Search

Your search keyword '"Harvey Whiteford"' showing total 316 results
Start Over Author "Harvey Whiteford"
316 results on '"Harvey Whiteford"'

1. Estimating levels of mental health service need by small geographic area: A case study for Aboriginal and Torres Strait Islander adults living in South East Queensland

Author

Imogen S. Page, Claudia Pagliaro, Alize J. Ferrari, Harvey Whiteford, and Sandra Diminic

Subjects
Aboriginal and Torres Strait Islander, social and emotional wellbeing, service planning, Indigenous, First Nations, health disparities, Public aspects of medicine, RA1-1270
Abstract

Objective: The objective of this study was to determine regional variation in need for mental health care for Aboriginal and Torres Strait Islander adults (18+ years). Methods: Three Australian Indigenous health surveys were analysed, and prevalence rates of high/very high psychological distress (as per the Kessler-5 tool) by the Index of Relative Socio-economic Disadvantage were computed and combined via meta-analysis. These estimates were applied to census population data to estimate regional needs and summed to geographic planning regions. Final estimates were assessed for face validity by comparing with other existing estimates of mental health need. Results: The Index of Relative Socioeconomic Disadvantage had a dose–response relationship with high/very high psychological distress, whereby the more disadvantaged an area, the greater the levels of reported distress. This methodology resulted in varying levels of need within South East Queensland. Conclusions: The approach was found to have good face validity and provides a data-driven method to determine relative levels of need. Implications for Public Health: To ensure equity of mental health service provision, planners should account for variation in levels of need within a catchment. This method may be used throughout Australia to determine regional variation in need for care where other data are lacking to ensure evidence-based investment planning decisions at the local level.

Published
2024
Full Text
View/download PDF

2. Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia

Author

Kate Gossip, Claudia Pagliaro, Charlotte Comben, Kevin Fjeldsoe, Harvey Whiteford, and Sandra Diminic

Subjects
Mental health, Mental health services, Health service planning, Service mapping, NMHSPF, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Abstract Background The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State. Methods The activity and capacity of Tasmania’s 2018–19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development. Results Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services. Conclusions This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

Published
2023
Full Text
View/download PDF

3. Educational level and the risk of mental disorders, substance use disorders and self‐harm in different age‐groups: A cohort study covering 1,6 million subjects in the Stockholm region

Author

Baojing Li, Peter Allebeck, Bo Burstöm, Anna‐Karin Danielsson, Louisa Degenhardt, Terje A. Eikemo, Alize Ferrari, Ann Kristin Knudsen, Andreas Lundin, Hélio Manhica, John Newton, Harvey Whiteford, Pär Flodin, Hugo Sjöqvist, and Emilie E. Agardh

Subjects
educational level, mental disorders, self‐harm, substance use disorders, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Abstract Objective To investigate the associations between low education and risk of mental disorders, substance use disorders and self‐harm in different age‐groups. Methods All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed‐up for these disorders in health care registers 2001–2016. Subjects were stratified into four age‐groups: 10–18, 19–27, 28–50, and 51–70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models. Results Low education increased the risk of substance use disorders and self‐harm in all age‐groups. Males aged 10–18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19–27 years had increased risks of anxiety and depression, and those aged 28–50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0–1.3) for bipolar disorder to 5.4 (95% CIs 5.1–5.7) for drug use disorder. Females aged 51–70 years had increased risks of schizophrenia and autism. Conclusion Low education is associated with risk of most mental disorders, substance use disorders and self‐harm in all age‐groups, but especially among those aged 28–50 years.

Published
2023
Full Text
View/download PDF

4. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and Bayesian meta-regression analysis

Author

Modhurima Moitra, Damian Santomauro, Pamela Y. Collins, Theo Vos, Harvey Whiteford, Shekhar Saxena, and Alize J. Ferrari

Subjects
Medicine
Abstract

Background The treatment coverage for major depressive disorder (MDD) is low in many parts of the world despite MDD being a major contributor to disability globally. Most existing reviews of MDD treatment coverage do not account for potential sources of study-level heterogeneity that contribute to variation in reported treatment rates. This study aims to provide a comprehensive review of the evidence and analytically quantify sources of heterogeneity to report updated estimates of MDD treatment coverage and gaps by location and treatment type between 2000 and 2019. Methods and findings A systematic review of the literature was conducted to identify relevant studies that provided data on treatment rates for MDD between January 1, 2000, and November 26, 2021, from 2 online scholarly databases PubMed and Embase. Cohort and cross-sectional studies were included if treatment rates pertaining to the last 12 months or less were reported directly or if sufficient information was available to calculate this along with 95% uncertainty intervals (UIs). Studies were included if they made use of population-based surveys that were representative of communities, countries, or regions under study. Studies were included if they used established diagnostic criteria to diagnose cases of MDD. Sample and methodological characteristics were extracted from selected studies. Treatment rates were modeled using a Bayesian meta-regression approach and adjusted for select covariates that quantified heterogeneity in the data. These covariates included age, sex, treatment type, location, and choice of MDD assessment tool. A total of 149 studies were included for quantitative analysis. Treatment coverage for health service use ranged from 51% [95% UI 20%, 82%] in high-income locations to 20% [95% UI 1%, 53%] in low- and lower middle-income locations. Treatment coverage for mental health service use ranged from 33% [95% UI 8%, 66%] in high-income locations to 8% [95% UI Conclusions In this study, we observed that the treatment coverage for MDD continues to be low in many parts of the world and in particular in low- and lower middle-income countries. There is a continued need for routine data collection that will help obtain more accurate estimates of treatment coverage globally. In a systematic review and Bayesian meta-regression analysis, Modhurima Moitra and colleagues estimate major depressive disorder treatment coverage in 84 countries. Author summary Why was this study done? ➢ Major depressive disorder (MDD) is one of the major contributors to disability worldwide, but treatment rates for this condition are remarkably low. ➢ To the best of our knowledge, previous systematic reviews on this topic provide more descriptive summaries of treatment rates without accounting for differences in study attributes that may contribute to variation in reported treatment rates. ➢ An updated systematic review that is more reflective of the recent literature on treatment rates as well as an improved analytical approach may provide more accurate estimates of treatment rates by resource setting and geography. What did the researchers do and find? ➢ We conducted a systematic review and meta-regression analysis using data on treatment rates for MDD from 149 studies and 84 countries between 2000 and 2021. ➢ We estimated pooled treatment rates adjusted for parameters of interest including age, sex, treatment type, study methods, and location. ➢ Mental health service use ranged from 33% (95% uncertainty interval (UI) 8, 66) in high-income countries to 8% (95% UI What do these findings mean? ➢ This systematic review provides updated evidence on treatment rates for MDD, and results suggest that there are wide disparities in treatment rates by resource setting. ➢ More high-quality data on depression treatment coverage and adequacy are needed from low- and lower middle-income countries. ➢ These findings may help prioritize efforts to scale up depression treatment in locations with clearly identified treatment gaps.

Published
2022

5. The Epidemiology of Psychosis in Indigenous Populations in Cape York and the Torres Strait

Author

Bruce Gynther, Fiona Charlson, Karin Obrecht, Michael Waller, Damian Santomauro, Harvey Whiteford, and Ernest Hunter

Subjects
Medicine (General), R5-920
Abstract

Background: The treated prevalence of psychotic disorders in remote communities of Cape York and the Torres Strait, Australia, has been shown to be elevated compared with the Australian population. Our study used a unique dataset to assess treated incidence and prevalence of psychotic disorders and mortality over a 23-year period in the adult Indigenous population of this region. Methods: Data was collated from a clinical database that contains complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients who received treatment for a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Deaths Registry. We calculated 12-month treated prevalence and incidence for each calendar year. Mortality rates were compared to the overall and Indigenous population death rates in Queensland. Findings: Between 1992 and 2015, 424 patients were treated for psychosis – an age-standardised 12-month prevalence of 1·7% in 2015, approximately two times higher in men than women, and three times higher in Aboriginal versus Torres Strait Islander populations. The highest treated prevalence was observed in 2015 in Aboriginal men (4.0%). A range of psychotic disorders were detected, including many substance-induced cases (n = 93) and schizophrenia (n = 252). The age-standardised 12-month incidence rate over the study period was 3.61 per 1000 person-years for women and 4.23 per 1000 person-years for men. Treated prevalence increased throughout the study period, largely attributable to increases in incidence of schizophrenia and schizoaffective disorder – in contrast, the incidence and prevalence of bipolar and mood disorders remained low and stable. Increased mortality risk compared to the Queensland Indigenous population (SMR = 1.9; 95% CI 1.4–2.6) was attributable to the elevated risk shown in the Aboriginal population in our study (SMR = 2.6; 95% CI 1.8–3.7). Interpretation: Our results show extremely high prevalence rates of psychosis; increasing prevalence over time; differences in the distribution of psychosis between Aboriginal and Torres Strait Islander populations; and increased mortality risk for Aboriginal people living with psychosis in this region. These observations strongly suggest an aetiological role of environmental and neurodevelopmental factors, and the contribution of social factors to vulnerability and premature mortality. Role of the funding source: This study was funded by Queensland Health who are the custodians of this database. The funder had no role in study design, data analysis, data interpretation, writing of the report, or submission for publication. All authors had full access to all the study data. The corresponding author had final responsibility for the decision to submit for publication. FJC is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1138488). Keywords: Mental health, Indigenous populations, Psychosis

Published
2019
Full Text
View/download PDF

6. A systematic review of service models and evidence relating to the clinically operated community-based residential mental health rehabilitation for adults with severe and persisting mental illness in Australia

Author

Stephen Parker, Gordon Hopkins, Dan Siskind, Meredith Harris, Gemma McKeon, Frances Dark, and Harvey Whiteford

Subjects
Psychiatry, RC435-571
Abstract

Abstract Background Clinically operated community-based residential rehabilitation units (Community Rehabilitation Units) are resource intensive services supporting a small proportion of the people with severe and persisting mental illness who experience difficulties living in the community. Most consumers who engage with these services will be diagnosed with schizophrenia or a related disorder. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers’ service experiences and outcomes. Method A systematic review was undertaken to identify studies describing Community Rehabilitation Units in Australia, consumer characteristics, and evidence about consumer experiences and outcomes. Search strings were applied to multiple databases; additional records were identified through snowballing. Records presenting unique empirical research were subject to quality appraisal. Results The typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach. Key differentiating features were the focus on transitional care and ‘recovery’ under TRR. Schizophrenia spectrum disorders were the most common primary diagnosis under both service types. TRR consumers were more likely to be male, referred from community settings, and less likely to be subject to involuntary treatment. Regarding outcomes, the limited quantitative evidence (4 records, 2 poor quality) indicated C-BRC was successful in supporting the majority of consumers transferred from long-term inpatient care to remain out of hospital. All qualitative research conducted in C-BRC settings was assessed to be of poor quality (3 records). No methodologically sound quantitative evidence on the outcomes of TRR was identified. Qualitative research undertaken in these settings was of mixed quality (9 records), and the four records exploring consumer perspectives identified them as valuing the service provided. Conclusions While there is qualitative evidence to suggest consumers value the support provided by Community Rehabilitation Units, there is an absence of methodologically sound quantitative research about the consumer outcomes achieved by these services. Given the ongoing and increasing investment in these facilities within the Australian context, there is an urgent need for high-quality research examining their efficiency and effectiveness. Trial registration PROSPERO (CRD42018097326).

Published
2019
Full Text
View/download PDF

7. A Comprehensive Cohort Description and Statistical Grouping of Community-Based Residential Rehabilitation Service Users in Australia

Author

Stephen Parker, Dan Siskind, Daniel F. Hermens, Frances Dark, Gemma McKeon, Nicole Korman, Urska Arnautovska, Meredith Harris, and Harvey Whiteford

Subjects
community care unit, rehabilitation, residential care, schizophrenia, severe and persistent mental illness, Psychiatry, RC435-571
Abstract

Background: Community Care Units (CCUs) are a model of community-based residential rehabilitation support available in Australia that assists people affected by severe and persistent mental illness to enhance their independent living skills and community involvement. These services have been subject to limited evaluation, and available descriptions of consumer cohorts lack relevance to the understanding of their rehabilitation needs.Method: A clinical assessment battery covering a broad range of relevant domains was completed with consumers commencing at three CCUs in Queensland, Australia, between December 2014 and December 2017 (N = 145). The cohort was described based on demographic, diagnostic, treatment-related variables, and the assessment battery. The comparability of included sites was assessed. This contemporary cohort was also compared to the pooled cohort of Australian community-based residential rehabilitation services emerging from a previous systematic review. Additionally, cluster analysis (CA) was completed in two stages based on the clinician-rated assessments: hierarchical CA (Wards method) to identify the optimal number of clusters, followed by K-means clustering.Results: Dominant features of the cohort were male sex and the primary diagnoses of schizophrenia spectrum disorders. The average consumer age was 31.4 years. Most consumers were referred from the community, had been living with family, and were not subject to involuntary treatment orders. No site-based differences were observed on demographic, diagnostic and treatment-related variables. However, some site-based variation in levels of symptoms and functional impairment emerged. Overall, the cohort was comparable with the Transitional Residential Rehabilitation (TRR) cohort defined in a previous systematic review. Through CA, a three-cluster solution emerged: Cluster 1 (15%) was characterised by higher levels of substance use comorbidity; Cluster 2 (39%) was characterised by higher levels of disability and symptoms; and Cluster 3 (46%) was distinguished by lower levels of general psychiatric symptoms.Conclusions: The cohort was generally comparable to the TRR cohort. Site-based variability in the characteristics of admitted consumers was minimal. The CA solution suggested that three different sub-groups of consumers are admitted to CCUs, which have implications for adapting the approach to rehabilitation. Recommendations include ensuring early availability of interventions to address co-morbidities and pacing rehabilitation expectations to consumers stage of recovery.

Published
2019
Full Text
View/download PDF

8. Implementing cognitive remediation and social cognitive interaction training into standard psychosis care

Author

Frances Dark, Meredith Harris, Victoria Gore-Jones, Ellie Newman, and Harvey Whiteford

Subjects
Implementation outcomes, Cognitive remediation, Social cognitive interaction training, Schizophrenia, Mental health services, Public aspects of medicine, RA1-1270
Abstract

Abstract Background To evaluate the planned implementation of group based Cognitive Remediation therapy (CR) and Social Cognitive Interaction Training (SCIT) into routine psychosis care in a mental health service in Australia. Method The study was conducted over 3 years in a mental health service in a metropolitan city in Australia. Participants were 22 program facilitators and 128 patients attending the programs. Implementation outcomes were assessed using administrative data, staff surveys and program audits. Results There was fidelity to the particular therapies at a program level. Programs were assessed as being feasible within the study setting with each hospital district developing a capacity to run CR and SCIT. The establishment of new programs improved the reach, but waiting lists indicate a need to expand capacity. There was a relatively high dropout and several factors impacted on completion of the programs - notably, acute exacerbation of psychosis. Once initiated the therapies were acceptable with no-one ceasing SCIT due to loss of interest and only 10% of participants ceasing CR due to loss of interest. Annual audits of programs found programs established were maintained and facilitators were retained. Conclusion SCIT and CR programs were successfully implemented in three hospital districts. Several factors impeded participants receiving the recommended “dose” of the programs. The maintenance of the programs in the short term is encouraging in regards to organisational fit. Dissemination of cognitive rehabilitation programs to a service population takes planning. An implementation plan is essential for guiding development and maintenance of programs. These therapies are best suited to people in a stable phase of illness. Service user co-production is recommended to improve recruitment in future studies.

Published
2018
Full Text
View/download PDF

9. Assessing service use for mental health by Indigenous populations in Australia, Canada, New Zealand and the United States of America: a rapid review of population surveys

Author

Cecily McIntyre, Meredith G. Harris, Amanda J. Baxter, Stuart Leske, Sandra Diminic, Joseph P. Gone, Ernest Hunter, and Harvey Whiteford

Subjects
Indigenous, Mental health services, Mental disorders, Surveys and questionnaires, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Indigenous people in Australia, Canada, New Zealand and the United States of America experience disproportionately poor mental health compared to their non-Indigenous counterparts. To optimally allocate resources, health planners require information about the services Indigenous people use for mental health, their unmet treatment needs and the barriers to care. We reviewed population surveys of Indigenous people to determine whether the information needed to guide service development is being collected. Methods We sought national- or state-level epidemiological surveys of Indigenous populations conducted in each of the four selected countries since 1990 that asked about service use for mental health. Surveys were identified from literature reviews and web searches. We developed a framework for categorising the content of each survey. Using this framework, we compared the service use content of the surveys of Indigenous people to each other and to general population mental health surveys. We focused on identifying gaps in information coverage and topics that may require Indigenous-specific questions or response options. Results Nine surveys met our inclusion criteria. More than half of these included questions about health professionals consulted, barriers to care, perceived need for care, medications taken, number, duration, location and payment of health professional visits or use of support services or self-management. Less than half included questions about interventions received, hospital admissions or treatment dropout. Indigenous-specific content was most common in questions regarding use of support services or self-management, types of health professionals consulted, barriers to care and interventions received. Conclusions Epidemiological surveys measuring service use for mental health among Indigenous populations have been less comprehensive and less standardised than surveys of the general population, despite having assessed similar content. To better understand the gaps in mental health service systems for Indigenous people, systematically-collected subjective and objective indicators of the quality of care being delivered are needed.

Published
2017
Full Text
View/download PDF

10. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017

Author

Hebe N Gouda, PhD, Fiona Charlson, PhD, Katherine Sorsdahl, PhD, Sanam Ahmadzada, MPH, Alize J Ferrari, PhD, Holly Erskine, PhD, Janni Leung, PhD, Damian Santamauro, PhD, Crick Lund, PhD, Leopold Ndemnge Aminde, MD, Bongani M Mayosi, MBChB, Andre Pascal Kengne, MD, Meredith Harris, PhD, Tom Achoki, MD, Charles S Wiysonge, MD, Dan J Stein, MD, and Harvey Whiteford, MD

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of non-communicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017. Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)—with crude counts as well as all-age and age-standardised rates per 100 000 population—with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country's Socio-demographic Index. Findings: All-age total DALYs due to NCDs increased by 67·0% between 1990 (90·6 million [95% UI 81·0–101·9]) and 2017 (151·3 million [133·4–171·8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18·6% [95% UI 17·1–20·4] to 29·8% [27·6–32·0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100 000 population) due to NCDs in 2017 (21 757·7 DALYs [95% UI 19 377·1–24 380·7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26 491·6 DALYs [25 165·2–28 129·8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22·9 million (21·5–24·3) DALYs (15·1% of the total NCD burden), after the group of disorders categorised as other NCDs (28·8 million [25·1–33·0] DALYs, 19·1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer). Interpretation: NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs. Funding: Bill & Melinda Gates Foundation, National Health and Medical Research Centre (Australia).

Published
2019
Full Text
View/download PDF

11. Republished: Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition

Author

Vikram Patel, Dan Chisholm, Rachana Parikh, Fiona J Charlson, Louisa Degenhardt, Tarun Dua, Alize J Ferrari, Steve Hyman, Ramanan Laxminarayan, Carol Levin, Crick Lund, María Elena Medina Mora, Inge Petersen, James Scott, Rahul Shidhaye, Lakshmi Vijayakumar, Graham Thornicroft, Harvey Whiteford, and on behalf of the DCP MNS Author Group

Subjects
Psychiatry, RC435-571
Abstract

The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of attaining optimal health and social outcomes.

Published
2016
Full Text
View/download PDF

13. The association between mental disorders and subsequent years of working life: a Danish population-based cohort study

Author

Oleguer Plana-Ripoll, Nanna Weye, Ann Kristin Knudsen, Christian Hakulinen, Kathrine Bang Madsen, Maria Klitgaard Christensen, Esben Agerbo, Thomas Munk Laursen, Merete Nordentoft, Allan Timmermann, Harvey Whiteford, Simon Øverland, Kim Moesgaard Iburg, and John J McGrath

Subjects
Cohort Studies, Male, Psychiatry and Mental health, Adolescent, Humans, Female, Registries, Sick Leave, Denmark/epidemiology, Mental Disorders/epidemiology, Biological Psychiatry, Aged
Abstract

BACKGROUND: Mental disorders can affect workforce participation via a range of mechanisms. In this study, we aimed to estimate the association between different types of mental disorders and working years lost, defined as the number of years not actively working or enrolled in an educational programme.METHODS: In this population-based cohort study, we included all people aged 18-65 years (mean 38·0 [SD 13·9]) in the Danish Civil Registration System from Jan 1, 1995 to Dec 31, 2016. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and information on labour market characteristics was obtained from administrative registers. Follow-up started at age 18 years, immigration to Denmark, or on Jan 1, 1995, whichever came later; and it ended at age 65 years, death, emigration from Denmark, disability pension, voluntary early retirement, or Dec 31, 2016 (whichever came earlier). As the main outcome, we estimated working years lost for those diagnosed with any mental disorder and 24 types of mental disorders, as well as for the general population of same age and sex. We decomposed total working years lost into periods of unemployment or sick leave, disability pension, voluntary early retirement, or death. Data on ethnicity were not available through administrative registers.FINDINGS: A total of 5 163 321 individuals, 2 642 383 men and 2 520 938 women, were followed up for 65·4 million person-years. Overall, 488 775 (9·47%) individuals were diagnosed with a mental disorder. On average, individuals with mental disorders lost an additional 10·52 (95% CI 10·48-10·57) years of working life compared with the general Danish population. Receiving a disability pension (7·54 [7·49-7·59] years) and longer periods of unemployment (2·24 [2·21-2·27] years) accounted for most of this difference.INTERPRETATION: Our findings foreground the substantial impact of mental disorders on workforce participation. There is a need to invest in programmes that reduce the burden of working years lost and assist people with mental disorders in returning to the workforce.FUNDING: Lundbeck Foundation and Danish National Research Foundation.

Published
2023

14. Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia

Author

Kate Gossip, Claudia Pagliaro, Charlotte Comben, Kevin Fjeldsoe, Harvey Whiteford, and Sandra Diminic

Abstract

Background The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State. Methods The activity and capacity of Tasmania’s 2018–19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development. Results Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services. Conclusions This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

Published
2022

15. Mental health systems modelling for evidence-informed service reform in Australia

Author

Harvey Whiteford, Nasser Bagheri, Sandra Diminic, Joanne Enticott, Caroline X. Gao, Matthew Hamilton, Ian B Hickie, Long Khanh-Dao Le, Yong Yi Lee, Katrina M Long, Patrick McGorry, Graham Meadows, Cathrine Mihalopoulos, Jo-An Occhipinti, Daniel Rock, Sebastian Rosenberg, Luis Salvador-Carulla, and Adam Skinner

Subjects
Psychiatry and Mental health, General Medicine
Abstract

Australia’s Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population.

