Browsing by Subject "LIFE EXPECTANCY"

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  • Hakulinen, Christian; Musliner, Katherine L.; Agerbo, Esben (2019)
    Background Mood disorders are known to be associated with poor socioeconomic outcomes, but no study has examined these associations across the entire worklife course. Our goal was to estimate the associations between bipolar disorder and depression in early adulthood and subsequent employment, income, and educational attainment. Methods We conducted a nationwide prospective cohort study including all individuals (n = 2,390,127; 49% female) born in Denmark between 1955 and 1990. Hospital-based diagnoses of depression and bipolar disorder before age 25 were obtained from the Danish psychiatric register. Yearly employment, earnings, and education status from ages 25 to 61 were obtained from the Danish labor market and education registers. We estimated both absolute and relative proportions. Results Population rates of hospital-diagnosed depression and bipolar between ages 15-25 were 1% and 0.12%, respectively. Compared to individuals without mood disorders, those with depression and particularly bipolar disorder had consistently poor socioeconomic outcomes across the entire work-life span. For example, at age 30, 62% of bipolar and 53% of depression cases were outside the workforce compared to 19% of the general population, and 52% of bipolar and 42% of depression cases had no higher education compared to 27% of the general population. Overall, individuals with bipolar disorder or depression earned around 36% and 51%, respectively, of the income earned by individuals without mood disorders. All associations were smaller for individuals not rehospitalized after age 25. Conclusions Severe mood disorders with onset before age 25, particularly bipolar disorder, are associated with persistent poor socioeconomic outcomes across the entire work-life course.
  • Makela, Keijo T.; Visuri, Tuomo; Pulkkinen, Pekka; Eskelinen, Antti; Remes, Ville; Virolainen, Petri; Junnila, Mika; Pukkala, Eero (2014)
  • Kuusi, Tuire; Haukka, Jari; Myllykangas, Liisa; Järvelä, Irma (2019)
    OBJECTIVE. Music practice and listening have been reported to have favorable effects on human health, but empirical data are largely missing about these effects. To obtain more information about the effect of exposure to music from early childhood, we examined the causes of death of professional musicians in the classical genre. METHODS: We used standardized mortality ratios (SMR) for Finnish performing artists (n=5,780) and church musicians (n=22,368) during 1981-2016. We examined deaths from cardiovascular diseases, cancers, and neurodegenerative and alcohol-related diseases. The diagnoses were based on the ICD-10, with data obtained from Statistics of Finland. RESULTS: Overall, SMR for all-cause mortality was 0.59 (95% CI 0.57-0.61) for church musicians and 0.75 (95% CI 0.70-0.80) for performing artists, suggesting a protective effect of music for health. In contrast, we found increased mortality in alcohol-related diseases among female performing artists (SMR 1.85, 95% CI 1.062.95) and in neurodegenerative diseases among male performing artists (1.46, 95% CI 1.13-1.84). Additionally, we found higher SMRs for female than male church musicians for cancers (SMRfemales 0.90, 95% CI 0.83-0.97; SMRmales 0.60, 95% CI 0.54-0.67) and cardiovascular diseases (SMRfemales 0.75, 95% CI 0.68-0.82; SMRmales 0.58, 95% CI 0.54-0.64). CONCLUSIONS: Our results show that the causes of death in performers differ from those in church musicians. Performing artists are not protected from neurodegenerative diseases or alcohol-related deaths. The findings call for further study on the life-long effects of music in musicians.
  • Teng, Andrea; Blakely, Tony; Atkinson, June; Kalėdienė, Ramunė; Leinsalu, Mall; Martikainen, Pekka T.; Rychtaříková, Jitka; Mackenbach, Johan P. (2020)
    Background In many countries smoking rates have declined and obesity rates have increased, and social inequalities in each have varied over time. At the same time, mortality has declined in most high-income countries, but gaps by educational qualification persist—at least partially due to differential smoking and obesity distributions. This study uses a compass typology to simultaneously examine the magnitude and trends in educational inequalities across multiple countries in: a) smoking and obesity; b) smoking-related mortality and c) cause-specific mortality. Methods Smoking prevalence, obesity prevalence and cause-specific mortality rates (35–79 year olds by sex) in nine European countries and New Zealand were sourced from between 1980 and 2010. We calculated relative and absolute inequalities in prevalence and mortality (relative and slope indices of inequality, respectively RII, SII) by highest educational qualification. Countries were then plotted on a compass typology which simultaneously examines trends in the population average rates or odds on the x-axis, RII on the Y-axis, and contour lines depicting SII. Findings Smoking and obesity. Smoking prevalence in men decreased over time but relative inequalities increased. For women there were fewer declines in smoking prevalence and relative inequalities tended to increase. Obesity prevalence in men and women increased over time with a mixed picture of increasing absolute and sometimes relative inequalities. Absolute inequalities in obesity increased for men and women in Czech Republic, France, New Zealand, Norway, for women in Austria and Lithuania, and for men in Finland. Cause-specific mortality. Average rates of smoking-related mortality were generally stable or increasing for women, accompanied by increasing relative inequalities. For men, average rates were stable or decreasing, but relative inequalities increased over time. Cardiovascular disease, cancer, and external injury rates generally decreased over time, and relative inequalities increased. In Eastern European countries mortality started declining later compared to other countries, however it remained at higher levels; and absolute inequalities in mortality increased whereas they were more stable elsewhere. Conclusions Tobacco control remains vital for addressing social inequalities in health by education, and focus on the least educated is required to address increasing relative inequalities. Increasing obesity in all countries and increasing absolute obesity inequalities in several countries is concerning for future potential health impacts. Obesity prevention may be increasingly important for addressing health inequalities in some settings. The compass typology was useful to compare trends in inequalities because it simultaneously tracks changes in rates/odds, and absolute and relative inequality measures.
  • Lehikoinen, Markku; Arffman, Martti; Manderbacka, Kristiina; Elovainio, Marko; Keskimaki, Ilmo (2016)
    Background: Large cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities. Methods: We analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992-2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas. Results: While mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p <0.027) and by 62 % in women (p <0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas. Conclusions: No geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.
