Browsing by Subject "SYSTEMATIC ANALYSIS"

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  • GBD 2015 Eastern Mediterranean Reg; Mokdad, Ali H.; Weiderpass, Elisabete; Rahman, Shiri (2018)
    The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.
  • Haagsma, Juanita A.; James, Spencer L.; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Lucchesi, Lydia R.; Roberts, Nicholas L. S.; Sylte, Dillon O.; Adebayo, Oladimeji M.; Ahmadi, Alireza; Ahmed, Muktar Beshir; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alghnam, Suliman A.; Aljunid, Syed Mohamed; Al-Raddadi, Rajaa M.; Alsharif, Ubai; Altirkawi, Khalid; Anjomshoa, Mina; Antonio, Carl Abelardo T.; Appiah, Seth Christopher Yaw; Aremu, Olatunde; Arora, Amit; Asayesh, Hamid; Assadi, Reza; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Balalla, Shivanthi; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Baernighausen, Till Winfried; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Behzadifar, Masoud; Behzadifar, Meysam; Benjet, Corina; Bennett, Derrick A.; Bensenor, Isabela M.; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bijani, Ali; Borges, Guilherme; Borschmann, Rohan; Bose, Dipan; Boufous, Soufiane; Brazinova, Alexandra; Rincon, Julio Cesar Campuzano; Cardenas, Rosario; Carrero, Juan J.; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Catala-Lopez, Ferran; Choi, Jee-Young J.; Christopher, Devasahayam J.; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Davitoiu, Dragos Virgil; Degenhardt, Louisa; De Leo, Diego; De Neve, Jan-Walter; Deribe, Kebede; Dessie, Getenet Ayalew; deVeber, Gabrielle Aline; Dharmaratne, Samath Dhamminda; Linh Phuong Doan,; Dolan, Kate A.; Driscoll, Tim Robert; Dubey, Manisha; El-Khatib, Ziad; Ellingsen, Christian Lycke; Zaki, Maysaa El Sayed; Endries, Aman Yesuf; Eskandarieh, Sharareh; Faro, Andre; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Franklin, Richard Charles; Fukumoto, Takeshi; Gezae, Kebede Embaye; Gill, Tiffany K.; Goulart, Alessandra C.; Grada, Ayman; Guo, Yuming; Gupta, Rahul; Bidgoli, Hassan Haghparast; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randah R.; Hamidi, Samer; Maria Haro, Josep; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hendrie, Delia; Henok, Andualem; Hijar, Martha; Hole, Michael K.; Rad, Enayatollah Homaie; Hossain, Naznin; Hostiuc, Sorin; Hu, Guoqing; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Jacobsen, Kathryn H.; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; Jonas, Jost B.; Shushtari, Zahra Jorjoran; Jozwiak, Jacek Jerzy; Jurisson, Mikk; Kabir, Ali; Kalani, Rizwan; Kasaeian, Amir; Kelbore, Abraham Getachew; Kengne, Andre Pascal; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khan, Ejaz Ahmad; Khoja, Abdullah T.; Kiadaliri, Aliasghar A.; Kim, Young-Eun; Kim, Daniel; Kisa, Adnan; Koyanagi, Ai; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kumar, Manasi; Lalloo, Ratilal; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van C.; Leasher, Janet L.; Li, Shanshan; Linn, Shai; Lunevicius, Raimundas; Machado, Flavia R.; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Malik, Manzoor Ahmad; Malta, Deborah Carvalho; Manda, Ana-Laura; Mansournia, Mohammad Ali; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Meheretu, Hailemariam Abiy Alemu; Mehndiratta, Man Mohan; Melese, Addisu; Mendoza, Walter; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Meretoja, Atte; Mestrovic, Tomislav; Miazgowski, Tomasz; Miller, Ted R.; Mini, G. K.; Mirrakhimov, Erkin M.; Moazen, Babak; Mezerji, Naser Mohammad Gholi; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Molokhia, Mariam; Monasta, Lorenzo; Mondello, Stefania; Montero-Zamora, Pablo A.; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi-Lakeh, Maziar; Morawska, Lidia; Moreno Velasquez, Ilais; Morrison, Shane Douglas; Moschos, Marilita M.; Mousavi, Seyyed Meysam; Murthy, Srinivas; Musa, Kamarul