Published
2023

16. Register-based metrics of years lived with disability associated with mental and substance use disorders: a register-based cohort study in Denmark

Author

Nanna Weye, Preben Bo Mortensen, Harvey Whiteford, Natalie C. Momen, Carsten Bøcker Pedersen, Kim Moesgaard Iburg, Maria K. Christensen, Oleguer Plana-Ripoll, Damian Santomauro, John J. McGrath, and Esben Agerbo

Subjects
Adult, Male, medicine.medical_specialty, Substance-Related Disorders, Denmark, Comorbidity, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, medicine, Humans, media_common.cataloged_instance, Disabled Persons, Prospective Studies, Registries, 030212 general & internal medicine, European union, Psychiatry, Biological Psychiatry, Aged, media_common, business.industry, Mental Disorders, Middle Aged, medicine.disease, 030227 psychiatry, Substance abuse, Psychiatry and Mental health, Conduct disorder, Schizophrenia, Major depressive disorder, Autism, Female, Quality-Adjusted Life Years, business, Cohort study
Abstract

BACKGROUND: Mental disorders account for a substantial proportion of the years lived with disability (YLDs) globally. These estimates have generally been calculated top down based on summary statistics. The aim for this study was to calculate YLDs and a novel related measure, Health Loss Proportion (HeLP), for 18 mental and substance use disorders, based on person-level register data (bottom up).METHODS: A cohort of 6 989 627 Danish residents (5·9% had a diagnosis of a mental or substance use disorder registered in the Danish Psychiatric Central Research Register) was investigated. YLDs (the duration of disease multiplied by a disability weight) were calculated for the disorder of interest and for comorbid mental and substance use disorders. HeLPs were estimated as YLDs associated with an index disorder and comorbid mental and substance use disorders divided by person-years at risk in persons with the index disorder. All analyses were adjusted for mental and substance use comorbidity using a multiplicative model of disability weights.FINDINGS: Major depressive disorder was the most prevalent disorder, although schizophrenia was the leading cause of YLDs in both sexes combined (YLDs 273·3 [95 % CI 232·3-313·6] per 100 000 person-years). People diagnosed with schizophrenia lost the equivalent of 73% (63-83%) of healthy life per year due to mental and substance use disorders, the largest HeLP of all mental and substance use disorders. Comorbidity of mental and substance use disorders accounted for 69-83% of HeLPs in people with either cannabis use disorders, other drug use disorder and ADHD. By contrast, comorbidity explained 11-23% of the HeLPs in people with autism spectrum disorders, conduct disorder, and schizophrenia.INTERPRETATION: Substantial variation in disability was observed across age, sex, and disorders. The new HeLP metric provides novel details of the contribution of comorbidity to the disability associated with mental and substance use disorders.FUNDING: The Danish National Research Foundation, Queensland Government Department of Health, European Union's Horizon 2020, Lundbeck Foundation, Stanley Medical Research Institute.TRANSLATION: For the Danish translation of the abstract see Supplementary Materials section.

Published
2021

17. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019

Author

Theo Vos, Sarah Melen, Deborah Mitchison, Harvey Whiteford, Damian Santomauro, and Alize J. Ferrari

Subjects
Burden of disease, medicine.medical_specialty, Anorexia nervosa, Feeding and Eating Disorders, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, Medicine, Humans, 030212 general & internal medicine, Psychiatry, Pandemics, Biological Psychiatry, National health, business.industry, Bulimia nervosa, Depression, SARS-CoV-2, digestive, oral, and skin physiology, COVID-19, Articles, medicine.disease, 030227 psychiatry, Psychiatry and Mental health, Eating disorders, Systematic review, business
Abstract

Summary Background Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD. Methods We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). Findings 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9–59·0), and consisted of 17·3 million (11·3–24·9) people with binge-eating disorder and 24·6 million (14·7–39·7) people with OSFED (vs 13·6 million [10·2–17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0–6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8–10·6) in 2019. Interpretation Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden. Funding Queensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.

Published
2021

18. Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis

Author

Damian Santomauro, Pamela Y. Collins, Modhurima Moitra, Theo Vos, Alize J. Ferrari, Harvey Whiteford, and Louisa Degenhardt

Subjects
Population, Meta-regression, Suicide prevention, Article, 03 medical and health sciences, 0302 clinical medicine, Global mental health, Risk Factors, Covariate, medicine, Humans, education, Biological Psychiatry, education.field_of_study, Depressive Disorder, Major, business.industry, Mental Disorders, Confounding, medicine.disease, 030227 psychiatry, Psychiatry and Mental health, Suicide, Relative risk, Case-Control Studies, Systematic review, Major depressive disorder, Regression Analysis, business, 030217 neurology & neurosurgery, Clinical psychology
Abstract

Background Mental disorders (MDs) are known risk factors for suicide. This systematic review updates the evidence base for this association and improves upon analytic approaches by incorporating study-level and methodological variables to account for measurement error in pooled suicide risk estimates. Methods A systematic review was conducted to review studies on MDs as risk factors for suicide. Relevant studies were searched using PubMed, Embase, PsychINFO, and existing reviews from 2010 to 19. Studies were eligible if they were longitudinal/case-control studies, representative of the general population, used diagnostic instruments, and quantified suicide risk. The outcome assessed was relative risks (RRs) for suicide due to MDs. A multi-level meta-regression approach was used to obtain pooled RRs adjusted for covariates and between-study effects. Findings We identified 20 eligible studies yielding 69 RRs. Disorder type, age, sex, use of psychological autopsy, study design, and adjustment for confounders were tested as predictors of pooled suicide risk. Overall, all disorders were significant predictors of suicide with predicted adjusted RRs ranging from 4·11 [2·09, 8·09] for dysthymia to 7·64 [4·3, 13·58] for major depressive disorder. Interpretation Our results indicate that MDs are important risk factors for suicide. This systematic review provides pooled RRs that have been adjusted for methodological sources of bias. Findings from our paper may inform suicide prevention strategies as part of national health agendas., Highlights • Mental disorders are important risk factors for suicide. • Differences in study methodology may contribute to over or underestimation of study-reported suicide risk. • It is important to analytically quantify sources of variation when synthesizing published evidence on suicide risk in a meta-regression framework.

Published
2021

20. Quantifying the size of the informal care sector for Australian adults with mental illness: caring hours and replacement cost

Author

Sandra Diminic, Yong Yi Lee, Meredith Harris, Harvey Whiteford, Jan Kealton, and Emily Hielscher

Subjects
Gerontology, education.field_of_study, Health (social science), Social Psychology, Epidemiology, media_common.quotation_subject, National Disability Insurance Scheme, Population, Mental illness, medicine.disease, Payment, Mental health, 030227 psychiatry, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Income Support, Respite care, medicine, 030212 general & internal medicine, education, Psychology, health care economics and organizations, media_common, Valuation (finance)
Abstract

To quantify and value the total informal support provided by family and friends to Australian adults with mental illness in 2018. The number of mental health carers was drawn from the 2015 Survey of Disability, Ageing and Carers (SDAC), adjusted to the 2018 population. Annual caring hours by type of assistance were estimated using the SDAC, 2007 National Survey of Mental Health and Wellbeing and an online carer survey. Caring hours for each task were assigned an hourly replacement cost from the National Disability Insurance Scheme. Informal caring was valued as the sum of these costs minus expenditure on carer income support payments, estimating how much it would hypothetically cost governments to replace this care with formal support services. An estimated 354,000 (95% uncertainty interval (UI): 327,000–383,000) Australian mental health carers provided 186 million (95% UI: 159–215) hours of support in 2018. The estimated replacement cost was AU$8.4 billion (95% UI: 7.0–10.0), excluding AU$1.3 billion in income support. Univariate sensitivity analyses demonstrated that results were robust to variation in model inputs, with total caring hours the most influential parameter. Using an alternative estimate of mean caring hours, the replacement cost could be as high as AU$13.2 billion (95% UI: 11.2–15.4). Informal carers provide substantial support to people with mental illness, highlighting their important contribution to the mental health system and reinforcing the need for carer support services. Future valuation studies would benefit from refinement of available data collections, particularly on hours and types of care provided.

Published
2020

21. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017

Author

Chris M Varghese, JS Thakur, Akhil Soman ThekkePurakkal, Atul Ambekar, Christopher M Odell, Rajesh Sagar, Rajesh Dhaliwal, Christopher J L Murray, Joy K Chakma, Parul Mutreja, Sanjay Prakash, Lalit Dandona, Scott D Glenn, Soumya Swaminathan, Ana Maria Mantilla Herrera, K. Srinath Reddy, Harvey Whiteford, Neerja Chowdhary, Fiona J Charlson, Alize J. Ferrari, Hendrik J Bekedam, Lakshmi Vijayakumar, G Anil Kumar, Holly E. Erskine, Varsha Krish, Pramod Kumar Pal, Theo Vos, Thara Rangaswamy, Tarun Dua, Mathew Varghese, Atreyi Ganguli, Rinu P Krishnankutty, Rakhi Dandona, Rohit Bhatia, Vivek Agarwal, Aditya Singh, Gopalkrishna Gururaj, D K Shukla, K S Shaji, R K Lenin Singh, Ravinder Singh, and Damian Santomauro

Subjects
Adult, Male, Adolescent, Persons with Mental Disabilities, India, Article, Global Burden of Disease, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Prevalence of mental disorders, Sex Factors, Cost of Illness, Intellectual disability, Suicide, Completed, Prevalence, Medicine, Humans, 030212 general & internal medicine, Bipolar disorder, Biological Psychiatry, Disease burden, Aged, Aged, 80 and over, Depressive Disorder, business.industry, Mental Disorders, Malaysia, Middle Aged, medicine.disease, Anxiety Disorders, 030227 psychiatry, Psychiatry and Mental health, Eating disorders, Socioeconomic Factors, Conduct disorder, Schizophrenia, Anxiety, Female, Quality-Adjusted Life Years, medicine.symptom, business, Demography
Abstract

Summary Background Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India. In this report, we describe the prevalence and disease burden of each mental disorder for the states of India, from 1990 to 2017. Methods We used all accessible data from multiple sources to estimate the prevalence of mental disorders, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by these disorders for all the states of India from 1990 to 2017, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We assessed the heterogeneity and time trends of mental disorders across the states of India. We grouped states on the basis of their Socio-demographic Index (SDI), which is a composite measure of per-capita income, mean education, and fertility rate in women younger than 25 years. We also assessed the association of major mental disorders with suicide deaths. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In 2017, 197·3 million (95% UI 178·4–216·4) people had mental disorders in India, including 45·7 million (42·4–49·8) with depressive disorders and 44·9 million (41·2–48·9) with anxiety disorders. We found a significant, but modest, correlation between the prevalence of depressive disorders and suicide death rate at the state level for females (r2=0·33, p=0·0009) and males (r2=0·19, p=0·015). The contribution of mental disorders to the total DALYs in India increased from 2·5% (2·0–3·1) in 1990 to 4·7% (3·7–5·6) in 2017. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33·8%, 29·5–38·5), followed by anxiety disorders (19·0%, 15·9–22·4), idiopathic developmental intellectual disability (IDID; 10·8%, 6·3–15·9), schizophrenia (9·8%, 7·7–12·4), bipolar disorder (6·9%, 4·9–9·6), conduct disorder (5·9%, 4·0–8·1), autism spectrum disorders (3·2%, 2·7–3·8), eating disorders (2·2%, 1·7–2·8), and attention-deficit hyperactivity disorder (ADHD; 0·3%, 0·2–0·5); other mental disorders comprised 8·0% (6·1–10·1) of DALYs. Almost all (>99·9%) of these DALYs were made up of YLDs. The DALY rate point estimates of mental disorders with onset predominantly in childhood and adolescence (IDID, conduct disorder, autism spectrum disorders, and ADHD) were higher in low SDI states than in middle SDI and high SDI states in 2017, whereas the trend was reversed for mental disorders that manifest predominantly during adulthood. Although the prevalence of mental disorders with onset in childhood and adolescence decreased in India from 1990 to 2017, with a stronger decrease in high SDI and middle SDI states than in low SDI states, the prevalence of mental disorders that manifest predominantly during adulthood increased during this period. Interpretation One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Substantial variations exist between states in the burden from different mental disorders and in their trends over time. These state-specific trends of each mental disorder reported here could guide appropriate policies and health system response to more effectively address the burden of mental disorders in India. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Published
2020

23. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

Author

Reed J D Sorensen, Beatrice Magistro, Sabina S Bloom, Carolyn Dapper, Alize J. Ferrari, Antonio Luiz Pinho Ribeiro, Aleksei Sholokhov, Lorenzo Monasta, Bulat Idrisov, Joseph Frostad, Gaorui Guo, James Kevin O'Halloran, Charlie Ashbaugh, Simon I. Hay, Suman Chakrabarti, Bree Bang-Jensen, Shuhei Nomura, Samuel B Ewald, Louise Penberthy, Rachel Castellano, Deborah Carvalho Malta, Emma Castro, William James Dangel, Cristiana Abbafati, Charles Shey Wiysonge, Amanda Deen, James K. Collins, Elena Varavikova, Aleksandr Y. Aravkin, Emily Linebarger, Megan Erickson, Damian Santomauro, Harvey Whiteford, Joanne O Amlag, Christopher Adolph, Abraham D. Flaxman, Rebecca Walcott, Anh Truc Vo, Bethany Zigler, Paulo A. Lotufo, Nancy Fullman, Peng Zheng, Christopher J L Murray, Jiawei He, Fatima Marinho, Rebecca M. Cogen, Robert Reiner, Monika Helak, John R Giles, David M. Pigott, Ana Maria Mantilla Herrera, Samuel M. Ostroff, Maja Pasovic, Grace Reinke, Jhilik Chattopadhyay, Paulami Naik, Ababi Zergaw Giref, Gregory J. Bertolacci, Xiaochen Dai, Akiaja Lindstrom, Rafael Lozano, Jamileh Shadid, Theo Vos, Johan C Månsson, Stefanie Watson, Erin N Hulland, and Ali H. Mokdad

Subjects
medicine.medical_specialty, mental disorder, Population, Psychological intervention, DALYs, Anxiety, Global Health, Global Burden of Disease, Surveys and Questionnaires, Pandemic, medicine, Global health, Prevalence, Humans, Data reporting, Psychiatry, education, Pandemics, education.field_of_study, business.industry, Depression, SARS-CoV-2, COVID-19, General Medicine, Articles, medicine.disease, Mental health, Anxiety Disorders, Major depressive disorder, meta-regression model, medicine.symptom, COVID 19, business
Abstract

Background Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. Methods We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. Findings We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p

Published
2021

24. The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys

Author

Louisa Degenhardt, Chrianna Bharat, Meyer D. Glantz, Evelyn J. Bromet, Jordi Alonso, Ronny Bruffaerts, Brendan Bunting, Giovanni de Girolamo, Peter de Jonge, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Hristo Hinkov, Elie G. Karam, Georges Karam, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, Maria Elena Medina-Mora, Fernando Navarro-Mateu, Marina Piazza, José Posada-Villa, Kate M. Scott, Dan J. Stein, Hisateru Tachimori, Nathan Tintle, Yolanda Torres, Maria Carmen Viana, Ronald C. Kessler, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Mohammed Salih Al-Kaisy, Yasmin Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Somnath Chatterji, Alfredo H. Cia, Koen Demyttenaere, Chi-yi Hu, Aimee Nasser Karam, Norito Kawakami, Andrzej Kiejna, Jean-Pierre Lepine, John McGrath, Zeina Mneimneh, Jacek Moskalewicz, Jose Posada-Villa, Tim Slade, Juan Carlos Stagnaro, Margreet ten Have, Daniel V. Vigo, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak, Developmental Psychology, and Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE)

Subjects
Pharmacology, Adult, substance use disorder, Substance-Related Disorders, traumatic experiences, Toxicology, World Health Organization, Trauma, Health Surveys, Psychiatry and Mental health, Humans, Pharmacology (medical), Child maltreatment, Substance use disorders, World mental health surveys, Retrospective Studies
Abstract

AIM: Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time.METHODS: Data come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: "exposure to organised violence"; "participation in organised violence"; "interpersonal violence"; "sexual-relationship violence"; "other life-threatening events"; and those involving loved ones ("network traumas"). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset.RESULTS: Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years.CONCLUSION: Sexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.

Published
2021

25. Exploring the cost-effectiveness of a Dutch collaborative stepped care intervention for the treatment of depression and/or anxiety when adapted to the Australian context: a model-based cost-utility analysis

Author

Harvey Whiteford, Emily Stockings, Cathy Mihalopoulos, Sandra Davidson, Meredith Harris, Mary Lou Chatterton, and Yong Yi Lee

Subjects
medicine.medical_specialty, economic evaluation, Referral, Epidemiology, Cost effectiveness, Psychological intervention, Collaborative Care, stepped care, law.invention, Randomized controlled trial, depressive disorder, law, Health care, medicine, collaborative care, health care economics and organizations, general practice, business.industry, Public Health, Environmental and Occupational Health, cost-effectiveness analysis, Cost-effectiveness analysis, Psychiatry and Mental health, Family medicine, Anxiety, Original Article, medicine.symptom, business, Anxiety disorders
Abstract

Aims Depression and anxiety are among the most common mental health conditions treated in primary care. They frequently co-occur and involve recommended treatments that overlap. Evidence from randomised controlled trials (RCTs) shows specific stepped care interventions to be cost-effective in improving symptom remission. However, most RCTs have focused on either depression or anxiety, which limits their generalisability to routine primary care settings. This study aimed to evaluate the cost-effectiveness of a collaborative stepped care (CSC) intervention to treat depression and/or anxiety among adults in Australian primary care settings. Method A quasi-decision tree model was developed to evaluate the cost-effectiveness of a CSC intervention relative to care-as-usual (CAU). The model adapted a CSC intervention described in a previous Dutch RCT to the Australian context. This 8-month, cluster RCT recruited patients with depression and/or anxiety (n = 158) from 30 primary care clinics in the Netherlands. The CSC intervention involved two steps: (1) guided self-help with a nurse at a primary care clinic; and (2) referral to specialised mental healthcare. The cost-effectiveness model adopted a health sector perspective and synthesised data from two main sources: RCT data on intervention pathways, remission probabilities and healthcare service utilisation; and Australia-specific data on demography, epidemiology and unit costs from external sources. Incremental costs and incremental health outcomes were estimated across a 1-year time horizon. Health outcomes were measured as disability-adjusted life years (DALYs) due to remitted cases of depression and/or anxiety. Incremental cost-effectiveness ratios (ICERs) were measured in 2019 Australian dollars (A$) per DALY averted. Uncertainty and sensitivity analyses were performed to test the robustness of cost-effectiveness findings. Result The CSC intervention had a high probability (99.6%) of being cost-effective relative to CAU. The resulting ICER (A$5207/DALY; 95% uncertainty interval: dominant to 25 345) fell below the willingness-to-pay threshold of A$50 000/DALY. ICERs were robust to changes in model parameters and assumptions. Conclusions This study found that a Dutch CSC intervention, with nurse-delivered guided self-help treatment as a first step, could potentially be cost-effective in treating depression and/or anxiety if transferred to the Australian primary care context. However, adaptations may be required to ensure feasibility and acceptability in the Australian healthcare context. In addition, further evidence is needed to verify the real-world cost-effectiveness of the CSC intervention when implemented in routine practice and to evaluate its effectiveness/cost-effectiveness when compared to other viable stepped care interventions for the treatment of depression and/or anxiety.

Published
2021

26. The Productivity Commission inquiry into mental health

Author

Harvey Whiteford

Subjects
Mental Health Services, education.field_of_study, medicine.medical_specialty, Mental Disorders, Population, Australia, General Medicine, Health Care Costs, Mental illness, medicine.disease, Mental health treatment, Mental health, Psychiatry and Mental health, Mental Health, Productivity commission, Cost of Illness, Economic cost, medicine, Humans, education, Psychology, Psychiatry, health care economics and organizations
Abstract

The report of the Productivity Commission Inquiry into mental health was released in November 2020, estimating the economic cost of mental illness in Australia at over $200 billion a year. The report makes wide-ranging recommendations for improving the mental health of the population, reforming the mental health treatment system, and in the way mental health is managed in other sectors of society.

Published
2021

27. Perceived helpfulness of treatment for alcohol use disorders: Findings from the World Mental Health Surveys

Author

Louisa Degenhardt, Chrianna Bharat, Wai Tat Chiu, Meredith G. Harris, Alan E. Kazdin, Daniel V. Vigo, Nancy A. Sampson, Jordi Alonso, Laura Helena Andrade, Ronny Bruffaerts, Brendan Bunting, Graça Cardoso, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Chiyi Hu, Aimee N. Karam, Elie G. Karam, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, John J. McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, José Posada-Villa, Charlene Rapsey, Juan Carlos Stagnaro, Hisateru Tachimori, Margreet ten Have, Yolanda Torres, David R. Williams, Zahari Zarkov, Ronald C. Kessler, Ali Al-Hamzawi, Mohammed Salih Al-Kaisy, Yasmin A. Altwaijri, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Jose Miguel Caldas-de-Almeida, Somnath Chatterji, Alfredo H. Cia, Koen Demyttenaere, null Giovanni de Girolamo, Hristo Hinkov, Chi-yi Hu, null Peter de Jonge, Aimee Nasser Karam, Georges Karam, Norito Kawakami, Andrzej Kiejna, Jean-Pierre Lepine, Zeina Mneimneh, Marina Piazza, Jose Posada-Villa, Kate M. Scott, Tim Slade, Dan J. Stein, null Margreet ten Have, Maria Carmen Viana, Harvey Whiteford, and Bogdan Wojtyniak

Subjects
Persistence (psychology), Adult, medicine.medical_specialty, Alcohol Drinking, Epidemiology, education, Alcohol use disorder, Toxicology, World health, Surveys and Questionnaires, medicine, Prevalence, Humans, Pharmacology (medical), Psychiatry, Pharmacology, business.industry, medicine.disease, Mental health, Health Surveys, Treatment, Psychiatry and Mental health, Alcoholism, Helpfulness, business
Abstract

AIM: We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment.METHODS: Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment).RESULTS: 11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378); of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8%; the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%.CONCLUSION: Fewer than half of people with AUDs who sought treatment found treatment helpful; the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.

