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1. Dutch DALYs, current and future burden of disease in the Netherlands

Author

Henk B. M. Hilderink, Marjanne H. D. Plasmans, M. J. J. C. (René) Poos, Petra E. D. Eysink, and Ronald Gijsen

Subjects
Dutch DALYs, National Burden of disease, Future projections, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The Disability Adjusted Life Year (DALY) is a measure to prioritize in the public health field. In the Netherlands, the DALY estimates are calculated since 1997 and are included in the Public Health Status and Foresight studies which is an input for public health priority setting and policy making. Over these 20 years, methodological advancements have been made, including accounting for multimorbidity and performing projections for DALYs into the future. Most important methodological choices and improvements are described and results are presented. Methods The DALY is composed of the two components years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Both the YLL and the YLD are distinguished by sex, age and health condition, allowing aggregation to the ICD-10 chapters. The YLD is corrected for multimorbidity, assuming independent occurrence of health conditions and a multiplicative method for the calculation of combined disability weights. Future DALYs are calculated based on projections for causes of death, and prevalence and incidence. Results The results for 2015 show that cancer is the ICD-10 chapter with the highest disease burden, followed by cardiovascular diseases and mental disorders. For the individual health conditions, coronary heart disease had the highest disease burden in 2015. In 2040, we see a strong increase in disease burden of dementia and arthrosis. For dementia this is due to a threefold increase in dementia as a cause of death, while for arthrosis this is mainly due to the increase in prevalence. Conclusions To calculate the DALY requires a substantial amount of data, methodological choices, interpretation and presentation of results, and the personnel capacity to carry out all these tasks. However, doing a National Burden of Disease study, and especially doing that for more than 20 years, proved to have an enormous additional value in population health information and thus supports better public health policies.

Published
2020
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2. Population vulnerability to COVID-19 in Europe: a burden of disease analysis

Author

Grant M. A. Wyper, Ricardo Assunção, Sarah Cuschieri, Brecht Devleeschauwer, Eilidh Fletcher, Juanita A. Haagsma, Henk B. M. Hilderink, Jane Idavain, Tina Lesnik, Elena Von der Lippe, Marek Majdan, Milena S. Milicevic, Elena Pallari, José L. Peñalvo, Sara M. Pires, Dietrich Plaß, João V. Santos, Diane L. Stockton, Sofie Theresa Thomsen, and Ian Grant

Subjects
COVID-19, Coronavirus, Burden of disease, DALY, YLD, Summary measures of population health, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.

Published
2020
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3. The increasing significance of disease severity in a burden of disease framework

Author

Ian Grant, Dietrich Plass, Henk B M Hilderink, Juanita A. Haagsma, Gerry McCartney, Maria Teresa de Haro Moro, Tina Lesnik, Elena von der Lippe, Milena Santric-Milicevic, Jane Idavain, Marek Majdan, Michael Porst, Sara Monteiro Pires, Ricardo Assunção, Grant M. A. Wyper, Diane Stockton, Brecht Devleesschauwer, Eilidh Fletcher, João Vasco Santos, Michelle Gourley, Elena Pallari, and Public Health

Subjects
Burden of disease, Coronavirus disease 2019 (COVID-19), Disease, Health outcomes, YLD, 03 medical and health sciences, 0302 clinical medicine, European burden of disease network, SDG 3 - Good Health and Well-being, Disease severity, Environmental health, Pandemic, Medicine, Disability-adjusted life year, 030212 general & internal medicine, 030203 arthritis & rheumatology, DALY, disability-adjusted life year, business.industry, Public Health, Environmental and Occupational Health, General Medicine, 3. Good health, years lived with disability, severity distribution, disease severity, Headaches, medicine.symptom, business, Scottish burden of disease
Abstract

Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) – put simply, ill-health – is what drives DALYs, not mortality. Being able to monitor trends in YLD closely is particularly relevant for countries that sit high on the socio-demographic spectrum of development, as it contributes more than half of all DALYs. There is a paucity of data on how the population-level occurrence of disease is distributed according to severity, and as such, the majority of global and national efforts in monitoring YLD lack the ability to differentiate changes in severity across time and location. This raises uncertainties in interpreting these findings without triangulation with other relevant data sources. Our commentary aims to bring this issue to the forefront for users of burden of disease estimates, as its impact is often easily overlooked as part of the fundamental process of generating DALY estimates. Moreover, the wider health harms of the COVID-19 pandemic have underlined the likelihood of latent and delayed demand in accessing vital health and care services that will ultimately lead to exacerbated disease severity and health outcomes. This places increased importance on attempts to be able to differentiate by both the occurrence and severity of disease.

Published
2023

4. Correction to: Population vulnerability to COVID-19 in Europe: a burden of disease analysis

Author

Grant M. A. Wyper, Ricardo Assunção, Sarah Cuschieri, Brecht Devleesschauwer, Eilidh Fletcher, Juanita A. Haagsma, Henk B. M. Hilderink, Jane Idavain, Tina Lesnik, Elena Von der Lippe, Marek Majdan, Milena S. Milicevic, Elena Pallari, José L. Peñalvo, Sara M. Pires, Dietrich Plaß, João V. Santos, Diane L. Stockton, Sofie Theresa Thomsen, and Ian Grant

Subjects
Public aspects of medicine, RA1-1270
Abstract

An amendment to this paper has been published and can be accessed via the original article.

Published
2020
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5. The Working Informal Caregiver Model:A Mixed Methods Approach to Explore Future Informal Caregiving by Working Caregivers

Author

Eline E. Vos, Henk B. M. Hilderink, Simone R. de Bruin, Allard J. van der Beek, Karin I. Proper, Public and occupational health, and APH - Societal Participation & Health

Subjects
Renewable Energy, Sustainability and the Environment, informal care, work, working caregivers, older adults, eldercare, conceptual model, framework, determinants, Delphi study, Geography, Planning and Development, Management, Monitoring, Policy and Law
Abstract

A growing number of informal caregivers of older adults combine caregiving with a paid job, raising the question of whether they will be able to meet the increasing demand for informal care. The aims of our study are twofold: first, to describe the development of a model providing insight into the factors that play a role in the availability and provision of informal care by working caregivers of older adults, and second, to investigate which societal developments will impact the factors in the model, and thus the future availability of informal care by workers. A mixed-methods approach was applied to integrate evidence from academic and grey literature, with insights from experts through a Group Model Building exercise and a Delphi study. The resulting Working Informal Caregiver (WIC) model presents a range of individual, social and environmental factors that are related to working caregivers’ ability and their willingness to engage in informal care. Experts foresee that future informal care will be impacted most by the increasing participation of women in the workforce, while changing household structures may diminish opportunities to share care tasks within their households or families. The WIC model can be used to gain better insight into the availability of informal care by workers, now and in the future.

Published
2022

6. Exploring health trends prior to state pension age for The Netherlands up to 2040

Author

Maaike van der Noordt, Johan J. Polder, Marjanne H. D. Plasmans, Henk B. M. Hilderink, Dorly J. H. Deeg, Theo G. van Tilburg, Suzan van der Pas, Fons van der Lucht, Epidemiology and Data Science, APH - Aging & Later Life, Healthy Ageing, Allied Health Care and Nursing, Sociology, The Social Context of Aging (SoCA), Tranzo, Scientific center for care and wellbeing, and Huisarts & Ziekenhuis

Subjects
Male, retirement age, Health, Toxicology and Mutagenesis, UNITED-STATES, functional limitations, extension of working lives, DISABILITY TRENDS, self-rated health, Pensions, pensioenleeftijd, Humans, RETIREMENT, publieke gezondheid, Aged, Netherlands, OLDER, PRODUCTIVITY, forecasting health, public health, Public Health, Environmental and Occupational Health, CARE, oudere werknemers, Health Surveys, PAID EMPLOYMENT, SHARE, older employees, Female, Self Report, EUROPEAN COUNTRIES, WORK ABILITY, Forecasting
Abstract

Background: In many Western countries, the state pension age is being raised to stimulate the extension of working lives. It is not yet well understood whether the health of older adults supports this increase. In this study, future health of Dutch adults aged 60 to 68 (i.e., the expected state pension age) is explored up to 2040. Methods: Data are from the Dutch Health Interview Survey 1990–2017 (N ≈ 10,000 yearly) and the Dutch Public Health Monitor 2016 (N = 205,151). Health is operationalized using combined scores of self-reported health and limitations in mobility, hearing or seeing. Categories are: good, moderate and poor health. Based on historical health trends, two scenarios are explored: a stable health trend (neither improving nor declining) and an improving health trend. Results: In 2040, the health distribution among men aged 60–68 is estimated to be 63–71% in good, 17–28% in moderate and 9–12% in poor health. Among women, this is estimated to be 64–69%, 17–24% and 12–14%, respectively. Conclusions: This study’s explorations suggest that a substantial share of people will be in moderate or poor health and, thus, may have difficulty continuing working. Policy aiming at sustainable employability will, therefore, remain important, even in the case of the most favorable scenario.

Published
2022

7. Nested archetypes of vulnerability in African drylands: where lies potential for sustainable agricultural intensification?

Author

D Sietz, J C Ordoñez, M T J Kok, P Janssen, H B M Hilderink, P Tittonell, and H Van Dijk

Subjects
archetype, transferability, pattern, nestedness, socio-ecological system, sustainable intensification, Environmental technology. Sanitary engineering, TD1-1066, Environmental sciences, GE1-350, Science, Physics, QC1-999
Abstract

Food production is key to achieving food security in the drylands of sub-Saharan Africa. Since agricultural productivity is limited, however, due to inherent agro-ecological constraints and land degradation, sustainable agricultural intensification has been widely discussed as an opportunity for improving food security and reducing vulnerability. Yet vulnerability determinants are distributed heterogeneously in the drylands of sub-Saharan Africa and sustainable intensification cannot be achieved everywhere in cost-effective and efficient ways. To better understand the heterogeneity of farming systems’ vulnerability in order to support decision making at regional scales, we present archetypes, i.e. socio-ecological patterns, of farming systems’ vulnerability in the drylands of sub-Saharan Africa and reveal their nestedness. We quantitatively indicated the most relevant farming systems’ properties at a sub-national resolution. These factors included water availability, agro-ecological potential, erosion sensitivity, population pressure, urbanisation, remoteness, governance, income and undernourishment. Cluster analysis revealed eight broad archetypes of vulnerability across all drylands of sub-Saharan Africa. The broad archetype representing better governance and highest remoteness in extremely dry and resource-constrained regions encompassed the largest area share (19%), mainly indicated in western Africa. Moreover, six nested archetypes were identified within those regions with better agropotential and prevalent agricultural livelihoods. Among these patterns, the nested archetype depicting regions with highest erosion sensitivity, severe undernourishment and lower agropotential represented the largest population (30%) and area (28%) share, mainly found in the Sahel region. The nested archetype indicating medium undernourishment, better governance and lowest erosion sensitivity showed particular potential for sustainable agricultural intensification, mainly in western and some parts of southeastern and eastern Africa. Insights into the nestedness of archetypes allowed a more differentiated discussion of vulnerability and sustainable intensification opportunities, enhancing the evaluation of key interlinkages between land management and food security. The archetypes may support the transfer of successful intensification strategies based on similarities among the drylands in sub-Saharan Africa.