Imran; Naik, Gurudatta; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Ndwandwe, Duduzile Edith; Negoi, Ionut; Trang Huyen Nguyen,; Son Hoang Nguyen,; Long Hoang Nguyen,; Huong Lan Thi Nguyen,; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew T.; Olagunju, Tinuke O.; Olivares, Pedro R.; Orpana, Heather M.; Otstavnov, Stanislav S.; Mahesh, P. A.; Pakhale, Smita; Park, Eun-Kee; Patton, George C.; Pesudovs, Konrad; Phillips, Michael R.; Polinder, Suzanne; Prakash, Swayam; Radfar, Amir; Rafay, Anwar; Rafiei, Alireza; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rai, Rajesh Kumar; Ramezanzadeh, Kiana; Rawaf, Salman; Rawaf, David Laith; Renzaho, Andre M. N.; Resnikoff, Serge; Rezaeian, Shahab; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Sabde, Yogesh Damodar; Saddik, Basema; Salamati, Payman; Salimi, Yahya; Salz, Inbal; Samy, Abdallah M.; Sanabria, Juan; Riera, Lidia Sanchez; Milicevic, Milena M. Santric; Satpathy, Maheswar; Sawhney, Monika; Sawyer, Susan M.; Saxena, Sonia; Saylan, Mete; Schneider, Ione J. C.; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamsizadeh, Morteza; Sharif-Alhoseini, Mahdi; Sheikh, Aziz; Shen, Jiabin; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Silva, Joao Pedro; Singh, Jasvinder A.; Sinha, Dhirendra Narain; Soares Filho, Adauto Martins; Soriano, Joan B.; Soshnikov, Sergey; Soyiri, Ireneous N.; Starodubov, Vladimir; Stein, Dan J.; Stokes, Mark A.; Sufiyan, Mu'awiyyah Babale; Sunshine, Jacob E.; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Tehrani-Banihashemi, Arash; Tessema, Gizachew Assefa; Thakur, Jarnail Singh; Khanh Bao Tran,; Bach Xuan Tran,; Car, Lorainne Tudor; Uthman, Olalekan A.; Uzochukwu, Benjamin S. Chudi; Valdez, Pascual R.; Varavikova, Elena; Nogales Vasconcelos, Ana Maria; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vlassov, Vasily; Waheed, Yasir; Wang, Yuan-Pang; Wijeratne, Tissa; Winkler, Andrea Sylvia; Yadav, Priyanka; Yano, Yuichiro; Yenesew, Muluken Azage; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z.; Yu, Chuanhua; Zafar, Shamsa; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zhao, Yong; Zodpey, Sanjay; Hay, Simon; Lopez, Alan D.; Mokdad, Ali H.; Vos, Theo (2020)
    Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
  • GBD 2015 Eastern Mediterranean Reg; Mokdad, Ali H.; Shiri, Rahman (2018)
    We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach. The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages. This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.
  • Lohela, Terhi J.; Nesbitt, Robin C.; Pekkanen, Juha; Gabrysch, Sabine (2019)
    Facility delivery should reduce early neonatal mortality. We used the Slope Index of Inequality and logistic regression to quantify absolute and relative socioeconomic inequalities in early neonatal mortality (0 to 6 days) and facility delivery among 679,818 live births from 72 countries with Demographic and Health Surveys. The inequalities in early neonatal mortality were compared with inequalities in postneonatal infant mortality (28 days to 1 year), which is not related to childbirth. Newborns of the richest mothers had a small survival advantage over the poorest in unadjusted analyses (-2.9 deaths/1,000; OR 0.86) and the most educated had a small survival advantage over the least educated (-3.9 deaths/1,000; OR 0.77), while inequalities in postneonatal infant mortality were more than double that in absolute terms. The proportion of births in health facilities was an absolute 43% higher among the richest and 37% higher among the most educated compared to the poorest and least educated mothers. A higher proportion of facility delivery in the sampling cluster (e.g. village) was only associated with a small decrease in early neonatal mortality. In conclusion, while socioeconomically advantaged mothers had much higher use of a health facility at birth, this did not appear to convey a comparable survival advantage.