Published
2021

28. Exploring Comorbidity Within Mental Disorders Among a Danish National Population

Author

Anders Prior, Ole Mors, Sukanta Saha, Aja Greve, Merete Nordentoft, Carsten Bøcker Pedersen, Brian K. Lee, Ronald C. Kessler, Harvey Whiteford, Preben Bo Mortensen, Chun Chieh Fan, Holger J. Sørensen, Kate M. Scott, Lars Vedel Kessing, Terry Stedman, Andrew J. Schork, Kim Moesgaard Iburg, Louisa Degenhardt, Carmen C.W. Lim, Yan Holtz, John J. McGrath, Jane Gunn, Annelieke M. Roest, Michael E. Benros, Peter de Jonge, Esben Agerbo, Andrea Ganna, Thomas Werge, Oleguer Plana-Ripoll, James Scott, Søren Dalsgaard, Thomas Munk Laursen, APH - Mental Health, Developmental Psychology, Life Course Epidemiology (LCE), and Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE)

Subjects
Male, Time Factors, Denmark, Comorbidity, Cohort Studies, 0302 clinical medicine, SCHIZOPHRENIA, Registries, Original Investigation, Psychiatry, RISK, education.field_of_study, DSM-IV DISORDERS, Mental Disorders, LIFETIME PREVALENCE, Hazard ratio, Age Factors, HEALTH SURVEY, 3. Good health, Psychiatry and Mental health, Eating disorders, Schizophrenia, RELIABILITY, Female, Coronavirus Infections, Cohort study, Adult, Population, Pneumonia, Viral, DIAGNOSES, CO-MORBIDITY, 03 medical and health sciences, Betacoronavirus, Young Adult, Sex Factors, medicine, International Statistical Classification of Diseases and Related Health Problems, Humans, VALIDITY, education, Pandemics, business.industry, SARS-CoV-2, COVID-19, medicine.disease, 030227 psychiatry, Mood disorders, business, 030217 neurology & neurosurgery, Demography
Abstract

IMPORTANCE Individuals with mental disorders often develop comorbidityover time. Past studies of comorbidity have often restricted analyses to a subset of disorders and few studies have provided absolute risks of later comorbidity.OBJECTIVES To undertake a comprehensive study of comorbidity within mental disorders, by providing temporally ordered age-and sex-specific pairwise estimates between the major groups of mental disorders, and to develop an interactive website to visualize all results and guide future research and clinical practice.DESIGN, SETTING. AND PARTICIPANTS This population-based cohort study included all individuals born in Denmark between January 1, 190 0, and December 31, 2015, and living in the country between January 1, 20 0 0, and December 31, 2016. The analyses were conducted between June 2017 and May 2018.MAIN OUTCOMES AND MEASURES Danish health registers were used to identify mental disorders, which were examined within the broad 10-level International Statistical Classification of Diseases and Related Health Problems, lOth Revision, subchapter groups (eg, codes F00-F09 and F10-F19). For each temporally ordered pair of disorders, overall and lagged hazard ratios and 95% Cls were calculated using Cox proportional hazards regress on models. Absolute risks were estimated using competing risks survival analyses. Estimates for each sex were generated.RESULTS A total of 5 940 778 persons were Included in this study (2 958 293 men and 2 982 485 women; mean [SD] age at beginning of follow-up, 32.1[25.4] years). They were followed up for 83.9 million person-years. All mental disorders were associated with an increased risk of all other mental disorders when adjusting for sex, age, and calendar time (hazard ratios ranging from 2.0 [95% CI, 1.7-2.4] for prior intellectual disabilities and later eating disorders to 48.6 [95% Cl, 46.6-50.7] for prior developmental disorders and later intellectual disabilities). The hazard ratios were temporally patterned, with higher estimates during the first year after the onset of the first disorder, but with persistently elevated rates during the entire observation period. Some disorders were associated with substantial absolute risks of developing specific later disorders (eg, 30.6% [95% CI, 29.3%-32.0%] of men and 38.4% [95% CI, 37.5%-39.4%] of women with a diagnosis of mood disorders before age 20 years developed neurotic disorders within the following 5 years).CONCLUSIONS AND RELEVANCE Comorbidity within mental disorders is pervasive, and the risk persists over time. This study provides disorder-, sex-, and age-specific relative and absolute risks of the comorbidity of mental disorders. Web-based interactive data visualization tools are provided for clinical utility.

Published
2019

29. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

Author

Shekhar Saxena, Harvey Whiteford, Mark van Ommeren, Fiona J Charlson, Joseph Cornett, and Abraham D. Flaxman

Subjects
medicine.medical_specialty, Population, Psychological intervention, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Prevalence of mental disorders, medicine, Prevalence, Humans, 030212 general & internal medicine, Bipolar disorder, education, Psychiatry, education.field_of_study, business.industry, Mental Disorders, General Medicine, medicine.disease, Mental health, Mental Health, Schizophrenia, Anxiety, medicine.symptom, business, Anxiety disorder
Abstract

Summary Background Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. Methods In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. Findings We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8–25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3–16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9–5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0–6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. Interpretation The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. Funding WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.

Published
2019

30. Epidemiology of binge eating disorder

Author

Holly E. Erskine and Harvey Whiteford

Subjects
050103 clinical psychology, medicine.medical_specialty, Optimal sampling, Future studies, Bulimia nervosa, 05 social sciences, Ethnic group, MEDLINE, Demographic profile, medicine.disease, Global Burden of Disease, 030227 psychiatry, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Binge-eating disorder, Epidemiology, medicine, Humans, 0501 psychology and cognitive sciences, Psychology, Binge-Eating Disorder, Clinical psychology
Abstract

In 2013, binge eating disorder (BED) was officially recognized as a distinct eating disorder in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders. The purpose of this review is to assess the available epidemiological data to determine whether BED should be considered for inclusion in global disease burden quantification efforts, such as the Global Burden of Disease Study (GBD).A systematic search of three electronic databases (PubMed, EMBASE, and PsycINFO) found 32 studes meeting GBD inclusion criteria. The global pooled prevalence of BED was 0.9% (95% confidence intervals: 0.7-1.0%). Although women (1.4%, 1.1-1.7%) had higher prevalence than men (0.4%, 0.3-0.6%), no significant difference in prevalence was found between high-income countries (0.9%, 0.8-1.1%) and low- and middle-income countries (0.7%, 0.3-1.1%).The current article presents the findings of a recent systematic review of the epidemiology of BED and discusses the case for including BED as a new cause in future iterations of GBD.

Published
2018

31. Measuring the Prevalence of Mental Disorders in Adolescents in Kenya, Indonesia, and Vietnam: Study Protocol for the National Adolescent Mental Health Surveys

Author

James Scott, Sarah J. Blondell, Jamileh Shadid, Hoa Thi Khanh Dao, Amirah Ellyza Wahdi, Harvey Whiteford, Yohannes Dibaba Wado, Mark R. Emerson, Holly E. Erskine, Frederick Wekesah, Mengmeng Li, Siswanto Agus Wilopo, Shoshanna L. Fine, Vinh Duc Nguyen, Meaghan E. Enright, Robert W. Blum, and Loi Manh Vu

Subjects
medicine.medical_specialty, Data collection, Generalized anxiety disorder, Public Health, Environmental and Occupational Health, Capacity building, medicine.disease, Mental health, Psychiatry and Mental health, Prevalence of mental disorders, Conduct disorder, Pediatrics, Perinatology and Child Health, medicine, Major depressive disorder, Cluster sampling, Psychiatry, Psychology
Abstract

PurposeIn low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protocol.MethodsIn each country, a multistage stratified cluster sampling design will be used. Participants will be eligible pairs of adolescents aged 10–17 years and their primary caregiver. Adolescents will be assessed for social phobia, generalized anxiety disorder, major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and post-traumatic stress disorder using the Diagnostic Interview Schedule for Children, version 5. Demographics, risk and protective factors, and service use information will also be collected. In the parallel clinical calibration study, diagnoses of major depressive disorder, social phobia, and generalized anxiety disorder made using the Diagnostic Interview Schedule for Children, version 5 will be calibrated against a diagnostic assessment by in-country clinicians in a separate sample.ResultsData collection for the national survey and clinical calibration study will commence in 2021, with dissemination of findings and methodology due to occur in 2022.ConclusionsAccurately quantifying the prevalence of mental disorders in adolescents is essential for service planning. NAMHS will address this lack of prevalence data, both within the NAMHS countries and within their respective regions, while establishing a gold-standard methodology for data collection on adolescent mental health in low- and middle-income countries. More broadly, NAMHS will encourage capacity building within each country by establishing linkages between researcher, clinician, government, and other networks.PurposeIn low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protocol.MethodsIn each country, a multistage stratified cluster sampling design will be used. Participants will be eligible pairs of adolescents aged 10–17 years and their primary caregiver. Adolescents will be assessed for social phobia, generalized anxiety disorder, major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and post-traumatic stress disorder using the Diagnostic Interview Schedule for Children, version 5. Demographics, risk and protective factors, and service use information will also be collected. In the parallel clinical calibration study, diagnoses of major depressive disorder, social phobia, and generalized anxiety disorder made using the Diagnostic Interview Schedule for Children, version 5 will be calibrated against a diagnostic assessment by in-country clinicians in a separate sample.ResultsData collection for the national survey and clinical calibration study will commence in 2021, with dissemination of findings and methodology due to occur in 2022.ConclusionsAccurately quantifying the prevalence of mental disorders in adolescents is essential for service planning. NAMHS will address this lack of prevalence data, both within the NAMHS countries and within their respective regions, while establishing a gold-standard methodology for data collection on adolescent mental health in low- and middle-income countries. More broadly, NAMHS will encourage capacity building within each country by establishing linkages between researcher, clinician, government, and other networks.

Published
2020

33. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. Stokes, Veincent Christian Filipino Pepito, Lidia Morawska, Fiona J Charlson, Babak Moazen, Dejana Braithwaite, Jonathan M. Kocarnik, Sergio I. Prada, Andrea Farioli, Zahra Atafar, Heather Orpana, Daniela Balzi, Marco Vacante, Rahmatollah Moradzadeh, Jacek A. Kopec, Iván Landires, Robert G. Weintraub, Leonardo Roever, Yannick Béjot, Markus P. Schlaich, Hamed Zandian, Subramanian Senthilkumaran, Klara Dokova, Vahid Alipour, Sowmya J. Rao, Rakesh Ghosh, Omar Mukhtar Salman, Faris Lami, Marcos Roberto Tovani-Palone, Hamid Reza Tohidinik, Seyed Mohammad Riahi, Adnan Kisa, Ghasem Azarian, Caroline Stein, Zulfiqar A. Bhutta, Sinead Langan, Kunihiro Matsushita, Lauren E. Schaeffer, Kathryn H. Jacobsen, Mehdi Naderi, Mehdi Hosseinzadeh, Nizal Sarrafzadegan, Bahram Armoon, Dan J. Stein, Jessica Fanzo, Morenike Oluwatoyin Folayan, Luca Ronfani, Phetole Walter Mahasha, Nicholas J K Breitborde, Adrian Oţoiu, Arash Sarveazad, Marc L. Serre, Mostafa Hosseini, Nicolas Cherbuin, George D. Thurston, Jalal Arabloo, Mokhtar Mahdavi, Andre Rodrigues Duraes, Ana Laura Manda, Ahmed Abualhasan, Nima Rezaei, Yuan-Pang Wang, Theodore Patrick Younker, Alireza Ansari-Moghaddam, Borhan Mansouri, Adam E. Berman, Khezar Hayat, Rosario Cárdenas, Bolajoko O. Olusanya, Tommi Vasankari, Simon I. Hay, Fatemeh Ghaffarifar, Leo Stockfelt, Ai Koyanagi, Giorgia Giussani, Yuming Guo, Sonia Saxena, Deborah Carvalho Malta, Mehedi Hasan, Negar Rezaei, Maja Pasovic, Jukka Takala, Bogdan Oancea, Sare Safi, A. Werdecker, Florian Fischer, Beatriz Paulina Ayala Quintanilla, Muhammad Shahdaat Bin Sayeed, Takeshi Fukumoto, Maha Atout, Brijesh Sathian, Cristina Bosetti, Mitchell T. Wallin, Agegnehu Bante, Helen Ippolito, Anthony Masaka, Chantal Huynh, Justin Lo, Jordan Weiss, Joemer C. Maravilla, Alberto Raggi, Peter W. Gething, Cristiana Abbafati, Daniela Ribeiro, Mohammad Farahmand, Yetunde O. John-Akinola, Isabela M. Benseñor, Emilie R Maddison, John J. McGrath, Salman Khazaei, Scott B. Patten, Jean Jacques Noubiap, Emmanuela Gakidou, Celine M. Barthelemy, Ashish Badiye, George C. Patton, Obinna Onwujekwe, Peter Allebeck, Victor Aboyans, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Nicholas L S Roberts, Joht Singh Chandan, Hans W. Hoek, Usman Iqbal, Nima Hafezi-Nejad, Haley Lescinsky, Naohiro Yonemoto, Ahmad Ghashghaee, Anders Larsson, David C. Schwebel, Milena Ilic, Richard T. Burnett, Yang Liu, Carlo La Vecchia, Felix Akpojene Ogbo, Morteza Naserbakht, Sangram Kishor Patel, Melanie S. Hammer, Prasanna Mithra, Mohammad Amin Bahrami, Kanyin L. Ong, Mona Pathak, Afshin Maleki, Saeid Safiri, Masood Ali Shaikh, Kate Causey, Michael R.M. Abrigo, Jost B. Jonas, Dian Kusuma, Jagadish Rao Padubidri, Mihajlo Jakovljevic, Ali S. Shalash, Abdiwahab Hashi, Ionut Negoi, Nataliya A. Foigt, Andrey Nikolaevich Briko, François Alla, Giuseppe Grosso, Houman Goudarzi, Di H. Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. Khater, Ehsan Sadeghi, Mahalaqua Nazli Khatib, Antonio Biondi, Valentin Yurievich Skryabin, Mohsen Abbasi-Kangevari, Andrew T Olagunju, Amir Radfar, Laith J. Abu-Raddad, Marcello Tonelli, Hesam Ghiasvand, Hanne Christensen, Juan Jesus Carrero, Maryam Adabi, Saravanan Muthupandian, Kurt Straif, Hossein Samadi Kafil, Lope H Barrero, Harish Chander Gugnani, Mohammad Fareed, Morteza Shamsizadeh, Jemal Abdu Mohammed, Juan A Rivera, Shai Linn, Saad M.A. Dahlawi, Janni Leung, Shokofeh Maleki, Mohd Anisul Karim, Kamarul Imran Musa, Farshad Pourmalek, Dietrich Rothenbacher, Kiomars Sharafi, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Helena Manguerra, Olatunji O. Adetokunboh, Srinivasa Vittal Katikireddi, Nermin Ghith, Maha El Tantawi, Awoke Misganaw, Yunquan Zhang, Carl Abelardo T. Antonio, Vahid Rashedi, Mehran Shams-Beyranvand, Bhaskaran Unnikrishnan, Holly E. Erskine, Ann Kristin Knudsen, Marissa B Reitsma, Getayeneh Antehunegn Tesema, Javad Javidnia, Ismael R. Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. M., Agarwal, G., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmed, M. B., Akalu, T. Y., Akinyemi, R. O., Akinyemiju, T., Akombi, B., Akunna, C. J., Alahdab, F., Al-Aly, Z., Alam, K., Alam, S., Alam, T., Alanezi, F. M., Alanzi, T. M., Alemu, B. W., Alhabib, K. F., Ali, M., Ali, S., Alicandro, G., Alinia, C., Alipour, V., Alizade, H., Aljunid, S. M., Alla, F., Allebeck, P., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Alonso, J., Altirkawi, K. A., Amini-Rarani, M., Amiri, F., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C. L., Andrei, T., Angus, C., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Antonazzo, I. C., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Ariani, F., Armoon, B., Arnlov, J., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Assmus, M., Atafar, Z., Atnafu, D. D., Atout, M. M. W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. A., Davitoiu, D. V., De Leo, D., Degenhardt, L., Delang, M., Dellavalle, R. P., Demeke, F. M., Demoz, G. T., Demsie, D. G., Denova-Gutierrez, E., Dervenis, N., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dibaji Forooshani, Z. S., Djalalinia, S., Do, H. T., Dokova, K., Dorostkar, F., Doshmangir, L., Driscoll, T. R., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S. I., Elyazar, I. R., Emmons-Bell, S., Erskine, H. E., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A. E., Fanzo, J., Farahmand, M., Fareed, M., Faridnia, R., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Force, L. M., Foroutan, M., Franklin, R. C., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Gallus, S., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B. S., Gebreslassie, A. A. A. A., Geremew, A., Gershberg Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Gill, P. S., Ginindza, T. G. G., Giussani, G., Gnedovskaya, E. V., Goharinezhad, S., Gopalani, S. V., Gorini, G., Goudarzi, H., Goulart, A. C., Greaves, F., Grivna, M., Grosso, G., Gubari, M. I. M., Gugnani, H. C., Guimaraes, R. A., Guled, R. A., Guo, G., Guo, Y., Gupta, R., Gupta, T., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamidi, S., Hammer, M. S., Hankey, G. J., Haririan, H., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hasanpoor, E., Hashi, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Henrikson, H. J., Herbert, M. E., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Holla, R., Hoogar, P., Hosgood, H. D., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Hsieh, V. C. -R., Hu, G., Hu, K., Huda, T. M., Humayun, A., Huynh, C. K., Hwang, B. -F., Iannucci, V. C., Ibitoye, S. E., Ikeda, N., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Inbaraj, L. R., Ippolito, H., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Iso, H., Ivers, R. Q., Iwu, C. C. D., Iwu, C. J., Iyamu, I. O., Jaafari, J., Jacobsen, K. H., Jafari, H., Jafarinia, M., Jahani, M. A., Jakovljevic, M., Jalilian, F., James, S. L., Janjani, H., Javaheri, T., Javidnia, J., Jeemon, P., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Johansson, L., John, O., John-Akinola, Y. O., Johnson, C. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Li, S., Lim, L. -L., Linn, S., Liu, S., Liu, Y., Lo, J., Lopez, A. D., Lopez, J. C. F., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lu, A., Lugo, A., Maddison, E. R., Mahasha, P. W., Mahdavi, M. M., Mahmoudi, M., Majeed, A., Maleki, A., Maleki, S., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manda, A. L., Manguerra, H., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M. A., Mantilla Herrera, A. M., Maravilla, J. C., Marks, A., Martin, R. V., Martini, S., Martins-Melo, F. R., Masaka, A., Masoumi, S. Z., Mathur, M. R., Matsushita, K., Maulik, P. K., Mcalinden, C., Mcgrath, J. J., Mckee, M., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mereke, A., Mereta, S. T., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Miller, T. R., Mills, E. J., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei, R., Mirzaei-Alavijeh, M., Misganaw, A. T., Mithra, P., Moazen, B., Mohammad, D. K., Mohammad, Y., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, A. S., Mohammed, H., Mohammed, J. A., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mooney, M. D., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morawska, L., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mousavi Khaneghah, A., Mueller, U. O., Mukhopadhyay, S., Mullany, E. C., Musa, K. I., Muthupandian, S., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Nagel, G., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Najafi, F., Nangia, V., Nansseu, J. R., Naserbakht, M., Nayak, V. C., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nguyen, M., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F. A., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Orpana, H. M., Ortiz, A., Osarenotor, O., Osei, F. B., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., P A, M., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Parry, C. D. H., Pasovic, M., Pasupula, D. K., Patel, S. K., Pathak, M., Patten, S. B., Patton, G. C., Pazoki Toroudi, H., Peden, A. E., Pennini, A., Pepito, V. C. F., Peprah, E. K., Pereira, D. M., Pesudovs, K., Pham, H. Q., Phillips, M. R., Piccinelli, C., Pilz, T. M., Piradov, M. A., Pirsaheb, M., Plass, D., Polinder, S., Polkinghorne, K. R., Pond, C. D., Postma, M. J., Pourjafar, H., Pourmalek, F., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Raggi, A., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S. B., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, D. C., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. L. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Saeedi Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S. M., Salam, N., Salamati, P., Salem, H., Salem, M. R. R., Salimzadeh, H., Salman, O. M., Salomon, J. A., Samad, Z., Samadi Kafil, H., Sambala, E. Z., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D. F., Santos, I. S., Santos, J. V., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Saxena, S., Schaeffer, L. E., Schiavolin, S., Schlaich, M. P., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Serdar, B., Serre, M. L., Shadid, J., Shafaat, O., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sheikh, A., Sheikhtaheri, A., Shibuya, K., Shield, K. D., Shigematsu, M., Shin, J. I., Shin, M. -J., Shiri, R., Shirkoohi, R., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, J. P., Simpson, K. E., Singh, J. A., Singh, P., Skiadaresi, E., Skou, S. T. S., Skryabin, V. Y., Smith, E. U. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soshnikov, S., Soyiri, I. N., Spencer, C. N., Spotin, A., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stein, C., Stein, D. J., Steiner, C., Stockfelt, L., Stokes, M. A., Straif, K., Stubbs, J. L., Sufiyan, M. B., Suleria, H. A. R., Suliankatchi Abdulkader, R., Sulo, G., Sultan, I., Szumowski, Tabares-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taherkhani, A., Tajdini, M., Takahashi, K., Takala, J. S., Tamiru, A. T., Taveira, N., Tehrani-Banihashemi, A., Temsah, M. -H., Tesema, G. A., Tessema, Z. T., Thurston, G. D., Titova, M. V., Tohidinik, H. R., Tonelli, M., Topor-Madry, R., Topouzis, F., Torre, A. E., Touvier, M., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Tsatsakis, A., Tudor Car, L., Tyrovolas, S., Uddin, R., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Vacante, M., Valdez, P. R., van Donkelaar, A., Vasankari, T. J., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vos, T., Vukovic, R., Waheed, Y., Wallin, M. T., Wang, Y., Wang, Y. -P., Watson, A., Wei, J., Wei, M. Y. W., Weintraub, R. G., Weiss, J., Werdecker, A., West, J. J., Westerman, R., Whisnant, J. L., Whiteford, H. A., Wiens, K. E., Wolfe, C. D. A., Wozniak, S. S., Wu, A. -M., Wu, J., Wulf Hanson, S., Xu, G., Xu, R., Yadgir, S., Yahyazadeh Jabbari, S. H., Yamagishi, K., Yaminfirooz, M., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yeheyis, T. Y., Yilgwan, C. S., Yilma, M. T., Yip, P., Yonemoto, N., Younis, M. Z., Younker, T. P., Yousefi, B., Yousefi, Z., Yousefinezhadi, T., Yousuf, A. Y., Yu, C., Yusefzadeh, H., Zahirian Moghadam, T., Zamani, M., Zamanian, M., Zandian, H., Zastrozhin, M. S., Zhang, Y., Zhang, Z. -J., Zhao, J. T., Zhao, X. -J. G., Zhao, Y., Zhou, M., Ziapour, A., Zimsen, S. R. M., Brauer, M., Afshin, A., Lim, S. S., Lacey, B, Sartorius, B, Abbafati, C, Abbas, K, Abbasi-Kangevari, M, Abd-Allah, F, Abdelalim, A, Abdollahi, M, Abdollahpour, I, Abegaz, K, Abolhassani, H, Aboyans, V, Abreu, L, Abrigo, M, Abualhasan, A, Abu-Raddad, L, Abushouk, A, Adabi, M, Adekanmbi, V, Adeoye, A, Adetokunboh, O, Adham, D, Advani, S, Afshin, A, Agarwal, G, Aghamir, S, Agrawal, A, Ahmad, T, Ahmadi, K, Ahmadi, M, Ahmadieh, H, Ahmed, M, Akalu, T, Akinyemi, R, Akinyemiju, T, Akombi, B, Akunna, C, Alahdab, F, Al-Aly, Z, Alam, K, Alam, S, Alam, T, Alanezi, F, Alanzi, T, Alemu, B, Alhabib, K, Ali, M, Ali, S, Alicandro, G, Alinia, C, Alipour, V, Alizade, H, Aljunid, S, Alla, F, Allebeck, P, Almasi-Hashiani, A, Al-Mekhlafi, H, Alonso, J, Altirkawi, K, Amini-Rarani, M, Amiri, F, Amugsi, D, Ancuceanu, R, Anderlini, D, Anderson, J, Andrei, C, Andrei, T, Angus, C, Anjomshoa, M, Ansari, F, Ansari-Moghaddam, A, Antonazzo, I, Antonio, C, Antony, C, Antriyandarti, E, Anvari, D, Anwer, R, Appiah, S, Arabloo, J, Arab-Zozani, M, Aravkin, A, Ariani, F, Armoon, B, Arnlov, J, Arzani, A, Asadi-Aliabadi, M, Asadi-Pooya, A, Ashbaugh, C, Assmus, M, Atafar, Z, Atnafu, D, Atout, M, Ausloos, F, Ausloos, M, Ayala Quintanilla, B, Ayano, G, Ayanore, M, Azari, S, Azarian, G, Azene, Z, Badawi, A, Badiye, A, Bahrami, M, Bakhshaei, M, Bakhtiari, A, Bakkannavar, S, Baldasseroni, A, Ball, K, Ballew, S, Balzi, D, Banach, M, Banerjee, S, Bante, A, Baraki, A, Barker-Collo, S, Barnighausen, T, Barrero, L, Barthelemy, C, Barua, L, Basu, S, Baune, B, Bayati, M, Becker, J, Bedi, N, Beghi, E, Bejot, Y, Bell, M, Bennitt, F, Bensenor, I, Berhe, K, Berman, A, Bhagavathula, A, Bhageerathy, R, Bhala, N, Bhandari, D, Bhattacharyya, K, Bhutta, Z, Bijani, A, Bikbov, B, Bin Sayeed, M, Biondi, A, Birihane, B, Bisignano, C, Biswas, R, Bitew, H, Bohlouli, S, Bohluli, M, Boon-Dooley, A, Borges, G, Borzi, A, Borzouei, S, Bosetti, C, Boufous, S, Braithwaite, D, Brauer, M, Breitborde, N, Breitner, S, Brenner, H, Briant, P, Briko, A, Briko, N, Britton, G, Bryazka, D, Bumgarner, B, Burkart, K, Burnett, R, Burugina Nagaraja, S, Butt, Z, Caetano Dos Santos, F, Cahill, L, Camera, L, Campos-Nonato, I, Cardenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castaneda-Orjuela, C, Castelpietra, G, Castro, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, K, Charlson, F, Chattu, V, Chaturvedi, S, Cherbuin, N, Chimed-Ochir, O, Cho, D, Choi, J, Christensen, H, Chu, D, Chung, M, Chung, S, Cicuttini, F, Ciobanu, L, Cirillo, M, Classen, T, Cohen, A, Compton, K, Cooper, O, Costa, V, Cousin, E, Cowden, R, Cross, D, Cruz, J, Dahlawi, S, Damasceno, A, Damiani, G, Dandona, L, Dandona, R, Dangel, W, Danielsson, A, Dargan, P, Darwesh, A, Daryani, A, Das, J, Das Gupta, R, das Neves, J, Davila-Cervantes, C, Davitoiu, D, De Leo, D, Degenhardt, L, Delang, M, Dellavalle, R, Demeke, F, Demoz, G, Demsie, D, Denova-Gutierrez, E, Dervenis, N, Dhungana, G, Dianatinasab, M, Dias da Silva, D, Diaz, D, Dibaji Forooshani, Z, Djalalinia, S, Do, H, Dokova, K, Dorostkar, F, Doshmangir, L, Driscoll, T, Duncan, B, Duraes, A, Eagan, A, Edvardsson, D, El Nahas, N, El Sayed, I, El Tantawi, M, Elbarazi, I, Elgendy, I, El-Jaafary, S, Elyazar, I, Emmons-Bell, S, Erskine, H, Eskandarieh, S, Esmaeilnejad, S, Esteghamati, A, Estep, K, Etemadi, A, Etisso, A, Fanzo, J, Farahmand, M, Fareed, M, Faridnia, R, Farioli, A, Faro, A, Faruque, M, Farzadfar, F, Fattahi, N, Fazlzadeh, M, Feigin, V, Feldman, R, Fereshtehnejad, S, Fernandes, E, Ferrara, G, Ferrari, A, Ferreira, M, Filip, I, Fischer, F, Fisher, J, Flor, L, Foigt, N, Folayan, M, Fomenkov, A, Force, L, Foroutan, M, Franklin, R, Freitas, M, Fu, W, Fukumoto, T, Furtado, J, Gad, M, Gakidou, E, Gallus, S, Garcia-Basteiro, A, Gardner, W, Geberemariyam, B, Ayalew Gebreslassie, A, Geremew, A, Gershberg Hayoon, A, Gething, P, Ghadimi, M, Ghadiri, K, Ghaffarifar, F, Ghafourifard, M, Ghamari, F, Ghashghaee, A, Ghiasvand, H, Ghith, N, Gholamian, A, Ghosh, R, Gill, P, Ginindza, T, Giussani, G, Gnedovskaya, E, Goharinezhad, S, Gopalani, S, Gorini, G, Goudarzi, H, Goulart, A, Greaves, F, Grivna, M, Grosso, G, Gubari, M, Gugnani, H, Guimaraes, R, Guled, R, Guo, G, Guo, Y, Gupta, R, Gupta, T, Haddock, B, Hafezi-Nejad, N, Hafiz, A, Haj-Mirzaian, A, Hall, B, Halvaei, I, Hamadeh, R, Hamidi, S, Hammer, M, Hankey, G, Haririan, H, Haro, J, Hasaballah, A, Hasan, M, Hasanpoor, E, Hashi, A, Hassanipour, S, Hassankhani, H, Havmoeller, R, Hay, S, Hayat, K, Heidari, G, Heidari-Soureshjani, R, Henrikson, H, Herbert, M, Herteliu, C, Heydarpour, F, Hird, T, Hoek, H, Holla, R, Hoogar, P, Hosgood, H, Hossain, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Hsairi, M, Hsieh, V, Hu, G, Hu, K, Huda, T, Humayun, A, Huynh, C, Hwang, B, Iannucci, V, Ibitoye, S, Ikeda, N, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Inbaraj, L, Ippolito, H, Iqbal, U, Irvani, S, Irvine, C, Islam, M, Islam, S, Iso, H, Ivers, R, Iwu, C, Iyamu, I, Jaafari, J, Jacobsen, K, Jafari, H, Jafarinia, M, Jahani, M, Jakovljevic, M, Jalilian, F, James, S, Janjani, H, Javaheri, T, Javidnia, J, Jeemon, P, Jenabi, E, Jha, R, Jha, V, Ji, J, Johansson, L, John, O, John-Akinola, Y, Johnson, C, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kabir, A, Kabir, Z, Kalani, H, Kalani, R, Kalankesh, L, Kalhor, R, Kanchan, T, Kapoor, N, Matin, B, Karch, A, Karim, M, Kassa, G, Katikireddi, S, Kayode, G, Kazemi Karyani, A, Keiyoro, P, Keller, C, Kemmer, L, Kendrick, P, Khalid, N, Khammarnia, M, Khan, E, Khan, M, Khatab, K, Khater, M, Khatib, M, Khayamzadeh, M, Khazaei, S, Kieling, C, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kivimaki, M, Knibbs, L, Knudsen, A, Kocarnik, J, Kochhar, S, Kopec, J, Korshunov, V, Koul, P, Koyanagi, A, Kraemer, M, Krishan, K, Krohn, K, Kromhout, H, Kuate Defo, B, Kumar, G, Kumar, V, Kurmi, O, Kusuma, D, La Vecchia, C, Lal, D, Lalloo, R, Lallukka, T, Lami, F, Landires, I, Lang, J, Langan, S, Larsson, A, Lasrado, S, Lauriola, P, Lazarus, J, Lee, P, Lee, S, Legrand, K, Leigh, J, Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Li, S, Lim, L, Linn, S, Liu, S, Liu, Y, Lo, J, Lopez, A, Lopez, J, Lopukhov, P, Lorkowski, S, Lotufo, P, Lu, A, Lugo, A, Maddison, E, Mahasha, P, Mahdavi, M, Mahmoudi, M, Majeed, A, Maleki, A, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manda, A, Manguerra, H, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martin, R, Martini, S, Martins-Melo, F, Masaka, A, Masoumi, S, Mathur, M, Matsushita, K, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Memish, Z, Mendoza, W, Menezes, R, Mengesha, E, Mereke, A, Mereta, S, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Miller, T, Mills, E, Mini, G, Miri, M, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei, R, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020

34. Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population-based cohort study

Author

Kim Moesgaard Iburg, Liselotte Petersen, Preben Bo Mortensen, Katherine L. Musliner, Esben Agerbo, John J. McGrath, Maria K. Christensen, Carsten Bøcker Pedersen, Natalie C. Momen, Harvey Whiteford, Nanna Weye, Oleguer Plana-Ripoll, Bjarni J. Vilhjálmsson, Damian Santomauro, Søren Dalsgaard, and Thomas Munk Laursen

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Mortality rate, Population, Research Reports, medicine.disease, Neuroticism, Comorbidity, 030227 psychiatry, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Mood disorders, Schizophrenia, Life expectancy, Medicine, Pshychiatric Mental Health, business, Psychiatry, education, 030217 neurology & neurosurgery, Cohort study
Abstract

The nature and prevalence of combinations of mental disorders and their associations with premature mortality have never been reported in a comprehensive way. We describe the most common combinations of mental disorders and estimate excess mortality associated with these combinations. We designed a population-based cohort study including all 7,505,576 persons living in Denmark at some point between January 1, 1995 and December 31, 2016. Information on mental disorders and mortality was obtained from national registers. A total of 546,090 individuals (10.5%) living in Denmark on January 1, 1995 were diagnosed with at least one mental disorder during the 22-year follow-up period. The overall crude rate of diagnosis of mental disorders was 9.28 (95% CI: 9.26-9.30) per 1,000 person-years. The rate of diagnosis of additional mental disorders was 70.01 (95% CI: 69.80-70.26) per 1,000 person-years for individuals with one disorder already diagnosed. At the end of follow-up, two out of five individuals with mental disorders were diagnosed with two or more disorder types. The most prevalent were neurotic/stress-related/somatoform disorders (ICD-10 F40-F48) and mood disorders (ICD-10 F30-F39), which - alone or in combination with other disorders - were present in 64.8% of individuals diagnosed with any mental disorder. Mortality rates were higher for people with mental disorders compared to those without mental disorders. The highest mortality rate ratio was 5.97 (95% CI: 5.52-6.45) for the combination of schizophrenia (ICD-10 F20-F29), neurotic/stress-related/somatoform disorders and substance use disorders (ICD-10 F10-F19). Any combination of mental disorders was associated with a shorter life expectancy compared to the general Danish population, with differences in remaining life expectancy ranging from 5.06 years (95% CI: 5.01-5.11) to 17.46 years (95% CI: 16.86-18.03). The largest excess mortality was observed for combinations that included substance use disorders. This study reports novel estimates related to the "force of comorbidity" and provides new insights into the contribution of substance use disorders to premature mortality in those with comorbid mental disorders.

Published
2020

35. Association between Mental Disorders and Subsequent Medical Conditions

Author

Louisa Degenhardt, Terry Stedman, Jean Christophe P.G. Debost, Katherine L. Musliner, Jane Gunn, Sukanta Saha, Michael E. Benros, Anders D. Børglum, Harvey Whiteford, Peter de Jonge, Holger J. Sørensen, Ole Mors, Mogens Vestergaard, Kim Moesgaard Iburg, Oleguer Plana-Ripoll, Bjarni J. Vilhjálmsson, Kate M. Scott, Carmen C.W. Lim, Preben Bo Mortensen, Lars Vedel Kessing, Ronald C. Kessler, Nanna Weye, Andrew J. Schork, Carson Sievert, Morten Fenger-Grøn, Thomas Werge, Carsten Bøcker Pedersen, Natalie C. Momen, Merete Nordentoft, Anders Prior, Annelieke M. Roest, Maria K. Christensen, Søren Dalsgaard, Anette Riisgaard Ribe, Esben Agerbo, Liselotte Petersen, John J. McGrath, Thomas Munk Laursen, APH - Mental Health, and Developmental Psychology

Subjects
Adult, Male, Risk, medicine.medical_specialty, Denmark, Population, DIAGNOSES, Disease, 030204 cardiovascular system & hematology, Article, Cohort Studies, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Sex Factors, Male Urogenital Diseases, PEOPLE, Neoplasms, SCHIZOPHRENIA, medicine, Humans, 030212 general & internal medicine, Musculoskeletal Diseases, Medical diagnosis, education, Psychiatry, Depression (differential diagnoses), REGISTER, RISK, education.field_of_study, business.industry, MORTALITY, Mental Disorders, General Medicine, NATIONWIDE, Middle Aged, DEPRESSION, medicine.disease, Mental health, Female Urogenital Diseases, Schizophrenia, Cardiovascular Diseases, ONSET, Female, HEALTH, business, Cohort study
Abstract

BACKGROUNDPersons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions.METHODSWe used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses.RESULTSA total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder.CONCLUSIONSMost mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753. opens in new tab.) BACKGROUND: Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions.METHODS: We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses.RESULTS: A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder.CONCLUSIONS: Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).

Published
2020

36. Research impact for (mental) health policy

Author

Kristel Alla, Wayne Hall, Carla Meurk, Brian Head, and Harvey Whiteford

Subjects
medicine.medical_specialty, Nursing, Public health, Political science, medicine, Mental health, Health policy
Published
2020

37. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. Undurraga, Oladimeji M. Adebayo, Simon Yadgir, Victor Aboyans, Justin J. Lang, Catherine O. Johnson, Soewarta Kosen, Carla Sofia e.Sá Farinha, Marcos Roberto Tovani-Palone, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Heather Orpana, Samuel B. Albertson, Mahdi Afshari, Nicholas J K Breitborde, Nelson J. Alvis-Zakzuk, Adrian Oţoiu, Iván Landires, Robert G. Weintraub, Kidanemaryam Berhe, André Faro, Sophia Emmons-Bell, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Yordanos Gizachew Yeshitila, Mehdi Hosseinzadeh, Arash Etemadi, Oleguer Plana-Ripoll, Theodore Patrick Younker, Joemer C. Maravilla, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayanaswamy Venketasubramanian, Seyed Mohammad Kazem Aghamir, Linda Morales, Amanda Deen, Noushin Mohammadifard, Obinna Onwujekwe, Ai Koyanagi, Michele Nguyen, Chieh Han, Kiana Ramezanzadeh, Mika Shigematsu, Mohammed Shannawaz, Khurshid Alam, Javad Nazari, Bryan L. Sykes, Rajat Das Gupta, Stephen S Lim, Lingkan Barua, Zubair Kabir, Michael Brauer, Afarin Rahimi-Movaghar, Deepa Jahagirdar, Kaja Abbas, Gholamreza Bazmandegan, Mark A. Stokes, Rajaa Al-Raddadi, Kanyin L. Ong, Kate Causey, Ahmed Omar Bali, Matilde Leonardi, Jeffrey V. Lazarus, Wondimeneh Shibabaw Shiferaw, André Karch, Blair R. Bumgarner, Nelson Alvis-Guzman, Jennifer H MacLachlan, Saeed Amini, Parvaiz A Koul, Blessing J. Akombi, Ro Ting Lin, Dabere Nigatu, Alaa Badawi, Flavia M. Cicuttini, Deanna Anderlini, Claudio Alberto Dávila-Cervantes, Rupert R A Bourne, Tanuj Kanchan, Catherine P. Benziger, Tahiya Alam, M. Mofizul Islam, Muktar Omer Omer, Leila Zaki, Mehdi Mirzaei-Alavijeh, Inbal Salz, Katharine J Looker, Shiwei Liu, Fatemeh Amiri, Christopher R. Cederroth, Mitra Abbasifard, Hamidreza Pazoki Toroudi, Gbenga A. Kayode, Antonio Luiz Pinho Ribeiro, Krishna Kumar Aryal, Mu'awiyyah Babale Sufiyan, Mohamed M. Gad, Assefa Desalew, Lidia Morawska, Davood Anvari, Mohammad Reza Salahshoor, Hadi Pourjafar, Abdu A. Adamu, Maryam Adabi, Zulfiqar A. Bhutta, Jessica A. Cruz, Foad Abd-Allah, Amir Hasanzadeh, Jordan Weiss, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Joanna L Whisnant, Kelly Compton, Priya Parmar, Sanjay Basu, Leila R Kalankesh, Nickolas Reinig, Ana Maria Mantilla Herrera, Fatemeh Rajati, Damian Santomauro, Mojisola Oluwasanu, Sheikh Mohammed Shariful Islam, David M. Pereira, Joht Singh Chandan, Deepak Kumar Pasupula, Aristidis Tsatsakis, Hoa Thi Do, Whitney L. Teagle, Hans W. Hoek, James Leigh, Morteza Arab-Zozani, Yasser Vasseghian, Stephanie R M Zimsen, Charlie Ashbaugh, Fariba Dorostkar, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Golnaz Heidari, Kala M. Mehta, Saeed Shahabi, Sarah Wulf Hanson, Nizal Sarrafzadegan, Dharmesh Kumar Lal, Hai Quang Pham, Aleksandr Y. Aravkin, Joshua A. Salomon, David C. Schwebel, Milena Ilic, Kareha M Agesa, Jost B. Jonas, Dian Kusuma, Benjamin B. Massenburg, Santosh Varughese, Yousef Mohammad, Beatriz Paulina Ayala Quintanilla, Mihaela Hostiuc, Richard G. Cowden, Morteza Shamsizadeh, Thomas Pilgrim, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Saravanan Muthupandian, Zahra Sadat Dibaji Forooshani, Maryam Mirzaei, Zabihollah Yousefi, Shadrach Wilson, Iman El Sayed, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Eirini Skiadaresi, Reza Shirkoohi, Tim Driscoll, Morteza Jafarinia, Maha El Tantawi, Telma Zahirian Moghadam, Katarzyna Kissimova-Skarbek, Abdilahi Yousuf Yousuf, Dickson A. Amugsi, Awoke Misganaw, Maseer Khan, Norito Kawakami, Jingkai Wei, Jai K Das, Vishnu Renjith, Tessa M. Pilz, Sameer Vali Gopalani, Roghiyeh Faridnia, Islam Y. Elgendy, Prateek Rastogi, Lauren B. Wilner, Josep Maria Haro, Zahiruddin Quazi Syed, Ben Lacey, Ketema Bizuwork Gebremedhin, Sam Rolfe, Iffat Elbarazi, Yannick Béjot, Raimundas Lunevicius, Sezer Kisa, Harish Chander Gugnani, Basema Saddik, Manu Raj Mathur, Mansour Ghafourifard, Riaz Uddin, Anna Poznańska, Faris Lami, Niguse Meles Alema, Michael T. Chung, Arya Aminorroaya, Arash Sarveazad, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, João M. Furtado, Hamid Ahmadieh, Sara Conti, Yunquan Zhang, Manthan D Janodia, Aislyn U. Orji, S. Mohammad Sajadi, Jalal Arabloo, Gabrielle B. Britton, Colm McAlinden, Francisco Rogerlândio Martins-Melo, Simona Cătălina Ştefan, Ester Cerin, Nuno Taveira, Lars Jacob Stovner, Amir Taherkhani, Masoud Foroutan, Tomasz Miazgowski, Amir Manafi, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Man Mohan Mehndiratta, Graeme J. Hankey, Mojgan Gitimoghaddam, Chantal Huynh, G Anil Kumar, Martin Amogre Ayanore, Abbas Sheikhtaheri, Turki Alanzi, Simon Øverland, David Laith Rawaf, Brian J. Hall, Edward J Mills, Ali Kabir, Ravi Prakash Jha, Akbar Barzegar, Simin Mouodi, Alize J. Ferrari, Chirag P. Doshi, Saleh Salehi Zahabi, Mohsen Naghavi, Mohammad Hassan Emamian, Amir Jalali, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Maarten J. Postma, David Edvardsson, Chhabi Lal Ranabhat, Catherine M. Antony, Hannah Han, Ken Lee Chin, Getinet Ayano, Kewal Krishan, Maryam Zamanian, Farshad Farzadfar, Ali A. Asadi-Pooya, Daniel Diaz, Oliver J. Brady, Mohsen Bayati, Christopher M Odell, Jalil Jaafari, Walter Mendoza, Susanna Dunachie, Raffaele Palladino, Raaj Kishore Biswas, Alessandra Lugo, Reshmi Bhageerathy, Paulo A. Lotufo, Maia Kereselidze, Salman Rawaf, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Mahesh P A, Harvey Whiteford, Gina Agarwal, Pallab K. Maulik, Ranjitha S Shetty, Adhanom Gebreegziabher Baraki, Prasanna Mithra, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Razique Anwer, Marcello Tonelli, Hanne Christensen, Juan Jesus Carrero, Ali H. Mokdad, Alberto Ortiz, Samad Azari, Ted R. Miller, Rebecca Ivers, Stephen R. Robinson, Saeid Safiri, Masood Ali Shaikh, Rajesh Sagar, Kelly Cercy, Mehran Asadi-Aliabadi, João Vasco Santos, Maziar Moradi-Lakeh, Sarah Lewington, Dimas Ria Angga Pribadi, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Burcu Kucuk Bicer, Praveen Hoogar, Fatemeh Heydarpour, Hala Rashad Elhabashy, Peng Zheng, Senthilkumar Balakrishnan, Paul H. Lee, Cameron J. Kneib, Srinivasa Rao Bolla, Harrison Chase Gottlich, Andrew M. Briggs, Alibek Mereke, Om P Kurmi, Kavumpurathu Raman Thankappan, Nikolay Ivanovich Briko, Shahram Saeidi, Anbissa Muleta Senbeta, Assefa Ayalew Ayalew Ayalew Gebreslassie, Aminu K. Bello, Tomi Akinyemiju, Ambrish Singh, Anamika Pandey, Matthew Cunningham, Endalkachew Worku Mengesha, Christine Linehan, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Stanislav S. Otstavnov, Andre M. N. Renzaho, Dinesh Bhandari, Masoud Moghadaszadeh, Atkilt Esaiyas Etisso, Valery L. Feigin, Christopher J L Murray, James D. Harvey, Daniel Cury Ribeiro, Girikumar Kumaresh, Javad Yoosefi Lebni, Elisabetta Pupillo, Shaimaa I. El-Jaafary, Marlena S Bannick, Caitlyn Steiner, Agus Sudaryanto, Eduardo Bernabé, Fereshteh Mehri, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Shaun Roberts, Rajeev Gupta, Jamal A. Yearwood, Nima Rezaei, Muhammad Shahdaat Bin Sayeed, David M. Pigott, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Pankaj Bhardwaj, Suzanne Lyn Barker-Collo, Fiona J Charlson, Norberto Perico, Jonathan M. Kocarnik, Sergio I. Prada, Mohammad Sadegh Rezai, Mustafa Z. Younis, Neeraj Bhala, Mahmoud Yousefifard, Hue Thi Mai, Marwa Rashad Salem, Reza Pourmirza Kalhori, Carl Abelardo T. Antonio, Stefan Lorkowski, Farzad Jalilian, Nicholas J Kassebaum, Haley Lescinsky, Gholamreza Roshandel, Reza Heidari-Soureshjani, Kirsten E. Wiens, Ionut Negoi, Bhaskaran Unnikrishnan, Daniel J. Weiss, Sare Safi, Hamid Reza Tohidinik, Fablina Sharara, François Alla, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Jack T Fox, Amirhossein Sahebkar, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Firooz Esmaeilzadeh, Brittney S. Sheena, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Morteza Abdullatif Khafaie, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, George C. Patton, Rashid Abdi Guled, Tim C.D. Lucas, Alberto Raggi, Peter W. Gething, Mohaimenul Islam, Abdallah M. Samy, Cuong Tat Nguyen, Kaleab Alemayehu Zewdie, Ahamarshan Jayaraman Nagarajan, Roman Topor-Madry, C. E. G. Brayne, Phoebe Anne Rhinehart, Isabela M. Benseñor, Michal Grivna, Taren M. Gorman, Natalie C. Momen, Afsaneh Arzani, Tufa Kolola, Maryam Khayamzadeh, Alexandra S. Boon-Dooley, Ihoghosa Osamuyi Iyamu, Nima Hafezi-Nejad, Hassan Abolhassani, Perminder S. Sachdev, Vivek Kumar, Anton Sokhan, Mahmood Moosazadeh, Davoud Adham, Ahad Bakhtiari, Nataliya A. Foigt, Venkatesh Maled, Henok Biresaw Netsere, Seyedeh Zahra Masoumi, Ashley Marks, Rizwan Kalani, Soraya Siabani, Jiayu Wang, Samath Dhamminda Dharmaratne, Lucas Guimarães Abreu, Vivian Chia-Rong Hsieh, Kris J. Krohn, Falk Schwendicke, Alex R. Chang, Muhammad Ali, Christine Lin, Rose G Bender, Arielle Wilder Eagan, Tissa Wijeratne, Chris D Castle, Saif Ullah, Nikolaos Dervenis, Joan B. Soriano, Syed Amir Gilani, Jianing Ma, Giuseppe Remuzzi, Dana Bryazka, Christian Razo, Manuela L. Ferreira, Ankur Joshi, Alireza Rafiei, Vinay Nangia, Victor Adekanmbi, Frances E. Dean, Chuanhua Yu, Elizabeth A. Cromwell, Pascual R. Valdez, Jennifer Rickard, Daniel Youngwhan Cho, Ashish Pathak, Angel Paternina-Caicedo, Mehdi Ahmadi, Zichen Liu, Achala Upendra Jayatilleke, Diego De Leo, Sarah Charlotte Johnson, Getenet Dessie, Zhi Jiang Zhang, Christopher S. Crowe, Farhad Ghamari, Behshad Naghshtabrizi, Francesco Saverio Violante, Muhammad Aziz Rahman, Ramesh Holla, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Shivanthi Balalla, Molly H Biehl, Mostafa Dianatinasab, Mina Anjomshoa, Abdel Douiri, Laith J. Abu-Raddad, Rade Vukovic, Amiran Gamkrelidze, Michael R. Phillips, Yafeng Wang, Sachin R Atre, Miriam Levi, Zelalem Nigussie Azene, Kevan R. Polkinghorne, Deepak Paudel, Hung Chun Liu, Zainab Samad, Robert P. Dellavalle, Florentino Luciano Caetano dos Santos, Juan Sanabria, Mohammad Fareed, Enrico Rubagotti, Samantha Leigh Larson, Anurag Agrawal, Shai Linn, Saad M.A. Dahlawi, Janni Leung, Shokofeh Maleki, Michael R.M. Abrigo, Michael Kravchenko, Mohd Anisul Karim, Alyssa N. Sbarra, Jacob L. Stubbs, Timothy J. Steiner, Helena Manguerra, Olatunji O. Adetokunboh, Amira Shaheen, Stein Emil Vollset, Yared Asmare Aynalem, Rajan Nikbakhsh, Ilana N. Ackerman, Srinivasa Vittal Katikireddi, Davide Rasella, Hedayat Abbastabar, Floriane Ausloos, Nauman Khalid, Ewerton Cousin, Nermin Ghith, Nebiyu Dereje Dereje, Rakhi Dandona, Mojtaba Bagherzadeh, Ahmed Abdelalim, Benn Sartorius, Giulio Castelpietra, Masih Tajdini, Stefanos Tyrovolas, Akram Pourshams, Ritesh G. Menezes, Eve E. Wool, Mohamed Hsairi, Alberto L. García-Basteiro, Lorainne Tudor Car, Rachelle Buchbinder, Franz Castro, Samiah Alam, Iman Ansari, Ahmed I. Hasaballah, Sanni Yaya, Silvia Schiavolin, Reza Mohammadpourhodki, Khalid A Altirkawi, Marco Vacante, Jacek A. Kopec, Archith Boloor, Simon I. Hay, Mathilde Touvier, Ensiyeh Jenabi, Deborah Carvalho Malta, Scott B. Patten, Arash Ziapour, Carlo La Vecchia, Seyed Sina Naghibi Irvani, Thomas Truelsen, Houman Goudarzi, Ryan Fitzgerald, Di H. Cross, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Iqbal R. F. Elyazar, Alexandrea Watson, Bo Norrving, Kerem Shuval, Chidozie Declan Iwu, Jasvinder A. Singh, Bárbara Niegia Garcia Goulart, Shirin Djalalinia, Marisa Freitas, Feleke Mekonnen Demeke, Hiroyasu Iso, Hussain Jafari, Lee Ling Lim, Roman V. Polibin, Charles D.A. Wolfe, Ulrich O Mueller, Luis Camera, Fabiana Madotto, Gregory A. Roth, Nevine El Nahas, Paul S. F. Yip, Miguel A Barboza, Anna E. Torre, Ali Rajabpour-Sanati, Hailey Hagins, Tauseef Ahmad, Platon D. Lopukhov, Giovanni Damiani, Mohammad Hossein Bakhshaei, Hirut Teame, Silvano Gallus, Tudorel Andrei, Suzanne H. Keddie, Madgalene K. Walters, Mohammad Abdollahi, Temesgen Yihunie Akalu, Catherine Bisignano, Iyad Sultan, Ira Martopullo, Emma L. Collins, Spencer L. James, Rasmus Havmoeller, Alireza Esteghamati, Seok Jun Yoon, Paramjit Gill, Maryam Hashemian, Klara Dokova, Weijia Fu, Anna Gershberg Hayoon, Kathryn H. Jacobsen, Zohra S Lassi, Morenike Oluwatoyin Folayan, Sanjeev Nair, Phetole Walter Mahasha, Shelly Balassyano, Giulia Carreras, Ruxandra Irina Negoi, Reinhard Busse, Takeshi Fukumoto, Abdullah Al Mamun, Sarika Chaturvedi, Stefania Mondello, Christoph Nowak, Vijay Kumar Chattu, Efat Mohamadi, Mohammad Ebrahimi Kalan, Paul S Briant, M Alijanzadeh, Giuseppe Gorini, Berhane Fseha Teklehaimanot, Jacqueline Elizabeth Alcalde-Rabanal, Katya Anne Shackelford, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Minh Nguyen, Payman Salamati, Itamar S. Santos, Bach Xuan Tran, Lal B. Rawal, Louisa Degenhardt, Dietrich Plass, Jacob Olusegun Olusanya, José Neves, Kazumasa Yamagishi, Mona M. Khater, Alyssa Pennini, Ehsan Sadeghi, Salah Eddin Karimi, Ravensara S. Travillian, Alexander C. Tsai, Emilie E. Agardh, Rahmatollah Moradzadeh, Hamed Zandian, Zahid A Butt, Subramanian Senthilkumaran, Ai-Min Wu, Bing Fang Hwang, Sadaf G. Sepanlou, Jeff T. Zhao, Paolo Cortesi, Giorgia Giussani, Gregory J. Bertolacci, Andrew T Olagunju, Søren Thorgaard Skou, Peter Allebeck, Benjamin C Cowie, Aso Mohammad Darwesh, In-Hwan Oh, Erin B. Hamilton, Puja C Rao, Vinod C Nayak, Carla Fornari, Khezar Hayat, Rannveig Sigurvinsdottir, Emmanuel Peprah, Oommen John, Sonyah Terrason, Mohammed Ibrahim Mohialdeen Gubari, Sojib Bin Zaman, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Celine M. Barthelemy, Nicholas L S Roberts, Jagadish Rao Padubidri, Navid Rabiee, Alireza Ghajar, Mark G. Shrime, Hamed Kalani, Mayowa O. Owolabi, Lisa M. Force, Irina Filip, Jacek Jerzy Jozwiak, Gelin Xu, Thomas R. Hird, Kara Estep, Mohammad Zamani, Lalit Dandona, João Massano, Antonio Maria Borzì, Masoud Moradi, Molly R Nixon, Delia Hendrie, Mostafa Amini-Rarani, Mikhail Sergeevich Zastrozhin, Rachel Feldman, Emmanuel Wandera Okunga, Bruce Bartholow Duncan, Nazir Fattahi, Joshua R. Ehrlich, Adnan Kisa, Ghasem Azarian, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Roderick J. Hay, Johan Ärnlöv, Liliana G Ciobanu, Claudiu Herteliu, Andreea Mirica, Sofia Boston Redford, Wahengbam Bigyananda Meitei, Jae Il Shin, Kanaan Hamagharib Abdullah, Abhijit Pakhare, Santosh Kumar Tadakamadla, Rixing Xu, Jonathan F. Mosser, Meresa Berwo Mengesha, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Jaimie D. Adelson, Felix Akpojene Ogbo, Alireza Vakilian, Mihajlo Jakovljevic, Ali S. Shalash, Vos, T, Lim, S, Abbafati, C, Abbas, K, Abbasi, M, Abbasifard, M, Abbasi-Kangevari, M, Abbastabar, H, Abd-Allah, F, Abdelalim, A, Abdollahi, M, Abdollahpour, I, Abolhassani, H, Aboyans, V, Abrams, E, Abreu, L, Abrigo, M, Abu-Raddad, L, Abushouk, A, Acebedo, A, Ackerman, I, Adabi, M, Adamu, A, Adebayo, O, Adekanmbi, V, Adelson, J, Adetokunboh, O, Adham, D, Afshari, M, Afshin, A, Agardh, E, Agarwal, G, Agesa, K, Aghaali, M, Aghamir, S, Agrawal, A, Ahmad, T, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmadpour, E, Akalu, T, Akinyemi, R, Akinyemiju, T, Akombi, B, Al-Aly, Z, Alam, K, Alam, N, Alam, S, Alam, T, Alanzi, T, Albertson, S, Alcalde-Rabanal, J, Alema, N, Ali, M, Ali, S, Alicandro, G, Alijanzadeh, M, Alinia, C, Alipour, V, Aljunid, S, Alla, F, Allebeck, P, Almasi-Hashiani, A, Alonso, J, Al-Raddadi, R, Altirkawi, K, Alvis-Guzman, N, Alvis-Zakzuk, N, Amini, S, Amini-Rarani, M, Aminorroaya, A, Amiri, F, Amit, A, Amugsi, D, Amul, G, Anderlini, D, Andrei, C, Andrei, T, Anjomshoa, M, Ansari, F, Ansari, I, Ansari-Moghaddam, A, Antonio, C, Antony, C, Antriyandarti, E, Anvari, D, Anwer, R, Arabloo, J, Arab-Zozani, M, Aravkin, A, Ariani, F, Arnlov, J, Aryal, K, Arzani, A, Asadi-Aliabadi, M, Asadi-Pooya, A, Asghari, B, Ashbaugh, C, Atnafu, D, Atre, S, Ausloos, F, Ausloos, M, Ayala Quintanilla, B, Ayano, G, Ayanore, M, Aynalem, Y, Azari, S, Azarian, G, Azene, Z, Babaee, E, Badawi, A, Bagherzadeh, M, Bakhshaei, M, Bakhtiari, A, Balakrishnan, S, Balalla, S, Balassyano, S, Banach, M, Banik, P, Bannick, M, Bante, A, Baraki, A, Barboza, M, Barker-Collo, S, Barthelemy, C, Barua, L, Barzegar, A, Basu, S, Baune, B, Bayati, M, Bazmandegan, G, Bedi, N, Beghi, E, Bejot, Y, Bello, A, Bender, R, Bennett, D, Bennitt, F, Bensenor, I, Benziger, C, Berhe, K, Bernabe, E, Bertolacci, G, Bhageerathy, R, Bhala, N, Bhandari, D, Bhardwaj, P, Bhattacharyya, K, Bhutta, Z, Bibi, S, Biehl, M, Bikbov, B, Bin Sayeed, M, Biondi, A, Birihane, B, Bisanzio, D, Bisignano, C, Biswas, R, Bohlouli, S, Bohluli, M, Bolla, S, Boloor, A, Boon-Dooley, A, Borges, G, Borzi, A, Bourne, R, Brady, O, Brauer, M, Brayne, C, Breitborde, N, Brenner, H, Briant, P, Briggs, A, Briko, N, Britton, G, Bryazka, D, Buchbinder, R, Bumgarner, B, Busse, R, Butt, Z, Caetano dos Santos, F, Camera, L, Campos-Nonato, I, Car, J, Cardenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castaneda-Orjuela, C, Castelpietra, G, Castle, C, Castro, F, Catala-Lopez, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, A, Charlson, F, Chattu, V, Chaturvedi, S, Chimed-Ochir, O, Chin, K, Cho, D, Christensen, H, Chu, D, Chung, M, Cicuttini, F, Ciobanu, L, Cirillo, M, Collins, E, Compton, K, Conti, S, Cortesi, P, Costa, V, Cousin, E, Cowden, R, Cowie, B, Cromwell, E, Cross, D, Crowe, C, Cruz, J, Cunningham, M, Dahlawi, S, Damiani, G, Dandona, L, Dandona, R, Darwesh, A, Daryani, A, Das, J, Das Gupta, R, das Neves, J, Davila-Cervantes, C, Davletov, K, De Leo, D, Dean, F, Decleene, N, Deen, A, Degenhardt, L, Dellavalle, R, Demeke, F, Demsie, D, Denova-Gutierrez, E, Dereje, N, Dervenis, N, Desai, R, Desalew, A, Dessie, G, Dharmaratne, S, Dhungana, G, Dianatinasab, M, Diaz, D, Dibaji Forooshani, Z, Dingels, Z, Dirac, M, Djalalinia, S, Do, H, Dokova, K, Dorostkar, F, Doshi, C, Doshmangir, L, Douiri, A, Doxey, M, Driscoll, T, Dunachie, S, Duncan, B, Duraes, A, Eagan, A, Ebrahimi Kalan, M, Edvardsson, D, Ehrlich, J, El Nahas, N, El Sayed, I, El Tantawi, M, Elbarazi, I, Elgendy, I, Elhabashy, H, El-Jaafary, S, Elyazar, I, Emamian, M, Emmons-Bell, S, Erskine, H, Eshrati, B, Eskandarieh, S, Esmaeilnejad, S, Esmaeilzadeh, F, Esteghamati, A, Estep, K, Etemadi, A, Etisso, A, Farahmand, M, Faraj, A, Fareed, M, Faridnia, R, Farinha, C, Farioli, A, Faro, A, Faruque, M, Farzadfar, F, Fattahi, N, Fazlzadeh, M, Feigin, V, Feldman, R, Fereshtehnejad, S, Fernandes, E, Ferrari, A, Ferreira, M, Filip, I, Fischer, F, Fisher, J, Fitzgerald, R, Flohr, C, Flor, L, Foigt, N, Folayan, M, Force, L, Fornari, C, Foroutan, M, Fox, J, Freitas, M, Fu, W, Fukumoto, T, Furtado, J, Gad, M, Gakidou, E, Galles, N, Gallus, S, Gamkrelidze, A, Garcia-Basteiro, A, Gardner, W, Geberemariyam, B, Gebrehiwot, A, Gebremedhin, K, Gebreslassie, A, Gershberg Hayoon, A, Gething, P, Ghadimi, M, Ghadiri, K, Ghafourifard, M, Ghajar, A, Ghamari, F, Ghashghaee, A, Ghiasvand, H, Ghith, N, Gholamian, A, Gilani, S, Gill, P, Gitimoghaddam, M, Giussani, G, Goli, S, Gomez, R, Gopalani, S, Gorini, G, Gorman, T, Gottlich, H, Goudarzi, H, Goulart, A, Goulart, B, Grada, A, Grivna, M, Grosso, G, Gubari, M, Gugnani, H, Guimaraes, A, Guimaraes, R, Guled, R, Guo, G, Guo, Y, Gupta, R, Haagsma, J, Haddock, B, Hafezi-Nejad, N, Hafiz, A, Hagins, H, Haile, L, Hall, B, Halvaei, I, Hamadeh, R, Hamagharib Abdullah, K, Hamilton, E, Han, C, Han, H, Hankey, G, Haro, J, Harvey, J, Hasaballah, A, Hasanzadeh, A, Hashemian, M, Hassanipour, S, Hassankhani, H, Havmoeller, R, Hay, R, Hay, S, Hayat, K, Heidari, B, Heidari, G, Heidari-Soureshjani, R, Hendrie, D, Henrikson, H, Henry, N, Herteliu, C, Heydarpour, F, Hird, T, Hoek, H, Hole, M, Holla, R, Hoogar, P, Hosgood, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Hoy, D, Hsairi, M, Hsieh, V, Hu, G, Huda, T, Hugo, F, Huynh, C, Hwang, B, Iannucci, V, Ibitoye, S, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Inbaraj, L, Ippolito, H, Irvani, S, Islam, M, Islam, S, Islami, F, Iso, H, Ivers, R, Iwu, C, Iyamu, I, Jaafari, J, Jacobsen, K, Jadidi-Niaragh, F, Jafari, H, Jafarinia, M, Jahagirdar, D, Jahani, M, Jahanmehr, N, Jakovljevic, M, Jalali, A, Jalilian, F, James, S, Janjani, H, Janodia, M, Jayatilleke, A, Jeemon, P, Jenabi, E, Jha, R, Jha, V, Ji, J, Jia, P, John, O, John-Akinola, Y, Johnson, C, Johnson, S, Jonas, J, Joo, T, Joshi, A, Jozwiak, J, Jurisson, M, Kabir, A, Kabir, Z, Kalani, H, Kalani, R, Kalankesh, L, Kalhor, R, Kamiab, Z, Kanchan, T, Karami