  • Lithovius, Raija; Toppila, Iiro; Harjutsalo, Valma; Forsblom, Carol; Groop, Per-Henrik; Makinen, Ville-Petteri; FinnDiane Study Grp (2017)
    Aims/hypothesis Previously, we proposed that data-driven metabolic subtypes predict mortality in type 1 diabetes. Here, we analysed new clinical endpoints and revisited the subtypes after 7 years of additional follow-up. Methods Finnish individuals with type 1 diabetes (2059 men and 1924 women, insulin treatment before 35 years of age) were recruited by the national multicentre FinnDiane Study Group. The participants were assigned one of six metabolic subtypes according to a previously published self-organising map from 2008. Subtype-specific all-cause and cardiovascular mortality rates in the FinnDiane cohort were compared with registry data from the entire Finnish population. The rates of incident diabetic kidney disease and cardiovascular endpoints were estimated based on hospital records. Results The advanced kidney disease subtype was associated with the highest incidence of kidney disease progression (67.5% per decade, p <0.001), ischaemic heart disease (26.4% per decade, p <0.001) and all-cause mortality (41.5% per decade, p <0.001). Across all subtypes, mortality rates were lower in women compared with men, but standardised mortality ratios (SMRs) were higher in women. SMRs were indistinguishable between the original study period (19942007) and the new period (2008-2014). The metabolic syndrome subtype predicted cardiovascular deaths (SMR 11.0 for men, SMR 23.4 for women, p <0.001), and women with the high HDL-cholesterol subtype were also at high cardiovascular risk (SMR 16.3, p <0.001). Men with the low-cholesterol or good glycaemic control subtype showed no excess mortality. Conclusions/interpretation Data-driven multivariable metabolic subtypes predicted the divergence of complication burden across multiple clinical endpoints simultaneously. In particular, men with the metabolic syndrome and women with high HDL-cholesterol should be recognised as important subgroups in interventional studies and public health guidelines on type 1 diabetes.
  • Mocroft, Amanda; Lundgren, Jens D.; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A.; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A.; Ryom, Lene; DAD Study Grp; Royal Free Hosp Clin Cohort; INSIGHT Study Grp; SMART Study Grp; ESPRIT Study Grp; Ristola, M. (2015)
    Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score <0, 33 events), rising to 1: 47 and 1: 6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score >= 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.
  • Ostergren, Olof; Lundberg, Olle; Artnik, Barbara; Bopp, Matthias; Borrell, Carme; Kalediene, Ramune; Leinsalu, Mall; Martikainen, Pekka; Regidor, Enrique; Rodriguez-Sanz, Maica; de Gelder, Rianne; Mackenbach, Johan P. (2017)
    Objective The aim of this paper is to empirically evaluate whether widening educational inequalities in mortality are related to the substantive shifts that have occurred in the educational distribution. Materials and methods Data on education and mortality from 18 European populations across several decades were collected and harmonized as part of the Demetriq project. Using a fixed-effects approach to account for time trends and national variation in mortality, we formally test whether the magnitude of relative inequalities in mortality by education is associated with the gender and age-group specific proportion of high and low educated respectively. Results The results suggest that in populations with larger proportions of high educated and smaller proportions of low educated, the excess mortality among intermediate and low educated is larger, all other things being equal. Conclusion We conclude that the widening educational inequalities in mortality being observed in recent decades may in part be attributed to educational expansion.
  • James, Spencer L.; Lucchesi, Lydia R.; Bisignano, Catherine; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Henry, Nathaniel J.; McCracken, Darrah; Roberts, Nicholas L. S.; Sylte, Dillon O.; Ahmadi, Alireza; Ahmed, Muktar Beshir; Alahdab, Fares; Alipour, Vahid; Andualem, Zewudu; Antonio, Carl Abelardo T.; Arabloo, Jalal; Badiye, Ashish D.; Bagherzadeh, Mojtaba; Banstola, Amrit; Baernighausen, Till Winfried; Barzegar, Akbar; Bayati, Mohsen; Bhaumik, Soumyadeep; Bijani, Ali; Bukhman, Gene; Carvalho, Felix; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Nasab, Mostafa Dianati; Hoa Thi Do,; Huyen Phuc Do,; Endries, Aman Yesuf; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Fukumoto, Takeshi; Gebremedhin, Ketema Bizuwork Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gilani, Syed Amir; Haagsma, Juanita A.; Hamidi, Samer; Hostiuc, Sorin; Househ, Mowafa; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Jayatilleke, Achala Upendra; Kahsay, Amaha; Kapoor, Neeti; Kasaeian, Amir; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Ejaz Ahmad; Khazaee-Pool, Maryam; Kokubo, Yoshihiro; Lopez, Alan D.; Madadin, Mohammed; Majdan, Marek; Maled, Venkatesh; Malekzadeh, Reza; Manafi, Navid; Manafi, Ali; Mangalam, Srikanth; Massenburg, Benjamin Ballard; Meles, Hagazi Gebre; Menezes, Ritesh G.; Meretoja, Tuomo J.; Miazgowski, Bartosz; Miller, Ted R.; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Morrison, Shane Douglas; Negoi, Ionut; Trang Huyen Nguyen,; Son Hoang Nguyen,; Cuong Tat Nguyen,; Nixon, Molly R.; Olagunju, Andrew T.; Olagunju, Tinuke O.; Padubidri, Jagadish Rao; Polinder, Suzanne; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rahimi-Movaghar, Vafa; Rawaf, Salman; Rawaf, David Laith; Rezapour, Aziz; Rickard, Jennifer; Roro, Elias Merdassa; Roy, Nobhojit; Safari-Faramani, Roya; Salamati, Payman; Samy, Abdallah M.; Satpathy, Maheswar; Sawhney, Monika; Schwebel, David C.; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Shigematsu, Mika; Soheili, Amin; Stokes, Mark A.; Tohidinik, Hamid Reza; Bach Xuan Tran,; Valdez, Pascual R.; Wijeratne, Tissa; Yisma, Engida; Zaidi, Zoubida; Zamani, Mohammad; Zhang, Zhi-Jiang; Hay, Simon; Mokdad, Ali H. (2020)
    Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
  • James, Spencer L.; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Bertolacci, Gregory J.; Cunningham, Matthew; Henry, Nathaniel J.; LeGrand, Kate E.; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abedi, Aidin; Abegaz, Kedir Hussein; Abosetugn, Akine Eshete; Abushouk, Abdelrahman; Adebayo, Oladimeji M.; Adsuar, Jose C.; Advani, Shailesh M.; Agudelo-Botero, Marcela; Ahmad, Tauseef; Ahmed, Muktar Beshir; Ahmed, Rushdia; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alanezi, Fahad Mashhour; Alema, Niguse Meles; Alemu, Biresaw Wassihun; Alghnam, Suliman A.; Ali, Beriwan Abdulqadir; Ali, Saqib; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi-Hashiani, Amir; Almasri, Nihad A.; Altirkawi, Khalid; Amer, Yasser Sami Abdeldayem; Andrei, Catalina Liliana; Ansari-Moghaddam, Alireza; Antonio, Carl Abelardo T.; Anvari, Davood; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Arab-Zozani, Morteza; Arefi, Zohreh; Aremu, Olatunde; Ariani, Filippo; Arora, Amit; Asaad, Malke; Ayala Quintanilla, Beatriz Paulina; Ayano, Getinet; Ayanore, Martin Amogre; Azarian, Ghasem; Badawi, Alaa; Badiye, Ashish D.; Baig, Atif Amin; Bairwa, Mohan; Bakhtiari, Ahad; Balachandran, Arun; Banach, Maciej; Banerjee, Srikanta K.; Banik, Palash Chandra; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Baernighausen, Till Winfried; Barzegar, Akbar; Bayati, Mohsen; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Behzadifar, Masoud; Belete, Habte; Bennett, Derrick A.; Bensenor, Isabela M.; Berhe, Kidanemaryam; Bhagavathula, Akshaya Srikanth; Bhardwaj, Pankaj; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhutta, Zulfiqar A.; Bibi, Sadia; Bijani, Ali; Boloor, Archith; Borges, Guilherme; Borschmann, Rohan; Borzi, Antonio Maria; Boufous, Soufiane; Braithwaite, Dejana; Briko, Nikolay Ivanovich; Brugha, Traolach; Budhathoki, Shyam S.; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Castaldelli-Maia, Joao Mauricio; Castaneda-Orjuela, Carlos A.; Castelpietra, Giulio; Catala-Lopez, Ferran; Cerin, Ester; Chandan, Joht S.; Chapman, Jens Robert; Chattu, Vijay Kumar; Chattu, Soosanna Kumary; Chatziralli, Irini; Chaudhary, Neha; Cho, Daniel Youngwhan; Choi, Jee-Young J.; Chowdhury, Mohiuddin Ahsanul Kabir; Christopher, Devasahayam J.; Dinh-Toi Chu,; Cicuttini, Flavia M.; Coelho, Joao M.; Costa, Vera M.; Dahlawi, Saad M. A.; Daryani, Ahmad; Alberto Davila-Cervantes, Claudio; De Leo, Diego; Demeke, Feleke Mekonnen; Demoz, Gebre Teklemariam; Demsie, Desalegn Getnet; Deribe, Kebede; Desai, Rupak; Nasab, Mostafa Dianati; da Silva, Diana Dias; Forooshani, Zahra Sadat Dibaji; Hoa Thi Do,; Doyle, Kerrie E.; Driscoll, Tim Robert; Dubljanin, Eleonora; Adema, Bereket Duko; Eagan, Arielle Wilder; Elemineh, Demelash Abewa; El-Jaafary, Shaimaa; El-Khatib, Ziad; Ellingsen, Christian Lycke; Zaki, Maysaa El Sayed; Eskandarieh, Sharareh; Eyawo, Oghenowede; Faris, Pawan Sirwan; Faro, Andre; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Ferrara, Pietro; Fischer, Florian; Folayan, Morenike Oluwatoyin; Fomenkov, Artem Alekseevich; Foroutan, Masoud; Francis, Joel Msafiri; Franklin, Richard Charles; Fukumoto, Takeshi; Geberemariyam, Biniyam Sahiledengle; Gebremariam, Hadush; Gebremedhin, Ketema Bizuwork; Gebremeskel, Leake G.; Gebremeskel, Gebreamlak Gebremedhn; Gebremichael, Berhe; Gedefaw, Getnet Azeze; Geta, Birhanu; Getenet, Agegnehu Bante; Ghafourifard, Mansour; Ghamari, Farhad; Gheshlagh, Reza Ghanei; Gholamian, Asadollah; Gilani, Syed Amir; Gill, Tiffany K.; Goudarzian, Amir Hossein; Goulart, Alessandra C.; Grada, Ayman; Grivna, Michal; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Gaurav; Haagsma, Juanita A.; Hall, Brian James; Hamadeh, Randah R.; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haro, Josep Maria; Hasanzadeh, Amir; Hassan, Shoaib; Hassanipour, Soheil; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hendrie, Delia; Heydarpour, Fatemeh; Hijar, Martha; Ho, Hung Chak; Chi Linh Hoang,; Hole, Michael K.; Holla, Ramesh; Hossain, Naznin; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hu, Guoqing; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Inbaraj, Leeberk Raja; Irvani, Seyed Sina Naghibi; Islam, M. Mofizul; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Jahani, Mohammad Ali; Jakovljevic, Mihajlo; Jalilian, Farzad; Jayaraman, Sudha; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; John-Akinola, Yetunde O.; Jonas, Jost B.; Jones, Kelly M.; Joseph, Nitin; Joukar, Farahnaz; Jozwiak, Jacek Jerzy; Jungari, Suresh Banayya; Jurisson, Mikk; Kabir, Ali; Kahsay, Amaha; Kalankesh, Leila R.; Kalhor, Rohollah; Kamil, Teshome Abegaz; Kanchan, Tanuj; Kapoor, Neeti; Karami, Manoochehr; Kasaeian, Amir; Kassaye, Hagazi Gebremedhin; Kavetskyy, Taras; Kayode, Gbenga A.; Keiyoro, Peter Njenga; Kelbore, Abraham Getachew; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalil, Ibrahim A.; Khalilov, Rovshan; Khan, Maseer; Khan, Ejaz Ahmad; Khan, Junaid; Khanna, Tripti; Khazaei, Salman; Khazaie, Habibolah; Khundkar, Roba; Kiirithio, Daniel N.; Kim, Young-Eun; Kim, Yun Jin; Kim, Daniel; Kisa, Sezer; Kisa, Adnan; Komaki, Hamidreza; Kondlahalli, Shivakumar K. M.; Koolivand, Ali; Korshunov, Vladimir Andreevich; Koyanagi, Ai; Kraemer, Moritz U. G.; Krishan, Kewal; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kugbey, Nuworza; Kumar, Nithin; Kumar, Manasi; Kumar, Vivek; Kumar, Narinder; Kumaresh, Girikumar; Lami, Faris Hasan; Lansingh, Van C.; Lasrado, Savita; Latifi, Arman; Lauriola, Paolo; La Vecchia, Carlo; Leasher, Janet L.; Lee, Shaun Wen Huey; Li, Shanshan; Liu, Xuefeng; Lopez, Alan D.; Lotufo, Paulo A.; Lyons, Ronan A.; Machado, Daiane Borges; Madadin, Mohammed; Abd El Razek, Muhammed Magdy; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Maled, Venkatesh; Malta, Deborah