  • Zhou, Bin; Bentham, James; Di Cesare, Mariachiara; Bixby, Honor; Danaei, Goodarz; Hajifathalian, Kaveh; Taddei, Cristina; Carrillo-Larco, Rodrigo M.; Djalalinia, Shirin; Khatibzadeh, Shahab; Lugero, Charles; Peykari, Niloofar; Zhang, Wan Zhu; Bennett, James; Bilano, Ver; Stevens, Gretchen A.; Cowan, Melanie J.; Riley, Leanne M.; Chen, Zhengming; Hambleton, Ian R.; Jackson, Rod T.; Kengne, Andre Pascal; Khang, Young-Ho; Laxmaiah, Avula; Liu, Jing; Malekzadeh, Reza; Neuhauser, Hannelore K.; Soric, Maroje; Starc, Gregor; Sundstrom, Johan; Woodward, Mark; Ezzati, Majid; Abarca-Gomez, Leandra; Abdeen, Ziad A.; Abu-Rmeileh, Niveen M.; Acosta-Cazares, Benjamin; Adams, Robert J.; Aekplakorn, Wichai; Afsana, Kaosar; Aguilar-Salinas, Carlos A.; Agyemang, Charles; Ahmad, Noor Ani; Ahmadvand, Alireza; Ahrens, Wolfgang; Ajlouni, Kamel; Akhtaeva, Nazgul; Eriksson, Johan G.; Kajantie, Eero O.; Kauhanen, Jussi; Peltonen, Markku; Salonen, Jukka Tapio; Saramies, Jouko L. (2018)
    Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group-and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
  • Andersen, Petter I.; Ianevski, Aleksandr; Lysvand, Hilde; Oksenych, Valentyn; Bjørås, Magnar; Telling, Kaidi; Lutsar, Irja; Dampis, Uga; Irie, Yasuhiko; Tenson, Tanel; Kantele, Anu; Kainov, Denis (2020)
    Viral diseases are one of the leading causes of morbidity and mortality in the world. Virus-specific vaccines and antiviral drugs are the most powerful tools to combat viral diseases. However, broad-spectrum antiviral agents (BSAAs, i.e. compounds targeting viruses belonging to two or more viral families) could provide additional protection of the general population from emerging and re-emerging viral diseases, reinforcing the arsenal of available antiviral options. Here, we review discovery and development of BSAAs and summarize the information on 120 safe-in-man agents in a freely accessible database (https://drugvirus.info/). Future and ongoing pre-clinical and clinical studies will increase the number of BSAAs, expand the spectrum of their indications, and identify drug combinations for treatment of emerging and re-emerging viral infections as well as co-infections. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
  • Lohela, Terhi; Campbell, Oona M. R.; Gabrysch, Sabine (2012)
  • 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.
  • Wang, Haidong; Wolock, Tim M.; Carter, Austin; Nguyen, Grant; Kyu, Hmwe Hmwe; Gakidou, Emmanuela; Hay, Simon I.; Mills, Edward J.; Trickey, Adam; Msemburi, William; Coates, Matthew M.; Mooney, Meghan D.; Fraser, Maya S.; Sligar, Amber; Salomon, Joshua; Larson, Heidi J.; Friedman, Joseph; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd El Razek, Mohamed Magdy; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abera, Semaw Ferede; Abubakar, Ibrahim; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M. E.; Abyu, Gebre Yitayih; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adelekan, Ademola Lukman; Adofo, Koranteng; Adou, Arsene Kouablan; Ajala, Oluremi N.; Akinyemiju, Tomi F.; Akseer, Nadia; Al Lami, Faris Hasan; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore K. M.; Alasfoor, Deena; Aldhahri, Saleh Fahed S.; Aldridge, Robert William; Alegretti, Miguel Angel; Aleman, Alicia V.; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete; GBD 2015 HIV Collaborators (2016)
    Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3.3 million new infections (95% uncertainty interval [UI] 3.1-3.4 million). Annual incidence has stayed relatively constant at about 2.6 million per year (range 2.5-2.8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million (95% UI 37.6-40.4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1.8 million deaths (95% UI 1.7-1.9 million) in 2005, to 1.2 million deaths (1.1-1.3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
  • 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.
