serdar, B. to, Servan-Mori, E. E. df, Setegn, T. ck, Shackelford K. A. a, Shaheen, A. tp, Shahraz, S. tq, Shaikh, M. A. tr, Shakh-Nazarova, Shamsipour M. x, Shariful Islam, S. M. bh, Sharma, J. ts, R. tt, She, J. lr, Sheikhbahaei S. t, wz Shen, J. ft, tu Shi, P. pk, Shigematsu, M. tv, tw Shin, M. -J. tx, Shiri, R. nj, Shoman, H. tz, Shrime, M. G. dy, Sibamo, E. L. S. if, Sigfusdottir, I. D. ua, Silva, D. A. S. ub, Silveira, D. G. A. uc, Sindi, S. ca, Singh, J. A. ud, O. P. ue, P. K. uf, V. ug, Sinke, A. H. uh, Sinshaw, A. E. ui, Skirbekk, V. hu, kn Sliwa, K. jy, Smith A. a, Sobngwi, E. uj, uk Soneji, S. ul, Soriano, J. B. um, Sousa, T. C. M. un, Sposato, L. A. uo, Sreeramareddy, C. T. up, Stathopoulou, V. uq, Steel, N. jm, ur Steiner, C. a Steinke, S. us, Stokes, M. A. qu, Stranges, S. bs, Strong, M. ut, Stroumpoulis, K. uu, uv Sturua, L. iv, Sufiyan, M. B. uw, Suliankatchi, R. A. ux, Sun, J. px, py uy, Sur P. a, Swaminathan, S. uz, Sykes, B. L. va, Tabarés-Seisdedos, R. gf, Tabb, K. M. vb, Taffere, G. R. ad, Talongwa, R. T. vc, Tarajia, M. vd, Tavakkoli, M. ve, Taveira, N. vf, vg Teeple, S. a Tegegne, T. K. ay, Tehrani-Banihashemi, A. pu, Tekelab, T. ip, vh Tekle, D. Y. ag, Temam Shifa, G. eq, vi Terkawi, A. S. vj, vk vl, Tesema, A. G. ag, Thakur, J. S. vm, Thomson, A. J. vn, Tillmann, T. ee, Tiruye, T. Y. ay, Tobe-Gai, R. vo, Tonelli, M. vp, Topor-Madry, R. vq, vr Tortajada, M. vs, Troeger C. a, Truelsen, T. vt, Tura, A. K. fg, jv Uchendu, U. S. vu, Ukwaja, K. N. vv, Undurraga, E. A. vw, Uneke, C. J. vx, Uthman, O. A. vy, Van Boven, J. F. M. jv, Van Dingenen, R. vz, Varughese, S. gq, Vasankari, T. wa, Venketasubramanian, N. wb, Violante, F. S. wc, Vladimirov, S. K. wd, Vlassov, V. V. we, Vollset S. E. a, ht jw, Vos T. a, Wagner J. A. a, Wakayo T. n, Waller, S. G. wf, Walson J. L. e, wg Wang, H. a Wang, Y. -P. wh, Watkins D. A. e, jz Weiderpass, E. bz, wi wj, wk Weintraub, R. G. dn, oh Wen, C. -P. iw, Werdecker, A. qb, Wesana, J. wl, wm Westerman, R. qc, wn Whiteford, H. A. a j, gi Wilkinson, J. D. ny, nz Wiysonge, C. S. qf, wo Woldeyes, Wolfe, C. D. A. fc, wp Won, S. mk, Workicho A. n, wq Workie, S. B. if, Wubshet, M. wr, ws Xavier, D. wt, G. wu, Yadav, A. K. hs, Yaghoubi, M. wv, Yakob, B. th, Yan, L. L. ww, Yano, Y. wx, Yaseri, M. la, xi Yimam, H. H. dc, Yip, P. xj, xk Yonemoto, N. xl, Yoon, S. -J. ty, Younis, M. Z. xm, C. xn, xo Zaidi, Z. xp, El Sayed Zaki, M. xq, Zambrana-Torrelio, C. xr, xs Zapata, T. xt, Zenebe, Z. M. ag, Zodpey, Zoeckler L. a, Zuhlke, L. J. xu, Murray C. J. L., Barber, Ryan, Fullman, Nancy, Sorensen, Reed, Thomas, Bollyky, Martin, Mckee, Ellen, Nolte, Amanuel, Alemu, Abajobir, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, Abba, Foad, Abd Allah, Abdishakur, Abdulle, Ahmed, Abdulahi, Abdurahman, Semaw, Ferede, Abera, Biju, Abraham, Girmatsion, Fisseha, Abreha, Kelemework, Adane, Ademola, Lukman, Adelekan, Ifedayo, Morayo, Adetifa, Ashkan, Afshin, Arnav, Agarwal, Sanjay, Kumar, Agarwal, Sunilkumar, Agarwal, Anurag, Agrawal, Aliasghar, Ahmad, Kiadaliri, Alireza, Ahmadi, Kedir, Yimam, Ahmed, Muktar, Beshir, Ahmed, Rufus, Olusola, Akinyemi, Tomi, F, Akinyemiju, Nadia, Akseer, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Sayed, Saidul, Alam, Zewdie, Aderaw, Alemu, Kefyalew, Addi, Alene, Lily, Alexander, Raghib, Ali, Syed, Danish, Ali, Reza, Alizadeh