Carvalho; Manafi, Navid; Manafi, Amir; Manda, Ana-Laura; Manjunatha, Narayana; Mansour-Ghanaei, Fariborz; Mansournia, Mohammad Ali; Maravilla, Joemer C.; Mason-Jones, Amanda J.; Masoumi, Seyedeh Zahra; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Mehndiratta, Man Mohan; Melketsedik, Zeleke Aschalew; Memiah, Peter T. N.; Mendoza, Walter; Menezes, Ritesh G.; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Meretoja, Atte; Merie, Hayimro Edemealem; Mestrovic, Tomislav; Miazgowski, Bartosz; Miazgowski, Tomasz; Miller, Ted R.; Mini, G. K.; Mirica, Andreea; Mirrakhimov, Erkin M.; Mirzaei-Alavijeh, Mehdi; Mithra, Prasanna; Moazen, Babak; Moghadaszadeh, Masoud; Mohamadi, Efat; Mohammad, Yousef; Darwesh, Aso Mohammad; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohebi, Farnam; Bandpei, Mohammad A. Mohseni; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Lakeh, Maziar; Moradzadeh, Rahmatollah; Morawska, Lidia; Moreno Velasquez, Ilais; Morrison, Shane Douglas; Mossie, Tilahun Belete; Muluneh, Atalay Goshu; Musa, Kamarul Imran; Mustafa, Ghulam; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naik, Gurudatta; Naimzada, Mukhammad David; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Naserbakht, Morteza; Nayak, Vinod; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Ngunjiri, Josephine W.; Trang Huyen Nguyen,; Cuong Tat Nguyen,; Diep Ngoc Nguyen,; Huong Lan Thi Nguyen,; Nikbakhsh, Rajan; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oghenetega, Onome Bright; Oh, In-Hwan; Olagunju, Andrew T.; Olagunju, Tinuke O.; Bali, Ahmed Omar; Onwujekwe, Obinna E.; Orpana, Heather M.; Ota, Erika; Otstavnov, Nikita; Otstavnov, Stanislav S.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pakshir, Keyvan; Panda-Jonas, Songhomitra; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Pati, Sanghamitra; Paulos, Kebreab; Peden, Amy E.; Pepito, Veincent Christian Filipino; Pereira, Jeevan; Phillips, Michael R.; Polibin, Roman; Polinder, Suzanne; Pourmalek, Farshad; Pourshams, Akram; Poustchi, Hossein; Prakash, Swayam; Pribadi, Dimas Ria Angga; Puri, Parul; Syed, Zahiruddin Quazi; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafay, Anwar; Rafiee, Ata; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahman, Muhammad Aziz; Rajabpour-Sanati, Ali; Rajati, Fatemeh; Rakovac, Ivo; Rao, Sowmya J.; Rashedi, Vahid; Rastogi, Prateek; Rathi, Priya; Rawaf, Salman; Rawal, Lal; Rawassizadeh, Reza; Renjith, Vishnu; Resnikoff, Serge; Rezapour, Aziz; Ribeiro, Ana Isabel; Rickard, Jennifer; Rios Gonzalez, Carlos Miguel; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Saddik, Basema; Safarpour, Hamid; Safdarian, Mahdi; Sajadi, S. Mohammad; Salamati, Payman; Salem, Marwa R. Rashad; Salem, Hosni; Salz, Inbal; Samy, Abdallah M.; Sanabria, Juan; Riera, Lidia Sanchez; Milicevic, Milena M. Santric; Sarker, Abdur Razzaque; Sarveazad, Arash; Sathian, Brijesh; Sawhney, Monika; Sayyah, Mehdi; Schwebel, David C.; Seedat, Soraya; Senthilkumaran, Subramanian; Seyedmousavi, Seyedmojtaba; Sha, Feng; Shaahmadi, Faramarz; Shahabi, Saeed; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Sheikh, Aziz; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Siabani, Soraya; Sigfusdottir, Inga Dora; Singh, Jasvinder A.; Singh, Pankaj Kumar; Sinha, Dhirendra Narain; Soheili, Amin; Soriano, Joan B.; Sorrie, Muluken Bekele; Soyiri, Ireneous N.; Stokes, Mark A.; Sufiyan, Mu'awiyyah Babale; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Taddele, Biruk Wogayehu; Tefera, Yonatal Mesfin; Tehrani-Banihashemi, Arash; Tekulu, Gebretsadkan Hintsa; Tesema, Ayenew Kassie Tesema; Tesfay, Berhe Etsay; Thapar, Rekha; Titova, Mariya Vladimirovna; Tlaye, Kenean Getaneh; Tohidinik, Hamid Reza; Topor-Madry, Roman; Khanh Bao Tran,; Bach Xuan Tran,; Tripathy, Jaya Prasad; Tsai, Alexander C.; Tsatsakis, Aristidis; Car, Lorainne Tudor; Ullah, Irfan; Ullah, Saif; Unnikrishnan, Bhaskaran; Upadhyay, Era; Uthman, Olalekan A.; Valdez, Pascual R.; Vasankari, Tommi Juhani; Veisani, Yousef; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vlassov, Vasily; Waheed, Yasir; Wang, Yuan-Pang; Wiangkham, Taweewat; Wolde, Haileab Fekadu; Woldeyes, Dawit Habte; Wondmeneh, Temesgen Gebeyehu; Wondmieneh, Adam Belay; Wu, Ai-Min; Wyper, Grant M. A.; Yadav, Rajaram; Yadollahpour, Ali; Yano, Yuichiro; Yaya, Sanni; Yazdi-Feyzabadi, Vahid; Ye, Pengpeng; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Yoon, Seok-Jun; Youm, Yoosik; Younis, Mustafa Z.; Yousefi, Zabihollah; Yu, Chuanhua; Yu, Yong; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zarei, Fatemeh; Zhang, Zhi-Jiang; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Dandona, Rakhi; Dharmaratne, Samath Dhamminda; Hay, Simon; Mokdad, Ali H.; Pigott, David M.; Reiner, Robert C.; Vos, Theo (2020)
    Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
  • Dieleman, Joseph; Campbell, Madeline; Chapin, Abigail; Eldrenkamp, Erika; Fan, Victoria Y.; Haakenstad, Annie; Kates, Jennifer; Liu, Yingying; Matyasz, Taylor; Micah, Angela; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Sorensen, Reed; Evans, Tim; Evans, David; Kurowski, Christoph; Tandon, Ajay; Abbas, Kaja M.; Abera, Semaw Ferede; Kiadaliri, Aliasghar Ahmad; Ahmed, Kedir Yimam; Ahmed, Muktar Beshir; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, Ala'a; Amini, Erfan; Ammar, Walid; Amrock, Stephen Marc; Antonio, Carl Abelardo T.; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Barac, Aleksandra; Alberto Bernal, Oscar; Beyene, Addisu Shunu; Beyene, Tariku Jibat; Birungi, Charles; Bizuayehu, Habtamu Mellie; Breitborde, Nicholas J. K.; Cahuana-Hurtado, Lucero; Estanislao Castro, Ruben; Catalia-Lopez, Ferran; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; de Jager, Pieter; Dharmaratne, Samath D.; Dubey, Manisha; Meretoja, Atte; Global Burden Dis Hlth Financing (2017)
    Background An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.