Published
2017
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8. Recommendations to plan a national burden of disease study

Author

Jürgen C Schmidt, Brecht Devleesschauwer, John N Newton, Alexander Rommel, Henk B M Hilderink, Ian Grant, Anne Gallay, Thomas Ziese, Romana Haneef, Grant M. A. Wyper, and Herman Van Oyen

Subjects
medicine.medical_specialty, 030309 nutrition & dietetics, Burden of Disease, Context (language use), Population health, DALYs, Health informatics, YLD, 03 medical and health sciences, 0302 clinical medicine, Knowledge translation, YLL, Medicine and Health Sciences, medicine, 030212 general & internal medicine, Health policy, 0303 health sciences, Public economics, business.industry, Public health, Public Health, Environmental and Occupational Health, Health services research, Methodology, European Burden of Disease Network, Life expectancy, Business, burden-eu, Public aspects of medicine, RA1-1270, InfAct
Abstract

Background The InfAct (Information for Action) project is a European Commission Joint Action on Health Information which has promoted the potential role of burden of disease (BoD) approaches to improve the current European Union-Health Information System (EU-HIS). It has done so by raising awareness of the concept, the methods used to calculate estimates and their potential implications and uses in policymaking. The BoD approach is a systematic and scientific effort to quantify and compare the magnitude of health loss due to different diseases, injuries, and risk factors with estimates produced by demographic characteristics and geographies for specific points in time. Not all countries have the resources to undertake such work, and may therefore start with a more restricted objective, e.g., a limited number of diseases, or the use of simple measures of population health such as disease prevalence or life expectancy. The main objective to develop these recommendations was to facilitate those countries planning to start a national burden of disease study. Results These recommendations could be considered as minimum requirements for those countries planning to start a BoD study and includes following elements: (1) Define the objectives of a burden of disease study within the context of your country, (2) Identify, communicate and secure the benefits of performing national burden of disease studies, (3) Secure access to the minimum required data sources, (4) Ensure the minimum required capacity and capability is available to carry out burden of disease study, (5) Establish a clear governance structure for the burden of disease study and stakeholder engagement/involvement, (6) Choose the appropriate methodological approaches and (7) Knowledge translation. These were guided by the results from our survey performed to identify the needs of European countries for BoD studies, a narrative overview from four European countries (Belgium, Germany, The Netherlands and Scotland) and the summary of a comparative study of country health profiles with national health statistics. Conclusions These recommendations as minimum requirements would facilitate efforts by those European countries who intend to perform national BoD studies.

Published
2021

9. Reflections on key methodological decisions in national burden of disease assessments

Author

Elena von der Lippe, Henk B M Hilderink, Ian Grant, Brecht Devleesschauwer, Juanita A. Haagsma, Annelene Wengler, Michael Porst, Grant M. A. Wyper, Michelle Gourley, and Public Health

Subjects
medicine.medical_specialty, 195 COUNTRIES, Harmonization, EUROPEAN BURDEN, Population health, DALYs, Health informatics, Disability-adjusted life years, 03 medical and health sciences, 0302 clinical medicine, European burden of disease network, Health care, Medicine and Health Sciences, SYSTEMATIC ANALYSIS, medicine, QUALITY, ddc:610, 030212 general & internal medicine, Health policy, Population health measures, ADJUSTED LIFE YEARS, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Public health, Research, Public Health, Environmental and Occupational Health, Health services research, Capacity building, lcsh:RA1-1270, Years lived with disability, GLOBAL BURDEN, Environmental economics, DISABILITY WEIGHTS, PREMATURE MORTALITY, HEALTH OUTCOMES, INJURIES, Business, 610 Medizin und Gesundheit, 0305 other medical science, Years of life lost, Burden of disease methodology
Abstract

Background Summary measures of population health are increasingly used in different public health reporting systems for setting priorities for health care and social service delivery and planning. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in the field of public health and have become the key metric for quantifying burden of disease (BoD). BoD methodology is, however, complex and highly data demanding, requiring a substantial capacity to apply, which has led to major disparities across researchers and nations in their resources to perform themselves BoD studies and interpret the soundness of available estimates produced by the Global Burden of Disease Study. Methods BoD researchers from the COST Action European Burden of Disease network reflect on the most important methodological choices to be made when estimating DALYs. The paper provides an overview of eleven methodological decisions and challenges drawing on the experiences of countries working with BoD methodology in their own national studies. Each of these steps are briefly described and, where appropriate, some examples are provided from different BoD studies across the world. Results In this review article we have identified some of the key methodological choices and challenges that are important to understand when calculating BoD metrics. We have provided examples from different BoD studies that have developed their own strategies in data usage and implementation of statistical methods in the production of BoD estimates. Conclusions With the increase in national BoD studies developing their own strategies in data usage and implementation of statistical methods in the production of BoD estimates, there is a pressing need for equitable capacity building on the one hand, and harmonization of methods on the other hand. In response to these issues, several BoD networks have emerged in the European region that bring together expertise across different domains and professional backgrounds. An intensive exchange in the experience of the researchers in the different countries will enable the understanding of the methods and the interpretation of the results from the local authorities who can effectively integrate the BoD estimates in public health policies, intervention and prevention programs.

Published
2020

10. Dutch DALYs, current and future burden of disease in the Netherlands

Author

M.J.J.C. René Poos, Henk B M Hilderink, Marjanne H.D. Plasmans, Gijsen R, and Petra E D Eysink

Subjects
medicine.medical_specialty, National Burden of disease, Population health, 03 medical and health sciences, 0302 clinical medicine, Environmental health, medicine, Disability-adjusted life year, Dementia, 030212 general & internal medicine, Health policy, Disease burden, Future projections, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Public health, Methodology, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, medicine.disease, Years of potential life lost, Dutch DALYs, 0305 other medical science, business
Abstract

Background The Disability Adjusted Life Year (DALY) is a measure to prioritize in the public health field. In the Netherlands, the DALY estimates are calculated since 1997 and are included in the Public Health Status and Foresight studies which is an input for public health priority setting and policy making. Over these 20 years, methodological advancements have been made, including accounting for multimorbidity and performing projections for DALYs into the future. Most important methodological choices and improvements are described and results are presented. Methods The DALY is composed of the two components years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Both the YLL and the YLD are distinguished by sex, age and health condition, allowing aggregation to the ICD-10 chapters. The YLD is corrected for multimorbidity, assuming independent occurrence of health conditions and a multiplicative method for the calculation of combined disability weights. Future DALYs are calculated based on projections for causes of death, and prevalence and incidence. Results The results for 2015 show that cancer is the ICD-10 chapter with the highest disease burden, followed by cardiovascular diseases and mental disorders. For the individual health conditions, coronary heart disease had the highest disease burden in 2015. In 2040, we see a strong increase in disease burden of dementia and arthrosis. For dementia this is due to a threefold increase in dementia as a cause of death, while for arthrosis this is mainly due to the increase in prevalence. Conclusions To calculate the DALY requires a substantial amount of data, methodological choices, interpretation and presentation of results, and the personnel capacity to carry out all these tasks. However, doing a National Burden of Disease study, and especially doing that for more than 20 years, proved to have an enormous additional value in population health information and thus supports better public health policies.

Published
2020

11. Knowledge translation and health policy for burden of disease

Author

Sofie Theresa Thomsen, Henk B M Hilderink, and E Pallari

Subjects
Gerontology, Burden of disease, Policy making, business.industry, Knowledge translation, Public Health, Environmental and Occupational Health, Cost of illness, Risk communication, Disability-adjusted life year, Medicine, business, Health policy
Abstract

A key goal of most Burden of Disease (BoD) studies is to support public health policies. However, while the concepts of BoD and Disability Adjusted Life years have been introduced more than 25 years, BoD researchers are still struggling to find better ways to translate their findings and communicate them to the relevant decision makers and other stakeholders. To address this gap, the burden-eu COST Action aims to generate better guidance of the use of BoD metrics in policy-making processes. In collaboration with experts in knowledge translation and risk communication, the Action will compile good practices in knowledge translation and develop a roadmap to integrate knowledge translation in national BOD studies. To support these objectives, collaborations have been established with knowledge translation experts from the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Public Health Association. During an initial meeting of the “knowledge translation” working group, 29 participants identified elements in the pathway from evidence generation to practice that need to be addressed. Building on the outcomes of this meeting and the inputs from the knowledge translation experts, this presentation will introduce the knowledge translation framework, and address some of the challenges in identifying best routes to reach out to the public and policy-makers. Specific emphasis will be placed in profiling the context, actors and processes of each country within the policy triangle, and drawing on best and worst example case studies. Additionally, the process will be discussed to co-create a toolkit or guide for using BoD evidence in policy and practice. The session will conclude with an interaction with the audience to learn about the perceived barriers for implementing knowledge translation within the BoD framework.

Published
2020

12. Correction to: Population vulnerability to COVID-19 in Europe: a burden of disease analysis

Author

Tina Lesnik, Grant M. A. Wyper, Milena M Santric Milicevic, Sofie Theresa Thomsen, Diane Stockton, Ian Grant, Juanita A. Haagsma, Dietrich Plaß, Brecht Devleesschauwer, Eilidh Fletcher, Sarah Cuschieri, Elena Pallari, Henk B M Hilderink, João Vasco Santos, Jane Idavain, Marek Majdan, Elena von der Lippe, José L. Peñalvo, Ricardo Assunção, and Sara Monteiro Pires

Subjects
Burden of disease, 0303 health sciences, 2019-20 coronavirus outbreak, education.field_of_study, History, Coronavirus disease 2019 (COVID-19), 030309 nutrition & dietetics, lcsh:Public aspects of medicine, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Published Erratum, Population, Public Health, Environmental and Occupational Health, Vulnerability, lcsh:RA1-1270, Genealogy, 03 medical and health sciences, 0302 clinical medicine, 030212 general & internal medicine, education, Author name
Abstract

Following publication of the original article [1], the authors identified an error in the author name of Brecht Devleesschauwer. The incorrect author name is: Brecht Devleeschauwer The correct author name is: Brecht Devleesschauwer The author group has been updated above and the original article [1] has been corrected.