Navaei, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, Altirkawi, Elena, Alvarez, Martin, Nelson, Alvis Guzman, Azmeraw, Amare, Erfan, Amini, Walid, Ammar, Joshu, Amo Adjei, Yaw, Ampem, Amoako, Benjamin, Anderson, Sofia, Androudi, Hossein, Ansari, Mustafa, Geleto, Ansha, Carl, Abelardo, Antonio, Johan, Ärnlöv, Al, Artaman, Hamid, Asayesh, Reza, Assadi, Ayalew, Astatkie, Tesfay, Mehari, Atey, Suleman, Atique, Niguse, Tadele, Atnafu, Sachin, Atre, Leticia, Avila Burgo, Euripide, Frinel, Arthur, Avokpaho, Beatriz, Paulina, Ayala, Quintanilla, Ashish, Awasthi, Nebiyu, Negussu, Ayele, Peter, Azzopardi, Huda, Omer, Ba, Saleem, Till, Bärnighausen, Umar, Bacha, Alaa, Badawi, Amitava, Banerjee, Aleksandra, Barac, Miguel, Barboza, Suzanne, Barker Collo, Lope, Barrero, Sanjay, Basu, Bernhard, Baune, Kaleab, Baye, Yibeltal, Tebekaw, Bayou, Shahrzad, Bazargan Hejazi, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Aminu, Bello, Derrick, Bennett, Isabela, Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Oscar, Alberto, Bernal, Addisu, Shunu, Beyene, Tariku, Jibat, Beyene, Zulfiqar, Bhutta, Sibhatu, Biadgilign, Boris, Bikbov, Sait, Mente, Birlik, Charles, Birungi, Stan, Biryukov, Donal, Bisanzio, Habtamu, Mellie, Bizuayehu, Dipan, Bose, Michael, Brainin, Michael, Brauer, Alexandra, Brazinova, Nicholas, Breitborde, Hermann, Brenner, Zahid, Butt, Rosario, Cárdena, Lucero, Cahuana Hurtado, Ismael, Ricardo, Campos, Nonato, Josip, Car, Juan, Jesu, Carrero, Daniel, Casey, Valeria, Caso, Carlos, Castañeda Orjuela, Jacqueline, Castillo, Rivas, Ferrán, Catalá López, Pedro, Cecilio, Kelly, Cercy, Fiona, Charlson, Alan, Chen, Adrienne, Chew, Mirriam, Chibalabala, Chioma, Ezinne, Chibueze, Vesper, Hichilombwe, Chisumpa, Abdulaal, Chitheer, Rajiv, Chowdhury, Hanne, Christensen, Devasahayam, Jesuda, Christopher, Liliana, Ciobanu, Cirillo, Massimo, Megan, Coggeshall, Leslie, Trumbull, Cooper, Monica, Cortinovi, John, Crump, Koustuv, Dalal, Hadi, Danawi, Lalit, Dandona, Rakhi, Dandona, Paul, Dargan, Jose, Da, Neves, Gail, Davey, Dragos, V, Davitoiu, Kairat, Davletov, Diego, De, Leo, Liana, Del, Gobbo, Borja, Del, Pozo, Cruz, Robert, Dellavalle, Kebede, Deribe, Amare, Deribew, Don, De, Jarlais, Subhojit, Dey, Samath, Dharmaratne, Daniel, Dicker, Eric, Ding, Klara, Dokova, Ray, Dorsey, Kerrie, Doyle, Manisha, Dubey, Rebecca, Ehrenkranz, Christian, Lycke, Ellingsen, Iqbal, Elyazar, Ahmadali, Enayati, Sergey, Petrovich, Ermakov, Babak, Eshrati, Alireza, Esteghamati, Kara, Estep, Thomas, Fürst, Imad, Faghmou, Fanuel, Belayneh, Bekele, Fanuel, Emerito, Jose, Aquino, Faraon, Talha, Farid, Carla, Sofia, Sa, Farinha, Andre, Faro, Maryam, Farvid, Farshad, Farzadfar, Valery, Feigin, Andrea, Feigl, Seyed Mohammad, Fereshtehnejad, Jefferson, Fernande, João, Fernande, Tesfaye, Regassa, Feyissa, Florian, Fischer, Christina, Fitzmaurice, Thomas, Fleming, Nataliya, Foigt, Kyle, Foreman, Mohammad, Forouzanfar, Richard, Franklin, Joseph, Frostad, Tsegaye, Tewelde, G/hiwot, Emmanuela, Gakidou, Ketevan, Gambashidze, Amiran, Gamkrelidze, Wayne, Gao, Alberto, Garcia