  • James, Spencer L.; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Henry, Nathaniel J.; LeGrand, Kate E.; Abdelalim, Ahmed; Abdoli, Amir; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abedi, Aidin; Abosetugn, Akine Eshete; Abushouk, Abdelrahman; Adebayo, Oladimeji M.; Agudelo-Botero, Marcela; Ahmad, Tauseef; Ahmed, Rushdia; Ahmed, Muktar Beshir; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alamene, Genet Melak; Alanezi, Fahad Mashhour; Alebel, Animut; Alema, Niguse Meles; Alghnam, Suliman A.; Al-Hajj, Samar; Ali, Beriwan Abdulqadir; Ali, Saqib; Alikhani, Mahtab; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi-Hashiani, Amir; Almasri, Nihad A.; Altirkawi, Khalid; Amer, Yasser Sami Abdeldayem; Amini, Saeed; Amit, Arianna Maever Loreche; Andrei, Catalina Liliana; Ansari-Moghaddam, Alireza; Antonio, Carl Abelardo T.; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Arab-Zozani, Morteza; Arefi, Zohreh; Aremu, Olatunde; Ariani, Filippo; Arora, Amit; Asaad, Malke; Asghari, Babak; Awoke, Nefsu; Quintanilla, Beatriz Paulina Ayala; Ayano, Getinet; Ayanore, Martin Amogre; Azari, Samad; Azarian, Ghasem; Badawi, Alaa; Badiye, Ashish D.; Bagli, Eleni; Baig, Atif Amin; Bairwa, Mohan; Bakhtiari, Ahad; Balachandran, Arun; Banach, Maciej; Banerjee, Srikanta K.; Banik, Palash Chandra; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Baernighausen, Till Winfried; Barrero, Lope H.; Barzegar, Akbar; Bayati, Mohsen; Baye, Bayisa Abdissa; Bedi, Neeraj; Behzadifar, Masoud; Bekuma, Tariku Tesfaye; Belete, Habte; Benjet, Corina; Bennett, Derrick A.; Bensenor, Isabela M.; Berhe, Kidanemaryam; Bhardwaj, Pankaj; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bibi, Sadia; Bijani, Ali; Bin Sayeed, Muhammad Shahdaat; Borges, Guilherme; Borzi, Antonio Maria; Boufous, Soufiane; Brazinova, Alexandra; Briko, Nikolay Ivanovich; Budhathoki, Shyam S.; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Mauricio Castaldelli-Maia, Joao; Castaneda-Orjuela, Carlos A.; Castelpietra, Giulio; Catala-Lopez, Ferran; Cerin, Ester; Chandan, Joht S.; Chanie, Wagaye Fentahun; Chattu, Soosanna Kumary; Chattu, Vijay Kumar; Chatziralli, Irini; Chaudhary, Neha; Cho, Daniel Youngwhan; Chowdhury, Mohiuddin Ahsanul Kabir; Chu, Dinh-Toi; Colquhoun, Samantha M.; Constantin, Maria-Magdalena; Costa, Vera M.; Damiani, Giovanni; Daryani, Ahmad; Alberto Davila-Cervantes, Claudio; Demeke, Feleke Mekonnen; Demis, Asmamaw Bizuneh; Demoz, Gebre Teklemariam; Demsie, Desalegn Getnet; Derakhshani, Afshin; Deribe, Kebede; Desai, Rupak; Nasab, Mostafa Dianati; da Silva, Diana Dias; Forooshani, Zahra Sadat Dibaji; Doyle, Kerrie E.; Driscoll, Tim Robert; Dubljanin, Eleonora; Adema, Bereket Duko; Eagan, Arielle Wilder; Eftekhari, Aziz; Ehsani-Chimeh, Elham; Zaki, Maysaa El Sayed; Elemineh, Demelash Abewa; El-Jaafary, Shaimaa; El-Khatib, Ziad; Ellingsen, Christian Lycke; Emamian, Mohammad Hassan; Endalew, Daniel Adane; Eskandarieh, Sharareh; Faris, Pawan Sirwan; Faro, Andre; Farzadfar, Farshad; Fatahi, Yousef; Fekadu, Wubalem; Ferede, Tomas Y.; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Ferrara, Pietro; Feyissa, Garumma Tolu; Filip, Irina; Fischer, Florian; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Francis, Joel Msafiri; Franklin, Richard Charles; Fukumoto, Takeshi; Geberemariyam, Biniyam Sahiledengle; Gebre, Abadi Kahsu; Gebremedhin, Ketema Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gebremichael, Berhe; Gedefaw, Getnet Azeze; Geta, Birhanu; Ghafourifard, Mansour; Ghamari, Farhad; Ghashghaee, Ahmad; Gholamian, Asadollah; Gill, Tiffany K.; Goulart, Alessandra C.; Grada, Ayman; Grivna, Michal; Gubari, Mohammed Ibrahim Mohialdeen; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Gaurav; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Bidgoli, Hassan Haghparast; Hall, Brian James; Hamadeh, Randah R.; Hamidi, Samer; Maria Haro, Josep; Hasan, Mehedi; Hasanzadeh, Amir; Hassanipour, Soheil; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hayat, Khezar; Hendrie, Delia; Heydarpour, Fatemeh; Hijar, Martha; Ho, Hung Chak; Chi Linh Hoang,; Hole, Michael K.; Holla, Ramesh; Hossain, Naznin; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hu, Guoqing; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Irena; Ilic, Milena D.; Inbaraj, Leeberk Raja; Indriasih, Endang; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Islam, M. Mofizul; Ivers, Rebecca Q.; Jacobsen, Kathryn H.; Jahani, Mohammad Ali; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalilian, Farzad; Jayaraman, Sudha; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; John-Akinola, Yetunde