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1. Burden of diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013

Author

Khalil, I, Colombara, D, Forouzanfar, M, Troeger, C, Daoud, F, Moradi-Lakeh, M, Bcheraoui, C, Rao, P, Afshin, A, Charara, R, Abate, K, Razek, M, Abd-Allah, F, Abu-Elyazeed, R, Kiadaliri, A, Akanda, A, Akseer, N, Alam, K, Alasfoor, D, Ali, R, AlMazroa, M, Alomari, M, Al-Raddadi, R, Alsharif, U, Alsowaidi, S, Altirkawi, K, Alvis-Guzman, N, Ammar, W, Antonio, C, Asayesh, H, Asghar, R, Atique, S, Awasthi, A, Bacha, U, Badawi, A, Barac, A, Bedi, N, Bekele, T, Bensenor, I, Betsu, B, Bhutta, Z, Abdulhak, A, Butt, Z, Danawi, H, Dubey, M, Endries, A, Faghmous, I, Farid, T, Farvid, M, Farzadfar, F, Fereshtehnejad, S, Fischer, F, Fitchett, J, Gibney, K, Ginawi, I, Gishu, M, Gugnani, H, Gupta, R, Hailu, G, Hamadeh, R, Hamidi, S, Harb, H, Hedayati, M, Hsairi, M, Husseini, A, Jahanmehr, N, Javanbakht, M, Jibat, T, Jonas, J, Kasaeian, A, Khader, Y, Khan, A, Khan, E, Khan, G, Khoja, T, Kinfu, Y, Kissoon, N, Koyanagi, A, Lal, A, Latif, A, Lunevicius, R, Razek, H, Majeed, A, Malekzadeh, R, Mehari, A, Mekonnen, A, Melaku, Y, Memish, Z, Mendoza, W, Misganaw, A, Mohamed, L, Nachega, J, Nguyen, Q, Nisar, M, Peprah, E, Platts-Mills, J, Pourmalek, F, Qorbani, M, Rafay, A, Rahimi-Movaghar, V, Rahman, S, Rai, R, Rana, S, Ranabhat, C, Rao, S, Refaat, A, Riddle, M, Roshandel, G, Ruhago, G, Saleh, M, Sanabria, J, Sawhney, M, Sepanlou, S, Setegn, T, and Mokdad, A

Abstract

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child’s potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0–1) in Bahrain and Oman to 471 (95% UI = 245–763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520–989) in Syria to 40,869 (95% UI = 21,540–65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