Basteiro, Teshome, Gebre, Amanuel, Tesfay, Gebremedhin, 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Albertina Santiago, Reitsma, Marissa, Remuzzi, Giuseppe, Renzaho, Andre M N N, Resnikoff, Serge, Rezaei, Satar, Rezai, Mohammad Sadegh, Ribeiro, Antonio L, Roba, Hirbo Shore, Rokni, Mohammad Bagher, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Nawal K, Sachdev, Perminder S, Sackey, Ben Benasco, Saeedi, Mohammad Yahya, Safiri, Saeid, Sagar, Rajesh, Sahraian, Mohammad Ali, Saleh, Muhammad Muhammad, Salomon, Joshua A, Samy, Abdallah M, Sanabria, Juan Ramon, Sanchez-Niño, Maria Dolore, Sandar, Logan, Santos, Itamar S, Santos, João Vasco, Milicevic, Milena M Santric, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Saylan, Mete I, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Seid, Abdulbasit Musa, Seifu, Canaan Negash, Sepanlou, Sadaf G, Serdar, Berrin, Servan-Mori, Edson E, Setegn, Tesfaye, Shackelford, Katya Anne, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Shamsipour, Mansour, Islam, Sheikh Mohammed Shariful, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Shi, Peilin, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shoman, Haitham, Shrime, Mark G, Sibamo, Ephrem Lejore Sibamo, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Sinke, Abiy Hiruye, Sinshaw, Aklilu Endalamaw, Skirbekk, Vegard, Sliwa, Karen, Smith, Alison, Sobngwi, Eugene, Soneji, Samir, Soriano, Joan B, Sousa, Tatiane Cristina Morae, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steel, Nichola, Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Stranges, Saverio, Strong, Mark, Stroumpoulis, Konstantino, Sturua, Lela, Sufiyan, Muawiyyah Babale, Suliankatchi, Rizwan Abdulkader, Sun, Jiandong, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Taffere, Getachew Redae, Talongwa, Roberto Tchio, Tarajia, Musharaf, Tavakkoli, Mohammad, Taveira, Nuno, Teeple, Stephanie, Tegegne, Teketo Kassaw, Tehrani-Banihashemi, Arash, Tekelab, Tesfalidet, Tekle, Dejen Yemane, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tesema, Azeb Gebresilassie, Thakur, J.S., Thomson, Alan J, Tillmann, Taavi, Tiruye, Tenaw Yimer, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Tortajada, Miguel, Troeger, Christopher, Truelsen, Thoma, Tura, Abera Kenay, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Boven, Job F M, Van Dingenen, Rita, Varughese, Santosh, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wagner, Joseph A, Wakayo, Tolassa, Waller, Stephen G, Walson, Judd L, Wang, Haidong, Wang, Yuan-Pang, Watkins, David A, Weiderpass, Elisabete, Weintraub, Robert G, Wen, Chi-Pang, Werdecker, Andrea, Wesana, Joshua, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D A, Won, Sungho, Workicho, Abdulhalik, Workie, Shimelash Bitew, Wubshet, Mamo, Xavier, Deni, Xu, Gelin, Yadav, Ajit Kumar, Yaghoubi, Mohsen, Yakob, Bereket, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yimam, Hassen Hamid, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zambrana-Torrelio, Carlo, Zapata, Toma, Zenebe, Zerihun Menlkalew, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, and Murray, Christopher J L