Published
2020

13. Population vulnerability to COVID-19 in Europe: a burden of disease analysis

Author

Dietrich Plaß, Juanita A. Haagsma, Jane Idavain, Marek Majdan, Elena von der Lippe, Ricardo Assunção, Sara Monteiro Pires, Elena Pallari, Ian Grant, José L. Peñalvo, Tina Lesnik, Sarah Cuschieri, Milena M Santric Milicevic, João Vasco Santos, Henk B M Hilderink, Grant M. A. Wyper, Sofie Theresa Thomsen, Diane Stockton, Eilidh Fletcher, Brecht Devleeschauwer, and Public Health

Subjects
Population -- Health aspects, Vulnerability, 030204 cardiovascular system & hematology, Health informatics, YLD, European burden of disease network, 0302 clinical medicine, COVID-19 (Disease) -- Risk factors -- Europe, Medicine and Health Sciences, Elderly people, 030212 general & internal medicine, education.field_of_study, DALY, lcsh:Public aspects of medicine, Health services research, Burden of disease, 1. No poverty, Health risk assessment -- Europe, 3. Good health, Europe, Chronic diseases -- Risk factors, Geography, Avaliação do Impacte em Saúde, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Age structure, GBD, Population, Bivariate analysis, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Environmental health, medicine, Veterinary Sciences, education, Health policy, Government, business.industry, Research, Public health, Public Health, Environmental and Occupational Health, Older people -- Health risk assessment, COVID-19, Correction, lcsh:RA1-1270, Summary measures of population health, Coronavirus, business, 030217 neurology & neurosurgery
Abstract

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Methods: Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Results: Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Conclusion: Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19., peer-reviewed

Published
2020

14. Quantitative Health Impact Assessment Methodology for Societal Initiatives: A Scoping Review

Author

D Ruwaard, H B M Hilderink, M W J Jansen, M P M Bekker, and L M Reumers

Subjects
Public Health, Environmental and Occupational Health
Abstract

Background Promoting health rather than treating disease is gaining popularity and promotion initiatives are increasingly situated in the societal domain. In this scoping review, the literature on quantitative health impact assessment (HIA) practice and methodology is explored in order to provide an overview of methods that have been used or proposed for estimating societal initiatives’ health outcomes. Methods Systematic searches were done in PubMed and Web of Science in order to identify relevant literature. A set of selection criteria ensured that studies held useful quantitative HIA methodology and a societal approach. Reference lists of all selected studies were then examined for other studies. After literature selection, quantifiable features of interest were recorded and general observations on the composition of the current literature were made. Results The literature selection process yielded 54 included studies, most of which focus on lifestyle-related determinants. Of different health outcome measurements, deaths (averted) was most frequently used, followed by life years and quality- and disability-adjusted life years. Equity is frequently mentioned, but not often estimated. Most studies made estimates based on simulation models, notably with Monte Carlo, Markov and system dynamics models (simulation period mean 46 years; median 50 years). Inputs for the models such as relative risks, transition probabilities and price elasticities were taken from census and register data, survey data, evidence from previous (scientific) studies and outcomes from stakeholder sessions. Conclusions HIA holds a wide range of practices with some overlap. Different methods’ strengths and weaknesses partly depend on the phenomenon of interest. Some policy types have standard approaches, but there is no one universal optimal method and therefore having a grasp of multiple methods is useful. Furthermore, estimating health effect distributions could make an important addition to HIA. Key messages Quantitative HIA can be conducted using various methodological bases and most studies use some form of simulation modelling. Different simulation methods are distinct, but do show some overlap. Quantitative HIA topics often relate to individual behaviour (micro-level proximal determinants). There is room for HIA method development for determinants with indirect connections to the individual.

Published
2019

15. Development of composite indicators to monitor burden of disease across Member States

Author

Brecht Devleesschauwer, Henk B M Hilderink, R Haneef, A Gallay, John N Newton, Thomas Ziese, and Jürgen C Schmidt

Subjects
Burden of disease, Member states, Environmental health, Public Health, Environmental and Occupational Health, Business
Abstract

Background The burden of disease (BoD) methods are not part of routine public health activities and policy development process across all Member States (MSs). The main reasons for this are varying levels of knowledge, experience, and capability to apply and use BoD methods. Therefore, MSs need support, guidance and training to adopt and integrate BoD approaches in their public health systems. In this context, two workshops have been organised by InfAct. The main objectives of the workshops are to raise awareness, share knowledge and experience, and to provide mutual support to to integrate BoD indicators in the public health policies across Europe. Methods The workshops were about the BoD concept and methodologies, and the use of BoD data in public health policy. These workshops were supported by technical presentations describing methods and the use of BoD data in health policy with various case studies, followed by expert exchange with facilitated discussions and group work. The case studies included national BoD studies from Belgium, Germany, Netherland, and Scotland. Results Two workshops were held at Santé Publique France, and attended by 16 BoD experts and 40 participants from 25 MSs. The workshops were well received by the participants particularly with regards to the diversity of the group and the possibility to share knowledge and experience from various perspectives. Three areas of action were highlighted: 1. the need for methodological trainings to strengthen skills in interpreting and calculating BoD estimates; 2. the encouragement of more collaborations across MSs to share or exchange good practices on BoD; and 3. the importance of the implications of BoD data to guide policies across MSs. Conclusions The workshops highlighted the need for capacity building activities to implement BoD approaches across MSs in routine public health activities and to use BoD data to guide health policy. More collaborations among MSs on BoD activities are needed in the future.

Published
2019

16. Biological Variation of Creatinine, Cystatin C, and eGFR over 24 Hours

Author

Breshna M Aref, Lieke J.J. Klinkenberg, Fahra Aziz, Otto Bekers, Judith M Hilderink, Elisabeth J R Litjens, Noreen van der Linden, Roger J M W Rennenberg, Dorien M Kimenai, Richard P. Koopmans, Jeroen P. Kooman, Steven J.R. Meex, MUMC+: DA CDL Algemeen (9), RS: CARIM - R2 - Cardiac function and failure, Promovendi CD, RS: CARIM - R2.02 - Cardiomyopathy, MUMC+: MA Nefrologie (9), RS: NUTRIM - R3 - Respiratory & Age-related Health, Interne Geneeskunde, MUMC+: MA Alg Interne Geneeskunde (9), MUMC+: DA CDL (5), and RS: SHE - R1 - Research (OvO)

Subjects
CHRONIC KIDNEY-DISEASE, medicine.medical_specialty, Clinical Biochemistry, Urology, Renal function, CARDIAC TROPONIN-T, COOKED-MEAT MEAL, CLINICAL-CHEMISTRY, 030204 cardiovascular system & hematology, urologic and male genital diseases, GLOMERULAR-FILTRATION-RATE, CRITICAL-APPRAISAL, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Biological variation, Epidemiology, medicine, Humans, 030212 general & internal medicine, Cystatin C, Creatinine, SERUM CREATININE, biology, business.industry, Biochemistry (medical), medicine.disease, ANALYTES, female genital diseases and pregnancy complications, INDIVIDUALS, VARIABILITY, chemistry, biology.protein, Cystatin, Analysis of variance, business, Glomerular Filtration Rate, Kidney disease
Abstract

BACKGROUND Estimated glomerular filtration rate (eGFR) is widely used in clinical practice. This study assessed the within-subject biological variation (CVI) of different eGFR equations in people with chronic kidney disease (CKD) and people without CKD. The aims of this study were (a) to determine the 24-h biological variation profiles of creatinine, cystatin C, and eGFR and (b) to determine whether CVI of creatinine, cystatin C, and eGFR changes on deterioration of glomerular filtration. METHODS Hourly blood samples were analyzed from 37 individuals (17 without CKD, 20 with CKD) during 24 h. Creatinine (enzymatic method) and cystatin C were measured using a Cobas 8000 (Roche Diagnostics). eGFR was estimated using the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration based on creatinine and/or cystatin C. Plasma samples were stored at −80 °C before analysis. Outlier and homogeneity analyses were checked before performing a nested ANOVA to determine biological variation. RESULTS CVI of creatinine was higher in people without CKD than in those with CKD (6.4% vs 2.5%) owing primarily to the more profound effect of meat consumption on creatinine variability in individuals with lower baseline creatinine concentrations. Unlike creatinine, cystatin C concentrations were unaffected by meat consumption. Cystatin C showed some diurnal rhythmic variation and less in people with CKD. Reference change values (RCVs) of all eGFR equations were within 13% to 20% in both study groups. CONCLUSIONS Despite differences in CVI of creatinine, the CVI and RCV of the eGFR equations were relatively similar for people with or without CKD.