Published
2016

2. 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

Wang H, Bhutta Z, Coates M, Coggeshall M, Dandona L, Diallo K, Franca E, Fraser M, Fullman N, Gething P, Hay S, Kinfu Y, Kita M, Kulikoff X, Larson H, Liang J, Liang X, Lim S, Lind M, Lopez A, Lozano R, Mensah G, Mikesell J, Mokdad A, Mooney M, Naghavi M, Nguyen G, Rakovac I, Salomon J, Silpakit N, Sligar A, Sorensen R, Vos T, Zhu J, Abajobir A, Abate K, Abbas K, Abd-Allah F, Abdulle A, Abera S, Aboyans V, Abraham B, Abubakar I, Abu-Raddad L, Abu-Rmeileh N, Abyu G, Achoki T, Adebiyi A, Adedeji I, Adelekan A, Adou A, Agarwal A, Ajala O, Akinyemiju T, Akseer N, Alam K, Alam N, Alasfoor D, Aldridge R, Alegretti M, Alemu Z, Ali R, Alkerwi A, Alla F, Al-Raddadi R, Alsharif U, Altirkawi K, Martin E, Alvis-Guzman N, Amare A, Amberbir A, Amegah A, Ameh E, Ammar W, Amrock S, Andersen H, Anderson G, Antonio C, Arlov J, Artaman A, Asayesh H, Asghar R, Assadi R, Atique S, Avokpaho E, Awasthi A, Quintanilla B, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Banigbe B, Barac A, Barber R, Barker-Collo S, Barnighausen T, Barrero L, Bayou T, Bayou Y, Bazargan-Hejazi S, Beardsley J, Bedi N, Bekele T, Bell M, Bello A, Bennett D, Bensenor I, Berhane A, Bernabe E, Betsu B, Beyene A, Bhatt S, Biadgilign S, Bikbov B, Birlik S, Bisanzio D, Bjertness E, Blore J, Bourne R, Brainin M, Brazinova A, Breitborde N, Brown A, Buckle G, Burch M, Butt Z, Campos-Nonato I, Campuzano J, Cardenas R, Carpenter D, Carrero J, Carter A, Casey D, Castaneda-Orjuela C, Rivas J, Castro R, Catala-Lopez F, Cercy K, Chang H, Chang J, Chibueze C, Chisumpa V, Choi J, Chowdhury R, Christopher D, Ciobanu L, Colquhoun S, Cooper C, Cornaby L, Damtew S, Danawi H, Dandona R, das Neves J, Davis A, de Jager P, De Leo D, Degenhardt L, Deribe K, Deribew A, Jarlais D, deVeber G, Dharmaratne S, Dhillon P, Ding E, Doshi P, Doyle K, Duan L, Dubey M, Ebrahimi H, Ellingsen C, Elyazar I, Endries A, Ermakov S, Eshrati B, Esteghamati A, Faraon E, Farid T, Farinha C, Faro A, Farvid M, Farzadfar F, Fereshtehnejad S, Fernandes J, Fischer F, Fitchett J, Foigt N, Franklin R, Friedman J, Furst T, Gambashidze K, Gamkrelidze A, Ganguly P, Gebre T, Gebrehiwot T, Gebremedhin A, Gebru A, Geleijnse J, Gessner B, Ginawi I, Giref A, Gishu M, Gomez-Dantes H, Gona P, Goodridge A, Gopalani S, Goto A, Gouda H, Gugnani H, Guo Y, Gupta R, Gupta V, Gyawali B, Haagsma J, Hafezi-Nejad N, Haile D, Hailu A, Hailu G, Hamadeh R, Hamidi S, Hancock J, Handal A, Hankey G, Harb H, Harikrishnan S, Harun K, Havmoeller R, Hay R, Heredia-Pi I, Hoek H, Horino M, Horita N, Hosgood H, Hotez P, Hoy D, Hsairi M, Hu G, Huang C, Huang J, Huang H, Huiart L, Huynh C, Iburg K, Idrisov B, Innos K, Jacobsen K, Jahanmehr N, Javanbakht M, Jayatilleke A, Jee S, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jin Y, Jonas J, Kabir Z, Kalkonde Y, Kamal R, Kan H, Kang G, Karch A, Karema C, Kasaeian A, Kaul A, Kawakami N, Kayibanda J, Kazanjan K, Keiyoro P, Kemp A, Kengne A, Keren A, Kereselidze M, Kesavachandran C, Khader Y, Khalil I, Khan A, Khan E, Khang Y, Khonelidze I, Khubchandani J, Kim C, Kim D, Kim Y, Kissoon N, Kivipelto M, Knibbs L, Kokubo Y, Kosen S, Koul P, Koyanagi A, Defo B, Bicer B, Kudom A, Kumar G, Kutz M, Kyu H, Lal D, Lalloo R, Lam H, Lam J, Lansingh V, Larsson A, Leigh J, Leung R, Li Y, Lindsay M, Liu P, Liu S, Lloyd B, Lo W, Logroscino G, Low N, Lunevicius R, Lyons R, Ma S, Abd El Razek H, Abd El Razek M, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Mapoma C, Marcenes W, Martinez-Raga J, Marzan M, Masiye F, McGrath J, Meaney P, Mehari A, Mehndiratta M, Mekonnen A, Melaku Y, Memiah P, Memish Z, Mendoza W, Meretoja A, Meretoja T, Mhimbira F, Miller T, Mills E, Mirarefin M, Misganaw A, Mock C, Mohammad K, Mohammadi A, Mohammed S, Monasta L, Hernandez J, Montico M, Moore A, Moradi-Lakeh M, Morawska L, Mori R, Mueller U, Murphy G, Murthy S, Nachega J, Naheed A, Naidoo K, Naldi L, Nand D, Nangia V, Neupane S, Newton C, Newton J, Ng M, Ngalesoni F, Nguhiu P, Nguyen Q, Nisar M, Pete P, Norheim O, Norman R, Ogbo F, Oh I, Ojelabi F, Olivares P, Olusanya B, Olusanya J, Oren E, Ota E, Mahesh P, Park E, Park H, Parsaeian M, Caicedo A, Patten S, Pedro J, Pereira D, Perico N, Pesudovs K, Petzold M, Phillips M, Pillay J, Pishgar F, Polinder S, Pope D, Popova S, Pourmalek F, Qorbani M, Rabiee R, Rafay A, Rahimi-Movaghar V, Rahman M, Rahman S, Rai R, Raju M, Ram U, Rana S, Ranabhat C, Rao P, Refaat A, Remuzzi G, Resnikoff S, Reynolds A, Rojas-Rueda D, Ronfani L, Roshandel G, Roth G, Roy A, Ruhago G, Sagar R, Saleh M, Sanabria J, Sanchez-Nino M, Santos I, Santos J, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schneider I, Schottker B, Schwebel D, Seedat S, Sepanlou S, Servan-Mori E, Setegn T, Shahraz S, Shaikh M, Shakh-Nazarova M, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth K, Shibuya K, Shin H, Shin M, Shiri R, Shuie I, Sigfusdottir I, Silva D, Silverberg J, Simard E, Sindi S, Singh A, Singh J, Singh O, Singh P, Singh V, Soriano J, Soshnikov S, Sposato L, Sreeramareddy C, Stathopoulou V, Steel N, Stroumpoulis K, Sturua L, Sunguya B, Swaminathan S, Sykes B, Szoeke C, Tabares-Seisdedos R, Tavakkoli M, Taye B, Tedla B, Tefera W, Tekle T, Shifa G, Terkawi A, Tesfay F, Tessema G, Thapa K, Thomson A, Thorne-Lyman A, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran B, Troeger C, Truelsen T, Dimbuene Z, Tura A, Tyrovolas S, Ukwaja K, Uneke C, Uthman O, Vaezghasemi M, Vasankari T, Vasconcelos A, Venketasubramanian N, Verma R, Violante F, Vladimirov S, Vlassov V, Vollset S, Wang L, Wang Y, Weichenthal S, Weiderpass E, Weintraub R, Weiss D, Werdecker A, Westerman R, Widdowson M, Wijeratne T, Williams T, Wiysonge C, Wolfe C, Wolfe I, Won S, Wubshet M, Xiao Q, Xu G, Yadav A, Yakob B, Yano Y, Yaseri M, Ye P, Yebyo H, Yip P, Yonemoto N, Yoon S, Younis M, Yu C, Zaidi Z, Zaki M, Zeeb H, Zhang H, Zhao Y, Zheng Y, Zhou M, Zodpey S, Murray C, and GBD 2015 Child Mortality Collabora