Subjects
Dánartíðni, Lífslíkur, Life expectancy, Diseases, Health insurance, Globan Burden of Disease, Healthcare Access, DEVELOPMENT GOALS, Methods, Psychology, LIFE EXPECTANCY, Risk assessment, Public health, Globan Burden of Disease, Injuries, Tölfræði, Sjúkdómar, Statistics, DEATH, Þjóðir, Staðtölur, 11 Medical And Health Sciences, Healthcare access, Health status indicators, Health policy, Global burden of disease, Gæðastjórnun, Sálfræði, COMPARATIVE RISK-ASSESSMENT, Lýðheilsa, Life Sciences & Biomedicine, Standards, UNITED-STATES, Sjúkratryggingar, Medicine, General & Internal, General & Internal Medicine, Heilbrigðisstefna, SYSTEMATIC ANALYSIS, Mortality, Public health systems, medicine (all), Áhættugreining, Science & Technology, Health services accessibility, Staðlar, TRENDS, Heilbrigðisþjónusta, MEDICAL-CARE, AVOIDABLE MORTALITY, Áverkar, Aðferðafræði, Quality of health care, EUROPEAN COUNTRIES, Heilbrigðiskerfi
Abstract

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world., Bill & Melinda Gates Foundation.

Published
2017

149. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Haidong, Wang, Mohsen, Naghavi, Christine, Allen, Ryan M, Barber Zulfi, qar A, Bhutta, Austin, Carter, Daniel C, Casey Fiona, J Charlson, Alan Zian, Chen Matthew, M Coates, Megan, Coggeshall, Lalit, Dandona, Daniel J, Dicker Holly, E Erskine, Alize J, Ferrari, Christina, Fitzmaurice, Kyle, Foreman, Mohammad H, Forouzanfar Maya, S Fraser, Nancy, Fullman, Peter W, Gething Ellen, M Goldberg, Nicholas, Graetz, Juanita A, Haagsma Simon, I Hay, Chantal, Huynh, Catherine O, Johnson Nicholas, J Kassebaum, Yohannes, Kinfu, Xie Rachel, Kulikoff, Michael, Kutz, Hmwe H, Kyu Heidi, J Larson, Janni, Leung, Xiaofeng, Liang, Stephen S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George A, Mensah, Joe, Mikesell, Ali H, Mokdad Meghan, D Mooney, Grant, Nguyen, Elaine, Nsoesie, David M, Pigott, Christine, Pinho, Gregory A, Roth Joshua, A Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed J, D Sorensen, Jeff rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette A, Thomas, Christopher, Troeger, Amelia, VanderZanden, Stein Emil, Vollset, Valentine, Wanga, Harvey A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan Hassen, Abate, Cristiana, Abbafati, Kaja M, Abbas, Foad, Abd-Allah, Semaw Ferede, Abera Daisy, M X, Abreu Laith, J Abu-Raddad, Gebre Yitayih, Abyu, Tom, Achoki, Ademola Lukman, Adelekan Zanfi, na Ademi, Arsène Kouablan, Adou José, C Adsuar, Kossivi Agbelenko, Afanvi, Ashkan, Afshin, Emilie Elisabet, Agardh, Arnav, Agarwal, Anurag, Agrawal, Aliasghar Ahmad, Kiadaliri Oluremi, N Ajala, Ali Shafqat, Akanda Rufus, Olusola Akinyemi, Tomi F, Akinyemiju, Nadia, Akseer, Faris Hasan, Al Lami, Samer, Alabed, Ziyad, Al-Aly, Khurshid, Alam, Noore K, M Alam, Deena, Alasfoor, Saleh Fahed, Aldhahri Robert, William Aldridge, Miguel Angel, Alegretti Alicia, V Aleman, Zewdie Aderaw, Alemu Lily, T Alexander, Samia, Alhabib, Raghib, Ali, Ala’a, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid A, Altirkawi Elena, Alvarez Martin, 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Subjects
VITAL-STATISTICS, INTEGRATED APPROACH, ECONOMIC-DEVELOPMENT, DEVELOPMENT ASSISTANCE, UNITED-STATES, Global Health, Communicable Disease, Communicable Diseases, cause of death, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Mortality, Medicine(all), Science & Technology, Mortality, Premature, Medicine (all), EPIDEMIOLOGIC TRANSITION, GBD 2015 Mortality and Causes of Death Collaborators, CIVIL REGISTRATION, Public Health, Global Health, Social Medicine and Epidemiology, Articles, 11 Medical And Health Sciences, ROAD TRAFFIC INJURIES, ALZHEIMERS-DISEASE, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, VERBAL AUTOPSY, Life Sciences & Biomedicine, Human
Abstract

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.