Published
2018

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

Author

Haidong, Wang, Mohsen, Naghavi, Christine, Allen, Ryan M, Barber Zulfi, qar A, Bhutta, Austin, Carter, Daniel C, Casey Fiona, J Charlson, Alan Zian, Chen Matthew, M Coates, Megan, Coggeshall, Lalit, Dandona, Daniel J, Dicker Holly, E Erskine, Alize J, Ferrari, Christina, Fitzmaurice, Kyle, Foreman, Mohammad H, Forouzanfar Maya, S Fraser, Nancy, Fullman, Peter W, Gething Ellen, M Goldberg, Nicholas, Graetz, Juanita A, Haagsma Simon, I Hay, Chantal, Huynh, Catherine O, Johnson Nicholas, J Kassebaum, Yohannes, Kinfu, Xie Rachel, Kulikoff, Michael, Kutz, Hmwe H, Kyu Heidi, J Larson, Janni, Leung, Xiaofeng, Liang, Stephen S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George A, Mensah, Joe, Mikesell, Ali H, Mokdad Meghan, D Mooney, Grant, Nguyen, Elaine, Nsoesie, David M, Pigott, Christine, Pinho, Gregory A, Roth Joshua, A Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed J, D Sorensen, Jeff rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette A, Thomas, Christopher, Troeger, Amelia, VanderZanden, Stein Emil, Vollset, Valentine, Wanga, Harvey A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan Hassen, Abate, Cristiana, Abbafati, Kaja M, Abbas, Foad, Abd-Allah, Semaw Ferede, Abera Daisy, M X, Abreu Laith, J Abu-Raddad, Gebre Yitayih, Abyu, Tom, Achoki, Ademola Lukman, Adelekan Zanfi, na Ademi, Arsène Kouablan, Adou José, C Adsuar, Kossivi Agbelenko, Afanvi, Ashkan, Afshin, Emilie Elisabet, Agardh, Arnav, Agarwal, Anurag, Agrawal, Aliasghar Ahmad, Kiadaliri Oluremi, N Ajala, Ali Shafqat, Akanda Rufus, Olusola Akinyemi, Tomi F, Akinyemiju, Nadia, Akseer, Faris Hasan, Al Lami, Samer, Alabed, Ziyad, Al-Aly, Khurshid, Alam, Noore K, M Alam, Deena, Alasfoor, Saleh Fahed, Aldhahri Robert, William Aldridge, Miguel Angel, Alegretti Alicia, V Aleman, Zewdie Aderaw, Alemu Lily, T Alexander, Samia, Alhabib, Raghib, Ali, Ala’a, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid A, Altirkawi Elena, Alvarez Martin, Nelson, Alvis-Guzman, Azmeraw T, Amare Adeladza, Kofi Amegah, Emmanuel A, Ameh, Heresh, Amini, Walid, Ammar, Stephen Marc, Amrock Hjalte, H Andersen, Benjamin O, Anderson Gregory, M Anderson, Carl Abelardo, T Antonio, Atsede Fantahun, Aregay, Johan, Ärnlöv, Valentina S, Arsic Arsenijevic, Al, Artaman, Hamid, Asayesh, Rana Jawad, Asghar, Suleman, Atique, Euripide Frinel, G Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Maria C, Bahit, Kalpana, Balakrishnan, Amitava, Banerjee, Aleksandra, Barac, Suzanne L, Barker-Collo, Till, Bärnighausen, Lars, Barregard, Lope H, Barrero, Arindam, Basu, Sanjay, Basu, Yibeltal Tebekaw, Bayou, Shahrzad, Bazargan-Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Haileeyesus Adamu, Belay, Brent, Bell, Michelle L, Bell Aminu, K Bello, Derrick A, Bennett Isabela, M Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Balem Demtsu, Betsu Addisu, Shunu Beyene, Neeraj, Bhala, Ashish, Bhalla, Sibhatu, Biadgilign, Boris, Bikbov, Aref A, Bin Abdulhak, Brian J, Biroscak, Stan, Biryukov, Espen, Bjertness, Jed D, Blore Christopher, D Blosser, Megan A, Bohensky, Rohan, Borschmann, Dipan, Bose, Rupert R, A Bourne, Michael, Brainin, Carol E, G Brayne, Alexandra, Brazinova, Nicholas J, K Breitborde, Hermann, Brenner, Jerry D, Brewer, Alexandria, Brown, Jonathan, Brown, Traolach S, Brugha Geoff, rey Colin, Buckle Zahid, A Butt, Bianca, Calabria, Ismael Ricardo, Campos-Nonato Julio, Cesar Campuzano, Jonathan R, Carapetis, Rosario, Cárdenas, David O, Carpenter Juan, Jesus Carrero, Carlos A, Castañeda-Orjuela Jacqueline, Castillo Rivas, Ferrán, Catalá-López, Fiorella, Cavalleri, Kelly, Cercy, Jorge, Cerda, Wanqing, Chen, Adrienne, Chew, Peggy Pei-Chia, Chiang, Mirriam, Chibalabala, Chioma Ezinne, Chibueze, Odgerel, Chimed-Ochir, Vesper Hichilombwe, Chisumpa Jee-Young, Jasmine Choi, Rajiv, Chowdhury, Hanne, Christensen, Devasahayam Jesudas, Christopher Liliana, G Ciobanu, Cirillo Massimo, Aaron J, Cohen, Valentina, Colistro, Mercedes, Colomar, Samantha M, Colquhoun, Cyrus, Cooper, Leslie Trumbull, Cooper, Monica, Cortinovis, Benjamin C, Cowie John, A Crump, James, Damsere-Derry, Hadi, Danawi, Rakhi, Dandona, Farah, Daoud, Sarah C, Darby Paul, I Dargan, José das, Neves, Gail, Davey, Adrian C, Davis Dragos, V Davitoiu, E Filipa, de Castro, Pieter de, Jager Diego, De Leo, Louisa, Degenhardt, Robert P, Dellavalle, Kebede, Deribe, Amare, Deribew, Samath D, Dharmaratne Preet, K Dhillon, Cesar, Diaz-Torné, Eric L, Ding Kadine, Priscila Bender, dos Santos, Edem, Dossou, Tim R, Driscoll, Leilei, Duan, Manisha, Dubey, Bruce Bartholow, Duncan Richard, G Ellenbogen, Christian Lycke, Ellingsen, Iqbal, Elyazar, Aman Yesuf, Endries Sergey, Petrovich Ermakov, Babak, Eshrati, Alireza, Esteghamati, Kara, Estep, Imad D, A Faghmous, Saman, Fahimi, Emerito Jose, Aquino Faraon, Talha A, Farid Carla, Sofi a, e Sa, Farinha, André, Faro, Maryam S, Farvid, Farshad, Farzadfar, Valery L, Feigin, Seyed-Mohammad, Fereshtehnejad, Jeff erson, G Fernandes, Joao C, Fernandes, Florian, Fischer, Joseph R, A Fitchett, Abraham, Flaxman, Nataliya, Foigt, F Gerry, R Fowkes, Elisabeth Barboza, Franca Richard, C Franklin, Joseph, Friedman, Joseph, Frostad, Thomas, Fürst, Neal D, Futran Seana, L Gall, Ketevan, Gambashidze, Amiran, Gamkrelidze, Parthasarathi, Ganguly, Fortuné Gbètoho, Gankpé, Teshome, Gebre, Tsegaye Tsewelde, Gebrehiwot Amanuel, Tesfay Gebremedhin, Alemseged Aregay, Gebru Johanna, M Geleijnse, Bradford D, Gessner Aloke, Gopal Ghoshal, Katherine B, Gibney Richard, F Gillum, Stuart, Gilmour, Ababi Zergaw, Giref, Maurice, Giroud, Melkamu Dedefo, Gishu, Giorgia, Giussani, Elizabeth, Glaser, William W, Godwin, Hector, Gomez-Dantes, Philimon, Gona, Amador, Goodridge, Sameer Vali, Gopalani Richard, A Gosselin, Carolyn C, Gotay, Atsushi, Goto, Hebe N, Gouda, Felix, Greaves, Harish Chander, Gugnani, Rahul, Gupta, Rajeev, Gupta, Vipin, Gupta, Reyna A, Gutiérrez, Nima, Hafezi-Nejad, Demewoz, Haile, Alemayehu Desalegne, Hailu Gessessew, Bugssa Hailu, Yara A, Halasa Randah, Ribhi Hamadeh, Samer, Hamidi, Jamie, Hancock, Alexis J, Handal Graeme, J Hankey, Yuantao, Hao, Hilda L, Harb, Sivadasanpillai, Harikrishnan, Josep Maria, Haro, Rasmus, Havmoeller, Susan R, Heckbert Ileana, Beatriz Heredia-Pi, Pouria, Heydarpour, Henk B, M Hilderink, Hans W, Hoek Robert, S Hogg, Masako, Horino, Nobuyuki, Horita, H Dean, Hosgood Peter, J Hotez, Damian G, Hoy, Mohamed, Hsairi, Aung Soe, Htet Maung, Maung Than, Htike, Guoqing, Hu, Cheng, Huang, Hsiang, Huang, Laetitia, Huiart, Abdullatif, Husseini, Inge, Huybrechts, Grace, Huynh, Kim Moesgaard, Iburg, Kaire, Innos, Manami, Inoue, Veena J, Iyer Troy, A Jacobs, Kathryn H, Jacobsen, Nader, Jahanmehr, Mihajlo B, Jakovljevic, Peter, James, Mehdi, Javanbakht, Sudha P, Jayaraman Achala, Upendra Jayatilleke, Panniyammakal, Jeemon, Paul N, Jensen, Vivekanand, Jha, Guohong, Jiang, Ying, Jiang, Tariku, Jibat, Aida, Jimenez-Corona, Jost B, Jonas Tushar, Kant Joshi, Zubair, Kabir, Ritul, Kamal, Haidong, Kan, Surya, Kant, André, Karch, Corine Kakizi, Karema, Chante, Karimkhani, Dimitris, Karletsos, Ganesan, Karthikeyan, Amir, Kasaeian, Marzieh, Katibeh, Anil, Kaul, Norito, Kawakami, Jeanne Françoise, Kayibanda Peter, Njenga Keiyoro, Laura, Kemmer, Andrew Haddon, Kemp Andre, Pascal Kengne, Andre, Keren, Maia, Kereselidze, Chandrasekharan Nair, Kesavachandran Yousef, Saleh Khader, Ibrahim A, Khalil Abdur, Rahman Khan, Ejaz Ahmad, Khan, Young-Ho, Khang, Sahil, Khera, Tawfi k, Ahmed Muthafer, Khoja, Christian, Kieling, Daniel, Kim, Yun Jin, Kim Brett, M Kissela, Niranjan, Kissoon, Luke D, Knibbs Ann, Kristin Knudsen, Yoshihiro, Kokubo, Dhaval, Kolte, Jacek A, Kopec, Soewarta, Kosen, Parvaiz A, Koul, Ai, Koyanagi, Norun Hjertager, Krog Barthelemy, Kuate Defo, Burcu Kucuk, Bicer Andreas, A Kudom, Ernst J, Kuipers Veena, S Kulkarni, G Anil, Kumar Gene, F Kwan, Aparna, Lal, Dharmesh Kumar, Lal, Ratilal, Lalloo, Hilton, Lam, Jennifer O, Lam Sinead, M Langan, Van C, Lansingh, Anders, Larsson, Dennis Odai, Laryea Asma, Abdul Latif, Alicia Elena, Beatriz Lawrynowicz, James, Leigh, Miriam, Levi, Yongmei, Li, M Patrice, Lindsay Steven, E Lipshultz, Patrick Y, Liu, Shiwei, Liu, Yang, Liu, Loon-Tzian, Lo, Giancarlo, Logroscino, Paulo A, Lotufo Robyn, M Lucas, Raimundas, Lunevicius, Ronan A, Lyons, Stefan, Ma, Vasco Manuel, Pedro Machado, Mark T, Mackay Jennifer, H MacLachlan, Hassan Magdy, Abd El, Razek Mohammed, Magdy Abd, El Razek, Marek, Majdan, Azeem, Majeed, Reza, Malekzadeh, Wondimu Ayele, Ayele Manamo, John, Mandisarisa, Srikanth, Mangalam, Chabila C, Mapoma, Wagner, Marcenes, David Joel, Margolis Gerard, Robert Martin, Jose, Martinez-Raga, Melvin Barrientos, Marzan, Felix, Masiye, Amanda J, Mason-Jones, João, Massano, Richard, Matzopoulos, Bongani M, Mayosi Stephen, Theodore McGarvey, John J, McGrath, Martin, McKee, McMahon Peter, A Meaney, Alem, Mehari, Man Mohan, Mehndiratta, Fabiola, Mejia-Rodriguez, Alemayehu B, Mekonnen Yohannes, Adama Melaku, Peter, Memiah, Ziad A, Memish, Walter, Mendoza, Atte, Meretoja, Tuomo J, Meretoja Francis, Apolinary Mhimbira, Renata, Micha, Ted R, Miller Mojde, Mirarefi n, Awoke, Misganaw, Charles N, Mock Karzan, Abdulmuhsin Mohammad, Alireza, Mohammadi, Shafi u, Mohammed, Viswanathan, Mohan, Glen Liddell, D Mola, Lorenzo, Monasta, Julio Cesar, Montañez Hernandez, Pablo, Montero, Marcella, Montico, Thomas J, Montine, Maziar, Moradi-Lakeh, Lidia, Morawska, Katherine, Morgan, Rintaro, Mori, Dariush Mozaff, arian Ulrich, O Mueller, Gudlavalleti Venkata, Satyanarayana Murthy, Srinivas, Murthy, Kamarul Imran, Musa Jean, B Nachega, Gabriele, Nagel, Kovin S, Naidoo, Nitish, Naik, Luigi, Naldi, Vinay, Nangia, Denis, Nash, Chakib, Nejjari, Subas, Neupane, Charles R, Newton John, N Newton, Marie, Ng, Frida Namnyak, Ngalesoni Jean, de Dieu, Ngirabega Quyen, Le Nguyen, Muhammad Imran, Nisar Patrick, Martial Nkamedjie, Pete, Marika, Nomura, Ole F, Norheim Paul, E Norman, Bo, Norrving, Luke, Nyakarahuka, Felix Akpojene, Ogbo, Takayoshi, Ohkubo, Foluke Adetola, Ojelabi Pedro, R Olivares, Bolajoko Olubukunola, Olusanya Jacob, Olusegun Olusanya, John Nelson, Opio, Eyal, Oren, Alberto, Ortiz, Majdi, Osman, Erika, Ota, Raziye, Ozdemir, Mahesh, PA, Jeyaraj D, Pandian Puspa, Raj Pant, Christina, Papachristou, Eun-Kee, Park, Jae-Hyun, Park, Charles D, Parry, Mahboubeh, Parsaeian, Angel J, Paternina Caicedo, Scott B, Patten George, C Patton, Vinod K, Paul, Neil, Pearce, João Mário, Pedro Ljiljana, Pejin Stokic, Pereira, Norberto, Perico, Konrad, Pesudovs, Max, Petzold, Michael Robert, Phillips Frédéric, B Piel, Julian David, Pillay, Dietrich, Plass, James A, Platts-Mills, Suzanne, Polinder, C Arden, Pope, Svetlana, Popova, Richie G, Poulton, Farshad, Pourmalek, Dorairaj, Prabhakaran, Mostafa, Qorbani, Justice, Quame-Amaglo, D