Matin, B, Karch, A, Karim, M, Karimi, S, Kassa, G, Kassebaum, N, Katikireddi, S, Kawakami, N, Kayode, G, Keddie, S, Keller, C, Kereselidze, M, Khafaie, M, Khalid, N, Khan, M, Khatab, K, Khater, M, Khatib, M, Khayamzadeh, M, Khodayari, M, Khundkar, R, Kianipour, N, Kieling, C, Kim, D, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kissimova-Skarbek, K, Kivimaki, M, Kneib, C, Knudsen, A, Kocarnik, J, Kolola, T, Kopec, J, Kosen, S, Koul, P, Koyanagi, A, Kravchenko, M, Krishan, K, Krohn, K, Kuate Defo, B, Kucuk Bicer, B, Kumar, G, Kumar, M, Kumar, P, Kumar, V, Kumaresh, G, Kurmi, O, Kusuma, D, Kyu, H, La Vecchia, C, Lacey, B, Lal, D, Lalloo, R, Lam, J, Lami, F, Landires, I, Lang, J, Lansingh, V, Larson, S, Larsson, A, Lasrado, S, Lassi, Z, Lau, K, Lavados, P, Lazarus, J, Ledesma, J, Lee, P, Lee, S, Legrand, K, Leigh, J, Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Lewington, S, Li, S, Lim, L, Lin, C, Lin, R, Linehan, C, Linn, S, Liu, H, Liu, S, Liu, Z, Looker, K, Lopez, A, Lopukhov, P, Lorkowski, S, Lotufo, P, Lucas, T, Lugo, A, Lunevicius, R, Lyons, R, Ma, J, Maclachlan, J, Maddison, E, Maddison, R, Madotto, F, Mahasha, P, Mai, H, Majeed, A, Maled, V, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manafi, A, Manafi, N, Manguerra, H, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martins-Melo, F, Martopullo, I, Masoumi, S, Massano, J, Massenburg, B, Mathur, M, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Meitei, W, Memiah, P, Mendoza, W, Menezes, R, Mengesha, E, Mengesha, M, Mereke, A, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Mihretie, K, Miller, T, Mills, E, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohamadi, E, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, S, Mokdad, A, Molokhia, M, Momen, N, Monasta, L, Mondello, S, Mooney, M, Moosazadeh, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morales, L, Morawska, L, Moreno Velasquez, I, Morgado-da-Costa, J, Morrison, S, Mosser, J, Mouodi, S, Mousavi, S, Mousavi Khaneghah, A, Mueller, U, Munro, S, Muriithi, M, Musa, K, Muthupandian, S, Naderi, M, Nagarajan, A, Nagel, G, Naghshtabrizi, B, Nair, S, Nandi, A, Nangia, V, Nansseu, J, Nayak, V, Nazari, J, Negoi, I, Negoi, R, Netsere, H, Ngunjiri, J, Nguyen, C, Nguyen, J, Nguyen, M, Nichols, E, Nigatu, D, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Otoiu, A, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Oluwasanu, M, Omar Bali, A, Omer, M, Ong, K, Onwujekwe, O, Orji, A, Orpana, H, Ortiz, A, Ostroff, S, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, P A, M, Padubidri, J, Pakhare, A, Palladino, R, Pana, A, Panda-Jonas, S, Pandey, A, Park, E, Parmar, P, Pasupula, D, Patel, S, Paternina-Caicedo, A, Pathak, A, Pathak, M, Patten, S, Patton, G, Paudel, D, Pazoki Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, A, Pereira, D, Perico, N, Pham, H, Phillips, M, Pigott, D, Pilgrim, T, Pilz, T, Pirsaheb, M, Plana-Ripoll, O, Plass, D, Pokhrel, K, Polibin, R, Polinder, S, Polkinghorne, K, Postma, M, Pourjafar, H, Pourmalek, F, Pourmirza Kalhori, R, Pourshams, A, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Quazi Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Rafiei, A, Raggi, A, Rahimi-Movaghar, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rasella, D, Rastogi, P, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Razo, C, Redford, S, Reiner, R, Reinig, N, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezai, M, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, A, Ribeiro, D, Rickard, J, Roberts, N, Roberts, S, Robinson, S, Roever, L, Rolfe, S, Ronfani, L, Roshandel, G, Roth, G, Rubagotti, E, Rumisha, S, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeidi, S, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sahraian, M, Sajadi, S, Salahshoor, M, Salamati, P, Salehi Zahabi, S, Salem, H, Salem, M, Salimzadeh, H, Salomon, J, Salz, I, Samad, Z, Samy, A, Sanabria, J, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sartorius, B, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Sbarra, A, Schaeffer, L, Schiavolin, S, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Shackelford, K, Shadid, J, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Shannawaz, M, Sharafi, K, Sharara, F, Sheena, B, Sheikhtaheri, A, Shetty, R, Shibuya, K, Shiferaw, W, Shigematsu, M, Shin, J, Shiri, R, Shirkoohi, R, Shrime, M, Shuval, K, Siabani, S, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, A, Singh, J, Skiadaresi, E, Skou, S, Skryabin, V, Sobngwi, E, Sokhan, A, Soltani, S, Sorensen, R, Soriano, J, Sorrie, M, Soyiri, I, Sreeramareddy, C, Stanaway, J, Stark, B, Stefan, S, Stein, C, Steiner, C, Steiner, T, Stokes, M, Stovner, L, Stubbs, J, Sudaryanto, A, Sufiyan, M, Sulo, G, Sultan, I, Sykes, B, Sylte, D, Szocska, M, Tabares-Seisdedos, R, Tabb, K, Tadakamadla, S, Taherkhani, A, Tajdini, M, Takahashi, K, Taveira, N, Teagle, W, Teame, H, Tehrani-Banihashemi, A, Teklehaimanot, B, Terrason, S, Tessema, Z, Thankappan, K, Thomson, A, Tohidinik, H, Tonelli, M, Topor-Madry, R, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Troeger, C, Truelsen, T, Tsai, A, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Ullah, S, Undurraga, E, Unnikrishnan, B, Vacante, M, Vakilian, A, Valdez, P, Varughese, S, Vasankari, T, Vasseghian, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vongpradith, A, Vukovic, A, Vukovic, R, Waheed, Y, Walters, M, Wang, J, Wang, Y, Ward, J, Watson, A, Wei, J, Weintraub, R, Weiss, D, Weiss, J, Westerman, R, Whisnant, J, Whiteford, H, Wiangkham, T, Wiens, K, Wijeratne, T, Wilner, L, Wilson, S, Wojtyniak, B, Wolfe, C, Wool, E, Wu, A, Wulf Hanson, S, Wunrow, H, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yearwood, J, Yeheyis, T, Yeshitila, Y, Yip, P, Yonemoto, N, Yoon, S, Yoosefi Lebni, J, Younis, M, Younker, T, Yousefi, Z, Yousefifard, M, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Zahirian Moghadam, T, Zaki, L, Zaman, S, Zamani, M, Zamanian, M, Zandian, H, Zangeneh, A, Zastrozhin, M, Zewdie, K, Zhang, Y, Zhang, Z, Zhao, J, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Naghavi, M, Murray, C, Vos, Theo, S Lim, Stephen, Abbafati, Cristiana, M Abbas, Kaja, Abbasi, Mohammad, Abbasifard, Mitra, Abbasi-Kangevari, Mohsen, Abbastabar, Hedayat, Abd-Allah, Foad, Abdelalim, Ahmed, Abdollahi, Mohammad, Abdollahpour, Ibrahim, Abolhassani, Hassan, Aboyans, Victor, M Abrams, Elissa, Guimarães Abreu, Luca, M Abrigo, Michael R, Jamal Abu-Raddad, Laith, I Abushouk, Abdelrahman, Acebedo, Alyssa, N Ackerman, Ilana, Adabi, Maryam, A Adamu, Abdu, M Adebayo, Oladimeji, Adekanmbi, Victor, D Adelson, Jaimie, O Adetokunboh, Olatunji, Adham, Davoud, Afshari, Mahdi, Afshin, Ashkan, E Agardh, Emilie, Agarwal, Gina, M Agesa, Kareha, Aghaali, Mohammad, Mohammad Kazem Aghamir, Seyed, Agrawal, Anurag, Ahmad, Tauseef, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmadpour, Ehsan, Yihunie Akalu, Temesgen, Olusola Akinyemi, Rufu, Akinyemiju, Tomi, Akombi, Blessing, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Samiah, Alam, Tahiya, M Alanzi, Turki, B Albertson, Samuel, Elizabeth Alcalde-Rabanal, Jacqueline, Meles Alema, Niguse, Ali, Muhammad, Ali, Saqib, Alicandro, Gianfranco, Alijanzadeh, Mehran, Alinia, Cyru, Alipour, Vahid, Mohamed Aljunid, Syed, Alla, Françoi, Allebeck, Peter, Almasi-Hashiani, Amir, Alonso, Jordi, M Al-Raddadi, Rajaa, A Altirkawi, Khalid, Alvis-Guzman, Nelson, J Alvis-Zakzuk, Nelson, Amini, Saeed, Amini-Rarani, Mostafa, Aminorroaya, Arya, Amiri, Fatemeh, L Amit, Arianna Maever, A Amugsi, Dickson, Gayle Herrera Amul, Gianna, Anderlini, Deanna, Liliana Andrei, Catalina, Andrei, Tudorel, Anjomshoa, Mina, Ansari, Fereshteh, Ansari, Iman, Ansari-Moghaddam, Alireza, T Antonio, Carl Abelardo, M Antony, Catherine, Antriyandarti, Ernoiz, Anvari, Davood, Anwer, Razique, Arabloo, Jalal, Arab-Zozani, Morteza, Y Aravkin, Aleksandr, Ariani, Filippo, Ärnlöv, Johan, K Aryal, Krishna, Arzani, Afsaneh, Asadi-Aliabadi, Mehran, A Asadi-Pooya, Ali, Asghari, Babak, Ashbaugh, Charlie, Debalkie Atnafu, Desta, R Atre, Sachin, Ausloos, Floriane, Ausloos, Marcel, Paulina Ayala Quintanilla, Beatriz, Ayano, Getinet, Amogre Ayanore, Martin, Asmare Aynalem, Yared, Azari, Samad, Azarian, Ghasem, Nigussie Azene, Zelalem, Babaee, Ebrahim, Badawi, Alaa, Bagherzadeh, Mojtaba, Hossein Bakhshaei, Mohammad, Bakhtiari, Ahad, Balakrishnan, Senthilkumar, Balalla, Shivanthi, Balassyano, Shelly, Banach, Maciej, Chandra Banik, Palash, S Bannick, Marlena, Bante Bante, Agegnehu, Gebreegziabher Baraki, Adhanom, A Barboza, Miguel, Lyn Barker-Collo, Suzanne, M Barthelemy, Celine, Barua, Lingkan, Barzegar, Akbar, Basu, Sanjay, T Baune, Bernhard, Bayati, Mohsen, Bazmandegan, Gholamreza, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, K Bello, Aminu, G Bender, Rose, A Bennett, Derrick, B Bennitt, Fiona, M Bensenor, Isabela, P Benziger, Catherine, Berhe, Kidanemaryam, Bernabe, Eduardo, J Bertolacci, Gregory, Bhageerathy, Reshmi, Bhala, Neeraj, Bhandari, Dinesh, Bhardwaj, Pankaj, Bhattacharyya, Krittika, A Bhutta, Zulfiqar, Bibi, Sadia, H Biehl, Molly, Bikbov, Bori, Shahdaat Bin Sayeed, Muhammad, Biondi, Antonio, Minuye Birihane, Binyam, Bisanzio, Donal, Bisignano, Catherine, Kishore Biswas, Raaj, Bohlouli, Somayeh, Bohluli, Mehdi, Rao Rao Bolla, Srinivasa, Boloor, Archith, S Boon-Dooley, Alexandra, Borges, Guilherme, Maria Borzì, Antonio, Bourne, Rupert, J Brady, Oliver, Brauer, Michael, Brayne, Carol, K Breitborde, Nicholas J, Brenner, Hermann, Svitil Briant, Paul, M Briggs, Andrew, Ivanovich Briko, Nikolay, B Britton, Gabrielle, Bryazka, Dana, Buchbinder, Rachelle, R Bumgarner, Blair, Busse, Reinhard, A Butt, Zahid, Luciano Caetano Dos Santos, Florentino, LA Alberto Cámera, Lui, R Campos-Nonato, Ismael, Car, Josip, Cárdenas, Rosario, Carreras, Giulia, J Carrero, Juan, Carvalho, Felix, Mauricio Castaldelli-Maia, Joao, A Castañeda-Orjuela, Carlo, Castelpietra, Giulio, D Castle, Chri, Castro, Franz, Catalá-López, Ferrán, Causey, Kate, R Cederroth, Christopher, M Cercy, Kelly, Cerin, Ester, Singh Chandan, Joht, R Chang, Alex, J Charlson, Fiona, Kumar Chattu, Vijay, Chaturvedi, Sarika, Chimed-Ochir, Odgerel, Lee Chin, Ken, Youngwhan Cho, Daniel, Christensen, Hanne, Chu, Dinh-Toi, T Chung, Michael, M Cicuttini, Flavia, G Ciobanu, Liliana, Cirillo, Massimo, L Collins, Emma, Compton, Kelly, Conti, Sara, Angelo Cortesi, Paolo, Marisa Costa, Vera, Cousin, Ewerton, G Cowden, Richard, C Cowie, Benjamin, A Cromwell, Elizabeth, H Cross, Di, Stephen Crowe, Christopher, A Cruz, Jessica, Cunningham, Matthew, A Dahlawi, Saad M, Damiani, Giovanni, Dandona, Lalit, Dandona, Rakhi, Mohammad Darwesh, Aso, Daryani, Ahmad, K Das, Jai, Das Gupta, Rajat, das Neves, José, Alberto Dávila-Cervantes, Claudio, Davletov, Kairat, De Leo, Diego, E Dean, France, K DeCleene, Nicole, Deen, Amanda, Degenhardt, Louisa, Paul Dellavalle, Robert, Mekonnen Demeke, Feleke, Getnet Demsie, Desalegn, Denova-Gutiérrez, Edgar, Dereje Dereje, Nebiyu, Dervenis, Nikolao, Desai, Rupak, Desalew, Assefa, Ayalew Dessie, Getenet, Dhamminda Dharmaratne, Samath, Prasad Dhungana, Govinda, Dianatinasab, Mostafa, Diaz, Daniel, Sadat Dibaji Forooshani, Zahra, V Dingels, Zachary, Ashworth Dirac, M, Djalalinia, Shirin, Thi Do, Hoa, Dokova, Klara, Dorostkar, Fariba, P Doshi, Chirag, Doshmangir, Leila, Douiri, Abdel, C Doxey, Matthew, Robert Driscoll, Tim, J Dunachie, Susanna, B Duncan, Bruce, Rodrigues Duraes, Andre, Wilder Eagan, Arielle, Ebrahimi Kalan, Mohammad, Edvardsson, David, R Ehrlich, Joshua, El Nahas, Nevine, El Sayed, Iman, El Tantawi, Maha, Elbarazi, Iffat, Y Elgendy, Islam, Rashad Elhabashy, Hala, I El-Jaafary, Shaimaa, Rf Elyazar, Iqbal, Hassan Emamian, Mohammad, Emmons-Bell, Sophia, E Erskine, Holly, Eshrati, Babak, Eskandarieh, Sharareh, Esmaeilnejad, Saman, Esmaeilzadeh, Firooz, Esteghamati, Alireza, Estep, Kara, Etemadi, Arash, Esaiyas Etisso, Atkilt, Farahmand, Mohammad, Faraj, Anwar, Fareed, Mohammad, Faridnia, Roghiyeh, E Sá Farinha, Carla Sofia, Farioli, Andrea, Faro, Andre, Faruque, Mithila, Farzadfar, Farshad, Fattahi, Nazir, Fazlzadeh, Mehdi, L Feigin, Valery, Feldman, Rachel, Fereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, J Ferrari, Alize, L Ferreira, Manuela, Filip, Irina, Fischer, Florian, L Fisher, Jame, Fitzgerald, Ryan, Flohr, Carsten, Sorio Flor, Luisa, A Foigt, Nataliya, Oluwatoyin Folayan, Morenike, M Force, Lisa, Fornari, Carla, Foroutan, Masoud, T Fox, Jack, Freitas, Marisa, Fu, Weijia, Fukumoto, Takeshi, M Furtado, João, M Gad, Mohamed, Gakidou, Emmanuela, C Galles, Natalie, Gallus, Silvano, Gamkrelidze, Amiran, L Garcia-Basteiro, Alberto, M Gardner, William, Sahiledengle Geberemariyam, Biniyam, Mekonnen Gebrehiwot, Abiyu, Bizuwork Gebremedhin, Ketema, Ayalew Ayalew Ayalew Gebreslassie, Assefa, Gershberg Hayoon, Anna, W Gething, Peter, Ghadimi, Maryam, Ghadiri, Keyghobad, Ghafourifard, Mansour, Ghajar, Alireza, Ghamari, Farhad, Ghashghaee, Ahmad, Ghiasvand, Hesam, Ghith, Nermin, Gholamian, Asadollah, Amir Gilani, Syed, Singh Gill, Paramjit, Gitimoghaddam, Mojgan, Giussani, Giorgia, Goli, Sriniva, Santiago Gomez, Ricardo, Vali Gopalani, Sameer, Gorini, Giuseppe, M Gorman, Taren, Chase Gottlich, Harrison, Goudarzi, Houman, C Goulart, Alessandra, Niegia Garcia Goulart, Bárbara, Grada, Ayman, Grivna, Michal, Grosso, Giuseppe, Ibrahim Mohialdeen Gubari, Mohammed, Chander Gugnani, Harish, Luiz Sena Guimaraes, Andre, Alves Guimarães, Rafael, Abdi Guled, Rashid, Guo, Gaorui, Guo, Yuming, Gupta, Rajeev, A Haagsma, Juanita, Haddock, Beatrix, Hafezi-Nejad, Nima, Hafiz, Abdul, Hagins, Hailey, M Haile, Lydia, J Hall, Brian, Halvaei, Iman, R Hamadeh, Randah, Hamagharib Abdullah, Kanaan, B Hamilton, Erin, Han, Chieh, Han, Hannah, J Hankey, Graeme, Maria Haro, Josep, D Harvey, Jame, I Hasaballah, Ahmed, Hasanzadeh, Amir, Hashemian, Maryam, Hassanipour, Soheil, Hassankhani, Hadi, J Havmoeller, Rasmu, J Hay, Roderick, I Hay, Simon, Hayat, Khezar, Heidari, Behnam, Heidari, Golnaz, Heidari-Soureshjani, Reza, Hendrie, Delia, J Henrikson, Hannah, J Henry, Nathaniel, Herteliu, Claudiu, Heydarpour, Fatemeh, R Hird, Thoma, W Hoek, Han, K Hole, Michael, Holla, Ramesh, Hoogar, Praveen, Dean Hosgood, H, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Househ, Mowafa, G Hoy, Damian, Hsairi, Mohamed, Chia-Rong Hsieh, Vivian, Hu, Guoqing, M Huda, Tanvir, N Hugo, Fernando, K Huynh, Chantal, Hwang, Bing-Fang, C Iannucci, Vincent, Emmanuel Ibitoye, Segun, S Ikuta, Kevin, Stephen Ilesanmi, Olayinka, M Ilic, Irena, D Ilic, Milena, Raja Inbaraj, Leeberk, Ippolito, Helen, Sina Naghibi Irvani, Seyed, Mofizul Islam, M, Islam, Mdmohaimenul, Mohammed Shariful Islam, Sheikh, Islami, Farhad, Iso, Hiroyasu, Q Ivers, Rebecca, D Iwu, Chidozie C, Osamuyi Iyamu, Ihoghosa, Jaafari, Jalil, H Jacobsen, Kathryn, Jadidi-Niaragh, Farhad, Jafari, Hussain, Jafarinia, Morteza, Jahagirdar, Deepa, Ali Jahani, Mohammad, Jahanmehr, Nader, Jakovljevic, Mihajlo, Jalali, Amir, Jalilian, Farzad, L James, Spencer, Janjani, Hosna, Dilipkumar Janodia, Manthan, Upendra Jayatilleke, Achala, Jeemon, Panniyammakal, Jenabi, Ensiyeh, Prakash Jha, Ravi, Jha, Vivekanand, S Ji, John, Jia, Peng, John, Oommen, O John-Akinola, Yetunde, Owens Johnson, Catherine, Charlotte Johnson, Sarah, B Jonas, Jost, Joo, Tama, Joshi, Ankur, Jerzy Jozwiak, Jacek, Jürisson, Mikk, Kabir, Ali, Kabir, Zubair, Kalani, Hamed, Kalani, Rizwan, R Kalankesh, Leila, Kalhor, Rohollah, Kamiab, Zahra, Kanchan, Tanuj, Karami Matin, Behzad, Karch, André, Anisul Karim, Mohd, Eddin Karimi, Salah, Mullu Kassa, Getachew, J Kassebaum, Nichola, Vittal Katikireddi, Srinivasa, Kawakami, Norito, A Kayode, Gbenga, H Keddie, Suzanne, Keller, Cathleen, Kereselidze, Maia, Abdullatif Khafaie, Morteza, Khalid, Nauman, Khan, Maseer, Khatab, Khaled, M Khater, Mona, Nazli Khatib, Mahalaqua, Khayamzadeh, Maryam, Taghi Khodayari, Mohammad, Khundkar, Roba, Kianipour, Neda, Kieling, Christian, Kim, Daniel, Kim, Young-Eun, Jin Kim, Yun, W Kimokoti, Ruth, Kisa, Adnan, Kisa, Sezer, Kissimova-Skarbek, Katarzyna, Kivimäki, Mika, J Kneib, Cameron, Kristin Skrindo Knudsen, Ann, M Kocarnik, Jonathan, Kolola, Tufa, A Kopec, Jacek, Kosen, Soewarta, A Koul, Parvaiz, Koyanagi, Ai, A Kravchenko, Michael, Krishan, Kewal, J Krohn, Kri, Kuate Defo, Barthelemy, Kucuk Bicer, Burcu, Anil Kumar, G, Kumar, Manasi, Kumar, Pushpendra, Kumar, Vivek, Kumaresh, Girikumar, P Kurmi, Om, Kusuma, Dian, Hmwe Kyu, Hmwe, La Vecchia, Carlo, Lacey, Ben, Kumar Lal, Dharmesh, Lalloo, Ratilal, O Lam, Jennifer, Hasan Lami, Fari, Landires, Iván, J Lang, Justin, Charles Lansingh, Van, Leigh Larson, Samantha, O Larsson, Ander, Lasrado, Savita, S Lassi, Zohra, Mei-Ming Lau, Kathryn, M Lavados, Pablo, V Lazarus, Jeffrey, R Ledesma, Jorge, H Lee, Paul, Wen Huey Lee, Shaun, E LeGrand, Kate, Leigh, Jame, Leonardi, Matilde, Lescinsky, Haley, Leung, Janni, Levi, Miriam, Lewington, Sarah, Li, Shanshan, Lim, Lee-Ling, Lin, Christine, Lin, Ro-Ting, Linehan, Christine, Linn, Shai, Liu, Hung-Chun, Liu, Shiwei, Liu, Zichen, J Looker, Katharine, D Lopez, Alan, D Lopukhov, Platon, Lorkowski, Stefan, A Lotufo, Paulo, D Lucas, Tim C, Lugo, Alessandra, Lunevicius, Raimunda, A Lyons, Ronan, Ma, Jianing, H MacLachlan, Jennifer, R Maddison, Emilie, Maddison, Ralph, Madotto, Fabiana, Walter Mahasha, Phetole, Thi Mai, Hue, Majeed, Azeem, Maled, Venkatesh, Maleki, Shokofeh, Malekzadeh, Reza, Carvalho Malta, Deborah, A Mamun, Abdullah, Manafi, Amir, Manafi, Navid, Manguerra, Helena, Mansouri, Borhan, Ali Mansournia, Mohammad, M Mantilla Herrera, Ana, C Maravilla, Joemer, Marks, Ashley, Rogerlândio Martins-Melo, Francisco, Martopullo, Ira, Zahra Masoumi, Seyedeh, Massano, João, Ballard Massenburg, Benjamin, Raj Mathur, Manu, K Maulik, Pallab, Mcalinden, Colm, J McGrath, John, Mckee, Martin, Mohan Mehndiratta, Man, Mehri, Fereshteh, M Mehta, Kala, Bigyananda Meitei, Wahengbam, N Memiah, Peter T, Mendoza, Walter, G Menezes, Ritesh, Worku Mengesha, Endalkachew, Berwo Mengesha, Meresa, Mereke, Alibek, Meretoja, Atte, J Meretoja, Tuomo, Mestrovic, Tomislav, Miazgowski, Bartosz, Miazgowski, Tomasz, Maria Michalek, Irmina, Mulatu Mihretie, Kebadnew, R Miller, Ted, J Mills, Edward, Mirica, Andreea, M Mirrakhimov, Erkin, Mirzaei, Hamed, Mirzaei, Maryam, Mirzaei-Alavijeh, Mehdi, Temesgen Misganaw, Awoke, Mithra, Prasanna, Moazen, Babak, Moghadaszadeh, Masoud, Mohamadi, Efat, K Mohammad, Dara, Mohammad, Yousef, Mohammad Gholi Mezerji, Naser, Mohammadian-Hafshejani, Abdollah, Mohammadifard, Noushin, Mohammadpourhodki, Reza, Mohammed, Shafiu, H Mokdad, Ali, Molokhia, Mariam, C Momen, Natalie, Monasta, Lorenzo, Mondello, Stefania, D Mooney, Meghan, Moosazadeh, Mahmood, Moradi, Ghobad, Moradi, Masoud, Moradi-Lakeh, Maziar, Moradzadeh, Rahmatollah, Moraga, Paula, Morales, Linda, Morawska, Lidia, Moreno Velásquez, Ilai, Morgado-da-Costa, Joana, Douglas Morrison, Shane, F Mosser, Jonathan, Mouodi, Simin, Meysam Mousavi, Seyyed, Mousavi Khaneghah, Amin, Otto Mueller, Ulrich, B Munro, Sandra, K Muriithi, Mose, Imran Musa, Kamarul, Muthupandian, Saravanan, Naderi, Mehdi, Jayaraman Nagarajan, Ahamarshan, Nagel, Gabriele, Naghshtabrizi, Behshad, Nair, Sanjeev, K Nandi, Anita, Nangia, Vinay, Richie Nansseu, Jobert, C Nayak, Vinod, Nazari, Javad, Negoi, Ionut, Irina Negoi, Ruxandra, Biresaw Netsere Netsere, Henok, W Ngunjiri, Josephine, Tat Nguyen, Cuong, Nguyen, Jason, Nguyen, Michele, Nguyen, Minh, Nichols, Emma, Nigatu, Dabere, T Nigatu, Yeshambel, Nikbakhsh, Rajan, R Nixon, Molly, A Nnaji, Chukwudi, Nomura, Shuhei, Norrving, Bo, Jacques Noubiap, Jean, Nowak, Christoph, Nunez-Samudio, Virginia, Oţoiu, Adrian, Oancea, Bogdan, M Odell, Christopher, Akpojene Ogbo, Felix, Oh, In-Hwan, Wandera Okunga, Emmanuel, Oladnabi, Morteza, T Olagunju, Andrew, Olubukunola Olusanya, Bolajoko, Olusegun