Published
2016

150. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Author

Vasiliki Stathopoulou, Kiran Thapa, Vesper Hichilombwe Chisumpa, Azeem Majeed, Hjalte Holm Andersen, Devasahayam J. Christopher, Alireza Mohammadi, John J. McGrath, Konstantin Kazanjan, Naohiro Yonemoto, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Frida Namnyak Ngalesoni, Jennifer O Lam, Laetitia Huiart, Xiaofeng Liang, Amanuel Tesfay Gebremedhin, Lalit Dandona, Felix Masiye, Joseph R Fitchett, Derrick A Bennett, Rosana E. Norman, Theo Vos, Tuomo J. Meretoja, Rahman Shiri, Melvin Barrientos Marzan, Charles R. Newton, Kelly Cercy, Masoud Vaezghasemi, Elena Alvarez Martin, Christopher Troeger, Ismael R. Campos-Nonato, Amany H Refaat, Ruben Castro, Amiran Gamkrelidze, Michael R. Phillips, Samath D Dharmaratne, Reed J D Sorensen, Roderick J. Hay, Johan Ärnlöv, Ivo Rakovac, Alexandra Brazinova, Nancy Fullman, Sara Sheikhbahaei, Liliana G Ciobanu, Nader Jahanmehr, Yuming Guo, Luigi Naldi, Rana Jawad Asghar, Tsegaye Tewelde Gebrehiwot, Corine Karema, Biju Abraham, Rynaz H S Rabiee, Emerito Jose A. Faraon, Philimon Gona, Jonathan I. Silverberg, Alexandria Brown, Kovin Naidoo, Suleman Atique, Yun Jin Kim, Benn Sartorius, Hwashin Hyun Shin, George Mugambage Ruhago, Adugnaw Berhane, Tesfaye Tekle, Abdur Rahman Khan, Vipin Gupta, Nima Hafezi-Nejad, Héctor Gómez-Dantés, Jun She, Ted R. Miller, Tolesa Bekele, Yohannes Kinfu, Srinivas Murthy, Alaa Badawi, Mahfuzar Rahman, Raghib Ali, Robert G. Weintraub, Nicholas Steel, Khalid A Altirkawi, Muhammad Imran Nisar, Man Mohan Mehndiratta, Thomas N. Williams, Adrian Davis, Usha Ram, Nobuyuki Horita, Qingyang Xiao, Bishal Gyawali, Burcu Kucuk Bicer, Eun-Kee Park, Subas Neupane, Mohammad Tavakkoli, Lorenzo Monasta, Roman Topor-Madry, Marc-Alain Widdowson, James Leigh, Padukudru Anand Mahesh, Stephen M. Amrock, Stefan Ma, Virendra Singh, Amir Kasaeian, Mahdi Mahdavi, Shahrzad Bazargan-Hejazi, Kim Moesgaard Iburg, Vafa Rahimi-Movaghar, Julio Cesar Campuzano, Maria Dolores Sanchez-Niño, Jean B. Nachega, Hamid Asayesh, Pratik Pinal Doshi, Charles Shey Wiysonge, Peter J. Hotez, Ying Jiang, Girma Temam Shifa, Warren D. Lo, Francis Apolinary Mhimbira, Joan B. Soriano, Ritul Kamal, Young-Ho Khang, Isaac Akinkunmi Adedeji, Daniel C Casey, Adeladza Kofi Amegah, Demewoz Haile, Tomi Akinyemiju, Andrew L. Thorne-Lyman, Achala Upendra Jayatilleke, Rajeev Gupta, Rosario Cárdenas, Peter W. Gething, Ami R. 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Subjects
Pediatrics, Nutrition and Disease, Global Health, Communicable Disease, 0302 clinical medicine, Voeding en Ziekte, Infant Mortality, Compensation law of mortality, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, DEVELOPING-COUNTRIES, 10. No inequality, Medicine(all), NEWBORN BABIES, Medicine (all), Mortality rate, 1. No poverty, DEATH, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, 11 Medical And Health Sciences, Stillbirth, 3. Good health, Child Mortality, SURVIVAL, CHILD-MORTALITY, HEALTH, Life Sciences & Biomedicine, DEVELOPMENT GOAL 4, Human, INTERVENTIONS, medicine.medical_specialty, RJ, INTEGRATED APPROACH, Developing country, Communicable Diseases, neonatal, 03 medical and health sciences, Medicine, General & Internal, 030225 pediatrics, General & Internal Medicine, Life Science, Humans, Global Burden of Disease Study, VLAG, Estimation, Science & Technology, business.industry, Klinisk medicin, Infant, GBD 2015 Child Mortality Collaborators, Infant mortality, Malaria, Child mortality, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Life expectancy, Clinical Medicine, RG, business, Demography
Abstract

BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. FUNDING: Bill & Melinda Gates Foundation. Erratum: Department of Error, The Lancet,Volume 389, Issue 10064, 2017, Page e1. DOI: 10.1016/S0140-6736(16)32608-3

Published
2016

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