Alex, Quistberg, Anwar, Rafay, Kazem, Rahimi, Vafa, Rahimi-Movaghar, Mahfuzar, Rahman, Mohammad Hifz, Ur Rahman, Sajjad Ur, Rahman Rajesh, Kumar Rai, Zhale, Rajavi, Sasa, Rajsic, Murugesan, Raju, Ivo, Rakovac, Saleem M, Rana Chhabi, L Ranabhat, Thara, Rangaswamy, Puja, Rao, Sowmya R, Rao Amany, H Refaat, Jürgen, Rehm, Marissa B, Reitsma, Giuseppe, Remuzzi, Serge Resnikoff, Antonio L, Ribeiro, Stefano, Ricci, Maria Jesus, Rios Blancas, Bayard, Roberts, Anna, Roca, David, Rojas-Rueda, Luca, Ronfani, Gholamreza, Roshandel, Dietrich, Rothenbacher, Ambuj, Roy, Nawal K, Roy George, Mugambage Ruhago, Rajesh, Sagar, Sukanta, Saha, Ramesh, Sahathevan, Muhammad Muhammad, Saleh Juan, R Sanabria, Maria Dolores, Sanchez-Niño, Lidia, Sanchez-Riera, Itamar S, Santos, Rodrigo, Sarmiento-Suarez, Benn, Sartorius, Maheswar, Satpathy, Miloje, Savic, Monika, Sawhney, Michael P, Schaub Maria, Inês Schmidt, Ione J, C Schneider, Ben, Schöttker, Aletta E, Schutte David, C Schwebel, Soraya, Seedat, Sadaf G, Sepanlou Edson, E Servan-Mori, Katya A, Shackelford, Gavin, Shaddick, Amira, Shaheen, Saeid, Shahraz, Masood Ali, Shaikh, Marina, Shakh-Nazarova, Rajesh, Sharma, Jun, She, Sara, Sheikhbahaei, Jiabin, Shen, Ziyan, Shen, Donald S, Shepard Kevin, N Sheth, Balakrishna P, Shetty, Peilin, Shi, Kenji, Shibuya, Min-Jeong, Shin, Rahman, Shiri, Ivy, Shiue, Mark G, Shrime Inga, Dora Sigfusdottir, Donald H, Silberberg Diego, Augusto Santos, Silva Dayane, Gabriele Alves, Silveira Jonathan, I Silverberg, Edgar P, Simard, Abhishek, Singh, Gitanjali M, Singh Jasvinder, A Singh, Om Prakash, Singh Prashant, Kumar Singh, Virendra, Singh, Samir, Soneji, Kjetil, Søreide, Joan B, Soriano Luciano, A Sposato, Chandrashekhar T, Sreeramareddy, Vasiliki, Stathopoulou, Dan J, Stein Murray, B Stein, Saverio, Stranges, Konstantinos, Stroumpoulis, Bruno F, Sunguya, Patrick, Sur, Soumya, Swaminathan, Bryan L, Sykes Cassandra, E I, Szoeke, Rafael, Tabarés-Seisdedos, Karen M, Tabb, Ken, Takahashi, Jukka S, Takala Roberto, Tchio Talongwa, Nikhil, Tandon, Mohammad, Tavakkoli, Bineyam, Taye, Hugh R, Taylor Braden, J Te, Ao Bemnet, Amare Tedla, Worku Mekonnen, Tefera 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Juanita, A, Haagsma, Simon, I, Hay, Chantal, Huynh, Catherine, O, Johnson, Nichola, J, Kassebaum, Yohannes, Kinfu, Xie, Rachel, Kulikoff, Michael, Kutz, Hmwe, H, Kyu, Heidi, J, Larson, Janni, Leung, Xiaofeng, Liang, Stephen, S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George, A, Mensah, Joe, Mikesell, Ali, H, Mokdad, Meghan, D, Mooney, Grant, Nguyen, Elaine, Nsoesie, David, M, Pigott, Christine, Pinho, Gregory, A, Roth, Joshua, A, Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed, J, D, Sorensen, Jeff, Rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette, A, Thomas, Christopher, Troeger, Amelia, Vanderzanden, Stein, Emil, Vollset, Valentine, Wanga, Harvey, A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd-Allah, Semaw, Ferede, Abera, Daisy, M, X, Abreu, Laith, J, Abu-Raddad, Gebre, Yitayih, Abyu, Tom, Achoki, Ademola, Lukman, Adelekan, Zanfi, Na, Ademi, Arsène, Kouablan, Adou, José, C, 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Buckle, Geoffrey Colin, Butt, Zahid A, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carapetis, Jonathan R, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesu, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Cavalleri, Fiorella, Cercy, Kelly, Cerda, Jorge, Chen, Wanqing, Chew, Adrienne, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesuda, Ciobanu, Liliana G, Cohen, Aaron J, Colistro, Valentina, Colomar, Mercede, Colquhoun, Samantha M, Cooper, Cyru, Cooper, Leslie Trumbull, Cortinovis, Monica, Cowie, Benjamin C, Crump, John A, Damsere-Derry, Jame, Danawi, Hadi, Dandona, Rakhi, Daoud, Farah, Darby, Sarah C, Dargan, Paul I, das Neves, José, Davey, Gail, Davis, Adrian C, Davitoiu, Dragos V, de Castro, E Filipa, de Jager, Pieter, Leo, Diego De, Degenhardt, Louisa, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Ding, Eric L, dos Santos, Kadine Priscila Bender, Dossou, Edem, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ellenbogen, Richard G, Ellingsen, Christian Lycke, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Faghmous, Imad D A, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Flaxman, Abraham, Foigt, Nataliya, Fowkes, F Gerry R, Franca, Elisabeth Barboza, Franklin, Richard C, Friedman, Joseph, Frostad, Joseph, Fürst, Thoma, Futran, Neal D, Gall, Seana L, Gambashidze, Ketevan, Gamkrelidze, Amiran, Ganguly, Parthasarathi, Gankpé, Fortuné Gbètoho, Gebre, Teshome, Gebrehiwot, Tsegaye Tsewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Geleijnse, Johanna M, Gessner, Bradford D, Ghoshal, Aloke Gopal, Gibney, Katherine B, Gillum, Richard F, Gilmour, Stuart, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Glaser, Elizabeth, Godwin, William W, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Greaves, Felix, Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Havmoeller, Rasmu, Heckbert, Susan R, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hilderink, Henk B M, Hoek, Hans W, Hogg, Robert S, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Guoqing, Huang, Cheng, Huang, Hsiang, Huiart, Laetitia, Husseini, Abdullatif, Huybrechts, Inge, Huynh, Grace, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jonas, Jost B, Joshi, Tushar Kant, Kabir, Zubair, Kamal, Ritul, Kan, Haidong, Kant, Surya, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Karletsos, Dimitri, Karthikeyan, Ganesan, Kasaeian, Amir, Katibeh, Marzieh, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Kieling, Christian, Kim, Daniel, Kim, Yun Jin, Kissela, Brett M, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Krog, Norun Hjertager, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Lansingh, Van C, Larsson, Ander, Laryea, Dennis Odai, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leigh, Jame, Levi, Miriam, Li, Yongmei, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimunda, Lyons, Ronan A, Ma, Stefan, Machado, Vasco Manuel Pedro, Mackay, Mark T, Maclachlan, Jennifer H, Razek, Hassan Magdy Abd El, Magdy, Mohammed, Razek, Abd El, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Manamo, Wondimu Ayele Ayele, Mandisarisa, John, Mangalam, Srikanth, Mapoma, Chabila C, Marcenes, Wagner, Margolis, David Joel, Martin, Gerard Robert, Martinez-Raga, Jose, Marzan, Melvin Barriento, Masiye, Felix, Mason-Jones, Amanda J, Massano, João, Matzopoulos, Richard, Mayosi, Bongani M, Mcgarvey, Stephen Theodore, Mcgrath, John J, Mckee, Martin, Mcmahon, Brian J, Meaney, Peter A, Mehari, Alem, Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Mohan, Viswanathan, Mola, Glen Liddell D, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montero, Pablo, Montico, Marcella, Montine, Thomas J, Moradi-Lakeh, Maziar, Morawska, Lidia, Morgan, Katherine, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O, Murthy, Gudlavalleti Venkata Satyanarayana, Murthy, Sriniva, Musa, Kamarul Imran, Nachega, Jean B, Nagel, Gabriele, Naidoo, Kovin S, Naik, Nitish, Naldi, Luigi, Nangia, Vinay, Nash, Deni, Nejjari, Chakib, Neupane, Suba, Newton, Charles R, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, de Dieu Ngirabega, Jean, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nomura, Marika, Norheim, Ole F, Norman, Paul E, Norrving, Bo, Nyakarahuka, Luke, Ogbo, Felix Akpojene, Ohkubo, Takayoshi, Ojelabi, Foluke Adetola, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osman, Majdi, Ota, Erika, Ozdemir, Raziye, Pa, Mahesh, Pandian, Jeyaraj D, Pant, Puspa Raj, Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Parry, Charles D, Parsaeian, Mahboubeh, Caicedo, Angel J Paternina, Patten, Scott B, Patton, George C, Paul, Vinod K, Pearce, Neil, Pedro, João Mário, Stokic, Ljiljana Pejin, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Plass, Dietrich, Platts-Mills, James A, Polinder, Suzanne, Pope, C Arden, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Qorbani, Mostafa, Quame-Amaglo, Justice, Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajavi, Zhale, Rajsic, Sasa, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Ranabhat, Chhabi L, Rangaswamy, Thara, Rao, Puja, Rao, Sowmya R, Refaat, Amany H, Rehm, Jürgen, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Ricci, Stefano, Blancas, Maria Jesus Rio, Roberts, Bayard, Roca, Anna, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Roy, Nawal K, Ruhago, George Mugambage, Sagar, Rajesh, Saha, Sukanta, Sahathevan, Ramesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Sanchez-Riera, Lidia, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schaub, Michael P, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya A, Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Shen, Ziyan, Shepard, Donald S, Sheth, Kevin N, Shetty, Balakrishna P, Shi, Peilin, Shibuya, Kenji, Shin, Min-Jeong, Shiri, Rahman, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silberberg, Donald H, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Silverberg, Jonathan I, Simard, Edgar P, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Soneji, Samir, Søreide, Kjetil, Soriano, Joan B, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Stein, Dan J, Stein, Murray B, Stranges, Saverio, Stroumpoulis, Konstantino, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Takahashi, Ken, Takala, Jukka S, Talongwa, Roberto Tchio, Tandon, Nikhil, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Ao, Braden J Te, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Have, Margreet Ten, Terkawi, Abdullah Sulieman, Tesfay, Fisaha Haile, Tessema, Gizachew Assefa, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tirschwell, David L, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Towbin, Jeffrey Allen, Traebert, Jefferson, Tran, Bach Xuan, Truelsen, Thoma, Trujillo, Ulise, Tura, Abera Kenay, Tuzcu, Emin Murat, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uthman, Olalekan A, Dingenen, Rita Van, van Donkelaar, Aaron, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Vidavalur, Ramesh, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Wagner, Joseph A, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, White, Richard A, Wijeratne, Tissa, Wilkinson, James D, Williams, Hywel C, Wiysonge, Charles Shey, Woldeyohannes, Solomon Meseret, Wolfe, Charles D A, Won, Sungho, Wong, John Q, Woolf, Anthony D, Xavier, Deni, Xiao, Qingyang, Xu, Gelin, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yirsaw, Biruck Desalegn, Yonemoto, Naohiro, Yonga, Gerald, Younis, Mustafa Z, Yu, Shicheng, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zannad, Faiez, Zavala, Diego E, Zeeb, Hajo, Zeleke, Berihun M, Zhang, Hao, Zodpey, Sanjay, Zonies, David, Zuhlke, Liesl Joanna, Vos, Theo, Lopez, Alan D, and Murray, Christopher J L