O.; Jonas, Jost B.; Joseph, Nitin; Joukar, Farahnaz; Jozwiak, Jacek Jerzy; Jungari, Suresh Banayya; Jurisson, Mikk; Kabir, Ali; Kadel, Rajendra; Kahsay, Amaha; Kalankesh, Leila R.; Kalhor, Rohollah; Kamil, Teshome Abegaz; Kanchan, Tanuj; Kapoor, Neeti; Karami, Manoochehr; Kasaeian, Amir; Kassaye, Hagazi Gebremedhin; Kavetskyy, Taras; Kebede, Hafte Kahsay; Keiyoro, Peter Njenga; Kelbore, Abraham Getachew; Kelkay, Bayew; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalil, Ibrahim A.; Khalilov, Rovshan; Khammarnia, Mohammad; Khan, Ejaz Ahmad; Khan, Maseer; Khanna, Tripti; Khazaie, Habibolah; Shadmani, Fatemeh Khosravi; Khundkar, Roba; Kiirithio, Daniel N.; Kim, Young-Eun; Kim, Daniel; Kim, Yun Jin; Kisa, Adnan; Kisa, Sezer; Komaki, Hamidreza; Kondlahalli, Shivakumar K. M.; Korshunov, Vladimir Andreevich; Koyanagi, Ai; Kraemer, Moritz U. G.; Krishan, Kewal; Bicer, Burcu Kucuk; Kugbey, Nuworza; Kumar, Vivek; Kumar, Nithin; Kumar, G. Anil; Kumar, Manasi; Kumaresh, Girikumar; Kurmi, Om P.; Kuti, Oluwatosin; La Vecchia, Carlo; Lami, Faris Hasan; Lamichhane, Prabhat; Lang, Justin J.; Lansingh, Van C.; Laryea, Dennis Odai; Lasrado, Savita; Latifi, Arman; Lauriola, Paolo; Leasher, Janet L.; Lee, Shaun Wen Huey; Lenjebo, Tsegaye Lolaso; Levi, Miriam; Li, Shanshan; Linn, Shai; Liu, Xuefeng; Lopez, Alan D.; Lotufo, Paulo A.; Lunevicius, Raimundas; Lyons, Ronan A.; Madadin, Mohammed; Abd El Razek, Muhammed Magdy; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Malagon-Rojas, Jeadran N.; Maled, Venkatesh; Malekzadeh, Reza; Malta, Deborah Carvalho; Manafi, Navid; Manafi, Amir; Manda, Ana-Laura; Manjunatha, Narayana; Mansour-Ghanaei, Fariborz; Mansouri, Borhan; Mansournia, Mohammad Ali; Maravilla, Joemer C.; March, Lyn M.; Mason-Jones, Amanda J.; Masoumi, Seyedeh Zahra; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Meles, Gebrekiros Gebremichael; Melese, Addisu; Melketsedik, Zeleke Aschalew; Memiah, Peter T. N.; Mendoza, Walter; Menezes, Ritesh G.; Mengesha, Meresa Berwo; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Meretoja, Atte; Merie, Hayimro Edemealem; Mestrovic, Tomislav; Miazgowski, Bartosz; Miazgowski, Tomasz; Miller, Ted R.; Mini, G. K.; Mirica, Andreea; Mirrakhimov, Erkin M.; Mirzaei-Alavijeh, Mehdi; Mithra, Prasanna; Moazen, Babak; Moghadaszadeh, Masoud; Mohamadi, Efat; Mohammad, Yousef; Mohammad, Karzan Abdulmuhsin; Darwesh, Aso Mohammad; Mezerji, Naser Mohammad Gholi; Mohammadian-Hafshejani, Abdollah; Mohammadoo-Khorasani, Milad; Mohammadpourhodki, Reza; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohebi, Farnam; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Masoud; Moradi, Ghobad; Moradi-Lakeh, Maziar; Moradpour, Farhad; Morawska, Lidia; Moreno Velasquez, Ilais; Morisaki, Naho; Morrison, Shane Douglas; Mossie, Tilahun Belete; Muluneh, Atalay Goshu; Murthy, Srinivas; Musa, Kamarul Imran; Mustafa, Ghulam; Nabhan, Ashraf F.; Nagarajan, Ahamarshan Jayaraman; Naik, Gurudatta; Naimzada, Mukhammad David; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Naserbakht, Morteza; Nayak, Vinod; Ndwandwe, Duduzile Edith; Negoi, Ionut; Ngunjiri, Josephine W.; Cuong Tat Nguyen,; Huong Lan Thi Nguyen,; Nikbakhsh, Rajan; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Nyasulu, Peter S.; Ogbo, Felix Akpojene; Oghenetega, Onome Bright; Oh, In-Hwan; Okunga, Emmanuel Wandera; Olagunju, Andrew T.; Olagunju, Tinuke O.; Bali, Ahmed Omar; Onwujekwe, Obinna E.; Asante, Kwaku Oppong; Orpana, Heather M.; Ota, Erika; Otstavnov, Nikita; Otstavnov, Stanislav S.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pakshir, Keyvan; Panda-Jonas, Songhomitra; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Pati, Sanghamitra; Patton, George C.; Paulos, Kebreab; Peden, Amy E.; Filipino Pepito, Veincent Christian; Pereira, Jeevan; Hai Quang Pham,; Phillips, Michael R.; Pinheiro, Marina; Polibin, Roman; Polinder, Suzanne; Poustchi, Hossein; Prakash, Swayam; Pribadi, Dimas Ria Angga; Puri, Parul; Syed, Zahiruddin Quazi; Rabiee, Mohammad; Rabiee, Navid; Radfar, Amir; Rafay, Anwar; Rafiee, Ata; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rajabpour-Sanati, Ali; Rajati, Fatemeh; Rakovac, Ivo; Ranganathan, Kavitha; Rao, Sowmya J.; Rashedi, Vahid; Rastogi, Prateek; Rathi, Priya; Rawaf, Salman; Rawal, Lal; Rawassizadeh, Reza; Renjith, Vishnu; Renzaho, Andre M. N.; Resnikoff, Serge; Rezapour, Aziz; Ribeiro, Ana Isabel; Rickard, Jennifer; Rios Gonzalez, Carlos Miguel; Ronfani, Luca; Roshandel, Gholamreza; Saad, Anas M.; Sabde, Yogesh