Olusanya, Jacob, Morenike Oluwasanu, Mojisola, Omar Bali, Ahmed, Omer Omer, Muktar, L Ong, Kanyin, E Onwujekwe, Obinna, U Orji, Aislyn, M Orpana, Heather, Ortiz, Alberto, M Ostroff, Samuel, Otstavnov, Nikita, S Otstavnov, Stanislav, Øverland, Simon, O Owolabi, Mayowa, P A, Mahesh, Rao Padubidri, Jagadish, P Pakhare, Abhijit, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandey, Anamika, Park, Eun-Kee, G Kumari Parmar, Priya, Kumar Pasupula, Deepak, Kishor Patel, Sangram, J Paternina-Caicedo, Angel, Pathak, Ashish, Pathak, Mona, B Patten, Scott, C Patton, George, Paudel, Deepak, Pazoki Toroudi, Hamidreza, E Peden, Amy, Pennini, Alyssa, Christian Filipino Pepito, Veincent, K Peprah, Emmanuel, Pereira, Alexandre, M Pereira, David, Perico, Norberto, Quang Pham, Hai, R Phillips, Michael, M Pigott, David, Pilgrim, Thoma, M Pilz, Tessa, Pirsaheb, Meghdad, Plana-Ripoll, Oleguer, Plass, Dietrich, Narayan Pokhrel, Khem, V Polibin, Roman, Polinder, Suzanne, R Polkinghorne, Kevan, J Postma, Maarten, Pourjafar, Hadi, Pourmalek, Farshad, Pourmirza Kalhori, Reza, Pourshams, Akram, Poznańska, Anna, I Prada, Sergio, Ria Angga Pribadi, Dima, Pupillo, Elisabetta, Quazi Syed, Zahiruddin, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiee, Ata, Rafiei, Alireza, Raggi, Alberto, Rahimi-Movaghar, Afarin, Aziz Rahman, Muhammad, Rajabpour-Sanati, Ali, Rajati, Fatemeh, Ramezanzadeh, Kiana, Lal Ranabhat, Chhabi, C Rao, Puja, J Rao, Sowmya, Rasella, Davide, Rastogi, Prateek, Rathi, Priya, Laith Rawaf, David, Rawaf, Salman, Rawal, Lal, Razo, Christian, Boston Redford, Sofia, C Reiner Jr, Robert, Reinig, Nickola, Bettay Reitsma, Marissa, Remuzzi, Giuseppe, Renjith, Vishnu, N Renzaho, Andre M, Resnikoff, Serge, Rezaei, Nima, Sadegh Rezai, Mohammad, Rezapour, Aziz, Rhinehart, Phoebe-Anne, Mohammad Riahi, Seyed, P Ribeiro, Antonio Luiz, Cury Ribeiro, Daniel, Ribeiro, Daniela, Rickard, Jennifer, S Roberts, Nicholas L, Roberts, Shaun, R Robinson, Stephen, Roever, Leonardo, Rolfe, Sam, Ronfani, Luca, Roshandel, Gholamreza, A Roth, Gregory, Rubagotti, Enrico, Fred Rumisha, Susan, Sabour, Siamak, S Sachdev, Perminder, Saddik, Basema, Sadeghi, Ehsan, Sadeghi, Masoumeh, Saeidi, Shahram, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Ali Sahraian, Mohammad, Mohammad Sajadi, S, Reza Salahshoor, Mohammad, Salamati, Payman, Salehi Zahabi, Saleh, Salem, Hosni, R Rashad Salem, Marwa, Salimzadeh, Hamideh, A Salomon, Joshua, Salz, Inbal, Samad, Zainab, M Samy, Abdallah, Sanabria, Juan, Francesco Santomauro, Damian, S Santos, Itamar, Vasco Santos, João, M Santric-Milicevic, Milena, Yegnanarayana Iyer Saraswathy, Sivan, Sarmiento-Suárez, Rodrigo, Sarrafzadegan, Nizal, Sartorius, Benn, Sarveazad, Arash, Sathian, Brijesh, Sathish, Thirunavukkarasu, Sattin, Davide, N Sbarra, Alyssa, E Schaeffer, Lauren, Schiavolin, Silvia, Inês Schmidt, Maria, Elisabeth Schutte, Aletta, C Schwebel, David, Schwendicke, Falk, Muleta Senbeta, Anbissa, Senthilkumaran, Subramanian, G Sepanlou, Sadaf, Anne Shackelford, Katya, Shadid, Jamileh, Shahabi, Saeed, A Shaheen, Amira, Ali Shaikh, Masood, S Shalash, Ali, Shams-Beyranvand, Mehran, Shamsizadeh, Morteza, Shannawaz, Mohammed, Sharafi, Kiomar, Sharara, Fablina, S Sheena, Brittney, Sheikhtaheri, Abba, S Shetty, Ranjitha, Shibuya, Kenji, Shibabaw Shiferaw, Wondimeneh, Shigematsu, Mika, Il Shin, Jae, Shiri, Rahman, Shirkoohi, Reza, G Shrime, Mark, Shuval, Kerem, Siabani, Soraya, Dora Sigfusdottir, Inga, Sigurvinsdottir, Rannveig, Pedro Silva, João, E Simpson, Kyle, Singh, Ambrish, A Singh, Jasvinder, Skiadaresi, Eirini, T Skou Skou, Søren, Yurievich Skryabin, Valentin, Sobngwi, Eugene, Sokhan, Anton, Soltani, Shahin, D Sorensen, Reed J, B Soriano, Joan, Bekele Sorrie, Muluken, N Soyiri, Ireneou, T Sreeramareddy, Chandrashekhar, D Stanaway, Jeffrey, A Stark, Benjamin, Cătălina Ştefan, Simona, Stein, Caroline, Steiner, Caitlyn, J Steiner, Timothy, A Stokes, Mark, Jacob Stovner, Lar, L Stubbs, Jacob, Sudaryanto, Agu, Babale Sufiyan, Mu'Awiyyah, Sulo, Gerhard, Sultan, Iyad, L Sykes, Bryan, O Sylte, Dillon, Szócska, Mikló, Tabarés-Seisdedos, Rafael, M Tabb, Karen, Kumar Tadakamadla, Santosh, Taherkhani, Amir, Tajdini, Masih, Takahashi, Ken, Taveira, Nuno, L Teagle, Whitney, Teame, Hirut, Tehrani-Banihashemi, Arash, Fseha Teklehaimanot, Berhane, Terrason, Sonyah, Tadesse Tessema, Zemenu, Raman Thankappan, Kavumpurathu, M Thomson, Azalea, Reza Tohidinik, Hamid, Tonelli, Marcello, Topor-Madry, Roman, E Torre, Anna, Touvier, Mathilde, Roberto Roberto Tovani-Palone, Marco, Xuan Tran, Bach, Travillian, Ravensara, E Troeger, Christopher, Clement Truelsen, Thoma, C Tsai, Alexander, Tsatsakis, Aristidi, Tudor Car, Lorainne, Tyrovolas, Stefano, Uddin, Riaz, Ullah, Saif, A Undurraga, Eduardo, Unnikrishnan, Bhaskaran, Vacante, Marco, Vakilian, Alireza, R Valdez, Pascual, Varughese, Santosh, Juhani Vasankari, Tommi, Vasseghian, Yasser, Venketasubramanian, Narayanaswamy, S Violante, Francesco, Vlassov, Vasily, Emil Vollset, Stein, Vongpradith, Avina, Vukovic, Ana, Vukovic, Rade, Waheed, Yasir, K Walters, Madgalene, Wang, Jiayu, Wang, Yafeng, Wang, Yuan-Pang, L Ward, Joseph, Watson, Alexandrea, Wei, Jingkai, G Weintraub, Robert, J Weiss, Daniel, Weiss, Jordan, Westerman, Ronny, L Whisnant, Joanna, A Whiteford, Harvey, Wiangkham, Taweewat, E Wiens, Kirsten, Wijeratne, Tissa, B Wilner, Lauren, Wilson, Shadrach, Wojtyniak, Bogdan, A Wolfe, Charles D, E Wool, Eve, Wu, Ai-Min, Wulf Hanson, Sarah, Yong Wunrow, Han, Xu, Gelin, Xu, Rixing, Yadgir, Simon, Hossein Yahyazadeh Jabbari, Seyed, Yamagishi, Kazumasa, Yaminfirooz, Mousa, Yano, Yuichiro, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, A Yearwood, Jamal, Y Yeheyis, Toma, Gizachew Yeshitila, Yordano, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yoosefi Lebni, Javad, Z Younis, Mustafa, Patrick Younker, Theodore, Yousefi, Zabihollah, Yousefifard, Mahmoud, Yousefinezhadi, Taraneh, Yousuf Yousuf, Abdilahi, Yu, Chuanhua, Yusefzadeh, Hasan, Zahirian Moghadam, Telma, Zaki, Leila, Bin Zaman, Sojib, Zamani, Mohammad, Zamanian, Maryam, Zandian, Hamed, Zangeneh, Alireza, Sergeevich Zastrozhin, Mikhail, Alemayehu Zewdie, Kaleab, Zhang, Yunquan, Zhang, Zhi-Jiang, T Zhao, Jeff, Zhao, Yingxi, Zheng, Peng, Zhou, Maigeng, Ziapour, Arash, M Zimsen, Stephanie R, Naghavi, Mohsen, L Murray, Christopher J, Tampere University, Tays Research Services, Health Sciences, Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Abreu, L. G., Abrigo, M. R. M., Abu-Raddad, L. J., Abushouk, A. I., Acebedo, A., Ackerman, I. N., Adabi, M., Adamu, A. A., Adebayo, O. M., Adekanmbi, V., Adelson, J. D., Adetokunboh, O. O., Adham, D., Afshari, M., Afshin, A., Agardh, E. E., Agarwal, G., Agesa, K. M., Aghaali, M., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmadpour, E., Akalu, T. Y., Akinyemi, R. O., Akinyemiju, T., Akombi, B., Al-Aly, Z., Alam, K., Alam, N., Alam, S., Alam, T., Alanzi, T. M., Albertson, S. B., Alcalde-Rabanal, J. E., Alema, N. M., Ali, M., Ali, S., Alicandro, G., Alijanzadeh, M., Alinia, C., Alipour, V., Aljunid, S. M., Alla, F., Allebeck, P., Almasi-Hashiani, A., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Aminorroaya, A., Amiri, F., Amit, A. M. L., Amugsi, D. A., Amul, G. G. H., Anderlini, D., Andrei, C. L., Andrei, T., Anjomshoa, M., Ansari, F., Ansari, I., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Ariani, F., Arnlov, J., Aryal, K. K., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Asghari, B., Ashbaugh, C., Atnafu, D. D., Atre, S. R., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Aynalem, Y. A., Azari, S., Azarian, G., Azene, Z. N., Babaee, E., Badawi, A., Bagherzadeh, M., Bakhshaei, M. H., Bakhtiari, A., Balakrishnan, S., Balalla, S., Balassyano, S., Banach, M., Banik, P. C., Bannick, M. S., Bante, A. B., Baraki, A. G., Barboza, M. A., Barker-Collo, S. L., Barthelemy, C. M., Barua, L., Barzegar, A., Basu, S., Baune, B. T., Bayati, M., Bazmandegan, G., Bedi, N., Beghi, E., Bejot, Y., Bello, A. K., Bender, R. G., Bennett, D. A., Bennitt, F. B., Bensenor, I. M., Benziger, C. P., Berhe, K., Bernabe, E., Bertolacci, G. J., Bhageerathy, R., Bhala, N., Bhandari, D., Bhardwaj, P., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Biehl, M. H., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisanzio, D., Bisignano, C., Biswas, R. K., Bohlouli, S., Bohluli, M., Bolla, S. R. R., Boloor, A., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Bourne, R., Brady, O. J., Brauer, M., Brayne, C., Breitborde, N. J. K., Brenner, H., Briant, P. S., Briggs, A. M., Briko, N. I., Britton, G. B., Bryazka, D., Buchbinder, R., Bumgarner, B. R., Busse, R., Butt, Z. A., Caetano dos Santos, F. L., Camera, L. L. A., Campos-Nonato, I. R., Car, J., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castle, C. D., Castro, F., Catala-Lopez, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, A. R., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Chimed-Ochir, O., Chin, K. L., Cho, D. Y., Christensen, H., Chu, D. -T., Chung, M. T., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Collins, E. L., Compton, K., Conti, S., Cortesi, P. A., Costa, V. M., Cousin, E., Cowden, R. G., Cowie, B. C., Cromwell, E. A., Cross, D. H., Crowe, C. S., Cruz, J. A., Cunningham, M., Dahlawi, S. M. A., Damiani, G., Dandona, L., Dandona, R., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. A., Davletov, K., De Leo, D., Dean, F. E., Decleene, N. K., Deen, A., Degenhardt, L., Dellavalle, R. P., Demeke, F. M., Demsie, D. G., Denova-Gutierrez, E., Dereje, N. D., Dervenis, N., Desai, R., Desalew, A., Dessie, G. A., Dharmaratne, S. D., Dhungana, G. P., Dianatinasab, M., Diaz, D., Dibaji Forooshani, Z. S., Dingels, Z. V., Dirac, M. A., Djalalinia, S., Do, H. T., Dokova, K., Dorostkar, F., Doshi, C. P., Doshmangir, L., Douiri, A., Doxey, M. C., Driscoll, T. R., Dunachie, S. J., Duncan, B. B., Duraes, A. R., Eagan, A. W., Ebrahimi Kalan, M., Edvardsson, D., Ehrlich, J. R., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., Elhabashy, H. R., El-Jaafary, S. I., Elyazar, I. R., Emamian, M. H., Emmons-Bell, S., Erskine, H. E., Eshrati, B., Eskandarieh, S., Esmaeilnejad, S., Esmaeilzadeh, F., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A. E., Farahmand, M., Faraj, A., Fareed, M., Faridnia, R., Farinha, C. S. E. S., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S. -M., Fernandes, E., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Fitzgerald, R., Flohr, C., Flor, L. S., Foigt, N. A., Folayan, M. O., Force, L. M., Fornari, C., Foroutan, M., Fox, J. T., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Galles, N. C., Gallus, S., Gamkrelidze, A., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B. S., Gebrehiwot, A. M., Gebremedhin, K. B., Gebreslassie, A. A. A. A., Gershberg Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghafourifard, M., Ghajar, A., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Gilani, S. A., Gill, P. S., Gitimoghaddam, M., Giussani, G., Goli, S., Gomez, R. S., Gopalani, S. V., Gorini, G., Gorman, T. M., Gottlich, H. C., Goudarzi, H., Goulart, A. C., Goulart, B. N. G., Grada, A., Grivna, M., Grosso, G., Gubari, M. I. M., Gugnani, H. C., Guimaraes, A. L. S., Guimaraes, R. A., Guled, R. A., Guo, G., Guo, Y., Gupta, R., Haagsma, J. A., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Hagins, H., Haile, L. M., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamagharib Abdullah, K., Hamilton, E. B., Han, C., Han, H., Hankey, G. J., Haro, J. M., Harvey, J. D., Hasaballah, A. I., Hasanzadeh, A., Hashemian, M., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, R. J., Hay, S. I., Hayat, K., Heidari, B., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Henrikson, H. J., Henry, N. J., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Hole, M. K., Holla, R., Hoogar, P., Hosgood, H. D., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hoy, D. G., Hsairi, M., Hsieh, V. C. -R., Hu, G., Huda, T. M., Hugo, F. N., Huynh, C. K., Hwang, B. -F., Iannucci, V. C., Ibitoye, S. E., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Inbaraj, L. R., Ippolito, H., Irvani, S. S. N., Islam, M. M., Islam, M., Islam, S. M. S., Islami, F., Iso, H., Ivers, R. Q., Iwu, C. C. D., Iyamu, I. O., Jaafari, J., Jacobsen, K. H., Jadidi-Niaragh, F., Jafari, H., Jafarinia, M., Jahagirdar, D., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Jalali, A., Jalilian, F., James, S. L., Janjani, H., Janodia, M. D., Jayatilleke, A. U., Jeemon, P., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jia, P., John, O., John-Akinola, Y. O., Johnson, C. O., Johnson, S. C., Jonas, J. B., Joo, T., Joshi, A., Jozwiak, J. J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kamiab, Z., Kanchan, T., Karami Matin, B., Karch, A., Karim, M. A., Karimi, S. E., Kassa, G. M., Kassebaum, N. J., Katikireddi, S. V., Kawakami, N., Kayode, G. A., Keddie, S. H., Keller, C., Kereselidze, M., Khafaie, M. A., Khalid, N., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khodayari, M. T., Khundkar, R., Kianipour, N., Kieling, C., Kim, D., Kim, Y. -E., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Knudsen, A. K. S., Kocarnik, J. M., Kolola, T., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M. A., Krishan, K., Krohn, K. J., Kuate Defo, B., Kucuk Bicer, B., Kumar, G. A., Kumar, M., Kumar, P., Kumar, V., Kumaresh, G., Kurmi, O. P., Kusuma, D., Kyu, H. H., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lam, J. O., Lami, F. H., Landires, I., Lang, J. J., Lansingh, V. C., Larson, S. L., Larsson, A. O., Lasrado, S., Lassi, Z. S., Lau, K. M. -M., Lavados, P. M., Lazarus, J. V., Ledesma, J. R., Lee, P. H., Lee, S. W. H., Legrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Lewington, S., Li, S., Lim, L. -L., Lin, C., Lin, R. -T., Linehan, C., Linn, S., Liu, H. -C., Liu, S., Liu, Z., Looker, K. J., Lopez, A. D., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lucas, T. C. D., Lugo, A., Lunevicius, R., Lyons, R. A., Ma, J., Maclachlan, J. H., Maddison, E. R., Maddison, R., Madotto, F., Mahasha, P. W., Mai, H. T., Majeed, A., Maled, V., Maleki, S., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manafi, A., Manafi, N., Manguerra, H., Mansouri, B., Mansournia, M. A., Mantilla Herrera, A. M., Maravilla, J. C., Marks, A., Martins-Melo, F. R., Martopullo, I., Masoumi, S. Z., Massano, J., Massenburg, B. B., Mathur, M. R., Maulik, P. K., Mcalinden, C., Mcgrath, J. J., Mckee, M., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Meitei, W. B., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mengesha, M. B., Mereke, A., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Mihretie, K. M., Miller, T. R., Mills, E. J., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei-Alavijeh, M., Misganaw, A. T., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, D. K., Mohammad, Y., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, S., Mokdad, A. H., Molokhia, M., Momen, N. C., Monasta, L., Mondello, S., Mooney, M. D., Moosazadeh, M., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morales, L., Morawska, L., Moreno Velasquez, I., Morgado-da-Costa, J., Morrison, S. D., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mousavi Khaneghah, A., Mueller, U. O., Munro, S. B., Muriithi, M. K., Musa, K. I., Muthupandian, S., Naderi, M., Nagarajan, A. J., Nagel, G., Naghshtabrizi, B., Nair, S., Nandi, A. K., Nangia, V., Nansseu, J. R., Nayak, V. C., Nazari, J., Negoi, I., Negoi, R. I., Netsere, H. B. N., Ngunjiri, J. W., Nguyen, C. T., Nguyen, J., Nguyen, M., Nichols, E., Nigatu, D., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F. A., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Oluwasanu, M. M., Omar Bali, A., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Orji, A. U., Orpana, H. M., Ortiz, A., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., P A, M., Padubidri, J. R., Pakhare, A. P., Palladino, R., Pana, A., Panda-Jonas, S., Pandey, A., Park, E. -K., Parmar, P. G. K., Pasupula, D. K., Patel, S. K., Paternina-Caicedo, A. J., Pathak, A., Pathak, M., Patten, S. B., Patton, G. C., Paudel, D., Pazoki Toroudi, H., Peden, A. E., Pennini, A., Pepito, V. C. F., Peprah, E. K., Pereira, A., Pereira, D. M., Perico, N., Pham, H. Q., Phillips, M. R., Pigott, D. M., Pilgrim, T., Pilz, T. M., Pirsaheb, M., Plana-Ripoll, O., Plass, D., Pokhrel, K. N., Polibin, R. V., Polinder, S., Polkinghorne, K. R., Postma, M. J., Pourjafar, H., Pourmalek, F., Pourmirza Kalhori, R., Pourshams, A., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahimi-Movaghar, A., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rasella, D., Rastogi, P., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Razo, C., Redford, S. B., Reiner, R. C., Reinig, N., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezai, M. S., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, A. L. P., Ribeiro, D. C., Ribeiro, D., Rickard, J., Roberts, N. L. S., Roberts, S., Robinson, S. R., Roever, L., Rolfe, S., Ronfani, L., Roshandel, G., Roth, G. A., Rubagotti, E., Rumisha, S. F., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeidi, S., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salamati, P., Salehi Zahabi, S., Salem, H., Salem, M. R. R., Salimzadeh, H., Salomon, J. A., Salz, I., Samad, Z., Samy, A. M., Sanabria, J., Santomauro, D. F., Santos, I. S., Santos, J. V., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Sbarra, A. N., Schaeffer, L. E., Schiavolin, S., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Shackelford, K. A., Shadid, J., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharara, F., Sheena, B. S., Sheikhtaheri, A., Shetty, R. S., Shibuya, K., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shiri, R., Shirkoohi, R., Shrime, M. G., Shuval, K., Siabani, S., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, J. P., Simpson, K. E., Singh, A., Singh, J. A., Skiadaresi, E., Skou, S. T. S., Skryabin, V. Y., Sobngwi, E., Sokhan, A., Soltani, S., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Sreeramareddy, C. T., Stanaway, J. D., Stark, B. A., Stefan, S. C., Stein, C., Steiner, C., Steiner, T. J., Stokes, M. A., Stovner, L. J., Stubbs, J. L., Sudaryanto, A., Sufiyan, M. B., Sulo, G., Sultan, I., Sykes, B. L., Sylte, D. O., Szocska, M., Tabares-Seisdedos, R., Tabb, K. M., Tadakamadla, S. K., Taherkhani, A., Tajdini, M., Takahashi, K., Taveira, N., Teagle, W. L., Teame, H., Tehrani-Banihashemi, A., Teklehaimanot, B. F., Terrason, S., Tessema, Z. T., Thankappan, K. R., Thomson, A. M., Tohidinik, H. R., Tonelli, M., Topor-Madry, R., Torre, A. E., Touvier, M., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Troeger, C. E., Truelsen, T. C., Tsai, A. C., Tsatsakis, A., Tudor Car, L., Tyrovolas, S., Uddin, R., Ullah, S., Undurraga, E. A., Unnikrishnan, B., Vacante, M., Vakilian, A., Valdez, P. R., Varughese, S., Vasankari, T. J., Vasseghian, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vongpradith, A., Vukovic, A., Vukovic, R., Waheed, Y., Walters, M. K., Wang, J., Wang, Y., Wang, Y. -P., Ward, J. L., Watson, A., Wei, J., Weintraub, R. G., Weiss, D. J., Weiss, J., Westerman, R., Whisnant, J. L., Whiteford, H. A., Wiangkham, T., Wiens, K. E., Wijeratne, T., Wilner, L. B., Wilson, S., Wojtyniak, B., Wolfe, C. D. A., Wool, E. E., Wu, A. -M., Wulf Hanson, S., Wunrow, H. Y., Xu, G., Xu, R., Yadgir, S., Yahyazadeh Jabbari, S. H., Yamagishi, K., Yaminfirooz, M., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yearwood, J. A., Yeheyis, T. Y., Yeshitila, Y. G., Yip, P., Yonemoto, N., Yoon, S. -J., Yoosefi Lebni, J., Younis, M. Z., Younker, T. P., Yousefi, Z., Yousefifard, M., Yousefinezhadi, T., Yousuf, A. Y., Yu, C., Yusefzadeh, H., Zahirian Moghadam, T., Zaki, L., Zaman, S. B., Zamani, M., Zamanian, M., Zandian, H., Zangeneh, A., Zastrozhin, M. S., Zewdie, K. A., Zhang, Y., Zhang, Z. -J., Zhao, J. T., Zhao, Y., Zheng, P., Zhou, M., Ziapour, A., Zimsen, S. R. M., Naghavi, M., Murray, C. J. L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL

Subjects
Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract

Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"

Published
2020

38. Epidemiology

Author

Elizabeth Ryznar and Harvey Whiteford

Abstract

Psychiatric epidemiology is the study of the distribution and determinants of mental disorders in populations, and the application of this to the prevention and treatment of disorders. Both genetic and environmental factors are involved in the onset and course of mental disorders. The field has evolved from smaller studies in one geographic area, often of patients in hospitals, to larger national and global studies. This chapter discusses studies that have aided this transition: the Epidemiological Catchment Area Study, which was the first to adopt a validated diagnostic instrument; the National Comorbidity Survey, which was the first to establish prevalence in a nationally representative sample; and the Global Burden of Disease Study, which was the first to assess mortality and disability of mental disorders globally. This chapter also discusses epidemiological contributions to understanding the aetiology of mental illness, focusing on a landmark paper separating family environment and genetics in schizophrenia.

Published
2020

39. The cost of mental disorders::a systematic review

Author

John J. McGrath, Oleguer Plana-Ripoll, Natalie C. Momen, Nanna Weye, Harvey Whiteford, Maria K. Christensen, Sukanta Saha, Danielle L. Cannon, Kim Moesgaard Iburg, F. Presley, and Carmen C.W. Lim

Subjects
medicine.medical_specialty, Web of science, Epidemiology, Cost-Benefit Analysis, Population, cost-of-illness studies, EconLit, Special Article, Key terms, systematic review, Cost of Illness, medicine, Humans, Psychiatry, education, education.field_of_study, Mental Disorders, Public Health, Environmental and Occupational Health, Health Care Costs, medicine.disease, Mental health, Psychiatry and Mental health, Eating disorders, economic burden, Mental health care, Psychology, Delivery of Health Care, Inclusion (education)
Abstract

Aims To identify and synthesise the literature on the cost of mental disorders. Methods Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980–May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783). Results In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ. Conclusions This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.

Published
2020

40. Estimating the Risk of Suicide Attributable to Mental Disorders: A Systematic Review and Meta-Regression Analysis

Author

Theo Vos, Alize J. Ferrari, Modhurima Moitra, Pamela Y. Collins, Harvey Whiteford, Damian Santomauro, and Louisa Degenhardt

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Confounding, Population, Declaration, medicine.disease, Suicide prevention, Relative risk, Covariate, Medicine, Major depressive disorder, Meta-regression, business, Psychiatry, education
Abstract

Background: Mental disorders (MDs) are known risk factors for suicide. This systematic review updates the evidence base for this association and improves upon analytic approaches by incorporating study-level and methodological variables to account for measurement error in pooled suicide risk estimates. Methods: A systematic review was conducted to review studies on MDs as risk factors for suicide. Relevant studies were searched using PubMed, Embase, PsychINFO, and existing reviews from 2010–19. Studies were eligible if they were longitudinal/case-control studies, representative of the general population, used diagnostic instruments, and quantified suicide risk. The outcome assessed was relative risks (RRs) for suicide due to MDs. A multi-level meta-regression approach was used to obtain pooled RRs adjusted for covariates and between-study effects. Findings: We identified 20 eligible studies yielding 69 RRs. Disorder type, age, sex, use of psychological autopsy, study design, and adjustment for confounders were tested as predictors of pooled suicide risk. Overall, all disorders were significant predictors of suicide with predicted adjusted RRs ranging from 4·11 [2·09, 8·09] for dysthymia to 7·64 [4·3, 13·58] for major depressive disorder. Interpretation: Our results indicate that MDs are important risk factors for suicide. This systematic review provides pooled RRs that have been adjusted for methodological sources of bias. Findings from our paper may inform suicide prevention strategies as part of national health agendas. Funding: Bill and Melinda Gates Foundation; Queensland Department of Health; National Health and Medical Research Council Early Career Fellowship Grant APP1121516. Declaration of Interests: We declare no competing interests.

Published
2020

41. Impact of the carer on length of hospital stay for mental health: Results from two Australian surveys

Author

Jan Kealton, Harvey Whiteford, Sandra Diminic, Meredith Harris, Yong Yi Lee, David J. Castle, and Emily Hielscher

Subjects
Adult, Male, Gerontology, Adolescent, health care facilities, manpower, and services, Logistic regression, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Young adult, health care economics and organizations, Depressive symptoms, 030504 nursing, business.industry, Mental Disorders, Australia, social sciences, Caregiver burden, Length of Stay, Middle Aged, medicine.disease, Mental illness, Mental health, humanities, 030227 psychiatry, Caregivers, Psychotic Disorders, Schizophrenia, Female, Patient Care, Pshychiatric Mental Health, 0305 other medical science, business, human activities, Hospital stay
Abstract

Informal carers play a vital role in supporting Australians living with a mental illness, including during the acute phases of illness; however, little is known about their impact on length of hospital stay. We aimed to investigate the impact of having a carer and of carer burden on length of hospital stay for mental health. Two Australian datasets were used. Data from the 2010 National Survey of High Impact Psychosis (n = 1825) were used to investigate the impact of having versus not having a carer on length of hospital stay for mental health. Data from the UQ Carer Survey 2016 (n = 105), a convenience sample of mental health carers, were used to investigate the impact of weekly hours of care (a measure of objective carer burden) on length of stay. Multiple logistic regression and correlation analyses were performed to investigate the association between carer status/burden and length of stay. Having a carer was associated with a significantly longer length of hospital stay; however, this relationship was no longer significant after adjusting for diagnosis, global functioning, depressive symptoms, deliberate self-harm, mental health outpatient contacts and type of admission. Weekly hours of care did not significantly impact on length of stay. Patients with carers had poorer functioning which may be related to longer stays. Our analysis was not able to look at subgroups of carers with different needs. Future work is required to determine other components of the admission and discharge process where having a carer is influential.

Published
2018

42. Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders

Author

Yong Yi Lee, Phillipa Hay, Jan J. Barendregt, Harvey Whiteford, Emily Stockings, Long Khanh-Dao Le, and Cathrine Mihalopoulos

Subjects
050103 clinical psychology, medicine.medical_specialty, Adolescent, Cost-Benefit Analysis, Risk Assessment, Feeding and Eating Disorders, 03 medical and health sciences, 0302 clinical medicine, Meta-Analysis as Topic, Outcome Assessment, Health Care, Health care, medicine, Humans, 0501 psychology and cognitive sciences, Depression (differential diagnoses), Randomized Controlled Trials as Topic, Estimation, Depressive Disorder, Major, Models, Statistical, business.industry, Health Policy, 05 social sciences, medicine.disease, 030227 psychiatry, Eating disorders, Strictly standardized mean difference, Relative risk, Meta-analysis, Physical therapy, Major depressive disorder, business, Algorithms
Abstract

Introduction. The raw mean difference (RMD) and standardized mean difference (SMD) are continuous effect size measures that are not readily usable in decision-analytic models of health care interventions. This study compared the predictive performance of 3 methods by which continuous outcomes data collected using psychiatric rating scales can be used to calculate a relative risk (RR) effect size. Methods. Three methods to calculate RR effect sizes from continuous outcomes data are described: the RMD, SMD, and Cochrane conversion methods. Each conversion method was validated using data from randomized controlled trials (RCTs) examining the efficacy of interventions for the prevention of depression in youth (aged ≤17 years) and adults (aged ≥18 years) and the prevention of eating disorders in young women (aged ≤21 years). Validation analyses compared predicted RR effect sizes to actual RR effect sizes using scatterplots, correlation coefficients ( r), and simple linear regression. An applied analysis was also conducted to examine the impact of using each conversion method in a cost-effectiveness model. Results. The predictive performances of the RMD and Cochrane conversion methods were strong relative to the SMD conversion method when analyzing RCTs involving depression in adults (RMD: r = 0.89–0.90; Cochrane: r = 0.73; SMD: r = 0.41–0.67) and eating disorders in young women (RMD: r = 0.89; Cochrane: r = 0.96). Moderate predictive performances were observed across the 3 methods when analyzing RCTs involving depression in youth (RMD: r = 0.50; Cochrane: r = 0.47; SMD: r = 0.46–0.46). Negligible differences were observed between the 3 methods when applied to a cost-effectiveness model. Conclusion. The RMD and Cochrane conversion methods are both valid methods for predicting RR effect sizes from continuous outcomes data. However, further validation and refinement are required before being applied more broadly.

Published
2018

43. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Author

Nanna Weye, James Scott, Harvey Whiteford, Preben Bo Mortensen, Alize J. Ferrari, Merete Nordentoft, Vladimir Canudas-Romo, Maria K. Christensen, Thomas Munk Laursen, Kim Moesgaard Iburg, John J. McGrath, Holly E. Erskine, Per Kragh Andersen, Esben Agerbo, Yan Holtz, Oleguer Plana-Ripoll, Natalie C. Momen, Damian Santomauro, Fiona J Charlson, Carsten Bøcker Pedersen, and Annette Erlangsen

Subjects
Adult, Male, Adolescent, Substance-Related Disorders, Denmark, Population, Substance-Related Disorders/mortality, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Cause of Death, medicine, Humans, Mental Disorders/mortality, 030212 general & internal medicine, Registries, education, Cause of death, Aged, Quality Indicators, Health Care, Aged, 80 and over, education.field_of_study, Mood Disorders, business.industry, Mortality, Premature, Mental Disorders, Mortality rate, Suicide/statistics & numerical data, General Medicine, Middle Aged, medicine.disease, Denmark/epidemiology, 3. Good health, Suicide, Mood disorders, Relative risk, Life expectancy, Female, Age of onset, business, Mood Disorders/mortality, Demography, Cohort study
Abstract

BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.FUNDING: Danish National Research Foundation.

Published
2019

44. Hours of Care and Caring Tasks Performed by Australian Carers of Adults with Mental Illness: Results from an Online Survey

Author

Yong Yi Lee, Sandra Diminic, Meredith Harris, Emily Hielscher, Harvey Whiteford, and Jan Kealton

Subjects
Adult, Male, Health (social science), Activities of daily living, Adolescent, health care facilities, manpower, and services, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Nursing, Respite care, Surveys and Questionnaires, Activities of Daily Living, Intellectual disability, medicine, Humans, 030212 general & internal medicine, health care economics and organizations, Government, Family caregivers, Mental Disorders, Australia, Public Health, Environmental and Occupational Health, Social Support, social sciences, Middle Aged, medicine.disease, Mental illness, Mental health, humanities, 030227 psychiatry, Psychiatry and Mental health, Caregivers, Schizophrenia, Female, Psychology
Abstract

The aim of this study was to provide a detailed profile of the hours of care Australian mental health carers provide for different types of caring tasks. The UQ Carer Survey 2016 was administered online to 105 adults caring for someone aged 16 years or older whose main condition is mental illness. Mental health carers reported providing on average 37.2 h of care per week to their main care recipient. Carers spent most of their active caring time providing emotional support, and the least of their time assisting with activities of daily living. Carers highlighted that this care time fluctuates with the undulating nature of mental illness, and many noted additional hours devoted to being 'on call' in case of emergency. Carers provide large amounts of support on a long-term and often unpredictable basis. Government services need to match the undulating nature of the illness by providing more flexible support options for mental health carers.

Published
2018

45. Identifying characteristics and practices of multidisciplinary team reviews for patients with severe mental illness: a systematic review

Author

Dan Siskind, Harvey Whiteford, Meredith Harris, Amanda J Baxter, and Charlotte Woody

Subjects
Mental Health Services, Patient Care Team, Mental Disorders, Multidisciplinary team, Mental illness, medicine.disease, Case review, Mental health, 030227 psychiatry, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Nursing, Multidisciplinary approach, medicine, Humans, 030212 general & internal medicine, Psychology
Abstract

Objectives: Multidisciplinary teams in mental health receive limited guidance, leading to inconsistent practices. We undertook a systematic review of the characteristics and practices of multidisciplinary team reviews for patients with severe mental illness or in relevant mental health service settings. Methods: Sources published since 2000 were located via academic database and web searches. Results were synthesised narratively. Results: A total of 14 sources were analysed. Important characteristics and practices identified included routine monitoring and evaluation, good communication, equality between team members, and clear documentation practices. Success factors included defined leadership and clear team goals. Four sources described considerations for patients with complex clinical needs, including allocating sufficient time for discussion, maintaining connections with community providers, and ensuring culturally sensitive practices. Conclusions: No single best practice model was found, due to variations in team caseload, casemix, and resourcing levels. However, key ingredients for success were proposed. Sources were mostly descriptive; there remains a lack of evidence-based guidance regarding multidisciplinary team review characteristics and practices.

Published
2018

46. The prevalence and burden of mental and substance use disorders in Australia: Findings from the Global Burden of Disease Study 2015

Author

Liliana G Ciobanu, Bernhard T. Baune, Azmeraw T. Amare, Alize J. Ferrari, Holly E. Erskine, Damian Santomauro, Janni Leung, Fiona J Charlson, Andrew T Olagunju, Harvey Whiteford, Ciobanu, Liliana G, Ferrari, Alize J, Erskine, Holly E, Santomauro, Damian F, Charlson, Fiona J, Leung, Janni, Amare, Azmeraw T, Olagunju, Andrew T, Whiteford, Harvey A, and Baune, Bernhard T

Subjects
Adult, Male, Burden of disease, medicine.medical_specialty, Adolescent, Substance-Related Disorders, prevalence, Global Burden of Disease, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Environmental health, Epidemiology, Prevalence, medicine, Humans, 030212 general & internal medicine, Disease burden, Aged, Aged, 80 and over, global burden of disease, Mortality, Premature, Mental Disorders, Australia, General Medicine, Middle Aged, Health Surveys, mental disorders, Time of death, Psychiatry and Mental health, Systematic review, Years of potential life lost, substance use disorders, Life expectancy, epidemiology, Substance use, 030217 neurology & neurosurgery
Abstract

Objectives: Timely and accurate assessments of disease burden are essential for developing effective national health policies. We used the Global Burden of Disease Study 2015 to examine burden due to mental and substance use disorders in Australia. Methods: For each of the 20 mental and substance use disorders included in Global Burden of Disease Study 2015, systematic reviews of epidemiological data were conducted, and data modelled using a Bayesian meta-regression tool to produce prevalence estimates by age, sex, geography and year. Prevalence for each disorder was then combined with a disorder-specific disability weight to give years lived with disability, as a measure of non-fatal burden. Fatal burden was measured as years of life lost due to premature mortality which were calculated by combining the number of deaths due to a disorder with the life expectancy remaining at the time of death. Disability-adjusted life years were calculated by summing years lived with disability and years of life lost to give a measure of total burden. Uncertainty was calculated around all burden estimates. Results: Mental and substance use disorders were the leading cause of non-fatal burden in Australia in 2015, explaining 24.3% of total years lived with disability, and were the second leading cause of total burden, accounting for 14.6% of total disability-adjusted life years. There was no significant change in the age-standardised disability-adjusted life year rates for mental and substance use disorders from 1990 to 2015. Conclusion: Global Burden of Disease Study 2015 found that mental and substance use disorders were leading contributors to disease burden in Australia. Despite several decades of national reform, the burden of mental and substance use disorders remained largely unchanged between 1990 and 2015. To reduce this burden, effective population-level preventions strategies are required in addition to effective interventions of sufficient duration and coverage.

Published
2018

48. Assessing service use for mental health by Indigenous populations in Australia, Canada, New Zealand and the United States of America: a rapid review of population surveys

Author

Sandra Diminic, Joseph P. Gone, Amanda J Baxter, Meredith Harris, Stuart Leske, Harvey Whiteford, Cecily McIntyre, and Ernest Hunter

Subjects
medicine.medical_specialty, Canada, Psychological intervention, Mental disorders, Indigenous, Health administration, 03 medical and health sciences, 0302 clinical medicine, Population Groups, Environmental health, Health care, medicine, Humans, 030212 general & internal medicine, Health policy, business.industry, Health Policy, Public health, Research, lcsh:Public aspects of medicine, Health services research, Australia, lcsh:RA1-1270, Mental health, Culturally Competent Care, United States, 030227 psychiatry, Mental Health, Mental health services, business, Surveys and questionnaires, New Zealand
Abstract

Background Indigenous people in Australia, Canada, New Zealand and the United States of America experience disproportionately poor mental health compared to their non-Indigenous counterparts. To optimally allocate resources, health planners require information about the services Indigenous people use for mental health, their unmet treatment needs and the barriers to care. We reviewed population surveys of Indigenous people to determine whether the information needed to guide service development is being collected. Methods We sought national- or state-level epidemiological surveys of Indigenous populations conducted in each of the four selected countries since 1990 that asked about service use for mental health. Surveys were identified from literature reviews and web searches. We developed a framework for categorising the content of each survey. Using this framework, we compared the service use content of the surveys of Indigenous people to each other and to general population mental health surveys. We focused on identifying gaps in information coverage and topics that may require Indigenous-specific questions or response options. Results Nine surveys met our inclusion criteria. More than half of these included questions about health professionals consulted, barriers to care, perceived need for care, medications taken, number, duration, location and payment of health professional visits or use of support services or self-management. Less than half included questions about interventions received, hospital admissions or treatment dropout. Indigenous-specific content was most common in questions regarding use of support services or self-management, types of health professionals consulted, barriers to care and interventions received. Conclusions Epidemiological surveys measuring service use for mental health among Indigenous populations have been less comprehensive and less standardised than surveys of the general population, despite having assessed similar content. To better understand the gaps in mental health service systems for Indigenous people, systematically-collected subjective and objective indicators of the quality of care being delivered are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0233-5) contains supplementary material, which is available to authorized users.

Published
2017

49. The prevalence and service utilisation associated with mental and substance use disorders in Lao People’s Democratic Republic: findings from a cross-sectional survey

Author

C. Choulamany, Damian Santomauro, S. Raja, Harvey Whiteford, Fiona J Charlson, and Sandra Diminic

Subjects
Adult, Mental Health Services, medicine.medical_specialty, Adolescent, Substance-Related Disorders, Epidemiology, Population, Health Services Accessibility, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Health care, Prevalence, medicine, Humans, 030212 general & internal medicine, Healthcare Disparities, education, Psychiatry, Aged, Mini-international neuropsychiatric interview, Aged, 80 and over, education.field_of_study, business.industry, Mental Disorders, Public Health, Environmental and Occupational Health, Original Articles, Middle Aged, Mental illness, medicine.disease, Mental health, 030227 psychiatry, Substance abuse, Psychiatry and Mental health, Cross-Sectional Studies, Mood disorders, Laos, Optometry, Anxiety, Female, medicine.symptom, business
Abstract

Aims.An epidemiological survey was conducted to determine the prevalence of the mental and substance use disorders and ascertain patterns of mental health services utilisation in Lao People's Democratic Republic (Lao PDR) with the aim of evaluating existing gaps and opportunities in the provision of mental health services.Methods.This study was a cross-sectional, household survey of adults living within Vientiane Capital province, Lao PDR. We collected data on participant demographics, mental and physical health status, family history of mental illness and exposure to potential risk factors. It also collected data on mental health service utilisation patterns, types of health professionals and treatment being accessed, barriers to treatment and perceived need for care. The MINI International Neuropsychiatric Interview (MINI v.6.0) was also administered to assess mental disorder prevalence.Results.Age- and sex-standardised current prevalence of any disorder was estimated at 15.2% (95% CI 11.0–20.7). Alcohol dependence (5.5% (95% CI 3.2–9.6)), was the most prevalent followed by anxiety disorders (5.2% (95% CI 3.2–8.3)) and mood disorders (2.5% (95% CI 1.5–4.4)). 11.0% (95% CI 5.8–20.1) of participants with a mental and/or substance use disorder suffered from other comorbid disorders. A number of variables demonstrated significant effects in final logistic regression models, including family history, education and employment for mental disorders; and gender, numbers of hours worked per week and number of dependants for substance use disorders. Having a mental or substance use disorder was associated with an OR of 11.6 of suicidality over participants without a mental or substance use disorder (95% CI 2.8–58.5). Of the 101 participants who met criteria for a current mental or substance use disorder, only two (2.1% (95% CI 0.5–8.0)) had accessed services for their mental health in the past 12 months. No participants who had seen a health professional in the past 12 months reported getting as much help as they needed. The vast majority (89.2% (95% CI 76.5–95.4)) of participants meeting criteria for a current mental or substance use disorder reported that they had not experienced mental health problems in the past 12 months.Conclusions.This study presents the first epidemiological estimates for a range of mental and substance use disorders in the general population of the most populous province in Lao PDR. A large treatment gap exists for mental and substance use disorders in Lao PDR. This research adds value for health care and has been an important precursor to developing informed and targeted mental health policy, services and health system reform in Lao PDR.

Published
2017

50. Impact of nurse-led behavioural counselling to improve metabolic health and physical activity among adults with mental illness

Author

Sarah J. Fraser, Harvey Whiteford, Nicola W. Burton, and Wendy J. Brown

Subjects
Adult, Counseling, Male, medicine.medical_specialty, Health Status, Population, Blood Pressure, Psychiatric Nursing, Health Promotion, 03 medical and health sciences, 0302 clinical medicine, Intervention (counseling), medicine, Humans, 030212 general & internal medicine, education, Psychiatry, Exercise, education.field_of_study, business.industry, Mental Disorders, Attendance, Anthropometry, Mental illness, medicine.disease, Mental health, 030227 psychiatry, Health promotion, Life expectancy, Female, Waist Circumference, Pshychiatric Mental Health, business
Abstract

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non-communicable disease. This repeated-measures, single-group intervention trial evaluated the effects of a 19-week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face-to-face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self-report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically-significant changes were demonstrated between baseline and post intervention for participants' waist circumference (P = 0.035) and waist-to-height ratio (P = 0.037). Non-significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse-led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an 'open door' policy to allow for attendance interruptions, such as hospitalization.

Published
2017

Catalog

Books, media, physical & digital resources
See catalog results