Subjects
VITAL-STATISTICS, INTEGRATED APPROACH, ECONOMIC-DEVELOPMENT, DEVELOPMENT ASSISTANCE, UNITED-STATES, Global Health, Communicable Disease, Communicable Diseases, cause of death, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Mortality, Medicine(all), Science & Technology, Mortality, Premature, Medicine (all), EPIDEMIOLOGIC TRANSITION, GBD 2015 Mortality and Causes of Death Collaborators, CIVIL REGISTRATION, Public Health, Global Health, Social Medicine and Epidemiology, Articles, 11 Medical And Health Sciences, ROAD TRAFFIC INJURIES, ALZHEIMERS-DISEASE, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, VERBAL AUTOPSY, Life Sciences & Biomedicine, Human
Abstract

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

Published
2016

18. Origin of Cardiac Troponin T Elevations in Chronic Kidney Disease

Author

Pål O. Westermark, Noreen van der Linden, Otto Bekers, Judith M Hilderink, Alexander S. Streng, Dorien M Kimenai, Elisabeth J R Litjens, Sarah Lück, Frederique E C M Peeters, Christian Mueller, Tobias Breidthardt, Luc J. C. van Loon, Steven J.R. Meex, Lieke J.J. Klinkenberg, Jeroen P. Kooman, Tom Cornelis, Human Physiology and Sports Physiotherapy Research Group, and Physiotherapy, Human Physiology and Anatomy

Subjects
Male, medicine.medical_specialty, Letter, Time Factors, Heart Diseases, Renal function, 030204 cardiovascular system & hematology, urologic and male genital diseases, Chest pain, Kidney, 03 medical and health sciences, 0302 clinical medicine, Troponin T, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Renal Insufficiency, Chronic, biology, business.industry, troponin, Myocardium, medicine.disease, kidney diseases, Troponin, Circadian Rhythm, Up-Regulation, Renal Elimination, medicine.anatomical_structure, Case-Control Studies, Cardiology, biology.protein, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Biomarkers, Kidney disease, Glomerular Filtration Rate
Abstract

Plasma concentrations of cardiac troponins, the preferred biomarkers for the diagnosis of acute myocardial infarction, are often persistently elevated in patients with chronic kidney disease (CKD). The origin of these elevations is unknown: Is it the heart, by increased release, or the kidneys, by decreased renal elimination? In clinical practice, this equivocal view on troponin elevations in patients with reduced glomerular clearance underlies countless clinical discussions among physicians and may delay rapid initiation of adequate treatment when these patients present with chest pain. In the present study, we aimed to discriminate between increased cardiac release and reduced renal elimination as the main process underlying this phenomenon. Specifically, we used the recently demonstrated rhythmic diurnal oscillation pattern of troponin T as a model to assess the contribution of impaired renal elimination to persistently elevated cardiac troponin levels in patients with CKD.1 The diurnal troponin T rhythm is characterized by gradually decreasing concentrations throughout daytime and rising concentrations during nighttime.1 If decreased renal clearance, and not increased production, is the key driver of elevated troponins in patients with CKD, the increased half-life and subsequent accumulation of cardiac troponin T will fade its diurnal rhythm. …

Published
2017

19. Labtracker+, a medical smartphone app for the interpretation of consecutive laboratory results: an external validation study

Author

Otto Bekers, Richard P. Koopmans, Steven J.R. Meex, Roger J M W Rennenberg, Floris Vanmolkot, Judith M Hilderink, MUMC+: DA CDL Algemeen (9), Interne Geneeskunde, MUMC+: MA Alg Interne Geneeskunde (9), RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: DA CDL (5), RS: NUTRIM - R4 - Gene-environment interaction, RS: SHE - R1 - Research (OvO), and RS: CARIM - R2.02 - Cardiomyopathy

Subjects
030213 general clinical medicine, Pediatrics, medicine.medical_specialty, Concordance, 03 medical and health sciences, 0302 clinical medicine, medicine, University medical, 030212 general & internal medicine, Clinical decision, biological variation, VALUES, business.industry, Research, External validation, General Medicine, Medical Education and Training, Laboratory results, Laboratory test, medical application, TESTS, Smartphone app, Physical therapy, business, Blood parameters, medical education
Abstract

ObjectivesWhen monitoring patients over time, clinicians may struggle to distinguish ‘real changes’ in consecutive blood parameters from so-called natural fluctuations. In practice, they have to do so by relying on their clinical experience and intuition. We developedLabtracker+, a medical app that calculates the probability that an increase or decrease over time in a specific blood parameter is real, given the time between measurements.DesignWe presented patient cases to 135 participants to examine whether there is a difference between medical students, residents and experienced clinicians when it comes to interpreting changes between consecutive laboratory results. Participants were asked to interpret if changes in consecutive laboratory values were likely to be ‘real’ or rather due to natural fluctuations. The answers of the study participants were compared with the calculated probabilities by the appLabtracker+and the concordance rates were assessed.Setting and participantsMedical students (n=92), medical residents from the department of internal medicine (n=19) and internists (n=24) at a Dutch University Medical Centre.Primary and secondary outcome measuresConcordance rates between the study participants and the calculated probabilities by the appLabtracker+were compared. Besides, we tested whether physicians with clinical experience scored better concordance rates with the appLabtracker+than inexperienced clinicians.ResultsMedical residents and internists showed significantly better concordance rates with the calculated probabilities by the appLabtracker+than medical students, regarding their interpretation of differences between consecutive laboratory results (p=0.009 and pConclusionThe appLabtracker+could serve as a clinical decision tool in the interpretation of consecutive laboratory test results and could contribute to rapid recognition of parameter changes by physicians.

Published
2017

20. [Myosotis in children with flu; a rare complication of influenza]

Author

M J M, Hilderink and G Th J, van Well

Subjects
Male, Myositis, Child, Preschool, Influenza, Human, Humans, Female, Seasons, Child
Abstract

Influenza is a common viral infection, which occurs in yearly endemics during the winter period. Complications are mostly seen amongst the elderly, but may also be seen in previously healthy children; the airways and central nervous system, in particular, may be affected. Another complication of influenza, first described in 1957 and only sporadically discussed, is influenza associated myositis (IAM). In this article we describe three patients with IAM. IAM is mainly seen in children, and boys are more often affected than girls. It is most commonly seen in influenza type B. The pathogenesis is largely unknown, but the clinical presentation and laboratory results for IAM are quite typical. Clinical presentation may be very severe, and when the clinical symptoms are not recognized, invasive tests will often follow. Most cases of IAM are self-limiting, but a minority of the patients might experience life-threatening complications.