Published
2016

3. Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013

Author

Khalil, I., Colombara, D. V., Forouzanfar, M. H., Troeger, C., Daoud, F., Moradi-Lakeh, M., Bcheraoui, C. E., Rao, P. C., Afshin, A., Charara, R., Abate, K. H., Razek, M. M. A. E., Abd-Allah, F., Abu-Elyazeed, R., Kiadaliri, A. A., Akanda, A. S., Akseer, N., Alam, K., Alasfoor, D., Ali, R., AlMazroa, M. A., Alomari, M. A., Al-Raddadi, R. M. S., Alsharif, U., Alsowaidi, S., Altirkawi, K. A., Alvis-Guzman, N., Ammar, W., Antonio, C. A. T., Asayesh, H., Asghar, R. J., Atique, S., Awasthi, A., Bacha, U., Badawi, A., Barac, A., Bedi, N., Bekele, T., Bensenor, I. M., Betsu, B. D., Bhutta, Z., Abdulhak, A. A. B., Butt, Z. A., Danawi, H., Dubey, M., Endries, A. Y., Faghmous, I. D. A., Farid, T., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S.-M., Fischer, Florian, Fitchett, J. R. A., Gibney, K. B., Ginawi, I. A. M., Gishu, M. D., Gugnani, H. C., Gupta, R., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Harb, H. L., Hedayati, M. T., Hsairi, M., Husseini, A., Jahanmehr, N., Javanbakht, M., Jibat, T., Jonas, J. B., Kasaeian, A., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khoja, T. A. M., Kinfu, Y., Kissoon, N., Koyanagi, A., Lal, A., Latif, A. A. A., Lunevicius, R., Razek, H. M. A. E., Majeed, A., Malekzadeh, R., Mehari, A., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Misganaw, A., Mohamed, L. A. I., Nachega, J. B., Nguyen, Q. L., Nisar, M. I., Peprah, E. K., Platts-Mills, J. A., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Rahman, S. U., Rai, R. K., Rana, S. M., Ranabhat, C. L., Rao, S. R., Refaat, A. H., Riddle, M., Roshandel, G., Ruhago, G. M., Saleh, M. M., Sanabria, J. R., Sawhney, M., Sepanlou, S. G., Setegn, T., Sliwa, K., Sreeramareddy, C. T., Sykes, B. L., Tavakkoli, M., Tedla, B. A., Terkawi, A. S., Ukwaja, K., Uthman, O. A., Westerman, R., Wubshet, M., Yenesew, M. A., Yonemoto, N., Younis, M. Z., Zaidi, Z., Zaki, M. E. S., Rabeeah, A. A. A., Wang, H., Naghavi, M., Vos, T., Lopez, A. D., Murray, C. J. L., and Mokdad, A. H.