Damodar; Sabour, Siamak; Saddik, Basema; Safari, Saeed; Safari-Faramani, Roya; Safarpour, Hamid; Safdarian, Mahdi; Sajadi, S. Mohammad; Salamati, Payman; Salehi, Farkhonde; Zahabi, Saleh Salehi; Salem, Marwa R. Rashad; Salem, Hosni; Salman, Omar; Salz, Inbal; Samy, Abdallah M.; Sanabria, Juan; Riera, Lidia Sanchez; Milicevic, Milena M. Santric; Sarker, Abdur Razzaque; Sarveazad, Arash; Sathian, Brijesh; Sawhney, Monika; Sawyer, Susan M.; Saxena, Sonia; Sayyah, Mehdi; Schwebel, David C.; Seedat, Soraya; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Seyedmousavi, Seyedmojtaba; Sha, Feng; Shaahmadi, Faramarz; Shahabi, Saeed; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamsizadeh, Morteza; Sharif-Alhoseini, Mahdi; Sharifi, Hamid; Sheikh, Aziz; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Siabani, Soraya; Sigfusdottir, Inga Dora; Singh, Pankaj Kumar; Singh, Jasvinder A.; Sinha, Dhirendra Narain; Smarandache, Catalin-Gabriel; Smith, Emma U. R.; Soheili, Amin; Soleymani, Bija; Soltanian, Ali Reza; Soriano, Joan B.; Sorrie, Muluken Bekele; Soyiri, Ireneous N.; Stein, N. J.; Stokes, Mark A.; Sufiyan, Mu'awiyyah Babale; Suleria, Hafiz Ansar Rasul; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Taddele, Biruk Wogayehu; Tadesse, Degena Bahrey; Tamiru, Animut Tagele; Tarigan, Ingan Ukur; Tefera, Yonatal Mesfin; Tehrani-Banihashemi, Arash; Tekle, Merhawi Gebremedhin; Tekulu, Gebretsadkan Hintsa; Tesema, Ayenew Kassie; Tesfay, Berhe Etsay; Thapar, Rekha; Tilahune, Asres Bedaso; Tlaye, Kenean Getaneh; Tohidinik, Hamid Reza; Topor-Madry, Roman; Bach Xuan Tran,; Khanh Bao Tran,; Tripathy, Jaya Prasad; Tsai, Alexander C.; Car, Lorainne Tudor; Ullah, Saif; Ullah, Irfan; Umar, Maida; Unnikrishnan, Bhaskaran; Upadhyay, Era; Uthman, Olalekan A.; Valdez, Pascual R.; Vasankari, Tommi Juhani; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vlassov, Vasily; Waheed, Yasir; Weldesamuel, Girmay Teklay; Werdecker, Andrea; Wiangkham, Taweewat; Wolde, Haileab Fekadu; Woldeyes, Dawit Habte; Wondafrash, Dawit Zewdu; Wondmeneh, Temesgen Gebeyehu; Wondmieneh, Adam Belay; Wu, Ai-Min; Yadav, Rajaram; Yadollahpour, Ali; Yano, Yuichiro; Yaya, Sanni; Yazdi-Feyzabadi, Vahid; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Yoon, Seok-Jun; Youm, Yoosik; Younis, Mustafa Z.; Yousefi, Zabihollah; Yu, Yong; Yu, Chuanhua; Yusefzadeh, Hasan; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zamanian, Maryam; Zandian, Hamed; Zarei, Ahmad; Zare, Fatemeh; Zhang, Zhi-Jiang; Zhang, Yunquan; Zodpey, Sanjay; Dandona, Lalit; Dandona, Rakhi; Degenhardt, Louisa; Dharmaratne, Samath Dhamminda; Hay, Simon; Mokdad, Ali H.; Reiner, Robert C.; Sartorius, Benn; Vos, Theo (2020)
    Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
  • Crowe, Christopher Stephen; Massenburg, Benjamin Ballard; Morrison, Shane Douglas; Chang, James; Friedrich, Jeffrey Barton; Abady, Gdiom Gebreheat; Alahdab, Fares; Alipour, Vahid; Arabloo, Jalal; Asaad, Malke; Banach, Maciej; Bijani, Ali; Borzi, Antonio Maria; Briko, Nikolay Ivanovich; Castle, Chris D.; Cho, Daniel Youngwhan; Chung, Michael T.; Daryani, Ahmad; Demoz, Gebre Teklemariam; Dingels, Zachary; Hoa Thi Do,; Fischer, Florian; Fox, Jack T.; Fukumoto, Takeshi; Gebre, Abadi Kahsu; Gebremichael, Berhe; Haagsma, Juanita A.; Haj-Mirzaian, Arvin; Handiso, Demelash Woldeyohannes; Hay, Simon; Chi Linh Hoang,; Irvani, Seyed Sina Naghibi; Jozwiak, Jacek Jerzy; Kalhor, Rohollah; Kasaeian, Amir; Khader, Yousef Saleh; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khundkar, Roba; Kisa, Sezer; Kisa, Adnan; Liu, Zichen; Majdan, Marek; Manafi, Navid; Manafi, Ali; Manda, Ana-Laura; Meretoja, Tuomo J.; Miller, Ted R.; Mohammadian-Hafshejani, Abdollah; Mohammadpourhodki, Reza; Bandpei, Mohammad A. Mohseni; Mokdad, Ali H.; Naimzada, Mukhammad David; Ndwandwe, Duduzile Edith; Cuong Tat Nguyen,; Huong Lan Thi Nguyen,; Olagunju, Andrew T.; Olagunju, Tinuke O.; Hai Quang Pham,; Pribadi, Dimas Ria Angga; Rabiee, Navid; Ramezanzadeh, Kiana; Ranganathan, Kavitha; Roberts, Nicholas L. S.; Roever, Leonardo; Safari, Saeed; Samy, Abdallah M.; Riera, Lidia Sanchez; Shahabi, Saeed; Smarandache, Catalin-Gabriel; Sylte, Dillon O.; Tesfay, Berhe Etsay; Bach Xuan Tran,; Ullah, Irfan; Vahedi, Parviz; Vahedian-Azimi, Amir; Theo Vos,; Woldeyes, Dawit Habte; Wondmieneh, Adam Belay; Zhang, Zhi-Jiang; James, Spencer L. (2020)
    Background As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. Results The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. Conclusions Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.