  • Dudel, Christian; Myrskylä, Mikko (2020)
    Background Markov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the expected number and length of episodes spent in a state. Methods The approach we propose is based on Markov chains with rewards. It allows us to identify the number of entries into a state and to calculate the average length of episodes as total time in a state divided by the number of entries. For sampling variance estimation, we employ the block bootstrap. Two case studies that are based on published literature illustrate how our methods can provide new insights into disability dynamics. Results The first application uses a classic textbook example on prednisone treatment and liver functioning among liver cirrhosis patients. We replicate well-known results of no association between treatment and survival or recovery. Our analysis of the episodes of normal liver functioning delivers the new insight that the treatment reduced the likelihood of relapse and extended episodes of normal liver functioning. The second application assesses frailty and disability among elderly people. We replicate the prior finding that frail individuals have longer life expectancy in disability. As a novel finding, we document that frail individuals experience three times as many episodes of disability that were on average twice as long as the episodes of nonfrail individuals. Conclusions We provide a simple analytical approach for calculating the number and length of episodes in Markov chain models. The results allow a description of the transition dynamics that goes beyond the results that can be obtained using standard tools for Markov chains. Empirical applications using published data illustrate how the new method is helpful in unraveling the dynamics of the modeled process.
  • 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.
  • Haagsma, Juanita A.; Olij, Branko F.; Majdan, Marek; van Beeck, Ed F.; Vos, Theo; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L. S.; Sylte, Dillon O.; Aremu, Olatunde; Baernighausen, Till Winfried; Borzi, Antonio M.; Briggs, Andrew M.; Carrero, Juan J.; Cooper, Cyrus; El-Khatib, Ziad; Ellingsen, Christian Lycke; Fereshtehnejad, Seyed-Mohammad; Filip, Irina; Fischer, Florian; Haro, Josep Maria; Jonas, Jost B.; Kiadaliri, Aliasghar A.; Koyanagi, Ai; Lunevicius, Raimundas; Meretoja, Tuomo J.; Mohammed, Shafiu; Pathak, Ashish; Radfar, Amir; Rawaf, Salman; Rawaf, David Laith; Riera, Lidia Sanchez; Shiue, Ivy; Vasankari, Tommi Juhani; James, Spencer L.; Polinder, Suzanne (2020)
    Introduction Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. Methods We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. Results In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. Conclusions From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.
  • Global Burden Dis 2019; Abbafati, Cristiana; Abbas, Kaja M.; Abbasi, Mohammad; Kivimaki, Mika; Lallukka, Tea; Meretoja, Atte; Meretoja, Tuomo J.; Shiri, Rahman (2020)
    The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
  • GBD 2019 Demographics (2020)
    Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2.72 (95% uncertainty interval [UI] 2.66-2.79) in 2000 to 2.31 (2.17-2.46) in 2019. Global annual livebirths increased from 134.5 million (131.5-137.8) in 2000 to a peak of 139.6 million (133.0-146.9) in 2016. Global livebirths then declined to 135.3 million (127.2-144.1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2.1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27.1% (95% UI 26.4-27.8) of global livebirths. Global life expectancy at birth increased from 67.2 years (95% UI 66.8-67.6) in 2000 to 73.5 years (72.8-74.3) in 2019. The total number of deaths increased from 50.7 million (49.5-51.9) in 2000 to 56.5 million (53.7-59.2) in 2019. Under-5 deaths declined from 9.6 million (9.1-10.3) in 2000 to 5.0 million (4.3-6.0) in 2019. Global population increased by 25.7%, from 6.2 billion (6.0-6.3) in 2000 to 7.7 billion (7.5-8.0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58.6 years (56.1-60.8) in 2000 to 63.5 years (60.8-66.1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
  • 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.
  • GBD 2019 Under-5 Mortality Collabo; Paulson, Katherine R.; Kamath, Aruna M.; Alam, Tahiya; Meretoja, Atte; Meretoja, Tuomo J.; Shiri, Rahman; Wang, Yuan-Pang (2021)
    Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
  • Global Burden Dis Hlth Financing; Micah, Angela E.; Su, Yanfang; Bachmeier, Steven D.; Meretoja, Tuomo J.; Meretoja, Atte (2020)
    Background Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7.9 trillion (95% uncertainty interval 7.8-8.0) in 2017 and is expected to increase to $11.0 trillion (10.7-11.2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20.2 billion (17.0-25.0) and on tuberculosis it was $10.9 billion (10.3-11.8), and in malaria-endemic countries spending on malaria was $5.1 billion (4.9-5.4). Development assistance for health was $40.6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81.6% (81.6-81.7) in 2015 to 83.1% (82.8-83.3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Copyright (C) 2020 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.
  • NCD Risk Factor Collaboration NCD-; Iurilli, Maria L. C.; Zhou, Bin; Eriksson, Johan G. (2021)
    From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.