Subjects
Diarrhea, Male, Mediterranean Region, Bedrijfseconomie, diarrhea, eastern mediterranean region, 11 Medical And Health Sciences, Articles, Global Burden of Disease, Cost of Illness, Risk Factors, Business Economics, Tropical Medicine, Child, Preschool, Life Science, Humans, Disabled Persons, Female, Quality-Adjusted Life Years, Child
Abstract

Diarrheal diseases ( DD ) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region ( EMR ) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years ( DALYs ), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths ( 3.6% of total deaths ) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one ( 95% uncertainty interval [UI] = 0–1 ) in Bahrain and Oman to 471 ( 95% UI = 245–763 ) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 ( 95% UI = 520–989 ) in Syria to 40,869 ( 95% UI = 21,540–65,823 ) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

Published
2016

6. Influence of knowledge about discriminatory practices towards HIV positive individuals with the uptake of HIV testing during pregnancy among reproductive-aged women in Nigeria.

Author

Nzelu C, Aagard M, Danawi H, Francavillo GS, and Melea P

Abstract

Background: The fear of positive HIV results has been reported as a determinant of HIV testing among pregnant women and women of reproductive age. When pregnant women know about discriminatory practices toward other people based on their HIV-positive status, it may impact their testing for HIV. Therefore, the purpose of this study was to examine the association between Nigerian pregnant women's knowledge of discriminatory practices against persons living with HIV and their self-reported HIV testing during antenatal visits or childbirth., Methodology: A secondary analysis of data from 659 t women who had experienced pregnancy aged 15-49 years from the 2013 Nigeria Demographic Health Survey (NDHS) was done. Multivariable logistic regression analysis was done to determine the association between knowledge about discriminatory practices towards HIV-positive individuals (independent variable) and HIV testing during pregnancy (dependent variable) after controlling for covariates (demographic characteristics). A P-value of ≤ 0.05 was taken as statistically significant., Results: Bivariate logistic regression analysis findings showed that educational level, place of residence, and religion statistically significantly predicted HIV testing of pregnant women, while age categories and marital status did not. The women's knowledge of discriminatory practices towards persons living with HIV/AIDS was not statistically significant at Alpha = 0.05 (AOR,1.51; 95% CI: .46, 4.95) Higher levels of education (Primary Education, AOR = 1.81; 95% CI: 1.03, 3.18; Secondary Education, AOR = 3.73; 95% CI: 1.92, 7.25; Higher Education, AOR = 10.92; 95% CI: 4.25, 28.05) and those living in urban areas (AOR = 1.62; 95% CI: 1.04, 2.51) were significantly associated with testing for HIV in the stepwise multivariable regression model of pregnant women's knowledge of discriminatory practices towards persons living with HIV/AIDS., Conclusion: Although knowledge of discriminatory practices did not predict pregnant women's HIV testing in this study, interventions by stakeholders to eliminate or reduce these practices should be stepped up towards facilitating positive social change., Competing Interests: We have no conflicts of interest., (Copyright © 2024 Nigerian Medical Association.)

Published
2024
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7. Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria.