Published
2017

21. Within-day biological variation and hour-to-hour reference change values for hematological parameters

Author

Otto Bekers, Kristin M. Aakre, Noreen van der Linden, Richard P. Koopmans, Norbert C. J. de Wit, Roger J M W Rennenberg, Yvonne M. C. Henskens, Steven J.R. Meex, Lieke J.J. Klinkenberg, Judith M Hilderink, MUMC+: DA CDL Algemeen (9), RS: CARIM - R2.02 - Cardiomyopathy, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: DA CDL (5), RS: NUTRIM - R4 - Gene-environment interaction, Interne Geneeskunde, MUMC+: MA Alg Interne Geneeskunde (9), and RS: SHE - R1 - Research (OvO)

Subjects
Male, Posture, Clinical Biochemistry, CLINICAL-CHEMISTRY, 030204 cardiovascular system & hematology, Biology, INTERVALS, Specimen Handling, diurnal rhythm, 03 medical and health sciences, 0302 clinical medicine, Animal science, MARKERS, Reference Values, Biological variation, medicine, Circadian rhythm, reference change value, INDEX, Aged, Aged, 80 and over, biological variation, Hematologic Tests, Mean corpuscular hemoglobin concentration, medicine.diagnostic_test, hematology, INDIVIDUALITY, Biochemistry (medical), HUMANS, Red blood cell distribution width, General Medicine, Middle Aged, Circadian Rhythm, RHYTHMS, QUANTITIES, 030220 oncology & carcinogenesis, Female, Every Hour, Sample collection
Abstract

Background: Middle- and long-term biological variation data for hematological parameters have been reported in the literature. Within-day 24-h variability profiles for hematological parameters are currently lacking. However, comprehensive hour-to-hour variability data are critical to detect diurnal cyclical rhythms, and to take into account the 'time of sample collection' as a possible determinant of natural fluctuation. In this study, we assessed 24-h variation profiles for 20 hematological parameters.Methods: Blood samples were collected under standardized conditions from 24 subjects every hour for 24 h. At each measurement, 20 hematological parameters were determined in duplicate. Analytical variation (CVA), within-subject biological variation (CVI), between-subject biological variation (CVG), index of individuality (II), and reference change values (RCVs) were calculated. For the parameters with a diurnal rhythm, hour-to-hour RCVs were determined.Results: All parameters showed higher CVG than CVI. Highest CVG was found for eosinophils (46.6%; 95% CI, 34.9%-70.1%) and the lowest value was mean corpuscular hemoglobin concentration (MCHC) (3.2%; 95% CI, 2.4%-4.8%). CVI varied from 0.4% (95% CI, 0.32%-0.42%) to 20.9% (95% CI, 19.4%-22.6%) for red cell distribution width (RDW) and eosinophils, respectively. Six hematological parameters showed a diurnal rhythm.Conclusions: We present complete 24-h variability profiles for 20 hematological parameters. Hour-to-hour reference changes values may help to better discriminate between random fluctuations and true changes in parameters with rhythmic diurnal oscillations.

Published
2017

22. Strong diurnal rhythm of troponin T, but not troponin I, in a patient with renal dysfunction

Author

Elisabeth J R Litjens, N. van der Linden, Dorien M Kimenai, Steven J.R. Meex, Judith M Hilderink, Otto Bekers, Jeroen P. Kooman, Tom Cornelis, M.P. van Dieijen-Visser, Lieke J.J. Klinkenberg, MUMC+: DA CDL Algemeen (9), Interne Geneeskunde, MUMC+: MA Nefrologie (9), RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, MUMC+: DA CDL (5), Med Microbiol, Infect Dis & Infect Prev, RS: NUTRIM - R4 - Gene-environment interaction, and RS: CARIM - R2.02 - Cardiomyopathy

Subjects
medicine.medical_specialty, Cardiac troponin, Troponin T, business.industry, Acute myocardial infarction, 030204 cardiovascular system & hematology, medicine.disease, End stage renal disease, 03 medical and health sciences, End-stage renal disease, 0302 clinical medicine, Internal medicine, Troponin I, Diagnosis, medicine, Cardiology, Diurnal rhythm, 030212 general & internal medicine, Circadian rhythm, Myocardial infarction, Cardiac troponins, Cardiology and Cardiovascular Medicine, business
Published
2016

23. Biological variation of cardiac markers in patients with aortic valve stenosis

Author

Harry J.G.M. Crijns, Marijke Niens, Steven J.R. Meex, Frederique E C M Peeters, Bas L.J.H. Kietselaer, Judith M Hilderink, Noreen van der Linden, Cardiologie, RS: CARIM - R2 - Cardiac function and failure, RS: CARIM - R1 - Thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Promovendi CD, MUMC+: MA Cardiologie (9), RS: CARIM - R2.01 - Clinical atrial fibrillation, RS: CARIM - R2.02 - Cardiomyopathy, RS: Carim - Blood, MUMC+: MA Med Staf Artsass Cardiologie (9), RS: Carim - Heart, RS: Carim - H01 Clinical atrial fibrillation, RS: CARIM - R3.11 - Imaging, and RS: Carim - H02 Cardiomyopathy

Subjects
medicine.medical_specialty, medicine.drug_class, BIOMARKERS, aortic valve stenosis, VALVULAR HEART-DISEASE, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, cardiac biomarkers, Internal medicine, Biological variation, SENSITIVITY TROPONIN-T, medicine, Natriuretic peptide, echocardiography, FAILURE, In patient, 030212 general & internal medicine, PREDICTORS, biological variation, EUROPEAN ASSOCIATION, biology, business.industry, valvular heart disease, Aortic and Vascular Disease, medicine.disease, Troponin, NATRIURETIC PEPTIDES, INDIVIDUALS, VARIABILITY, Aortic valve stenosis, biology.protein, Cardiology, Biomarker (medicine), progression, Cardiology and Cardiovascular Medicine, business, TASK-FORCE, Blood sampling
Abstract

ObjectiveCardiac biomarkers hold promise for follow-up and management of aortic valve stenosis (AVS). When interpreting serial biomarker measurements of patients with AVS, it can be challenging to distinguish ‘real changes’ from ‘random fluctuation’. Hence, robust estimation of the biological variation of these biomarkers is essential. In the present study we assessed biological variation of B-type natriuretic peptide (BNP), N-terminus pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-T and high-sensitivity troponin-I (hs-TnT and hs-TnI), and ST2 in subjects with stable AVS.MethodsSerial blood sampling was performed in 25 subjects with moderate AVS—confirmed by echocardiography—and all free from acute cardiovascular events in the past 6 months. Blood samples were taken on seven standardised occasions during 1 year. Analytical variation (CVA), within-subject biological variation (CVI), between-subject biological variation (CVG), index of individuality (II) and reference change values were calculated for all cardiac biomarkers.ResultsCVI was highest for BNP (62.0%, 95% CI 52.5 to 75.4) and lowest for hs-TnI (9.2%, 95% CI 2.8 to 13.8). CVG exceeded the CVI for all biomarkers except BNP, and ranged from 19.8% (95% CI 13.8 to 33.4) for ST2 to 57.2% (95% CI 40.4 to 97.3) for hs-TnT. NT-proBNP, hs-TnT and ST2 revealed CVA A (19.7 and 14.9, respectively). All biomarkers except BNP showed marked individuality, with II ranging from 0.21 to 0.67 (BNP 1.34).ConclusionThis study provides the first biological variation estimates of cardiac biomarkers in patients with stable AVS. These estimates allow a more evidence-based interpretation of biomarker changes in the follow-up and management of patients with AVS.Trial registration numberNCT02510482

Published
2019

24. Accounting for multimorbidity can affect the estimation of the Burden of Disease : A comparison of approaches

Author

Mjjc Poos, Bianca E. P. Snijders, Marjanne H.D. Plasmans, Coen H. van Gool, Henk B M Hilderink, and Hendriek C. Boshuizen

Subjects
medicine.medical_specialty, Accounting, Affect (psychology), 03 medical and health sciences, 0302 clinical medicine, Prevalence, Medicine, 030212 general & internal medicine, Limit (mathematics), Disease burden, Health policy, VLAG, Human Nutrition & Health, Estimation, business.industry, 030503 health policy & services, Public health, Research, Humane Voeding & Gezondheid, Public Health, Environmental and Occupational Health, Health services research, Multimorbidity, Middle age, Disability weights, 0305 other medical science, business
Abstract

Background: Various Burden of Disease (BoD) studies do not account for multimorbidity in their BoD estimates. Ignoring multimorbidity can lead to inaccuracies in BoD estimations, particularly in ageing populations that include large proportions of persons with two or more health conditions. The objective of this study is to improve BoD estimates for the Netherlands by accounting for multimorbidity. For this purpose, we analyzed different methods for 1) estimating the prevalence of multimorbidity and 2) deriving Disability Weights (DWs) for multimorbidity by using existing data on single health conditions. Methods: We included 25 health conditions from the Dutch Burden of Disease study that have a high rate of prevalence and that make a large contribution to the total number of Years Lived with a Disability (YLD). First, we analyzed four methods for estimating the prevalence of multimorbid conditions (i.e. independent, independent age-and sex-specific, dependent, and dependent sex-and age-specific). Secondly, we analyzed three methods for calculating the Combined Disability Weights (CDWs) associated with multimorbid conditions (i.e. additive, multiplicative and maximum limit). A combination of these two approaches was used to recalculate the number of YLDs, which is a component of the Disability-Adjusted Life Years (DALY). Results: This study shows that the YLD estimates for 25 health conditions calculated using the multiplicative method for Combined Disability Weights are 5 % lower, and 14 % lower when using the maximum limit method, than when calculated using the additive method. Adjusting for sex-and age-specific dependent co-occurrence of health conditions reduces the number of YLDs by 10 % for the multiplicative method and by 26 % for the maximum limit method. The adjustment is higher for health conditions with a higher prevalence in old age, like heart failure (up to 43 %) and coronary heart diseases (up to 33 %). Health conditions with a high prevalence in middle age, such as anxiety disorders, have a moderate adjustment (up to 13 %). Conclusions: We conclude that BoD calculations that do not account for multimorbidity can result in an overestimation of the actual BoD. This may affect public health policy strategies that focus on single health conditions if the underlying cost-effectiveness analysis overestimates the intended effects. The methodology used in this study could be further refined to provide greater insight into co-occurrence and the possible consequences of multimorbid conditions in terms of disability for particular combinations of health conditions.