  • GBD 2017 HIV Collaborators; Frank, Tahvi D.; Carter, Austin; Meretoja, Tuomo J. (2019)
    Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1.95 million deaths (95% uncertainty interval 1.87-2.04) and has since decreased to 0.95 million deaths (0.91-1.01) in 2017. New cases of HIV globally peaked in 1999 (3.16 million, 2.79-3.67) and since then have gradually decreased to 1.94 million (1.63-2.29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36.8 million (34.8-39.2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65.7% in Lesotho to 85.7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
  • Barber, Ryan M.; Fullman, Nancy; Sorensen, Reed J. D.; Bollyky, Thomas; McKee, Martin; Nolte, Ellen; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abdurahman, Ahmed Abdulahi; Abera, Semaw Ferede; Abraham, Biju; Abreha, Girmatsion Fisseha; Adane, Kelemework; Adelekan, Ademola Lukman; Adetifa, Ifedayo Morayo O.; Afshin, Ashkan; Agarwal, Arnav; Agarwal, Sanjay Kumar; Agarwal, Sunilkumar; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ahmadi, Alireza; Ahmed, Kedir Yimam; Ahmed, Muktar Beshir; Akinyemi, Rufus Olusola; Akinyemiju, Tomi F.; Akseer, Nadia; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore; Alam, Sayed Saidul; Alemu, Zewdie Aderaw; Alene, Kefyalew Addis; Alexander, Lily; Ali, Raghib; Ali, Syed Danish; Alizadeh-Navaei, Reza; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Allen, Christine; Al-Raddadi, Rajaa; Lallukka, Tea; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete; GBD 2015 Healthcare Access Quality (2017)
    Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.
  • GBD 2015 Eastern Mediterranean Reg; Mokdad, Ali H.; Weiderpass, Elisabete; Shiri, Rahman (2018)
    Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. In 2015, 755,844 (95% uncertainty interval (UI) 712,064-801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812-181,463) in 1990 to 80,985 (76,308-85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths.
  • Nyberg, Solja T.; Batty, G. David; Pentti, Jaana; Virtanen, Marianna; Alfredsson, Lars; Fransson, Eleonor I.; Goldberg, Marcel; Heikkila, Katriina; Jokela, Markus; Knutsson, Anders; Koskenvuo, Markku; Lallukka, Tea; Leineweber, Constanze; Lindbohm, Joni V.; Madsen, Ida E. H.; Hanson, Linda L. Magnusson; Nordin, Maria; Oksanen, Tuula; Pietiläinen, Olli; Rahkonen, Ossi; Rugulies, Reiner; Shipley, Martin J.; Stenholm, Sari; Suominen, Sakari; Theorell, Tores; Vahtera, Jussi; Westerholm, Peter J. M.; Westerlund, Hugo; Zins, Marie; Hamer, Mark; Singh-Manoux, Archana; Bell, Joshua A.; Ferrie, Jane E.; Kivimäki, Mika (2018)
    Background Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991-2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI = 25 kg/m(2) to = 30 kg/m(2) to <35 kg/m(2); class II-III [severe] >= 35 kg/m(2)) compared with normal weight (>= 18.5 kg/m(2) to Findings Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0.4%) were underweight, 21 468 (45.6%) normal weight, 20 738 (44.0%) overweight, 3982 (8.4%) class I obese, and 728 (1.5%) class II-III obese. The corresponding numbers among the 73 054 women were 1493 (2.0%), 44 760 (61.3%), 19 553 (26.8%), 5670 (7.8%), and 1578 (2.2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11.5 years [range 6.3-18.6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29.3 (95% CI 28.8-29.8) in normal-weight men and 29.4 (28.7-30.0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1.8 (95% CI -1.3 to 4.9) for underweight, 1.1 (0.7 to 1.5) for overweight, 3.9 (2.9 to 4.9) for class I obese, and 8.5 (7.1 to 9.8) for class II-III obese. The corresponding estimates for women were 0.0 (-1.4 to 1.4) for underweight, 1.1 (0.6 to 1.5) for overweight, 2.7 (1.5 to 3.9) for class I obese, and 7.3 (6.1 to 8.6) for class II-III obese. The loss of disease-free years associated with class II-III obesity varied between 7.1 and 10.0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. Interpretation Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  • Barclay, Kieron; Myrskyla, Mikko (2018)
    As parental ages at birth continue to rise, concerns about the effects of fertility postponement on offspring are increasing. Due to reproductive ageing, advanced parental ages have been associated with negative health outcomes for offspring, including decreased longevity. The literature, however, has neglected to examine the potential benefits of being born at a later date. Secular declines in mortality mean that later birth cohorts are living longer. We analyse mortality over ages 30-74 among 1.9 million Swedish men and women born 1938-60, and use a sibling comparison design that accounts for all time-invariant factors shared by the siblings. When incorporating cohort improvements in mortality, we find that those born to older mothers do not suffer any significant mortality disadvantage, and that those born to older fathers have lower mortality. These findings are likely to be explained by secular declines in mortality counterbalancing the negative effects of reproductive ageing.
  • Kaseva, Kaisa; Hintsa, Taina; Lipsanen, Jari; Pulkki-Raback, Laura; Hintsanen, Mirka; Yang, Xiaolin; Hirvensalo, Mirja; Hutri-Kähönen, Nina; Raitakari, Olli; Keltikangas-Jarvinen, Liisa; Tammelin, Tuija (2017)
    Background: Parents' physical activity associates with their children's physical activity. Prospective designs assessing this association are rare. This study examined how parents' physical activity was associated with their children's physical activity from childhood to middle adulthood in a 30-year pro'spective, population-based setting. Methods: Participants (n = 3596) were from the ongoing Cardiovascular Risk in Young Finns study started in 1980. Participants' physical activity was self-reported at 8 phases from 1980 to 2011, and their parents' physical activity at 1980. Analyses were adjusted for a set of health-related covariates assessed from 1980 to 2007. Results: High levels of mothers' and fathers' physical activity were systematically associated with increased levels of their children's physical activity until offspring's age of 24. Longitudinal analyses conducted from 1980 to 2011 showed that higher levels of parents' physical activity were associated with increased levels of physical activity within their offspring until midlife, but the association between parents' and their children's physical activity weakened when participants aged (P