Author

Nass SS, Danawi H, Cain L, and Sharma M

Abstract

Background: The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria., Methods: The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics., Results: The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively., Conclusion: The study shows underreporting of NNT in the existing IDSR system., Implications: Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2017
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8. Predictors of Neonatal Tetanus Mortality in Katsina State, Northwestern Nigeria.

Author

Nass SS, Danawi H, Cain L, and Sharma M

Abstract

Background: The mortality rate of neonatal tetanus (NNT) remains high in Nigeria. The study was guided by Mosley and Chen's model for the elements of child survival in developing countries. The goal of the study was to assess the associations between selected NNT risk factors, number of maternal tetanus toxoid injections, frequency of antenatal visits, place of delivery, and cord care with neonatal mortality as the outcome variable., Methods: The study is a retrospective record review using data from 332 NNT records and analyzed using a logistic regression model., Findings: Neonates whose mothers had 1 dose of tetanus toxoid vaccine were found to be 4% less prone to NNT mortality compared to neonates whose mothers did not have any dose of tetanus toxoid vaccine during pregnancy ( P < .05, odds ratio = 4.12, 95% confidence interval = 1.04-16.29. Frequency of antenatal visits, place of delivery, and cord care were all not significant predictors of NNT mortality., Conclusion: The study shows that there is association between NNT risk factors and neonatal mortality, hence the need to further strengthen the NNT surveillance system for early detection of potential risk factors. This would help develop specific public health interventions aimed at improving the outcome of NNT., Implications: The identification and analysis of NNT mortality risk factors and promoting tetanus toxoid vaccination among pregnant women are effective strategies toward attaining NNT elimination goals in Nigeria., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2017.)

Published
2017
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9. Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

Author

Moradi-Lakeh M, Forouzanfar MH, Vollset SE, El Bcheraoui C, Daoud F, Afshin A, Charara R, Khalil I, Higashi H, Abd El Razek MM, Kiadaliri AA, Alam K, Akseer N, Al-Hamad N, Ali R, AlMazroa MA, Alomari MA, Al-Rabeeah AA, Alsharif U, Altirkawi KA, Atique S, Badawi A, Barrero LH, Basulaiman M, Bazargan-Hejazi S, Bedi N, Bensenor IM, Buchbinder R, Danawi H, Dharmaratne SD, Zannad F, Farvid MS, Fereshtehnejad SM, Farzadfar F, Fischer F, Gupta R, Hamadeh RR, Hamidi S, Horino M, Hoy DG, Hsairi M, Husseini A, Javanbakht M, Jonas JB, Kasaeian A, Khan EA, Khubchandani J, Knudsen AK, Kopec JA, Lunevicius R, Abd El Razek HM, Majeed A, Malekzadeh R, Mate K, Mehari A, Meltzer M, Memish ZA, Mirarefin M, Mohammed S, Naheed A, Obermeyer CM, Oh IH, Park EK, Peprah EK, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Shiri R, Rahman SU, Rai RK, Rana SM, Sepanlou SG, Shaikh MA, Shiue I, Sibai AM, Silva DAS, Singh JA, Skogen JC, Terkawi AS, Ukwaja KN, Westerman R, Yonemoto N, Yoon SJ, Younis MZ, Zaidi Z, Zaki MES, Lim SS, Wang H, Vos T, Naghavi M, Lopez AD, Murray CJL, and Mokdad AH

Subjects
Adult, Africa, Northern epidemiology, Aged, Djibouti epidemiology, Female, Humans, Male, Mediterranean Region epidemiology, Middle Aged, Middle East epidemiology, Mortality, Musculoskeletal Diseases epidemiology, Prevalence, Quality-Adjusted Life Years, Somalia epidemiology, Arthritis, Rheumatoid epidemiology, Global Burden of Disease, Gout epidemiology, Low Back Pain epidemiology, Neck Pain epidemiology, Osteoarthritis epidemiology
Abstract