Published
2016

25. [Living longer, with more disease and less disability; trends in public health 2000-2030]

Author

Nancy, Hoeymans, Maartje M, Harbers, and Henk B M, Hilderink

Subjects
Aging, Life Expectancy, Chronic Disease, Humans, Health Care Costs, Public Health, Life Style, Forecasting, Netherlands
Abstract

The Dutch Public Health Status and Foresight report 2014 explores the future of public health in the Netherlands, using a trend scenario and four future scenarios. The trend scenario provides projections until 2030, based on the trends over the last decades and assuming the policy stays the same. After many years the unfavourable trends in lifestyle seem to have ended: the percentage of smokers is decreasing and the percentage of people who are overweight is no longer increasing. Life expectancy will continue to increase, but the differences between socioeconomic groups will not become smaller. Demographic changes (rise in the ageing population) and improvements in health care will contribute to an increase in the number of chronically ill which will increase from 5.3 million in 2011 to 7 million in 2030. However, most people with a chronic disease feel healthy, have no disabilities and participate fully in society. Health care expenditures rose from 9.5% of the GDP in 2000 to 14% in 2012. How this growth will continue in the next years is uncertain.

Published
2014

26. Costs, effects, and savings of screening for cystic fibrosis gene carriers

Author

H. B. M. Hilderink, J. D. F. Habbema, J. G. Verzijl, L. Kooij, Mark F. Wildhagen, T. Tijmstra, Joke B. G. M. Verheij, L. P. Ten Kate, Public Health, and Science in Healthy Ageing & healthcaRE (SHARE)

Subjects
Male, medicine.medical_specialty, Cystic fibrosis gene, Cystic Fibrosis, Epidemiology, Genetic counseling, Cost-Benefit Analysis, NETHERLANDS, Population, Genetic Carrier Screening, Prenatal diagnosis, Genetic Counseling, Abortion, DIAGNOSIS, Decision Support Techniques, Prenatal Diagnosis, YOUNG-PEOPLE THINK, Medicine, Humans, Genetic Testing, Prospective Studies, ATTITUDES, education, Child, POPULATION, Genetic testing, Pregnancy, education.field_of_study, medicine.diagnostic_test, IDENTIFICATION, business.industry, Obstetrics, Public Health, Environmental and Occupational Health, Infant, Newborn, PRIMARY-CARE, Articles, medicine.disease, Surgery, Models, Economic, PRACTITIONERS, Costs and Cost Analysis, EXPERIENCE, Female, business, PREGNANT-WOMEN
Abstract

Study objective-Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening.Design-A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For prenatal and preconceptional screening, two strategies were evaluated: single entry and double entry two step couple screening. Firstly, the Dutch situation was evaluated prospectively; subsequently the results were generalised to other carrier frequencies.Setting-Prospective simulation model.Main results-Of all screening strategies, neonatal carrier screening gives most carrier couples an informed choice concerning reproduction. If the parents of carrier newborns would not be tested however, prenatal screening detects most carrier couples. Prenatal and single entry preconceptional screening programmes have a favourable cost-savings balance in the Netherlands under a wide range of assumptions. For double entry preconceptional screening and neonatal screening, high enough values of uptake of screening, prenatal diagnosis, and induced abortion are necessary. School carrier screening does not have a favourable cost-savings balance.Conclusions-If a CF screening programme is judged to be useful on individual and social grounds, costs considerations are no obstacle for prenatal and single entry preconceptional screening.

Published
1998

27. ICT in nursing in Dutch hospitals

Author

H G M, Hilderink, P, Epping, and W T F, Goossen

Subjects
Systems Integration, Medical Records Systems, Computerized, Computer Systems, Nursing Records, Hospital Information Systems, Humans, Netherlands
Abstract

VIZI and its successor NICTIZ (National ICT Institute for Healthcare) carried out a study to assess the status of ICT use in hospitals. The statutory obligation for the retention of care records and instructions was highlighted by the professional nursing institutions. Literature was studied to find out more about the contribution of nursing records to the care provided. Nursing records are kept in all hospitals, and keeping a good record is essential to the care. Nevertheless not much evidence was found to support the idea that the traditional way of keeping of keeping a nursing record has substantial positive effect on the care provided. It became clear however that Clinical Pathways does indeed seem to be promising as a protocol for treating patients and putting demands on registration, and to provide a clear method by which the electronic nursing record could be built up as a part of the integrated electronic patient record. By means of two questionnaires, one applied to suppliers and one applied to hospitals, the status of ICT in hospitals was addressed. It transpired that several suppliers are active in this area, but usually with general EPR systems which have little dedicated functionality for nurses. The number of nurses in hospitals who are using computers on a regular basis is on the increase. It also transpired that most of the functions that are being used by nurses are general functions such as recording demographic patient data, roster planning, etc. Finally we asked the hospitals to send us information about their own projects. Some 20 projects where submitted, 10 of which were regarded as being significant. The best application was rewarded with a prize.

Published
2004

28. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water

Author

Jacques F. Meis, Paul E. Verweij, V. Christmann, Andreas Voss, Willem J. G. Melchers, B. G. M. Hilderink, and M. Van Der Bor

Subjects
Male, Hand washing, congenital, hereditary, and neonatal diseases and abnormalities, Neonatal intensive care unit, Epidemiology, Disturbances of cerebral development in the young child, Pathogenese, epidemiologie en behandeling van microbiële infecties, Microbiology, Disease Outbreaks, Pathogenesis, epidemiology, and treatment of microbial infections, Tap water, Water Supply, Medicine, Humans, Colonization, Nosocomial outbreak, Cross Infection, biology, business.industry, Infant, Newborn, Outbreak, Contamination, biology.organism_classification, bacterial infections and mycoses, Stenotrophomonas maltophilia, Infectious Diseases, Cerebrale ontwikkelingsstoornissen bij het jonge kind, business, Gram-Negative Bacterial Infections, Water Microbiology, Infant, Premature, Research Article
Abstract

Between March and May 1996 Stenotrophomonas maltophilia was cultured from endotracheal aspirate samples from five preterm infants in a neonatal intensive care unit (NICU). Four infants were superficially colonized, but a fifth died due to S. maltophilia septicaemia. S. maltophilia was cultured from tap water from three outlets in the NICU including one with a previously unnoticed defective sink drain. Water from these outlets was used to wash the preterm infants. Environmental and clinical S. maltophilia isolates yielded identical banding patterns on random arbitrary polymorphic DNA (RAPD) PCR analysis. The outbreak was controlled by reinforcement of hand disinfection, limitation of the use of tap water for hand washing and by using sterile water to wash the preterm infants. We conclude that tap water should not be used for washing preterm infants in the NICU, unless steps are taken to prevent microbial growth in the outlets.

Published
1998

29. Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1

Author

Joke B. G. M. Verheij, H. B. M. Hilderink, J. D. F. Habbema, Jorrit Gerritsen, L. Kooij, Mark F. Wildhagen, T. Tijmstra, L P ten Kate, J. G. Verzijl, F Habbema, and W. Bakker

Subjects
Pulmonary and Respiratory Medicine, Adult, Pediatrics, medicine.medical_specialty, Adolescent, Cystic Fibrosis, Cystic fibrosis, Patient questionnaire, Cost of Illness, Health care, medicine, Humans, Child, Letters to the Editor, health care economics and organizations, Physical Therapy Modalities, Netherlands, business.industry, Public health, Medical record, Infant, Patient data, Health Care Costs, Patient Acceptance of Health Care, medicine.disease, Home Care Services, Hospital care, Hospitalization, Child, Preschool, business, Cost of care, Research Article
Abstract

BACKGROUND: Research on the cost of care of patients with cystic fibrosis is scarce. The aim of this study was to estimate the costs using age-specific medical consumption from real patient data. METHODS: The age-specific medical consumption of patients with cystic fibrosis in The Netherlands in 1991 was estimated from a survey of medical records and a patient questionnaire. A distinction was made between costs of hospital care, hospital and non-hospital medication, and home care. Costs per year were obtained by multiplying the yearly amount of care and the costs per unit. RESULTS: On average the annual cost of a patient with cystic fibrosis in 1991 was 10,908 pounds (hospital care 42%, medication 37%, home care 20%). The cost of care of cystic fibrosis in The Netherlands, with approximately 1000 patients, is estimated at 10.9 million pounds per year, which is 0.07% of the total health care budget. The cost of care of a patient up to the age of 35 is estimated at 614,587 pounds. When year-to-year survival is taken into account and future costs are discounted to the year of birth with a yearly discount rate of 5%, the cost of care of a patient with cystic fibrosis is estimated at 164,365 pounds for 1991. This estimate will be used in a prospective evaluation of screening for cystic fibrosis carriers. CONCLUSIONS: The cost of care of patients with cystic fibrosis estimated by age-specific medical consumption of real patients is higher than that estimated by non-age-specific medical consumption and/or expert opinions.

Published
1996

30. The nonhospital costs of care of patients with CF in The Netherlands: Results of a questionnaire

Author

W. Bakker, T. Tijmstra, J. G. Verzijl, J. D. F. Habbema, H. B. M. Hilderink, Joke B. G. M. Verheij, L.P. ten Kate, Mark F. Wildhagen, L. Kooij, Jorrit Gerritsen, and Faculteit Medische Wetenschappen/UMCG

Subjects
Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Pediatrics, Adolescent, Home Nursing, Transportation, Medical care, cystic fibrosis, Drug Therapy, Surveys and Questionnaires, Absenteeism, Medicine, Humans, Per patient per year, Child, costs of care, health care economics and organizations, Netherlands, Response rate (survey), CYSTIC-FIBROSIS, business.industry, Infant, The Netherlands, Health Care Costs, Middle Aged, Pays bas, El Niño, Equipment and Supplies, Child, Preschool, Emergency medicine, Food, Fortified, Cost analysis, Costs and Cost Analysis, business, home care
Abstract

Cystic fibrosis (CF) causes a relatively high medical consumption. A large part of the treatment takes place at home. Because data regarding nonhospital care are lacking, we wished to determine the costs of care of patients with CF outside the hospital. A questionnaire was sent to 73 patients with CF from two Dutch hospitals (response rate 64%, 14 children and 33 adults). Average consumption and average costs per patient per year were calculated for children and adults for six categories: nonhospital medical care; domestic help; diet; travelling because of CF; medication; and devices and special facilities at home, work or school. The average nonhospital costs of care amounted to Pounds 4,641 per child per year (range Pounds 712-13,269) and Pounds 10,242 per adult (range Pounds 1,653-26,571). Nonhospital medical care for children and adults accounted for, respectively, 8 and 5% of these costs, domestic help for 15 and 9%, diet for 10 and 7%, travelling because of CF for 4 and 8%, medication for 63 and 67%, and devices and special facilities at home, work or school for 1 and 4%. Nonhospital costs of care of cystic fibrosis are very high and amount to 50% of the total (medical and nonmedical) lifetime costs of cystic fibrosis.

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