Objectives: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR)., Methods: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs)., Results: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries., Conclusions: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Published
2017
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10. Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Mokdad AH, Forouzanfar MH, Daoud F, El Bcheraoui C, Moradi-Lakeh M, Khalil I, Afshin A, Tuffaha M, Charara R, Barber RM, Wagner J, Cercy K, Kravitz H, Coates MM, Robinson M, Estep K, Steiner C, Jaber S, Mokdad AA, O'Rourke KF, Chew A, Kim P, El Razek MM, Abdalla S, Abd-Allah F, Abraham JP, Abu-Raddad LJ, Abu-Rmeileh NM, Al-Nehmi AA, Akanda AS, Al Ahmadi H, Al Khabouri MJ, Al Lami FH, Al Rayess ZA, Alasfoor D, AlBuhairan FS, Aldhahri SF, Alghnam S, Alhabib S, Al-Hamad N, Ali R, Ali SD, Alkhateeb M, AlMazroa MA, Alomari MA, Al-Raddadi R, Alsharif U, Al-Sheyab N, Alsowaidi S, Al-Thani M, Altirkawi KA, Amare AT, Amini H, Ammar W, Anwari P, Asayesh H, Asghar R, Assabri AM, Assadi R, Bacha U, Badawi A, Bakfalouni T, Basulaiman MO, Bazargan-Hejazi S, Bedi N, Bhakta AR, Bhutta ZA, Bin Abdulhak AA, Boufous S, Bourne RR, Danawi H, Das J, Deribew A, Ding EL, Durrani AM, Elshrek Y, Ibrahim ME, Eshrati B, Esteghamati A, Faghmous IA, Farzadfar F, Feigl AB, Fereshtehnejad SM, Filip I, Fischer F, Gankpé FG, Ginawi I, Gishu MD, Gupta R, Habash RM, Hafezi-Nejad N, Hamadeh RR, Hamdouni H, Hamidi S, Harb HL, Hassanvand MS, Hedayati MT, Heydarpour P, Hsairi M, Husseini A, Jahanmehr N, Jha V, Jonas JB, Karam NE, Kasaeian A, Kassa NA, Kaul A, Khader Y, Khalifa SE, Khan EA, Khan G, Khoja T, Khosravi A, Kinfu Y, Defo BK, Balaji AL, Lunevicius R, Obermeyer CM, Malekzadeh R, Mansourian M, Marcenes W, Farid HM, Mehari A, Mehio-Sibai A, Memish ZA, Mensah GA, Mohammad KA, Nahas Z, Nasher JT, Nawaz H, Nejjari C, Nisar MI, Omer SB, Parsaeian M, Peprah EK, Pervaiz A, Pourmalek F, Qato DM, Qorbani M, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Rai RK, Rana SM, Rao SR, Refaat AH, Resnikoff S, Roshandel G, Saade G, Saeedi MY, Sahraian MA, Saleh S, Sanchez-Riera L, Satpathy M, Sepanlou SG, Setegn T, Shaheen A, Shahraz S, Sheikhbahaei S, Shishani K, Sliwa K, Tavakkoli M, Terkawi AS, Uthman OA, Westerman R, Younis MZ, El Sayed Zaki M, Zannad F, Roth GA, Wang H, Naghavi M, Vos T, Al Rabeeah AA, Lopez AD, and Murray CJ

Subjects
Adult, Africa epidemiology, Aged, Aged, 80 and over, Aging, Child, Child, Preschool, Diarrhea epidemiology, Humans, Infant, Infant, Newborn, Life Expectancy, Middle Aged, Middle East epidemiology, Noncommunicable Diseases epidemiology, Obesity complications, Risk Factors, Cardiovascular Diseases epidemiology, Global Burden of Disease trends, Infections epidemiology, Obesity epidemiology, Quality-Adjusted Life Years, Social Problems, Wounds and Injuries epidemiology
Abstract

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013., Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically., Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred., Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts., Funding: Bill & Melinda Gates Foundation., (Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)

Published
2016
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11. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NM, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CA, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs AD, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PG, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TK, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJ, Farzadfar F, Fay DF, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IA, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SE, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VM, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KM, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega Jde D, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS Jr, Pain AW, Pandian JD, Panelo CI, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SA, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJ, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJ, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AM, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CD, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, and Murray CJ

Subjects
Female, Global Health statistics & numerical data, Health Behavior, Humans, Male, Nutritional Status, Occupational Exposure adverse effects, Risk Assessment methods, Risk Factors, Sanitation trends, Environmental Exposure adverse effects, Global Health trends, Metabolic Diseases epidemiology, Occupational Diseases epidemiology
Abstract

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution., Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol., Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa., Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Published
2015
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12. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

Author

Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Ackerman IN, Ademi Z, Adou AK, Adsuar JC, Afshin A, Agardh EE, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allebeck P, Almazroa MA, Alsharif U, Alvarez E, Alvis-Guzman N, Amare AT, Ameh EA, Amini H, Ammar W, Anderson HR, Anderson BO, Antonio CA, Anwari P, Arnlöv J, Arsic Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Avila MA, Awuah B, Bachman VF, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Basu A, Basu S, Basulaiman MO, Beardsley J, Bedi N, Beghi E, Bekele T, Bell ML, Benjet C, Bennett DA, Bensenor IM, Benzian H, Bernabé E, Bertozzi-Villa A, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bienhoff K, Bikbov B, Biryukov S, Blore JD, Blosser CD, Blyth FM, Bohensky MA, Bolliger IW, Bora Başara B, Bornstein NM, Bose D, Boufous S, Bourne RR, Boyers LN, Brainin M, Brayne CE, Brazinova A, Breitborde NJ, Brenner H, Briggs AD, Brooks PM, Brown JC, Brugha TS, Buchbinder R, Buckle GC, Budke CM, Bulchis A, Bulloch AG, Campos-Nonato IR, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chiang PP, Chimed-Ochir O, Chowdhury R, Christensen H, Christophi CA, Cirillo M, Coates MM, Coffeng LE, Coggeshall MS, Colistro V, Colquhoun SM, Cooke GS, Cooper C, Cooper LT, Coppola LM, Cortinovis M, Criqui MH, Crump JA, Cuevas-Nasu L, Danawi H, Dandona L, Dandona R, Dansereau E, Dargan PI, Davey G, Davis A, Davitoiu DV, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dherani MK, Diaz-Torné C, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Duber HC, Ebel BE, Edmond KM, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Estep K, Faraon EJ, Farzadfar F, Fay DF, Feigin VL, Felson DT, Fereshtehnejad SM, Fernandes JG, Ferrari AJ, Fitzmaurice C, Flaxman AD, Fleming TD, Foigt N, Forouzanfar MH, Fowkes FG, Paleo UF, Franklin RC, Fürst T, Gabbe B, Gaffikin L, Gankpé FG, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Giroud M, Giussani G, Gomez Dantes H, Gona P, González-Medina D, Gosselin RA, Gotay CC, Goto A, Gouda HN, Graetz N, Gugnani HC, Gupta R, Gupta R, Gutiérrez RA, Haagsma J, Hafezi-Nejad N, Hagan H, Halasa YA, Hamadeh RR, Hamavid H, Hammami M, Hancock J, Hankey GJ, Hansen GM, Hao Y, Harb HL, Haro JM, Havmoeller R, Hay SI, Hay RJ, Heredia-Pi IB, Heuton KR, Heydarpour P, Higashi H, Hijar M, Hoek HW, Hoffman HJ, Hosgood HD, Hossain M, Hotez PJ, Hoy DG, Hsairi M, Hu G, Huang C, Huang JJ, Husseini A, Huynh C, Iannarone ML, Iburg KM, Innos K, Inoue M, Islami F, Jacobsen KH, Jarvis DL, Jassal SK, Jee SH, Jeemon P, Jensen PN, Jha V, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Karch A, Karema CK, Karimkhani C, Karthikeyan G, Kassebaum NJ, Kaul A, Kawakami N, Kazanjan K, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SE, Khan EA, Khan G, Khang YH, Kieling C, Kim D, Kim S, Kim Y, Kinfu Y, Kinge JM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kosen S, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kyu HH, Lai T, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larsson A, Lawrynowicz AE, Leasher JL, Leigh J, Leung R, Levitz CE, Li B, Li Y, Li Y, Lim SS, Lind M, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Lofgren KT, Logroscino G, Looker KJ, Lortet-Tieulent J, Lotufo PA, Lozano R, Lucas RM, Lunevicius R, Lyons RA, Ma S, Macintyre MF, Mackay MT, Majdan M, Malekzadeh R, Marcenes W, Margolis DJ, Margono C, Marzan MB, Masci JR, Mashal MT, Matzopoulos R, Mayosi BM, Mazorodze TT, Mcgill NW, Mcgrath JJ, Mckee M, Mclain A, Meaney PA, Medina C, Mehndiratta MM, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Mitchell PB, Mock CN, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Montine TJ, Mooney MD, Moore AR, Moradi-Lakeh M, Moran AE, Mori R, Moschandreas J, Moturi WN, Moyer ML, Mozaffarian D, Msemburi WT, Mueller UO, Mukaigawara M, Mullany EC, Murdoch ME, Murray J, Murthy KS, Naghavi M, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KM, Nejjari C, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Nguyen G, Nisar MI, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Ohno SL, Olusanya BO, Opio JN, Ortblad K, Ortiz A, Pain AW, Pandian JD, Panelo CI, Papachristou C, Park EK, Park JH, Patten SB, Patton GC, Paul VK, Pavlin BI, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phillips BK, Phillips DE, Piel FB, Plass D, Poenaru D, Polinder S, Pope D, Popova S, Poulton RG, Pourmalek F, 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Subjects
Aged, Female, Humans, Male, Middle Aged, Mortality, Premature, Quality-Adjusted Life Years, Socioeconomic Factors, Chronic Disease epidemiology, Communicable Diseases epidemiology, Global Health statistics & numerical data, Health Transition, Life Expectancy, Wounds and Injuries epidemiology
Abstract

Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development., Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time., Findings: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries., Interpretation: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Published
2015
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13. Comparing Stage at Diagnosis Among Patients With Breast Cancer Served by Military and Civilian Medical Care Systems.

Author

Salai S, Rohrer JE, Peoples GE, Stoodt G, and Danawi H

Abstract

Background: Breast cancer (BC) remains one of the top causes of cancer-related deaths in women in the United States, and little is known about the differences in access to health care between military and civilians. This study compared the differences in access to health care between military and civilian female patients with BC. In particular, this study examined whether patients with BC, in an equal access health care system such as the military, are diagnosed at an earlier stage of disease process in comparison to the patients with BC in the civilian health care system., Methods: Independent variables included military versus civilian care and demographic variables. Dependent variable was the stage of cancer at diagnosis. This cross-sectional study of 2 groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Multiple logistic regression was used to analyze the data., Results: There was no difference in the early BC stage (0, I, and II) diagnosis prevalence rate between the military and the civilian groups (95% confidence interval [CI], P = .15). The logistic regression analysis indicated that both the health systems had equal performance with respect to the stage at diagnosis indicator but found that black patients had higher odds of being in the late stage (III and IV) BC group at diagnosis (1.62 OR, 1.14-2.30 CI, P = .0068) than white patients., Conclusions: Although no difference was found between the performance of the 2 health systems in the early (0, I, and II) versus late stage (III and IV) at diagnosis indicator, this study further confirms the existence of racial disparities in late-stage BC regardless of whether the patient was diagnosed in the civilian or military health system. More research is needed to further investigate the potential explanations of racial disparities other than just differences in access to health care., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2014
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14. Management of central venous catheters in patients with cancer and candidemia.

Author

Raad I, Hanna H, Boktour M, Girgawy E, Danawi H, Mardani M, Kontoyiannis D, Darouiche R, Hachem R, and Bodey GP

Subjects
Candidiasis mortality, Female, Humans, Male, Middle Aged, Multivariate Analysis, Prosthesis-Related Infections complications, Prosthesis-Related Infections microbiology, Retrospective Studies, Candidiasis complications, Catheterization, Central Venous adverse effects, Fungemia complications, Neoplasms complications
Abstract

To determine the need and appropriate timing of catheter removal in patients with candidemia, the records for 404 patients with cancer and central venous catheters (CVCs) who developed candidemia during the period of 1993-1998 were retrospectively reviewed. Of the total 404 cases of candidemia, 241 (60%) were due to a primary source, 111 (27%) were catheter related, and 52 (13%) were secondary cases of candidemia caused by a source other than the catheter. Multivariate analysis showed that catheter removal < or =72 h after onset improved response to antifungal therapy exclusively in patients with catheter-related candidemia (P=.04). Clinical characteristics that suggested a noncatheter source for the candidemia were disseminated infection (P<.01), previous chemotherapy (P<.01), previous corticosteroid therapy (P=.02), and poor response to antifungal therapy (P<.03). CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.

Published
2004
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